bluuebunny/crossref_metadata_2025 huggingface dataset:
Radiographic anatomy of the equine distal tibia
Authors: Huguet Elodie E. , Porter Erin G. , Chapman Kristina A. , Saunders Fritha C. , Davis Bobbie , Berry Clifford R.
Published: June 2020

The radiographic anatomy of the equine distal tibia is complex and is not widely described in the current literature. Superimposition and radiographic similarities between the different osseous structures of the equine distal tibia can make it difficult for anatomic localization of pathology. The purpose of this prospective, descriptive, anatomic study was to detail the normal anatomy of the equine distal tibia using routine radiographic projections and CT of the equine tarsus. Radiographic identification of the different osseous protuberances of the distal tibia on three cadaveric limbs was achieved using radiopaque markers and evaluation of multiplanar and 3D CT reconstructions to create anatomical maps. It was found that the lateral malleolus is composed of cranial and caudal protuberances that are superimposed over the intermediate cochlear ridge of the distal tibia on the lateromedial, dorsal 45° lateral‐plantaromedial, and dorsal 65° medial‐plantarolateral oblique views, thereby hindering visualization of the cranial protuberance of the lateral malleolus. The medial malleolus is a simple rounded protuberance with discrete margins. On the dorsal 65° medial‐plantarolateral oblique, the medial malleolus is ill‐defined due to superimposition with the talus. The intermediate cochlear ridge of the distal tibia extends in a craniolateral to caudomedial direction, with its cranial protuberance largely superimposed with the calcaneus and talus on the dorsoplantar view. In summary, the distal tibial anatomy is complex and a thorough anatomical reference is necessary when reviewing radiographs of the equine tarsus for pathology. A plantaro 15° distal 85° lateral‐dorsoproximomedial oblique projection is proposed to isolate all distal tibial protuberances.
Are humans evolved specialists for running in the heat? Man vs. horse races provide empirical insights
Authors: Halsey Lewis G. , Bryce Caleb M.
Published: June 2020

New Findings

What is the central question of this study?

Do available comparative data provide empirical evidence that humans are adapted to endurance running at high ambient temperatures?

What is the main finding and its importance?

Comparing the results of races that pit man against horse, we find that ambient temperature on race day has less deleterious effects on running speed in humans than it does on their quadrupedal adversary. This is evidence that humans are adapted for endurance running at high ambient temperatures. We debate whether this supports the hypothesis that early man was evolutionarily adapted for persistence hunting.

Many mammals run faster and for longer than humans and have superior cardiovascular physiologies. Yet humans are considered by some scholars to be excellent endurance runners at high ambient temperatures, and in our past to have been persistence hunters capable of running down fleeter quarry over extended periods during the heat of the day. This suggests that human endurance running is less affected by high ambient temperatures than is that of other cursorial ungulates. However, there are no investigations of this hypothesis. We took advantage of longitudinal race results available for three annual events that pit human athletes directly against a hyper‐adapted ungulate racer, the thoroughbred horse. Regressing running speed against ambient temperature shows race speed deteriorating with hotter temperatures more slowly in humans than in horses. This is the first direct evidence that human running is less inhibited by high ambient temperatures than that of another endurance species, supporting the argument that we are indeed adapted for high temperature endurance running. Nonetheless, it is far from clear that this capacity is explained by an endurance hunting past because in absolute terms humans are slower than horses and indeed many other ungulate species. While some human populations have persistence hunted (and on occasion still do), the success of this unlikely foraging strategy may be best explained by the application of another adaption – high cognitive capacity. With dedication, experience and discipline, capitalising on their small endurance advantage in high temperatures, humans have a chance of running a more athletic prey to exhaustion.
Las disputas por la Jurisdicción Especial para la Paz (JEP): una reflexión crítica sobre su sentido político y jurídico
Authors: Gómez Gabriel Ignacio
Published: June 2020

Este artículo busca hacer una caracterización de la Jurisdicción Especial para la Paz (JEP) en Colombia desde una perspectiva sociopolítica y sociojurídica crítica. De acuerdo con esta perspectiva, la justicia transicional conlleva una profunda relación entre la política y el derecho, de manera que el análisis que se haga sobre una institución como la JEP debe tener en cuenta el contexto, las construcciones discursivas y las tensiones políticas que inciden en su configuración. El artículo se basa en un trabajo de investigación fundamentalmente bibliográfico y documental en el que se examina, además de la literatura especializada, información de prensa, documentación institucional e informes sobre el tema. El artículo, en primer lugar, da cuenta del contexto sociopolítico que dio lugar a la creación de la JEP; posteriormente, describe las principales discusiones y disputas políticas y jurídicas por transformar la JEP; y concluye con un análisis en el que se destaca la tensión entre una orientación retributivista de carácter selectivo, especialmente por parte de quienes han tenido una postura de oposición al Acuerdo Final, y una perspectiva holista, liderada por quienes han defendido las bondades de una paz negociada.
Experimental Study of Mechanical Properties of 30SiMn2MoVA Steel Gun Barrel Processed by Cold Radial Forging
Authors: Yang Yuzhao , Fan Lixia , Xu Cheng , Dong Xuehua
Published: June 2020

This work focused on the mechanical properties of 30SiMn2MoVA high strength steel gun barrel processed by cold radial forging. Three states of the tube made of this material (the state without forging, the as-forged state without annealing, and the as-forged state with annealing) were chosen to compare the axial and circumferential mechanical properties. As a result, anisotropy was found at as-forged state. The circumferential mechanical properties were inferior to the axial. The circumferential yield and tensile strength were about 150 MPa lower than the axial after forging, and the axial elongation was 155% higher than the circumferential. Even after annealing, the circumferential elongation cannot be restored to the same level as the state without forging. The reasons for anisotropy were investigated by the microstructure. The banded structure along the axial direction was observed in the forged barrel. Meanwhile, the crystalline grains of the forged gun barrel had the highest intensity of {111}〈110〉 texture which meant the grains had obvious preferential orientation. The relationship between crystallographic texture and yield strength was analyzed based on the Schmid factor. Additionally, the elastic limit internal pressure of anisotropic gun barrel was calculated, and it was lower than that under isotropic condition.
Static Elastic-Plastic Analysis of a Pipe Structure by the Transfer Matrix Method
Authors: Arai Masayuki , Kuroda Shoichi , Ito Kiyohiro
Published: June 2020

Pipe systems have been widely used in industrial plants such as power stations. In these systems, the displacement and stress distributions often need to be predicted. Analytical and numerical methods, such as the finite element method (FEM), boundary element method (BEM), and frame structure method (FSM), are typically adopted to predict these distributions. The analytical methods, which can only be applied to problems with simple geometries and boundary conditions, are based on the Timoshenko beam theory. Both FEM and BEM can be applied to more complex problems, although this usually requires a stiffness matrix with a large number of degrees-of-freedom. In FSM, although the structure is modeled by a beam element, the stiffness matrix still becomes large; furthermore, the matrix size needed in FEM and BEM is also large. In this study, the transfer matrix method, which is simply referred to as TMM, is studied to effectively solve complex problems, such as a pipe structure under a small size stiffness matrix. The fundamental formula is extended to a static elastic-plastic problem. The efficiency and simplicity of this method in solving a space-curved pipe system that involves an elbow are demonstrated. The results are compared with those obtained by FEM to verify the performance of the method.
Player Wellness (Soreness and Stress) and Injury in Elite Junior Australian Football Players Over 1 Season
Authors: Lathlean Timothy J.H. , Gastin Paul B. , Newstead Stuart V. , Finch Caroline F.
Published: June 2020

Purpose: To investigate the association between player wellness and injury in elite junior Australian football players over 1 competitive season. Methods: Prospective cohort study. Elite junior Australian football players (N = 196, average age = 17.7 y, range = 16–18 y) were recruited in the under-18 state league competition in Victoria, Australia. They recorded their wellness (sleep, fatigue, soreness, stress, and mood) according to a 5-point Likert scale 3 times weekly, with injuries (missed match/training session) entered into an online sport-injury surveillance system. A logistic generalized estimating equation was used to examine the association (expressed as odds ratio [OR]) between wellness and injury (yes/no). Results: Soreness was associated with injury at each time point across the week, with the strongest association evident for soreness reported 6 d postmatch (OR = 1.30; 95% confidence interval [CI], 1.17–1.44; P < .001). Stress and injury were associated with injury for average stress values across the week, as well as specifically on day 1 postmatch (OR = 1.10; 95% CI, 1.01–1.21; P = .038). Mood reported in the middle of the week (3 d postmatch) was associated with injury (OR = 0.87; 95% CI, 0.78–0.97; P = .014), as was fatigue (OR = 1.10; 95% CI, 1.00–1.22; P = .044). Conclusions: This study demonstrates key associations between wellness and injury in elite junior Australian football, specifically soreness, stress, fatigue, and mood. Monitoring strategies help identify injury-risk profiles, which can help decision makers (coaches or medical staff) intervene when relevant to reduce injury risk.
Changes in Strength, Mobility, and Body Composition Following Self-Selected Exercise in Older Adults
Authors: Herda Ashley A. , McKay Brianna D. , Herda Trent J. , Costa Pablo B. , Stout Jeffrey R. , Cramer Joel T.
Published: June 2020

The purpose of this trial was to examine the effects of self-selected exercise intensities plus either whey protein or placebo supplementation on vital signs, body composition, bone mineral density, muscle strength, and mobility in older adults. A total of 101 participants aged 55 years and older (males [n = 34] and females [n = 67]) were evaluated before and after 12 weeks of self-selected, free-weight resistance exercise plus 30 min of self-paced walking three times per week. The participants were randomized into two groups: whey protein (n = 46) or placebo (n = 55). Three-way mixed factorial analyses of variance were used to test for mean differences for each variable. The 12 weeks of self-selected, self-paced exercise intensities improved resting heart rate, fat-free mass, percent body fat, handgrip strength, bench press strength, leg press strength, and all mobility measurements (p < .05) in males and females despite supplementation status. This suggests that additional protein in well-fed healthy older adults does not enhance the benefit of exercise.
Ubiquitination and functional modification of GluN2B subunit–containing NMDA receptors by Cbl-b in the spinal cord dorsal horn
Authors: Zhang Zi-Yang , Bai Hu-Hu , Guo Zhen , Li Hu-Ling , Diao Xin-Tong , Zhang Tian-Yu , Yao Lin , Ma Juan-Juan , Cao Zheng , Li Yin-Xia , Bai Xue , Chen Hai-Kun , Suo Zhan-Wei , Yang Xian , Hu Xiao-Dong
Published: June 2020

Peripheral inflammation overrides a developmental, ubiquitin-mediated switch limiting neuronal sensitivity.
Architecture and Self-Assembly of Clostridium sporogenes and Clostridium botulinum Spore Surfaces Illustrate a General Protective Strategy across Spore Formers
Authors: Janganan Thamarai K. , Mullin Nic , Dafis-Sagarmendi Ainhoa , Brunt Jason , Tzokov Svetomir B. , Stringer Sandra , Moir Anne , Chaudhuri Roy R. , Fagan Robert P. , Hobbs Jamie K. , Bullough Per A.
Published: June 2020

Bacteria such as those causing botulism and anthrax survive harsh conditions and spread disease as spores. Distantly related species have similar spore architectures with protective proteinaceous layers aiding adhesion and targeting. The structures that confer these common properties are largely unstudied, and the proteins involved can be very dissimilar in sequence. We identify CsxA as a cysteine-rich protein that self-assembles in a two-dimensional lattice enveloping the spores of several
Clostridium
species. We show that apparently unrelated cysteine-rich proteins from very different species can self-assemble to form remarkably similar and robust structures. We propose that diverse cysteine-rich proteins identified in the genomes of a broad range of spore formers may adopt a similar strategy for assembly.
Increasing Temperature and Relative Humidity Accelerates Inactivation of SARS-CoV-2 on Surfaces
Authors: Biryukov Jennifer , Boydston Jeremy A. , Dunning Rebecca A. , Yeager John J. , Wood Stewart , Reese Amy L. , Ferris Allison , Miller David , Weaver Wade , Zeitouni Nathalie E. , Phillips Aaron , Freeburger Denise , Hooper Idris , Ratnesar-Shumate Shanna , Yolitz Jason , Krause Melissa , Williams Gregory , Dawson David G. , Herzog Artemas , Dabisch Paul , Wahl Victoria , Hevey Michael C. , Altamura Louis A.
Published: June 2020

Mitigating the transmission of SARS-CoV-2 in clinical settings and public spaces is critically important to reduce the number of COVID-19 cases while effective vaccines and therapeutics are under development. SARS-CoV-2 transmission is thought to primarily occur through direct person-to-person transfer of infectious respiratory droplets or through aerosol-generating medical procedures. However, contact with contaminated surfaces may also play a significant role. In this context, understanding the factors contributing to SARS-CoV-2 persistence on surfaces will enable a more accurate estimation of the risk of contact transmission and inform mitigation strategies. To this end, we have developed a simple mathematical model that can be used to estimate virus decay on nonporous surfaces under a range of conditions and which may be utilized operationally to identify indoor environments in which the virus is most persistent.
mSphere of Influence: Microbiome-Associated Phenotypes Are Modifiable
Authors: Woodworth Michael H.
Published: June 2020

Michael Woodworth focuses on translational microbiome therapeutic research. In this mSphere of Influence article, he reflects on how “Gut microbiomes of Malawian twin pairs discordant for kwashiorkor
”
by Michelle Smith et al. (M. I. Smith, T. Yatsunenko, M. J. Manary, I. Trehan, et al., Science 339:548–554, 2013,
https://doi.org/10.1126/science.1229000
) made an impact on him by revealing the causal influence of microbial communities in the development of severe malnutrition.
Excision of a massive lipoma of the thigh following extensive weight loss and bariatric surgery
Authors: McIntosh Stuart , Agilinko Joshua , Rahman Kaz
Published: June 2020

A 52-year-old morbidly obese man with a body mass index (BMI) of 78 kg/m2lost a great deal of weight through diet control over a 3-year period before undergoing bariatric surgery in the form of laparoscopic sleeve gastrectomy. He continued to lose weight, reducing BMI to 56 kg/m2; however, a large left medial thigh mass persisted. Differential diagnoses included lipoma, liposarcoma and hernia. An MRI scan revealed a 37 × 23 × 23 cm oedematous fatty swelling through which contained multiple enlarged inguinal lymph nodes and the great saphenous vein. Plastic surgeons excised the mass with direct closure of skin. Pathology confirmed lipoma with localised lymphoedema. This represents a case of giant lipoma, of which several reports have been described. We highlight the importance of preoperative imaging when planning resection of large masses to delineate the regional anatomy and the need for histological and genetic analysis to differentiate liposarcoma from lipoma due to their similar presentations.
Odevixibat and partial external biliary diversion showed equal improvement of cholestasis in a patient with progressive familial intrahepatic cholestasis
Authors: Slavetinsky Christoph , Sturm Ekkehard
Published: June 2020

Untreated progressive familial intrahepatic cholestasis (PFIC) type 2, or bile salt exporter protein deficiency, frequently leads to severe pruritus, impaired growth and progressive liver fibrosis with risk of organ failure. We describe a 15-month-old male patient with severe pruritus diagnosed with PFIC type 2 enrolled in an open-label phase 2 study who received 4 weeks of treatment with odevixibat, an ileal bile acid transporter inhibitor under development for cholestatic liver disease treatment. The patient experienced reductions in serum bile acids and improvement in itching and sleep scores, and odevixibat was well tolerated. After the odevixibat study, symptoms returned and the patient underwent partial external biliary diversion (PEBD). Odevixibat treatment and PEBD produced similar normalisation of serum bile acid levels and improvements in pruritus and sleep disruptions. Thus, odevixibat appeared to be as effective as invasive PEBD in treating serum bile acids and cholestatic pruritus in this patient.
Case of aggressive metastatic follicular variant papillary thyroid carcinoma with BRAF K601E and BCORL1 mutations
Authors: Attia Doaa , Lurie Alexander , Zhai Qihui , Mesko Thomas , Smallridge Robert
Published: June 2020

BCL6 corepressor like-1 (BCORL1) mutation has rarely been described in thyroid cancer or in association with BRAF mutations in any malignancy. However, we report a 49-year-old woman who had aggressive follicular variant papillary thyroid carcinoma (FV-PTC) with both the BRAF K601E and BCORL1 mutations. The patient underwent a total thyroidectomy for a 3.6 cm right thyroid nodule and a smaller lesion in the left lobe in 2007; both were FV-PTCs with no lymphovascular invasion or metastases. In 2015, a positron emission tomography–CT scan showed a small defect in the left posterior lateral fifth rib with mild increased hypermetabolic activity with standardised uptake value of 3.9 and another lesion in the right hip at the junction of the femoral neck and trochanter. Tumour biopsy and genetic analysis revealed an uncommon BRAF K601E and a rare BCORL1 mutation. While rare, we report a case of aggressive FV-PTC with both the BRAF K601E and BCORL1 mutations.
Filgrastim induced thrombocytopenia
Authors: Kango Ghazal , Haroun Faysal
Published: June 2020

Drug-induced thrombocytopenia (DITP) is suggested by severe thrombocytopenia with subsequent recovery of platelet count after removal of the offending drug. The diagnosis is ascertained when there is reproducibility of thrombocytopenia with repeated exposure. Filgrastim is used during peripheral blood progenitor cell harvest during autologous stem cell transplantation in the setting of multiple myeloma to prolong event-free survival and overall mortality. The following case illustrates all of the suggestive features of DITP after filgrastim exposure during elective stem cell harvest. Due to the inability to tolerate filgrastim, autologous stem cell transplant was aborted in this patient and he was maintained on induction chemotherapy.
Intracardiac metastasis from head and neck squamous cell carcinoma
Authors: Abu Khalaf Suha , Riaz Talha , Mansour Abdallah , Doll Donald
Published: June 2020

Cardiac metastasis from head and neck cancer is an extremely rare and devastating condition with an abysmal prognosis. Most of our knowledge about this condition is from case reports and series. We present a case of squamous cell carcinoma of the tonsils that was complicated by embolic stroke and critical limb ischemia that were found to be secondary to intracardiac metastasis. We believe that this condition is under-reported; hence, we conducted a thorough review of the literature to highlight the characteristics and previous therapeutic experiences with various presentations of cardiac metastasis from head and neck carcinoma. Clinicians are encouraged to report their experience with evaluating and managing this type of metastasis.
Stroke and spinal infarct caused by percutaneous coronary intervention
Authors: Spindel Jeffrey , Karmali Dipan , Chen Elizabeth , Ghafghazi Shahab
Published: June 2020

Acute ischaemic stroke is a known risk of percutaneous coronary intervention (PCI). The incidence of such complications has increased in frequency over the last decade due to higher comorbidity burden and increased complexity of PCI procedures. The overall incidence of post-PCI ischaemic stroke remains low at 0.56%, but some groups of patients have significantly higher risk. Risk factors include atherosclerotic plaques, atrial fibrillation, cardiogenic shock, older age and arterial disease. Although the overall incidence of acute ischaemic stroke following PCI is low, it can result in lifelong disability and is associated with high morbidity, mortality and significant costs. Spinal infarctions due to PCI are exceedingly rare. Here, we discuss a 71-year-old woman who presented with a non ST-elevation myocardial infarction and developed both stroke and spinal infarction post PCI due to a thromboembolic event resulting in long-term debility.
Aarskog-Scott syndrome: clinical and molecular characterisation of a family with the coexistence of a novel FGD1 mutation and 16p13.11-p12.3 microduplication
Authors: Pavone Piero , Marino Silvia , Maniaci Antonino , Cocuzza Salvatore
Published: June 2020

Aarskog-Scott syndrome (AAS), also known as facio-genital dysplasia or faciodigitogenital syndrome, is a rare genetic disorder clinically characterised by facial, limb and genitalanomalies. Although also autosomal dominance and recessive patterns have been reported, up to now, only an X linked form associated to mutations of theFGD1gene has been recognised as causative for this syndrome.

In this case report, we describe a large Italian family in which three members across three generations show classical features of the syndrome. The youngest patient, the proband, and his mother were both molecularly studied and characterised for the not previously reported variant c.1828C>T (p. Arg610*) in theFGD1gene but with the classic phenotype of AAS. Additionally, both the proband and his mother present a 2.5 Mb 16p13.11-p12.3 microduplication, a genetic variant still unclear for the phenotypic consequences: the co-occurrence of the two rare conditions is discussed for the possible clinical significance.
Isolated second-phase diabetes insipidus post-transsphenoidal surgery
Authors: Montebello Annalisa , Portelli Darryl , Gruppetta Mark
Published: June 2020

A 57-year-old woman presented with severe lethargy, dizziness and nausea 1 week after transsphenoidal resection of a growth hormone secreting pituitary adenoma. She was found to have severe hyponatremia of 115 mmol/L. Importantly, she was neurologically intact and clinically euvolaemic. Her fluid intake was restricted and her sodium levels increased to 131 mmol/L over 4 days. She made a full recovery.

She was diagnosed with isolated second-phase diabetes insipidus, a state of symptomatic hypoosmolar hyponatremia that usually occurs 7–10 days after transsphenoidal surgery. The sodium levels improve with fluid restriction.
No evidence of vertical transmission of SARS-CoV-2 after induction of labour in an immune-suppressed SARS-CoV-2-positive patient
Authors: Grimminck Koen , Santegoets Lindy Anne Maria , Siemens Frederike Charlotte , Fraaij Pieter Leendert Alex , Reiss Irwin Karl Marcel , Schoenmakers Sam
Published: June 2020

We present a case of a 38+1 weeks pregnant patient (G1P0) with a proven COVID-19 infection, who was planned for induction of labour because of pre-existent hypertension, systemic lupus erythematosus, respiratory problem of coughing and mild dyspnoea without fever during the COVID-19 pandemic in March 2020. To estimate the risk of vertical transmission of Severe Acute Respiratory Syndrome CoronaVirus 2 (SARS-CoV-2) during labour and delivery, we collected oropharyngeal, vaginal, urinary, placental and neonatal PCRs for SARS-CoV-2 during the period of admission. All PCRs, except for the oropharyngeal, were negative and vertical transmission was not observed. Labour and delivery were uncomplicated and the patient and neonate were discharged the next day. We give a short overview of the known literature about SARS-CoV-2-related infection during pregnancy, delivery and outcome of the neonate.
Neighborhood walkability and pre-diabetes incidence in a multiethnic population
Authors: Fazli Ghazal S , Moineddin Rahim , Chu Anna , Bierman Arlene S , Booth Gillian L
Published: June 2020

Introduction

We examined whether adults living in highly walkable areas are less likely to develop pre-diabetes and if so, whether this association is consistent according to immigration status and ethnicity.

Research design and methods

Population-level health, immigration, and administrative databases were used to identify adults aged 20–64 (n=1 128 181) who had normoglycemia between January 2011 and December 2011 and lived in one of 15 cities in Southern Ontario, Canada. Individuals were assigned to one of ten deciles (D) of neighborhood walkability (from lowest (D1) to highest (D10)) and followed until December 2013 for the development of pre-diabetes.

Results

Overall, 220 225 individuals in our sample developed pre-diabetes during a median follow-up of 8.4 years. Pre-diabetes incidence was 20% higher among immigrants living in the least (D1) (adjusted HR 1.20, 95% CI 1.15 to 1.25, p<0.0001) versus most (D10, referent) walkable neighborhoods after accounting for age, sex, and area income. Findings were similar among long-term residents and across sexes. However, susceptibility to walkability varied by ethnicity where D1 versus D10 adjusted HRs ranged from 1.17 (95% CI 1.02 to 1.35, p=0.03) among West Asian and Arab immigrants to 1.32 (95% CI 1.19 to 1.47, p<0.0001) in Southeast Asians. Ethnic variation in pre-diabetes incidence was more marked in low walkability settings. Relative to Western Europeans, the adjusted HR for pre-diabetes incidence was 2.11 (95% CI 1.81 to 2.46, p<0.0001) and 1.50 (95% CI 1.27 to 1.77, p<0.0001) among Sub-Saharan African and the Carribean and Latin American immigrants, respectively, living in the least walkable (D1) neighborhoods, but only 1.24 (95% CI 1.08 to 1.42, p=0.002) and 1.00 (95% CI 0.87 to 1.15, p=0.99) for these same groups living in the most walkable (D10) neighborhoods.

Conclusions

Pre-diabetes incidence was reduced in highly walkable areas for most groups living in Southern Ontario cities. These findings suggest a potential role for walkable urban design in diabetes prevention.
Operational research to support equitable non-communicable disease policy in low-income and middle-income countries in the sustainable development era: a scoping review
Authors: Gibbs Naomi , Kwon Joseph , Balen Julie , Dodd Peter J
Published: June 2020

Introduction

Non-communicable diseases (NCDs) represent a growing health burden in low-income and middle-income countries (LMICs). Operational research (OR) has been used globally to support the design of effective and efficient public policies. Equity is emphasised in the Sustainable Development Goal (SDG) framework introduced in 2015 and can be analysed within OR studies.

Methods

We systematically searched MEDLINE, Embase, Scopus and Web of Science for studies published between 2015 and 2018 at the intersection of five domains (OR, LMICs, NCDs, health and decision-making and/or policy-making). We categorised the type of policy intervention and described any concern for equity, which we defined as either analysis of differential impact by subgroups or, policy focus on disadvantaged groups or promoting universal health coverage (UHC).

Results

A total of 149 papers met the inclusion criteria. The papers covered a number of policy types and a broad range of NCDs, although not in proportion to their relative disease burden. A concern for equity was demonstrated by 88 of the 149 papers (59%), with 8 (5%) demonstrating differential impact, 47 (32%) targeting disadvantaged groups, and 68 (46%) promoting UHC.

Conclusion

Overall, OR for NCD health policy in the SDG era is being applied to a diverse set of interventions and conditions across LMICs and researchers appear to be concerned with equity. However, the current focus of published research does not fully reflect population needs and the analysis of differential impact within populations is rare.
Theory-based electronic learning intervention to support appropriate antibiotic prescribing by nurse and pharmacist independent prescribers: an acceptability and feasibility experimental study using mixed methods
Authors: Lim Rosemary , Courtenay Molly , Deslandes Rhian , Ferriday Rebecca , Gillespie David , Hodson Karen , Reid Nicholas , Thomas Neil , Chater Angel
Published: June 2020

Objectives

To assess the acceptability and feasibility of using a theory-based electronic learning intervention designed to support appropriate antibiotic prescribing by nurse and pharmacist independent prescribers for patients presenting with common, acute, uncomplicated self-limiting respiratory tract infections (RTIs).

Design

Experimental with mixed methods; preintervention and postintervention online surveys and semistructured interviews.

Setting

Primary care settings across the UK.

Participants

11 nurse and 4 pharmacist prescribers.

Intervention

A theory-based brief interactive animation electronic learning activity comprised a consultation scenario by a prescriber with an adult presenting with a common, acute, uncomplicated self-limiting RTI to support a ‘no antibiotic prescribing strategy’.

Outcome measures

Recruitment, response and attrition rates were assessed. The overall usefulness of the intervention was assessed by analysing prescribers’ self-reported confidence and knowledge in treating patients with RTIs before and after undertaking the intervention, and views on the relevance of the intervention to their work. Acceptability of the intervention was assessed in semistructured interviews. The feasibility of data collection methods was assessed by recording the number of study components completed by prescribers.

Results

15 prescribers (maximum sample size) consented and completed all four stages of the study. Prescribers reported high to very high levels of confidence and knowledge preintervention and postintervention, with slight postintervention increases in communicating with patients and a slight reduction in building rapport. Qualitative findings supported quantitative findings; prescribers were reassured of their own practice which in turn increased their confidence and knowledge in consultations. The information in the intervention was not new to prescribers but was applicable and useful to consolidate learning and enable self-reflection. Completing the e-learning intervention was acceptable to prescribers.

Conclusions

It was feasible to conduct the study. The intervention was acceptable and useful to prescribers. Future work will add complex clinical content in the intervention before conducting a full trial.
Long-term outcomes for Asian patients with X-linked hypophosphataemia: rationale and design of the SUNFLOWER longitudinal, observational cohort study
Authors: Kubota Takuo , Fukumoto Seiji , Cheong Hae Il , Michigami Toshimi , Namba Noriyuki , Ito Nobuaki , Tokunaga Shin , Gibbs Yoshimi , Ozono Keiichi
Published: June 2020

Introduction

X-linked hypophosphataemic rickets/osteomalacia (XLH) is a chronic, debilitating genetic disease characterised by skeletal abnormalities and growth disorder. The burden of XLH begins in childhood and continues throughout life. Conventional medical therapy with phosphate, active vitamin D and surgery do not address the underlying pathophysiology of the disease. While treatment during childhood may improve bone deformity and growth retardation, a large proportion of adult patients still fail to reach normal stature. Furthermore, adult patients with XLH report comorbidities associated with unresolved childhood disease, as well as newly developed disease-related complications and significantly impaired quality of life (QOL). Despite the multiple negative aspects of XLH, Asian consensus statements for diagnosis and management are lacking.

Methods and analysis

The Study of longitUdinal observatioN For patients with X-Linked hypOphosphataemic rickets/osteomalacia in collaboration With Asian partnERs study is a longitudinal observational cohort study of patients with XLH, designed to determine the medical characteristics and burdens (physical, emotional and financial) of this progressive disease and to evaluate the impact of treatment (including the use of burosumab) on clinical outcomes. The study was initiated in April 2018, and registration will remain open until 30 April 2022. The sample size planned for analyses is 160 patients, consisting of 100 patients in Japan and 60 patients in Korea. Up to 5 years of observation are planned per patient, from enrolment through to April 2023. Prospective and retrospective data will be collected to evaluate variables, including height/growth, rickets severity score, QOL, motor function and biomarkers for phosphate metabolism and bone turnover.

Ethics and dissemination

Ethics approval was obtained from the Ethics Committee of Osaka University, the Ethics Committee of Kyowa Kirin Co and by the Ethics Committee of each participating medical institution. Two interim analyses and associated publications are planned using retrospective and enrolment data at year 1 and results at year 3.

Trial registration numbers

NCT03745521; UMIN000031605.
Study protocol for the ACT response pilot intervention: development, implementation and evaluation of a systems-based Agitation Code Team (ACT) in the emergency department
Authors: Wong Ambrose H , Ray Jessica M , Auerbach Marc A , Venkatesh Arjun K , McVaney Caitlin , Burness Danielle , Chmura Christopher , Saxa Thomas , Sevilla Mark , Flood Colin T , Patel Amitkumar , Whitfill Travis , Dziura James D , Yonkers Kimberly A , Ulrich Andrew , Bernstein Steven L
Published: June 2020

Introduction

Emergency department (ED) visits for behavioural conditions are rising, with 1.7 million associated episodes of patient agitation occurring annually in acute care settings. When de-escalation techniques fail during agitation management, patients are subject to use of physical restraints and sedatives, which are associated with up to 37% risk of hypotension, apnoea and physical injuries. At the same time, ED staff report workplace violence due to physical assaults during agitation events. We recently developed a theoretical framework to characterise ED agitation, which identified teamwork as a critical component to reduce harm. Currently, no structured team response protocol for ED agitation addressing both patient and staff safety exists.

Methods and analysis

Our proposed study aims to develop and implement the agitation code team (ACT) response intervention, which will consist of a standardised, structured process with defined health worker roles/responsibilities, work processes and clinical protocols. First, we will develop the ACT response intervention in a two-step design loop; conceptual design will engage users in the creation of the prototype, and iterative refinement will occur through in situ simulated agitated patient encounters in the ED to assess and improve the design. Next, we will pilot the intervention in the clinical environment and use a controlled interrupted time series design to evaluate its effect on our primary outcome of patient restraint use. The intervention will be considered efficacious if we effectively lower the rate of restraint use over a 6-month period.

Ethics and dissemination

Ethical approval by the Yale University Human Investigation Committee was obtained in 2019 (HIC #2000025113). Results will be disseminated through peer-reviewed publications and presentations at scientific meetings for each phase of the study. If this pilot is successful, we plan to formally integrate the ACT response intervention into clinical workflows at all EDs within our entire health system.
Study protocol: building an evidence base for epidemiology emergency response, a mixed-methods study
Authors: Parry Amy Elizabeth , Kirk Martyn D , Durrheim David N , Olowokure Babatunde , Housen Tambri
Published: June 2020

Introduction

Determinants and drivers for emergencies, such as political instability, weak health systems, climate change and forcibly displaced populations, are increasing the severity, complexity and frequency of public health emergencies. As emergencies become more complex, it is increasingly important that the required skillset of the emergency response workforce is clearly defined. To enable essential epidemiological activities to be implemented and managed during an emergency, a workforce is required with the right mix of skills, knowledge, experience and local context awareness. This study aims to provide local and international responders with an opportunity to actively contribute to the development of new thinking around emergency response roles and required competencies. In this study, we will develop recommendations using a broad range of evidence to address identified lessons and challenges so that future major emergency responses are culturally and contextually appropriate, and less reliant on long-term international deployments.

Method and analysis

We will conduct a mixed-methods study using an exploratory sequential study design. The integration of four data sources, including key informant interviews, a scoping literature review, survey and semistructured interviews will allow the research questions to be examined in a flexible, semistructured way, from a range of perspectives. The study is unequally weighted, with a qualitative emphasis. We will analyse all activities as individual components, and then together in an integrated analysis. Thematic analysis will be conducted in NVivo V.11 and quantitative analysis will be conducted in Stata V.15.

Ethics and dissemination

All activities have been approved by the Science and Medical Delegated Ethics Review Committee at the Australian National University (protocol numbers 2018–521, 2018–641, 2019–068). Findings will be disseminated through international and local deployment partners, peer-reviewed publication, presentation at international conferences and through social media such as Twitter and Facebook.
Comparison of prevalence and associated factors of depressive disorder between patients with head and neck cancer and those with lung cancer at a tertiary hospital in Taiwan: a cross-sectional study
Authors: Lee Yu , Hung Chi-Fa , Chien Chih-Yen , Lin Pao-Yen , Lin Meng-Chih , Wang Chin-Chou , Lu Hung-I , Chen Yung-Che , Chong Mian-Yoon , Wang Liang-Jen
Published: June 2020

Objective

Depression is a common comorbidity in cancer patients. This study aimed to compare the prevalence and associated factors of depressive disorder between patients with head and neck cancer (HNC) and those with lung cancer (LC).

Design

This study used a cross-sectional design with consecutive sampling.

Setting

A medical centre (Kaohsiung Chang Gung Memorial Hospital, Taiwan).

Participants

Patients for the study were recruited from the HNC and LC outpatient clinic and inpatient ward from March 2016 to February 2018. Patients with HNC and LC were enrolled and assessed using the Mini International Neuropsychiatric Interview (MINI).

Primary and secondary outcome measures

The primary outcome was psychiatric diagnoses assessed using the MINI. The secondary outcomes were psychological well-being assessed using the Beck Anxiety Inventory, Taiwanese Depression Questionnaire, Brief Fatigue Inventory, Numeric Pain Rating Scale and the List of Threatening Experiences Questionnaire.

Results

In total, 113 HNC patients and 104 LC patients were recruited for the study. The most common psychiatric comorbidity of HNC patients was alcohol use disorder (49.6%), followed by adjustment disorder (20.4%) and depressive disorder (11.5%). The most common psychiatric comorbidity of LC patients was depressive disorder (25.0%), followed by adjustment disorder (17.3%), alcohol use disorder (3.8%) and insomnia disorder (3.8%). Among HNC patients, a self-harm history was positively associated with depression (OR=11.91; 95% CI, 1.47 to 96.83), and a higher educational level was negatively associated with depression (OR=0.77; 95% CI, 0.66 to 0.91). Among LC patients, severity of stressor (OR=2.78; 95% CI, 1.50 to 5.15) and severity of anxiety (OR=1.18; 95% CI, 1.04 to 1.34) were two significant factors associated with depression.

Conclusion

We reported the prevalence and associated factors of depression between patients with HNC and those with LC. Clinicians should be aware of this comorbidity and the associated risk factors, and conduct intervention programmes to prevent these cancer patients from developing depression.
Global PRoMiSe (Perioperative Recommendations for Medication Safety): protocol for a mixed-methods study
Authors: Nanji Karen C , Merry Alan Forbes , Shaikh Sofia D , Pagel Christina , Deng Hao , Wahr Joyce A , Gelb Adrian W , Orser Beverley A
Published: June 2020

Introduction

Medication errors (MEs), which occur commonly in the perioperative period, have the potential to cause patient harm or death. Many published recommendations exist for preventing perioperative MEs; however, many of these recommendations conflict and are often not applicable to middle-income and low-income countries. The goal of this study is to develop and disseminate consensus-based recommendations for perioperative medication safety that are tailored to country income level.

Methods and analysis

The primary site of this mixed-methods study is Massachusetts General Hospital/Harvard Medical School. Participants include a minimum of 108 international medication safety experts, 27 from each of the World Bank’s four country income groups (high, upper-middle, lower-middle and low-income). Using the Delphi method, participants will rate the appropriateness of candidate medication safety recommendations by completing online surveys using RedCAP. We will use Condorcet ranking methods to prioritise the final recommendations for each country income group. We will execute a comprehensive dissemination strategy for the recommendations across each country income group. Finally, we will conduct semistructured interviews with our participants to evaluate the initial adoption and implementation of the recommendations in each country income group.

Ethics and dissemination

This study was approved by the Human Research Committee/Institutional Review Board at Partners Healthcare (2019P003567). Findings will be published in peer-reviewed journals and presented at local and international conferences.

Trial registration number

NCT04240301.
Development and validation of a genomic mutation signature to predict response to PD-1 inhibitors in non-squamous NSCLC: a multicohort study
Authors: Bai Xue , Wu De-Hua , Ma Si-Cong , Wang Jian , Tang Xin-Ran , Kang Shuai , Fu Qiang John , Cao Chuan-Hui , Luo He-San , Chen Yu-Han , Zhu Hong-Bo , Yan Hong-Hong , Wu Yi-Long , Dong Zhong-Yi
Published: June 2020

Background

Genetic variations of some driver genes in non-small cell lung cancer (NSCLC) had shown potential impact on immune microenvironment and associated with response or resistance to programmed cell death protein 1 (PD-1) blockade immunotherapy. We therefore undertook an exploratory analysis to develop a genomic mutation signature (GMS) and predict the response to anti-PD-(L)1 therapy.

Methods

In this multicohort analysis, 316 patients with non-squamous NSCLC treated with anti-PD-(L)1 from three independent cohorts were included in our study. Tumor samples from the patients were molecularly profiled by MSK-IMPACT or whole exome sequencing. We developed a risk model named GMS based on the MSK training cohort (n=123). The predictive model was first validated in the separate internal MSK cohort (n=82) and then validated in an external cohort containing 111 patients from previously published clinical trials.

Results

A GMS risk model consisting of eight genes (TP53,KRAS,STK11,EGFR,PTPRD,KMT2C,SMAD4, andHGF) was generated to classify patients into high and low GMS groups in the training cohort. Patients with high GMS in the training cohort had longer progression-free survival (hazard ratio (HR) 0.41, 0.28–0.61, p<0.0001) and overall survival (HR 0.53, 0.32–0.89, p=0.0275) compared with low GMS. We noted equivalent findings in the internal validation cohort and in the external validation cohort. The GMS was demonstrated as an independent predictive factor for anti-PD-(L)1 therapy comparing with tumor mutational burden. Meanwhile, GMS showed undifferentiated predictive value in patients with different clinicopathological features. Notably, both GMS and PD-L1 were independent predictors and demonstrated poorly correlated; inclusion of PD-L1 with GMS further improved the predictive capacity for PD-1 blockade immunotherapy.

Conclusions

Our study highlights the potential predictive value of GMS for immunotherapeutic benefit in non-squamous NSCLC. Besides, the combination of GMS and PD-L1 may serve as an optimal partner in guiding treatment decisions for anti-PD-(L)1 based therapy.
Transition to severe phenotype in systemic lupus erythematosus initially presenting with non-severe disease: implications for the management of early disease
Authors: Nikolopoulos Dionysis S , Kostopoulou Myrto , Pieta Antigoni , Flouda Sofia , Chavatza Katerina , Banos Aggelos , Boletis John , Katsimbri Pelagia , Boumpas Dimitrios T , Fanouriakis Antonis
Published: June 2020

Objective

Changes in the care of patients with SLE dictate a re-evaluation of its natural history and risk factors for disease deterioration and damage accrual. We sought to decipher factors predictive of a deterioration in phenotype (‘transition’) in patients initially presenting with non-severe disease.

Methods

Patients from the ‘Attikon’ cohort with disease duration ≥1 year were included. Disease at diagnosis was categorised as mild, moderate or severe, based on the British Isles Lupus Assessment Group manifestations and physician judgement. ‘Transition’ in severity was defined as an increase in category of severity at any time from diagnosis to last follow-up. Multivariable logistic regression was performed to identify baseline factors associated with this transition.

Results

462 patients were followed for a median (IQR) of 36 (120) months. At diagnosis, more than half (56.5%) had a mild phenotype. During disease course, transition to more severe forms was seen in 44.2%, resulting in comparable distribution among severity patterns at last follow-up (mild 28.4%, moderate 33.1%, severe 38.5%). Neuropsychiatric involvement at onset (OR 6.33, 95% CI 1.22 to 32.67), male sex (OR 4.53, 95% CI 1.23 to 16.60) and longer disease duration (OR 1.09 per 1 year, 95% CI 1.04 to 1.14) were independently associated with transition from mild or moderate to severe disease. Patients with disease duration ≥3 years who progressed to more severe disease had more than 20-fold increased risk to accrue irreversible damage.

Conclusion

Almost half of patients with initially non-severe disease progress to more severe forms of SLE, especially men and patients with positive anti-double-stranded DNA or neuropsychiatric involvement at onset. These data may have implications for the management of milder forms of lupus.