bluuebunny/crossref_metadata_2025 huggingface dataset:
The foraging perspective in criminology: A review of research literature
Authors: Vandeviver Christophe , Neirynck Elias , Bernasco Wim
Published: June 2021

In order to explain how crimes are carried out, and why at a particular place and time and against a specific target, crime studies increasingly harness theory from behavioural ecology, in particular Optimal Foraging Theory (OFT). However, an overview of their main findings does not exist. Given the growing focus on OFT as a behavioural framework for structuring crime research, in this article we review the extant OFT-inspired empirical crime research. Systematic search in Google Scholar and Web of Science yielded 32 crime studies, which were grouped into four categories according to their research topic. Empirical results largely support predictions made by OFT. However, there remains much potential for future OFT applications to crime research, in particular regarding the theoretical foundation of OFT in criminology, and through the application of contemporary extensions to OFT using specific tools developed for the study of animal foraging decisions.
Post-Traumatic Orientation to Bodily Signals: A Systematic Literature Review
Authors: Tsur Noga , Talmon Ada
Published: June 2021

Theoretical literature suggests that trauma and (PTSD) may instigate changes in the interpretation of bodily signals. Some findings support these inquiries, revealing that exposure to traumatic events and PTSD are associated with pain catastrophizing, body vigilance, fear of pain, and other manifestations of bodily perceptions and interpretations. However, these findings are not integrated into an inclusive empirically based conceptualization, thus leading to a limited comprehension of this phenomenon. This systematic literature review was conducted to synthesize the existing literature referring to orientation to bodily signals. Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the review included a final of 48 manuscripts that addressed orientation to bodily signals among participants (aged 18 and above) and its potential associations with PTSD. The review revealed that most studies assessed one orientation manifestation, which was tested for its link to PTSD. The majority of the manuscripts were cross-sectional and included participants who faced combat, vehicle accidents, or various types of traumas. Only five manuscripts focused on interpersonal trauma and abuse. Most manuscripts reported significant correlations, revealing that trauma and PTSD are associated with a negative, catastrophic and frightful interpretation of bodily signals. These findings emphasize the need to encapsulate the various manifestations of orientation to bodily signals under a unified construct, as proposed by the term post-traumatic orientation to bodily signals. Further research is needed to illuminate the circumstances and processes by which trauma is implicated in post-traumatic orientation to bodily signals.
Review of Malpractice Lawsuits in the Diagnosis and Management of Aortic Aneurysms and Aortic Dissections
Authors: Choinski Krystina , Sanon Omar , Tadros Rami , Koleilat Issam , Phair John
Published: June 2021

Objective:

Aortic aneurysms and dissections are prevalent causes of morbidity and mortality. The management of aortic pathologies may be called into question in malpractice suits. Malpractice claims were analyzed to understand common reasons for litigation, medical specialties involved, patient injuries, and outcomes.

Methods:

Litigation cases in the Westlaw database from September 1st, 1987 to October 23 rd, 2019 were analyzed. Search terms included “aortic aneurysm” and “aortic dissection.” Data on plaintiff, defendant, litigation claims, patient injuries, misdiagnoses, and case outcomes were collected and compared for aortic aneurysms, aortic dissections, and overall cases.

Results:

A total of 346 cases were identified, 196 involving aortic aneurysms and 150 aortic dissections. Physician defendants were emergency medicine (29%), cardiology (20%), internal medicine (14%), radiology (11%), cardiothoracic (10%) and vascular surgery (10%). Litigation claims included “failure to diagnose and treat” (61%), “delayed diagnosis and treatment” (21%), “post-operative complications after open repair” (10%) and “negligent post-operative care” (10%). Patients with aneurysms presented with abdominal (63%) and back pain (37%), while dissections presented with chest pain (78%), abdominal pain (15%), and shortness of breath (14%). Misdiagnoses included gastrointestinal (12%), other cardiovascular (9%), and musculoskeletal conditions (9%), but many were not specified (58%). Overall, 83% of cases were wrongful death suits. Injuries included loss of consortium (23%), emotional distress (19%), and bleeding (17%). In 53% of the cases, the jury ruled in favor of the defendant. 25% of cases ruled for the plaintiff. 22% of cases resulted in a settlement. The mean rewarded for each case was $1,644,590.66 (SD: $5,939,134.58; Range: $17,500-$68,035,462).

Conclusion:

For aortic pathologies, post-operative complications were not prominent among the reasons why suits were brought forth. This suggests improvements in education across all involved medical specialties may allow for improved diagnostic accuracy and efficient treatment, which could then translate to a decrease in associated litigation cases.
What is Videogame Formalism? Exploring the Pillars of Russian Formalism for the Study of Videogames
Authors: Vught Jasper V.
Published: June 2021

This article provides a general overview of the theoretical foundations of formalism to assess their usefulness for the study of videogames and thereby establish grounds for a more robust approach. After determining that formalism has been used as a go-to term for a variety of ontological and methodological approaches in game studies, this article draws more specifically from Russian Formalism to use the label for a functionalist approach interested in how formal devices in videogames work to cue aesthetic responses. Through an exploration of three pillars of Russian Formalism, a videogame formalism emerges that focuses on the workings of the game as a machine while still taking the aesthetic player response as the methodological starting point and acknowledging the importance of synchronic and diachronic historical perspectives in establishing the functioning of game devices.
Application of image recognition in workpiece classification
Authors: Chien Hsin-Yi , Wang Yu-Chen , Chen Guan-Chen
Published: June 2021

With the rapid development of information technology and widespread use of the Internet of Things, machine intelligence will undoubtedly emerge as a leading research topic in the future. The main purpose of the present research is to incorporate an image recognition system into a robotic arm motion to achieve automatic classification. First, we upload captured images to a PC for classification process and use chess patterns to conduct a sampling test. Next, when the system identifies these patterns as proper chess patterns, the robotic arm grabs the objects and moves them to designated locations. The project is divided into two main sections: image recognition and robotic arm motion. In the image recognition section, we use Keras and the Tensorflow open source learning machine to build a convolutional neural network model. Then, we use a learning model network that is a considerably more compact variant of the VGGNet network in the image recognition system. With this model, we achieve a recognition accuracy of 95%. In the robotic arm section, we use a five-axis robotic arm and an Arduino Uno board as the controller. We design the Denavit–Hartenberg parameters of the arm and calculate the direct (inverse) kinematics parameters to plan its trajectory. Thereafter, we use MATLAB software to simulate prototype processes, such as grabbing, moving, and placing. Finally, we import the program into the controller so that the robotic arm can execute classification based on the chess pattern.
Electronic hand hygiene monitoring systems can be well-tolerated by health workers: Findings of a qualitative study
Authors: Kelly D , Purssell E , Wigglesworth N , Gould DJ
Published: June 2021

Background:

Electronic hand hygiene monitoring overcomes limitations associated with manual audit but acceptability to health workers varies and may depend on culture of the ward and the nature of the system.

Objectives:

Evaluate the acceptability of a new fifth type electronic monitoring system to frontline health workers in a National Health Service trust in the UK.

Methods:

Qualitative interviews with 11 informants following 12 months experience using an electronic monitoring system.

Results:

Informants recognised the importance of hand hygiene and embraced technology to improve adherence. Barriers to hand hygiene adherence included heavy workload, dealing with emergencies and ergonomic factors related to placement of alcohol dispensers. Opinions about the validity of the automated readings were conflicting. Some health workers thought they were accurate. Others reported problems associated with differences in the intelligence of the system and their own clinical decisions. Opinions about feedback were diverse. Some health workers thought the system increased personal accountability for hand hygiene. Others ignored feedback on suboptimal performance or ignored the data altogether. It was hard for health workers to understand why the system registered some instances of poor performance because feedback did not allow omissions in hand hygiene to be related to the context of care.

Conclusion:

Electronic monitoring can be very well tolerated despite some limitations. Further research needs to explore different reactions to feedback and how often clinical emergencies arise. Electronic and manual audit have complementary strengths.
Understanding loneliness: a systematic review of the impact of social prescribing initiatives on loneliness
Authors: Reinhardt GY , Vidovic D , Hammerton C
Published: June 2021

Aims:

The aim of this systematic literature review is to assess the impact of social prescribing (SP) programmes on loneliness among participants and the population.

Methods:

We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to search EBSCOHost (CINAHL Complete, eBook Collection, E-Journals, MEDLINE with Full Text, Open Dissertations, PsycARTICLES, and PsycINFO), UK National Institute for Health and Care Excellence (NICE), Web of Science Core Collection, and grey literature. We included studies measuring the effectiveness and impact of SP programmes in terms of loneliness. We excluded systematic reviews and studies without evaluations. Due to the absence of confidence intervals and the low number of studies, we conduct no meta-analysis.

Results:

From 4415 unique citations, nine articles met the inclusion criteria. The studies do not use uniform measures or randomised samples. All nine studies report positive individual impacts; three report reductions in general practitioner (GP), A&E, social worker, or inpatient/outpatient services; and one shows that belonging to a group reduces loneliness and healthcare usage.

Conclusion:

The findings of this systematic review indicate that individuals and service providers view SP as a helpful tool to address loneliness. However, evidence variability and the small number of studies make it difficult to draw a conclusion on the extent of the impact and the pathways to achieving positive change. More research is needed into the impact of SP programmes on participants, populations, and communities in terms of loneliness, isolation, and connectedness, especially in light of the surge in SP activity as a key part of pandemic response.
Local Knowledge and Use of Pangolins by Culturally Diverse Communities in the Forest-Savannah Transition Area of Cameroon
Authors: Mouafo Alain D. T. , Ingram Daniel J. , Tegang Pagning Romaric , Nfor Ngwayi Itoe Constantine , Mayaka Theodore B.
Published: June 2021

Information about the presence and population status of pangolins, and the threats they face, remains limited in many parts of Cameroon, a country that is home to three species of pangolin and considered to be a global hub of pangolin trafficking. Local communities living in rural areas can provide valuable information on species presence, local uses of wildlife, and possible threats, that is useful for prioritising conservation actions. Using interview surveys in 20 villages surrounding Mbam and Djerem National Park, we investigated local peoples’ knowledge of pangolin presence, perceptions of population trends, cultural importance, consumptive and non-consumptive uses, and hunting of pangolins. Our results showed that most people recognised the white-bellied and giant pangolins, but only 10% recognised the black-bellied pangolin. Ethnolinguistic group significantly affected the likelihood of respondents recognising and having seen a pangolin before. Giant pangolin populations were perceived to be declining, particularly by older respondents. We found evidence of local use of pangolins for meat, but few respondents reported uses of scales. Cultural significance was reported by few respondents, but when it was reported it mostly referred to giant pangolin. White-bellied pangolins are reportedly hunted using bare hands for local consumption most frequently, whilst giant pangolins were mainly hunted for local consumption and income generation using wire snares. Overall, our study shows the possible value of local knowledge for planning and prioritising conservation actions for pangolins. We highlight the urgent need to monitor pangolin populations, and assess the possible impacts to pangolins from threats such as hunting.
Dialectical Waves of Change: Using Dialectics, Emerging Issue Analysis and the Futures Wheel to Develop a Tool for Applied Futures Research
Authors: Dujardin Yannick
Published: June 2021

The dialectical method is a well-known and often used framework for the analysis of historical processes. We argue that its features could also be useful in futures studies. This idea was confirmed during a case study for an arts center in Flanders, Belgium, when an exploration of the history of the cultural landscape made clear that dialectics would present an interesting lens for looking forward too. The need for a practical tool using dialectical analysis presented itself. This article further builds upon Timothy E. Dolan’s protocol to use dialectics as a framing tool in futures, which is worked into a technique that can be used in applied futures exercises by implementing mechanics that take into account the time it takes for emerging issues to develop within a dialectical process, as well as ways to reflect on those developments over time. In this article, different iterations of dialectics through history are explored, as well as arguments for using it in futures studies. Next, a model of “dialectical waves of change” is created by combining Dolan’s concept of “emerging contradictions” with features of Marxist dialectic, as well as with aspects of existing futures techniques such as emerging issue analysis and the futures wheel. The use of this new tool in the case study for the Flemish arts center nOna is explained and learnings from the project are discussed.
Wild-type ATTR amyloidosis of the prostate: a case review
Authors: Sterrett Russell , McCurdy Arleigh
Published: June 2021

The amyloidoses are a rare group of disorders caused by the deposition of amyloid fibrils in organ tissues. Transthyretin-mediated amyloidosis is a subcategory of amyloidosis, which can be further subdivided into hereditary transthyretin-mediated or wild-type (‘senile’) amyloidosis. Involvement of the prostate by any type of amyloidosis is rare, with only a handful of cases reported in the literature. We report here a case of a 64-year-old Caucasian man who was incidentally found to have wild-type transthyretin-mediated amyloidosis of the prostate following a radical prostatectomy for treatment of a localised, Gleason 7 (4 + 3) adenocarcinoma of the prostate. TTR subtyping was confirmed by mass spectrometry. His family history was negative for known amyloidosis, and sequencing of the entire TTR gene was negative for any mutations, so he was therefore considered to have wild-type TTR amyloidosis. He was subsequently found to have additional foci of amyloid deposition in the gastrointestinal tract. Wild-type transthyretin-mediated amyloidosis as an incidental finding in a prostate biopsy is an extremely rare finding. Treatment options for transthyretin-mediated amyloidosis are limited, and further research and treatment options are needed in this rare and difficult to manage disease.

Level of evidence: The level of evidence according to the Oxford Centre of Evidence-based Medicine levels of evidence is not applicable to this case report. Given that this is a rare entity, decisions made in managing this case were based on a level of evidence of 5.
Brain smart – Let's play safely: Evaluation of a concussion education program in schools
Authors: Falla Katie Alison , Randall Sarah , DeMatteo Carol
Published: June 2021

Objectives

There are two objectives for this paper. First, to determine effects of a concussion education program in a local school board in terms of concussion-specific knowledge in children and confidence in identifying and managing concussion in adults. Second, to identify differences and similarities in concussion knowledge between children who participate in sports and those who do not and between children with a history of one or more concussions and those without.

Design

A cross sectional survey regarding concussion knowledge was distributed randomly to students and adults at both pre- and posteducation timepoints. A concussion education program was disseminated across the school board for students between the distribution survey timepoints. Following the education program, adults and students completed their respective post-test surveys. Chi-squared tests in SPSS determined the significance of between-group differences.

Results

All 17 adults (100.0%) who had received concussion education recently reported confidence in their knowledge of concussion management, compared to 35.7% adults who had not received education for over a year (p = 0.020). For students, all of whom completed the concussion education training between the pre- and post-tests, there were no significant differences in concussion knowledge scores between athletes and non-athletes (either in or outside of school) or between those with a history of concussion and those without. There were no significant changes in concussion knowledge between the pre- and post-tests, except for one question.

Conclusion

Concussion education programs increase confidence of concussion management protocols in adults involved in sport, but they require improvements to better support knowledge amelioration, particularly for target groups that are at high risk of sustaining another injury.
Myths, Similes and Memory Traces: Images of Abduction in the Ramayana Universe
Authors: Chatterji Roma
Published: June 2021

In this essay, the Ramayana is conceptualised not merely as a text but as a narrative universe constituted by the multiplicity of its telling. Each telling is unique and involves combining fragments or narrative elements in particular ways. This universe occupies not merely a geographical but also a kind of virtual topological space made up of the relation between narrative elements. The argument is exemplified at two levels, first through an abstraction of one theme—abduction—from the text of the Valmiki Ramayana, which is then mined for significant poetic elements. Second, the article takes up the Ramayani gathas (ballads) of the Pardhan Gonds of Madhya Pradesh and describes some stories also based on the theme of abduction. A comparison of the fragments from the two types of texts reveals comparable elements such that poetic elements, like similes and metaphors, used to describe Sita’s abduction and Rama’s grief undergo structural transformation and are expanded into metonymic configurations, that is, plot elements in the Pardhan Gond gathas.  Thus, the Valmiki Ramayana and the Gondi Ramayani seem to have a metonymic connection with each other. The second part of the article then shows how transformations occur within the narrative universe of the Gondi Ramayani itself as the storyable themes move from the aural medium to that of painting, as contemporary Pardhan Gond artists use themes and poetic imagery inspired by the gathas for their compositions.
Operative Outcome of Side-Locking Loop Suture Technique Accompanied by Autologous Semitendinosus Tendon Grafting for Chronic Rupture of Achilles Tendon
Authors: Tsukada Keisuke , Yasui Youichi , Kubo Maya , Miki Shinya , Matsui Kentaro , Sasahara Jun , Kawano Hirotaka , Miyamoto Wataru
Published: June 2021

Background:

The purpose of this retrospective study was to clarify the operative outcomes of the side-locking loop suture (SLLS) technique accompanied by autologous semitendinosus tendon grafting for chronic Achilles tendon rupture.

Methods:

A chart review was conducted of consecutive patients treated with the SLLS technique at our department from 2012 to 2017. Postoperatively, a below-knee splint was applied for 2 weeks in 20 degrees of plantar flexion and then active range of motion exercise was started. Partial weightbearing exercise was allowed at 4 weeks according to patient tolerance, and full weightbearing without crutches was allowed at 8 weeks. The American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale score and the Achilles tendon rupture score (ATRS) were used to evaluate clinical outcomes preoperatively and at the final follow-up.

Results:

Ten patients (6 men, 4 women) were included in the analysis. Mean AOFAS ankle-hindfoot scale score increased significantly from 64.2 ± 5.6 points preoperatively to 95.0 ± 5.3 points at the final follow-up ( P < .001). The mean ATRS also increased significantly from 29.8 ± 4.4 points to 86.2 ± 7.7 points, respectively ( P < .001). Mean time between surgery and ability to perform 20 continuous double-leg heel raises of the operated foot was 13.5 ± 3.4 (range 10-18) weeks. One patient complained of postoperative hypoesthesia in the foot, which had spontaneously resolved by 3 months after surgery.

Conclusion:

The SLLS technique accompanied by autologous semitendinosus tendon grafting provided successful operative outcomes for patients with chronic Achilles tendon rupture regardless of the size of the defect, and thus long-term orthotic use was not needed after surgery.

Level of Evidence:

Level IV, retrospective case series.
Comparison of ocular discomfort after three different epithelial debridement techniques for corneal collagen cross-linking in keratoconus treatment
Authors: Alkayid Hosamadden , Asena Leyla , Yüce Aslihan , Yavuz Çolak Meriç , Altınörs Dilek Dursun
Published: June 2021

Purpose:

To compare the severity and duration of ocular discomfort after three different epithelial debridement techniques for corneal collagen cross-linking in the treatment of keratoconus.

Methods:

Fifty-five patients (65 eyes) known to have keratoconus were enrolled in this retrospective study. The eyes were divided into three groups based on the technique used for epithelial debridement for corneal collagen cross-linking procedure; excimer laser transepithelial phototherapeutic keratectomy was used in group 1 (18 eyes), alcohol-assisted epithelial removal was used in group 2 (27 eyes), and mechanical epithelial debridement was used in group 3 (20 eyes). Preoperative and postoperative (third month) best-corrected visual acuity (BCVA) using Snellen chart, objective refraction, and keratometry results were recorded. The results of the questionnaire obtained from the patient’s medical records were reviewed regarding their subjective evaluation of postoperative symptoms including foreign body sensation, tearing, photophobia, and burning at the end of the first postoperative week. Paired-samples t test was used to compare preoperative and postoperative clinical findings. One-way analysis of variance (ANOVA) was used to analyze the differences between three independent groups.

Results:

BCVA improved from 0.51 ± 0.27 to 0.58 ± 0.21 ( p = 0.05). Objective mean spherical and cylindrical refraction decreased from −5.08 ± 2.78D to −4.46 ± 2.91D ( p = 0.22) and from −3.45 ± 2.73D to −3.03 ± 1.97D ( p = 0.25). Mean maximum keratometry reading ( Kmax) decreased from 57.63 ± 4.73D to 56.13 ± 4.47D ( p = 0.001). The mean score for foreign body sensation was the highest in group 3 (4.50 ± 0.53) and the lowest in group 1 (2.10 ± 1.85) ( p = 0.01). The mean scores for tearing, photophobia, and burning sensation were comparable in three groups ( p = 0.84, p = 0.13, and p = 0.61, respectively). The duration of photophobia was the shortest in group 1 (1.50 ± 2.37 days), followed by group 3 (2.00 ± 1.31 days) and group 2 (4.00 ± 1.83 days) ( p = 0.04).

Conclusions:

The severity and duration of adverse subjective symptoms during the first postoperative week after corneal collagen cross-linking appear to be milder with epithelial debridement using excimer laser transepithelial technique compared with -assisted debridement and mechanical debridement.
The clinical impact of adherence to therapy in airways disease
Authors: Brennan Vincent , Mulvey Christopher , Costello Richard W.
Published: June 2021

For a physician, the final step of a consultation consists of developing a treatment plan and prescription. For the patient, this is the start of a process. First, their role in the treatment plan must be clarified, then they may have to obtain an alternative prescription from their general practitioner. Next, they must have the prescription filled and dispensed from the pharmacy and, finally, they must take the treatment on time and for the required duration. For people with chronic conditions, this requires repeatedly returning to the pharmacy for the prescription to be renewed and dispensed. Given that many patients are on multiple treatment regimens and may have poor health literacy, this becomes a complex process and it is not surprising that this can, and frequently does, go wrong.

Research shows that when a patient does not adhere to standard asthma or COPD treatment, they report poor control and overuse of rescue β-agonists, experience frequent exacerbations and are often prescribed add-on treatments such as biological agents. In short, poor treatment adherence can manifest in the same way as a refractory condition.

These clinical features should prompt a clinician to investigate poor adherence as they might investigate a new blood or radiological finding. Examining a patient's prescription refill records or a digitally enabled inhaler can demonstrate a number of patterns of inhaler use. A small minority regularly use their treatment as prescribed but many appear to be “cluster users”: a group of patients who use their treatment correctly when they are unwell, but once some level of personal control is attained, they cease or reduce their use. Others may cease using their treatment because they are not perceiving a benefit or because an alternative condition accounts for their symptoms. In other words, clinicians can consider that treatment adherence is like a clinical sign: something to be investigated so that they may understand the patient's condition better.

Educational aims

To highlight the clinical consequences of poor adherence to standard treatments for airways diseases.

To describe how poor treatment adherence manifests as complications of the condition.

To highlight that when a patient does not benefit as might be expected from a treatment, poor adherence should be considered and evaluated for, before more treatment is added.
Development of a new COVID-19 panel survey: the IAB high-frequency online personal panel (HOPP)
Authors: Haas Georg-Christoph , Müller Bettina , Osiander Christopher , Schmidtke Julia , Trahms Annette , Volkert Marieke , Zins Stefan
Published: June 2021

Since January 2020, the COVID-19 crisis has affected everyday life around the world, and rigorous government lockdown restrictions have been implemented to prevent the further spread of the pandemic. The consequences of the corona crisis and the associated lockdown policies for public health, social life, and the economy are vast. In view of the rapidly changing situation during this crisis, policymakers require timely data and research results that allow for informed decisions. Addressing the requirement for adequate databases to assess people’s  life and work situations during the pandemic, the Institute for Employment Research (IAB) developed the High-frequency Online Personal Panel (HOPP). The HOPP study started in May 2020 and is based on a random sample of individuals drawn from the administrative data of the Federal Employment Agency in Germany, containing information on all labour market participants except civil servants and self-employed. The main goal of the HOPP study is to assess the short-term as well as long-term changes in people’s social life and working situation in Germany due to the corona pandemic. To assess individual dynamics the HOPP collected data on a monthly (wave  one to four) and bi-monthly (wave five to seven) basis. Furthermore, respondents were divided into four groups. The different groups of a new wave were invited to the survey at weekly intervals (wave two to four) or bi-weekly intervals (wave five to seven). This gives us the advantage of being able to provide weekly data while each participant only had to participate on a monthly or bi-monthly basis. In this article, we delineate the HOPP study in terms of its main goals and features, topics, and survey design. Furthermore, we provide a summary of results derived from HOPP and the future prospects of the study.
The effect of COVID-19 pandemic and lockdown on consultation numbers, consultation reasons and performed services in primary care: results of a longitudinal observational study
Authors: Schäfer Ingmar , Hansen Heike , Menzel Agata , Eisele Marion , Tajdar Daniel , Lühmann Dagmar , Scherer Martin
Published: June 2021

Objectives

The aims of our study were to describe the effect of the COVID-19 pandemic and lockdown on primary care in Germany regarding the number of consultations, the prevalence of specific reasons for consultation presented by the patients, and the frequency of specific services performed by the GP.

Methods

We conducted a longitudinal observational study based on standardised GP interviews in a quota sampling design comparing the time before the COVID-19 pandemic (12 June 2015 to 27 April 2017) with the time during lockdown (21 April to 14 July 2020). The sample included GPs in urban and rural areas 120 km around Hamburg, Germany, and was stratified by region type and administrative districts. Differences in the consultation numbers were analysed by multivariate linear regressions in mixed models adjusted for random effects on the levels of the administrative districts and GP practices.

Results

One hundred ten GPs participated in the follow-up, corresponding to 52.1% of the baseline. Primary care practices in 32 of the 37 selected administrative districts (86.5%) could be represented in both assessments. At baseline, GPs reported 199.6 ± 96.9 consultations per week, which was significantly reduced during COVID-19 lockdown by 49.0% to 101.8 ± 67.6 consultations per week (p < 0.001). During lockdown, the frequency of five reasons for consultation (-43.0% to -31.5%) and eleven services (-56.6% to -33.5%) had significantly decreased. The multilevel, multivariable analyses showed an average reduction of 94.6 consultations per week (p < 0.001).

Conclusions

We observed a dramatic reduction of the number of consultations in primary care. This effect was independent of age, sex and specialty of the GP and independent of the practice location in urban or rural areas. Consultations for complaints like low back pain, gastrointestinal complaints, vertigo or fatigue and services like house calls/calls at nursing homes, wound treatments, pain therapy or screening examinations for the early detection of chronic diseases were particularly affected.
Adapting the definition of multimorbidity – development of a locality-based consensus for selecting included Long Term Conditions
Authors: Hafezparast Nasrin , Turner Ellie Bragan , Dunbar-Rees Rupert , Vodden Alice , Dodhia Hiten , Reynolds Brian , Reichwein Barbara , Ashworth Mark
Published: June 2021

Background

Defining multimorbidity has proved elusive in spite of attempts to standardise definitions. For national studies, a broad definition is required to capture national diversity. For locally based studies, the definition may need to reflect demographic and morbidity patterns. We aimed to define multimorbidity for an inner city, multi-ethnic, deprived, young age community typical of many large cities.

Methods

We used a scoping literature review to identify the international literature, standards and guidelines on Long Term Condition (LTC) definitions for inclusion in our multimorbidity definition. Consensus was categorised into high, medium or low consensus, depending on the number of literature sources citing each LTC. Findings were presented to a workshop consisting of local health service stakeholders who were asked to select LTCs for inclusion in a second stage review. In the second stage, each LTC was tested against seven evaluation domains: prevalence, impact, preventability, treatment burden, progression to multiple LTCs, impact on younger people, data quality. These domains were used to create 12 target criteria. LTC rankings according to consensus group and target criteria scores were presented to a second workshop for a final decision about LTC inclusion.

Results

The literature review identified 18 literature sources citing 86 LTCs: 11 were excluded because they were LTC clusters. The remainder were allocated into consensus groupings: 13 LTCs were ‘high consensus’ (cited by ≥ 11 sources); 15 were ‘medium consensus’ (cited by 5–10 sources); 47 were ‘low consensus’ (cited by < 5 sources). The first workshop excluded 31 LTCs. The remaining 44 LTCs consisted of: 13 high consensus LTCs, all with high target score (score 6–12); 15 medium consensus LTCs, 11 with high target scores; 16 low consensus LTCs, 6 with high target scores.

The final workshop selected the 12 high consensus conditions, 12 medium consensus LTCs (10 with high target scores) and 8 low consensus LTCs (3 with high target scores), producing a final selection of 32 LTCs.

Conclusions

Redefining multimorbidity for an urban context ensures local relevance but may diminish national generalisability. We describe a detailed LTC selection process which should be generalisable to other contexts, both local and national.
Pregnant women’s experiences of social distancing behavioural guidelines during the Covid-19 pandemic ‘lockdown’ in the UK, a qualitative interview study
Authors: Anderson Emma , Brigden Amberly , Davies Anna , Shepherd Emily , Ingram Jenny
Published: June 2021

Background

Covid-19 triggered the rapid roll-out of mass social distancing behavioural measures for infection control. Pregnant women were categorised as ‘at risk’ requiring extra vigilance with behavioural guidelines. Their understanding and ability to adhere to recommendations was unknown.

Objectives

To complete a behavioural analysis of the determinants of recommended social distancing behaviour in pregnant women, according to the ‘capability, opportunity, motivation and behaviour’ (‘COM-B’) model to inform the development of recommendations/materials to support pregnant women in understanding and adhering to behavioural guidelines.

Design

Qualitative interview study with pregnant women in the Bristol area (UK).

Methods

Semi-structured telephone/videoconference interviews were conducted following a topic guide informed by the COM-B model, transcribed verbatim and subjected to framework analysis. Infographic materials were iteratively produced with stakeholder consultation, to support pregnant women.

Results

Thirty-one women participated (selected for demographic range). Women reported adhering to social distancing recommendations and intended to continue. COM-B analysis identified gaps in understanding around risk, vulnerability, and the extent of required social distancing, as well as facilitators of social distancing behaviour (e.g. social support, motivation to stay safe, home environment/resources). Additional themes around detrimental mental health effects and changes to maternity healthcare from the social distancing measures were identified. Infographic resources (plus midwife report) addressing women’s key concerns were produced and disseminated.

Conclusions

The COM-B model provided useful details of determinants of pregnant women’s adherence to social distancing behaviours. The confusion of what being ‘at risk’ meant and varying interpretation of what was expected indicates a need for greater clarity around categories and guidance. The loss of maternity care and negative mental health effects of social distancing suggest a growing area of unmet health needs to be addressed in future.
A comparison of tobacco product prevalence by different frequency of use thresholds across three US surveys
Authors: Sánchez-Romero Luz María , Cadham Christopher J. , Hirschtick Jana L. , Mattingly Delvon T. , Cho Beomyoung , Fleischer Nancy L. , Brouwer Andrew , Mistry Ritesh , Land Stephanie R. , Jeon Jihyoun , Meza Rafael , Levy David T.
Published: June 2021

Background

With the increasing changes in tobacco use patterns, “current use” definition and the survey used may have important implications for monitoring population use trends.

Methods

Using three US surveys (2014/15 TUS-CPS, NHIS and PATH), we compared the adult (age 18+) prevalence of four product groups (cigarettes, other combustibles, smokeless tobacco, and e-cigarettes) based on three past 30-day frequency of use thresholds: 1+, 10+, and 25+ days. We also examined mutually exclusive single, dual, and polytobacco users as a percentage of total users for each product group.

Results

Regardless of threshold or product, the prevalence was higher in PATH followed by NHIS and TUS-CPS, in some cases by large percentages. The differences in cigarette and smokeless tobacco use prevalence in going from the 1+ to 10+ days and to the 25+ days threshold were minimal. Applying different frequency thresholds had the largest impact on other combustibles prevalence, with a 60% reduction with the 10+ days threshold and a 80% reduction with the 25+ days threshold, compared to the 1+ days threshold, followed by e-cigarettes with 40 and 60% reductions, respectively. The proportion of dual and polytobacco users decreased considerably when using the 10+ vs. the 1+ days threshold and polytobacco use was almost non-existent with the 25+ days threshold.

Conclusion

The estimated prevalence of each tobacco product use depends largely on the survey and frequency of use threshold adopted. The choice of survey and frequency threshold merits serious consideration when monitoring patterns of tobacco use.
End-of-life care preferences among cancer patients in Southern Thailand: a university hospital-based cross-sectional survey
Authors: Pitanupong Jarurin , Janmanee Sahawit
Published: June 2021

Background

End-of-life care preferences may be highly individual, heterogenic, and variable according to culture and belief. This study aimed to explore preferences and factors associated with end-of-life care among Thai cancer patients. Its findings could help optimize the quality of life of palliative cancer patients.

Methods

A cross-sectional study surveyed palliative cancer outpatients at Songklanagarind Hospital from August to November 2020. The questionnaires inquired about: (1) personal and demographic information, (2) experiences with end-of-life care for their relatives, and (3) end-of-life care preferences. To determine end-of life preferences, the data were analyzed using descriptive statistics. The data concerning patient demographics and end-of-life care preferences were compared using Fisher’s exact test.

Results

The majority of the 96 palliative cancer outpatients were female (65.6 %), and the overall mean age was 55.8 ± 11.6 years. More than half of them had an experience of observing someone die (68.8 %), and they were predominantly being conscious until the time of death (68.2 %). Most participants preferred receiving the full truth satisfied with the care their relatives had received in passing away at home surrounded by family (47.0 %) and regarding their illness (99.0 %), being free of uncomfortable symptoms (96.9 %), having their loved ones around (93.8 %), being mentally aware at the last hour (93.8 %), and having the sense of being meaningful in life (92.7 %). Their 3 most important end-of-life care wishes were receiving the full truth regarding their illness, disclosing the full truth regarding their illness to family members, and passing away at home.

Conclusions

In order to optimize the quality of life of palliative cancer patients, end-of-life care should ensure they receive the full truth regarding their illness, experience no distressing symptoms, remain mentally aware at the last hour of life, feel meaningful in life, and pass away comfortably with loved ones around.
Exploring the use of health and wellbeing measures during pregnancy and the first year following birth in women living with pre-existing long-term conditions: qualitative interviews with women and healthcare professionals
Authors: Kelly Laura , Kurinczuk Jennifer J. , Rivero-Arias Oliver , Fitzpatrick Ray , Gibbons Elizabeth , Alderdice Fiona
Published: June 2021

Background

One way in which care for pregnant and postpartum women living with long-term health conditions (LTCs) may be improved is through the adoption of standardised measures to provide evidence of health outcomes and wellbeing from the woman’s perspective.

Aim

The study explores the views of pregnant and postpartum women living with LTCs, and healthcare professionals to better understand the potential value of using standardised health and wellbeing measures within this patient population.

Methods

Qualitative semi-structured telephone interviews were conducted to explore the perceived value of using measures with pregnant and postpartum women living with LTCs within maternity services. Participants were asked to provide feedback on three exemplar measures: the Long Term Conditions Questionnaire, the Wellbeing in Pregnancy Questionnaire and the EuroQol EQ-5D-5L instrument. Thematic analysis was used in the analysis of the transcripts.

Results

Eleven women and 11 healthcare professionals took part in semi-structured interviews. Analysis identified five themes as relevant to the use of measures within maternity services: 1) Improving care, 2) Assessing outcomes, 3) Interpretation and application of data, 4) Engagement challenges and implementation and, 5) Women and healthcare professionals alignment.

Conclusions

Despite varying prior experience and expressing some questions about implementation, respondents were cautiously positive about the use of standardised health and wellbeing measures. Their use offers the opportunity for both affected women and healthcare professionals caring for them to collectively identify and assess important areas of unmet needs and improve outcomes. Incorporating the perspectives of women with LTC’s will help bring awareness to elements of women centred care which health services may seek to address.
Use of the rhizobial type III effector gene nopP to improve Agrobacterium rhizogenes-mediated transformation of Lotus japonicus
Authors: Wang Yan , Yang Feng , Zhu Peng-Fei , Khan Asaf , Xie Zhi-Ping , Staehelin Christian
Published: June 2021

Background

Protocols for Agrobacterium rhizogenes-mediated hairy root transformation of the model legume Lotus japonicus have been established previously. However, little efforts were made in the past to quantify and improve the transformation efficiency. Here, we asked whether effectors (nodulation outer proteins) of the nodule bacterium Sinorhizobium sp. NGR234 can promote hairy root transformation of L. japonicus. The co-expressed red fluorescent protein DsRed1 was used for visualization of transformed roots and for estimation of the transformation efficiency.

Results

Strong induction of hairy root formation was observed when A. rhizogenes strain LBA9402 was used for L. japonicus transformation. Expression of the effector gene nopP in L. japonicus roots resulted in a significantly increased transformation efficiency while nopL, nopM, and nopT did not show such an effect. In nopP expressing plants, more than 65% of the formed hairy roots were transgenic as analyzed by red fluorescence emitted by co-transformed DsRed1. A nodulation experiment indicated that nopP expression did not obviously affect the symbiosis between L. japonicus and Mesorhizobium loti.

Conclusion

We have established a novel protocol for hairy root transformation of L. japonicus. The use of A. rhizogenes LBA9402 carrying a binary vector containing DsRed1 and nopP allowed efficient formation and identification of transgenic roots.
The dosimetric impact of deep learning-based auto-segmentation of organs at risk on nasopharyngeal and rectal cancer
Authors: Guo Hongbo , Wang Jiazhou , Xia Xiang , Zhong Yang , Peng Jiayuan , Zhang Zhen , Hu Weigang
Published: June 2021

Purpose

To investigate the dosimetric impact of deep learning-based auto-segmentation of organs at risk (OARs) on nasopharyngeal and rectal cancer.

Methods and materials

Twenty patients, including ten nasopharyngeal carcinoma (NPC) patients and ten rectal cancer patients, who received radiotherapy in our department were enrolled in this study. Two deep learning-based auto-segmentation systems, including an in-house developed system (FD) and a commercial product (UIH), were used to generate two auto-segmented OARs sets (OAR_FD and OAR_UIH). Treatment plans based on auto-segmented OARs and following our clinical requirements were generated for each patient on each OARs sets (Plan_FD and Plan_UIH). Geometric metrics (Hausdorff distance (HD), mean distance to agreement (MDA), the Dice similarity coefficient (DICE) and the Jaccard index) were calculated for geometric evaluation. The dosimetric impact was evaluated by comparing Plan_FD and Plan_UIH to original clinically approved plans (Plan_Manual) with dose-volume metrics and 3D gamma analysis. Spearman’s correlation analysis was performed to investigate the correlation between dosimetric difference and geometric metrics.

Results

FD and UIH could provide similar geometric performance in parotids, temporal lobes, lens, and eyes (DICE,p > 0.05). OAR_FD had better geometric performance in the optic nerves, oral cavity, larynx, and femoral heads (DICE,p < 0.05). OAR_UIH had better geometric performance in the bladder (DICE,p < 0.05). In dosimetric analysis, both Plan_FD and Plan_UIH had nonsignificant dosimetric differences compared to Plan_Manual for most PTV and OARs dose-volume metrics. The only significant dosimetric difference was the max dose of the left temporal lobe for Plan_FD vs. Plan_Manual (p = 0.05). Only one significant correlation was found between the mean dose of the femoral head and its HD index (R = 0.4,p = 0.01), there is no OARs showed strong correlation between its dosimetric difference and all of four geometric metrics.

Conclusions

Deep learning-based OARs auto-segmentation for NPC and rectal cancer has a nonsignificant impact on most PTV and OARs dose-volume metrics. Correlations between the auto-segmentation geometric metric and dosimetric difference were not observed for most OARs.