bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparative analysis of whole vs. split liver transplantation in infants
Authors: Rokop Zachary P. , Mangus Richard S. , Tolliver Kyla , Jarasvaraparn Chaowapong , Molleston Jean , Mihaylov Plamen , Kubal Chandrashekhar
Published: July 2023

Background

Liver transplantation (LT) in infants can be challenging due to their small size and small vasculature. Although both whole LT (WLT) and split LT (SLT) have been described in infants, the head‐to‐head comparison of these techniques in this population is sparse.

Methods

We retrospectively analyzed the records of all patients with age ≤1 year at Indiana University between 2016 and 2022. All SLT were left lateral segment grafts split in situ.

Results

A total of 24 infants were transplanted, with 11 SLT and 13 WLT. The median follow‐up time was 52.1 months. Donor and recipient characteristics were comparable except for donor age (19 years vs. 2 years; p < .01) and weight (64 kg vs. 14.2 kg; p < .01). Early allograft dysfunction, primary nonfunction, and hepatic artery thrombosis developed more frequently in the WLT group. There were no biliary complications. There were two early deaths (2 and 4 days) in the WLT group. One‐year graft survival (100% vs. 77%; p = .10) and patient survival (100% vs. 85%; p = .18) were numerically higher in the SLT group.

Conclusions

SLT with LLS offers a safe and viable option for liver transplantation in infants and is associated with a trend toward superior outcomes. SLT should be considered as a strategy to reduce waitlist times for infants in the absence of small, deceased donors for WLT.
Using data visualization to characterize whole‐person health of public health nurses
Authors: Pirsch Anna M. , Austin Robin R. , Martin Lisa , Pieczkiewicz David , Monsen Karen A.
Published: July 2023

Objective

To characterize patterns in whole‐person health of public health nurses (PHNs).

Design and Sample

Survey of a convenience sample of PHNs (n = 132) in 2022. PHNs self‐identified as female (96.2%), white (86.4%), between the ages 25–44 (54.5%) and 45–64 (40.2%), had bachelor's degrees (65.9%) and incomes of $50‐75,000 (30.3%) and $75‐100,000/year (29.5%).

Measurements

Simplified Omaha System Terms (SOST) within the MyStrengths+MyHealth assessment of whole‐person health (strengths, challenges, and needs) across Environmental, Psychosocial, Physiological, and Health‐related Behaviors domains.

Results

PHNs had more strengths than challenges; and more challenges than needs. Four patterns were discovered: (1) inverse relationship between strengths and challenges/needs; (2) Many strengths; (3) High needs in Income; (4) Fewest strengths in Sleeping, Emotions, Nutrition, and Exercise. PHNs with Income as a strength (n = 79) had more strengths (t = 5.570, p < .001); fewer challenges (t = ‐5.270, p < .001) and needs (t = ‐3.659, p < .001) compared to others (n = 53).

Conclusions

PHNs had many strengths compared to previous research with other samples, despite concerning patterns of challenges and needs. Most PHN whole‐person health patterns aligned with previous literature. Further research is needed to validate and extend these findings toward improving PHN health.
Comparing monetary gain and loss in the monetary incentive delay task: EEG evidence
Authors: Zhang Yan , Li Qiuhao , Rong Yachao , Hu Li , Müller Hermann J. , Wei Ping
Published: July 2023

What is more effective to guide behavior: The desire to gain or the fear to lose? Electroencephalography (EEG) studies have yielded inconsistent answers. In a systematic exploration of the valence and magnitude parameters in monetary gain and loss processing, we used time‐domain and time‐frequency‐domain analyses to uncover the underlying neural processes. A group of 24 participants performed a monetary incentive delay (MID) task in which cue‐induced anticipation of a high or low magnitude of gain or loss was manipulated trial‐wise. Behaviorally, the anticipation of both gain and loss expedited responses, with gain anticipation producing greater facilitation than loss anticipation. Analyses of cue‐locked P2 and P3 components revealed the significant valence main effect and valence × magnitude interaction: amplitude differences between high and low incentive magnitudes were larger with gain vs. loss cues. However, the contingent negative variation component was sensitive to incentive magnitude but did not vary with incentive valence. In the feedback phase, the RewP component exhibited reversed patterns for gain and loss trials. Time‐frequency analyses revealed a large increase in delta/theta‐ERS oscillatory activity in high‐ vs. low‐magnitude conditions and a large decrease of alpha‐ERD oscillatory activity in gain vs. loss conditions in the anticipation stage. In the consumption stage, delta/theta‐ERS turned out stronger for negative than positive feedback, especially in the gain condition. Overall, our study provides new evidence for the neural oscillatory features of monetary gain and loss processing in the MID task, suggesting that participants invested more attention under gain and high‐magnitude conditions vs. loss and low‐magnitude conditions.
The hypotheses of oral disease‐associated perioprosthetic joint infections to understand the role of oral health for endoprostheses ‐ a narrative review
Authors: Schmalz Gerhard , Ziebolz Dirk
Published: July 2023

Aims

Periprosthetic infections are a severe complication, causing enormous morbidity. The role of oral diseases in the development of such infections has been discussed controversially, showing a large discrepancy between prevalence of oral foci and infections of endoprostheses (EP). This narrative review aimed in explaining and discussing two hypotheses for the occurrence of oral disease‐associated EP infections.

Methods and Results

The hypotheses include two mechanisms. (1) In case of an acute exacerbation during the early healingperiod after EP surgery (first 3 months). (2) Coincidental in the context of late EP infections (after successful initial healing), where an initial periprosthetic inflammation can be colonized secondarily by oral microorganisms. In both settings,oral foci are not primarily causative for EP infection, but represent an important reservoir for EP colonization, while the immunological conditions (locally and systemically) are crucial for the onset of an EP infection. As potential consequence, patients with risk factors should be orally rehabilitated prior to EP surgery. Usage of antibiotic prophylaxis during the first 3 months after EP implantation (initial healing period) might be considered, but has no reliable evidence. To avoid morbidity of patients, radical dental clearance is unfavorable for the respective patients.

Conclusion

Altogether, patients with EP should receive increased attention from the dental perspective alongside with dental preventive measures, because they show a high dental and periodontal treatment need.
For the good of the children—Life and ethical values when undergoing paternal alienation and involuntary loss of paternity
Authors: Koskinen C. , Wallgren G. C. , Thorkildsen K. M. , Kaldestad K.
Published: July 2023

Background and Aim

Today there is an aspiration and desire for fathers to be caring masculinities that build long‐term father‐child relationships and emotional presence with their children. Previous research shows that life changes where fathers are deprived of the opportunity for equal parenting and close contact with their children affect the fathers' lives and mental health. The aim of this caring science study is thereby to gain a deeper understanding of life and ethical values when undergoing paternal alienation and experiencing involuntary loss of paternity.

Design, Research Methods, and Participants

The study has a qualitative design. The data collection was carried out in 2021 through individual in‐depth interviews according to Kvale and Brinkmann. The five fathers who participated in the interviews had experiences of undergoing paternal alienation and involuntary loss of paternity. The interviews were analysed with a reflexive thematic analysis according to Braun and Clarke.

Results

Three main themes emerged. Putting yourself aside includes forgetting one's own needs and prioritising the children's and being the best version of oneself for them. In playing with the cards you have been dealt lies an acceptance of life as it has become and also a responsibility not to let the grief take over, by creating new patterns for everyday life and holding up hope. Keeping your dignity as a human being includes being heard, affirmed and consoled, and a form of re‐awakening one's dignity as a human being.

Conclusion

It is fundamental to understand the grief, longing and sacrifice that paternal alienation and involuntary loss of paternity cause human life and how every day can be a struggle to hold on to hope, find comfort and reconcile with the situation. The fundamental foundation that makes life worth living is love and responsibility for the good of the children.
Fertilizer technology based on optimized nitrogen release from urea‐loaded natural superabsorbent carriers
Authors: Jancar J. , Skarpa P. , Abdel‐Mohsen A. M.
Published: July 2023

There is a pressing need for advanced fertilizer application technologies that enhance crop yields, maintain soil health and reduce the environmental impact from agriculture. Here, we report on the optimization of nitrogen release profiles of urea‐loaded polysaccharide (starch) superabsorbent carriers, employing analytical techniques including UV–VIS, FTIR, EDX, SEM and GC‐FID for structural and phospholipid fatty acids PLFA analyses. We fitted existing kinetic models to the uptake and release profiles, providing a link between nitrogen release kinetics and carrier structural variables. The inclusion of zeolite microparticles in the starch‐based carriers accelerated the rate of nitrogen release and increasing the maximum amount released. Field tests of the technology on maize crops demonstrated improved plant parameters and enhanced the soil microbial population. These findings highlight the promise of urea‐loaded natural superabsorbent carriers as a sustainable alternative to core‐shell CRF fertilizers and urease inhibitors.
Students' perceptions of a UK physiotherapy student‐led clinic
Authors: Wynne Donna , Cooper Kay
Published: July 2023

Background

Student‐led clinics (SLCs) are a mode of delivery whereby students take responsibility for the delivery of a health service or intervention. SLCs for physiotherapy have a wide range of uses, including enhancement of learning, replacement of clinical placement hours and serving population and community needs. Evidence is emerging globally as to the outcomes of SLCs in physiotherapy, but little exists in the United Kingdom (UK) context. The purpose of this study was to explore student perceptions of running, leading and participating in a UK physiotherapy student‐led neurological rehabilitation clinic.

Methods

A qualitative design using a focus group.

Findings

Four themes were identified relating to students' perceptions of SLCs associated with the learning environment, self‐development, enhanced clinical skill development and reflections on experience at the SLC.

Discussion

The findings of this study suggest that physiotherapy SLCs in a UK context can contribute positively to student experience and skill development, particularly in relation to the learning environment, development of clinical skills, leadership and autonomy. Some aspects related to, for example, student induction and preparation could be further developed. Further research should explore if these findings are applicable in other countries where SLCs are less established.

Conclusion

Further research in the UK and globally related to SLC models in different courses and across varying stages is required. Exploration of the SLC as a viable form of clinical placement experience is also warranted.
Compliance with yellow fever and measles vaccines in the revaccination program post‐hematopoietic cell transplantation
Authors: de Almeida Testa Lucia H. , Simione Anderson J. , dos Santos Ana Claudia F. , Colturato Iago , Barbieri Fernanda , de Souza Mair Pedro , Colturato Vergilio R. , Machado Clarisse M.
Published: July 2023

Introduction

Measles, mumps, rubella, and even poliomyelitis outbreaks have recently perplexed infectious disease clinicians and epidemiologists globally due to the decline in vaccination coverage rates in children and adults. Measles and yellow fever (YF) have represented an increasing burden on the Brazilian public health system in recent decades. Both diseases are preventable by live‐attenuated viral vaccines (LAVV), which have restricted use in hematopoietic cell transplant (HCT) recipients.

Methods

Autologous and allogeneic HCT recipients returning for regular appointments at the outpatient clinic were invited to participate in the study. Patients transplanted for at least 2 years and with a printed copy of the vaccination record were included.

Results

We assessed the vaccination records of 273 HCT recipients after the second year of HCT (193 allogeneic and 80 autologous) and observed lower compliance with the YF vaccine (58 patients, 21.2%) than with the measles vaccine (138 patients, 50.5%, p ≤ .0001). This is the largest published series of YF vaccination in HCT recipients so far. No severe adverse events occurred. Although expected, chronic graft‐versus‐host disease (GVHD) did not affect the compliance with measles (p = .08) or YF vaccination (p = .7). Indeed, more allogeneic recipients received measles vaccine in comparison with autologous patients (p < .0001), suggesting that chronic GVHD was not the main reason for not being vaccinated. Children and allogeneic HCT were more likely to receive measles vaccine. Time elapsed from HCT >5 years favored both measles and YF vaccination.

Conclusion

A better understanding of the reasons for low compliance with LAVV is necessary to overcome this problem.

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Intraspecific functional trait variation in weeds: A strategy in response to competition with crop and weed plants
Authors: Romillac Nicolas , Piutti Séverine , Slezack‐Deschaumes Sophie , Gaba Sabrina
Published: July 2023

Weeds are a key component of agroecosystems and compete with crop plants. Crop‐weed competition has been widely investigated over the past decades, although how functional traits mediate these competitive interactions has rarely been explored. In this study, we measured functional traits in 4400 individual plants belonging to 32 weed species, growing among four crops differing in functional traits. We assessed the intraspecific variation in weed functional traits in response to competition with crops but also with the other weeds. We found that the most abundant weeds have a lower intraspecific trait variability than other weed species for leaf dry matter content (LDMC), but this pattern was not observed for canopy height (CH) nor for specific leaf area (SLA). We found that most of the weed species tended to grow taller and have higher LDMC values when crop CH and LDMC increased. We propose that these species display a ‘crop matching’ strategy, tending to match crop functional trait values in response to competition. We also found that weed‐weed competition affected weed functional traits, sometimes more strongly than crop‐weed competition. This study highlights that intraspecific trait variation is important to consider when investigating the processes underlying weed species community assembly, especially resource competition. Further studies are required to identify the source of intraspecific trait variation in weeds and the consequences for weed fitness.
High utility of Ultraconserved Elements (UCE) for disentangling the elusive relationships of tarantulas
Authors: Ortiz David
Published: July 2023

Although tarantulas are a widespread, highly diversified, and charismatic spider group, our understanding of their evolution remains limited. A recent transcriptome‐based approach, including 16% of the nominal tarantula genera (25), provided the first robust phylogenetic hypothesis of deep tarantula relationships. However, transcriptomics has practical downsides, making it less than ideal for phylogenomic analyses. Ultraconserved Elements (UCE) sequencing, a cost‐effective alternative, allows for the simultaneous reading of hundreds of loci and utilizing samples with degraded DNA, including museum material, but its utility for resolving deep tarantula relationships remains to be tested. In this study, I recovered up to ~850 unique UCE loci from publicly available individual tarantula transcriptomes. Phylogenetic estimation using these loci resulted in topologies identical to those obtained from the published complete transcriptomic datasets, with limited phylogenetic uncertainty restricted to two branches in the tarantula tree of life. I conclude that UCE information has great potential for resolving at least moderate to deep tarantula relationships and that numerous UCE loci can be harvested from tarantula transcriptomic data. Finally, I provide databases of transcripts and UCE loci for the 27 currently available tarantula genera, facilitating their inclusion in future phylogenomic studies with deeper taxon coverage.
Modeling Method for Static Large Deflection Problem of Curved Planar Beams in Compliant Mechanisms Based on a Novel Governing Equation
Authors: Jiang Jingyu , Lin Song , Wang Hanchao , Modler Niels
Published: July 2023

Slender beams serve as typical flexible components to transfer motion, force, and energy in compliant mechanisms. Therefore, the accurate and efficient kinetostatic modeling for the slender beams is highly needed in the synthesis and analysis of compliant mechanisms. Several impressive and great modeling methods have been completed by the pioneering researchers based on the governing equation of slender beams, which can solve the deflection of the beam while the beam-tip loads are known. However, parts of the beam-tip loads are unknown in some scenarios and the traditional governing equation becomes inefficient in these scenarios. The aim of this paper is to propose a novel modeling method for the compliant mechanism, which can solve the large deflection problem without iterative algorithm. In this research, a novel governing equation of slender beams has been established based on Castigliano’s principle and simplified by the differential geometry. In the proposed governing equation, the statically force equilibrium equations and geometric constraint equations between different slender beams can be established in the boundary conditions, therefore the model of compliant mechanisms can be solved directly even if parts of the beam’s tip loads and displacements are unknown. The proposed governing equation provides the deformed shapes and cross-sectional loads of the slender beams, which help the designer to check the mechanical interference and strength in the design process. The numerical examples are presented to demonstrate the feasibility of proposed method.
Point-Contact Bonding of Integrated Three-Dimensional Manifold Microchannel Cooling Within Direct Bonded Copper Platform
Authors: Lin Yujui , Wei Tiwei , Moy Wyatt Jason , Chen Hao , Gupta Man Prakash , Degner Michael , Asheghi Mehdi , Mantooth H. Alan , Goodson Kenneth E.
Published: July 2023

A microchannel heat sink integrated with a three-dimensional manifold using direct bonded copper (DBC) is promising for high power density electronics due to the combination of low thermal resistance and reduced pressure drop. However, this requires much progress on the fabrication and high-quality point-contact bonding processes of the microchannel substrate and three-dimensional manifold DBCs. In this study, we have developed processing techniques for surface preparations and high-quality point-contact solder bonding between the two DBC substrates. We utilized chemical polishing followed by electroless plating to prevent excess solder from blocking the microchannels. We performed a parametric study to investigate the impact of bonding time and surface roughness on the tensile strength of the bonding interface. The bonding strength increased from 1.8 MPa to 2.3 MPa as the bonding time increased from 10 to 30 min while reducing the surface roughness from Rz = 0.21 to 0.05 μm, resulting in increasing the bonding strength from 0.16 MPa to 2.07 MPa. We successfully tested the microcooler up to the inlet pressure of 70 kPa and pressure drop of 30 kPa, which translates to the tensile strength at the bonding point contacts, which remains well below the 2.30 MPa. We achieved the junction-to-coolant thermal resistance of 0.2 cm2 K/W at chip heat flux of 590 W/cm2. Thus, our study provides an important proof-of-concept demonstration toward enabling high power density modules for power conversion applications.
Temporal dynamics of genetically heterogeneous extended-spectrum cephalosporin-resistant
Escherichia coli
bloodstream infections
Authors: Shropshire William C. , Strope Benjamin , Selvaraj Anand Selvalakshmi , Bremer Jordan , McDaneld Patrick , Bhatti Micah M. , Flores Anthony R. , Kalia Awdhesh , Shelburne Samuel A.
Published: July 2023

Extended-spectrum cephalosporin-resistant
Escherichia coli
(ESC-R-
Ec
) is an urgent public health threat with sequence type clonal complex 131 (STc131), phylogroup B2 strains being particularly concerning as the dominant cause of ESC-R-
Ec
infections. To address the paucity of recent ESC-R-
Ec
molecular epidemiology data in the United States, we used whole-genome sequencing (WGS) to fully characterize a large cohort of invasive ESC-R-
Ec
at a tertiary care cancer center in Houston, Texas, collected from 2016 to 2020. During the study time frame, there were 1,154 index
E. coli
bloodstream infections (BSIs) of which 389 (33.7%) were ESC-R-
Ec
. Using time series analyses, we identified a temporal dynamic of ESC-R-
Ec
distinct from ESC-susceptible
E. coli
(ESC-S-
Ec
), with cases peaking in the last 6 months of the calendar year. WGS of 297 ESC-R-
Ec
strains revealed that while STc131 strains accounted for ~45% of total BSIs, the proportion of STc131 strains remained stable across the study time frame with infection peaks driven by genetically heterogeneous ESC-R-
Ec
clonal complexes.
bla
CTX-M
variants accounted for most β-lactamases conferring the ESC-R phenotype (89%; 220/248 index ESC-R
-Ec
), and amplification of
bla
CTX-M
genes was widely detected in ESC-R-
Ec
strains, particularly in carbapenem non-susceptible, recurrent BSI strains.
Bla
CTX-M-55
was significantly enriched within phylogroup A strains, and we identified
bla
CTX-M-55
plasmid-to-chromosome transmission occurring across non-B2 strains. Our data provide important information regarding the current molecular epidemiology of invasive ESC-R-
Ec
infections at a large tertiary care cancer center and provide novel insights into the genetic basis of observed temporal variability for these clinically important pathogens.

IMPORTANCE

Given that
E. coli
is the leading cause of worldwide ESC-R
Enterobacterales
infections, we sought to assess the current molecular epidemiology of ESC-R-
Ec
using a WGS analysis of many BSIs over a 5-year period. We identified fluctuating temporal dynamics of ESC-R-
Ec
infections, which have also recently been identified in other geographical regions such as Israel. Our WGS data allowed us to visualize the stable nature of STc131 over the study period and demonstrate a limited but genetically diverse group of ESC-R-
Ec
clonal complexes are detected during infection peaks. Additionally, we provide a widespread assessment of β-lactamase gene copy number in ESC-R-
Ec
infections and delineate mechanisms by which such amplifications are achieved in a diverse array of ESC-R-
Ec
strains. These data suggest that serious ESC-R-
Ec
infections are driven by a diverse array of strains in our cohort and impacted by environmental factors suggesting that community-based monitoring could inform novel preventative measures.
A Dutch highly pathogenic H5N6 avian influenza virus showed remarkable tropism for extra-respiratory organs and caused severe disease but was not transmissible via air in the ferret model
Authors: Herfst Sander , Begeman Lineke , Spronken Monique I. , Poen Marjolein J. , Eggink Dirk , de Meulder Dennis , Lexmond Pascal , Bestebroer Theo M. , Koopmans Marion P. G. , Kuiken Thijs , Richard Mathilde , Fouchier Ron A. M.
Published: July 2023

Continued circulation of A/H5N1 influenza viruses of the A/goose/Guangdong/1/96 lineage in poultry has resulted in the diversification in multiple genetic and antigenic clades. Since 2009, clade 2.3.4.4 hemagglutinin (HA) containing viruses harboring the internal and neuraminidase (NA) genes of other avian influenza A viruses have been detected. As a result, various HA-NA combinations, such as A/H5N1, A/H5N2, A/H5N3, A/H5N5, A/H5N6, and A/H5N8 have been identified. As of January 2023, 83 humans have been infected with A/H5N6 viruses, thereby posing an apparent risk for public health. Here, as part of a risk assessment, the
in vitro
and
in vivo
characterization of A/H5N6 A/black-headed gull/Netherlands/29/2017 is described. This A/H5N6 virus was not transmitted between ferrets via the air but was of unexpectedly high pathogenicity compared to other described A/H5N6 viruses. The virus replicated and caused severe lesions not only in respiratory tissues but also in multiple extra-respiratory tissues, including brain, liver, pancreas, spleen, lymph nodes, and adrenal gland. Sequence analyses demonstrated that the well-known mammalian adaptation substitution D701N was positively selected in almost all ferrets. In the
in vitro
experiments, no other known viral phenotypic properties associated with mammalian adaptation or increased pathogenicity were identified. The lack of transmission via the air and the absence of mammalian adaptation markers suggest that the public health risk of this virus is low. The high pathogenicity of this virus in ferrets could not be explained by the known mammalian pathogenicity factors and should be further studied.

IMPORTANCE

Avian influenza A/H5 viruses can cross the species barrier and infect humans. These infections can have a fatal outcome, but fortunately these influenza A/H5 viruses do not spread between humans. However, the extensive circulation and reassortment of A/H5N6 viruses in poultry and wild birds warrant risk assessments of circulating strains. Here an in-depth characterization of the properties of an avian A/H5N6 influenza virus isolated from a black-headed gull in the Netherlands was performed
in vitro
and
in vivo
, in ferrets. The virus was not transmissible via the air but caused severe disease and spread to extra-respiratory organs. Apart from the detection in ferrets of a mutation that increased virus replication, no other mammalian adaptation phenotypes were identified. Our results suggest that the risk of this avian A/H5N6 virus for public health is low. The underlying reasons for the high pathogenicity of this virus are unexplained and should be further studied.
Influenza A Virus Multicycle Replication Yields Comparable Viral Population Emergence in Human Respiratory and Ocular Cell Types
Authors: Kieran Troy J. , DaSilva Juliana , Stark Thomas J. , York Ian A. , Pappas Claudia , Barnes John R. , Maines Taronna R. , Belser Jessica A.
Published: July 2023

Influenza A virus (IAV) can infect tissues both within and beyond the respiratory tract, leading to extrapulmonary complications, such as conjunctivitis or gastrointestinal disease. Selective pressures governing virus replication and induction of host responses can vary based on the anatomical site of infection, yet studies examining within-host assessments of genetic diversity are typically only conducted in cells derived from the respiratory tract.
Clinical Characteristics and Treatment Outcomes of Mycobacterium fortuitum Pulmonary Disease
Authors: Kim Sae Rom , Yu Jin Young , Kim Su-Young , Kim Dae Hun , Jhun Byung Woo
Published: July 2023

Mycobacterium fortuitum
(
M. fortuitum
) is a rapidly growing
mycobacterium
that causes
M. fortuitum
-pulmonary disease (PD). It is common among individuals with preexisting lung conditions.
Diagnostic dilemma: drug-induced vasculitis versus systemic vasculitis
Authors: Acharya Indira , Weisman David S , Smith Lanaya Williams , Arend Lois Johanna
Published: July 2023

Drug-induced vasculitis can rarely cause inflammation and necrosis of blood vessel walls of both kidney and lung tissue. Diagnosis is challenging because of the lack of difference between systemic and drug-induced vasculitis in clinical presentation, immunological workup and pathological findings. Tissue biopsy guides diagnosis and treatment. Pathological findings must be correlated with clinical information to arrive at a presumed diagnosis of drug-induced vasculitis. We present a patient with hydralazine-induced antineutrophil cytoplasmic antibodies-positive vasculitis with a pulmonary-renal syndrome manifesting as pauci-immune glomerulonephritis and alveolar haemorrhage.
Expression of antenatal symptoms of common mental disorders in The Gambia and the UK: a cross-sectional comparison study
Authors: Sanfilippo Katie Rose M , Glover Vivette , Cornelius Victoria , Amiel Castro Rita T , McConnell Bonnie , Darboe Buba , Huma Hajara B , Ceesay Hassoum , Ramchandani Paul , Cross Ian , Stewart Lauren
Published: July 2023

Objectives

It is important to be able to detect symptoms of common mental disorders (CMDs) in pregnant women. However, the expression of these disorders can differ across cultures and depend on the specific scale used. This study aimed to (a) compare Gambian pregnant women’s responses to the Edinburgh Postnatal Depression Scale (EPDS) and Self-reporting Questionnaire (SRQ-20) and (b) compare responses to the EPDS in pregnant women in The Gambia and UK.

Design

This cross-sectional comparison study investigates Gambian EPDS and SRQ-20 scores through correlation between the two scales, score distributions, proportion of women with high levels of symptoms, and descriptive item analysis. Comparisons between the UK and Gambian EPDS scores were made by investigating score distributions, proportion of women with high levels of symptoms, and descriptive item analysis.

Setting

This study took place in The Gambia, West Africa and London, UK.

Participants

221 pregnant women from The Gambia completed both the SRQ-20 and the EPDS; 368 pregnant women from the UK completed the EPDS.

Results

Gambian participants’ EPDS and SRQ-20 scores were significantly moderately correlated (rs=0.6, p<0.001), had different distributions, 54% overall agreement, and different proportions of women identified as having high levels of symptoms (SRQ-20=42% vs EPDS=5% using highest cut-off score). UK participants had higher EPDS scores (M=6.5, 95% CI (6.1 to 6.9)) than Gambian participants (M=4.4, 95% CI (3.9 to 4.9)) (p<0.001, 95% CIs (−3.0 to –1.0), Cliff’s delta = −0.3).

Conclusions

The differences in scores from Gambian pregnant women to the EPDS and SRQ-20 and the different EPDS responses between pregnant women in the UK and The Gambia further emphasise how methods and understanding around measuring perinatal mental health symptoms developed in Western countries need to be applied with care in other cultures.Cite Now
Comparison of COVID-19 with influenza A in the ICU: a territory-wide, retrospective, propensity matched cohort on mortality and length of stay
Authors: Chu Raymond Bak Hei , Zhao Shi , Zhang Jack Zhenhe , Chan King Chung Kenny , Ng Pauline Yeung , Chan Carol , Fong Ka Man , Au Shek Yin , Yeung Alwin Wai Tak , Chan Jacky Ka Hing , Tsang Hin Hung , Law Kin Ip , Chow Fu Loi , Lam Koon Ngai , Chan Kai Man , Dharmangadan Manimala , Wong Wai Tat , Joynt Gavin Matthew , Wang Maggie Haitian , Ling Lowell
Published: July 2023

Objectives

Direct comparisons between COVID-19 and influenza A in the critical care setting are limited. The objective of this study was to compare their outcomes and identify risk factors for hospital mortality.

Design and setting

This was a territory-wide, retrospective study on all adult (≥18 years old) patients admitted to public hospital intensive care units in Hong Kong. We compared COVID-19 patients admitted between 27 January 2020 and 26 January 2021 with a propensity-matched historical cohort of influenza A patients admitted between 27 January 2015 and 26 January 2020. We reported outcomes of hospital mortality and time to death or discharge. Multivariate analysis using Poisson regression and relative risk (RR) was used to identify risk factors for hospital mortality.

Results

After propensity matching, 373 COVID-19 and 373 influenza A patients were evenly matched for baseline characteristics. COVID-19 patients had higher unadjusted hospital mortality than influenza A patients (17.5% vs 7.5%, p<0.001). The Acute Physiology and Chronic Health Evaluation IV (APACHE IV) adjusted standardised mortality ratio was also higher for COVID-19 than influenza A patients ((0.79 (95% CI 0.61 to 1.00) vs 0.42 (95% CI 0.28 to 0.60)), p<0.001). Adjusting for age, PaO2/FiO2, Charlson Comorbidity Index and APACHE IV, COVID-19 (adjusted RR 2.26 (95% CI 1.52 to 3.36)) and early bacterial-viral coinfection (adjusted RR 1.66 (95% CI 1.17 to 2.37)) were directly associated with hospital mortality.

Conclusions

Critically ill patients with COVID-19 had substantially higher hospital mortality when compared with propensity-matched patients with influenza A.
Association between homocysteine level and length of stay in patients with lower extremity atherosclerotic disease: a retrospective cohort study
Authors: Wang Xue , Yang Yu , Xu Li , Yu Ling , Zang Shuang , Li Xuan
Published: July 2023

Objectives

Homocysteine (Hcy) level has been widely identified as a risk factor associated with adverse outcomes in patients with lower extremity atherosclerotic disease (LEAD). However, there are still some knowledge gaps in research on the association between Hcy level and downstream adverse outcomes, such as length of stay (LOS). This study aims to explore whether and to what extent Hcy level is associated with LOS in patients with LEAD.

Design

Retrospective cohort study.

Setting

China.

Participants, primary and secondary outcomes

We conducted a retrospective cohort study of 748 patients from inpatients with LEAD between January 2014 and November 2021 at the First Hospital of China Medical University in China. We used a slew of generalised linear models to evaluate the association between Hcy level and LOS.

Results

The patients’ median age was 68 years and 631 (84.36%) were males. A dose–response curve with an inflection point at 22.63 µmol/L was observed between Hcy level and LOS after the adjustment of potential confounders. LOS increased before Hcy level reached the inflection point (β: 0.36; 95% CI: 0.18 to 0.55; p<0.001).

Conclusion

Our results show that an Hcy level <22.63 µmol/L is associated with increased LOS in patients with LEAD, which was independent of some other risk factors. This might shed light on how Hcy can be used as a key marker in the comprehensive management of patients with LEAD during hospitalisation.
Protocol for the mixed methods, Managing young people (aged 16–25) with Attention deficit hyperactivity disorder in Primary care (MAP) study: mapping current practice and co-producing guidance to improve healthcare in an underserved population
Authors: Price Anna , Smith Jane R , Mughal Faraz , Salimi Anita , Melendez-Torres G J , Newlove-Delgado Tamsin
Published: July 2023

Introduction

Attention deficit hyperactivity disorder (ADHD) is the most common neurodevelopmental disorder in children and adolescents, with an average worldwide prevalence of 5%. Up to 40% of young people continue to experience symptoms into adulthood. Young people with ADHD experience poorer outcomes than their peers across multiple domains, with treatment shown to reduce these risks. Primary care practitioners play an important role in healthcare provision for this group in the UK. However, many feel unsure about how best to provide support, reporting prescribing concerns and need for more evidence-based guidance. A lack of national data on primary care provision hinders efforts to improve access to care and optimise outcomes. This mixed-methods study aims to provide evidence that may be used to improve primary care services for young people aged 16–25 years with ADHD.

Methods and analysis

There are three interlinked work packages: (a) a mapping study including a survey of stakeholders (healthcare professionals, people with ADHD and commissioners) will map ADHD prescribing practice, shared-care arrangements, available support and practitioner roles by geographic locations across England for different respondent groups; (b) a qualitative study involving semi-structured interviews with stakeholders (10–15 healthcare professionals and 10–15 people with ADHD) will explore experiences of ‘what works’ and ‘what is needed’ in terms of service provision and synthesise findings; (c) workshops will integrate findings from (a) and (b) and work with stakeholders to use this evidence to codevelop key messages and guidance to improve care.

Ethics and dissemination

The protocol has been approved by Yorkshire and the Humber—Bradford Leeds Research Ethics Committee. Recruitment commenced in September 2022. Findings will be disseminated via research articles in peer-reviewed journals, conference presentations, public involvement events, patient groups and media releases. A summary of study findings will be shared with participants at the end of the study.

Trial registration number

NCT05518435.
Bridging that gap: a qualitative study of perceptions of equality, diversity and inclusivity in colorectal surgery in the UK and Ireland
Authors: Harji Deena , Sarmah Panchali , Gwyther Bethany , Lyons M K , Boereboom Catherine Louise , Siddiqi S , Arnott R , Harikrishnan Athur , Maxwell-Armstrong Charles , Cuming Tamzin
Published: July 2023

Background

There is a growing recognition on the importance of equality, diversity and inclusion (EDI) within surgery and the need to diversify the surgical community and its various organisations, in a bidto reflect the diverse populations they serve. To create, sustain and encourage a diverse surgical workforce requires an in-depth understanding of the current makeup of key surgical institutions, relevant issues pertaining to EDI and appropriate solutions and strategies to ensure tangible change.

Objectives

Following on from the recent Kennedy Review into Diversity and Inclusion commissioned by the Royal College of Surgeons of England, the aim of this qualitative study was to understand the EDI issues which affected the membership of the Association of Coloproctology of Great Britain and Ireland, while seeking appropriate solutions to address them.

Design

Dedicated, online and qualitative focus groups.

Participants

Colorectal surgeons, trainees and nurse specialists were recruited using a volunteer sampling strategy.

Methods

A series of online, dedicated, qualitative focus groups across the 20 chapter regions were held. Each focus group was run informed by a structured topic guide. All participants who were given the opportunity to remain anonymous were offered a debriefing at the end. This study has been reported in keeping with the Standards for Reporting Qualitative Research.

Results

Between April and May 2021, a total number of 20 focus groups were conducted, with a total of 260 participants across 19 chapter regions. Seven themes and one standalone code pertaining to EDI were identified: support, unconscious behaviours, psychological consequences, bystander behaviour, preconceptions, inclusivity and meritocracy and the one standalone code was institutional accountability. Five themes were identified pertaining to potential strategies and solutions: education, affirmative action, transparency, professional support and mentorship.

Conclusion

The evidence presented here is of a range of EDI issues which affect the working lives of those within colorectal surgery in the UK and Ireland, and of potential strategies and solutions which can help build a more inclusive, equitable and diverse colorectal community.
Effects of different palliative care models on decedents with kidney failure receiving maintenance dialysis: a nationwide population-based retrospective observational study in Taiwan
Authors: Chu Wei-Min , Kuo Wen-Yu , Tung Yu-Chi
Published: July 2023

Objectives

Patients with kidney failure receiving maintenance dialysis are a particularly important population and carry a heavy disease burden. However, evidence related to palliative care for patients with kidney failure receiving maintenance dialysis remains scarce, especially in regard to palliative care consultation services and palliative home care. This study aimed to evaluate the effects of different palliative care models on aggressive treatment among patients with kidney failure receiving maintenance dialysis during the end of life.

Design

A population-based retrospective observational study.

Setting

This study used a population database maintained by Taiwan’s Ministry of Health and Welfare in combination with Taiwan’s National Health Research Insurance Database.

Participants

We enrolled all decedents who were patients with kidney failure receiving maintenance dialysis from the period 1 January 2017 to 31 December 2017 in Taiwan.

Main exposure measure

Hospice care during the 1-year period before death.

Main outcome measures

Eight aggressive treatments within 30 days before death, more than one emergency department visit, more than one admission, a longer than 14-day admission, admission to an intensive care unit, death in hospital, endotracheal tube use, ventilator use and need for cardiopulmonary resuscitation.

Results

A total of 10 083 patients were enrolled, including 1786 (17.7%) patients with kidney failure who received palliative care 1 year before death. Compared with patients without palliative care, patients with palliative care had significantly less aggressive treatments within 30 days before death (Estimates: −0.09, CI: −0.10 to −0.08). Patients with inpatient palliative care, palliative home care or a mixed model experienced significantly lower treatment aggressiveness within 30 days before death.

Conclusions

Palliative care, particularly use of a mixed care model, inpatient palliative care and palliative home care in patients with kidney failure receiving dialysis, could all significantly reduce the aggressiveness of treatment within 30 days before death.
Study protocol for assessment of the coagulation potential of concomitantly used factor VIII concentrates in patients with haemophilia A with emicizumab prophylaxis (CAGUYAMA Study): a multicentre open-label non-randomised clinical trial
Authors: Takeyama Masahiro , Ozu Naoki , Kasama Shu , Kasahara Masato , Matsumoto Masanori , Shima Midori , Nogami Keiji
Published: July 2023

Introduction

Emicizumab prophylaxis substantially reduces bleeding episodes in patients with haemophilia A (HA). The haemostatic efficacy of emicizumab in patients with HA is estimated as approximately 15% based on mimic activity of factor (F) VIII. Although it has been proven effective in preventing bleeding, its haemostatic effect during breakthrough bleeding or surgery is considered insufficient. Therefore, haemostatic management of emicizumab-treated patients with HA without inhibitors frequently requires FVIII replacement therapy. In haemostatic management of emicizumab-treated patients with HA, conventional FVIII dosage calculations are used in clinical practice without considering the coagulant effects of emicizumab.

Methods and analysis

In the CAGUYAMA study, 100 patients with HA without inhibitors will be enrolled for a maximum duration of 1 year, and samples of 30 events following the concomitant use of FVIII concentrates (30±5 U/kg) with emicizumab will be collected. An ‘event’ is defined as obtaining blood samples at preadministration and postadministration of FVIII concentrates during a breakthrough bleeding or a surgical procedure. Global coagulation assays will be used to measure the coagulation potential of the obtained samples. Clot waveform analysis (CWA) is used to identify the primary end-point, that is, the degree of improvement in the maximum coagulation rate at preadministration and post-administration of fixed-dose FVIII concentrations. The parameter obtained from CWA, which is triggered by an optimally diluted mixture of prothrombin time reagent and activated partial thromboplastin time reagent, is reported to be an excellent marker for assessing the degree of improvement of the coagulation potential in emicizumab-treated plasmas.

Ethics and dissemination

The CAGUYAMA study was approved by the Japan-Certified Review Board of Nara Medical University (Approval ID; nara0031). The study results will be communicated through publication in international scientific journals and presentations at (inter)national conferences.

Trial registration number

jRCTs051210137.
Protocol for virtual physical examination in an observational, longitudinal study evaluating virtual outcome measures in SLE
Authors: Askanase Anca D , Aranow Cynthia , Kim Mimi Y , Kamen Diane L , Arriens Cristina , Khalili Leila , Tang Wei , Barasch Julia , Dall'Era Maria , Mackay Meggan
Published: July 2023

Objective

There is a lack of data on the use of telemedicine (TM) in SLE. SLE outcome measures remain complex, and clinicians and clinical trialists have raised concerns about the accuracy of virtual disease activity measures. This study evaluates the level of agreement between virtual SLE outcome measures and face-to-face (F2F) encounter. Here, we describe the study design, virtual physical examination protocol and demographics for the first 50 patients evaluated.

Methods and analysis

This is an observational, longitudinal study of 200 patients with SLE with varying levels of disease activity from 4 academic lupus centres serving diverse populations. Each study participant will be evaluated at a baseline and a follow-up visit. At each visit, participants are evaluated by the same physician first via a videoconference-based TM and then a F2F encounter. For this protocol, virtual physical examination guidelines relying on physician-directed patient self-examination were established. SLE disease activity measures will be completed immediately after the TM encounter and repeated after the F2F encounter for each visit. The degree of agreement between TM and F2F disease activity measures will be analysed using the Bland-Altman method. An interim analysis is planned after the enrolment of the first 50 participants.

Ethics and dissemination

This study has been reviewed by the Columbia University Medical Center Institutional Review Board (IRB Protocol #: AAAT6574). The full results of this study will be published after the final data analysis of 200 patients. The abrupt shift to TM visits due to the COVID-19 pandemic disrupted clinical practice and clinical trials. Establishing a high level of agreement between SLE disease activity measures obtained with videoconference TM and F2F at the same time point, will allow for improved assessment of disease activity when F2F data cannot be acquired. This information may guide both medical decision-making and provide reliable outcome measures for clinical research.