bluuebunny/crossref_metadata_2025 huggingface dataset:
Functional evaluation in inherited retinal disease
Authors: Daich Varela Malena , Georgiou Michalis , Hashem Shaima A , Weleber Richard G , Michaelides Michel
Published: November 2021

Functional assessments are a fundamental part of the clinical evaluation of patients with inherited retinal diseases (IRDs). Their importance and impact have become increasingly notable, given the significant breadth and number of clinical trials and studies investigating multiple avenues of intervention across a wide range of IRDs, including gene, pharmacological and cellular therapies. Moreover, the fact that many clinical trials are reportingimprovementsin vision, rather than the previously anticipated structural stability/slowing of degeneration, makes functional evaluation of primary relevance. In this review, we will describe a range of methods employed to characterise retinal function and functional vision, beginning with tests variably included in the clinic, such as visual acuity, electrophysiological assessment and colour discrimination, and then discussing assessments often reserved for clinical trials/research studies such as photoaversion testing, full-field static perimetry and microperimetry, and vision-guided mobility testing; addressing perimetry in greatest detail, given it is commonly a primary outcome metric. We will focus on how these tests can help diagnose and monitor particular genotypes, also noting their limitations/challenges and exploring analytical methodologies for better exploiting functional measurements, as well as how they facilitate patient inclusion and stratification in clinical trials and serve as outcome measures.
Subnational mortality estimates for India in 2019: a baseline for evaluating excess deaths due to the COVID-19 pandemic
Authors: Rao Chalapati , John Amrit Jose , Yadav Ajit Kumar , Siraj Mansha
Published: November 2021

Background

Estimates of excess mortality are required to assess and compare the impact of the COVID-19 pandemic across populations. For India, reliable baseline prepandemic mortality patterns at national and subnational level are necessary for such assessments. However, available data from the Civil Registration System (CRS) is affected by incompleteness of death recording that varies by sex, age and location.

Methods

Under-reporting of CRS 2019 deaths was assessed for three age groups (< 5 years, 15–59 years and ≥60 years) at subnational level, through comparison with age-specific death rates from alternate sources. Age-specific corrections for under-reporting were applied to derive adjusted death counts by sex for each location. These were used to compute life expectancy (LE) at birth by sex in 2019, which were compared with subnational LEs from the Global Burden of Disease (GBD) 2019 Study.

Results

A total of 9.92 million deaths (95% UI 9.70 to 10.02) were estimated across India in 2019, about 2.28 million more than CRS reports. Adjustments to under-five and elderly mortality accounted for 30% and 56% of additional deaths, respectively. Adjustments in Bihar, Jharkhand, Madhya Pradesh, Maharashtra, Rajasthan and Uttar Pradesh accounted for 75% of all additional deaths. Adjusted LEs were below corresponding GBD estimates by ≥2 years for males at national level and in 20 states, and by ≥1 year for females in 12 states.

Conclusions

These results represent the first-ever subnational mortality estimates for India derived from CRS reported deaths, and serve as a baseline for assessing excess mortality from the COVID-19 pandemic. Adjusted life expectancies indicate higher mortality patterns in India than previously perceived. Under-reporting of infant deaths and those among women and the elderly is evident in many locations. Further CRS strengthening is required to improve the empirical basis for local mortality measurement across the country.
Simple scoring algorithm to identify community-dwelling older adults with limited health literacy: a cross-sectional study in Taiwan
Authors: Hou Wen-Hsuan , Kuo Ken N , Chen Mu-Jean , Chang Yao-Mao , Tsai Han-Wei , Chan Ding-Cheng , Su Chien-Tien , Han Der-Sheng , Shen Hsiu-Nien , Li Chung-Yi
Published: November 2021

Objective

Health literacy (HL) is the degree of individuals’ capacity to access, understand, appraise and apply health information and services required to make appropriate health decisions. This study aimed to establish a predictive algorithm for identifying community-dwelling older adults with a high risk of limited HL.

Design

A cross-sectional study.

Setting

Four communities in northern, central and southern Taiwan.

Participants

A total of 648 older adults were included. Moreover, 85% of the core data set was used to generate the prediction model for the scoring algorithm, and 15% was used to test the fitness of the model.

Primary and secondary outcome measures

Pearson’s χ2test and multiple logistic regression were used to identify the significant factors associated with the HL level. An optimal cut-off point for the scoring algorithm was identified on the basis of the maximum sensitivity and specificity.

Results

A total of 350 (54.6%) patients were classified as having limited HL. We identified 24 variables that could significantly differentiate between sufficient and limited HL. Eight factors that could significantly predict limited HL were identified as follows: a socioenvironmental determinant (ie, dominant spoken dialect), a health service use factor (ie, having family doctors), a health cost factor (ie, self-paid vaccination), a heath behaviour factor (ie, searching online health information), two health outcomes (ie, difficulty in performing activities of daily living and requiring assistance while visiting doctors), a participation factor (ie, attending health classes) and an empowerment factor (ie, self-management during illness). The scoring algorithm yielded an area under the curve of 0.71, and an optimal cut-off value of 5 represented moderate sensitivity (62.0%) and satisfactory specificity (76.2%).

Conclusion

This simple scoring algorithm can efficiently and effectively identify community-dwelling older adults with a high risk of limited HL.
Childhood abuse and its association with adults’ mental health problems: a cross-sectional study among men and women in the Yangon Region of Myanmar
Authors: Aye Win Thuzar , Lien Lars , Stigum Hein , Bjertness Espen
Published: November 2021

Objectives

To estimate the prevalence of emotional, physical and sexual childhood abuse, and symptoms of post-traumatic stress disorder (PTSD) and to examine the association between childhood abuse and adult mental health problems, including mental distress and PTSD symptoms.

Design

A community-based cross-sectional study was conducted. Childhood abuse was assessed with the NorVold Abuse Questionnaire, and mental distress and symptoms of PTSD were measured using the Hopkins Symptom Checklist 10 and the Impact of Event Scale—Revised, respectively. The Wald test and multiple linear regression analysis were applied for testing differences between proportions and the association between childhood abuse and adult mental health outcomes, respectively.

Setting

Urban and rural areas of the Yangon Region, Myanmar.

Participants

A total of 2377 men and women aged 18–49 years were included. Institutionalised people, monks, nuns and individuals deemed too ill physically and/or mentally to participate were excluded.

Results

Overall, 21.1% (95% CI 18.8 to 23.6) reported any form of childhood abuse, 10.4% (95% CI 8.9 to 12.4) physical abuse, 10.4% (95% CI 8.8 to 12.2) emotional abuse and 7.3% (95% CI 5.7 to 9.3) sexual abuse. Childhood abuse was more common in women (29.8%) than in men (12.4%). The prevalence of PTSD symptoms in the total sample was 6.6%. After adjusting for confounding variables, positive associations were found between childhood abuse with adult mental distress and PTSD symptoms among women and older men.

Conclusions

Childhood abuse is prevalent among both men and women in the Yangon Region of Myanmar and associated with adult mental health problems. Approximately 7% of people report PTSD symptoms. It should prompt local health professionals and policy makers to establish prevention programmes to eliminate violence against children and to organise services for victims of childhood abuse. Care should be taken in generalising findings for less populated areas.
Parents’ preferences for follow-up care in a type 1 diabetes paediatric population: a survey-based study in Quebec, Canada
Authors: Laberge Maude , Rekik Monia , Djiffa Kodjo Mawuegnigan
Published: November 2021

Objectives

Examine variations in parent’s preferences for their child’s type 1 diabetes (T1D) follow-up care and the determinants of the preferred intensity of care. Clinical guidelines recommend multidisciplinary management of T1D, with follow-up visits with an endocrinologist at least every 3 months in the paediatric population. However, there could be heterogeneity in parents’ needs, and preferences in terms of care management may deviate from clinical guidelines.

Setting

Not applicable.

Participants

Parents who have a child living with T1D and who reside in Quebec, Canada.

Intervention

In collaboration with a patient-partner (a parent of a child with T1D), we developed a survey to collect data from parents of children living with T1D. Our primary outcome of interest was the preferred time in months between two appointments. We ran a probit model to analyse longer time (over 3 months between appointments), compared with the standard of care (3 months or less).

Results

Results suggest that about one-third (33%) of parents want to deviate from the guideline. Parents who want to increase the time between appointments are more experienced in the management of the disease and have higher costs than those who wish to follow the 3-month guideline. The number of years since the diagnosis is positively associated with a preference for a longer time between appointments, while the perceived useful of information provided during the consultation, and a parent having made a change in their professional life were negatively associated with a desire to space out appointments. The child’s gender is not a significant factor in parents’ preferences.

Conclusions

Adapting visit protocols could make the health system more efficient to respond to T1D patients and their parent’s needs.
Correlation between masked hypertension and endothelial dysfunction measured by flow-mediated dilation: a protocol of systematic review and meta-analysis
Authors: Zhang Xiaohua , Li Yong , Gao Ling , Yu Qian , Zhou Congliang , Zou Wenshu
Published: November 2021

Introduction

A surrogate marker to evaluate artery endothelial response when stimulated by reactive hyperaemia, known as brachial flow-mediated dilation (FMD), has prognostic value in predicting hypertensive organ damage and cardiovascular disease events. However, the degree of correlation between brachial FMD and masked hypertension (MH) outcomes is still unclear. Therefore, the purpose of this study is to pool data regarding FMD with respect to MH.

Methods and analysis

Electronic databases MEDLINE, EMBASE, China National Knowledge Infrastructure and Cochrane Library will be searched for the following keywords: endothelial dysfunction, flow-mediated dilation, and masked hypertension, masked uncontrolled hypertension (MUCH) and prehypertension. The following are the eligibility criteria: population—adults (18 years old or older) without hypertension at baseline, with suspected endothelial dysfunction, or from MH/MUCH populations (office blood pressure <140/90 mm Hg and home blood pressure ≥135 mm Hg and/or 85 mm Hg) and from controlled clinical trials, cohort studies, or randomised and controlled trials; exposures—any metrics for FMD; comparisons—participants without MH or MUCH; and outcome—change in FMD between the case group and the control group. Two authors will be engaged in screening and collecting data independently; disagreements will be resolved through discussion. Data extraction will include primary data designated as HR, OR, correlations and regression coefficients. Comprehensive Meta-Analysis V.2.0 will be used to conduct related subgroup and sensitivity analyses and publication bias.

Ethics and dissemination

This study does not require ethics approval. It will be submitted to a peer-reviewed journal.

PROSPERO registration number

CRD42020208362.
Differences in beliefs about COVID-19 by gun ownership: a cross-sectional survey of Texas adults
Authors: Johnson Renee M , Crifasi Cassandra , Anderson Goodell Erin M , Wiśniowski Arkadiusz , Sakshaug Joseph W , Thrul Johannes , Owens Mark
Published: November 2021

Objectives

We investigated the association between gun ownership and perceptions about COVID-19 among Texas adults as the pandemic emerged. We considered perceived likelihood that the pandemic would lead to civil unrest, perceived importance of taking precautions to prevent transmission and perceptions that the threat of COVID-19 has been exaggerated.

Methods

Data were collected from 5 to 12 April 2020, shortly after Texas’ stay-at-home declaration. We generated a sample using random digit dial methods for a telephone survey (n=77, response rate=8%) and by randomly selecting adults from an ongoing panel to complete the survey online (n=1120, non-probability sample). We conducted a logistic regression to estimate differences in perceptions by gun ownership. To account for bias associated with use of a non-probability sample, we used Bayesian data integration and ran linear regression models to produce more accurate measures of association.

Results

Among the 60% of Texas adults who reported gun ownership, estimates of past 7-day gun purchases, ammunition purchases and gun carrying were 15% (n=78), 20% (n=100) and 24% (n=130), respectively. We found no evidence of an association between gun ownership with perceived importance of taking precautions to prevent transmission or with perceived likelihood of civil unrest. Results from the logistic regression (OR 1.27, 95% CI 0.99 to 1.63) and the linear regression (β=0.18, 95% CI 0.07 to 0.29) suggest that gun owners may be more likely to believe the threat of COVID-19 was exaggerated.

Conclusions

Compared with those without guns, gun owners may have been inclined to downplay the threat of COVID-19 early in the pandemic.
Integrating the clinical pharmacist into the emergency department interdisciplinary team: a study protocol for a multicentre trial applying a non-randomised stepped-wedge study design
Authors: Vesela Renata , Elenjord Renate , Lehnbom Elin C , Ofstad Eirik Hugaas , Johnsgård Tine , Zahl-Holmstad Birgitte , Risør Torstein , Wisløff Torbjørn , Røslie Lars , Filseth Ole Magnus , Valle Per-Christian , Svendsen Kristian , Frøyshov Hanne Mathilde , Garcia Beate H
Published: November 2021

Introduction

The ‘emergency department (ED) pharmacist’ is an integrated part of the ED interdisciplinary team in many countries, which have shown to improve medication safety and reduce costs related to hospitalisations. In Norway, few EDs are equipped with ED pharmacists, and research describing effects on patients has not been conducted. The aim of this study is to investigate the impact of introducing clinical pharmacists to the interdisciplinary ED team. In this multicentre study, the intervention will be pragmatically implemented in the regular operation of three EDs in Northern Norway; Tromsø, Bodø and Harstad. Clinical pharmacists will work as an integrated part of the ED team, providing pharmaceutical care services such as medication reconciliation, review and/or counselling. The primary endpoint is ‘time in hospital during 30 days after admission to the ED’, combining (1) time in ED, (2) time in hospital (if hospitalised) and (3) time in ED and/or hospital if re-hospitalised during 30 days after admission. Secondary endpoints include time to rehospitalisation, length of stay in ED and hospital and rehospitalisation and mortality rates.

Methods and analysis

We will apply a non-randomised stepped-wedge study design, where we in a staggered way implement the ED pharmacists in all three EDs after a 3, 6 and 9 months control period, respectively. We will include all patients going through the three EDs during the 12-month study period. Patient data will be collected retrospectively from national data registries, the hospital system and from patient records.

Ethics and dissemination

The Regional Committee for Medical and Health Research Ethics and Local Patient Protection Officers in all hospitals have approved the study. Patients will be informed about the ongoing study on a general basis with ads on posters and flyers.

Trial registration number

NCT04722588.
Effect of tranexamic acid on the prognosis of patients with traumatic brain injury undergoing craniotomy: study protocol for a randomised controlled trial
Authors: Wu Bei , Lu Yu , Yu Yun , Yue Hongli , Wang Jie , Chong Yingzi , Cui Weihua
Published: November 2021

Introduction

Abnormal coagulation function aggravates the prognosis of patients with traumatic brain injury (TBI). It was reported that the antifibrinolytic drug tranexamic acid (TXA) could reduce intracranial haemorrhage and mortality in non-operative patients with TBI. However, there is a lack of evaluation of TXA in patients with TBI undergoing craniotomy.

Methods and analysis

This is a single-centre randomised controlled, double-blind, parallel study aiming to investigate the effectiveness and safety of TXA in patients with TBI during the perioperative period. Blood loss and transfusion, neurological function, adverse events, mortality and serum immune-inflammatory cytokines will be collected and analysed.

Ethics and dissemination

Ethical approval has been granted by the Medical Ethics Committee of Beijing Tian Tan Hospital, Capital Medical University (reference number KY 2020-136-03). The results of this study will be disseminated through presentations at scientific conferences and publication in peer-reviewed journals.

Trial registration number

ChiCTR2100041911.
Ethnicity matters in perceived impacts and information sources of COVID-19 among mothers with young children in Australia: a cross-sectional study
Authors: Wen Li Ming , Xu Huilan , Jawad Danielle , Buchanan Limin , Rissel Chris , Phongsavan Philayrath , Baur Louise A , Taki Sarah
Published: November 2021

Objectives

This study aimed to investigate perceived impacts, ways of communication with professionals and information sources related to COVID-19, and explore whether these impacts or information sources were associated with ethnicity that is, language spoken at home.

Design

A cross-sectional study.

Setting

Sydney, Australia during the period from March to October 2020.

Participants

Mothers of young children participating in an existing trial.

Outcome measures

Mothers were asked to respond to a set of survey questions related to COVID-19 via telephone. The questions included a mental health scale, and how they communicated with health professionals and their information sources related to COVID-19 during the COVID-19 pandemic.

Results

Of 537 mothers who completed the survey (81% response rate), 45% reported they spoke a language other than English at home. Overall, 136 (26%) reported experiencing mental distress. 234 (44%) reported that COVID-19 affected the way they receive and communicate health-related information with health professionals, especially for those from non-English speaking backgrounds with an adjusted odds ratio (AOR) 1.58 (95% CI 1.10 to 2.27). They were less likely to use a face-to-face service (AOR 0.55, 95% CI 0.37 to 0.80) and more likely to use social media (AOR 2.11, 95% CI 1.40 to 3.17) for health-related information. Regarding sources of COVID-19-related information, mothers from non-English-speaking backgrounds were more likely to rely on family members (AOR 1.49, 95% CI 1.01 to 2.19) and social media (AOR 3.34, 95% CI 2.05 to 5.43).

Conclusions

COVID-19 has significantly impacted mothers with young children in regard to their mental health, means of communication with health professionals and sources of health information. Mothers from non-English-speaking communities were less likely to use a face-to-face service, and more likely to seek information from family members and social media. Appropriate health support for non-English-speaking community needs to take these factors into account.

Trial registration number

ANZCTR:12618001571268.

they
Surveying and mapping breast cancer services in Ghana: a cross-sectional pilot study in the Eastern Region
Authors: Moustafa Moustafa , Mali Meghan Eileen , Lopez-Verdugo Fidel , Sanyang Ousman , Nellermoe Jonathan , Price Raymond R , Manortey Stephen , Biritwum-Nyarko Alberta , Ofei Irina , Sorensen Justin , Goldsmith Alison , Brownson Kirstyn E , Kumah Augustine , Sutherland Edward
Published: November 2021

Objectives

Define the services available for the care of breast cancer at hospitals in the Eastern Region of Ghana, identify areas of the region with limited access to care through geospatial mapping, and test a novel survey instrument in anticipation of a nationwide scale up of the study.

Design

A cross-sectional, facility-based survey study.

Setting

This study was conducted at 33 of the 34 hospitals in the Eastern Region of Ghana from March 2020 to May 2020.

Participants

The 33 hospitals surveyed represented 97% of all hospitals in the region. This included private, government, quasi-government and faith-based organisation owned hospitals.

Results

Sixteen hospitals (82%) surveyed provided basic screening services, 11 (33%) provided pathological diagnosis and 3 (9%) provided those services in addition to basic surgical care.53%, 64% and 78% of the population lived within 10 km, 25 km and 45 km of screening, diagnostic and treatment services respectively. Limited chemotherapy was available at two hospitals (6%), endocrine therapy at one hospital (3%) and radiotherapy was not available. Twenty-nine hospitals (88%) employed a general practitioner and 13 (39%) employed a surgeon. Oncology specialists, pathology personnel and a plastic surgeon were only available in one hospital (3%) in the Eastern Region.

Conclusions

Although 16 hospitals (82%) provided screening, only half the population lived within reasonable distance of these services. Few hospitals offered diagnosis and surgical services, but 64% and 78% of the population lived within a reasonable distance of these hospitals. Geospatial analysis suggested two priorities to cost-effectively expand breast cancer services: (1) increase the number of health facilities providing screening services and (2) centralise basic imaging, pathological and surgical services at targeted hospitals.
Continuum of maternal healthcare services utilisation and associated factors among women who gave birth in Siyadebirena Wayu district, Ethiopia: community-based cross-sectional study
Authors: Sertsewold Seblewongel Gebretsadik , Debie Ayal , Geberu Demiss Mulatu
Published: November 2021

Objective

This study aimed to analyse the prevalence and factors associated with continuum of maternal healthcare services among women who gave birth in Siyadebirena Wayu district, Central Ethiopia.

Design

Community-based cross-sectional study.

Setting

At eight Kebeles in Central Ethiopia.

Participants

The study was done on 614 women aged 15–49 years using interviewer-administered structured questionnaire. Following proportional allocation of the sample, we used simple random sampling technique to select study participants.

Methods

Binary logistic regression model was fitted to identify the factors associated with the outcome. Variables with p<0.2 in the bivariable analysis were the candidates for multivariable analysis. A p<0.05 and adjusted OR (AOR) with 95% CI were taken to declare the factors and the strengths of association with continuum of maternal healthcare utilisation.

Outcome

Continuum of maternal healthcare utilisation.

Results

Only 16.1% (95% CI 13.3% to 19.0%) of the women had used a complete continuum of maternal health services. Variables, such as contraceptive use (AOR 4.95; 95% CI 1.61 to 15.20), autonomy (AOR 4.45; 95% CI 1.69 to 11.60), urban residence (AOR 3.91; 95% CI 1.06 to 14.39), educated women (AOR 5.36; 95% CI 1.15 to 25.06), took less than 30 min to reach a health facility (AOR 3.17; 95% CI 1.38 to 7.25), use public transportation (AOR 2.48; 95% CI 1.12 to 5.52) and good knowledge (AOR 9.88; 95% CI 3.89 to 25.0) were positively associated with continuum of maternal healthcare. In the contrary, women who had third child birth order (AOR 0.22; 95% CI 0.06 to 0.8) was negatively associated.

Conclusions

Overall, the level of the continuum of maternal healthcare services utilisation was low compared with the national and global targets. Therefore, programme planners and implementer had better conduct health education to enhance the awareness of women about continuum of maternal healthcare services. Healthcare sector policy-makers and managers shall also scale up healthcare facilities to improve access to maternal healthcare services.
Point-of-care testing in a high-income country paediatric emergency department: a qualitative study in Sweden
Authors: Rasti Reza , Brännström Johanna , Mårtensson Andreas , Zenk Ingela , Gantelius Jesper , Gaudenzi Giulia , Alvesson Helle Mölsted , Alfvén Tobias
Published: November 2021

Objectives

In many resource-limited health systems, point-of-care tests (POCTs) are the only means for clinical patient sample analyses. However, the speed and simplicity of POCTs also makes their use appealing to clinicians in high-income countries (HICs), despite greater laboratory accessibility. Although also part of the clinical routine in HICs, clinician perceptions of the utility of POCTs are relatively unknown in such settings as compared with others. In a Swedish paediatric emergency department (PED) where POCT use is routine, we aimed to characterise healthcare providers’ perspectives on the clinical utility of POCTs and explore their implementation in the local setting; to discuss and compare such perspectives, to those reported in other settings; and finally, to gather requests for ideal novel POCTs.

Design

Qualitative focus group discussions study. A data-driven content analysis approach was used for analysis.

Setting

The PED of a secondary paediatric hospital in Stockholm, Sweden.

Participants

Twenty-four healthcare providers clinically active at the PED were enrolled in six focus groups.

Results

A range of POCTs was routinely used. The emerging themeUtility of our POCT use is double-edgedillustrated the perceived utility of POCTs. While POCT services were considered to have clinical and social value, the local routine for their use was named to distract clinicians from the care for patients. Requests were made for ideal POCTs and their implementation.

Conclusion

Despite their clinical integration, deficient implementation routines limit the benefits of POCT services to this well-resourced paediatric clinic. As such deficiencies are shared with other settings, it is suggested that some characteristics of POCTs and of their utility are less related to resource level and more to policy deficiency. To address this, we propose the appointment of skilled laboratory personnel as ambassadors to hospital clinics offering POCT services, to ensure higher utility of such services.
Clinical effectiveness and bacteriological eradication of three different Short-COurse antibiotic regimens and single-dose fosfomycin for uncomplicated lower Urinary Tract infections in adult women (SCOUT study): study protocol for a randomised clinical trial
Authors: Garcia-Sangenís Ana , Morros Rosa , Aguilar-Sánchez Mercedes , Medina-Perucha Laura , Leiva Alfonso , Ripoll Joana , Martínez-Pecharromán Mar , Bartolomé-Moreno Cruz B , Magallon Botaya Rosa , Marín-Cañada Jaime , Molero José M , Moragas Ana , Troncoso Amelia , Monfà Ramon , Llor Carl
Published: November 2021

Introduction

Uncomplicated lower urinary tract infections (uLUTI) are a common problem in primary care. Current local guidelines recommend the use of a single 3 g dose of fosfomycin. However, most general practitioners (GP) prefer short-course therapies to single-dose therapy. No study has compared head-to-head short-course antimicrobial agents for uLUTIs. Therefore, the aim of this randomised clinical trial is to compare three different short-course antibiotic therapies with a single-dose of fosfomycin for these infections.

Methods and analysis

This will be a pragmatic, multicentre, parallel group, open trial. Women aged 18 or older and with symptoms of uLUTI and a positive urine dipstick analysis will be randomised to one of the following four groups: a single dose of 3 g of fosfomycin, 2 days of 3 g of fosfomycin o.d., 3 days of pivmecillinam 400 mg three times per day (t.i.d) or 5 days of nitrofurantoin 100 mg t.i.d. A total sample of 1120 patients was calculated. The primary endpoint is clinical effectiveness at day 7, defined as cure of symptoms reported by the patients in a diary including four symptoms: dysuria, urgency, frequency and suprapubic pain, which will be scored on a 4-point severity scale (not present/mild/moderate/severe). Follow-up visits are scheduled at days 7 (phone call), 14 and 28 for assessing evolution. Urine samples will be collected in the three on-site visits and urine cultures performed. If positive, antibiograms for the three antibiotics studied will be performed. Bacterial eradication will be measured at days 14 and 28.

Ethics and dissemination

The study was approved by the Ethical Board of IDIAP Jordi Gol (reference number: 21/173-AC) and Spanish Agency of Medicines and Medical Devices. The findings of this trial will be disseminated through research conferences and peer-review journals.

Trial registration number

NCT04959331; EudraCT Number: 2021-001332-26.

Time schedule

January 2022 to April 2023.
Interventions to reduce the incidence of surgical site infection in colorectal resections: systematic review with multicomponent network meta-analysis (INTRISSI): study protocol
Authors: Friedrichs Juliane , Seide Svenja , Vey Johannes , Zimmermann Samuel , Hardt Julia , Kleeff Jorg , Klose Johannes , Michalski Christoph W , Kieser Meinhard , Pilz Maximilian , Ronellenfitsch Ulrich
Published: November 2021

Objective

To assess the relative contribution of intravenous antibiotic prophylaxis, mechanical bowel preparation, oral antibiotic prophylaxis, and combinations thereof towards the reduction of surgical site infection (SSI) incidence in elective colorectal resections.

Methods and analysis

A systematic search of randomised controlled trials comparing interventions to reduce SSI incidence will be conducted with predefined search terms in the following databases: MEDLINE, LILACS, Cochrane Central Register of Controlled Trials (CENTRAL) and the Cochrane Database of Systematic Reviews (CDSR). Additionally, several online databases will be searched for ongoing trials, and conference proceedings and reference lists of retrieved articles will be hand searched. The title–abstract screening will be partly performed by means of a semiautomated supervised machine learning approach, which will be trained on a subset of the identified titles and abstracts identified through traditional screening methods.

The primary analysis will be a multicomponent network meta-analysis, as we expect to identify studies that investigate combinations of interventions (eg, mechanical bowel preparation combined with oral antibiotics) as well as studies that focus on individual components (mechanical bowel preparation or oral antibiotics). By means of a multicomponent network meta-analysis, we aim at estimating the effects of the separate components along the effects of the observed combinations. To account for between-trial heterogeneity, a random-effect approach will be combined with inverse variance weighting for estimation of the treatment effects. Associated 95% CIs will be calculated as well as the ranking for each component in the network using P scores. Results will be visualised by network graphics and forest plots of the overall pairwise effect estimates. Comparison-adjusted funnel plots will be used to assess publication bias.

Ethics and dissemination

Ethical approval by the Ethical Committee of the Medical Faculty of the Martin-Luther-University Halle-Wittenberg (ID of approval: 2021–148). Results shall be disseminated directly to decision-makers (eg, surgeons, gastroenterologists, wound care specialists) by means of publication in peer-reviewed journals, presentation at conferences and through the media (eg, radio, TV, etc).

PROSPERO registration number

CRD42021267322.
International variation in oesophageal and gastric cancer survival 2012–2014: differences by histological subtype and stage at diagnosis (an ICBP SURVMARK-2 population-based study)
Authors: Arnold Melina , Morgan Eileen , Bardot Aude , Rutherford Mark J , Ferlay Jacques , Little Alana , Møller Bjorn , Bucher Oliver , De Prithwish , Woods Ryan R , Saint-Jacques Nathalie , Gavin Anna T , Engholm Gerda , Achiam Michael P , Porter Geoff , Walsh Paul M , Vernon Sally , Kozie Serena , Ramanakumar Agnihotram V , Lynch Charlotte , Harrison Samantha , Merrett Neil , O’Connell Dianne L , Mala Tom , Elwood Mark , Zalcberg John , Huws Dyfed W , Ransom David , Bray Freddie , Soerjomataram Isabelle
Published: November 2021

Objective

To provide the first international comparison of oesophageal and gastric cancer survival by stage at diagnosis and histological subtype across high-income countries with similar access to healthcare.

Methods

As part of the ICBP SURVMARK-2 project, data from 28 923 patients with oesophageal cancer and 25 946 patients with gastric cancer diagnosed during 2012–2014 from 14 cancer registries in seven countries (Australia, Canada, Denmark, Ireland, New Zealand, Norway and the UK) were included. 1-year and 3-year age-standardised net survival were estimated by stage at diagnosis, histological subtype (oesophageal adenocarcinoma (OAC) and oesophageal squamous cell carcinoma (OSCC)) and country.

Results

Oesophageal cancer survival was highest in Ireland and lowest in Canada at 1 (50.3% vs 41.3%, respectively) and 3 years (27.0% vs 19.2%) postdiagnosis. Survival from gastric cancer was highest in Australia and lowest in the UK, for both 1-year (55.2% vs 44.8%, respectively) and 3-year survival (33.7% vs 22.3%). Most patients with oesophageal and gastric cancer had regional or distant disease, with proportions ranging between 56% and 90% across countries. Stage-specific analyses showed that variation between countries was greatest for localised disease, where survival ranged between 66.6% in Australia and 83.2% in the UK for oesophageal cancer and between 75.5% in Australia and 94.3% in New Zealand for gastric cancer at 1-year postdiagnosis. While survival for OAC was generally higher than that for OSCC, disparities across countries were similar for both histological subtypes.

Conclusion

Survival from oesophageal and gastric cancer varies across high-income countries including within stage groups, particularly for localised disease. Disparities can partly be explained by earlier diagnosis resulting in more favourable stage distributions, and distributions of histological subtypes of oesophageal cancer across countries. Yet, differences in treatment, and also in cancer registration practice and the use of different staging methods and systems, across countries may have impacted the comparisons. While primary prevention remains key, advancements in early detection research are promising and will likely allow for additional risk stratification and survival improvements in the future.
Functional (psychogenic non-epileptic/dissociative) seizures: why and how?
Authors: Ertan Deniz , Aybek Selma , LaFrance, Jr. W Curt , Kanemoto Kousuke , Tarrada Alexis , Maillard Louis , El-Hage Wissam , Hingray Coraline
Published: November 2021

Functional seizures (FS) known also as psychogenic non-epileptic seizures or dissociative seizures, present with ictal semiological manifestations, along with various comorbid neurological and psychological disorders. Terminology inconsistencies and discrepancies in nomenclatures of FS may reflect limitations in understanding the neuropsychiatric intricacies of this disorder. Psychological and neurobiological processes of FS are incompletely understood. Nevertheless, important advances have been made on underlying neuropsychopathophysiological mechanisms of FS. These advances provide valuable information about the underlying mechanisms of mind–body interactions. From this perspective, this narrative review summarises recent studies about aetiopathogenesis of FS at two levels: possible risk factors (why) and different aetiopathogenic models of FS (how). We divided possible risk factors for FS into three categories, namely neurobiological, psychological and cognitive risk factors. We also presented different models of FS based on psychological and neuroanatomical understanding, multilevel models and integrative understanding of FS. This work should help professionals to better understand current views on the multifactorial mechanisms involved in the development of FS. Shedding light on the different FS profiles in terms of aetiopathogenesis will help guide how best to direct therapy, based on these different underlying mechanisms.
Implementation of an early rule-out pathway for myocardial infarction using a high-sensitivity cardiac troponin T assay
Authors: Sandeman Dennis , Syed Maaz B J , Kimenai Dorien M , Lee Kuan Ken , Anand Atul , Joshi Shruti S , Dinnel Lorraine , Wenham Philip R , Campbell Ken , Jarvie Mary , Galloway Donna , Anderson Mhairi , Roy Bappa , Andrews Jack P M , Strachan Fiona E , Ferry Amy V , Chapman Andrew R , Elsby Sarah , Francis Mark , Cargill Robert , Shah Anoop S V , Mills Nicholas L
Published: November 2021

Objectives

Patients with suspected acute coronary syndrome and high-sensitivity cardiac troponin (hs-cTn) concentrations below the limit of detection at presentation are low risk. We aim to determine whether implementing this approach facilitates the safe early discharge of patients.

Methods

In a prospective single-centre cohort study, consecutive patients with suspected acute coronary syndrome were included before (standard care) and after (intervention) implementation of an early rule-out pathway. During standard care, myocardial infarction was ruled out if hs-cTnT concentrations were <99th centile (14 ng/L) at presentation and at 6–12 hours after symptom onset. In the intervention, patients were ruled out if hs-cTnT concentrations were <5 ng/L at presentation and symptoms present for ≥3 hours or were ≥5 ng/L and unchanged within the reference range at 3 hours. We compared duration of stay (efficacy) and all-cause death at 1 year (safety) before and after implementation.

Results

We included 10 315 consecutive patients (64±16 years, 46% women) with 6642 (64%) and 3673 (36%) in the standard care and intervention groups, respectively. Duration of stay was reduced from 534 (IQR, 220–2279) to 390 (IQR, 218–1910) min (p<0.001) after implementation. At 1 year, all-cause death occurred in 10.9% (721 of 6642) and 10.4% (381 of 3673) of patients in the standard care group (referent) and intervention group, respectively (adjusted OR 1.02, 95% CI 0.88 to 1.18).

Conclusion

In patients with suspected acute coronary syndrome, implementing an early rule-out pathway using hs-cTnT concentrations <5 ng/L at presentation reduced the duration of stay in hospital without compromising safety.
Variational theory of the Ricci curvature tensor dynamics
Authors: Cremaschini Claudio , Kovář Jiří , Stuchlík Zdeněk , Tessarotto Massimo
Published: November 2021

In this letter a new Lagrangian variational principle is proved to hold for the Einstein field equations, in which the independent variational tensor field is identified with the Ricci curvature tensor $$R^{\mu \nu }$$

R

μ
ν

rather than the metric tensor $$g_{\mu \nu }$$

g

μ
ν

. The corresponding Lagrangian function, denoted as $$L_{R}$$

L
R

, is realized by a polynomial expression of the Ricci 4-scalar $$R\equiv g_{\mu \nu }R^{\mu \nu }$$

R
≡

g

μ
ν

R

μ
ν

and of the quadratic curvature 4-scalar $$\rho \equiv R^{\mu \nu }R_{\mu \nu }$$

ρ
≡

R

μ
ν

R

μ
ν

. The Lagrangian variational principle applies both to vacuum and non-vacuum cases and for its validity it demands a non-vanishing, and actually also positive, cosmological constant $$\Lambda >0$$

Λ
>
0

. Then, by implementing the deDonder–Weyl formalism, the physical conditions for the existence of a manifestly-covariant Hamiltonian structure associated with such a Lagrangian formulation are investigated. As a consequence, it is proved that the Ricci tensor can obey a Hamiltonian dynamics which is consistent with the solutions predicted by the Einstein field equations.
Wormhole geometries in f(Q) gravity and the energy conditions
Authors: Banerjee Ayan , Pradhan Anirudh , Tangphati Takol , Rahaman Farook
Published: November 2021

Following the recent theory of f(Q) gravity, we continue to investigate the possible existence of wormhole geometries, where Q is the non-metricity scalar. Recently, the non-metricity scalar and the corresponding field equations have been studied for some spherically symmetric configurations in Mustafa (Phys Lett B 821:136612, 2021) and Lin and Zhai (Phys Rev D 103:124001, 2021). One can note that field equations are different in these two studies. Following Lin and Zhai (2021), we systematically study the field equations for wormhole solutions and found the violation of null energy conditions in the throat neighborhood. More specifically, considering specific choices for the f(Q) form and for constant redshift with different shape functions, we present a class of solutions for static and spherically symmetric wormholes. Our survey indicates that wormhole solutions could not exist for specific form function $$f(Q)= Q+ \alpha Q^2$$

f

(
Q
)

=
Q
+
α

Q
2

. To summarize, exact wormhole models can be constructed with violation of the null energy condition throughout the spacetime while being $$\rho \ge 0$$

ρ
≥
0

and vice versa.
Linearized von Kármán theory for incompressible magnetoelastic plates
Authors: Bresciani Marco
Published: November 2021

We study the asymptotic behavior, in the sense of [Formula: see text]-convergence, of a thin incompressible magnetoelastic plate, as its thickness goes to zero. We focus on the linearized von Kármán regime. The model features a mixed Eulerian–Lagrangian formulation, as magnetizations are defined on the deformed configuration.
Uncertainty principles for the windowed offset linear canonical transform
Authors: Gao Wen-Biao , Li Bing-Zhao
Published: November 2021

The windowed offset linear canonical transform (WOLCT) can be identified as a generalization of the windowed linear canonical transform (WLCT). In this paper, we generalize several different uncertainty principles for the WOLCT, including Heisenberg uncertainty principle, Hardy’s uncertainty principle, Donoho–Stark’s uncertainty principle and Nazarov’s uncertainty principle. Finally, as application analogues of the Poisson summation formula and sampling formulas are given.
Kinetic Monte Carlo Simulations of Electrochemical Oxidation and Reduction of Pt(111)
Authors: Erlebacher J. , Kubal J. , Zeng Z. , Greeley J. , Struk K. , Steinbach A. J.
Published: November 2021

Kinetic Monte Carlo simulations of electrochemical oxidation and reduction are presented that match many features of the experimentally observed electrochemical and morphological response of Pt(111). Included in the simulation are all relevant microscopic transitions, including the formation of Pt-OH and Pt-O from Pt, surface diffusion of all three species, as well as an effective place exchange diffusion at high potential. A detailed description of this approach to modeling such a complex surface is also presented. Overall, it is found that many features of the Pt(111) CV, including hydroxylation, hysteresis, and surface roughening, can be correlated to events associated with n-coordinated surface species, such as the hydroxylation wave corresponding to a one-electron oxidation of 9-coordinated terrace sites. Oxidation to Pt-O species at potentials above 1.0 V are shown to correlate to the presence of growing surface roughness, and the simulations suggest the onset of Pt-O formation in steady-state cyclic voltammetry is dominated by the oxidation of 8-coordinated step edges rather than terrace sites. Implications for the stability of Pt(111) catalysts after thousands of voltammetric cycles are discussed.
In Vitro Activity of Various Sulbactam Compounds and Piperacillin/Tazobactam against Clinical Isolates of Different Gram-Negative Bacteria
Authors: Xiao Shunian , Zhuo Chuyue , Zhuo Chao
Published: November 2021

To provide direction for clinical application and pharmaceutical exploitation, the in vitro activity of sulbactam compounds and PIP/TAZ 8 : 1 against clinical isolates of Gram-negative bacteria (GNB,

n
=
976

) was evaluated according to Clinical and Laboratory Standards Institute (CLSI) 2019. By minimal inhibitory concentrations (MICs), the resistance rate of all GNB to AMP/SBT 2 : 1 (56.9-100%) was significantly higher than other drugs, except the resistance rate of Acinetobacter baumannii (Aba,

n
=
204

) to piperacillin/tazobactam (PIP/TAZ 8 : 1, 78.4%) which was close to it (76.5%). Additionally, the resistance rate of Aba to other compounds except AMP/SBT 2 : 1 differed greatly, but that of Klebsiella pneumonia (Kpn,

n
=
205

) varied rarely. In addition, Escherichia coli (Eco,

n
=
204

) and Kpn demonstrated low and high resistance rates, respectively. Compared with cefoperazone/sulbactam (CPZ/SBT 2 : 1), PIP/TAZ 8 : 1 had advantage in anti-Eco (

RR
=
0.5

and

OR
=
2.17

) and anti-Kpn activity (

RR
=
0.88

and

OR
=
1.27

), while its activity against Pseudomonas aeruginosa (Pae:

n
=
194

,

RR
=
0.91

, and

OR
=
1.12

), Aba (

RR
=
1.31

and

OR
=
0.41

), and other Enterobacteriaceae (other Ebc:

n
=
169

,

RR
=
1.40

, and

OR
=
0.62

) was not better than CPZ/SBT 2 : 1. Although it had advantage against Eco (

RR
=
0.60

and

OR
=
1.78

), Pae (

RR
=
0.67

and

OR
=
1.63

), and Aba (

RR
=
0.70

and

OR
=
2.05

), the inhibition effect of piperacillin/sulbactam (PIP/SBT 2 : 1) against Kpn (

RR
=
0.94

and

OR
=
1.12

) and other Ebc was just similar with CPZ/SBT 2 : 1 (

RR
=
0.93

and

OR
=
1.10

). Furthermore, the anti-Eco (

RR
=
0.70

and

OR
=
1.50

), anti-Kpn (

RR
=
0.89

and

OR
=
1.24

), and anti-Pae (

RR
=
0.74

and

OR
=
1.46

) activities of ceftazidime/sulbactam (CAZ/SBT 1 : 1) had a weak advantage, while its activity against Aba (

RR
=
0.94

and

OR
=
1.15

) and other Ebc (

RR
=
0.79

and

OR
=
1.36

) was just close to CPZ/SBT 2 : 1. Moreover, the inhibitory effect of PIP/SBT 1 : 1 against all tested clinical species was more active than CPZ/SBT 2 : 1, while that of CAZ/SBT 2 : 1 against all species of bacteria analyzed was weaker than the controls.