bluuebunny/crossref_metadata_2025 huggingface dataset:
Heavy metal removal applications using adsorptive membranes
Authors: Vo Thi Sinh , Hossain Muhammad Mohsin , Jeong Hyung Mo , Kim Kyunghoon
Published: November 2020

Water is a significant natural resource for humans. As such, wastewater containing heavy metals is seen as a grave problem for the environment. Currently, adsorption is one of the common methods used for both water purification and wastewater treatment. Adsorption relies on the physical and chemical interactions between heavy metal ions and adsorbents. Adsorptive membranes (AMs) have demonstrated high effectiveness in heavy metal removal from wastewater owing to their exclusive structural properties. This article examines the applications of adsorptive membranes such as polymeric membranes (PMs), polymer-ceramic membranes (PCMs), electrospinning nanofiber membranes (ENMs), and nano-enhanced membranes (NEMs), which demonstrate high selectivity and adsorption capacity for heavy metal ions, as well as both advantages and disadvantages of each one all, are summarized and compared shortly. Moreover, the general theories for both adsorption isotherms and adsorption kinetics are described briefly to comprehend the adsorption process. This work will be valuable to readers in understanding the current applications of various AMs and their mechanisms in heavy metal ion adsorption, as well as the recycling methods in heavy ions desorption process are summarized and described clearly. Besides, the influences of morphological and chemical structures of AMs are presented and described in detail as well.
Intermediate weight changes and follow-up of dietetic treatment in primary health care: an observational study
Authors: Verberne Lisa D. M. , Leemrijse Chantal J. , Nielen Markus M. J. , Friele Roland D.
Published: November 2020

Background

Primary health care data have shown that most patients who were treated for overweight or obesity by a dietitian did not accomplish the recommended treatment period. It is hypothesised that a slow rate of weight loss might discourage patients from continuing dietetic treatment. This study evaluated intermediate weight changes during regular dietetic treatment in Dutch primary health care, and examined whether weight losses at previous consultations were associated with attendance at follow-up consultations.

Methods

This observational study was based on real life practice data of overweight and obese patients during the period 2013–2017, derived from Dutch dietetic practices that participated in the Nivel Primary Care Database. Multilevel regression analyses were conducted to estimate the mean changes in body mass index (BMI) during six consecutive consultations and to calculate odds ratios for the association of weight change at previous consultations with attendance at follow-up consultations.

Results

The total study population consisted of 25,588 overweight or obese patients, with a mean initial BMI of 32.7 kg/m2. The BMI decreased between consecutive consultations, with the highest weight losses between the first and second consultation. After six consultations, a mean weight loss of − 1.5 kg/m2was estimated. Patients who lost weight between the two previous consultations were more likely to attend the next consultation than patients who did not lose weight or gained weight.

Conclusions

Body mass index decreased during consecutive consultations, and intermediate weight losses were associated with a higher attendance at follow-up consultations during dietetic treatment in overweight patients. Dietitians should therefore focus on discussing intermediate weight loss expectations with their patients.
Results from a pre-post, uncontrolled pilot study of a mindfulness-based program for early elementary school teachers
Authors: Braun Summer S. , Roeser Robert W. , Mashburn Andrew J.
Published: November 2020

Background

Mindfulness-based programs are a novel and promising approach for supporting teachers’ occupational health and well-being. Although rationales for mindfulness programs for teachers have been offered, the empirical research base evaluating approaches for educating teachers in mindfulness is still developing. This study reports the findings of a pilot study of a mindfulness-based program. This study is unique in that it is one of the only studies of the Mindfulness-Based Emotional Balance (MBEB) program to focus on early elementary teachers, to be implemented by a new instructor, and to recruit teachers via extrinsic motivators.

Methods

A pre-post, uncontrolled pilot study of a 27.5-h mindfulness-based program for teachers was conducted with 21 pre-kindergarten–third-grade teachers from the Pacific Northwest of the USA. Program acceptability was assessed based on attendance and teacher reports of program benefits. Effect sizes for within-person changes (from pre- to post-program) in teachers’ skills and mindsets, well-being, occupational health, and teaching practices were calculated. Teachers also suggested improvements to the program.

Results

With regard to program attendance and acceptability, teachers attended 87% of sessions, with 58% of teachers reporting a personal benefit and 58% of teachers reporting a professional benefit of the program. Effect sizes for changes in teachers’ skills and mindsets ranged from small to large, |d| = 0.30 to 0.83, and ranged from small to medium for changes in teachers’ well-being |d| = 0.07 to 0.48, occupational health |d| = 0.14 to 0.39, and teaching practices |d| = 0.15 to 0.48. Teachers suggested shortening the program and linking it more closely to their work in the classroom.

Conclusions

This study suggests that the MBEB program may be beneficial to early elementary teachers, even when implemented by someone other than the program developer, and when provided with extrinsic motivation to participate (more closely mapping to a larger-scale trial of the program). Teachers’ suggestions regarding program length and structure are considered, along with useful avenues for future research on mindfulness-based programs for teachers.
Mantodea oasis of Palaearctic region: biogeographical analysis of Mantodea in Egypt
Authors: Okely M. , Nasser M. , Enan R. , GadAllah S. , AlAshaal S.
Published: November 2020

Background

Egypt forms a home for the highest number of recorded Mantodea species of the Palaearctic Region. The status and ecology of such diversity are far from being completely understood.

Main body

Through this study, the similarity of Mantodea species composition among Egyptian ecological zones has been examined by using the Sørensen-Dice coefficient, beside the calculation of species richness for each zone. Also, maximum entropy (Maxent) modeling was used to estimate the potential distribution of Mantodea species throughout the country. Three topographical and 19 bioclimatic variables have been used to estimate the current status of all Mantodea species in Egypt. The collected materials of adult mantis have been used to analyze the seasonality of 14 Egyptian common genera. Our results indicated that there was a high faunal similarity between the Western and Eastern deserts, the coastal strip, and the lower Nile valley. The lowest similarity was between Gebel Elba and all other zones. The analysis of habitat suitability of Mantodea in Egypt was fragmentary and focused on different distinct ecological zones. Altitude was the most effective ecological factor that affected Mantodea distribution as a group. Analysis of seasonality data of the common genera of Mantodea indicated that all are found in summer except for Miomantis, Severinia, and Sinaiella.

Conclusion

Our results can be used as a basis for future studies of the ecology of certain species and conservation of this interesting group in Egypt.
Sphingomonadaceae: Protective against breast cancer?
Authors: Lawani-Luwaji Ebidor Ufoumanefe , Alade Tolulope
Published: November 2020

Background

Breast cancer is the most common malignancy and one of the leading causes of cancer-linked deaths in women. The development of the mammary gland is regulated by oestrogen whose activities have also been linked with various diseases including breast cancer. Research has shown that host–microbiota relationship plays a role in human health and disease, so we investigated the association between breast microbiota and breast cancer. A search of the literature was conducted using search tools such as Google Scholar, PubMed, EBSCO and Cochrane library with the terms breast cancer, breast microbiota, microbiome and dysbiosis. A further search included Sphingomonas, Sphingobium yanoikuyae and oestrogen. The search terms were combined in original forms to get relevant studies related to the subject under review. All articles written in English were included and publication dates were not limited.

Conclusion

Taken together, the studies show that Sphingobium yanoikuyae might have a protective role in breast cancer, especially oestrogen positive, and highlights the need for further investigation into the use of the bacteria for prevention and possibly management of breast cancer.
Correction to: Revealing historical fire regimes of the Cumberland Plateau, USA, through remnant fire-scarred shortleaf pines (Pinus echinata Mill.)
Authors: Stambaugh Michael C. , Marschall Joseph M. , Abadir Erin R.
Published: November 2020

An amendment to this paper has been published and can be accessed via the original article.
Parasite-host ecology: the limited impacts of an intimate enemy on host microbiomes
Authors: Clements Cody S. , Burns Andrew S. , Stewart Frank J. , Hay Mark E.
Published: November 2020

Background

Impacts of biotic stressors, such as consumers, on coral microbiomes have gained attention as corals decline worldwide. Corallivore feeding can alter coral microbiomes in ways that contribute to dysbiosis, but feeding strategies are diverse – complicating generalizations about the nature of consumer impacts on coral microbiomes.

Results

In field experiments, feeding by Coralliophila violacea, a parasitic snail that suppresses coral growth, altered the microbiome of its host, Porites cylindrica, but these impacts were spatially constrained. Alterations in microbial community composition and variability were largely restricted to snail feeding scars; basal or distal areas ~ 1.5 cm or 6–8 cm away, respectively, were largely unaltered. Feeding scars were enriched in taxa common to stressed corals (e.g. Flavobacteriaceae, Rhodobacteraceae) and depauperate in putative beneficial symbionts (e.g. Endozoicomonadaceae) compared to locations that lacked feeding.

Conclusions

Previous studies that assessed consumer impacts on coral microbiomes suggested that feeding disrupts microbial communities, potentially leading to dysbiosis, but those studies involved mobile corallivores that move across and among numerous individual hosts. Sedentary parasites like C. violacea that spend long intervals with individual hosts and are dependent on hosts for food and shelter may minimize damage to host microbiomes to assure continued host health and thus exploitation. More mobile consumers that forage across numerous hosts should not experience these constraints. Thus, stability or disruption of microbiomes on attacked corals may vary based on the foraging strategy of coral consumers.
Doppler ultrasound for prediction of IUCD-induced heavy menstrual bleeding: a prospective cohort study
Authors: Sweed Mohamed S. , Swidan Khaled H. , Ibrahim Naira S. , NasrElDin Eman A. , Gomaa Ihab A.
Published: November 2020

Background

Previous studies reported changes in the local vasoactive substance production within the endometrium with a subsequent increase in vascularity as a possible mechanism of intrauterine contraceptive device (IUCD)-induced heavy menstrual bleeding. This research investigates the role of power Doppler velocimetries of the uterine arteries, endometrium, and sub-endometrium vascularization as a predictor of IUCD-induced heavy menstrual bleeding.

Results

Endometrium flow index (FI) and vascularization flow index (VFI) significantly increased in both groups: women with heavy menstrual bleeding (group A) and women without heavy menstrual bleeding (group B), with significantly higher increase in group A. Endometrium VFI ≥ 0.18 had the highest significant diagnostic characteristics in the prediction of heavy menstrual bleeding, followed by sub-endometrium VI ≥ 3.75.

Conclusion

The results of this study suggest an increase in uterine blood flow in women with IUCD-induced menorrhagia. Endometrial and sub-endometrial Doppler vascular indices can be used for the prediction of IUCD-induced heavy menstrual bleeding.
Impact of the COVID-19 pandemic on maternal mental health
Authors: Rose Elizabeth , Manoharan Manonmani , Powell Jennifer
Published: November 2020

The ongoing impact on global mental health of the COVID-19 pandemic and the isolation measures used to combat its spread is increasingly acknowledged. This reflection focuses on the effect the pandemic has had specifically on the mental health of women in the peripartum period, using recent case examples from a busy and diverse south London community perinatal psychiatry service.
Phase III Trial of Avelumab Maintenance After First-Line Induction Chemotherapy Versus Continuation of Chemotherapy in Patients With Gastric Cancers: Results From JAVELIN Gastric 100
Authors: Moehler Markus , Dvorkin Mikhail , Boku Narikazu , Özgüroğlu Mustafa , Ryu Min-Hee , Muntean Alina S. , Lonardi Sara , Nechaeva Marina , Bragagnoli Arinilda C. , Coşkun Hasan S. , Cubillo Gracian Antonio , Takano Toshimi , Wong Rachel , Safran Howard , Vaccaro Gina M. , Wainberg Zev A. , Silver Matthew R. , Xiong Huiling , Hong Janet , Taieb Julien , Bang Yung-Jue
Published: November 2020

PURPOSE

The role of maintenance therapy for gastric (GC) or gastroesophageal junction cancer (GEJC) is unclear. We investigated avelumab (anti–programmed death ligand-1 [PD-L1]) maintenance after first-line induction chemotherapy for GC/GEJC.

PATIENTS AND METHODS

JAVELIN Gastric 100 was a global, open-label, phase III trial. Eligible patients had untreated, unresectable, human epidermal growth factor receptor 2–negative, locally advanced or metastatic GC or GEJC. Patients without progressive disease after 12 weeks of first-line chemotherapy with oxaliplatin plus a fluoropyrimidine were randomly assigned 1:1 to avelumab 10 mg/kg every 2 weeks or continued chemotherapy, stratified by region (Asia v non-Asia). The primary end point was overall survival (OS) after induction chemotherapy in all randomly assigned patients or the PD-L1–positive randomly assigned population (≥ 1% of tumor cells; 73-10 assay).

RESULTS

A total of 805 patients received induction; 499 were randomly assigned to avelumab (n = 249) or continued chemotherapy (n = 250). Median OS was 10.4 months (95% CI, 9.1 to 12.0 months) versus 10.9 months (95% CI, 9.6 to 12.4 months) and 24-month OS rate was 22.1% versus 15.5% with avelumab versus chemotherapy, respectively (hazard ratio [HR], 0.91; 95% CI, 0.74 to 1.11; P = .1779). In the PD-L1–positive population (n = 54), the HR for OS was 1.13 (95% CI, 0.57 to 2.23; P = .6352). In an exploratory analysis of the PD-L1–positive population, defined as combined positive score ≥ 1 (22C3 assay; n = 137), median OS was 14.9 months (95% CI, 8.7 to 17.3 months) with avelumab versus 11.6 months (95% CI, 8.4 to 12.6 months) with chemotherapy (unstratified HR, 0.72; 95% CI, 0.49 to 1.05). With avelumab and chemotherapy, treatment-related adverse events (TRAEs) occurred in 149 (61.3%) and 184 (77.3%) patients, including grade ≥ 3 TRAEs in 31 (12.8%) and 78 (32.8%) patients, respectively.

CONCLUSION

JAVELIN Gastric 100 did not demonstrate superior OS with avelumab maintenance versus continued chemotherapy in patients with advanced GC or GEJC overall or in a prespecified PD-L1–positive population.
Using Quality Improvement to Increase Access to Palliative Care
Authors: Lally Kate , Chua Isaac S. , Lin Nancy U. , Siegel Jocelyn , Bernacki Rachelle
Published: November 2020

PURPOSE:

As part of a larger effort to integrate palliative care into a cancer center, we identified barriers to palliative care referral for patients with breast or gynecologic cancer and developed a pilot program to improve access to palliative care services.

METHODS:

We developed a multidisciplinary steering committee to uncover barriers to palliative care referral and developed a pilot program, called the Warm Handoff. Through ongoing collaboration and midpilot feedback sessions, we identified several additional barriers and opportunities to increase access to palliative care.

RESULTS:

Clinicians used the initial Warm Handoff process only 20 times over a period of 7 months. Of those calls, 10 were for issues outside of those that the Warm Handoff pilot was intended to address. During the pilot, we identified lack of access to urgent visits and clinician telephone availability for clinical case discussion as additional barriers to access. Increased collaboration led to the creation of a clinical provider of the day (CPOD) care model, which allowed for a notable increase in the capacity to see urgent consults. After this intervention, we observed an average of 19 patients seen urgently per month. In addition, there was a trend toward increasing referrals from breast oncology after the initiation of the CPOD.

CONCLUSION:

A CPOD model, developed via close oncology/palliative care collaboration, resulted in increased utilization of palliative care services.
All You Need to Know About DPYD Genetic Testing for Patients Treated With Fluorouracil and Capecitabine: A Practitioner-Friendly Guide
Authors: Innocenti Federico , Mills Sarah C. , Sanoff Hanna , Ciccolini Joseph , Lenz Heinz-Josef , Milano Gerard
Published: November 2020

Fluoropyrimidines (fluorouracil, capecitabine, and other analogs) are highly used anticancer drugs worldwide. However, patients with cancer treated with these drugs might experience severe, life-threatening toxicity because of germline genetic variation in the DPYD gene. This is a genetic predisposition with an established mechanistic basis that links genetic variation in the DPYD gene to an increase in systemic drug exposure, resulting in an increased risk of toxicity. Pharmacology guidelines provide recommendations on avoiding treatment with fluoropyrimidines or reducing their dose in patients carrying DPYD genetic variants conferring an increased risk of toxicity. However, oncology societies in the United States do not recommend systematic testing. Instead, on April 30, 2020, the European Society for Medical Oncology issued a document recommending genetic testing. In this scenario of contradicting information, practicing oncologists struggle with reaching an informed decision on whether genetic testing should be applied before treatment. This is mostly due to uncertainty about the clinical relevance of genetic testing from the perspective of a practicing oncologist. To reach an informed decision, practicing oncologists need access to concise information on the genetic variants to be tested and a practitioner-friendly interpretation of the test results. We believe this information is currently lacking. To our knowledge, for the first time, we provide a single guide for health care professionals to make an evidence-based decision about DPYD testing for patients with cancer. This article provides the essential knowledge base for oncologists to have an informed discussion with their patients about the genetic testing for DPYD. This document assists practitioners in quickly evaluating whether, when, where, and how to order a DPYD genetic test.
Bone Metabolism in Adolescents Undergoing Bariatric Surgery
Authors: Misra Madhusmita , Bredella Miriam A
Published: November 2020

Purpose

The prevalence of childhood obesity has increased over past decades with a concomitant increase in metabolic and bariatric surgery (MBS). While MBS in adults is associated with bone loss, only a few studies have examined the effect of MBS on the growing skeleton in adolescents.

Methods

This mini-review summarizes available data on the effects of the most commonly performed MBS (sleeve gastrectomy and gastric bypass) on bone in adolescents. A literature review was performed using PubMed for English-language articles.

Results

Dual-energy x-ray absorptiometry (DXA) measures of areal bone mineral density (aBMD) and BMD Z scores decreased following all MBS. Volumetric BMD (vBMD) by quantitative computed tomography (QCT) decreased at the lumbar spine while cortical vBMD of the distal radius and tibia increased over a year following sleeve gastrectomy (total vBMD did not change). Reductions in narrow neck and intertrochanteric cross-sectional area and cortical thickness were observed over this duration, and hip strength estimates were deleteriously impacted. Marrow adipose tissue (MAT) of the lumbar spine increased while MAT of the peripheral skeleton decreased a year following sleeve gastrectomy. The amount of weight loss and reductions in lean and fat mass correlated with bone loss at all sites, and with changes in bone microarchitecture at peripheral sites.

Conclusion

MBS in adolescents is associated with aBMD reductions, and increases in MAT of the axial skeleton, while sleeve gastrectomy is associated with an increase in cortical vBMD and decrease in MAT of the peripheral skeleton. No reductions have been reported in peripheral strength estimates.
Male Fertility Before and After Androgen Abuse
Authors: Windfeld-Mathiasen Josefine , Dalhoff Kim Peder , Andersen Jon Trærup , Klemp Marc , Horwitz Anna , Horwitz Henrik
Published: November 2020

Purpose

Previous research has found that male users of androgens are diagnosed approximately twice as often with infertility. We therefore set out to investigate the fertility in men using androgens.

Methods

The study included 545 males who tested positive for androgens in an anti-doping test program in Danish fitness centers during the period from January 3, 2006, to March 1, 2018. The confirmed androgen users were matched by birth year with 5450 male controls. We followed this cohort from 10 years prior to testing positive until the end of follow-up in May 2018.

Results

During the 10-year period prior to testing positive, the group of androgen users experienced a 26% lower fertility rate than the controls (rate ratio [RR] 0.74; 95% CI, 0.60-0.90; P = 0.0028). However, in the years following the doping sanction, they made a significant catch-up, and at completed follow-up the total fertility rate was only 7% lower than expected (RR 0.93, 95% CI, 0.84-1.03). The prevalence of assisted reproduction was 5.69% in the group of androgen users and 5.28% in the control group (P = 0.69).

Conclusion

Androgen use was associated with a temporary decline in fertility and most androgen users achieved parenthood without any help from the health care system. Overall, the fertility rate and the prevalence of assisted reproduction among androgen users were close to those in the background population.
Jug Songs: Acoustic Enclosure from Ovid to Eliot
Authors: Dukes Hunter
Published: November 2020

Philomela holds a privileged place in Euro-American poetry. Tracking the nightingales in Ovid, Marie de France, Gascoigne, Shakespeare, Milton, Coleridge, and Elizabeth Barrett Browning reveals a new dimension of an old trope. Frequently paired with images of architectural and bodily containment, the nightingale’s song mediates between sound and space. This article builds on Michel Serres, Gilles Deleuze, and Félix Guattari, who use the bird to think about enclosure (sonic, spatial) and territorial possession. Nesting T. S. Eliot’s nightingales within a wider context clarifies other kinds of containment in “A Game of Chess” from The Waste Land, resolving some of the section’s enduring ambiguity concerning images of vacuity and the disembodied voice. Ultimately, this article contributes to debates in lyric studies, arguing for a reappraisal of the nightingale in comparative verse history.
Femicide and the Speaking State
Authors: Atuk Sumru
Published: November 2020

High rates of gender-based violence and sexist political rhetoric are central features of contemporary Turkey. This article explores the complex relationship between the two by drawing on the literature that investigates the (re)making of the category of “woman” in the Middle East and the scholarship on femicide/feminicide. The article employs critical discourse analysis of ruling politicians’ gender-normative statements and shows how they reconstruct the category of “proper woman” as one with institutional and social consequences that compromise women’s safety. Using John L. Austin’s theory of performative speech acts, the article develops a theory of the speaking state to explain the effects of political speech. Ultimately it argues that the politics of “woman making” is central to “the politics of woman killing.”
Iron Catalyzed C–C-Bond Formation: From Canonical Cross Coupling to a Quest for New Reactivity
Authors: Fürstner Alois
Published: November 2020

This Account summarizes our work in the area of organoiron chemistry during the last two decades, with special emphasis on iron catalyzed C-C-bond formation. Specifically, it is shown that iron catalysts can emulate reactivity more befitting noble metals in that they allow various cross coupling, cycloaddition and cycloisomerization reactions to be carried out with surprising ease. At the same time, this base metal opens opportunities for the discovery of genuinely new transformations.
Exfoliation Chemistry of Soft Layered Materials toward Tailored 2D Materials
Authors: Oaki Yuya
Published: November 2020

Exfoliation of layered materials provides nanosheets, such as monolayers and few-layers. In recent years, nanosheets have attracted much interest as two-dimensional (2D) materials for their diverse properties and applications originating from the anisotropic characteristic structures. Exfoliation methods have been developed depending on the types of interactions between the layers, such as van der Waals and electrostatic interactions. The present review focuses on exfoliation chemistry based on rigid and soft natures of the layered materials. The rigid inorganic layered compounds are converted to the soft layered materials with interaction of organic guests. The surface-functionalized nanosheets are obtained by exfoliation of the soft layered composites with dispersion in organic media. The exfoliation behavior is governed by the flexibility of the precursor layered materials, i.e. interaction between the interlayer guest and dispersion medium. Although exfoliation is generally an uncontrollable top-down process, materials informatics on our own experimental small data assists elucidation of the control factors toward tailored 2D materials. The exfoliation schemes are applied to a variety of layered materials. The present review shows potential new insights for exfoliation chemistry of soft layered materials.
Combined hamartoma of the retina and retinal pigment epithelium – MRI features of a rare paediatric intraocular tumour
Authors: Waelti Stephan , Fischer Tim , Sturm Veit , Heckmann Jan
Published: November 2020

Combined hamartoma of the retina and retinal pigment epithelium is a rare benign ocular tumour in children, composed of glial cells, vascular tissue, and sheets of pigmented epithelial cells. Although generally thought to be congenital, acquired cases are known to exist. It usually presents with reduced visual acuity and/or strabismus and it can be associated with several syndromes, including Neurofibromatosis Type 2. There is no consensus on the management of combined hamartoma of the retina and retinal pigment epithelium.

We present a case, including MRI features, of a 4,5-years-old girl with a combined hamartoma of the retina and retinal pigment epithelium.
Steps Ahead: optimising physical activity in adults with cystic fibrosis: Study Protocol for a pilot randomised trial using wearable technology, goal setting and text message feedback.
Authors: Curran Maire , Tierney Audrey C. , Collins Louise , Kennedy Lauren , McDonnell Ciara , Jurascheck Andrew J. , Sheikhi Ali , Walsh Cathal , Button Brenda , Galvin Rose , Casserly Brian , Cahalan Roisin
Published: November 2020

Background: Physical activity (PA) and exercise are widely documented as key components in the management of cystic fibrosis (CF). In recent years there have been significant improvements in telehealth, in particular; wearable technology,  smartphone use and remote monitoring, all of which may have potential to impact on PA in adults  with CF. The objective of this pilot randomised trial is to explore the effect of wearable technology, which is remotely monitored, combined with personalised text message feedback and goal setting, on PA in adults with CF. Secondary endpoints include lung function, aerobic capacity, quality of life, body composition, wellbeing and sleep.

Methods: This is a pilot randomised trial which will be conducted at the University Hospital Limerick, Ireland. Participants will be randomised to the intervention or active comparator after their baseline assessment. The 12-week intervention will consist of wearable technology (Fitbit Charge 2) which is linked to an online monitoring system (Fitabase) that enables the physiotherapist to remotely monitor participant data. The CF physiotherapist will set individualised PA goals with each participant at baseline and will send text message feedback each week. The text messages will be personalised, one-way texts with positive reinforcement on step count attained by the participant. The active comparator group will receive this wearable technology which is also linked to Fitabase; however, no feedback will be provided to participants in this group. Both groups will be re-assessed at 12 weeks. After this point, both groups will continue with the Fitbit alone for a further 12 weeks. Both groups will be re-assessed at 24 weeks. A semi structured interview will assess satisfaction and acceptability of the intervention.

Discussion: This is a novel concept which utilises modern technology, remote monitoring and personalised feedback to investigate the effect on PA  in adults with CF. 

Trial registration: ClinicalTrials.gov NCT03672058 (14/09/2018)
Implementing a National Approach to Research Ethics Review during a Pandemic – the Irish Experience
Authors: Sheehy Aileen , Ralph James Jennifer , Horgan Mary
Published: November 2020

The surge of coronavirus disease 2019 (COVID-19) research studies involving human participants in response to the pandemic has meant that research ethics committees across the world have been challenged to adapt their processes to meet demand while retaining high standards of review. Ethics review during this pandemic remains essential to ensure the safety, dignity and well-being of research participants, however research ethics committees are now faced with new, and often complex, ethics considerations and logistical challenges.

This Open Letter looks specifically at the Irish experience of establishing a national approach to research ethics review amidst a global pandemic. This represents Ireland’s first National Research Ethics Committee, which provided the research community with an expedited and ‘single national opinion’ for ethics review for COVID-related research. The insights gleaned and lessons learned from the Irish experience may inform emergency responses to future pandemics or public health emergencies.
Recent advances in the diagnosis and management of pre-eclampsia
Authors: Hurrell Alice , Duhig Kate , Vandermolen Brooke , Shennan Andrew
Published: November 2020

Pre-eclampsia is an elusive condition to diagnose and a complex disease to manage. There have been recent developments in prediction, prevention, diagnosis, and management. Risk modelling has been used to identify women at highest risk of developing pre-eclampsia as well as predicting maternal adverse outcomes in confirmed disease. New evidence has shown that aspirin prophylaxis significantly reduces early onset pre-eclampsia as well as preterm birth. The criteria for the diagnosis of pre-eclampsia are evolving, and proteinuria is no longer a pre-requisite to make a diagnosis. Angiogenic biomarker testing accelerates diagnosis as well as minimises adverse maternal outcomes and has been incorporated into national guidelines. Emerging evidence demonstrates that expedited delivery in late preterm pre-eclampsia may be protective against maternal adverse outcomes but increase the risk of neonatal unit admission. Both women and their offspring are at increased risk of long-term health complications following pre-eclampsia, and it is important that postnatal health is optimised. This article summarises recent developments in the field of pre-eclampsia research, evaluating the impact on clinical care for women at risk of, or with suspected or confirmed, pre-eclampsia.
Clinical complexity – where to find it and how to use it
Authors: Kobyłko Agnieszka , Rymaszewska Julia , Rymaszewska Joanna , Szcześniak Dorota
Published: November 2020

Kompleksowość kliniczna pacjenta oznacza wieloaspektowość problemów jednostki w podejściu biopsychospołecznym, w którym ocenia się, czy pacjent doświadcza trudności w sferze biologicznej, w życiu psychicznym, społecznym i w zakresie opieki zdrowotnej.
Skuteczna, całościowa ocena pacjenta podczas procesu leczenia ma kluczowe znaczenie dla efektywnej pracy publicznej ochrony zdrowia i zapewnia pacjentom indywidualną, holistyczną i kompleksową opiekę zdrowotną. Pacjenci, którzy nie zawsze są w stanie samodzielnie szukać pomocy, wymagają zapewnienia kompleksowej opieki, skutecznej diagnostyki we wczesnych stadiach choroby oraz pomocy w koordynacji i kontynuacji leczenia.
Kompleksowość kliniczna dotyczy pacjentów wielu dziedzin medycyny, ale przede wszystkim medycyny ratunkowej, chorób wewnętrznych, geriatrii, psychiatrii i podstawowej opieki zdrowotnej. Brak dostępu do kompleksowej opieki zdrowotnej z podejściem biopsychospołecznym ogranicza dobór najodpowiedniejszych opcji terapeutycznych, ich jakość oraz satysfakcję chorego. Istnieje kilka narzędzi do badań przesiewowych pod kątem kompleksowości klinicznej, takich jak: platforma INTERMED, INTERMED Self-Assessment, INTERMED dla osób starszych, INTERMED dla osób starszych Self-Assessment i Kwestionariusz prawdopodobieństwa ponownego przyjęcia (Probability of Repeated Admission). Co ważniejsze, istnieją również interwencje, które można wykorzystać do zarządzania kompleksową i skuteczną opieką nad pacjentem, takie jak: Zarządzenie przypadkiem (Case Management), Udostępnianie informacji (Information Sharing) oraz Samozarządzanie (Self-Management). Badania przesiewowe i interwencje razem mogą być bardzo efektywne w pomocy pacjentom, wymagającym kompleksowej opieki oraz w zapewnieniu dobrze zorganizowanej, wysokiej jakości opieki zdrowotnej z ukierunkowanym na pacjenta biopsychospołecznym podejściem.
An Improved Branch-and-Bound Algorithm for the One-Machine Scheduling Problem with Delayed Precedence Constraints
Authors: Zhang Wenda , Sauppe Jason J. , Jacobson Sheldon H.
Published: November 2020

In this paper, we discuss the one-machine scheduling problem with release and delivery times with the minimum makespan objective. Both heuristics and branch-and-bound algorithms have been formulated for the problem. One such branch-and-bound algorithm solves the problem and a variation that requires a delay between the completion of one job and the start of another (delayed precedence constraints). This paper analyzes key components of this branch-and-bound algorithm and proposes an improved heuristic to be used in conjunction with a different search strategy. Computational experiments demonstrate that the modifications lead to substantial improvements in running time and number of iterations on the one-machine problem instances both with and without delayed precedence constraints.
Language and meaning
Authors: Winter George
Published: November 2020

Combating barriers of language and meaning in practice has the potential to be damaging to a patient's wellbeing. George Winter examines how healthcare professionals can be better equipped to give evidence-based guidance
Oral nutritional supplement prescribing in primary care: a new dietitian-led medicines management team model of practice
Authors: Rose Emily , Avey Wenda , Begum Kulsuma , Brooks Nikki , Davies Gareth , Finall Sue , Guerrero Natalia , Lawrence Karl , Pietzsch Wipaporn , Porter-Jones Robert , Makuvise Louise , Morozinska Agnieska , Mcgrath Craig , Tyreman Linsey , Wallis Jade
Published: November 2020

Oral nutritional supplements may be prescribed for the management of disease-related malnutrition, but there is a large variety of nutritionally differing products available. ONS prescribing in primary care is an area of uncertainty for GPs and prescribing of ONS on the NHS in England and Wales in 2018/2019 was over £150000000. Clinically appropriate prescribing of oral nutritional supplements is supported by the use of validated malnutrition screening tools to assess the patient's risk of malnutrition. Local prescribing formularies promote the use of cost-effective oral nutritional supplements products in primary care which are often not available for use in secondary care. A new medicines management model of practice which uses pharmacy technicians, with clinical support from a dietitian, to address inappropriate oral nutritional supplements prescribing in primary care is described here. The model maximises the skills within the medicines management team and promotes a food first, aging-well approach to managing malnutrition in primary care.
Anticipatory Counseling About Miscarriage Management in Catholic Hospitals: A Qualitative Exploration of Women's Preferences
Authors: Wingo Erin E. , Wascher Jocelyn M. , Stulberg Debra B. , Freedman Lori R.
Published: November 2020

CONTEXT

Catholic hospitals represent a large and growing segment of U.S. health care. Because these facilities follow doctrines that restrict reproductive health services, including miscarriage management options when a fetal heartbeat is present, it is critical to understand whether and how women would want to learn about miscarriage treatment restrictions from providers.

METHODS

From May 2018 to January 2019, semistructured interviews were conducted with 31 women aged 21–44 who had had exposure to religious‐based health care; all were drawn from a nationally representative survey sample. Participants responded to a hypothetical scenario regarding the anticipatory disclosure of miscarriage management policy during routine prenatal care. Responses were inductively coded and thematically analyzed using modified grounded theory to understand women's attitudes and considerations related to receiving anticipatory miscarriage management information.

RESULTS

Respondents supported the routine disclosure of miscarriage management policies during prenatal care. Some expressed concern that this might increase patient anxiety during pregnancy, but most felt that the information would serve to prepare and empower patients, and likened the topic to other anticipatory health information provided during prenatal care. Identified themes related to how providers can disclose this information (including the need for a precautionary framing to reduce patient stress), sharing the rationale for institutional policy, and the importance of provider neutrality to ensure patient autonomy.

CONCLUSIONS

To respect patient autonomy, health care providers working in Catholic hospitals should routinely discuss institutional miscarriage management policies with patients, and anticipatory counseling should give patients the balanced information they need to decide where to go for care should pregnancy complications arise.
Deep learning approach to improve tangential resolution in photoacoustic tomography
Authors: Rajendran Praveenbalaji , Pramanik Manojit
Published: November 2020

In circular scan photoacoustic tomography (PAT), the axial resolution is spatially invariant and is limited by the bandwidth of the detector. However, the tangential resolution is spatially variant and is dependent on the aperture size of the detector. In particular, the tangential resolution improves with the decreasing aperture size. However, using a detector with a smaller aperture reduces the sensitivity of the transducer. Thus, large aperture size detectors are widely preferred in circular scan PAT imaging systems. Although several techniques have been proposed to improve the tangential resolution, they have inherent limitations such as high cost and the need for customized detectors. Herein, we propose a novel deep learning architecture to counter the spatially variant tangential resolution in circular scanning PAT imaging systems. We used a fully dense U-Net based convolutional neural network architecture along with 9 residual blocks to improve the tangential resolution of the PAT images. The network was trained on the simulated datasets and its performance was verified by experimental in vivo imaging. Results show that the proposed deep learning network improves the tangential resolution by eight folds, without compromising the structural similarity and quality of image.
Visceral to subcutaneous fat ratio as an indicator of a ≥30% eGFR decline in chronic kidney disease
Authors: Kataoka Hiroshi , Mochizuki Toshio , Iwadoh Kazuhiro , Ushio Yusuke , Kawachi Keiko , Watanabe Saki , Watanabe Kentaro , Akihisa Taro , Makabe Shiho , Manabe Shun , Sato Masayo , Iwasa Naomi , Yoshida Rie , Sawara Yukako , Hanafusa Norio , Tsuchiya Ken , Nitta Kosaku
Published: November 2020

Whether the visceral-to-subcutaneous fat ratio (V/S ratio) is associated with renal prognosis in patients with chronic kidney disease (CKD) remains unclear. Furthermore, little is known about the effect of sex and the absolute amount of visceral fat accumulation such as visceral fat area (VFA) ≥100 cm2on the V/S ratio in relation to renal prognosis. In this study, 200 patients with CKD were evaluated for renal prognosis. Survival analyses and logistic regression analyses were conducted, generating time-series pseudo-R2values. The mean and percent change of the pseudo-R2values from the 6thyear to the 10thyear (6Y–10Y Mean and 6Y–10Y Change, respectively) were calculated for determining the cut-off points for the medium-term renal prognosis. Multivariate Cox regression analysis revealed that the V/S ratio was significantly associated with renal outcomes and that the VFA category (VFA ≥ 100 cm2) had significant interactions with the V/S ratio regarding renal prognosis. The hazard ratio (HR) of the V/S ratio was higher in the sub-cohort of VFA<100 cm2than in the sub-cohort of VFA ≥ 100 cm2(HR: 6.42 vs. 1.00). Regarding sex differences, a strong association was noted between the V/S ratio and renal prognosis in women but not in men (HR: 2.40 vs. 1.10). On the other hand, 6Y–10Y Mean of the pseudo-R2values indicated differences in the cut-off points of the V/S ratio between men and women (V/S ratio: 0.75 vs. 0.5). Our findings indicate that it may be clinically meaningful to consider the differences in sex and the amount of VFA ≥100 cm2for the V/S ratio in relation to renal outcomes in patients with CKD. The 6Y–10Y Mean of the pseudo-R2values contributed to determining the cut-off points of the V/S ratio according to the sex difference.
A simple method to estimate flow restriction for dual ventilation of dissimilar patients: The BathRC model
Authors: Plummer Andrew R. , du Bois Jonathan L. , Flynn Joseph M. , Roesner Jens , Lee Siu Man , Magee Patrick , Thornton Malcolm , Padkin Andrew , Gill Harinderjit S.
Published: November 2020

Background

With large numbers of COVID-19 patients requiring mechanical ventilation and ventilators possibly being in short supply, in extremis two patients may have to share one ventilator. Careful matching of patient ventilation requirements is necessary. However, good matching is difficult to achieve as lung characteristics can have a wide range and may vary over time. Adding flow restriction to the flow path between ventilator and patient gives the opportunity to control the airway pressure and hence flow and volume individually for each patient. This study aimed to create and validate a simple model for calculating required flow restriction.

Methods and findings

We created a simple linear resistance-compliance model, termed the BathRC model, of the ventilator tubing system and lung allowing direct calculation of the relationships between pressures, volumes, and required flow restriction. Experimental measurements were made for parameter determination and validation using a clinical ventilator connected to two test lungs. For validation, differing amounts of restriction were introduced into the ventilator circuit. The BathRC model was able to predict tidal lung volumes with a mean error of 4% (min:1.2%, max:9.3%).

Conclusion

We present a simple model validated model that can be used to estimate required flow restriction for dual patient ventilation. The BathRC model is freely available; this tool is provided to demonstrate that flow restriction can be readily estimated.

Models and data are available at DOI 10.15125/BATH-00816.
Real-time drone derived thermal imagery outperforms traditional survey methods for an arboreal forest mammal
Authors: Witt Ryan R. , Beranek Chad T. , Howell Lachlan G. , Ryan Shelby A. , Clulow John , Jordan Neil R. , Denholm Bob , Roff Adam
Published: November 2020

Koalas (Phascolarctos cinereus) are cryptic and currently face regional extinction. The direct detection (physical sighting) of individuals is required to improve conservation management strategies. We provide a comparative assessment of three survey methods for the direct detection of koalas: systematic spotlighting (Spotlight), remotely piloted aircraft system thermal imaging (RPAS), and the refined diurnal radial search component of the spot assessment technique (SAT). Each survey method was repeated on the same morning with independent observers (03:00–12:00 hrs) for a total of 10 survey occasions at sites with fixed boundaries (28–76 ha) in Port Stephens (n = 6) and Gilead (n = 1) in New South Wales between May and July 2019. Koalas were directly detected on 22 occasions during 7 of 10 comparative surveys (Spotlight: n = 7; RPAS: n = 14; and SAT: n = 1), for a total of 12 unique individuals (Spotlight: n = 4; RPAS: n = 11; SAT: n = 1). In 3 of 10 comparative surveys no koalas were detected. Detection probability was 38.9 ± 20.03% for Spotlight, 83.3 ± 11.39% for RPAS and 4.2 ± 4.17% for SAT. Effective detectability per site was 1 ± 0.44 koalas per 6.75 ± 1.03 hrs for Spotlight (1 koala per 6.75 hrs), 2 ± 0.38 koalas per 4.35 ± 0.28 hrs for RPAS (1 koala per 2.18 hrs) and 0.14 ± 0.14 per 6.20 ± 0.93 hrs for SAT (1 koala per 43.39 hrs). RPAS thermal imaging technology appears to offer an efficient method to directly survey koalas comparative to Spotlight and SAT and has potential as a valuable conservation tool to inform on-ground management of declining koala populations.