bluuebunny/crossref_metadata_2025 huggingface dataset:
Erdheim-Chester disease: an unusual aetiology of bilateral lipomatous perinephric masses
Authors: Singh Rashmi , Naranje Priyanka , Ramateke Prashant , Damle Nishikant Avinash
Published: April 2021

A 53-year-old man presented with a history of progressive abdominal distention for 1 year. Physical examination revealed large palpable masses in the bilateral flank regions. Contrast-enhanced CT of the abdomen showed bilateral, symmetrical large perinephric masses with fat attenuating areas, which was further confirmed on MRI. CT of the paranasal sinuses revealed circumscribed extraconal soft tissue mass in the left orbit, causing scalloping and erosion of the left orbital roof. Fluorine-18 fluorodeoxyglucose (FDG) positron emission tomography/CT showed FDG uptake in the bilateral perinephric masses. Based on imaging appearance, a diagnosis of Erdheim-Chester disease (ECD) was suggested. Ultrasound-guided biopsy from perinephric masses revealed a sheet of histiocytes with sprinkled lymphocytes and plasma cells in the background. The histiocytes were immunopositive for CD68, S100 and immunonegative for CD1a, which confirmed the diagnosis of ECD. The patient was started on interferon-α-2a and showed symptomatic improvement.
Cardiovascular complications ofStreptococcus pneumoniaebacteraemia
Authors: de Leau Michelle M , Kuipers Remko S
Published: April 2021

The incidence ofStreptococcus pneumoniaebacteraemia has risen due to a worldwide increase in immunocompromised patients and antibiotic resistance. We describe three patients who experienced severe, including cardiovascular, complications of pneumococcal bacteraemia. Cardiovascular complications related to pneumococci may run a fulminant course. However, some of these life-threatening complications (eg, endocarditis and aortitis) may long remain unnoticed or be misdiagnosed and therefore delay correct treatment. We review the literature with regards to the incidence, diagnosis and treatment of these rare but possibly lethal and hence important cardiovascular complications.
Avoiding anchoring bias in unexplained chronic pain: an unexpected diagnosis of synovial osteochondromatosis
Authors: Murani Rehana , Manocha Ranita Harpreet Kaur
Published: April 2021

Unconscious biases may influence clinical decision making, leading to diagnostic error. Anchoring bias occurs when a physician relies too heavily on the initial data received. We present a 57-year-old man with a 3-year history of unexplained right thigh pain who was referred to a physiatry clinic for suggestions on managing presumed non-organic pain. The patient had previously been assessed by numerous specialists and had undergone several imaging investigations, with no identifiable cause for his pain. Physical examination was challenging and there were several ‘yellow flags’ on history. A thorough reconsideration of the possible diagnoses led to the discovery of hip synovial osteochondromatosis as the cause for his symptoms. Over-reliance on the referral information may have led to this diagnosis being missed. In patients with unexplained pain, it is important to be aware of anchoring bias in order to avoid missing rare diagnoses.
Response of factor X deficiency to darutumumab in the treatment of AL amyloidosis: a novel finding
Authors: Mar Ethan , Taylor Kerry , Mollee Peter
Published: April 2021

We report a case of progressive light-chain amyloidosis (otherwise known as AL amyloidosis) with acquired factor X (aFX) deficiency with a complete haematological response and rapid normalisation of FX levels following daratumumab monotherapy. To our knowledge, this is the first case report documenting successful treatment with daratumumab of aFX deficiency secondary to AL amyloidosis. The patient responded well to this therapy, with excellent symptomatic and quality of life improvements as well as a reduction in bleeding manifestations. This case highlights the value in considering daratumumab treatment when AL amyloidosis is complicated by FX deficiency.
Acute kidney injury and nephrotic syndrome associated with eltrombopag therapy in chronic idiopathic thrombocytopenic purpura
Authors: Ghosh Suchi Anindita , Patrick Jean , Maw Kyaw Zin
Published: April 2021

A 77-year-old man was admitted with severe acute kidney injury and nephrotic syndrome. He was started on eltrombopag for chronic idiopathic thrombocytopenic purpura 6 weeks earlier. An ultrasound of the kidneys was normal and an auto-antibody screen was negative. The use of the Naranjo adverse drug reaction probability scale indicated a probable relationship (score of 5) between the patient’s development of acute renal failure and eltrombopag therapy. Literature review identified only one other case of nephrotic syndrome and acute kidney injury associated with eltrombopag therapy in which a kidney biopsy revealed focal segmental glomerulosclerosis. Due to the challenges faced during the prevailing SARS-CoV-2 pandemic and persistent low platelet counts a renal biopsy was not undertaken. On stopping eltrombopag, the patients renal function stabilised and he successfully went into remission following treatment with high dose corticosteroids and diuretics. This report of a serious case of reversible renal failure and nephrotic syndrome after treatment with eltrombopag may serve to inform clinicians about the possible severe renal adverse effects of eltrombopag before its commencement for future use.
Serrating through vascular access catheters: a great masquerader with severe systemic manifestations
Authors: Deliwala Smit Sunil , Hussain Murtaza , Ponnapalli Anoosha , Awuah Dominic , McDonald Philip , Bachuwa Ghassan
Published: April 2021

Serratia marcescens, time and again, has demonstrated its ability to easily adhere and infect vascular access catheters, making them a bona fide source of hospital outbreaks and contributing to adverse patient outcomes. We present a unique case of a severe recurrentSerratiainfection, leading to persistent bacteria in the blood, haematogenous dissemination and subsequent development of abscesses, to a degree not reported in the literature before. These infections are exceedingly challenging to eradicate, owing to multiple virulence mechanisms and the deep seeding ability of this microorganism.Serratiainfections require a multifaceted approach with intricacies in identification, therapeutics and surveillance, all of which are sparsely reported in the literature and reviewed in this report.
Usefulness of dynamic stabilisation with mobile percutaneous pedicle screw for thoracic vertebral fractures in diffuse idiopathic skeletal hyperostosis
Authors: Eguchi Yawara , Suzuki Munetaka , Orita Sumihisa , Ohtori Seiji
Published: April 2021

We report a case of vertebral fracture with diffuse idiopathic skeletal hyperostosis (DISH) who underwent posterior dynamic stabilisation using mobile percutaneous pedicle screws (PPS) with 1 above-1 below and obtained good bone fusion. A 76-year-old man experienced severe low back pain after he fell backward 1 m off a stepladder during work. A 12th thoracic vertebral fracture with DISH was observed. As the fractured part was unstable due to a three-column injury, and the conservative treatment of resting was not successful, posterior dynamic stabilisation with a mobile PPS between T11–L1 was performed the 38th day after injury. Immediately after surgery, a fracture gap was observed, but 5 months later, vertebral body height was shortened by about 4 mm, and good bone fusion was observed without loosening of the screw. The mobile PPS flexibly adapts to spinal plasticity and may be useful for bone union in vertebral fractures associated with DISH.
Leucocytoclastic vasculitis secondary to COVID-19 infection in a young child
Authors: Kumar Gurinder , Pillai Shanta , Norwick Paige , Bukulmez Hulya
Published: April 2021

The current case report describes a 13-year-old young boy who presented with purpuric rashes following a completely asymptomatic COVID-19 infection and biopsy-confirmed leucocytoclastic vasculitis, mild haematuria and mild elevation of serum IgA. This case highlights one of the dermatological manifestations of COVID-19 infection which has not been reported so far. Paediatricians should explore the history of this infection when evaluating any child presenting with a vasculitic rash.
Prone ventilation in a pregnant patient with scrub typhus-induced acute respiratory distress syndrome
Authors: Arasu Meenupriya , Swaminathan Nagalakshmi , Cherian Anusha , Parthiban Magesh
Published: April 2021

A 23-year-old primigravida at 20 weeks of gestation presented to our hospital with undifferentiated febrile illness and severe acute respiratory distress syndrome. She was intubated in the emergency department and transferred to the intensive care unit. Initial treatment included ventilatory care, vasopressor support and broad-spectrum antibiotics. Based on a positive PCR assay for scrub typhus, she was treated with intravenous doxycycline and azithromycin. Despite reduction in fever, her oxygenation further declined. Following a risk–benefits assessment, we decided to ventilate her in prone position for 8 hours a day for three consecutive days using a checklist-based protocol. Her oxygenation indices and lung compliance markedly improved over this period, and she was extubated a day later. She was eventually discharged home after 1 week.
Retinal vascular bed area on ultra-wide field fluorescein angiography indicates the severity of diabetic retinopathy
Authors: Fan Wenying , Uji Akihito , Nittala Muneeswar , Wykoff Charles Clifton , Brown David , Fleming Alan , Robertson Gavin , van Hemert Jano , Sadda SriniVas , Ip Michael S
Published: April 2021

Aims

To quantify retinal vascular bed area (RVBA) in square millimetres on stereographically projected ultra-wide field (UWF) fluorescein angiography (FA) in eyes with diabetic retinopathy (DR).

Methods

A prospective, observational study. Baseline Optos 200Tx UWF FA images of 80 eyes with DR from the DAVE (NCT01552408) and RECOVERY (NCT02863354) studies were stereographically projected at the Doheny Image Reading Center to adjust for peripheral distortion. The early-phase FA frame was used to extract the retinal vasculature as a mask for calculating RVBA. The pixels of the retinal vasculature were automatically computed in square millimetres using manufacturer-provided software.

Results

Eighteen of 80 diabetic eyes were excluded because image quality and contrast were insufficient for automatic extraction of the retinal vasculature from the background fluorescence. The remaining 62 eyes were included in the final analysis. In comparison with age-matched and sex-matched normal controls, eyes with DR had a higher global RVBA for the entire retina (p<0.001), and RVBA correlated with DR severity (p<0.001), with a higher RVBA in eyes with proliferative DR (66.1±16.2 mm2) than in those with non-proliferative DR (56.2±16.6 mm2) or in normal controls (37.2±9.9 mm2). This tendency was also present in the posterior retina and mid-periphery but absent in the far-periphery. RVBA did not correlate with retinal ischaemia (p>0.05).

Conclusions

Eyes with DR harboured a larger global RVBA for the entire retina than normal controls, and RVBA appeared to indicate DR severity. However, this biomarker was not observed to be a good indicator of retinal ischaemia.
Association of foveal avascular zone area withstructural and functional progression in glaucoma patients
Authors: Li Fei , Lin Fengbin , Gao Kai , Cheng Weijing , Song Yunhe , Liu Yuhong , Wang Yu Meng , Lam Alexander , Tham Clement C , Cheung Carol , Zhang Xiulan , Zangwill Linda M.
Published: April 2021

Background

To investigate whether quantitative optical coherence tomography angiography (OCTA) metrics of the superficial/deep macular retina and optic disc are associated with glaucoma progression risk.

Methods

A total of 238 eyes from 119 patients with open angle glaucoma or ocular hypertension, and no history of systemic hypertension or diabetes mellitus were included. All participants underwent OCTA imaging with a swept-source OCT (DRI-OCT 1, Topcon, Japan). OCTA metrics of superficial capillary plexus (SCP) and deep capillary plexus (DCP) in the macular region, and radial peripapillary capillary network of the optic disc were measured by a customised MATLAB program to obtain foveal avascular zone (FAZ) area, FAZ circularity and capillary density of SCP/DCP, and capillary density of the peripapillary region. Relationships between baseline OCTA metrics, visual field (VF) metrics, intraocular pressure fluctuation and risk of glaucoma progression were analysed with the Cox proportional hazards model. A frailty model was used to adjust for intereye correlation.

Results

During a mean follow-up duration of 29.39 months (range 12–56 months), 50, 48 and 16 eyes were determined to have retinal nerve fibre layer (RNFL), ganglion cell-inner plexiform layer (GC-IPL) and VF progression respectively. FAZ area per SD increase at baseline were significantly associated with both RNFL thinning (HR 1.73 95% CI 1.04 to 2.90); p=0.036) and GC-IPL thinning (HR 2.62, 95% CI 1.59 to 4.31; p<0.001), after adjusting for age, axial length and other potential confounding factors. VF progression was associated with age (HR 1.05, 95% CI 1.02 to 1.08; p<0.001) and mean deviation value (HR 0.91, 95% CI 0.84 to 0.98; p=0.010), but not with any OCTA metrics.

Conclusion

Enlarged FAZ area measured by OCTA was associated with a higher risk of RNFL and GC-IPL thinning associated with glaucoma, but not with functional deterioration in glaucoma.
From hospitalisation to primary care: integrative model of clinical pharmacy with patients implanted with a PICC line—research protocol for a prospective before–after study
Authors: Pouget Alix Marie , Civade Elodie , Cestac Philippe , Rouzaud-Laborde Charlotte
Published: April 2021

Introduction

Clinical pharmacy improves patient safety and secures drug management using information, education and good clinical practices. However, medical device management is still unexplored, and proof of effectiveness is needed. A PICC line (peripherally inserted central catheter) is a medical device for infusion. It accesses the central venous system after being implanted in a peripheral vein. However, complications after implantation often interfere with smooth execution of the treatment. We hypothesise that clinical pharmacy for medical devices could be as effective as clinical pharmacy for medications. The main objective is to assess the effectiveness of clinical pharmacy activities on the complication rate after PICC line implantation.

Methods and analysis

This is a before–after prospective study. The study will begin with an observational period without clinical pharmacy activities, followed by an interventional period where pharmacists will intervene on drug and medical device management and provide personalised follow-up and advice. Sixty-nine adult patients will be recruited in each 6-month period from all traditional care units. The main inclusion criteria will be the implantation of a PICC line. The primary outcome is the decrease in the number of complications per patient and per month. Secondary outcomes are the consultation and hospital readmission rates, the acceptance rate of pharmaceutical interventions, the patients’ quality of life, the direct hospital induced or avoided costs and the participants’ satisfaction. Data will be collected using case report forms during hospitalisation and telephone follow-up after discharge. The analysis will compare these criteria during the two periods.

Ethics and dissemination

The study has received the approval of our Ethics Committee (Clermont-Ferrand Southeast VI, France, number AU1586). Results will be made available to the patients or their caregivers, the sponsor and other researchers when asked, as described in the consent form.

Trial registration number

NCT04359056.
Outcomes of out-of-hospital cardiac arrest in Beijing: a 5-year cross-sectional study
Authors: Shao Fei , Li Haibin , Ma Shengkui , Li Dou , Li Chunsheng
Published: April 2021

Objective

The purpose of this study was to assess the trends in outcomes of out-of-hospital cardiac arrest (OHCA) in Beijing over 5 years.

Design

Cross-sectional study.

Methods

Adult patients with OHCA of all aetiologies who were treated by the Beijing emergency medical service (EMS) between January 2013 and December 2017 were analysed. Data were collected using the Utstein Style. Cases were followed up for 1 year. Descriptive statistics were used to characterise the sample and logistic regression was performed.

Results

Overall, 5016 patients with OHCA underwent attempted resuscitation by the EMS in urban areas of Beijing during the study period. Survival to hospital discharge was 1.2% in 2013 and 1.6% in 2017 (adjusted rate ratio=1.0, p for trend=0.60). Survival to admission and neurological outcome at discharge did not significantly improve from 2013 to 2017. Patient characteristics and the aetiology and location of cardiac arrest were consistent, but there was a decrease in the initial shockable rhythm (from 6.5% to 5.6%) over the 5 years. The rate of bystander cardiopulmonary resuscitation (CPR) increased steadily over the years (from 10.4% to 19.4%).

Conclusion

Survival after OHCA in urban areas of Beijing did not improve significantly over 5 years, with long-term survival being unchanged, although the rate of bystander CPR increased steadily, which enhanced the outcomes of patients who underwent bystander CPR.
Randomised controlled feasibility trial of an active communication education programme plus hearing aid provision versus hearing aid provision alone (ACE To HEAR)
Authors: Watson Judith , Coleman Elizabeth , Jackson Cath , Bell Kerry , Maynard Christina , Hickson Louise , Forster Anne , Fairhurst Caroline , Hewitt Catherine , Gardner Rob , Iley Kate , Gailey Lorraine , Thyer Nicholas J
Published: April 2021

Objective

To establish the acceptability and feasibility of delivering the Active Communication Education (ACE) programme to increase quality of life through improving communication and hearing aid use in the UK National Health Service.

Design

Randomised controlled, open feasibility trial with embedded economic and process evaluations.

Setting

Audiology departments in two hospitals in two UK cities.

Participants

Twelve hearing aid users aged 18 years or over who reported moderate or less than moderate benefit from their new hearing aid.

Interventions

Consenting participants (along with a significant other) were to be randomised by a remote, centralised randomisation service in groups to ACE plus treatment-as-usual (intervention group) or treatment-as-usual only (control group).

Primary outcome measures

The primary outcomes were related to feasibility: recruitment, retention, treatment adherence and acceptability to participants and fidelity of treatment delivery.

Secondary outcome measures

International Outcomes Inventory for Hearing Aids, Self-Assessment of Communication, EQ-5D-5L and Short-Form 36. Blinding of the participants and facilitator was not possible.

Results

Twelve hearing aid users and six significant others consented to take part. Eight hearing aid users were randomised: four to the intervention group; and four to treatment-as-usual only. Four significant others participated alongside the randomised participants. Recruitment to the study was very low and centres only screened 466 hearing aid users over the 15-month recruitment period, compared with the approximately 3500 anticipated. Only one ACE group and one control group were formed. ACE could be delivered and appeared acceptable to participants. We were unable to robustly assess attrition and attendance rates due to the low sample size.

Conclusions

While ACE appeared acceptable to hearing aid users and feasible to deliver, it was not feasible to identify and recruit participants struggling with their hearing aids at the 3-month posthearing aid fitting point.

Trial registration number

ISRCTN28090877.
Quantifying the association between ethnicity and COVID-19 mortality: a national cohort study protocol
Authors: Dambha-Miller Hajira , Tan Pui San , Saatci Defne , Clift Ashley Kieran , Zaccardi Francesco , Coupland Carol , Locufier Patrick , Davies Firoza , Khunti Kamlesh , Griffin Simon J , Hippisley-Cox Julia
Published: April 2021

Introduction

Recent evidence suggests that ethnic minority groups are disproportionately at increased risk of hospitalisation and death from SARS-CoV-2 infection. Population-based evidence on potential explanatory factors across minority groups and within subgroups is lacking. This study aims to quantify the association between ethnicity and the risk of hospitalisation and mortality due to COVID-19.

Methods and analysis

This is a retrospective cohort study of adults registered across a representative and anonymised national primary care database (QResearch) that includes data on 10 million people in England. Sociodemographic, deprivation, clinical and domicile characteristics will be summarised and compared across ethnic subgroups (categorised as per 2011 census). Cox models will be used to calculate HR for hospitalisation and COVID-19 mortality associated with ethnic group. Potential confounding and explanatory factors (such as demographic, socioeconomic and clinical) will be adjusted for within regression models. The percentage contribution of distinct risk factor classes to the excess risks seen in ethnic groups/subgroups will be calculated.

Ethics and dissemination

The study has undergone ethics review in accordance with the QResearch agreement (reference OX102). Findings will be disseminated through peer-reviewed manuscripts, presentations at scientific meetings and conferences with national and international stakeholders.
Association between parental socioeconomic status and offspring overweight/obesity from the China Family Panel Studies: a longitudinal survey
Authors: Ding Suqin , Chen Jingqi , Dong Bin , Hu Jie
Published: April 2021

Objective

To examine the association between parental socioeconomic status (SES) and the risk of offspring overweight/obesity and the changes of the association that occur as children grow older.

Design

We used data from the nationally representative longitudinal survey of the China Family Panel Studies of 2010 and its three follow-up waves in 2012, 2014 and 2016.

Participants

A total of 6724 children aged 0–15 years old were included.

Primary and secondary outcome measures

Average household income and paternal and maternal education levels were used as SES indicators. Logistic regression model for panel data was used to examine the associations between SES indicators and child overweight/obesity. A restricted cubic spline linear regression model was used to estimate body mass index (BMI) trajectories with child growth across parental SES levels.

Results

Compared with the lowest education level (primary school or less), the ORs for fathers who had completed junior high school, senior high school and junior college or higher were 0.85 (95% CI 0.75 to 0.97), 0.77 (95% CI 0.64 to 0.92) and 0.72 (95% CI 0.55 to 0.93), respectively. The corresponding ORs for mothers were 0.76 (95% CI 0.67 to 0.86), 0.59 (95% CI 0.47 to 0.72) and 0.45 (95% CI 0.34 to 0.60), respectively. A negative association between parental education and offspring overweight/obesity was observed in the first 10 years but not in children 11–15 years old. BMI differences across parental education levels emerged from birth and widened before 6–7 years old, but decreased before adolescence. High average household income was related to a low risk of offspring overweight/obesity but not when parental education level was adjusted for.

Conclusion

High parental education levels were associated with a low risk of offspring overweight/obesity, especially before adolescence. Effective approaches need to be adopted in early childhood to reduce socioeconomic differences in overweight/obesity.
Emerging responses implemented to prevent and respond to violence against women and children in WHO European member states during the COVID-19 pandemic: a scoping review of online media reports
Authors: Pearson Isabelle , Butler Nadia , Yelgezekova Zhamin , Nihlén Åsa , Yordi Aguirre Isabel , Quigg Zara , Stöckl Heidi
Published: April 2021

Objectives

This study aims to explore the strategies that governments and civil society organisations implemented to prevent and respond to the anticipated rise in violence against women and/or children (VAWC) during the 2019 novel coronavirus (COVID-19) pandemic.

Design

A scoping review and content analysis of online media reports.

Setting

WHO European region.

Methods

A scoping review of media reports and publications and a search of other grey literature (published from 1 January to 17 September 2020). Primary and secondary outcome measures included measures implemented by governments, public services and non-governmental and civil organisations to prevent or respond to VAWC during the early months of the COVID-19 pandemic.

Results

Our study found that in 52 of the 53 member states there was at least one measure undertaken to prevent or respond to VAWC during the pandemic. Government-led or government-sponsored measures were the most common, reported in 50 member states. Non-governmental and other civil society-led prevention and response measures were reported in 40 member states. The most common measure was the use of media and social media to raise awareness of VAWC and to provide VAWC services through online platforms, followed by measures taken to expand and/or maintain helpline services for those exposed to violence.

Conclusion

The potential increase in VAWC during COVID-19-imposed restrictions and lockdowns resulted in adaptations and/or increases in prevention and response strategies in nearly all member states. The strength of existing public health systems influenced the requirement and choice of strategies and highlights the need for sustaining and improving violence prevention and response services. Innovative strategies employed in several member states may offer opportunities for countries to strengthen prevention and responses in the near future and during similar emergencies.
Retrospective cohort analysis of Spanish national trends of coronary artery bypass grafting and percutaneous coronary intervention from 1998 to 2017
Authors: Carnero Alcazar Manuel , Hernandez-Vaquero Daniel , Cubero-Gallego Hector , Lopez Menendez Jose , Piñon Miguel , Albors Martin Jose , Cuerpo Caballero Gregorio , Cobiella Carnicer Javier , Villamor Cristina , Forteza Alberto , Pascual Isaac , Maroto Castellanos Luis Carlos
Published: April 2021

Introduction

Spain is one of the countries with the lowest rates of revascularisation and highest ratio of percutaneous coronary intervention (PCI) to coronary artery bypass grafting (CABG).

Objectives

To investigate the changes and trends in the two revascularisation procedures between 1998 and 2017 in Spain.

Design

Retrospective cohort study. Analysis of in-hospital outcomes.

Setting

Minimum basic data set from the Spanish National Department of Health: mandatory database collecting information of patients who are attended in the Spanish public National Health System.

Participants

603 976 patients who underwent isolated CABG or PCI in the Spanish National Health System. The study period was divided in four 5-year intervals. Patients with acute myocardial infarction on admission were excluded.

Primary and secondary outcomes

We investigated the volume of procedures nationwide, the changes of the risk profile of patients and in-hospital mortality of both techniques.

Results

We observed a 2.2-fold increase in the rate of any type of myocardial revascularisation per million inhabitants-year: 357 (1998) to 776 (2017). 93 682 (15.5%) had a coronary surgery. PCI to CABG ratio rose from 2.2 (1998–2002) to 8.1 (2013–2017). Charlson’s index increased by 0.8 for CABG and 1 for PCI. The median annual volume of PCI/hospital augmented from 136 to 232, while the volume of CABG was reduced from 137 to 74. In the two decades, we detected a significant reduction of CABG in-hospital mortality (6.5% vs 2.6%, p<0.001) and a small increase in PCI (1.2% vs 1.5%, p<0.001). Risk adjusted mortality rate was reduced for both CABG (1.51 vs 0.48, p<0.001), and PCI (1.42 vs 1.05, p<0.001).

Conclusion

We detected a significant increase in the volume of revascularisations (particularly PCI) in Spain. Risk-adjusted in-hospital mortality was significantly reduced.
Economic evaluation of a novel community-based diabetes care model in rural Mexico: a cost and cost-effectiveness study
Authors: Duan Kevin I , Rodriguez Garza Francisco , Flores Hugo , Palazuelos Daniel , Maza Jimena , Martinez-Juarez Luis Alberto , Elliott Patrick F , Moreno Lázaro Elena , Enriquez Rios Natán , Nigenda Gustavo , Palazuelos Lindsay , McBain Ryan K
Published: April 2021

Objectives

Diabetes is the leading cause of disability-adjusted life years in Mexico, and cost-effective care models are needed to address the epidemic. We sought to evaluate the cost and cost-effectiveness of a novel community-based model of diabetes care in rural Mexico, compared with usual care.

Design

We performed time-driven activity-based costing to estimate annualised costs associated with typical diabetes care in Chiapas, Mexico, as well as a novel diabetes care model known as Compañeros En Salud Programa de Enfermedades Crónicas (CESPEC). We conducted Markov chain analysis to estimate the cost-effectiveness of CESPEC compared with usual care from a societal perspective. We used patient outcomes from CESPEC in 2016, as well as secondary data from existing literature.

Setting

Rural primary care clinics in Chiapas, Mexico.

Participants

Adults with diabetes.

Interventions

CESPEC is a novel, comprehensive, diabetes care model that integrates community health workers, provider education, supply chain management and active case finding.

Outcome measure

The primary outcome was the incremental cost-effectiveness of CESPEC compared with care as usual, per quality-adjusted life year (QALY) gained, expressed in 2016 US dollars.

Results

The economic cost of the CESPEC diabetes model was US$144 per patient per year, compared with US$125 for diabetes care as usual. However, CESPEC care was associated with 0.13 additional years of health-adjusted life expectancy compared with usual care and 0.02 additional years in the first 5 years of treatment. This translated to an incremental cost-effectiveness ratio (ICER) of US$2981 per QALY gained over a patient’s lifetime and an ICER of US$10 444 over the first 5 years. Findings were robust to multiple sensitivity analyses.

Conclusions

CESPEC is a cost-effective, community-based model of diabetes care for patients in rural Mexico. Given the high prevalence and significant morbidity associated with diabetes in Mexico and other countries in Central America, this model should be considered for broader scale up and evaluation.
Prognostic model to identify and quantify risk factors for mortality among hospitalised patients with COVID-19 in the USA
Authors: Incerti Devin , Rizzo Shemra , Li Xiao , Lindsay Lisa , Yau Vincent , Keebler Dan , Chia Jenny , Tsai Larry
Published: April 2021

Objectives

To develop a prognostic model to identify and quantify risk factors for mortality among patients admitted to the hospital with COVID-19.

Design

Retrospective cohort study. Patients were randomly assigned to either training (80%) or test (20%) sets. The training set was used to fit a multivariable logistic regression. Predictors were ranked using variable importance metrics. Models were assessed by C-indices, Brier scores and calibration plots in the test set.

Setting

Optum de-identified COVID-19 Electronic Health Record dataset including over 700 hospitals and 7000 clinics in the USA.

Participants

17 086 patients hospitalised with COVID-19 between 20 February 2020 and 5 June 2020.

Main outcome measure

All-cause mortality while hospitalised.

Results

The full model that included information on demographics, comorbidities, laboratory results, and vital signs had good discrimination (C-index=0.87) and was well calibrated, with some overpredictions for the most at-risk patients. Results were similar on the training and test sets, suggesting that there was little overfitting. Age was the most important risk factor. The performance of models that included all demographics and comorbidities (C-index=0.79) was only slightly better than a model that only included age (C-index=0.76). Across the study period, predicted mortality was 1.3% for patients aged 18 years old, 8.9% for 55 years old and 28.7% for 85 years old. Predicted mortality across all ages declined over the study period from 22.4% by March to 14.0% by May.

Conclusion

Age was the most important predictor of all-cause mortality, although vital signs and laboratory results added considerable prognostic information, with oxygen saturation, temperature, respiratory rate, lactate dehydrogenase and white cell count being among the most important predictors. Demographic and comorbidity factors did not improve model performance appreciably. The full model had good discrimination and was reasonably well calibrated, suggesting that it may be useful for assessment of prognosis.
Clinical practice guidelines for the management of atraumatic shoulder conditions: protocol for a systematic review
Authors: Lee Dana Yen Lin , Haas Romi , Wallis Jason A , O’Connor Denise A , Buchbinder Rachelle
Published: April 2021

Introduction

Shoulder conditions are a major cause of morbidity in the general population. Many clinical practice guidelines (CPGs) for shoulder conditions have been developed. Their purpose is to provide evidence-based recommendations to assist clinicians in providing optimal care to maximise patient outcomes. The aim of this systematic review is to identify, appraise, and compare the content and quality of CPGs for atraumatic shoulder conditions.

Methods and analysis

CPGs for atraumatic shoulder conditions will be included provided they make recommendations about diagnosis and/or management, are identified by their authors as a guideline and are consistent with the Appraisal of Guidelines for Research and Evaluation (AGREE) II definition of a guideline. A systematic search of electronic databases, online guideline repositories and the websites of relevant professional societies will be conducted to identify eligible CPGs. Search terms relating to shoulder conditions (eg, ‘adhesive capsulitis’, ‘rotator cuff’ and ‘bursitis’) will be combined with a validated search filter for CPGs. Pairs of independent reviewers will determine eligibility of CPGs identified by the search. Quality appraisal of included CPGs will be performed using the AGREE II instrument. Recommendations from each CPG and how they were determined will be extracted and compared across similar CPGs. Results from this systematic review will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement.

Ethics and dissemination

Ethical approval is not required for this systematic review. The results from this study will be published in a peer-reviewed journal and disseminated to professional societies that publish shoulder CPGs, clinical policy groups, clinicians, researchers and consumers.

PROSPERO registration number

CRD42020182723.
Symptomatic, biochemical and radiographic recovery in patients with COVID-19
Authors: Mallia Patrick , Meghji Jamilah , Wong Brandon , Kumar Kartik , Pilkington Victoria , Chhabra Shaan , Russell Ben , Chen Jian , Srikanthan Karthikan , Park Mirae , Owles Harriet , Liew Felicity , Alcada Joana , Martin Laura , Coleman Meg , Elkin Sarah , Ross Clare , Agrawal Shweta , Gardiner Thomas , Bell Aaron , White Alice , Hampson Dominic , Vithlani Gauri , Manalan Kavina , Bramer Solange , Martin Segura Alejandra , Kucheria Anushree , Ratnakumar Prashanthi , Sheeka Alexander , Anandan Lavanya , Copley Susan , Russell Georgina , Bloom Chloe I , Kon Onn Min
Published: April 2021

Background

The symptoms, radiography, biochemistry and healthcare utilisation of patients with COVID-19 following discharge from hospital have not been well described.

Methods

Retrospective analysis of 401 adult patients attending a clinic following an index hospital admission or emergency department attendance with COVID-19. Regression models were used to assess the association between characteristics and persistent abnormal chest radiographs or breathlessness.

Results

75.1% of patients were symptomatic at a median of 53 days post discharge and 72 days after symptom onset and chest radiographs were abnormal in 47.4%. Symptoms and radiographic abnormalities were similar in PCR-positive and PCR-negative patients. Severity of COVID-19 was significantly associated with persistent radiographic abnormalities and breathlessness. 18.5% of patients had unscheduled healthcare visits in the 30 days post discharge.

Conclusions

Patients with COVID-19 experience persistent symptoms and abnormal blood biomarkers with a gradual resolution of radiological abnormalities over time. These findings can inform patients and clinicians about expected recovery times and plan services for follow-up of patients with COVID-19.
Small airway determinants of airflow limitation in chronic obstructive pulmonary disease
Authors: Polosukhin Vasiliy V , Gutor Sergey S , Du Rui-Hong , Richmond Bradley W , Massion Pierre P , Wu Pingsheng , Cates Justin M , Sandler Kim L , Rennard Stephen I , Blackwell Timothy S
Published: April 2021

Background

Although a variety of pathological changes have been described in small airways of patients with COPD, the critical anatomic features determining airflow limitation remain incompletely characterised.

Methods

We examined lung tissue specimens from 18 non-smokers without chronic lung disease and 55 former smokers with COPD for pathological features of small airways that could contribute to airflow limitation. Morphometric evaluation was performed for epithelial and subepithelial tissue thickness, collagen and elastin content, luminal mucus and radial alveolar attachments. Immune/inflammatory cells were enumerated in airway walls. Quantitative emphysema scoring was performed on chest CT scans.

Results

Small airways from patients with COPD showed thickening of epithelial and subepithelial tissue, mucus plugging and reduced collagen density in the airway wall (in severe COPD). In patients with COPD, we also observed a striking loss of alveolar attachments, which are connective tissue septa that insert radially into the small airway adventitia. While each of these parameters correlated with reduced airflow (FEV1), multivariable regression analysis indicated that loss of alveolar attachments was the major determinant of airflow limitation related to small airways. Neutrophilic infiltration of airway walls and collagen degradation in airway adventitia correlated with loss of alveolar attachments. In addition, quantitative analysis of CT scans identified an association between the extent of emphysema and loss of alveolar attachments.

Conclusion

In COPD, loss of radial alveolar attachments in small airways is the pathological feature most closely related to airflow limitation. Destruction of alveolar attachments may be mediated by neutrophilic inflammation.
Prediction and model-assisted estimation of diameter distributions using Norwegian national forest inventory and airborne laser scanning data
Authors: Räty Janne , Astrup Rasmus , Breidenbach Johannes
Published: April 2021

Diameter at breast height (DBH) distributions offer valuable information for operational and strategic forest management decisions. We predicted DBH distributions using Norwegian national forest inventory and airborne laser scanning data and compared the predictive performances of linear mixed-effects (PPM), generalized linear-mixed (GLM), and k nearest-neighbor (NN) models. While GLM resulted in smaller prediction errors than PPM, both were clearly outperformed by NN. We therefore studied the ability of the NN model to improve the precision of stem frequency estimates by DBH classes in the 8.7 Mha study area using a model-assisted (MA) estimator suitable for systematic sampling. MA estimates yielded greater than or approximately equal efficiencies as direct estimates using field data only. The relative efficiencies (REs) associated with the MA estimates ranged between 0.95–1.47 and 0.96–1.67 for 2 and 6 cm DBH class widths, respectively, when dominant tree species were assumed to be known. The use of a predicted tree species map, instead of the observed information, decreased the REs by up to 10%.
Determination of $$\alpha _{S}$$ beyond NNLO using event shape averages
Authors: Kardos Adam , Somogyi Gábor , Verbytskyi Andrii
Published: April 2021

We consider a method for determining the QCD strong coupling constant using fits of perturbative predictions for event shape averages to data collected at the LEP, PETRA, PEP and TRISTAN colliders. To obtain highest accuracy predictions we use a combination of perturbative $${{{\mathcal {O}}}}(\alpha _{S}^{3})$$

O
(

α

S

3

)

calculations and estimations of the $${{{\mathcal {O}}}}(\alpha _{S}^{4})$$

O
(

α

S

4

)

perturbative coefficients from data. We account for non-perturbative effects using modern Monte Carlo event generators and analytic hadronization models. The obtained results show that the total precision of the $$\alpha _{S}$$

α
S

determination cannot be improved significantly with the higher-order perturbative QCD corrections alone, but primarily requires a deeper understanding of the non-perturbative effects.
High-energy resummed distributions for the inclusive Higgs-plus-jet production at the LHC
Authors: Celiberto Francesco G. , Ivanov Dmitry Yu. , Mohammed Mohammed M. A. , Papa Alessandro
Published: April 2021

The inclusive hadroproduction of a Higgs boson and of a jet, featuring large transverse momenta and well separated in rapidity, is proposed as a novel probe channel for the manifestation of the Balitsky–Fadin–Kuraev–Lipatov (BFKL) dynamics. Using the standard BFKL approach, with partial inclusion of next-to-leading order effects, predictions are presented for azimuthal Higgs-jet correlations and other observables, to be possibly compared with experimental analyses at the LHC and with theoretical predictions obtained in different schemes.
Quantum Aitchison geometry
Authors: Andai Attila , Lovas Attila
Published: April 2021

Multiplying a likelihood function with a positive number makes no difference in Bayesian statistical inference, therefore after normalization the likelihood function in many cases can be considered as probability distribution. This idea led Aitchison to define a vector space structure on the probability simplex in 1986. Pawlowsky-Glahn and Egozcue gave a statistically relevant scalar product on this space in 2001, endowing the probability simplex with a Hilbert space structure. In this paper, we present the noncommutative counterpart of this geometry. We introduce a real Hilbert space structure on the quantum mechanical finite dimensional state space. We show that the scalar product in quantum setting respects the tensor product structure and can be expressed in terms of modular operators and Hamilton operators. Using the quantum analogue of the log-ratio transformation, it turns out that all the newly introduced operations emerge naturally in the language of Gibbs states. We show an orthonormal basis in the state space and study the introduced geometry on the space of qubits in details.
The origin of carbonatites from the eastern Armutlu Peninsula (NW Turkey)
Authors: Özkan Mutlu , Çelik Ömer Faruk , Marzoli Andrea , Çörtük Rahmi Melih , Billor Mehmet Zeki
Published: April 2021

Unusual carbonate dykes, which have a thickness of up to 4 m, cross-cut the amphibolites from the high-grade metamorphic rocks in the Armutlu Peninsula (NW Turkey). They are described as carbonatites on the basis of their petrographic, geochemical and isotope-geochemical characteristics. The carbonatites, which commonly show equigranular texture, are composed of calcite and clinopyroxene with other minor phases of plagioclase, mica, garnet, K-feldspar, quartz, epidote, titanite and opaque minerals. They contain abundant xenoliths of pyroxenite and amphibolite. The geochemical characteristics of the carbonatites are significantly different from those of mantle-derived carbonatites. They have remarkably low incompatible element (e.g. Ba, Th, Nb) and total REE (11–91 ppm) contents compared with mantle-derived carbonatites. The high
87
Sr/
86
Sr
(i)
(0.70797–0.70924) and low

ε

Nd
(t) (−8.08 to −9.57) of the carbonatites confirm that they were derived from the continental crust rather than from a mantle source. Mica from carbonatite was dated by the
40
Ar/
39
Ar method, yielding a Late Jurassic–Early Cretaceous age (148–137 Ma). This is significantly younger than the age of adjacent amphibolites (Upper Triassic). All data from field studies, as well as petrographic, geochemical and geochronological observations, suggest that these carbonatites were formed from anatectic melting of a carbonated source area in the continental crust.

Supplementary material:
A complete description of the analytical methods (whole rock chemistry, mineral chemistry, strontium and neodymium isotopes and
40
Ar/
39
Ar measurements) and mineral chemistry and
40
Ar-
39
Ar dating results are available at
https://doi.org/10.6084/m9.figshare.12946955
The Role of Raman Spectroscopy Within Quantitative Metabolomics
Authors: Lima Cassio , Muhamadali Howbeer , Goodacre Royston
Published: April 2021

Ninety-four years have passed since the discovery of the Raman effect, and there are currently more than 25 different types of Raman-based techniques. The past two decades have witnessed the blossoming of Raman spectroscopy as a powerful physicochemical technique with broad applications within the life sciences. In this review, we critique the use of Raman spectroscopy as a tool for quantitative metabolomics. We overview recent developments of Raman spectroscopy for identification and quantification of disease biomarkers in liquid biopsies, with a focus on the recent advances within surface-enhanced Raman scattering–based methods. Ultimately, we discuss the applications of imaging modalities based on Raman scattering as label-free methods to study the abundance and distribution of biomolecules in cells and tissues, including mammalian, algal, and bacterial cells.
Does Vote Trading Improve Welfare?
Authors: Casella Alessandra , Macé Antonin
Published: April 2021

Voters have strong incentives to increase their influence by trading votes, acquiring others’ votes when preferences are strong in exchange for giving votes away when preferences are weak. But is vote trading welfare improving or welfare decreasing? For a practice long believed to be central to collective decisions, the lack of a clear answer is surprising. We review the theoretical literature and, when available, its related experimental tests. We begin with the analysis of logrolling, the exchange of votes for votes. We then focus on vote markets, where votes can be traded against a numeraire. We conclude with procedures allowing voters to shift votes across decisions—that is, allowing one to trade votes with oneself only. We find that vote trading and vote markets are typically inefficient; more encouraging results are obtained by allowing voters to allocate votes across decisions.
Confronting Banking Crises: Lessons from the Field
Authors: Dobler Marc , Moretti Marina , Piris Alvaro
Published: April 2021

Financial crises are a recurring feature of modern economies. This article summarizes the lessons learned from policy interventions and tools used to resolve banking crises from a practical, operational perspective and in light of the experiences and challenges faced during and since the 2008 global financial crisis. Managing a systemic banking crisis is a complex, multiyear process and requires a comprehensive framework for addressing systemic banking problems while minimizing taxpayers’ costs.