bluuebunny/crossref_metadata_2025 huggingface dataset:
The utility of a fidelity measure to monitor implementation of new early psychosis services across Australia
Authors: Williams Georgia , Farrelly Simone , Thompson Andrew , Stavely Heather , Albiston Dianne , van der El Kristie , McGorry Patrick , Killackey Eóin
Published: February 2021

Aim

Early psychosis delivery models have proliferated worldwide, but there is limited research into establishing model fidelity. In this context, this article aims to describe the development and implementation of a fidelity tool in a national network of early psychosis services across Australia—the headspace Early Psychosis program.

Methods

Following a detailed consultation process, and based on the Australian Early Psychosis model, an 80‐item Early Psychosis Prevention and Intervention Centre Model Integrity Tool (EMIT) was developed along with predefined thresholds for fidelity. The tool was used to assess adherence to the model in six clusters of service sites across Australia. Ratings on the EMIT were informed by interviews with site staff and young people receiving the service, routinely collected data and site policies and procedures.

Results

All six clusters of headspace Early Psychosis programs participated in five fidelity assessments across a period of two and a half years. In the initial two visits, the average fidelity score was in the ‘low’ fidelity range (i.e., <75%). By the fifth fidelity visit, the network average improved to 92.35%, reflecting ‘superior’ fidelity.

Conclusions

Results of the longitudinal fidelity assessments indicate the successful implementation of the Australian Early Psychosis model across the headspace Early Psychosis program. Utilisation of ongoing fidelity assessments has proved an effective method to improve and maintain adherence to the model.
Spatial music
Authors: Dyck John
Published: February 2021

Everyone agrees that musical works are individuated by essential elements such as tone, harmony, and rhythm. Some argue that timbre or instrumentation is an essential element of some musical works, too. I argue here that there is a further essential element of some musical works: spatial location. Some works of music are partly constituted by the location and motion of their sound sources. I begin by describing works of spatial music and arguing that they exist. I then consider the implications for the ontology of music. Hardcore formalists cannot allow for spatial music. I argue that two other views, which allow a close relationship between sounds and musical works, can allow for works of spatial music. However, their ability to do so turns on issues in the philosophy of sound. I appeal to work in the philosophy of sound to show that music is an art not just of hearing, but of sounds. Musical elements can be located just like sounds are located.
Can hedge funds benefit from corporate social responsibility investment?
Authors: Duanmu Jun , Huang Qiping , Li Yongjia , McBrayer Garrett A.
Published: February 2021

We explore the extent to which hedge funds incorporate corporate social responsibility (CSR) considerations in the development of their investment strategies. Using an asset‐weighted composite measure of CSR by fund, we examine the difference in financial performance between hedge funds with high CSR investment relative to those with low CSR investment and document no significant difference. Yet, we find that hedge funds increase their exposure to high‐CSR investments over our sample period, specifically postfinancial crisis. We find that the increases in CSR investment are associated with lower return volatilities in the future. Additionally, hedge funds with higher weighted CSR scores exhibit significantly lower risk factor loadings than funds with lower weighted CSR scores. Our results suggest that hedge funds are able to derive benefits by using CSR considerations as a form of risk mitigation in their investment policies.
Improving the oxygen barrier of microcapsules using cellulose nanofibres
Authors: Kak Atisheel , Parhi Ashutos , Rasco Barbara A. , Tang Juming , Sablani Shyam S.
Published: February 2021

In this study, the oxygen barrier and physical properties of two maltodextrin/gum Arabic (MD/GA) (3:1 w/w) microcapsules with dextrose equivalence (DE) 26 and 6 were assessed with or without the incorporation of cellulose nanofibres (CNF). The oxygen diffusion coefficient (Deff) was between 10.6 × 10−15 m2 s−1 and 17.3 × 10−15 m2 s−1 for all microcapsules. The addition of CNF improved the oxygen barrier of MD/GA microcapsules. The incorporation of CNF did not significantly impact Tg due to the low quantity of CNF present in the microcapsules. Wettability was higher in CNF incorporated microcapsules, and dispersibility was lower only for microcapsules with maltodextrin of DE 26. Spray‐dried microcapsules exhibited poor flowability and high cohesiveness due to the moisture content (2.0–2.5%) of the powders. The results suggest that incorporation of CNF can increase the oxygen barrier of MD/GA microcapsules which may lead to better oxidative stability of micronutrients incorporated in the microcapsules.
Risk factors of falls and the gender differences in older adults with diabetes at outpatient clinics
Authors: Wang Ruey‐Hsia , Hsu Hui‐Chun , Chen Shi‐Yu , Lee Chun‐Ming , Lee Yau‐Jiunn , Ma Shin‐Ming , Chen Wan‐Yi
Published: February 2021

Aims

To explore the risk factors of falls and the gender differences based on demographic and disease characteristics, physical capability, and fear of falling in older adults with diabetes visiting outpatient clinics in Taiwan.

Design

Cross‐sectional design.

Methods

A total of 485 patients with type 2 diabetes aged between 65 and 80 years were recruited from three endocrine outpatient clinics in Taiwan. Demographic and disease characteristics, fall history in the previous one year and fear of falling were collected by a self‐reported questionnaire. Calf circumference, handgrip strength, one‐leg standing and time up‐and‐go tests were all performed to assess the physical capability of participants. Data were collected from May 2019 to May 2020.

Results

Female gender (OR = 1.75), handgrip strength (OR = 2.43) and fear of falling (OR = 3.38) were important risk factors of falls overall, although fear of falling (OR = 4.69) was the only important risk factor of falls in males, while handgrip strength (OR = 3.48) and fear of falling (OR = 2.86) were important risk factors of falls in females. The sensitivity of simultaneous screening handgrip strength and fear of falling were 85.7, 86.4 and 86.2 in males, females and older adults overall with diabetes, respectively.

Conclusion

Fear of falling was an important risk factor of falls in both genders, especially in males. Handgrip strength was an important risk factor of falls specifically for females. By simultaneously screening fear of falling and handgrip strength, risk of falls in older adults with diabetes at outpatient clinics could be identified in a more timely manner.

Impact

Nurses could periodically and simultaneously assess fear of falling and handgrip strength of older adults with diabetes at outpatient clinics. For those are identified at risk of falls on either fear of falling or handgrip strength, nurses could provide corresponding interventions to reduce the fear of falling or improve muscle strength to prevent such falls.
Belief in group interdependence: Facilitating evacuee–host interactions after the Fukushima nuclear accident
Authors: Kobayashi Tomoyuki , Yoshida Kazuki , Takebayashi Yoshitake , Goto Aya , Kumagai Atsushi , Murakami Michio
Published: February 2021

After the 2011 Fukushima nuclear accident, intercultural friction and aversion arose between evacuees and host community residents in relocation areas. We examined whether a belief in group interdependence—the extent to which an individual believes that group function is realized through interdependence with related other groups—is consistent with positive interactions between evacuees and hosts. A door‐to‐door survey of 77 evacuees and 75 hosts revealed that residents with an integrated social identity interacted favorably with both ingroup and outgroup members, and that a belief in group interdependence was consistent with the integration of social identity between the evacuee and host communities. Those findings suggest that a belief in group interdependence can reduce intercultural conflict by allowing both immigrants and host residents to acquire an integrated social identity without the dilemma of internalizing different cultures into an individual's mind.
Commentary: The critical role of oral language deficits in reading disorders: reflections on Snowling and Hulme (2021)
Authors: Catts Hugh W.
Published: February 2021

Learning to read is a primary goal of early education, and considerable instructional time is focused on it. Most children respond well to this instruction and soon become accurate and fluent readers. But a small percentage of children find learning to read a significant challenge and often struggle educationally and psychologically as a result. In an earlier review, Snowling and Hulme (2012) argued that weaknesses in oral language development play a causal role in reading disorders such as dyslexia and reading comprehension impairment. They further proposed that these impairments should be recognized as distinct disorders within the DSM‐5 classification system. In the current review, Snowling and Hulme (this issue) consider how risk factors at the biological, cognitive, and environmental levels combine to cause reading disorders. Again, they focus particular attention on oral language development and its critical role in reading success/failure.
Urban Chandelier: How Experiences of Being Vision Impaired Inform Designing for Attentiveness
Authors: Liebergesell Natalia Pérez , Vermeersch Peter–Willem , Heylighen Ann
Published: February 2021

Prevailing conceptions of disability in architectural discourse give rise to the devaluing of disabled people's lived experiences. However, several studies in architecture and disability studies show how disability experience may lead to a careful attentiveness toward the qualities of the built environment that are relevant for design. Using focused ethnography, we examine how architect William Feuerman's disruptive vision impairment restructured his attention. The insights gained from his experience were incorporated conceptually into his design practice, and the resulting design principles were realized in one of his office's projects—Urban Chandelier, a design intervention positioned in an urban installation. Feuerman's experiences encouraged him to deliberately introduce disruption into his design, aiming not to disable everyone, but to make passers–by attentive to their surroundings. He re–organizes people's modes of attention through the distinct visual qualities of architecture, generating new meaning, in a similar manner as the stroke that affected his attention. We conclude that considering disabled people's lived experiences demonstrates potential in designing artifacts experientially interesting for a broad population, including but not limited to disabled people.
A rapid in vitro leaf inoculation assay to investigate Phytophthora palmivora–coconut interactions
Authors: Karyath Palliyath Gangaraj , Kilingar Subrahmanya Muralikrishna , Antony Ginny , Binod Bihari Sahu , Hegde Vinayaka , Muliyar Krishna Rajesh
Published: February 2021

Bud rot, caused by Phytophthora palmivora, is one of the major lethal diseases of the coconut palm. It is a sporadic disease but can assume epidemic proportions occasionally. There is a high risk involved in carrying out studies of plant–pathogen interactions through field trials, especially in a crop like coconut. We have developed an in vitro leaf assay, which would enable an easy and close monitoring of interactions occurring between P. palmivora and coconut during the course of infection by recreating the field infection process in the laboratory. Spindle leaves from adult coconut palms were surface sterilized and inoculated in basal Y3 medium in Petri plates. After a week in culture, the surface of the leaves was pricked and inoculated with zoospore suspension of P. palmivora culture. Typical lesion development was noticed on the surface of the coconut leaves 12–24 hr after inoculation of the pathogen. Electrolyte leakage assays and histological studies using scanning electron microscopy, were also undertaken to study the disease progression. The presence of the pathogen in the coconut leaflets was confirmed using PCR and RT‐PCR with Phytophthora‐specific primers. The pathogen could be re‐isolated from the infected regions, fulfilling Koch's postulates. The novel in vitro leaf assay developed through this study is rapid, space‐effective, precise and inexpensive. It could be utilized for detailed investigations of the qualitative interactions between coconut and P. palmivora.
Exploring health care graduates' conceptualisations of preparedness for practice: A longitudinal qualitative research study
Authors: Ottrey Ella , Rees Charlotte E. , Kemp Caitlin , Brock Tina P. , Leech Michelle , Lyons Kayley , Monrouxe Lynn V. , Morphet Julia , Palermo Claire
Published: February 2021

Introduction

Although preparedness for practice (P4P) has been variously described, little shared understanding exists about what P4P is across the health professions. How P4P is conceptualised matters, because this shapes how stakeholders think, talk about and act towards it. Further, multiple understandings can result in diverse expectations for graduate performance. This study therefore explores health care learners’ solicited and unsolicited conceptualisations of P4P over their early graduate transition.

Methods

We conducted longitudinal qualitative research including individual and group entrance interviews (phase 1: n = 35), longitudinal audio‐diaries (phase 2: n = 30), and individual and group exit interviews (phase 3: n = 22) with learners from four disciplines (dietetics, medicine, nursing and pharmacy). We employed framework analysis to interrogate data cross‐sectionally and longitudinally.

Results

We found 13 conceptualisations of P4P (eg knowledge, confidence), broadly similar across the disciplines. We found some conceptualisations dominant in both solicited and unsolicited talk (eg skills), some dominant only in solicited talk (eg competence) and others dominant only in unsolicited talk (eg experience). Although most conceptualisations appeared relatively stable across time, some appeared to dominate at certain time points only (eg employability and skills in phases 1 and 2, and competence in phase 3).

Discussion

This novel study extends previous uniprofessional work by illustrating a broader array of conceptualisations, differences between professions, solicited versus unsolicited talk and longitudinal cohort patterns. We encourage health care educators to discuss these different P4P understandings in graduate transition interventions. Further research is needed to explore other stakeholders’ conceptualisations, and over a duration beyond the early graduate transition.
Gender and medical education authorship: Moving forward comfortably with necessary conversations
Authors: V Nadarajah Vishna Devi
Published: February 2021

Significant advancement in gender parity for medical education scholarship is used to beg for evidence of parity in career development and reignite interest in global representation of scholarship.
A case of overshunting‐associated myelopathy that developed 27 years after placement of a ventriculoperitoneal shunt
Authors: Fujimori Juichi , Kikuchi Hirokazu , Kameyama Masayuki , Haryu Shinya , Sato Kenichi , Sasaki Tatsuya , Ozawa Hiroshi , Murata Takaki , Nakashima Ichiro
Published: February 2021

Overshunting‐associated myelopathy (OSAM) is a rare complication of ventriculoperitoneal (VP) shunts. Here, we report the case of a 52‐year‐old man who presented with OSAM without positional headache 27 years after the placement of a VP shunt. The patient recovered after shunt ligation and transection. Although rare, chronic cerebrospinal fluid overdrainage can lead to cervical myelopathy due to spinal cord compression by the dilated vertebral veins/epidural venous plexus. Thus, reversible OSAM needs to be differentiated during the diagnosis of cervical myelopathy.
Photoactive Platinum(II) Azopyridine Complexes†
Authors: Farley Sarah J. , Salassa Luca , Pizarro Ana M. , Sadler Peter J.
Published: February 2021

Platinum(II) complexes containing the strong π‐acceptor N,N‐chelating ligand phenylazopyridine (Ph‐azpy) [Pt(p‐R‐Ph‐azpy)X2], R = H, NMe2 or OH, X = Cl or N3, have been synthesized and characterized to explore the effects of monodentate ligands and phenyl substituents on their absorption spectra and photoactivation. Time‐dependent density functional theory calculations showed that the complexes have a low‐lying unoccupied orbital with strong σ‐antibonding character toward the majority of the coordination bonds. The UV–visible absorption bands were assigned as mainly ligand‐centered or metal‐to‐ligand charge‐transfer transitions, with strong contributions from the chlorido and azido groups. In complexes with substituted Ph‐azpy ligands, σ‐donation from NMe2 and OH/O– groups results in a redshift of the main absorption bands compared with unsubstituted Ph‐azpy complexes. The diazido complexes are photoactive in solution upon irradiation with either UVA or visible light for R = H or NMe2, or UVA only when R = OH/O–. Intriguingly, the phenolate group of the latter complex undergoes very slow protonation in solution. Biological screening was limited by poor solubility; however, initial tests showed that the phenolato diazido complex is rapidly taken up into the nuclei of HaCaT keratinocytes, which are stained intensely blue, and its cytotoxicity is increased upon irradiation with UVA light.
Psychophysical dual‐task setups do not measure pre‐saccadic attention but saccade‐related strengthening of sensory representations
Authors: Huber‐Huber Christoph , Steininger Julia , Grüner Markus , Ansorge Ulrich
Published: February 2021

Visual attention and saccadic eye movements are linked in a tight, yet flexible fashion. In humans, this link is typically studied with dual‐task setups. Participants are instructed to execute a saccade to some target location, while a discrimination target is flashed on a screen before the saccade can be made. Participants are also instructed to report a specific feature of this discrimination target at the trial end. Discrimination performance is usually better if the discrimination target occurred at the same location as the saccade target compared to when it occurred at a different location, which is explained by the mandatory shift of attention to the saccade target location before saccade onset. This pre‐saccadic shift of attention presumably enhances the perception of the discrimination target if it occurred at the same, but not if it occurred at a different location. It is, however, known that a dual‐task setup can alter the primary process under investigation. Here, we directly compared pre‐saccadic attention in single‐task versus dual‐task setups using concurrent electroencephalography (EEG) and eye‐tracking. Our results corroborate the idea of a pre‐saccadic shift of attention. They, however, question that this shift leads to the same‐position discrimination advantage. The relation of saccade and discrimination target position affected the EEG signal only after saccade onset. Our results, thus, favor an alternative explanation based on the role of saccades for the consolidation of sensory and short‐term memory. We conclude that studies with dual‐task setups arrived at a valid conclusion despite not measuring exactly what they intended to measure.
Network‐led advocacy for a green shipping transformation: A case study of governance networks in the Norwegian maritime sector
Authors: Hessevik Agnete
Published: February 2021

Climate action has until recently been slow in the shipping industry. The sector is notoriously difficult to regulate by individual states, and international governance is moving slowly. In such a context, networks of actors can potentially contribute to a sustainability transition. In Norway, which is widely considered a leader in maritime environmental innovations, two networks have become prominent. This article studies how the cluster organization Norwegian Centre of Expertise Maritime CleanTech and the public–private partnership named the Green Shipping Programme have developed, gained influence in policymaking, and are now taking part in governing a transition toward low‐ and zero‐emission shipping. I argue that these governance networks gained governance capacity because of how network organization allow for utilization of the resources of individual members. The resources of individual network members are “mixed and matched” through network activities. In particular, the combination of technical expertise, lobbying expertise, and relational capital is important when a network seeks to influence policy in sustainability transitions.
Choroidal neuroendocrine neoplasia in a dog
Authors: Lucyshyn Danica R. , Knickelbein Kelly E. , Hollingsworth Steven R. , Reilly Christopher M. , Brust Kelsey D. , Visser Lance C. , Burge Rhonda , Willcox Jennifer L. , Maggs David J.
Published: February 2021

Objective

To report onset and progression of clinical signs of a neuroendocrine neoplasm (NEN) presumed metastatic to the choroid in a dog.

Animals Studied

A 7.5‐year‐old female spayed German shepherd dog mix referred for advanced imaging and evaluation of a subretinal mass in the right eye.

Procedures

Procedures performed included general physical and ophthalmic examinations; ocular, orbital, and abdominal ultrasonography; thoracic radiographs; cranial magnetic resonance imaging; serologic testing for infectious agents; analysis of hematologic as well as serum and urine biochemical parameters; echocardiography; electrocardiography; cytologic assessment of lymph nodes; and histopathology and immunohistochemistry of the enucleated globe.

Results

Examination and imaging identified a pigmented mass within and expanding the superior choroid. Following enucleation, a choroidal NEN with tumor emboli in scleral blood vessels was diagnosed by histopathologic assessment and confirmed by immunohistochemical labelling. Despite extensive and repeated diagnostic testing over many months, a putative primary site was not identified until 19 months after the initial ocular signs were noted. At that time, a heart‐base mass and congestive heart failure were highly suggestive of a chemodectoma.

Conclusion

This comprehensive report of a NEN presumed metastatic to the choroid in a dog suggests that ocular disease can be a very early and solitary sign of NEN in the dog.
The Workplace Comedy and Pandemic Politics in Greg Daniels’ Upload
Authors: Brayton Sean
Published: February 2021

This paper examines the critical potential and pedagogic possibilities of the workplace television comedy during the COVID-19 pandemic. It is particularly interested in Greg Daniels’ Upload, a series that debuted during the first wave of infections in North America. Although it was produced before the current health crisis, Upload offers a prescient social commentary on the depravities of late capitalism, one that speaks to present concerns over access to vital health resources and the importance of “essential” workers, specifically in the service industry. However, Upload is driven by a liberal version of multiculturalism that emphasizes racial equality and ostensibly recognizes “difference” but downplays economic disparities and racial divisions of labor even as it draws on them repeatedly in its critique of inequality. Whereas the series effectively challenges the monetization of everyday life and death, a point of praise for many critics, it fails to disrupt or even call attention to how low-wage and purportedly low-skilled work is currently and historically racialized in the US. As a result, Upload’s efficacy as a social commentary and indictment of late capitalism is more interested in the unequal distribution of essential resources and services than the political economy of their provision, that is, the social relations of their production.
Metagenomic Insights into the Metabolic and Ecological Functions of Abundant Deep-Sea Hydrothermal Vent DPANN Archaea
Authors: Cai Ruining , Zhang Jing , Liu Rui , Sun Chaomin
Published: February 2021

DPANN archaea show high distribution in the hydrothermal system, although they display small genome size and some incomplete biological processes. Exploring their metabolism is helpful to understand how such small forms of life adapt to this unique environment and what ecological roles they play.
Staphylococcus aureus Tet38 Efflux Pump Structural Modeling and Roles of Essential Residues in Drug Efflux and Host Cell Internalization
Authors: Truong-Bolduc Q. C. , Wang Y. , Hooper D. C.
Published: February 2021

The
Staphylococcus aureus
Tet38 membrane protein has distinct functions, including drug efflux and host cell attachment and internalization mediated by interaction with host cell CD36. Using structural modeling and site-directed mutagenesis, we identified key amino acids involved in different functions.
Bacteriophage Treatment Rescues Mice Infected with Multidrug-Resistant Klebsiella pneumoniae ST258
Authors: Hesse Shayla , Malachowa Natalia , Porter Adeline R. , Freedman Brett , Kobayashi Scott D. , Gardner Donald J. , Scott Dana P. , Adhya Sankar , DeLeo Frank R.
Published: February 2021

Infections caused by multidrug-resistant
K. pneumoniae
pose a serious threat to at-risk patients and present a therapeutic challenge for clinicians. Bacteriophage (phage) therapy is an alternative treatment approach that has been associated with positive clinical outcomes when administered experimentally to patients with refractory bacterial infections.
Subcellular Architecture of the
xyl
Gene Expression Flow of the TOL Catabolic Plasmid of Pseudomonas putida mt-2
Authors: Kim Juhyun , Goñi-Moreno Angel , de Lorenzo Víctor
Published: February 2021

The transfer of information between DNA, RNA, and proteins in a bacterium is often compared to the decoding of a piece of software in a computer. However, the tridimensional layout and the relational logic of the cognate biological hardware, i.e., the nucleoid, the RNA polymerase, and the ribosomes, are habitually taken for granted.
Recurrent perineal aggressive angiomyxoma: dilemma in diagnosis and outcome of this rare disease
Authors: Ambrose Nitin Paul , Coelho Victor Vijay , Roopavathana Beulah , Chase Suchita
Published: February 2021

Aggressive angiomyxoma (AAM) is a very rare, benign, locally infiltrative mesenchymal tumour with a high chance of recurrence following surgical excision. In the male population, it is so rare that less than only 50 cases have been reported so far. We present a case of a large recurrent perineal AAM in a man who presented with swelling in the perineal region following surgical excision 3 years ago. After evaluation, the diagnostic dilemma of a possible perineal hernia or recurrence remained. Surgical exploration ruled out hernia and the tumour was excised with difficulty. Immunohistochemical examination showed tumour cells with diffuse nuclear positivity for oestrogen receptor and patchy cytoplasmic positivity for desmin (A2). Histological and immunohistochemical features confirmed the diagnosis. Being very rare, AAMs need to be considered as a differential diagnosis of pelvic/perineal tumours among males. With no standardised therapy for AAM, complete resection would be the goal of therapy.
Blastomycosis with rapid-onset acute respiratory distress syndrome in an urban setting
Authors: Agarwal Arnav , Losie Jennifer A , Kain Dylan , Kaul Rupert
Published: February 2021

While blastomycosis is endemic to eastern USA and northwestern Ontario, acquisition is an anomaly in urban settings. We present a 54-year-old immunocompetent man from the greater Toronto area with no travel, who presented with a 3-week history of chest pain and dyspnoea. Initial radiographic workup revealed a mass-like opacification in the right apical mediastinum. Extensive investigations including bronchoscopy with bronchoalveolar lavage, mediastinal mass biopsy with fungal and mycobacterial cultures and multiple stains, and CT were unrevealing. The patient progressed to respiratory failure over 4 months. Ultimately, sputum and bone marrow cultures confirmed a diagnosis of disseminated blastomycosis. The patient required prolonged extracorporeal membrane oxygenation and ongoing ventilation postdecannulation. Our case highlights diagnostic challenges with blastomycosis, particularly in immunocompetent individuals with no travel to recreational areas, and emphasises the importance of maintaining a high index of suspicion and sending fungal cultures of appropriate specimens and/or cytopathology in clinically compatible cases.
Scombroid pancreatitis from mahi-mahi consumption
Authors: Hernandez Garcilazo Nora , Prasad Rohan Madhu , Varghese Merryl , Kemnic Tyler
Published: February 2021

A 61-year-old woman with no significant previous medical history presented to an urgent care facility with generalised rash, flushing and abdominal pain after eating mahi-mahi. She was diagnosed with an allergic reaction and discharged home. Later she experienced severe acute abdominal pain and multiple episodes of vomiting, which prompted her to go to the hospital. On admission, the patient had an elevated white count, lipase, amylase and C reactive protein with normal liver enzymes and bilirubin. Imaging showed acute pancreatitis that was suspected to be secondary to scombroid poisoning. This was confirmed by elevated immunoglobulin E and histamine levels. The acute pancreatitis was treated with pain management and supportive treatment. Scombroid poisoning is a well-recognised disease, however, acute pancreatitis secondary to this is rare as only two cases have been reported in the literature, one with codfish and the second an unknown type of fish.
Reasonable adjustments for people with intellectual disability in acute care: a scoping review of the evidence
Authors: Moloney Mairead , Hennessy Therese , Doody Owen
Published: February 2021

Objectives

People with intellectual disability are vulnerable in terms of health service provision due to increased comorbidity, higher dependency and cognitive impairment. This review explored the literature to ascertain what reasonable adjustments are evident in acute care to support people with intellectual disability, ensuring they have fair access and utilisation of health services.

Design

Scoping review.

Setting

Acute care settings.

Methods

Five databases were systematically searched to identify studies that reported on the implementation of reasonable adjustments. Authors worked in pairs to screen studies for inclusion, data were extracted and charted and findings were synthesised according to content and themes.

Results

Of the 7770 records identified, six studies were included in the review. The volume of evidence was influenced by specific inclusion criteria, and only papers that reported on the actual implementation of a reasonable adjustment within an acute care setting were included. Many papers reported on the concept of reasonable adjustment; however, few identified its applications in practice.

Conclusions

The scoping review highlights a lack of research on the practice and implementation of reasonable adjustments within acute care settings. There is a need for increased support, education and the provision of intellectual disability specialists across acute care settings.
Preliminary study of the relationship between career choice motivation and understanding of professionalism in newly enrolled medical students in China: a cross-sectional study
Authors: Cui Xuemei , Ding Ning , Jiang Nan , Li Honghe , Wen Deliang
Published: February 2021

Objectives

Early professionalism education for first-year students is important for generating sound knowledge and attitudes towards medical professionalism. Of the many factors affecting professionalism and professional identity formation in medical students, career choice motivation is an understudied one. This study aimed to explore the relationship between the career choice motivations of first-year medical students and their understanding of professionalism.

Settings and participants

A cross-sectional survey of 940 first-year clinical medicine students was conducted at China Medical University in September 2017 to explore students’ motivation to study medicine and its relationship with students’ understanding of professionalism. Demographics, career choice motivation and professionalism were obtained through paper questionnaires. Logistic regression analysis was used to analyse the association between career choice motivation and understanding of professionalism while controlling for potential demographic confounders.

Results

The most common career choice motivations for first-year medical students (N=843) were interested in the health sciences, income and social status and advocating altruism. The most mentioned subdimensions of professionalism were accountability, pursuit of excellence and compassion. There were significant differences in the understanding of professionalism among students with different career choice motivations.

Conclusion

First-year medical students with different motivations to study medicine also have different understandings of professionalism. Medical educators can explore motivations to learning medicine as a new entry point to providing professionalism education for newly enrolled medical students.
Are National Cancer Control Indicators for patient experiences being met in regional and remote Australia? A cross-sectional study of cancer survivors who travelled for treatment
Authors: Dunn Jeff , Goodwin Belinda , Aitken Joanne F , March Sonja , Crawford-Williams Fiona , Ireland Michael , Ralph Nicholas , Zajdlewicz Leah , Rowe Arlen , Chambers Suzanne K
Published: February 2021

Objective

To examine the health services experience of patients with cancer from regional and remote Australia using the Australian National Cancer Control Indicators (NCCI) guidelines as an assessment framework.

Design

Cross-sectional.

Setting

Queensland non-for-profit cancer accommodation lodges.

Participants

Participants were patients with cancer who travelled for treatment from rural and remote Queensland to major urban centres (n=518; age mean=64.6, SD=11.18).

Outcome measures

Assessments included NCCI patient indicators, quality of life (QoL), psychological distress and unmet supportive care needs.

Results

The frequency at which NCCI indicators were met ranged from 37.5% for receiving an assessment and care plan to 97.3% for understanding explanations about diagnosis. Geographical considerations did not impact patient experience, whereas middle school educated participants were more likely than those with senior-level education or higher to receive an assessment and care plan (OR=1.90, 95% CI 1.23 to 2.91) and to report having their views on treatment taken into account (OR=2.22, 95% CI 1.49 to 3.33). Patients with breast or prostate cancer reported better communication and patient involvement and information and services provision (r=p<0.001) compared with those with skin and head and neck cancer. When compared with information and service provision, communication and patient involvement showed stronger positive associations with QoL (z=2.03, p=0.042), psychosocial (z=2.05, p=0.040) and patient care (z=2.00, p=0.046) outcomes.

Conclusion

The patient care experience varies across the NCCI indicators by sociodemographic and clinical factors that likely reflect healthcare system biases. Perceptions about communication and involvement appear most critical for optimal outcomes and should be a priority action area for cancer control.
Cohort profile: South Australian Aboriginal Birth Cohort (SAABC)—a prospective longitudinal birth cohort
Authors: Jamieson Lisa M , Hedges Joanne , Ju X , Kapellas Kostas , Leane Cathy , Haag Dandara G , Santiago Pedro Ribeiro , Macedo Davi Manzini , Roberts Rachel M , Smithers Lisa G
Published: February 2021

Purpose

The South Australian Aboriginal Birth Cohort (SAABC) is a prospective, longitudinal birth cohort established to: (1) estimate Aboriginal child dental disease compared with population estimates; (2) determine the efficacy of an early childhood caries intervention in early versus late infancy; (3) examine if efficacy was sustained over time and; (4) document factors influencing social, behavioural, cognitive, anthropometric, dietary and educational attainment over time.

Participants

The original SAABC comprised 449 women pregnant with an Aboriginal child recruited February 2011 to May 2012. At child age 2 years, 324 (74%) participants were retained, at age 3 years, 324 (74%) participants were retained and at age 5 years, 299 (69%) participants were retained. Fieldwork for follow-up at age 7 years is underway, with funding available for follow-up at age 9 years.

Findings to date

At baseline, 53% of mothers were aged 14–24 years and 72% had high school or less educational attainment. At age 3 years, dental disease experience was higher among children exposed to the intervention later rather than earlier in infancy. The effect was sustained at age 5 years, but rates were still higher than general child population estimates. Experiences of racism were high among mothers, with impacts on both tooth brushing and toothache. Compared with population estimates, levels of self-efficacy and self-rated oral health of mothers at baseline were low.

Future plans

Our data have contributed to a better understanding of the environmental, behavioural, dietary, biological and psychosocial factors contributing to Aboriginal child oral and general health, and social and emotional well-being. This is beneficial in charting the trajectory of cohort participants’ health and well-being overtime, particularly in identifying antecedents of chronic diseases which are highly prevalent among Aboriginal Australians. Funding for continued follow-up of the cohort will be sought.

Trial registration number

ACTRN12611000111976; Post-results.
Evaluation for the safety and effectiveness of the in situ fenestration system in TEVAR for aortic arch pathologies: protocol for a prospective, multicentre and single-arm study
Authors: Sun Xiaofan , Kan Yuanqing , Huang Lihong , Dong Zhihui , Guo Daqiao , Si Yi , Fu Weiguo
Published: February 2021

Introduction

Thoracic endovascular aortic repair (TEVAR) has gradually become the mainstream therapy for aortic arch pathologies (AAP). Our centre developed the in situ fenestration (ISF) system according to years of clinical experience and technological innovation. This study aims to evaluate the safety and effectiveness of the innovative, self-developed ISF system in TEVAR for AAP.

Methods and analysis

The study is a prospective, multicentre and single-arm study. Patients diagnosed with AAPs in five centres on 1 January 2021 will be recruited and general TEVAR with ISF system will be performed. Clinical information and CT angiography images will be collected and recorded. Patients will be followed up for 5 years. Safety and efficacy endpoints are planned to be reported to evaluate this self-developed ISF system.

Ethics and dissemination

The study is a registry. We have registered the study on the Chinese Clinical Trial Registry website (http://www.chictr.org.cn/). This study has been approved by the Ethics Committee of Zhongshan Hospital Fudan University (B2020-371) and individual consents will be signed at the time of enrolment. We anticipate that this self-developed ISF system will result in favourable social and economic benefits. Findings will be disseminated in peer-reviewed journals to provide reference for future clinical practice.

Trial registration number

ChiCTR1900026696.
Smoking cessation in individuals who use vaping as compared with traditional nicotine replacement therapies: a systematic review and meta-analysis
Authors: Pound Catherine M , Zhang Jennifer Zhe , Kodua Ama Tweneboa , Sampson Margaret
Published: February 2021

Objectives

Despite the aggressive marketing of electronic nicotine device systems (ENDS) as smoking cessation tools, the evidence of their effectiveness is mixed. We conducted a systematic review of randomised controlled trials to determine the effect of ENDS on cigarette smoking cessation, as compared with other types of nicotine replacement therapies (NRT).

Design

Systematic review and meta-analysis using the Grading of Recommendations Assessment, Development and Evaluation approach.

Data sources

MEDLINE, Embase, the CENTRAL Trials Registry of the Cochrane Collaboration using the Ovid interface, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform trials registries were searched through 17 June 2020.

Eligibility criteria for studies

Randomised controlled trials in which any type of ENDS was compared with any type of NRT, in traditional cigarette users.

Data extraction and synthesis

The primary outcome was smoking cessation, defined as abstinence from traditional cigarette smoking for any time period, as reported in each included study, regardless of whether abstinence is self-reported or biochemically validated. Secondary outcomes included smoking reduction, harms, withdrawal and acceptance of therapy. A random-effect model was used, and data were pooled in meta-analyses where appropriate.

Results

Six studies were retained from 270. Most outcomes were judged to be at high risk of bias. The overall quality of evidence was graded as ‘low’ or ‘very low’. Pooled results showed no difference in smoking cessation (rate ratio (RR) 1.42, 95% CI 0.97 to 2.09), proportion of participants reducing smoking consumption (RR 1.25, 95% CI 0.79 to 1.98), mean reduction in cigarettes smoked per day (mean difference 1.11, 95% CI −0.41 to 2.63), or harms (RR 0.96, 95% CI 0.76 to 1.20), between groups.

Conclusion

We found no difference in smoking cessation, harms and smoking reduction between e-cigarette and NRT users. However, the quality of the evidence was low. Further research is needed before widespread recommendations are made with regard to the use of ENDS.

PROSPERO registration number

Systematic review registration number: protocol registered with the International Prospective Register of Systematic Reviews (PROSPERO) on February 27th, 2020; CRD42020169416.
Downsides of face masks and possible mitigation strategies: a systematic review and meta-analysis
Authors: Bakhit Mina , Krzyzaniak Natalia , Scott Anna Mae , Clark Justin , Glasziou Paul , Del Mar Chris
Published: February 2021

Objective

To identify, appraise and synthesise studies evaluating the downsides of wearing face masks in any setting. We also discuss potential strategies to mitigate these downsides.

Design

Systematic review and meta-analysis.

Data sources

PubMed, Embase, CENTRAL and EuropePMC were searched (inception–18 May 2020), and clinical registries were searched via CENTRAL. We also did a forward–backward citation search of the included studies.

Inclusion criteria

We included randomised controlled trials and observational studies comparing face mask use to any active intervention or to control.

Data extraction and analysis

Two author pairs independently screened articles for inclusion, extracted data and assessed the quality of included studies. The primary outcomes were compliance, discomforts, harms and adverse events of wearing face masks.

Results

We screened 5471 articles, including 37 (40 references); 11 were meta-analysed. For mask wear adherence, 47% (95% CI 25% to 68%, p<0.0001), more people wore face masks in the face mask group compared with control; adherence was significantly higher (26%, 95% CI 8% to 46%, p<0.01) in the surgical/medical mask group than in N95/P2 group. The largest number of studies reported on the discomfort and irritation outcome (20 studies); fewest reported on the misuse of masks, and none reported on mask contamination or risk compensation behaviour. Risk of bias was generally high for blinding of participants and personnel and low for attrition and reporting biases.

Conclusions

There are insufficient data to quantify all of the adverse effects that might reduce the acceptability, adherence and effectiveness of face masks. New research on face masks should assess and report the harms and downsides. Urgent research is also needed on methods and designs to mitigate the downsides of face mask wearing, particularly the assessment of possible alternatives.

Systematic review registration

Open Science Framework websitehttps://osf.io/sa6kf/(timestamp 20-05-2020).
Protocol for a randomised controlled trial to compare postoperative complications between minimally invasive and open DIStal PAnCreaTectomy (DISPACT-2 trial)
Authors: Probst Pascal , Schuh Fabian , Dörr-Harim Colette , Sander Anja , Bruckner Thomas , Klose Christina , Rossion Inga , Nickel Felix , Müller-Stich Beat Peter , Mehrabi Arianeb , Hackert Thilo , Büchler Markus W. , Diener Markus K.
Published: February 2021

Introduction

In recent years, minimally invasive distal pancreatectomy (MIDP) has been used with increasing frequency to accelerate patient recovery. Distal pancreatectomy has an overall morbidity rate of 30%–40%. The known advantages of minimally invasive techniques must be rigorously compared with those of open surgery before they can be completely implemented into clinical practice.

Methods and analysis

DISPACT-2 is a multicentre randomised controlled trial comparing minimally invasive (conventional laparoscopic or robotic assisted) with open distal pancreatic resection in patients undergoing elective surgery for benign as well as malign diseases of the pancreatic body and tail. After screening for eligibility and obtaining informed consent, a total of 294 adult patients will be preoperatively randomised in a 1:1 ratio. The primary hypothesis is that MIDP is non-inferior to open distal pancreatectomy in terms of postoperative mortality and morbidity expressed as the Comprehensive Complication Index (CCI) within 3 months after index operation, with a non-inferiority margin of 7.5 CCI points. Secondary endpoints include pancreas-specific complications, oncological safety and patient reported outcomes. Follow-up for each individual patient will be 2 years.

Ethics and dissemination

The DISPACT-2 trial has been approved by the Ethics Committee of the medical faculty of Heidelberg University (S-693/2017). Results of the primary endpoint will be available in 2024 and will be published at national and international meetings. Full results will be made available in an open access, peer-reviewed journal. The websitewww.dispact.decontains up-to-date information regarding the trial.

Trial registration number

DRKS00014011