bluuebunny/crossref_metadata_2025 huggingface dataset:
The development of acne vulgaris due to face masks during the pandemic, risk awareness and attitudes of a group of university students
Authors: Tunçer Vural Ayşe
Published: May 2022

Background

Recent work conducted with healthcare workers and middle‐aged populations has recognized the association between acne vulgaris (AV) and mask‐wearing.

Objective

This study aimed to evaluate the correlation between the face mask and AV in a group of university students, triggering factors, the awareness, and attitudes of the students.

Methods

A face‐to‐face survey was conducted to 200 participants (84 males, 116 females) who composed of third‐ and fifth‐grade medical faculty students. The questionnaire compiled the demographic data, skin care habits, mask‐wearing habits, skin lesions developed on their faces with the use of face masks, awareness, and attitudes of the students.

Results

The mean age of the participants was 21.39 ± 1.34 (range, 19–26 years). While 40.5% of the students developed new AV, 20.5% had exacerbation of their old AV. Lesions developed most frequently in the cheek (51%) and chin (45.5%) regions. During the COVID‐19 pandemic, being female (p = 0.04), prolonged masks use (p = 0.001), and fewer mask changes throughout the day (p = 0.01) were found to be associated with the development of AV. Moreover, 90.5% of students stated that the face mask could cause the development of AV. The most frequent protective precautions of the students were the intermittent removal of face masks and regular handwashing.

Conclusion

The use of face masks triggers the development of AV in young people. Wearing masks over long periods of time without breaks and infrequently changing one's mask throughout the day may lead to the development of new or worsening of AV in young populations.
Investigation of the relationship between seborrheic dermatitis and metabolic syndrome parameters
Authors: Akbaş Ayşe , Kılınç Fadime , Şener Sertaç , Hayran Yıldız
Published: May 2022

Background

Seborrheic dermatitis (SD) is a common, chronic inflammatory disease with relapses and remissions.

Objectives

So we planned to investigate the relationship between SD and metabolic syndrome (Mets).

Methods

54 patients over 18 years of age without known diabetes mellitus, hypertension, coronary artery disease who were clinically diagnosed with SD in our clinic and 47 healthy controls were included in the study. Body mass index (BMI) was calculated of all participants. Complete blood count, fasting blood sugar (FBG), triglyceride (TG), total cholesterol, high‐density lipoprotein (HDL), and low‐density lipoprotein (LDL) were examined. The relationship between the presence of MetS, disease severity, and duration was investigated.

Results

Average age of patients was 35.4 (sd: 12). Average age of controls was 32.9 (sd: 10.7). MetS was detected in 35.2% (n = 19) of the patient group and 10.6% (n = 5) of the control group. The presence of MetS was higher in SD patients than in the control group (p = 0.004). The rate of people with high TG was significantly higher in the SD group than the controls (p = 0.015). HDL level was significantly lower in the patient group (p = 0.050). Systolic and diastolic blood pressure were high in patients (p = 0.016, p = 0.029).

Conclusions

Seborrheic dermatitis should be considered as a MetS marker and the presence of MetS should be examined in this group of patients. This can be helpful for the early diagnosis of a systemic disease complex with numerous complications. Also, treatment of MetS can also improve SD lesions.
Clinical evaluation and microbiota analysis in 9 dogs with antibiotic‐responsive enteropathy: A prospective comparison study
Authors: Bottero Enrico , Ferriani Riccardo , Benvenuti Elena , Ruggiero Pietro , Astorina Simona , Giraldi Marco , Bertoldi Loris , Benvenuto Giuseppe , Sattin Eleonora , Gianella Paola , Suchodolski Jan S.
Published: May 2022

Background

Antibiotic‐responsive enteropathy (ARE) is diagnosed by excluding other causes of diarrhea and when there is a short‐term response to administration of antibiotics.

Objectives

To characterize the gut microbiota and clinical trend of dogs with suspected ARE and to evaluate the variation in microbiota before (T0), after 30 days (T30) of tylosin treatment, and 30 days after discontinuation of treatment (T60). A further objective was to evaluate whether changes in gut microbiota are related to relapses of diarrhea when the therapy is tapered.

Animals

Study sample (group A) was composed of 15 dogs with chronic diarrhea, group B was composed of 15 healthy dogs. Group A was given tylosin for 30 days.

Methods

A multicentric prospective study. Clinical Indexes, fecal score, and samples for microbiota analysis were collected at T0, T30, and T60 in group A and T0 and T30 in group B. The gut microbiota was analyzed via 16S ribosomal RNA gene. Qiime2 version 2020.2 was used to perform bioinformatic analyses, and Alpha‐ and Beta‐diversity were computed.

Results

Diarrhea recurred after T30 in 9 of 14 dogs, which were classified as affected by ARE. At T0, a difference was noted in the beta‐diversity between groups (Bray Curtis metric P = .006). A T0‐T30 difference in alpha‐diversity was noted in group A (Shannon index P = .001, Faith PD P = .007).

Conclusions and Clinical Importance

Although tylosin influences the microbiota of dogs with ARE, we failed to find any specific characteristic in the microbiota of dogs with ARE.
The lipopeptides fengycin and iturin are involved in the anticandidal activity of endophytic Bacillus sp. as determined by experimental and in silico analysis
Authors: Banerjee S. , Sen S. , Bhakat A. , Bhowmick A. , Sarkar K.
Published: May 2022

In this study, an endophytic Bacillus sp. strain (K7) was isolated from the medicinally important ornamental plant, Jasminum officinale. Biochemical analyses were conducted to evaluate the nature of the extracted product, which displayed strong anticandidal activity against Candida albicans (CA) SC5314, as evident from the results obtained in agar-cup diffusion tests, phase-contrast microscopy, scanning electron microscopy and minimum inhibitory concentration assays. After confirming the presence of the gene clusters encoding the lipopeptides iturins and fengycin in the genome of K7, their corresponding molecular ions were identified using MALDI-TOF-MS. 3D structures of the lipopeptides were downloaded from specific databases and molecular docking was performed against a vital CA enzyme, exo-1,3-beta-glucanase, involved in cell wall remodelling, adhesion to polymer materials and biofilm formation. The docking score of iturins was found to be −8·6 and −8·2 kcal mol−1 and for fengycin it was −9·4 kcal mol−1, indicating a strong affinity of these cyclic lipopeptides towards exo-1,3-beta-glucanase. The combined in vitro and in silico anticandidal studies suggested that these secreted lipopeptides from Bacillus sp. may be used as potential therapeutics against opportunistic and complicated infections of CA.
Coping with antagonistic predation risks: Predator‐dependent unique responses are dominant in Ceriodaphnia cornuta
Authors: Gu Lei , Qin Shanshan , Sun Yunfei , Huang Jing , Akbar Siddiq , Zhang Lu , Yang Zhou
Published: May 2022

Inducible defences of prey are evolved under diverse and variable predation risks. However, during the co‐evolution of prey and multiple predators, the responses of prey to antagonistic predation risks, which may put the prey into a dilemma of responding to predators, remain unclear. Based on antagonistic predation pressure from an invertebrate (Chaoborus larvae) and a vertebrate (Rhodeus ocellatus) predator, we studied the responses of multiple traits and transcriptomes of the freshwater crustacean Ceriodaphnia cornuta under multiple predation risks. Chaoborus predation risk altered the expression of genes encoding cuticle proteins and modulated the biosynthesis of steroid hormones, cutin, suberine, and wax, leading to the development of horns and increase in size at the late developmental stage. Meanwhile, fish predation risk primarily triggered genes encoding ribosomes and those involved in unsaturated fatty acid biosynthesis and cysteine and methionine metabolism, resulting in smaller individual size and earlier reproduction. Inducible responses of both transcriptome and individual traits revealed that predator‐dependent unique responses were dominant and the dilemma of antagonistic responses was relatively limited. However, the unique individual traits in response to invertebrate predation could be significantly impaired by vertebrate predation risk, even though the unique responses to different predators were extremely weakly correlated and could be elicited simultaneously. These results indicate that diverse predator‐dependent unique responses are favoured by Ceriodaphnia during its co‐evolution with multiple predators. Nonetheless, Ceriodaphnia is not a generalist that can fully adopt all predator‐dependent unique responses simultaneously under multiple predation risks.
Struggling with the logic of EPA frameworks
Authors: Sibbald Matt , Regehr Glenn
Published: May 2022

The authors provide a taxonomy of EPA frameworks, identifying 3 dominant lines of logic, and highlighting a fourth category of EPAs that do not lend themselves easily to entrustment ratings.
Older persons with multiple chronic conditions' experiences of unplanned readmission: An integrative review
Authors: Coatsworth‐Puspoky Robin , Dahlke Sherry , Duggleby Wendy , Hunter Kathleen F.
Published: May 2022

Background

As persons, 60 years of age and older live longer, they are more likely to develop one or more chronic conditions. Rising numbers of older persons with multiple chronic conditions (MCCs) will increase the need for home healthcare services and hospital services and unplanned readmissions will increase globally.

Aim

The aim of this integrative review was to explore the experiences of older persons with MCCs' unplanned readmission from home to hospital within 30 days of discharge using an integrative review.

Method

Whittemore and Knafl's method was followed to address the research aim. Four databases (Ovid MEDLINE, Scopus, CINAHL and Embase) were searched between 2005 and 2020, suitability for inclusion was assessed, and data were extracted and analysed using content analysis.

Results

Thirteen articles (10 qualitative, one quantitative, and two mixed methods) were included in this review. Three themes emerged from the data that reflected older persons with MCCs' unplanned readmission experiences. These themes included (a) feelings of security, support and relief; (b) undesirable challenges at home (struggling to manage care and balancing support needs); and (c) unpleasant feelings and emotions (feelings of fear and mistrust, feelings of disappointment and loss, feelings of anxiousness and pressure).

Conclusion

Research about unplanned readmission to the hospital does not provide sufficient detail or understanding about older persons with MCCs' experiences or their psychosocial experiences. Addressing research gaps related to the psychosocial processes and factors associated with unplanned readmission is needed to expand the current understanding of the process and concept of unplanned readmission.
Consumer search with anticipated regret
Authors: Jin Qingwei , Zhu Mengyan , Yang Yi , Liu Lin
Published: May 2022

Uncertainty before purchase often gives rise to postpurchase emotions that consumers might anticipate when making purchase decisions. Our study investigates how consumers' anticipated postpurchase regret affects their optimal search behavior and how this affects firms' price and assortment competition. The key tension considered in this study is that consumers balance between saving the cost of product evaluation by searching less and alleviating the potential postpurchase regret on their purchase by searching more. We use a classical sequential search framework to examine this key tension. Our results show that anticipated regret encourages more intense search across competitive alternatives, leading to an intensified price competition when search depth is exogenous (searching a fixed number of attributes) or when search depth is endogenous but full‐depth search (inspecting all attributes) emerges (with high regret intensity). However, when search depth is endogenous but partial‐depth search (inspecting a subset of attributes) emerges (with low regret intensity), the blessing effect of anticipated regret on softening firms' price competition begins to emerge. In addition, anticipated regret can achieve a “win‐win‐win” situation for consumers, firms, and the social planner. Moreover, multiproduct firms use different competitive devices with different levels of regret intensity: When regret intensity is low (high), firms focus on assortment (price) competition to retain consumers. The relevant managerial implications are discussed.
Sex differences on the relation among gross motor competence, cognition, and academic achievement in children
Authors: Fernández‐Sánchez Antonio , Redondo‐Tébar Andrés , Sánchez‐López Mairena , Visier‐Alfonso María Eugenia , Muñoz‐Rodríguez José Ramón , Martínez‐Vizcaíno Vicente
Published: May 2022

An association between gross motor competence (GMC) and academic achievement (AA) has been described, but the potential mechanisms behind this association are still unknown. It is not known either whether these mechanisms are similar for boys and girls. The aim of this study was to analyse whether the association between GMC and AA is mediated by executive functions (EFs), and to investigate whether this mediation differs by sex. This cross‐sectional study involved 451 children aged 8 to 10 (234 girls; mean age 9.95 ± 0.59). The Movement Assessment Battery for Children‐Second Edition (MABC‐2), NIH Toolbox, and grades in language and mathematics were used to test GMC, EFs, and AA, respectively. Multifactorial structural equation model (SEM) was used to evaluate a possible relation between variables, controlling for confounders. The differences by sex were examined using a multi‐group SEM approach. The results showed that EFs acted as a full mediator of the relationship between GMC and AA in boys (β = 0.14, p = 0.012) but not in girls (β = 0.10, p = 0.326). These results show that the benefit of GMC on AA is mediated by EFs in boys but not in girls. Nevertheless, these conclusions should be carefully considered due to the cross‐sectional nature of the study.
The current epidemiology of leishmaniasis in Turkey, Azerbaijan and Georgia and implications for disease emergence in European countries
Authors: Özbel Yusuf , Töz Seray , Muñoz Clara , Ortuño Maria , Jumakanova Zarima , Pérez‐Cutillas Pedro , Maia Carla , Conceição Cláudia , Baneth Gad , Pereira André , Van der Stede Yves , Gossner Céline M. , Berriatua Eduardo
Published: May 2022

Leishmania spp. are sand fly‐borne protozoan parasites causing leishmaniasis in humans and animals. The aim of the study was to analyse the epidemiology of leishmaniasis in Turkey, Azerbaijan and Georgia from 2005 to 2020 and evaluate the associated risk for disease emergence in European countries. It is based on an analysis of WHO and OIE reported cases between 2005 and 2020, a review of scientific articles published in SCOPUS between 2009 and 2020 and a questionnaire survey to public health and veterinary authorities in these countries. Endemic Leishmania spp. include L. infantum in the three countries, L. major in Azerbaijan and Turkey and L. tropica and L. donovani in Turkey. Leishmaniasis is reported in humans, animals and sand flies and incidence is spatially and temporarily variable. In the southern Caucasus and particularly in Georgia, reported incidence of human visceral leishmaniasis by L. infantum remains high. However, whilst Georgia experienced a gradual decrease from >4.0 cases per 100,000 population in 2005–09 to 1.13 cases per 100,000 population in 2020, the period with highest incidence in Azerbaijan, which ranged between 0.40 and 0.61 cases per 100,000 population, was 2016–2019, and no cases have so far been reported for 2020. Visceral leishmaniasis in the Southern Caucasus affects mostly young children from deprived urban areas and its closely associated to canine leishmaniasis. Turkey reported cases of visceral leishmaniasis between 2005 and 2012 and in 2016 only, and incidence ranged between 0.02 and 0.05 per 100,000 population. In contrast, the reported annual incidence of cutaneous leishmaniasis in Turkey was much greater and peaked at 7.02 cases per 100,000 population in 2013, associated to imported cases from cutaneous leishmaniasis endemic Syria. Leishmaniasis by L. infantum in Azerbaijan and Georgia represents a regional public and animal health challenge that requires support to improve diagnosis, treatment and control. The unprecedented rise of cutaneous leishmaniasis and the spread of L. tropica and L. donovani in Turkey is an important risk factor for their emergence in Europe, especially in Mediterranean countries where competent vectors are widespread.
Localization and nilpotent spaces in -homotopy theory
Authors: Asok Aravind , Fasel Jean , Hopkins Michael J.
Published: May 2022

For a subring$R$of the rational numbers, we study$R$-localization functors in the local homotopy theory of simplicial presheaves on a small site and then in${\mathbb {A}}^1$-homotopy theory. To this end, we introduce and analyze two notions of nilpotence for spaces in${\mathbb {A}}^1$-homotopy theory, paying attention to future applications for vector bundles. We show that$R$-localization behaves in a controlled fashion for the nilpotent spaces we consider. We show that the classifying space$BGL_n$is${\mathbb {A}}^1$-nilpotent when$n$is odd, and analyze the (more complicated) situation where$n$is even as well. We establish analogs of various classical results about rationalization in the context of${\mathbb {A}}^1$-homotopy theory: if$-1$is a sum of squares in the base field,${\mathbb {A}}^n \,{\setminus}\, 0$is rationally equivalent to a suitable motivic Eilenberg–Mac Lane space, and the special linear group decomposes as a product of motivic spheres.
Comparison of Lost Circulation Material Sealing Effectiveness in Water-Based and Oil-Based Drilling Fluids and Under Conditions of Mechanical Shear and High Differential Pressures
Authors: Klungtvedt Karl Ronny , Saasen Arild
Published: May 2022

A study was conducted to assess the performance of granular and fibrous lost circulation materials as preventative treatments and in remedial treatment of lost circulation in water-based and oil-based drilling fluids. For the preventative treatments, a factor that introduced increased mechanical wear on the particles was added to the hot-rolling process, to identify signs of deterioration of performance of certain materials. The study of remedial treatments of lost circulation was conducted on slotted discs with apertures of 750 µm and up to 5 mm and with a differential pressure of up to 34.5 MPa (5000 psi). To compare the sealing pressures of the different tests, a simple statistical analysis was introduced to differentiate between the peak holding pressures and the sustainable holding pressures of the various material and fluids combinations. The material degradation studies showed that CaCO3-based lost circulation materials rapidly experienced significant particle degradation after exposure to fluid shear and mechanical degradation and that this considerably reduced the sealing performance of the materials. Also, synthetic graphite-based products showed clear signs in particle size degradation and a significant reduction in sealing performance. Cellulose-based products showed superior resistance toward mechanical wear and only small changes in sealing performance. When comparing water-based and oil-based fluids, it was clear that granular lost circulation materials showed considerably lower sealing efficiency in oil-based drilling fluids compared to water-based drilling fluids. In contrast, cellulose-based materials showed similar sealing performance in oil-based fluids and water-based fluids.
Dynamic Analysis of a Curved Beam With Tuning of Elastic Modulus and Mass Density in Circumferential Direction
Authors: Tatari Milad , Irandoust Soroush , Ghosh Ranajay , Tjiptowidjojo Yustianto , Nayeb-Hashemi Hamid
Published: May 2022

Deformation and stress fields in a curved beam can be tailored by changing its mechanical properties such as the elastic modulus/mass density, which is typically done using functionally graded materials (FGM). Such functional gradation can be done, for instance, by using particles or fiber-reinforced materials with different volume fractions along the beam length. This article presents in-plane vibrations of functionally graded (FG) cantilevered curved beams. Both semi-analytical and finite element modeling are employed to find natural frequencies and mode shapes of such beams. The natural frequencies obtained from the analytical solution and finite element analysis are in close agreement with an error of 6.2% when the variance of material properties gradation is relatively small. In the analytical approach, the direct method is employed to derive the governing linear differential equations of motion. The natural frequencies and mode shapes are obtained using the Galerkin and the finite element methods. First, three natural frequencies and corresponding mode shapes are analyzed for different elastic modulus/mass density distribution functions. Furthermore, the natural frequencies of FG curved beams with a crack are also investigated. Our results indicate that larger cracks near the clamped side of the beam significantly decrease the first natural frequency. In the second and third vibration modes, cracks located in the area with a maximum moment result in the lowest natural frequency values. However, the second and third natural frequencies of the cracked curved beam are not affected by the presence of a crack, if the crack is located at the nodal points of the curved beam.
The evolution of cooperative breeding by direct and indirect fitness effects
Authors: García-Ruiz Irene , Quiñones Andrés , Taborsky Michael
Published: May 2022

The evolution of cooperative breeding has been traditionally attributed to the effect of kin selection. While there is increasing empirical evidence that direct fitness benefits are relevant, the relative importance of alternative selection mechanisms is largely obscure. Here, we model the coevolution of the cornerstones of cooperative breeding, delayed dispersal, and alloparental care, across different ecological scenarios while allowing individuals to adjust philopatry and helping levels. Our results suggest that (i) direct fitness benefits from grouping are the main driver for the evolution of philopatry; (ii) kin selection is mainly responsible for the emergence of alloparental care, but group augmentation can be a sufficient promoter in harsh environments; (iii) the coevolution of philopatry and alloparental care is subject to positive feedback; and (iv) age-dependent dispersal is triggered by both group benefits and relatedness. Model predictions are supported by empirical data and provide good opportunities for comparative analyses and experimental tests of causality.
Shape and interaction decoupling for colloidal preassembly
Authors: Baldauf Lucia , Teich Erin G. , Schall Peter , van Anders Greg , Rossi Laura
Published: May 2022

Creating materials with structure that is independently controllable at a range of scales requires breaking naturally occurring hierarchies. Breaking these hierarchies can be achieved via the decoupling of building block attributes from structure during assembly. Here, we demonstrate, through computer simulations and experiments, that shape and interaction decoupling occur in colloidal cuboids suspended in evaporating emulsion droplets. The resulting colloidal clusters serve as “preassembled” mesoscale building blocks for larger-scale structures. We show that clusters of up to nine particles form mesoscale building blocks with geometries that are independent of the particles’ degree of faceting and dipolar magnetic interactions. To highlight the potential of these superball clusters for hierarchical assembly, we demonstrate, using computer simulations, that clusters of six to nine particles can assemble into high-order structures that differ from bulk self-assembly of individual particles. Our results suggest that preassembled building blocks present a viable route to hierarchical materials design.
Sexually divergent development of depression-related brain networks during healthy human adolescence
Authors: Dorfschmidt Lena , Bethlehem Richard A. , Seidlitz Jakob , Váša František , White Simon R. , Romero-García Rafael , Kitzbichler Manfred G. , Aruldass Athina R. , Morgan Sarah E. , Goodyer Ian M. , Fonagy Peter , Jones Peter B. , Dolan Ray J. ,   NSPN Consortium, Harrison Neil A. , Vértes Petra E. , Bullmore Edward T.
Published: May 2022

Sexual differences in human brain development could be relevant to sex differences in the incidence of depression during adolescence. We tested for sex differences in parameters of normative brain network development using fMRI data on
N
= 298 healthy adolescents, aged 14 to 26 years, each scanned one to three times. Sexually divergent development of functional connectivity was located in the default mode network, limbic cortex, and subcortical nuclei. Females had a more “disruptive” pattern of development, where weak functional connectivity at age 14 became stronger during adolescence. This fMRI-derived map of sexually divergent brain network development was robustly colocated with i prior loci of reward-related brain activation ii a map of functional dysconnectivity in major depressive disorder (MDD), and iii an adult brain gene transcriptional pattern enriched for genes on the X chromosome, neurodevelopmental genes, and risk genes for MDD. We found normative sexual divergence in adolescent development of a cortico-subcortical brain functional network that is relevant to depression.
Gouge fabrics reset by thermal pressurization record stress on faults after earthquakes
Authors: Kuo Li-Wei , Sone Hiroki , Luzin Vladimir , Yeh En-Chao , Hsu Ya-Ju , Tan Eh
Published: May 2022

Stress on seismogenic faults provides critical information about how much elastic energy is stored in the crust and released by earthquakes, which is crucial in understanding earthquake energetics and recurrence. However, determining post-earthquake stress states on faults remains challenging because current borehole methods are rarely applicable to damaged fault zone rocks. We applied neutron texture analysis to gouge samples of the 1999 Chi-Chi earthquake in Taiwan to infer the stress state after the earthquake. Results indicate that the clay fabric within the principal slip zone is orthogonal to the fault plane, whereas outside the principal slip zone the fabric is predominantly parallel to the bedding-parallel fault plane. We suggest that the clay fabric in the slip zone was first neutralized by the coseismic fluidization caused by thermal pressurization and later re-oriented to the new direction of post-earthquake principal stress. Such stress orientation is consistent with the orientations inferred from core-scale fault slip data and dislocation models constrained from global navigation satellite system displacements. If thermal pressurization is a ubiquitous process during earthquakes, gouge fabrics can be used to help probe the post-earthquake stress state of faults.
Acute and post-acute COVID-19 presentations in athletes: a systematic review and meta-analysis
Authors: Lemes Italo Ribeiro , Smaira Fabiana Infante , Ribeiro Willian J. D. , Favero Natalia Koenig , Matos Luciana Diniz Nagem Janot , Pinto Ana Lúcia de Sá , Dolan Eimear , Gualano Bruno
Published: May 2022

Objective

To describe acute/postacute COVID-19 presentations in athletes.

Design

Systematic review and meta-analysis.

Data sources

The search was conducted in four databases (MEDLINE, EMBASE, SCOPUS, SPORTDiscus) and restricted to studies published from 2019 to 6 January 2022.

Eligibility criteria for selecting studies

Studies were required to (1) include professional, amateur or collegiate/university athletes with COVID-19; (2) present data on acute/postacute COVID-19 symptoms and (3) have an observational design. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal tools.

Results

43 studies with 11 518 athletes were included. For acute presentation, the pooled event rates for asymptomatic and severe COVID-19 were 25.5% (95% CI: 21.1% to 30.5%) and 1.3% (95% CI: 0.7% to 2.3%), respectively. For postacute presentations, the pooled estimate of persistent symptoms was 8.3% (95% CI: 3.8% to 17.0%). Pooled estimate for myocardial involvement was 5.0% (95% CI: 2.5% to 9.8%) in athletes undergoing any cardiac testing, and 2.5% (95% CI: 1.0% to 5.8%) in athletes undergoing MRI, although clinical symptoms were not characterised. None of the studies with a control group (eg, non-infected athletes) could confirm a causal relationship between COVID-19 and myocardial involvement.

Conclusion

This broad characterisation of COVID-19 presentations in athletes indicates that ~94% exhibited mild or no acute symptoms. The available evidence did not confirm a causal relationship between COVID-19 and myocardial involvement. A small proportion of athletes experienced persistent symptoms while recovering from infection, which were mostly mild in nature, but could affect return-to-play decisions and timing.
Cost-effectiveness of vitamin D3supplementation in older adults with vitamin D deficiency in Ireland
Authors: Lacey Laurence Francis , Armstrong David J , Royle Emily , Magee Pamela , Pourshahidi L Kirsty , Ray Sumantra , Strain J J , McSorley Emeir
Published: May 2022

Background

This study investigated the cost-effectiveness of vitamin D3supplementation in older adults in Ireland, with year-round vitamin D deficiency (serum 25-hydroxyvitamin D concentration <30 nmol/L) (13% of Irish adults), from the perspective of the Health Service Executive.

Methods

Three age groups were investigated: (1) ≥50 years, (2) ≥60 years and (3) ≥70 years. Based on the clinical literature, vitamin D3supplementation may: (1) decrease all-cause mortality by 7% and (2) reduce hip fractures by 16% and non-hip fractures by 20%. A discount rate of 4% was applied to life years and quality-adjusted life years (QALYs) gained, and healthcare costs. The annual healthcare costs per patient used in the model are based on the average annual health resource use over the 5-year time horizon of the model.

Results

The cost/QALY estimates in all three age groups are below the usually acceptable cost-effectiveness threshold of €20 000/QALY. The most cost-effective and least costly intervention was in adults ≥70 years. For this age group, the average annual costs and outcomes would be approximately €5.6 million, 1044 QALYs gained, with a cost/QALY of approximately €5400. The results are most sensitive to the mortality risk reduction following vitamin D3supplementation.

Conclusion

The cost-effectiveness of vitamin D3supplementation is most robust in adults ≥70 years. Clinical uncertainty in the magnitude of the benefits of vitamin D3supplementation could be further addressed by means of: (1) performing a clinical research study or (2) conducting a pilot/regional study, prior to reaching a decision to invest in a nationwide programme.
Can a practice pharmacist improve prescribing safety and reduce costs in polypharmacy patients? A pilot study of an intervention in an Irish general practice setting
Authors: Ó Ciardha Darach , Blake Anne-Marie , Creane Dylan , Callaghan Michael Ó , Darker Catherine
Published: May 2022

Objectives

This study aimed to develop and assess the feasibility and cost impact of an intervention involving a practice pharmacist embedded in general practice to improve prescribing safety, deprescribe where appropriate and reduce costs.

Setting

Four-doctor suburban general practice.

Participants

Inclusion criteria: patients receiving 10+ repeat drugs per month. Exclusion criteria: deceased, <18 years of age, nursing home resident, no longer attending, late-stage life-limiting condition, unsuitable on clinical/capacity grounds. 137 patients were eligible. 78 were recruited as participants, all of whom completed the study.

Intervention

Pharmacist conducting holistic medication reviews in the study group over a 6-month period.

Primary outcome measures

Anonymised medication changes, cost, biochemical monitoring and clinical measurements data were collected. Cost analysis of having a pharmacist as part of the general practice team was calculated.

Results

In total, 198 potentially inappropriate prescriptions (PIPs), and 163 opportunities for deprescribing were identified; 127 PIPs (64.1%) were actioned; 104 deprescribing opportunities were actioned (63.8%). The pharmacist identified 101 instances in which further investigations were warranted prior to prescription issue, of which 80 were actioned (79.2%). It was calculated that monthly savings of €1252 were made as a result of deprescribing.

Conclusions

This study has shown that the integration of pharmacists within general practice in Ireland is feasible and is an effective means of improving prescribing safety and implementing deprescribing through medication reviews. The combination of safety and cost concerns support taking a holistic approach to deprescribing with the patient. This study highlights the ease with which a pharmacist could integrate into the general practice setting in Ireland and points to how this could be sustainably funded.
Factors influencing the implementation of labour companionship: formative qualitative research in Thailand
Authors: Rungreangkulkij Somporn , Ratinthorn Ameporn , Lumbiganon Pisake , Zahroh Rana Islamiah , Hanson Claudia , Dumont Alexandre , de Loenzien Myriam , Betrán Ana Pilar , Bohren Meghan A.
Published: May 2022

Introduction

WHO recommends that all women have the option to have a companion of their choice throughout labour and childbirth. Despite clear benefits of labour companionship, including better birth experiences and reduced caesarean section, labour companionship is not universally implemented. In Thailand, there are no policies for public hospitals to support companionship. This study aims to understand factors affecting implementation of labour companionship in Thailand.

Methods

This is formative qualitative research to inform the ‘Appropriate use of caesarean section through QUALIty DECision-making by women and providers’ (QUALI-DEC) study, to design, adapt and implement a strategy to optimise use of caesarean section. We use in-depth interviews and readiness assessments to explore perceptions of healthcare providers, women and potential companions about labour companionship in eight Thai public hospitals. Qualitative data were analysed using thematic analysis, and narrative summaries of the readiness assessment were generated. Factors potentially affecting implementation were mapped to the Capability, Opportunity, and Motivation behaviour change model (COM-B).

Results

127 qualitative interviews and eight readiness assessments are included in this analysis. The qualitative findings were grouped in four themes: benefits of labour companions, roles of labour companions, training for labour companions and factors affecting implementation. The findings showed that healthcare providers, women and their relatives all had positive attitudes towards having labour companions. The readiness assessment highlighted implementation challenges related to training the companion, physical space constraints, overcrowding and facility policies, reiterated by the qualitative reports.

Discussion

If labour companions are well-trained on how to best support women, help them to manage pain and engage with healthcare teams, it may be a feasible intervention to implement in Thailand. However, key barriers to introducing labour companionship must be addressed to maximise the likelihood of success mainly related to training and space. These findings will be integrated into the QUALI-DEC implementation strategies.
Assessing the impact of selective licencing schemes for private rental housing on mental health and well-being: protocol for a mixed-method natural experiment study in Greater London, UK
Authors: Petersen Jakob , Seguin Maureen , Alexiou Alexandros , Cornelsen Laura , Courtin Emilie , Cummins Steven , Marks Dalya , Egan Matt
Published: May 2022

Introduction

The UK private rental housing market has poorer quality housing compared with other sectors and is subjected to calls for better regulation. Poor quality housing poses risks to mental and physical health, and housing improvement can potentially benefit health and well-being. Local authorities have powers to implement selective licencing (SL) schemes in specific localities. Such schemes involve landlord registration, payment of licence fees, local authority inspection and requirements that landlords conduct any necessary renovation works to ensure housing standards are met. We aim to evaluate SL in Greater London and to test the feasibility of a national evaluation.

Methods and analysis

We will measure individual-level and area-level impacts of SL in Greater London between 2011 and 2019. A difference-in-differences approach with propensity score-matched controls will be used. We propose to exploit data from the Annual Population Survey (APS) and health and social benefit registers to measure mental health and well-being at individual (self-reported anxiety) and area (Small Area Mental Health Index) level. We estimate 633 APS participants in our intervention groups compared with 1899 participants in control areas (1:3 ratio of intervention to control). Secondary outcomes will be self-reported well-being and residential stability at the individual level and incidence of police-recorded antisocial behaviour calls and population turnover at the area level. The study size of the area-level analyses will be 3684 lower layer super output areas (including controls). Qualitative semistructured interviews with lead implementers in several London boroughs will produce insights into variations and commonalities between schemes.

Ethics and dissemination

Ethical approval was obtained from London School of Hygiene and Tropical Medicine’s Ethics Committee (reference number 26481) and London Borough of Hackney. All interviewees will be asked for informed written consent. Study findings will be published in a peer-reviewed journal.
A composite clinical motor score as a comprehensive and sensitive outcome measure for Parkinson’s disease
Authors: Lo Christine , Arora Siddharth , Lawton Michael , Barber Thomas , Quinnell Timothy , Dennis Gary J , Ben-Shlomo Yoav , Hu Michele Tao-Ming
Published: May 2022

Background

An unmet need remains for sensitive outcome measures in neuroprotective trials. The study aims to determine whether a composite clinical motor score, combining the Movement Disorders Society-Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) III motor examination score, Purdue Pegboard Test, and Timed Up and Go, provides greater sensitivity in detecting motor change in early disease than the MDS-UPDRS III alone.

Methods

The Oxford Discovery longitudinal cohort study involves individuals with isolated rapid eye movement sleep behaviour disorder (iRBD) (n=272, confirmed polysomnographically, median follow-up: 1.6 years), idiopathic Parkinson’s disease (PD) (n=909, median follow-up: 3.5 years, baseline: <3.5 years disease duration) and controls (n=316, age-matched and sex-matched, without a first-degree family history of PD). Motor and non-motor assessments were performed at each in-person visit.

Results

Compared with the MDS-UPDRS III, the composite clinical motor score demonstrated a wider score distribution in iRBD and controls, lower coefficient of variation (37% vs 67%), and higher correlation coefficients with self-reported measures of motor severity (0.65 vs 0.61) and overall health status (−0.40 vs −0.33). Greater score range in mild to moderate PD, higher magnitude of longitudinal change in iRBD and longitudinal score linearity suggest better sensitivity in detecting subtle motor change. The composite clinical motor score was more accurate than the MDS-UPDRS III in predicting clinical outcomes, requiring 64% fewer participants with PD and 51% fewer participants with iRBD in sample size estimations for a hypothetical 18-month placebo-controlled clinical trial.

Conclusion

The composite clinical motor score may offer greater consistency and sensitivity in detecting change than the MDS-UPDRS III.
Dissecting the autoantibody repertoire in CASPR2-antibody encephalitis
Authors: Sun Bo , Akdeniz Deniz , Kienzler Anne-Katrin , Tan Jeanne , Ramberger Melanie , Dawes John , Trendafilova Teodora , Bennett David , Waters Patrick , Irani Sarosh
Published: May 2022

Autoantibodies to contactin-associated protein 2 (CASPR2) are found in patients with an immunothe- rapy-responsive encephalitis, and show a strong HLA-DRB1*11:01 restriction. However, no studies have focussed on how the autoreactive B cells are produced and perpetuate longitudinal autoantibody production. This question has therapeutic implications.

To isolate B-cells reactive to CASPR2, we cultured naïve and memory B-cells from two CASPR2-antibody encephalitis patients and two healthy donors with screening for CASPR2-reactivity on live-cell based assays. CASPR2-reactive immunoglobulins were cloned and recombinantly expressed as monoclonal antibodies (mAbs). Naïve B-cell CASPR2-reactivity was detected in both patients and healthy donors, both at a frequency of ~ 1/250 B cells. However, memory B-cell CASPR2-reactivity was exclusive to patients at a frequency of ~1/250. CASPR2-specific mAbs showed discrete domain-specificities between the antigen-specific naïve and memory B-cell derived clones. Furthermore, only memory B-cell-derived CASPR2-specific mAbs were able to bind live rat hippocampal neurons and induce internalisation of surface CASPR2.

In summary, we show that early B-cell tolerance against the neuronal antigen CASPR2 is not counter-se- lected in health; however, only patients have CASPR2-specific memory B-cells, suggesting that late B-cell tolerance dysfunction may have a key role in disease pathogenesis.

bo.sun@ndcn.ox.ac.uk
067  Mycoplasma auto-immune mediated encephalitis
Authors: Diyab Mohamed , Bose Sumanjeet , Zukos Ioannis , Dasari Ravi , Awad Ezzat , Saltogiannis Dmitry Ostrovsky G
Published: May 2022

49 Year old male police officer, presented with acute onset fever, headache, arthralgia, ataxia, dysar- thria, opthalmoplegia, and diplopia, on a background of a 3 day skin erythematous skin rash, which was previously treated as SWEET syndrome. Physical examination further showed cerebellar syndrome, with no pyramidal signs. Blood tests showed raised inflammatory markers. Patient was initially treated for meningoencephalitis, with no change in symptoms after antibiotics and antivirals were administered. MRI revealed hyper intensity at the right pons and cerebellar peduncles, raising concerns of subacute infarct or demyelination. Lumbar puncture showed high protein of 1.15 mg/dL, and no other findings. However, when PCR was performed on the cerebrospinal fluid, mycoplasma pneumoniae was successfully isolated. IV prednisolone 1g was initially trialled, with no obvious therapeutic response after 5 days. As antibiotics and steroids had proved ineffective, decision was made to trial IV-IG. Two courses of IV-IG were trialled on suspicion of mycoplasma auto-immune mediated encephalitis, and symptoms subsequently resolved after 5 days. MRI was repeated after neurorehabilitation, and the hyper intensity found on the previous MRI had resolved completely. (Full Case Report Available on Request)

d.mosh666@yahoo.com
069  Co-existent autoimmune disease in AQP4-IgG, MOG-IgG and seronegative NMOSD
Authors: Linaker Samantha , Kelly Patricia , Gibbons Emily , Campagna Giovanna , Whittam Daniel , Karthikeayan Venkatra- man , Mutch Kerry , Jacob Anu , Huda Saif
Published: May 2022

Background

Neuromyelitis Optica Spectrum Disorder (NMOSD) is an autoimmune inflammatory disorder of the central nervous system (CNS), and in most cases is associated with Aquaporin-4 antibodies (AQP4- IgG). Severe optic neuritis, longitudinally extensive myelitis and brain involvement is characteristic. Similarly presenting patients may not have detectable AQP4-IgG (seronegative NMOSD) or have Myelin Oligo- dendrocyte Glycoprotein IgG (MOG-IgG).

Method

A retrospective study of AQP4-IgG, MOG-IgG, and seronegative NMOSD patients attending the highly specialised NMOSD service between September 2010-August 2019 was performed. In particular, the presence of coexistent autoimmunity was assessed.

Results

Coexistent autoimmunity in AQP4-IgG patients was higher as compared to MOG-IgG and seron- egative NMOSD (30% vs. 8% vs. 8%). Some AQP4-IgG patients had 2nd and 3rd autoimmune diseases (7% and 1% respectively). In contrast no patients with MOG-IgG or seronegative NMOSD had 2 or more other autoimmune diseases.

Conclusion

Coexistent autoimmunity in AQP4-IgG NMOSD is more common that in seronegative NMOSD and patients with MOG-IgG. It is reasonable to periodically assess for coexistent autoimmunity in AQP4-IgG NMOSD as it is present in almost a third of patients. Finally the detection of ≥2 autoimmune diseases in newly presenting cases provides a useful clue to AQP4-IgG NMOSD whilst antibody results are awaited.

giovanna.campagna@thewaltoncentre.nhs.uk
071  Causes of death in AQP4-IgG neuromyelitis optica spectrum disorder
Authors: Gibbons Emily , Everett Rosie , Whittam Daniel , Karthikeayan Venkatraman , Messina Silvia , Radu Simona , Leite Maria Isabel , Palace Jacqueline , Huda Saif , Jacob Anu
Published: May 2022

Objective

To evaluate causes of death in Aquaporin-4 antibody positive Neuromyelitis Optica Spectrum Disorder (AQP4-IgG NMOSD) patients treated in the National NMOSD service.

Method

Retrospective review of Liverpool and Oxford patient databases (NMOSD national referral centres) between January 2010–2020.

Results

AQP4-IgG NMOSD=414 patients attended the NMOSD Service and 34 died. Of these, 32/34(94%) were female with a median disease duration of 10 years (0.5–19.1). The median age at death was 67.1(45.1–88.3) years. Median EDSS score prior to death was 8(2–9.5). The median number of relapses from disease onset to death was 3(0–10), with 94% of patients experiencing at least 1 relapse. All but one patient was immunosuppressed (Azathioprine=15, Mycophenolate=3, Rituximab=7, Methotrexate=4, IVIg=1, Ciclosporin=1, Eculizumab=1, Prednisolone=1). Causes of death were available in 31/34 patients; infections=18, coronary artery disease=5, malignancy=4, bowel obstruction=1 and respiratory failure=2. Only one patient died from an acute brain stem relapse.

Conclusion

Approximately 1 in 10 AQP4-NMOSD patients died over a 10-year period. The majority of patients had significant disability, suggesting possible association with NMOSD mortality. Infection was the leading cause of death, suggesting a possible relationship with immunosuppression. Striking a balance between disease suppression and mitigation of side effects poses a significant challenge in autoimmune neurological conditions.

emily.gibbons@doctors.org.uk