bluuebunny/crossref_metadata_2025 huggingface dataset:
Does geriatric follow-up visits reduce hospital readmission among older patients discharged to temporary care at a skilled nursing facility: a before-and-after cohort study
Authors: Thomsen Katja , Fournaise Anders , Matzen Lars Erik , Andersen-Ranberg Karen , Ryg Jesper
Published: August 2021

Introduction

Hospital readmission is a burden to patients, relatives and society. Older patients with frailty are at highest risk of readmission and its negative outcomes.

Objective

We aimed at examining whether follow-up visits by an outgoing multidisciplinary geriatric team (OGT) reduces unplanned hospital readmission in patients discharged to a skilled nursing facility (SNF).

Design

A retrospective single-centre before-and-after cohort study.

Setting and participants

Study population included all hospitalised patients discharged from a Danish geriatric department to an SNF during 1 January 2016–25 February 2020. To address potential changes in discharge and readmission patterns during the study period, patients discharged from the same geriatric department to own home were also assessed.

Intervention

OGT visits at SNF within 7 days following discharge. Patients discharged to SNF before 12 March 2018 did not receive OGT (−OGT). Patients discharged to SNF on or after 12 March 2018 received the intervention (+OGT).

Main outcome measures

Unplanned hospital readmission between 4 hours and 30 days following initial discharge.

Results

Totally 847 patients were included (440 −OGT; 407 +OGT). No differences were seen between the two groups regarding age, sex, activities of daily living (ADLs), Charlson Comorbidity Index (CCI) or 30-day mortality. The cumulative incidence of readmission was 39.8% (95% CI 35.2% to 44.8%, n=162) in −OGT and 30.2% (95% CI 25.8% to 35.2%, n=113) in +OGT. The unadjusted risk (HR (95% CI)) of readmission was 0.68 (0.54 to 0.87, p=0.002) in +OGT compared with –OGT, and remained significantly lower (0.72 (0.57 to 0.93, p=0.011)) adjusting for age, length of stay, sex, ADL and CCI. For patients discharged to own home the risk of readmission remained unchanged during the study period.

Conclusion

Follow-up visits by OGT to patients discharged to temporary care at an SNF significantly reduced 30-day readmission in older patients.
Study protocol for the evaluation of long-term effects of the school-based obesity prevention program Lekker Fit! (‘enjoy being fit’): a retrospective, controlled design
Authors: Smit Michel Sebastiaan , Raat Hein , Mölenberg Famke , Wolfers Mireille Eleonore Gabriëlle , Bannink Rienke , Jansen Wilma
Published: August 2021

Introduction

Preventive interventions to reduce overweight and obesity in childhood and adolescence are studied on their effectiveness worldwide. A number with positive results. However, long-term effects of these interventions and their potentially wider influence on well-being and health have been less studied. This study aims to evaluate the long-term effects of a multicomponent intervention in elementary school children targeting individual behaviour as well as environment (Lekker Fit!). The primary outcomeis body mass index and the secondary outcomes are waist circumference, weight status, physical fitness, lifestyle, psychosocial health and academic performance.

Methods and analysis

In a naturalistic effect evaluation with a retrospective, controlled design adolescents in secondary schools, from intervention and non-intervention elementary schools, will be compared on a wide set of outcome variables. Data will be collected by questionnaires and through anthropometric and fitness measurements by trained physical education teachers and research assistants. Baseline data consist of measurements from the adolescents at the age of 5 years old and are gathered from preventive youth healthcare records, from before the intervention took place. Multilevel regression models will be used and adjusted for baseline measurements and potential confounding variables on the individual and environmental level. Furthermore, propensity scores will be applied.

Ethics and dissemination

The study has been approved by the Medical Research Ethics Committee of the Erasmus Medical Centre, Rotterdam, The Netherlands (permission ID: MEC-2020-0644). Study findings will be disseminated in peer-reviewed journals and by conference presentations.

Trial registration number

NL8799. Pre-results.
Innovative measurement of routine physiological variables (heart rate, respiratory rate and oxygen saturation) using a remote photoplethysmography imaging system: a prospective comparative trial protocol
Authors: Allado Edem , Poussel Mathias , Moussu Anthony , Saunier Véronique , Bernard Yohann , Albuisson Eliane , Chenuel Bruno
Published: August 2021

Introduction

Physiological signals are essential for assessing human health. The absence of a medical device to carry out these measurements remotely is one of the main limitations of telemedicine. Remote photoplethysmography imaging (rPPG) makes it possible to use a camera video to measure some of the most valuable physiological variables: heart rate (HR), respiratory rate (RR) and oxygen saturation (SpO2). Our objective was to evaluate the value of such remote measurements compared with existing contact point measurements techniques in real-life clinical settings.

Methods and analysis

Prospective hospital-based study that will recruit 1045 patients who require a pulmonary function test. For each patient, measurements of HR, RR and SpO2, using a standard acquisition system, will be carried out concomitantly with the measurements made by the rPPG system. 30, 60 and 120 s time frames will be used to take measurements. Age, gender and skin phototype will also be collected. The intraclass coefficient correlation will be performed to determine the accuracy and precision of the rPPG algorithm readings.

Ethics and dissemination

The study protocol has been approved by the French Agency for the Safety of Health Products (ANSM registration no. ID RCB 2020-A02428-31) and by a French ethics committee (CPP OUEST I-TOURS-2020T1-30 DM at 30 October 2020). Results will be published in peer-reviewed journals, at scientific conferences and through press releases.

Trial registration number

NCT04660318.
Low-dose aspirin for preventing intrauterine growth restriction and pre-eclampsia in sickle cell pregnancy (PIPSICKLE): a randomised controlled trial (study protocol)
Authors: Afolabi Bosede Bukola , Babah Ochuwa Adiketu , Adeyemo Titilope Adenike , Odukoya Oluwakemi Ololade , Ezeaka Chinyere Veronica , Nwaiwu Obinyo , Oshodi Yusuf Abisowo , Ogunnaike Babatunde A
Published: August 2021

Introduction

Pregnancy in sickle cell disease is fraught with many complications including pre-eclampsia (PE) and intrauterine growth restriction (IUGR). Previously, we found an abnormality in prostacyclin–thromboxane ratio in sickle cell pregnant women, a situation that is also found in non-sickle pregnancies with PE and unexplained IUGR. Low-dose aspirin (LDA) has been shown to reduce the incidence of PE and IUGR in high-risk women by reducing the vasoconstrictor thromboxane while sparing prostacyclin, in effect ‘correcting’ the ratio. It has been found to be safe for use in pregnancy but has not been tested in sickle cell pregnancy. We hypothesise that LDA will reduce the incidence of IUGR and PE in pregnant haemoglobin SS (HbSS) and haemoglobin SC (HbSC) women.

Methods and analysis

This is a multisite, double blind, randomised controlled trial, comparing a daily dose of 100 mg aspirin to placebo, from 12 to 16 weeks’ gestation until 36 weeks, in Lagos state, Nigeria. Four hundred and seventy-six eligible pregnant HbSS and HbSC women will be recruited consecutively, randomly assigned to either group and followed from recruitment until delivery. The primary outcome will be the incidence of birth weight below 10th centile for gestational age on INTERGROWTH 21 birth weight charts, or incidence of miscarriage or perinatal death. Secondary outcomes will include PE, maternal death, preterm delivery, perinatal death, number of crises, need for blood transfusion and complications such as infections and placental abruption. Analysis will be by intention to treat and the main treatment effects will be quantified by relative risk with 95% CI, at a 5% significance level.

Ethical approval

Ethical approval has been granted by the Health Research and Ethics committees of the recruiting hospitals and the National Health Research and Ethics Committee. Study findings will be presented at conferences and published appropriately.

Trail registration number

PACTR202001787519553; Pre-results.
Changes in medical use of central nervous system stimulants among US adults, 2013 and 2018: a cross-sectional study
Authors: Moore Thomas J , Wirtz Phillip W , Kruszewski Stefan P , Alexander G Caleb
Published: August 2021

Objective

To assess the 5-year changes in the adult medical use of central nervous system (CNS) stimulants with higher risk of dependence and evaluate the population characteristics of users and their medical and/or neurological conditions.

Design

Cross-sectional study.

Setting

Annual US Medical Expenditure Panel Survey, a stratified random sample of approximately 30 000 persons designed to produce national population estimates. It focuses on reported medical spending, medical services used, health status and prescription medications.

Participants

Adults age 19 years and older who reported obtaining one or more prescriptions for amphetamine or methylphenidate products during two survey years, 2013 and 2018.

Main outcomes measures

Prescriptions obtained, the specific stimulant product and annual treatment days of drug supplied.

Results

In 2018, an estimated 4.1 million US adults (95% CI 3.4 million to 4.8 million) reported prescriptions for CNS stimulants, having filled a mean of 7.3 (95% CI 6.8 to 7.8) prescriptions with a mean of 226 (95% CI 210 to 242) days’ supply. Compared with 2013, the estimated number of adults reporting using CNS stimulants in 2018 increased by 1.8 million (95% CI 1.0 million to 2.7 million) or 79.8%. Most 2018 adult stimulant users reported taking psychoactive medication for one or more mental, behavioural or neurodevelopment disorders. Overall, 77.8% (95% CI 72.6% to 83.0%) reported some medication for adult attention deficit disorder, 26.8% (95% CI 22.2% to 31.5%) took medication for anxiety, 25.1% (95% CI 19.9% to 30.3%) for depression and 15.3% (95% CI 9.8% to 20.8%) indicated drug treatment for other mental or neurological disorders. Adult CNS stimulant use was higher in females, in younger age cohorts and among individuals of white race/ethnicity.

Conclusions

Adult medical use of prescription stimulants increased markedly in 5 years and occurred in a population often reporting multiple mental or neurological disorders. Further action is needed to understand and manage this new resurgence in drugs with high risks of dependence.
Relationship between maternal healthcare utilisation and empowerment among women in Bangladesh: evidence from a nationally representative cross-sectional study
Authors: Anik Asibul Islam , Ghose Bishwajit , Rahman Md. Mosfequr
Published: August 2021

Objective

To examine the relationship between women’s empowerment and maternal healthcare utilisation in Bangladesh.

Design

This cross-sectional study uses data from the most recent nationally representative Bangladesh Demographic and Health Survey, 2017–2018.

Setting

Bangladesh.

Participants

Married women aged 15–49 years who had a live birth within the 3 years preceding the survey (n=4767).

Primary and secondary outcome measures

Women’s empowerment was measured using the recently developed and validated survey-based Women’s emPowERment (SWPER) index. The index includes three domains: social independence, decision-making and attitude to violence. Outcomes included utilisation of at least one antenatal care from skilled providers (ANC1), at least four antenatal care visits (≥4 ANC), delivery assisted by a skilled birth attendant (SBA) and a postnatal visit within 2 days of delivery (PNC). Logistic regression analyses were used to assess the identified relationships.

Results

Among participants, 83% received ANC1, 46.3% received ≥4 ANC, 51.9% reported SBA and 50.9% sought PNC. Women with high levels of social empowerment relative to those with low levels were more likely to use ANC1 (adjusted OR (AOR) 1.85; 95% CI 1.40 to 2.45), ≥4 ANC (AOR 1.55; 95% CI 1.27 to 1.90), SBA (AOR 2.12; 95% CI 1.71 to 2.62) and PNC (AOR 1.95; 95% CI 1.56 to 2.44). Compared with women with low levels of decision-making empowerment, women with high levels were more likely to use SBA (AOR 1.49; 95% CI 1.21 to 1.83) and PNC (AOR 1.47; 95% CI 1.19 to 1.81). Additionally, significant inequality was observed among women moving from low to high empowerment in all domains of the empowerment index.

Conclusions

Higher empowerment levels were positively associated with maternal healthcare utilisation in Bangladesh. Our findings suggest the need to address women’s empowerment in policies aiming to expand health service utilisation.
Study protocol for the TRUSt trial: a pragmatic randomised controlled trial comparing the standard of care with a transitional pain service for patients at risk of chronic postsurgical pain undergoing surgery
Authors: Admiraal Manouk , Hermanns Henning , Hermanides Jeroen , Wensing Carin G.C.L. , Meinsma Soe L. , Wartenberg Hans C. H. , Rutten Martin V. H. , Ward - van der Stam Vivian M. C. , Hollmann Markus W.
Published: August 2021

Introduction

Patients with either surgery-related or patient-related risk factors are at an increased risk of acute and chronic postsurgical pain (CPSP) and long-term opioid use. To improve recovery, prevent CPSP and decrease opioid use, we need to identify these patients before surgery and provide a multidisciplinary pain management strategy throughout hospital admission and follow-up in the postdischarge period. We hypothesise that a multidisciplinary transitional pain service (TPS) improves quality of recovery and reduce the incidence of CPSP and opioid consumption.

Methods and analysis

We aim to investigate the effectiveness of implementation of a TPS for patients at risk of developing CPSP. The trial design is a pragmatic, open-label, randomised controlled trial (RCT). After stratification for sex, patients are randomly assigned to the TPS or standard of care (SOC) group. Our primary outcome is the quality of recovery, measured at the morning of the third postoperative day, employing the quality of recovery (QoR)-15 questionnaire. Secondary outcomes are the incidence of CPSP, opioid consumption and patient-reported outcome measures at 3 and 6 months postoperatively. We need to enrol 176 patients to detect a minimal clinical important difference of 8 points on the QoR-15 score.

Ethics and dissemination

Ethics approval was obtained by the accredited medical research ethics committee of the Academic Medical Center in Amsterdam (2020_211) on 15 October 2020. Protocol version 3.2 was approved on 25 January 2020. The trial is registered with the Netherlands Trial Register, NL9115. The results will be disseminated by open access publication in a peer-reviewed journal.

Trial registration numberNL9115
Municipal acute care teams as a flexible solution for the treatment of acutely ill patients at-home: a mixed-method study of patients’ and caregivers’ experiences with an acute care team
Authors: Udesen Stine Emilie Junker , Nielsen Dorthe Susanne , Andersen Nina , Østervang Christina , Lassen Annmarie Touborg
Published: August 2021

Objective

Development of initiatives to reduce hospitalisations is a major focus of healthcare planning. Strengthening the community with municipal acute care teams or units is a newly implemented Danish initiative aimed at preventing hospitalisations and supporting more flexible services. This study aims to describe patients treated by a municipal acute care team and to explore patients’ and caregivers’ experiences with at-home treatment.

Design

A mixed-method study consisting of descriptive statistics of patients treated by an acute care team, and quantitative and qualitative data from follow-up telephone questionnaires with patients and caregivers.

Setting

The acute care team, ‘Acute Team Odense’ (ATO), in the Odense Municipality, Denmark.

Participants

Patients treated by ATO and their caregivers. ATO treated 3231 patients (5676 contacts) in the period of 2018–2019.

Results

Average number of new contacts per day was 7.8, and the median treatment-length was 1 day. Patients were referred by various healthcare providers and most often by general practitioners, municipal staff and hospital staff. The median age of the patients was 80 years, and 20% were independent before the treatment. In total, 787/5676 contacts received at-home intravenous therapy, which corresponded to 3.6 hospital beds saved per day. The questionnaires were completed by 307/478 patients and 168/254 caregivers. Most respondents stated they would prefer at-home treatment in future similar situations as it enabled them to maintain their lives. Several respondents also experienced that ATO avoided hospitalisations or reduced hospital stays, which was described as a relief.

Conclusion

ATO was frequently used, indicating the demand for community-based acute healthcare. The patients and caregivers experienced that this solution avoided hospitalisations and allowed them to maintain their lives, and this was described as less burdensome. As a result of these findings, this initiative has been continued with an ongoing focus on searching for possibilities aimed to prevent hospitalisations.
Analysis of the factors affecting the adoption and compliance of the NHS COVID-19 mobile application: a national cross-sectional survey in England
Authors: Panchal Marcus , Singh Sukhpreet , Rodriguez-Villegas Esther
Published: August 2021

Objectives

To conduct an independent study investigating how adults perceive the usability and functionality of the ‘National Health Service (NHS) COVID-19’ application (app). This study aims to highlight strengths and provide recommendations to improve adoption of future contact tracing developments.

Design

A 60-item, anonymous online questionnaire, disseminated through social media outlets and email lists by a team from Imperial College London.

Setting

England.

Participants

Convenience sample of 1036 responses, from participants aged 18 years and above, between December 2020 and January 2021.

Primary outcome measures

Evaluate the compliance and public attitude towards the ‘NHS COVID-19’ app regarding its functionality and features. This included whether participants’ expectations were met, and their thoughts on the app privacy and security. Furthermore, to distinguish how usability, perception, and adoption differed with varying demographics and user values.

Results

Fair compliance with the app features was identified, meeting expectations of the 62.1% of participants who stated they downloaded it after weighted analysis. However, participants finding the interface challenging were less likely to read information in the app and had a lesser understanding of its functionality. Furthermore, little understanding regarding the app’s functionality and privacy concerns was a possible reason why users did not download it. A readability analysis of the text revealed information within the app was conveyed at a level that may be too complex for up to 43% of the UK population. The study highlighted issues related to the potential of false positives caused by the design choices in the ‘Check-In’ feature.

Conclusion

This study showed that while the ‘NHS COVID-19’ app was viewed positively, there remained issues regarding participants’ perceived knowledge of app functionality, potentially affecting compliance. Therefore, we recommended improvements regarding the delivery and presentation of the app’s information, and highlighted the potential need for the ability to check out of venues to reduce the number of false positive contacts.
Cardiorespiratory fitness in breast cancer survivors: a randomised controlled trial of home-based smartphone supported high intensity interval training
Authors: Ochi Eisuke , Tsuji Katsunori , Narisawa Tomomi , Shimizu Yoichi , Kuchiba Aya , Suto Akihiko , Jimbo Kenjiro , Takayama Shin , Ueno Taro , Sakurai Naomi , Matsuoka Yutaka
Published: August 2021

Background

A strategy for maintaining and/or improving cardiorespiratory fitness (CRF) in the growing population of cancer survivors is of major clinical importance, especially in the COVID-19 era. The effect of unsupervised high-intensity interval training (HIIT) on increasing CRF in breast cancer survivors is unknown.

Purpose

The purpose of this study was to determine whether the newly developed habit-B programme, which involves home-based smartphone-supported HIIT using body weight exercises, improves CRF in early-stage breast cancer survivors.

Methods

This single-centre, 12-week, parallel-group, single-blind, randomised controlled trial involved 50 women with stage I–IIa breast cancer, aged 20–59 years, who had completed initial treatment except for hormone therapy. Participants were randomised to either the exercise or control group. The primary outcome was the 12-week change in peak oxygen uptake(V˙O2peak). Other outcomes included muscle strength, 6 min walk test, resting heart rate, physical activity, fatigue, safety and quality of life.

Results

The change inV˙O2peakand leg strength increased significantly in the exercise group compared with the control group (p<0.01). Changes in other outcomes were not significantly different between the groups.

Conclusion

A home-based HIIT intervention can lead to improve CRF and muscle strength in early-stage breast cancer survivors.
Opioid safety recommendations in adult palliative medicine: a North American Delphi expert consensus
Authors: Lau Jenny , Mazzotta Paolo , Whelan Ciara , Abdelaal Mohamed , Clarke Hance , Furlan Andrea D , Smith Andrew , Husain Amna , Fainsinger Robin , Hui David , Sunderji Nadiya , Zimmermann Camilla
Published: August 2021

Objectives

Despite the escalating public health emergency related to opioid-related deaths in Canada and the USA, opioids are essential for palliative care (PC) symptom management.

Opioid safety is the prevention, identification and management of opioid-related harms. The Delphi technique was used to develop expert consensus recommendations about how to promote opioid safety in adults receiving PC in Canada and the USA.

Methods

Through a Delphi process comprised of two rounds, USA and Canadian panellists in PC, addiction and pain medicine developed expert consensus recommendations. Elected Canadian Society of Palliative Care Physicians (CSPCP) board members then rated how important it is for PC physicians to be aware of each consensus recommendation.

They also identified high-priority research areas from the topics that did not achieve consensus in Round 2.

Results

The panellists (Round 1, n=23; Round 2, n=22) developed a total of 130 recommendations from the two rounds about the following six opioid-safety related domains: (1) General principles; (2) Measures for healthcare institution and PC training and clinical programmes; (3) Patient and caregiver assessments; (4) Prescribing practices; (5) Monitoring; and (6) Patients and caregiver education. Fifty-nine topics did not achieve consensus and were deemed potential areas of research. From these results, CSPCP identified 43 high-priority recommendations and 8 high-priority research areas.

Conclusions

Urgent guidance about opioid safety is needed to address the opioid crisis. These consensus recommendations can promote safer opioid use, while recognising the importance of these medications for PC symptom management.
RecombinantMycobacterium smegmatisdelivering a fusion protein of human macrophage migration inhibitory factor (MIF) and IL-7 exerts an anticancer effect by inducing an immune response against MIF in a tumor-bearing mouse model
Authors: Jeong Hyein , Lee So-Young , Seo Hyejun , Kim Bum-Joon
Published: August 2021

Background

Macrophage migration inhibitory factor (MIF) is a pleotropic inflammatory cytokine that is overexpressed in a number of cancer types including most types of human cancer. Inhibition of MIF signaling can restore anticancer immune responses in tumor microenvironments. In this study, we aimed to develop a therapeutic vaccine capable of inhibiting tumor development by inducing anti-MIF immune responses.

Methods

We introduced a recombinantMycobacterium smegmatis(rSmeg-hMIF-hIL-7) vaccine that could deliver a fusion protein of human macrophage migration inhibitory factor (MIF) and interleukin 7, which could act as a target antigen and as an adjuvant of cancer vaccine, respectively. We checked the anticancer potential of the vaccine in a tumor-bearing mouse model.

Results

We found that rSmeg-hMIF-hIL-7 showed enhanced oncolytic activity compared with PBS, BCG or Smeg in MC38-bearing mice, and there was an increase in the humoral and cell-mediated immune responses against MIF. rSmeg-hMIF-hIL-7 can also induce a neutralizing effect regarding MIF tautomerase activity in the serum of vaccinated mice. We also found downregulation of MIF, CD74, and CD44, which are related to the MIF signaling pathway and PI3K/Akt and MMP2/9 signaling, which are regulated by MIF in the tumor tissue of rSmeg-hMIF-hIL-7-vaccinated mice, suggesting a significant role of the anti-MIF immune response to rSmeg-hMIF-hIL-7 in its anticancer effect. In addition, rSmeg-hMIF-hIL-7 treatment led to enhanced activation of CD4+and CD8+T cells in the tumor regions of vaccinated mice, also contributing to the anticancer effect. This trend was also found in LLC-bearing and PanO2-bearing mouse models. In addition, rSmeg-hMIF-hIL-7 treatment exerted an enhanced anticancer effect with one of the immune checkpoint inhibitors, the anti-PD-L1 antibody, in a tumor-bearing mouse model.

Conclusions

In conclusion, our data showed that rSmeg-hMIF-hIL-7 exerts a strong antitumor immune response in mice, possibly by inhibiting the MIF-dependent promotion of tumorigenesis by the anti-MIF immune response and via enhanced cytotoxic T cell recruitment into tumor microenvironments. We also found that it also exerted an enhanced anticancer effect with immune checkpoint inhibitors. These results suggest that rSmeg-hMIF-hIL-7 is a potential adjuvant for cancer immunotherapy. This is the first report to prove anticancer potential of immunotherapeutic vaccine targeting immune response against MIF.
Implantable loop recorders in patients with heart disease: comparison between patients with and without syncope
Authors: Assaf Amira , Sakhi Rafi , Michels Michelle , Roos-Hesselink Jolien W , Verhagen Judith M A , Bhagwandien Rohit E , Szili-Torok Tamas , Theuns Dominic , Yap Sing-Chien
Published: August 2021

Objective

Patients with heart disease are at increased risk for sudden cardiac death. Guidelines recommend an implantable loop recorder (ILR) for symptomatic patients when symptoms are sporadic and possibly arrhythmia-related. In clinical practice, an ILR is mainly used in patients with unexplained syncope. We aimed to compare the clinical value of an ILR in patients with heart disease and a history of syncope versus those with non-syncopal symptoms.

Methods

In this observational single-centre study, we included symptomatic patients with heart disease who received an ILR. The primary endpoint was an actionable event which was defined as an arrhythmic event leading to a change in clinical management. The secondary endpoint was an event leading to device implantation.

Results

One hundred and twenty patients (mean age 47±17 years, 49% men) were included. The underlying disease substrate was inherited cardiomyopathy (31%), congenital heart disease (28%), channelopathy (23%) and other (18%). Group A consisted of 43 patients with prior syncope and group B consisted of 77 patients with palpitations and/or near-syncope. The median follow-up duration was 19 months (IQR 8–36). The 3-year cumulative event rate was similar between groups with regard to the primary endpoint (38% vs 39% for group A and B, respectively, logrank p=0.54). There was also no difference in the 3-year cumulative rate of device implantation (21% vs 13% for group A and B, respectively, logrank p=0.65).

Conclusion

In symptomatic patients with heart disease, there is no difference in the yield of an ILR in patients presenting with or without syncope.
Cerebellar ataxia, neuropathy and vestibular areflexia syndrome (CANVAS): genetic and clinical aspects
Authors: Cortese Andrea , Curro' Riccardo , Vegezzi Elisa , Yau Wai Yan , Houlden Henry , Reilly Mary M
Published: August 2021

Cerebellar ataxia, neuropathy and vestibular areflexia syndrome (CANVAS) typically presents in middle life with a combination of neuropathy, ataxia and vestibular disease, with patients reporting progressive imbalance, oscillopsia, sensory disturbance and a dry cough. Examination identifies a sensory neuropathy or neuronopathy and bilaterally impaired vestibulo-ocular reflex. The underlying genetic basis is of biallelic AAGGG expansions in the second intron of replication factor complex subunit 1 (RFC1). The frequency and phenotype spectrum of RFC1 disease is expanding, ranging from typical CANVAS to site-restricted variants affecting the sensory nerves, cerebellum and/or the vestibular system. Given the wide phenotype spectrum of RFC1, the differential diagnosis is broad. RFC1 disease due to biallelic AAGGG expansions is probably the most common cause of recessive ataxia. The key to suspecting the disease (and prompt genetic testing) is a thorough clinical examination assessing the three affected systems and noting the presence of chronic cough.
‘Scan-negative’ cauda equina syndrome: what to do when there is no neurosurgical cause
Authors: Hoeritzauer Ingrid , Stanton Biba , Carson Alan , Stone Jon
Published: August 2021

Suspected cauda equina syndrome is a common presentation in emergency departments, but most patients (≥70%) have no cauda equina compression on imaging. As neurologists become more involved with ‘front door’ neurology, referral rates of patients with these symptoms are increasing. A small proportion of patients without structural pathology have other neurological causes: we discuss the differential diagnosis and how to recognise these. New data on the clinical features of patients with ‘scan-negative’ cauda equina syndrome suggest that the symptoms are usually triggered by acute pain (with or without root impingement) causing changes in brain–bladder feedback in vulnerable individuals, exacerbated by medication and anxiety, and commonly presenting with features of functional neurological disorder.
Hypnosis
Authors: Phillips Wendy , Price Jason , Molyneux Paul D , Deeley Quinton
Published: August 2021

Clinical hypnosis is an important therapeutic tool with an increasingly understood cognitive and neurobiological basis, and evidence for efficacy. Hypnosis involves controlled modulation of components of cognition—such as awareness, volition, perception and belief—by an external agent (the hypnotist) or by oneself (self-hypnosis) employing suggestion. In this article, we describe what hypnosis is, how it can be used in clinical settings, and how it is done.
When the balloon goes up, blood transfusion goes down: a pilot study of REBOA in placenta accreta spectrum disorders
Authors: Ioffe Yevgeniya J M , Burruss Sigrid , Yao Ruofan , Tse Beverly , Cryer Alicia , Mukherjee Kaushik , Hong Linda J
Published: August 2021

Background

Patients with placenta accreta spectrum (PAS) disorders often suffer massive hemorrhage during cesarean hysterectomies (CHyst). A novel strategy to decrease blood loss and minimize perioperative morbidity associated with PAS is utilization of ER-REBOA Catheter intraoperatively. In this study, we explore the use of ER-REBOA Catheter during CHyst with the goal of minimizing perioperative morbidity and packed red blood cell (PRBC) transfusions.

Methods

We conducted a retrospective case–control study at a regional referral center of consecutive patients with PAS undergoing CHyst. The primary outcomes were PRBC transfusions of ≥4 units. Secondary outcomes included surgical intensive care unit admissions, postoperative length of stay (LOS), postoperative ileus, and vascular complication rate. We also explored utilization of manual palpation and omission of precesarean fluoroscopy for resuscitative endovascular balloon occlusion of the aorta (REBOA) placement verification in distal aortic zone 3.

Results

90 patients were included in the study. REBOA and non-REBOA cases were similar in clinicodemographic characteristics. 17.7% of REBOA cases received ≥4 units of PRBC compared with 49.3% of non-REBOA cases (p=0.03). Zero REBOA patients developed postoperative ileus, whereas 18 (25%) non-REBOA patients did (p=0.02). LOS was reduced in the REBOA group. Postplacement fluoroscopy was omitted in all REBOA cases. Two postoperative arterial thrombotic events (2 of 19, 11% of REBOA patients) were identified in the REBOA group, one requiring a thrombectomy (1 of 19, 5%).

Discussion

Decrease in blood transfusions of ≥4 units of PRBC is demonstrated when ER-REBOA Catheter is placed in distal aortic zone 3 during CHyst performed for severe PAS disorders. The incidence of postoperative ileus and LOS are reduced in the ER-REBOA Catheter group. Placement and utilization of ER-REBOA Catheter during CHyst may be feasible without fluoroscopy when manual placement verification is performed by an experienced operator. Protocol modifications focusing on reducing thrombotic rate are ongoing.

Level of evidence

IV.
Characterizing entanglement and measurement’s uncertainty in neutrino oscillations
Authors: Li Li-Juan , Ming Fei , Song Xue-Ke , Ye Liu , Wang Dong
Published: August 2021

Since neutrino oscillations (NOs) show nonclassical features with the Leggett–Garg inequality and exhibit potential applications in quantum information processing and telecommunications, in order to further reveal quantum properties of the NO systems, we herein focus on investigating entanglement and entropic uncertainty relation in the context of three-flavor NOs. Specifically, we take advantage of three different types of entanglement measures to characterize quantum resources originating from NO systems, and examine the hierarchical relationship among them. Moreover, we analyze the experiment data from different neutrino sources including Daya Bay (0.5 and 1.6 km) and MINOS+ (735 km) collaborations in comparison with our theoretical results. We find that the dynamical evolution of both the entropic uncertainty and entanglement of system shows non-monotonicity, and the experimental results coincide with our theoretical prediction very well. Interestingly, it shows that neutrinos always maintain quantum properties during oscillation process. More importantly, we reveal that the variation of the uncertainty is almost anti-correlated with that of the entanglement of system. Therefore, the nature of entanglement and uncertainty in NOs can be explored in the practical experiment when the three-flavor neutrino states are treated as three-qubit ones, which might be useful for the potential NO-based applications on prospective quantum information processing.
Particle identification at FCC-ee
Authors: Wilkinson Guy
Published: August 2021

Equipping an experiment at FCC-ee with particle identification (PID) capabilities, in particular the ability to distinguish between hadron species, would bring great benefits to the physics programme. Good PID is essential for precise studies in quark flavour physics and is also a great asset for many measurements in tau, top, and Higgs physics. The requirements placed by flavour physics and these other applications are surveyed, with an emphasis on the momentum range over which PID is necessary. Possible solutions are discussed, including classical RICH counters, time-of-flight systems, and dE/dx and cluster counting. Attention is paid to the impact on the global detector design that including PID capabilities would imply.
Heavy-quark opportunities and challenges at FCC-ee
Authors: Monteil Stéphane , Wilkinson Guy
Published: August 2021

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decays expected at FCC-ee offers outstanding opportunities in flavour physics that in general exceed those available at Belle II and are complementary to the heavy-flavour programme of the LHC. A wide range of measurements will be possible in heavy-flavour spectroscopy, rare decays of heavy-flavoured particles and $$C\!P$$

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-violation studies, which will benefit from the low-background experimental environment, the high Lorentz boost and the availability of the full spectrum of hadron species. This essay first surveys the important questions in heavy-flavour physics and assesses the likely theoretical and experimental landscape at the turn-on of FCC-ee. From this certain, measurements are identified where the impact of FCC-ee will be particularly important. A full exploitation of the heavy-flavour potential of FCC-ee places specific constraints and challenges on detector design, which in some cases are in tension with those imposed by the other physics goals of the facility. These requirements and conflicts are discussed.
Additional baryons and mesons
Authors: Frampton Paul H.
Published: August 2021

In a particle theory model whose most readily discovered new particle is the [Formula: see text] TeV bilepton resonance in same-sign leptons, currently being sought at CERN’s LHC, there exist three quarks [Formula: see text], [Formula: see text], [Formula: see text] which will be bound by QCD into baryons and mesons. We consider the decays of these additional baryons and mesons whose detailed experimental study will be beyond the reach of the 14 TeV CERN collider and accessible only at an O(100 TeV) collider.
RF parameters design for a Circular Electron–Positron Collider
Authors: Gong Dianjun , Gao Jie , Zhai Jiyuan
Published: August 2021

Radio frequency (RF) parameters design is an important part in RF system design. In this paper we will introduce a general method of choosing appropriate RF parameters for a circular [Formula: see text] collider. The RF parameters are determined with several analytical formulas. With this method, the RF parameters of the Circular Electron–Positron Collider (CEPC) for Conceptual Design Report (CDR) are verified. A new set of RF parameters for the CEPC with 1-cell LG Nb cavities is also designed. Besides, the RF parameters of the CEPC Advanced Partial Double Ring (APDR) and the CEPC Damping Ring (DR) are designed for the first time, and a preliminary study of the beam loading effects of APDR and DR is also carried out.
Refraction simulation of internal solitary waves for the fractional Benjamin–Ono equation in fluid dynamics
Authors: Duran Serbay , Yokuş Asıf , Durur Hülya , Kaya Doğan
Published: August 2021

In this study, the modified [Formula: see text]-expansion method and modified sub-equation method have been successfully applied to the fractional Benjamin–Ono equation that models the internal solitary wave event in the ocean or atmosphere. With both analytical methods, dark soliton, singular soliton, mixed dark-singular soliton, trigonometric, rational, hyperbolic, complex hyperbolic, complex type traveling wave solutions have been produced. In these applications, we consider the conformable operator to which the chain rule is applied. Special values were given to the constants in the solution while drawing graphs representing the stationary wave. By making changes of these constants at certain intervals, the refraction dynamics and physical interpretations of the obtained internal solitary waves were included. These physical comments were supported by simulation with 3D, 2D and contour graphics. These two analytical methods used to obtain analytical solutions of the fractional Benjamin–Ono equation have been analyzed in detail by comparing their respective states. By using symbolic calculation, these methods have been shown to be the powerful and reliable mathematical tools for the solution of fractional nonlinear partial differential equations.
The Complexity of Investment Spillover from New-Type Agricultural Business Entities to Small-Scale Farmers
Authors: Su Xin , Hu Yufeng , Liu Haolong
Published: August 2021

Aiming to clarify the leading roles of new-type agricultural business entities (abbreviated as NABEs) to small-scale farmers, integrated game models between NABEs and small-scale farmers are designed to verify the impact of scale economy and investment spillover on the equilibrium points of the game system. The influence of the investment spillover rate and the decision-making adjustment speed on the stability of the system are emphatically discussed. Numerical simulation shows that, with the increase of small-scale farmers’ decision-making adjustment speed, the system would successively show the phenomena of stability, period doubling bifurcation, chaos and discreteness. In the Cournot game, the two sides’ decision-making results such as investment intensity, selling price and eventual profits vary in the opposite direction. In the Stackelberg game of the basic mode, the two sides’ decision-making results are not evidently changed, and NABEs’ investment intensity, selling price and eventual profits are higher than those of small-scale farmers. In the order mode, system improvement can be realized by controlling the investment spillover rate. The research results indicate that with the increase of the adjustment speed of small-scale farmers’ decision-making, the repeated game decision-making aggravates the instability of the Cournot game system. This paper finds that the order pattern can make up for the scale weakness of small-scale farmers, and finally achieve a win-win situation for decision makers in the case of uncertain demands.
Dynamics of an Age Structured Heroin Transmission Model with Imperfect Vaccination
Authors: Duan Xi-Chao , Cheng Huanhuan , Martcheva Maia , Yuan Sanling
Published: August 2021

In this paper, we formulate a new-age structured heroin transmission model with respect to the age of vaccination which structures the vaccine wanes rate [Formula: see text] and infection ratio of vaccination individuals [Formula: see text]. The well-posedness and the basic reproduction number [Formula: see text] of our model are first presented. If [Formula: see text], the drug-free steady state [Formula: see text] is locally stable and there will be multiple positive steady states due to the imperfect vaccine. If [Formula: see text], there is a unique drug spread steady state, and our model is uniformly persistent. To reveal the dynamics of our model in detail, we carry out a further analysis in some special cases, including the backward and forward bifurcation results of our model when [Formula: see text] and [Formula: see text], and the unique drug-spread steady state’s stability when [Formula: see text]. Finally, a brief conclusion and discussion are presented.
Theoretical and Experimental Research of Viscoelastic Damping Limb-Like-Structure Device with Coupling Nonlinear Characteristics
Authors: He Zhen-Hua , Xu Zhao-Dong , Xue Jian-Yang , Jing Xing-Jian , Dong Yao-Rong , Li Qiang-Qiang
Published: August 2021

The nonlinear characteristic of vibration control systems has attracted increasing attention for its advantage in improving structural performance. In this paper, a new type of viscoelastic damping limb-like-structure (VE-LLS) device is proposed by combing the viscoelastic (VE) damper and limb-like-structure (LLS) together, which possesses coupling nonlinearity characteristic caused by geometric and material factors, as well as a remarkable advantage in improving the control performance. First, to explore the nonlinear geometrical effects on the static stiffness of the VE-LLS device, a formula is derived from static stiffness, and the results are discussed. Second, dynamic analysis is performed of the proposed device considering the coupling geometrical and material nonlinearities in frequency domain, with the real-time effect of frequency and temperature on the mechanical properties of the viscoelastic damper considered in solving the nonlinear vibration equation. The harmonic balance method (HBM) is used to solve the nonlinear dynamic equation. Then, the displacement transmissibility of the VE-LLS device is calculated and assessed. The results indicate that the proposed device possesses excellent vibration isolation performance, and the geometric parameters of the viscoelastic damper have significant nonlinear effect on the performance. Finally, an experiment is carried out of the VE-LLS device to verify the accuracy of the static stiffness analysis. The results show that the theoretical results agree well the experimental ones, and that the theoretical results have high accuracy and reliability.
Development and Validation of Industry 4.0 Readiness Scale — A Formative Model
Authors: Hajoary Pinosh Kumar
Published: August 2021

The purpose of this paper is to develop a suitable formative scale for Industry 4.0 readiness assessment and validate in the Indian steel manufacturing sector. For this, a literature review was undertaken to identify the relevant dimensions and items to assess the Industry 4.0 readiness at micro-level. Further, a pilot study and content validity were undertaken with experts from the industry and academia to find out the relevance of the dimensions and their items. The index thus developed was administered among top-level managers from steel manufacturing organizations and the data was analyzed using PLS-SEM. The findings revealed the most important parameters — strategy & organization; business model; manufacturing & operations; supply chain; products & services along with 21 indicators to be significant in all cases to assess Industry 4.0 readiness.
Urban Air Mobility: Projections for Air Taxis
Authors: Nehk Nadia , Tiberius Victor , Kraus Sascha
Published: August 2021

The growing global demand for efficient and sustainable urban mobility in metropolitan areas has created innovative approaches to new modes of transportation and vehicles. Using the Delphi method, this study explored the prospective development of urban air mobility (UAM), specifically the emergence of air taxis or vertical take-off and landing (VTOLs). The two-staged study examined 25 projections regarding technological and infrastructural aspects to propose a future scenario for UAM and air taxis for the next 5–10 years. The questioned experts confirmed most of the proposed statements from both areas but were undetermined regarding certain technological aspects. Considering the crucial impacts of regulation and certification as well as consumer perception and acceptance for UAM and air taxis, further research on these topics and their correlation is suggested.