bluuebunny/crossref_metadata_2025 huggingface dataset:
Recent court orders in patent suits on limits of Bolar exemption: Shrinking space for pharmaceutical generic companies in India?
Authors: Rathod Sandeep K , Cherian Priyam Lizmary , Jha Ketki P
Published: August 2021

The generic pharmaceutical sector in India transformed over the last few decades. However, certain recent judicial developments may impact the flexibility that generic companies have for development of future generics. This article looks at some of these developments. The developments covered are: a) interpretation and application of the Bolar flexibilities and b) hurdles in claiming use under S.107 A.
Do facially disfiguring features influence attention and perception of faces? Evidence from an antisaccade task
Authors: Boutsen Luc , Pearson Nathan A , Jüttner Martin
Published: August 2021

Facial disfigurements can influence how observers attend to and interact with the person, leading to disease-avoidance behaviour and emotions (disgust, threat, fear for contagion). However, it is unclear whether this behaviour is reflected in the effect of the facial stigma on attention and perceptual encoding of facial information. We addressed this question by measuring, in a mixed antisaccade task, observers’ speed and accuracy of orienting of visual attention towards or away from peripherally presented upright and inverted unfamiliar faces that had either a realistic looking disease-signalling feature (a skin discolouration), a non-disease-signalling control feature, or no added feature. The presence of a disfiguring or control feature did not influence the orienting of attention (in terms of saccadic latency) towards upright faces, suggesting that avoidance responses towards facial stigma do not occur during covert attention. However, disfiguring and control features significantly reduced the effect of face inversion on saccadic latency, thus suggesting an impact on the holistic processing of facial information. The implications of these findings for the encoding and appraisal of facial disfigurements are discussed.
‘Trying to make it matter’: The challenges of assimilating a resettlement culture into a ‘local’ prison
Authors: Cracknell Matthew
Published: August 2021

As part of the Transforming Rehabilitation reforms, 70 ‘local’ prisons in England and Wales were re-designated as resettlement prisons, in order to provide additional through-the-gate support to individuals serving short sentences. Drawing on staff and prisoner interviews in one case study resettlement prison, this article considers what challenges were involved with implementing a resettlement culture in a local prison. Findings first outline factors inhibiting the resettlement status of the prison; these include a tension between attempts to implement a more expansive resettlement remit into the prison, while also fulfilling more long-standing core institutional duties; the size and churn of the prison population; wide-scale apathy caused by change fatigue; and government austerity policies which caused significant difficulties in the day-to-day staffing of the prison. This article then turns to practitioner responses to the re-designation, finding that practitioners interpreted resettlement in two limited ways: top-down managerial attempts to instil a wider resettlement culture into the prison, and resistance from prison officers who felt unwilling or unable to expand their roles beyond custodial and security concerns. This article concludes by outlining how this set of inter-related barriers frustrated staff and prisoners alike, eroding a sense of hope and purpose and impeding true cultural change.
Hypoglycaemia in non-diabetic pregnancy
Authors: Morton Adam
Published: August 2021

Hypoglycaemia in non-diabetic pregnancy is rare, the majority of reported cases being due to insulinoma, acute fatty liver of pregnancy, malaria and inborn errors of metabolism. A case of hypoglycaemia in a woman with previous laparoscopic sleeve gastrectomy, and hypothalamic-pituitary-adrenal axis insufficiency in the setting of opioid dependence is presented. The timing of low interstitial glucose levels was atypical for late dumping syndrome following bariatric surgery, and a change in the woman’s glucocorticoid replacement resulted in resolution of hypoglycaemic symptoms. The incidence of opioid dependence in pregnancy is increasing rapidly. Health professionals should be aware of the possibility of opioids causing hypothalamic-pituitary-adrenal axis insufficiency, and the additional mechanisms by which opioids may cause hypoglycaemia.
Using an overhead target increases volleyball-specific vertical jump performance
Authors: Yildiz Mehmet , Akyildiz Zeki , Clemente Filipe Manuel , Yildiz Deniz
Published: August 2021

In volleyball, spikes, and block jumps are among the most important movements when earning points and impacting performance. Many studies have found a greater jump height after acutely augmented feedback and extrinsic focus of attention on vertical jump height. However, there are limited studies on the long-term effects of using an overhead target on volleyball-specific vertical jumps (block and spike jumps). Therefore, the aim of the current study was to investigate the effects of using an overhead target on the vertical jump heights of volleyball players. Twenty-five professional male volleyball players (age: 24.44 ± 3.78 years; height: 1.82 ± 8.79 cm; body mass: 80.96 ± 9.37 kg) were randomly assigned either to the experimental group with an overhead target (OHT) ( n = 9), group without an overhead target (WOHT) ( n = 10), or the control group ( n = 8). The OHT group performed vertical jumps with an overhead target before their regular training program, while the WOHT group completed vertical jumps without an overhead target before their regular training program. Meanwhile, the control group performed only their regular training program, which was a 5 week (3 days per week) program. All participants’ spike jump (SPJ) and block jump (BJ) results were assessed before and after the intervention. A repeated-measures analysis of variance (3 × 2) did not reveal any significant between-group interactions for SPJ and BJ ( F = 7.32, p < 0.11 and F = 1.59, p < 0.22 respectively), but significant results were found for the time effect ( F = 96.33, p < 0.01 and F = 132.25, p < 0.01 respectively) and group × time interaction ( F = 42.59, p < 0.01 and F = 61.52, p < 0.01, respectively). While the pre- and post-tests for BJ and SPJ values did not change in the control group ( p > 0.05), both of these values increased in the OHT group (60.00 ± 5.95–67.44 ± 5.98 cm, p < 0.01 for d = 1.24 and 49.00 ± 6.74–56.22 ± 5.29 cm p < 0.01 for d = 1.19, respectively) and WOHT group (57.50 ± 4.86–60.50 ± 4.99 cm, p < 0.01 for d = 0.60 and 47.75 ± 4.65–50.25 ± 3.69 cm, p < 0.01 for d = 0.59). It has been suggested that trainers and professionals can use an overhead target to increase the BJ and SPJ heights of professional volleyball players.
The clinical utility of gene expression assays in breast cancer patients with 0–3 involved lymph nodes
Authors: Barbi Mali , Makower Della , Sparano Joseph A.
Published: August 2021

Multigene expression assays are prognostic for recurrence in hormone-receptor positive 2 (HER-2) negative breast cancer, and, in some cases, predictive of benefit from chemotherapy or extended endocrine therapy. The results of these assays may be used to guide treatment recommendations for early HER-2 negative breast cancer. We review the results of trials establishing the clinical utility of several commercially available gene expression assays.
TGFBR2 mutation predicts resistance to immune checkpoint inhibitors in patients with non-small cell lung cancer
Authors: Li Teng , Wang Han , Xu Jiachen , Li Chengcheng , Zhang Yudong , Wang Guoqiang , Liu Yutao , Cai Shangli , Fang Wenfeng , Li Junling , Wang Zhijie
Published: August 2021

Background:

Resistance or even hyper-progression to immune checkpoint inhibitors (ICIs) manifesting as accelerated disease progression or death has impeded the clinical use of ICIs. The transforming growth factor beta (TGFβ) receptor pathway has been identified in contributing to immune dysfunction, which might be associated with resistance to ICIs. We aimed to explore the role of TGFβ in the resistance to ICIs in non-small cell lung cancer (NSCLC) in this study.

Methods:

Public cohorts with patients treated with ICIs or chemotherapy including POPLAR/OAK ( n = 853), MSKCC ( n = 1662) and Van Allen ( n = 57) and TCGA ( n = 3210) cohorts were obtained and analyzed.

Results:

The expression of immune-checkpoint related genes, including programmed death-ligand 1 ( CD274), lymphocyte-activation gene 3 ( LAG3), T cell immunoreceptor with Ig and ITIM domains (TIGIT), cytotoxic T-lymphocyte-associated protein 4 ( CTLA-4), programmed cell death ligand 1 ( PDCD1), and programmed cell death 1 ligand 2 ( PDCD1LG2) were significantly upregulated in transforming growth factor beta TGFβ receptor 2 (TGFβR2)-mutated patients than those with wild-type TGFBR2 ( p < 0.05). In the POPLAR/OAK cohort, TGFBR2-mutated patients showed shorter progression-free survival (PFS) [ p = 0.004; hazard ratio (HR), 2.83; 95% confidence interval (CI), 1.34–6.00] and overall survival (OS) ( p = 0.0006; HR, 3.46; 95% CI, 1.63–7.35) than those with wild-type TGFBR2 when treated with ICIs but not chemotherapy. In the merged MSKCC and Van Allen cohorts, a similar result was observed that the OS was inferior in patients with mutated TGFBR2 compared with those with wild-type TGFBR2 ( p = 0.007; HR, 2.53; 95% CI, 1.25–5.12). The association between TGBFR2 mutation and survival remained significant in multivariable cox regression in both POPLAR/OAK cohort ( p = 0.02; HR, 2.53; 95% CI, 1.17–5.45) and merged cohort ( p = 0.008; HR, 2.63; 95% CI, 1.29–5.35). We further evaluated the association between TGFBR2 mutations and OS in multiple types of tumors. The association between TGFBR2 mutations and OS remained significant in NSCLC ( p = 0.02; HR, 2.47; 95% CI, 1.16–5.26), but not in other type of tumors.

Conclusions:

We identified that TGFBR2 mutation predicted the resistance to ICIs in NSCLCs. The clinical delivery of ICIs should be cautious in those patients.
Novel and emerging approaches in the management of non-muscle invasive urothelial carcinoma
Authors: Yassaie Omid , Chehroudi Cyrus , Black Peter C.
Published: August 2021

Non-muscle invasive bladder cancer (NMIBC) has traditionally been managed with transurethral resection followed by intravesical chemotherapy and/or bacillus Calmette–Guerin (BCG) in a risk-adapted manner. These tumors commonly recur and can progress potentially to lethal muscle invasive disease. A major unmet need in the field of NMIBC is bladder preserving therapy for recurrent high-grade NMIBC after adequate intravesical BCG therapy. The current gold standard treatment for these BCG-unresponsive patients is radical cystectomy, which is associated with considerable morbidity and mortality, particularly in older and frailer patients. It is therefore critical to provide alternative treatment options with acceptable oncological outcomes. In this review we explore novel bladder-sparing treatment options including combination intravesical therapy, enhanced instillation methods, immunotherapy, gene therapy, targeted therapy, photodynamic therapy and BCG variants across the spectrum of NMIBC disease states, ranging from low grade BCG-naïve patients through to high-grade BCG-unresponsive NMIBC.
Healthcare Utilization, Costs, and Adverse Events of Real-Time Continuous Glucose Monitoring versus Traditional Blood Glucose Monitoring Among US Adults with Type 1 Diabetes
Authors: Wong Benjamin , Deng Yalin , Rascati Karen L.
Published: August 2021

Objective:

To compare healthcare utilization, costs, and incidence of diabetes-specific adverse events (ie, hyperglycemia, diabetic ketoacidosis, and hypoglycemia) in type 1 diabetes adult patients using real-time continuous glucose monitoring (rtCGM) versus traditional blood glucose monitoring (BG).

Methods:

Adult patients (≥18 years old) with type 1 diabetes in a large national administrative claims database between 2013 and 2015 were identified. rtCGM patients with 6-month continuous health plan enrollment and ≥1 pharmacy claim for insulin during pre-index and post-index periods were propensity-score matched with BG patients. Healthcare utilization associated with diabetic adverse events were examined. A difference-in-difference (DID) method was used to compare the change in costs between rtCGM and BG cohorts.

Results:

Six-month medical costs for rtCGM patients ( N = 153) increased from pre- to post-index period, while they decreased for matched BG patients ( N = 153). DID analysis indicated a $2,807 ( P = .062) higher post-index difference in total medical costs for rtCGM patients. Pharmacy costs for both cohorts increased. DID analysis indicated a $1,775 ( P < .001) higher post-index difference in pharmacy costs for rtCGM patients. The incidence of hyperglycemia for both cohorts increased minimally from pre- to post-index period. The incidence of hypoglycemia for rtCGM patients decreased, while it increased marginally for BG patients. Inpatient hospitalizations for rtCGM and BG patients increased and decreased marginally, respectively.

Conclusions:

rtCGM users had non-significantly higher pre-post differences in medical costs but significantly higher pre-post differences in pharmacy costs (mostly due to the rtCGM costs themselves) compared to BG users. Changes in adverse events were minimal.
Post-acute COVID-19 functional movement disorder
Authors: Garg Alpana , Goyal Sachin , Comellas Alejandro P
Published: August 2021

Movement disorders are rare compared to other neurological manifestations of COVID-19. Patients who have recovered from acute severe acute respiratory syndrome coronavirus-2 infection continue to have multiple debilitating symptoms months later. We report a case of 54-year-old man who presented with repetitive flexion movement of head which started 2 months after severe acute respiratory syndrome coronavirus-2 infection. Extensive work-up including neurological examination, neuroimaging, cerebrospinal fluid analysis, and electroencephalogram were normal. The self-reported questionnaires for depression and anxiety were suggestive of severe anxiety and depression. The patient continued to have the jerky movements besides cognitive impairment, frequent headaches, intermittent shortness of breath, sleeping difficulties, fatigue, and dizziness at 1-year follow-up. This case highlights the presentation of functional movement disorder as one of the manifestations of underlying neuropsychiatric condition. Our patient had significant effect on quality of life with high symptom burden which further highlights the struggle and unmet needs of the patients with multiple symptoms after severe acute respiratory syndrome coronavirus-2 infection.
Knowledge infrastructure and research agendas for quotidian Anthropocenes: Critical localism with planetary scope
Authors: Fortun Kim , Adams James , Schütz Tim , Knowles Scott Gabriel
Published: August 2021

The Anthropocene requires the development of new forms of knowledge and supporting sociotechnical infrastructure. While there have been calls for both interdisciplinary and community-engaged approaches, there remains a need to develop, test, and sustain modes of Anthropocene knowledge production that effectively link people working at different scales, in different sites, with many different types of expertise. In this Perspectives piece, we describe one such approach to Anthropocene knowledge production, centered in short-term Field Campuses that bring together community actors in cultural institutions, media, and government agencies with external academic researchers, bringing cultural analysis into the work of characterizing and responding to the Anthropocene. We argue that it is important to build public knowledge infrastructure that allows people to visualize and address many intersecting scales and systems (ecological, atmospheric, economic, technological, social, cultural, etc.) that shape the Anthropocene at the local level.
The ICF model as a practical tool to facilitate holistic communication with individuals during their rehabilitation: A qualitative study
Authors: Bjørnshave Noe Bodil , Angel Sanne , Bjerrum Merete
Published: August 2021

During rehabilitation, professionals and patients experience difficulties addressing complex issues. In a hermeneutical approach we examine how the ICF model can capture the complexity of the rehabilitation process using secondary deductive content analysis of transcripts from a previous interview study in line with COREQ. When focusing on interactions, the ICF model captures the complexity of individuals’ issues in a convincing way. Three themes were identified: ‘The influence body function, activity, participation and environment have on an individual’s ability to handle daily tasks of personal importance’, ‘The influence the environment in combination with body function, activity, and personal factors have on an individual’s ability to maintain their social roles’, and ‘The influence personal factors and body functions have on an individual’s confidence in participating in activities they like’. The findings show that the ICF model could provide a useful tool to facilitate communication regarding individuals’ complex issues that are often neglected.
Customising clinical studies for the new nursing generation
Authors: Gunnarsdottir Thora Jenny , Henriksen Jette , Löfmark Anna , Slettebø Åshild , Levy-Malmberg Rika
Published: August 2021

Nursing education in the Nordic countries follows the European Union directive requirements, and clinical studies for nursing students in the Nordic countries have many similarities. Now a new generation of students with different needs and characteristics is entering the nursing profession. The faculty, teachers and nurses will face challenges in meeting this new generation’s needs. The primary aim of this discussion paper is to explore and compare the current clinical studies in the five Nordic countries. The secondary aim is to find means to address the future challenges with a focus on the new generation. The idea of Objective Structured Clinical Reflection creates the possibility to discuss a new form of evaluation that may enhance the clinical competencies of the new generation entering clinical studies during their nursing education.
Nurses’ experiences of simulation-based learning, 12–18 months after the simulation: A qualitative study
Authors: Solheim Elisabeth , Flo Jill
Published: August 2021

Simulation-based learning is a learning method used in educational programmes for health professionals. Little is known about nurses’ experiences after a long period of time has elapsed since the simulation. The aim of this study was to describe nurses’ experiences of simulation scenarios and their perceptions of learning 12–18 months after the simulation. An explorative qualitative approach, including three focus-group interviews, was used. A total of 21 nurses participated. Data were collected in September 2017 and April 2018. The COREQ checklist was used to report the study. Three themes emerged: Simulation as a rewarding learning method, Pedagogical factors that affect the simulation and Perception of different roles in the simulation. The findings indicate that 12–18 months after the simulation took place, the nurses could still recall their experiences from simulation-based learning and the cases used. This indicates that simulation is an important method for strengthening clinical competence.
Released from foreign detention: Examining reoffending rates among returning Dutch detainees in the Netherlands
Authors: Van Hall Matthias , Cleofa-van Der Zwet Laura
Published: August 2021

At least 1,900 Dutch detainees are detained abroad yearly. They are housed in foreign detention because they are accused of having committed a criminal offence in a country that is not their country of residence. This study used data regarding Dutch detainees who were supervised by the International Office of the Dutch Probation Service to examine detainees’ background characteristics and their offending behaviour after returning to the Netherlands. The findings show that 23% of the Dutch detainees reoffended within 2 years of release from foreign detention. Furthermore, several background characteristics, such as their age at release from foreign detention, are related to reoffending behaviour.
Magnesium and Fibromyalgia: A Literature Review
Authors: Boulis Michael , Boulis Mary , Clauw Daniel
Published: August 2021

Fibromyalgia, a widespread chronic pain disorder, imposes a multitude of hardships on patients and their communities. Supplements, specifically magnesium supplements, have been widely used by fibromyalgia patients in an attempt to control their symptoms. The aim of this work is to investigate if the widespread use of magnesium in fibromyalgia is supported by evidence in the literature. This review provides a layout of the studies examining the correlation between body magnesium levels and fibromyalgia. Furthermore, it elaborates on the trials testing the effectiveness of magnesium in treating different clinical parameters of fibromyalgia.
The role of interleukin-17 in the pathogenesis of systemic sclerosis: Pro-fibrotic or anti-fibrotic?
Authors: Bellando-Randone Silvia , Della-Torre Emanuel , Balanescu Andra
Published: August 2021

Systemic sclerosis is characterized by widespread fibrosis of the skin and internal organs, vascular impairment, and dysregulation of innate and adaptive immune system. Growing evidence indicates that T-cell proliferation and cytokine secretion play a major role in the initiation of systemic sclerosis, but the role of T helper 17 cells and of interleukin-17 cytokines in the development and progression of the disease remains controversial. In particular, an equally distributed body of literature supports both pro-fibrotic and anti-fibrotic effects of interleukin-17, suggesting a complex and nuanced role of this cytokine in systemic sclerosis pathogenesis that may vary depending on disease stage, target cells in affected organs, and inflammatory milieu. Although interleukin-17 already represents an established therapeutic target for several immune-mediated inflammatory diseases, more robust experimental evidence is required to clarify whether it may become an attractive therapeutic target for systemic sclerosis as well.
Assessing post-disaster recovery using sentiment analysis: The case of L’Aquila, Italy
Authors: Contreras Diana , Wilkinson Sean , Balan Nipun , James Philip
Published: August 2021

Memorial days of disasters represent an opportunity to evaluate the progress of recovery. This article uses sentiment analysis (SA) to assess post-disaster recovery on the 10th anniversary of L’Aquila’s earthquake using Twitter data. We have analyzed 4349 tweets from 4 to 10 April 2019 with the hashtag: #L’Aquila that we have obtained from a third-party vendor. The polarity is first defined using a supervised classification based on experts’ rules on post-disaster reconstruction and Grammarly tones. Then, this polarity is compared with the outcome of an unsupervised classification based on the pre-trained SA machine learning algorithm developed by MonkeyLearn. We have found a significant negative assessment of the post-disaster recovery process in L’Aquila. About 33.1% of the tweets had a negative polarity, followed by 29.3% tweets with a neutral polarity, 28.7% with positive polarity, and 8.9% unrelated to the anniversary. Further analysis of the tweets confirms that after 10 years, the reconstruction is still ongoing and that criticism of the recovery reported in the literature is also found in the tweets. Based on our analysis, the critical day to collect most of the data is the anniversary’s exact day. Tweets from citizens and/or news agencies, which are more likely to express the reality experienced, are therefore more useful in understanding recovery than tweets from government officials and/or governmental institutions. From the total 4349 tweets, we can state that 2488 (57%) were correctly classified by the pre-trained SA machine learning algorithm developed by MonkeyLearn, while 1861 (43%) were misclassified. It means an overall accuracy (ACC) of 57% and a misclassification rate of 43% by the algorithm. We argue that our results have the potential to serve as a benchmark that can be used to compare other post-disaster recovery processes using the same Twitter-based SA on their anniversaries.
Rituximab for non-infectious Uveitis and Scleritis
Authors: Ng Caleb C. , Sy Aileen , Cunningham Emmett T.
Published: August 2021

Purpose

To provide a comprehensive review of rituximab use for the treatment of non-infectious uveitis and scleritis.

Methods

Review of literature through December 2020.

Results

Individual data was available for 229 patients with refractory non-infectious uveitis (n = 108) or scleritis (n = 121) who received treatment with rituximab (RTX). Rituximab was generally utilized as third-line or later treatment (uveitis: 67/90, 74.4%; scleritis: 90/96, 93.8%) at a mean of 33.5 months following the diagnosis of uveitis (range = 0 to 168.0 months; median = 24.0 months) and 39.4 months after diagnosis of scleritis (range = 1.0 to 168.0 months; median = 21.0 months). Patients with non-infectious uveitis and scleritis either received prior treatment with corticosteroids only (uveitis: 18/90, 20%; scleritis: 4/94, 4.3%), or with one (uveitis: 19/90, 21.1%; scleritis: 30/94, 31.9%), two (uveitis: 11/90, 12.2%; scleritis 27/94, 28.7%), or three or more (uveitis: 37/90, 41.1%; scleritis: 31/94, 33.0%) corticosteroid-sparing immunosuppressive agents with or without corticosteroids before initiation of RTX treatment. The rheumatologic protocol (two infusions of 1 gram of RTX separated by 14 days) was utilized most frequently (uveitis: 45/87, 51.7%; scleritis: 87/114, 76.3%), followed by the Foster protocol (eight weekly infusions of 375 mg/m2 RTX; uveitis: 18/87, 20.7%; scleritis: 10/114, 8.8%), and the oncologic protocol (four weekly infusions of 375 mg/m2 RTX; uveitis: 5/87, 5.7%; scleritis: 6/114, 5.3%). Various other off-label regimens were used infrequently (uveitis: 19/87, 21.8%; scleritis 11/114, 9.6%). Rituximab treatments resulted in a positive therapeutic response for the majority of patients with non-infectious uveitis (81/97, 83.5%). Commonly treated uveitic diagnoses included non-paraneoplastic autoimmune retinopathy (30/107, 28.0%), juvenile idiopathic arthritis (21/107, 19.6%), Vogt-Koyanagi-Harada disease (12/107, 11.2%), and Behçet disease (11/107, 10.3%). Cases of non-infectious scleritis were most commonly attributed to granulomatosis with polyangiitis (75/121, 62.0%) and rheumatoid arthritis (15/121, 12.4%), and showed an even greater rate of positive therapeutic response (112/120, 93.3%) following RTX treatment. No side effects were reported in 76.3% (74/97) of uveitis and 85.5% (71/83) scleritis cases. Of those cases associated with RTX-induced adverse events, the most common were infusion reactions of various severity (11/35, 31.4%).

Conclusions

Overall, RTX appeared to be both effective and well-tolerated as second or third-line therapy for patients with non-infectious uveitis and scleritis.
Management of COVID-19-related challenges faced by EMS personnel: a qualitative study
Authors: Mohammadi Fateme , Tehranineshat Banafsheh , Bijani Mostafa , Khaleghi Ali Asghar
Published: August 2021

Background

As the first link in the chain of providing healthcare services in the frontline of the battle against COVID-19, emergency medical services (EMS) personnel are faced with various challenges, which affect their professional performance. The present study aimed to identify some strategies to manage the COVID-19-related challenges faced by the pre-hospital emergency care personnel in the south of Iran.

Methods

In this qualitative descriptive study, 27 pre-hospital emergency care personnel who were selected through the purposeful sampling method. Data were collected through 27 semi-structured, in-depth, individual interviews. The collected data were then analyzed based on the Granheim and Lundman’s method.

Results

Analysis of the data resulted in the identification of 3 main themes and eight sub-themes. These three main themes were as follows: comprehensive and systematic planning, provision of medical equipment, and reduction of professional challenges.

Conclusion

The findings of the present study showed that, during the COVID-19 crisis, emergency medical services personnel should be provided with a comprehensive and systematic protocol to provide pre-hospital care and their performance should be assessed in terms of a set of scientific standards. Due to lack of equipment and work overload in the current crisis, emergency medical services personnel are faced with many psychological challenges, which adversely affect their quality of pre-hospital emergency care. Furthermore, emergency care senior managers should develop comprehensive protocols, provide more equipment, and eliminate professional challenges to pave the ground for improving the quality and safety of the healthcare services in pre-hospital emergency care during the current COVID-19 crisis.
Hepatitis B vaccination coverage in Germany: systematic review
Authors: Steffen Gyde , Sperle Ida , Harder Thomas , Sarma Navina , Beermann Sandra , Thamm Roma , Bremer Viviane , Zimmermann Ruth , Dudareva Sandra
Published: August 2021

Background

Despite being considered as a low prevalence country for hepatitis B (HBV), some populations in Germany are at higher risk of infection. In the context of the World Health Organization’s (WHO) viral hepatitis elimination goals, a valid epidemiological data base is needed to plan and monitor the national response. Prevention strategies include general and targeted HBV vaccination programmes.

Objective

The aim of this work was to estimate the HBV vaccination coverage (VC) in the general population (GP) and different population groups in Germany from available evidence and to identify current evidence gaps for future research.

Methods

We conducted a systematic review on HBV VC in the general population and populations at high risk of HBV exposure or severe infection in Germany. We included eligible publications (01/01/2017 to 06/06/2020) from databases Embase, Pubmed and Livivo, from a previous scoping review (including data published 01/01/2005–17/03/2017), from the national surveillance system and screened the reference lists of all publications at full text level. Risk of bias was assessed using the Hoy et al. tool.

Results

We included 68 publications of 67 studies and assigned them to one or more suitable population groups. Twenty-one studies contained data among children/adolescents and three among adults from the GP (VC 65.8–90.5% and 22.9–52.1%, respectively), one among travelers (VC 89.0%), 13 among immunocompromised populations (VC 7.8–89.0%), 16 among populations with occupational risk and 16 with non-occupational risk of HBV exposure (VC 63.6–96.5% and 4.4–84.5%, respectively).

Conclusion

Comprehensive evidence at low risk of bias was identified for children/adolescents. However, 25 years after including HBV in the national immunisation schedule, VC in Germany is still below the 95%-goal defined by WHO. For people at occupational risk of HBV exposure, VC was mostly reported to be over the WHO goal of 80%, but quality of evidence was heterogenous and should be improved. For people at non-occupational risk of HBV exposure, evidence was sparse and of low quality. The low VC highlights the need for future research to plan vaccination programmes targeting these populations.
Alterations of brain metrics in fetuses of women with polycystic ovary syndrome : a retrospective study based on fetal magnetic resonance imaging
Authors: Bao Zhongkun , Zhang Qing , Pan Manman , Xi Xi , Wang Yuanlin , Zhang Fangfang , Wang Fangfang , Zou Yu , Qu Fan
Published: August 2021

Background

Maternal polycystic ovary syndrome (PCOS) has potential detrimental effects on the neurodevelopment of offspring. This study aimed to evaluate the brain metrics in fetuses of women with PCOS based on fetal magnetic resonance imaging (MRI).

Methods

This retrospective study included 60 pregnant women with PCOS (PCOS group) and 120 pregnant non-PCOS women (control group). Fetal MRI was performed followed an ultrasound and for numerous clinical indications including known or suspected fetal pathology, history of fetal abnormality in previous pregnancy or in a family member. Fetal brain biometry and apparent diffusion coefficient (ADC) value were analysed.

Results

After adjusting for potential confounders, fetuses in the PCOS group showed the following characteristics compared to fetuses in the control group: (1) smaller cerebral fronto-occipital diameter (FOD), vermian height (VH) and anteroposterior diameter of the pons (APDP) (evident before 32 weeks;P = 0.042,P = 0.002 andP = 0.016, respectively); (2) larger left and right biparietal index (evident before 32 weeks;P = 0.048 andP = 0.025, respectively); (3) smaller left lateral ventricle (LV) (evident after 32 weeks;P = 0.005); (4) larger anteroposterior diameter of the vermis (APDV) and hippocampal infolding angle (HIA) (evident after 32 weeks;P = 0.003 andP < 0.001, respectively); (5) higher ADC value in frontal white matter (FWM) and in basal ganglia (BG) (evident before and after 32 weeks; allP < 0.05).

Conclusions

There exist a different pattern of brain metrics in PCOS offspringin utero.
TGFB-induced factor homeobox 1 (TGIF) expression in breast cancer
Authors: Stürken Christine , Möbus Volker , Milde-Langosch Karin , Schmatloch Sabine , Fasching Peter A. , Rüschoff Josef , Stickeler Elmar , Henke Rolf-Peter , Denkert Carsten , Hanker Lars , Schem Christian , Vladimirova Valentina , Karn Thomas , Nekljudova Valentina , Köhne Claus-Henning , Marmé Frederik , Schumacher Udo , Loibl Sibylle , Müller Volkmar
Published: August 2021

Background

Breast cancer (BC) is the most frequent female cancer and preferentially metastasizes to bone. The transcription factor TGFB-induced factor homeobox 1 (TGIF) is involved in bone metabolism. However, it is not yet known whether TGIF is associated with BC bone metastasis or patient outcome and thus of potential interest.

Methods

TGIF expression was analyzed by immunohistochemistry in 1197 formalin-fixed, paraffin-embedded tissue samples from BC patients treated in the GAIN (German Adjuvant Intergroup Node-Positive) study with two adjuvant dose-dense schedules of chemotherapy with or without bisphosphonate ibandronate. TGIF expression was categorized into negative/low and moderate/strong staining. Endpoints were disease-free survival (DFS), overall survival (OS) and time to primary bone metastasis as first site of relapse (TTPBM).

Results

We found associations of higher TGIF protein expression with smaller tumor size (p = 0.015), well differentiated phenotype (p < 0.001) and estrogen receptor (ER)-positive BC (p < 0.001). Patients with higher TGIF expression levels showed a significantly longer disease-free (DFS: HR 0.75 [95%CI 0.59–0.95], log-rank p = 0.019) and overall survival (OS: HR 0.69 [95%CI 0.50–0.94], log-rank p = 0.019), but no association with TTPBM (HR 0.77 [95%CI 0.51–1.16]; p = 0.213). Univariate analysis in molecular subgroups emphasized that elevated TGIF expression was prognostic for both DFS and OS in ER-positive BC patients (DFS: HR 0.68 [95%CI 0.51–0.91]; log-rank p = 0.009, interaction p = 0.130; OS: HR 0.60 [95%CI 0.41–0.88], log-rank p = 0.008, interaction p = 0.107) and in the HER2-negative subgroup (DFS:HR 0.67 [95%CI 0.50–0.88], log-rank p = 0.004, interaction p = 0.034; OS: HR 0.57 [95%CI 0.40–0.81], log-rank p = 0.002, interaction p = 0.015).

Conclusions

Our results suggest that moderate to high TGIF expression is a common feature of breast cancer cells and that this is not associated with bone metastases as first site of relapse. However, a reduced expression is linked to tumor progression, especially in HER2-negative breast cancer.

Trial registration

This clinical trial has been registered with ClinicalTrials.gov; registration number: NCT00196872.
The factors associated with transient hypothyroxinemia of prematurity
Authors: Yilmaz Aslan , Ozer Yavuz , Kaya Nesrin , Turan Hande , Acar Hazal Cansu , Ercan Oya , Perk Yildiz , Evliyaoglu Olcay , Vural Mehmet
Published: August 2021

Background

Hypothyroxinemia is defined by low levels of thyroxine (T4) despite low or normal levels of thyroid-stimulating hormone (TSH). This study aimed to evaluate the factors associated with transient hypothyroxinemia of prematurity (THOP) in newborns admitted to the neonatal intensive care unit (NICU).

Method

This is a single center, retrospective, case-control study. Premature newborns, between 24 and 34 weeks of gestation, hospitalised between January 2014–December 2019 in Istanbul University-Cerrahpasa Faculty of Medicine NICU were analyzed through their medical records. Thyroid function tests were routinely performed between the 10th and 20th days of postnatal life and were evaluated according to the gestational age references. Thirty six possible associated factors (prenatal and postnatal parameters, medical treatments, clinical diagnoses and applications in NICU) were searched in the patient group with THOP (n = 71) and the control group with euthyroid prematures (n = 73). The factors for THOP were identified by univariate analysis, followed by multivariate analysis.

Results

Mean gestational ages of the study and the control groups were 29.7 ± 2.48 and 30.5 ± 2.30 weeks, respectively (p = 0.606). The birth weight, small for gestational age (SGA), intraventricular hemorrhage (IVH), congenital heart disease (CHD) were found to be the possible associated factors for THOP in the univariate analysis and CHD (p = 0.007, odds ratio [OR]:4.9, 95% confidence interval [CI]: 1.5–15.8), BW (p = 0.004, OR:0.999, 95% CI: 0.9–1.0) and SGA (p = 0.010, OR:4.6, 95% CI: 1.4–14.7) were found to be factors associated with THOP determined by univariate logistic regression analysis.

Conclusıons

Although some treatment practices might have had direct effects on pituitary–thyroid axis, related with the severity of the newborn clinical conditions, non of them was found to be a associated factor for THOP. However, CHD and SGA may be considered as associated factors with THOP detected in preterm infants.
Deep vein thrombosis in acute respiratory distress syndrome caused by bacterial pneumonia
Authors: Cui Na , Mi Song , Jiang Chunguo , Sun Wanlu , Mao Wenping , Zhang Liming , Feng Xiaokai
Published: August 2021

Background

Acute respiratory distress syndrome (ARDS) is a clinical syndrome characterized by acute hypoxaemia, and few studies have reported the incidence of deep vein thrombosis (DVT) in direct ARDS caused by bacterial pneumonia. We performed a study to evaluate the prevalence, risk factors, prognosis and potential thromboprophylaxis strategies of DVT in these patients.

Methods

Ninety patients were included. Demographic, and clinical data, laboratory data and outcome variables were obtained, and comparisons were made between the DVT and non-DVT groups.

Results

Of the 90 patients, 40 (44.4%) developed lower extremity DVT. Compared with non-DVT patients, DVT patients had higher systemic inflammatory response syndrome (SIRS) scores, lower serum creatinine levels, higher D-dimer levels, and higher rates of sedative therapy and invasive mechanical ventilation (IMV). Multivariate analysis showed an association between the SIRS score (OR 3.803, P = 0.027), level of serum creatinine (OR 0.988, P = 0.001), IMV (OR 5.822, P = 0.002) and DVT. The combination of SIRS score, serum creatinine level and IMV has a sensitivity of 80.0% and a specificity of 74.0% for screening for DVT. The survival rate within 28 days after ARDS in the DVT group was significantly lower than that in the non-DVT group (P = 0.003). There was no difference in the prevalence of DVT between the 41 patients who received thromboprophylaxis and the 49 patients who did not receive thromboprophylaxis (41.5% vs 46.9%; P = 0.603).

Conclusions

The prevalence of DVT is high in hospitalized patients with direct ARDS caused by bacterial pneumonia and may be associated with adverse outcomes. The current thromboprophylaxis strategies may need to be further optimized.
The impact of artificial intelligence on clinical education: perceptions of postgraduate trainee doctors in London (UK) and recommendations for trainers
Authors: Banerjee Maya , Chiew Daphne , Patel Keval T. , Johns Ieuan , Chappell Digby , Linton Nick , Cole Graham D. , Francis Darrel P. , Szram Jo , Ross Jack , Zaman Sameer
Published: August 2021

Background

Artificial intelligence (AI) technologies are increasingly used in clinical practice. Although there is robust evidence that AI innovations can improve patient care, reduce clinicians’ workload and increase efficiency, their impact on medical training and education remains unclear.

Methods

A survey of trainee doctors’ perceived impact of AI technologies on clinical training and education was conducted at UK NHS postgraduate centers in London between October and December 2020. Impact assessment mirrored domains in training curricula such as ‘clinical judgement’, ‘practical skills’ and ‘research and quality improvement skills’. Significance between Likert-type data was analysed using Fisher’s exact test. Response variations between clinical specialities were analysed using k-modes clustering. Free-text responses were analysed by thematic analysis.

Results

Two hundred ten doctors responded to the survey (response rate 72%). The majority (58%) perceived an overall positive impact of AI technologies on their training and education. Respondents agreed that AI would reduce clinical workload (62%) and improve research and audit training (68%). Trainees were skeptical that it would improve clinical judgement (46% agree,p = 0.12) and practical skills training (32% agree,p < 0.01). The majority reported insufficient AI training in their current curricula (92%), and supported having more formal AI training (81%).

Conclusions

Trainee doctors have an overall positive perception of AI technologies’ impact on clinical training. There is optimism that it will improve ‘research and quality improvement’ skills and facilitate ‘curriculum mapping’. There is skepticism that it may reduce educational opportunities to develop ‘clinical judgement’ and ‘practical skills’. Medical educators should be mindful that these domains are protected as AI develops. We recommend that ‘Applied AI’ topics are formalized in curricula and digital technologies leveraged to deliver clinical education.
Nurse practitioner led model of after-hours emergency care in an Australian rural urgent care Centre: health service stakeholder perceptions
Authors: Wilson Elena , Hanson Lisa C. , Tori Kathleen E. , Perrin Byron M.
Published: August 2021

Background

The challenges of providing and accessing quality health care in rural regions have long been identified. Innovative solutions are not only required but are also vital if effective, timely and equitable access to sustainable health care in rural communities is to be realised. Despite trial implementation of some alternative models of health care delivery, not all have been evaluated and their impacts are not well understood. The aim of this study was to explore the views of staff and stakeholders of a rural health service in relation to the implementation of an after-hours nurse practitioner model of health care delivery in its Urgent Care Centre.

Methods

This qualitative study included semi-structured individual and group interviews with professional stakeholders of a rural health service in Victoria, Australia and included hospital managers and hospital staff who worked directly or indirectly with the after-hours NPs in addition to local GPs, GP practice nurses, and paramedics. Thematic analysis was used to generate key themes from the data.

Results

Four themes emerged from the data analysis: transition to change; acceptance of the after-hours nurse practitioner role; workforce sustainability; and rural context.

Conclusions

This study suggests that the nurse practitioner-led model is valued by rural health practitioners and could reduce the burden of excessive after-hour on-call duties for rural GPs while improving access to quality health care for community members. As pressure on rural urgent care centres further intensifies with the presence of the COVID-19 pandemic, serious consideration of the nurse practitioner-led model is recommended as a desirable and effective alternative.
Early detection of myocardial dysfunction in a cat that gradually progressed to endomyocardial form of restrictive cardiomyopathy
Authors: Saito Takahiro , Suzuki Ryohei , Yuchi Yunosuke , Teshima Takahiro , Matsumoto Hirotaka , Koyama Hidekazu
Published: August 2021

Background

Restrictive cardiomyopathy (RCM) is a common myocardial disease in cats, characterized by diastolic dysfunction and atrial enlargement without myocardial hypertrophy. Especially, endomyocardial form of RCM, one of the subtypes in RCM, is characterized by endocardial fibrosis, endocardial scar bridging the interventricular septum and left ventricular (LV) free wall, and deformation and distortion of the LV. However, it is unclear how the myocardial dysfunction and the endocardial scar contribute to the pathophysiology of RCM disease progression.

Case presentation

A 3 years and 2 months old, intact male, Domestic shorthaired cat was presented for consultation of cardiac murmur. At the first visit (day 0), the notable abnormal finding was echocardiography-derived chordae tendineae-like structure bridging the interventricular septum and the LV free wall, resulting high-speed blood flow in the left ventricle. Electrocardiography, thoracic radiography and noninvasive blood pressure measurements were normal. No left atrial enlargement was observed, and LV inflow velocity showed an abnormal relaxation pattern. Although there was no abnormality in tissue Doppler imaging-derived myocardial velocity, two-dimensional speckle tracking echocardiography (2D-STE) revealed a decrease in the LV longitudinal strain and an increase in endocardial to epicardial ratio of the LV circumferential strain on day 0. On day 468, obvious left atrium enlargement and smoke like echo in the left atrium were observed. The LV inflow velocity was fused, and the tissue Doppler imaging-derived early-diastolic myocardial velocity of the septal mitral annulus decreased. Regarding 2D-STE, LV circumferential strain was further decreased, and right ventricular strain was additionally decreased. Although the general condition was good, we made a clinical diagnosis of endomyocardial RCM based on the above findings. On day 503, the cat showed the radiographic evidence of pulmonary edema and congestive heart failure signs.

Conclusions

Cats with abnormal LV structure and associated myocardial dysfunction like this case needs careful observation. Additionally, 2D-STE indices may be useful for early detection of myocardial dysfunction in feline RCM.