bluuebunny/crossref_metadata_2025 huggingface dataset:
Missing the Mark: Gathering Better Data From Student-Athlete Exit Interviews
Authors: Strode James , Davies Melissa , Lawrence Heather J.
Published: January 2021

A great deal of sport management literature in recent years draws upon the need for effective quantitative and qualitative research methods. However, there are limited cases for a sport management faculty to effectively teach students proper process, design, and implementation of survey or interview research, particularly for real-world sport applications, such as student-athlete exit interviews. This case aims to fill this gap and outlines a plan for students to identify limitations in current student-athlete exit data collection methods and to learn the common barriers associated with effective research design. Students are made aware of common missteps throughout the research process and are provided foundations for effective survey and interview design. Information taught via this case can also be used across sport management contexts, such as fan experience surveys, retail customer satisfaction surveys, or donor satisfaction interviews.
State Versus Professional: A Case Study of How Chinese New Media Construct Elite Female Athletes
Authors: Xu Qingru , Kreshel Peggy J.
Published: January 2021

In this case study, the authors examined media representations of two Chinese female athletes—state athlete Ding Ning and professional athlete Li Na—in China, a nation undergoing social transformation and a sport-reform initiative. Analyzing stories from two Chinese web portals (i.e., Sina and Tencent), the authors analyzed how (a) gender, (b) nationalism, and (c) the individualism–collectivism continuum entered into media representations of these two female athletes. Notable differences emerged in all three conceptual areas. A fourth theme, which the authors have identified as the commercialized athlete, also emerged. Possible explanations and implications are discussed.
Effects of 2 Intersection Strategies for Physical Recovery in Jiu-Jitsu Athletes
Authors: César Eurico P. , Júnior Cleito S.R. , Francisco Raphael N.
Published: January 2021

Purpose: To compare the effect of static stretching (SS) and cold-water immersion (CWI) on strength performance and blood lactate levels of jiu-jitsu athletes. Methods: A total of 21 male Brazilian jiu-jitsu fighters were randomly assigned to SS (9 × 30-s carpal extension), CWI (3 × 3 min at 10°C), or a control group (CG); their maximal handgrip strength, handgrip muscle endurance, dynamic kimono grip strength test, and blood lactate concentration were assessed before and after a simulated Brazilian jiu-jitsu fight and after one of the recovery interventions. Results: There was an interaction (F = 9.075; P = .002) and a time effect (F = 11.792; P = .003) for dynamic kimono grip strength test, showing a decrease in performance for the CG (P = .0001; effect size [ES] = 0.52, moderate) and after SS (P = .006; ES = 0.43, small). There was an interaction (F = 3.592; P = .015) and a time effect (F = 122.631; P = .0001) for blood lactate concentration, showing lower levels after CWI versus CG (P = .028; ES = 0.93, moderate) and after CWI versus SS (P = .042; ES = 0.82, moderate). There was an interaction (F = 9.617; P = .001) for handgrip strength, showing an impairment in performance after SS (P = .001; ES = 0.67, moderate). Conclusion: CWI promoted restoration of muscle strength and endurance and reduction in blood lactate levels after the simulated fight and can thus be used by jiu-jitsu athletes as a recovery strategy between fights.
Effect of the Cooldown Type on Session Rating of Perceived Exertion
Authors: Rodríguez-Marroyo Jose A. , González Beltrán , Foster Carl , Belén Carballo-Leyenda Ana , Villa José G.
Published: January 2021

Purpose:This study investigated the effect of cooldown modality (active vs passive) and duration (5, 10, and 15 min) on session rating of perceived exertion (sRPE). Secondarily, the possible influence of training sessions’ demand on this effect was studied.Methods:A total of 16 youth male soccer players (15.7 [0.4] y) completed 2 standardized training sessions per week across 6 weeks. During weeks 1 to 2, 3 to 4, and 5 to 6, cooldown lengths of 15, 10, and 5 minutes were studied, respectively. Using a crossover design, players were randomly assigned to 2 groups and each group performed 1 of 2 different cooldown interventions. Passive and active cooldown interventions based on static stretching and running exercises were studied. Heart rate and sRPE were recorded during all training sessions.Results:The lowest sRPE was observed when passive cooldown was performed. When the hardest training sessions were considered, a significant main effect of cooldown modality (P < .01) and duration (P < .05) and an interaction effect between these variables (P < .05) on sRPE were obtained. The lowest (P < .01) sRPE was observed during the longest cooldown (15 min).Conclusion:The findings suggest that sRPE may be sensitive to the selected cooldown modality and duration, especially following the most demanding training sessions.
Controversial study says U.S. labs use 111 million mice, rats
Authors: Grimm David
Published: January 2021

Figure is more than seven times some estimates, but critics say analysis is flawed.
Ancient balancing selection maintains incompatible versions of the galactose pathway in yeast
Authors: Boocock James , Sadhu Meru J. , Durvasula Arun , Bloom Joshua S. , Kruglyak Leonid
Published: January 2021

Yeast switches for glucose and galactose

Some organisms can switch metabolic pathways depending on their environment. One such example is yeast, which can transition between the sugars glucose and galactose as carbon sources. Boocock
et al.
show that this ability has undergone selection, resulting in the maintenance of two incompatible metabolic pathways in a select set of yeast strains within a single species. A phylogenetic analysis supports that these different pathways are mediated by three genes that differ between strains within and among yeast species and likely have been maintained over 10 million to 20 million years.

Science
, this issue p.
415
Bifurcation of planetary building blocks during Solar System formation
Authors: Lichtenberg Tim , Dra̧żkowska Joanna , Schönbächler Maria , Golabek Gregor J. , Hands Thomas O.
Published: January 2021

Two-part formation of the Solar System

Measurements of meteorites have shown that the inner and outer Solar System formed from two distinct reservoirs of material. Existing models have proposed that these were split by Jupiter forming first, which would open a gap in the protoplanetary disc. Lichtenberg
et al.
instead argue that the snow line, the boundary between regions containing water vapor and solid ice, migrated first outward and then inward, forming two separate populations of planetesimals. Those planetesimals then grew through collisions to form the planets. Their simulation of this model explains the meteorite data and is consistent with astronomical observations of protoplanetary disks around other stars.

Science
, this issue p.
365
Single-cell lineages reveal the rates, routes, and drivers of metastasis in cancer xenografts
Authors: Quinn Jeffrey J. , Jones Matthew G. , Okimoto Ross A. , Nanjo Shigeki , Chan Michelle M. , Yosef Nir , Bivona Trever G. , Weissman Jonathan S.
Published: January 2021

Following cancer through the body

The heterogeneity of mammalian tumors has been well documented, but it remains unknown how differences between individual cells lead to metastasis and spread throughout the body. Quinn
et al.
created a Cas9-based lineage tracer and used single-cell sequencing to generate phylogenies and follow the movement of metastatic human cancer cells implanted in the lung of a mouse xenograph model. Using this model, they found that within the same cell line, cancer cells exhibited diverse metastatic phenotypes. These subclones exhibited differential gene expression profiles, some of which were previously associated with metastasis.

Science
, this issue p.
eabc1944
Ultrafast nanoimaging of the order parameter in a structural phase transition
Authors: Danz Thomas , Domröse Till , Ropers Claus
Published: January 2021

Watching a phase transition unfold

The layered material 1
T
-polytype of tantalum disulfide has several intricate charge-ordered phases. How exactly one phase transitions into another is tricky to observe directly with current technologies. Danz
et al.
used pump-probe ultrafast dark-field electron microscopy to follow such a transition with fine spatial and temporal resolution (see the Perspective by Kogar). To achieve that goal, they shaped the electron beam used as the probe to bring out the features peculiar to the transition.

Science
, this issue p.
371
; see also p.
341
Model-informed COVID-19 vaccine prioritization strategies by age and serostatus
Authors: Bubar Kate M. , Reinholt Kyle , Kissler Stephen M. , Lipsitch Marc , Cobey Sarah , Grad Yonatan H. , Larremore Daniel B.
Published: January 2021

Limited initial supply of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine raises the question of how to prioritize available doses. We used a mathematical model to compare five age-stratified prioritization strategies. A highly effective transmission-blocking vaccine prioritized to adults ages 20 to 49 years minimized cumulative incidence, but mortality and years of life lost were minimized in most scenarios when the vaccine was prioritized to adults greater than 60 years old. Use of individual-level serological tests to redirect doses to seronegative individuals improved the marginal impact of each dose while potentially reducing existing inequities in COVID-19 impact. Although maximum impact prioritization strategies were broadly consistent across countries, transmission rates, vaccination rollout speeds, and estimates of naturally acquired immunity, this framework can be used to compare impacts of prioritization strategies across contexts.
Thermopower and harvesting heat
Authors: Shi Xun , He Jian
Published: January 2021

A metric to compare low-grade heat-to-electricity conversion can be misleading
Masatoshi Koshiba (1926–2020)
Authors: Nakahata Masayuki , Suzuki Atsuto
Published: January 2021

Innovative founder of neutrino astronomy
Optimizing age-specific vaccination
Authors: Fitzpatrick Meagan C. , Galvani Alison P.
Published: January 2021

Vaccination strategies are not one-size-fits-all
Isolate-Dependent Differences in Clinical, Pathological, and Transcriptional Profiles followingIn VitroandIn VivoInfections with Rickettsia rickettsii
Authors: Galletti Maria F. B. M. , Paddock Christopher D. , Hecht Joy A. , Biggerstaff Brad J. , Ritter Jana M. , Karpathy Sandor E.
Published: January 2021

Rickettsia rickettsii, the etiological agent of Rocky Mountain spotted fever (RMSF), a life-threatening tick-borne disease that affects humans and various animal species, has been recognized in medicine and science for more than 100 years. Isolate-dependent differences in virulence ofR. rickettsiihave been documented for many decades; nonetheless, the specific genetic and phenotypic factors responsible for these differences have not been characterized.
Spatiotemporal Variations in Growth Rate and Virulence Plasmid Copy Number during
Yersinia pseudotuberculosis
Infection
Authors: Schneiders Stephan , Hechard Tifaine , Edgren Tomas , Avican Kemal , Fällman Maria , Fahlgren Anna , Wang Helen
Published: January 2021

Pathogenic
Yersinia
spp. depend on the activity of a potent virulence plasmid-encoded
ysc
/
yop
type 3 secretion system (T3SS) to colonize hosts and cause disease. It was recently shown that
Yersinia pseudotuberculosis
upregulates the virulence plasmid copy number (PCN) during infection and that the resulting elevated gene dose of plasmid-encoded T3SS genes is essential for virulence.
Viral-Mediated Tethering to SEL1L Facilitates Endoplasmic Reticulum-Associated Degradation of IRE1
Authors: Hinte Florian , Müller Jendrik , Brune Wolfram
Published: January 2021

Viruses infect cells of their host and force them to produce virus progeny. This can impose stress on the host cell and activate counterregulatory mechanisms.
Efficacy and safety of antidepressants for the treatment of back pain and osteoarthritis: systematic review and meta-analysis
Authors: Ferreira Giovanni E , McLachlan Andrew J , Lin Chung-Wei Christine , Zadro Joshua R , Abdel-Shaheed Christina , O’Keeffe Mary , Maher Chris G
Published: January 2021

Objective

To investigate the efficacy and safety of antidepressants for back and osteoarthritis pain compared with placebo.

Design

Systematic review and meta-analysis.

Data sources

Medline, Embase, Cochrane Central Register of Controlled Trials, CINAHL, International Pharmaceutical Abstracts, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform from inception to 15 November and updated on 12 May 2020.

Eligibility criteria for study selection

Randomised controlled trials comparing the efficacy or safety, or both of any antidepressant drug with placebo (active or inert) in participants with low back or neck pain, sciatica, or hip or knee osteoarthritis.

Data extraction and synthesis

Two independent reviewers extracted data. Pain and disability were primary outcomes. Pain and disability scores were converted to a scale of 0 (no pain or disability) to 100 (worst pain or disability). A random effects model was used to calculate weighted mean differences and 95% confidence intervals. Safety (any adverse event, serious adverse events, and proportion of participants who withdrew from trials owing to adverse events) was a secondary outcome. Risk of bias was assessed with the Cochrane Collaboration’s tool and certainty of evidence with the grading of recommendations assessment, development and evaluation (GRADE) framework.

Results

33 trials (5318 participants) were included. Moderate certainty evidence showed that serotonin-noradrenaline reuptake inhibitors (SNRIs) reduced back pain (mean difference −5.30, 95% confidence interval −7.31 to −3.30) at 3-13 weeks and low certainty evidence that SNRIs reduced osteoarthritis pain (−9.72, −12.75 to −6.69) at 3-13 weeks. Very low certainty evidence showed that SNRIs reduced sciatica at two weeks or less (−18.60, −31.87 to −5.33) but not at 3-13 weeks (−17.50, −42.90 to 7.89). Low to very low certainty evidence showed that tricyclic antidepressants (TCAs) did not reduce sciatica at two weeks or less (−7.55, −18.25 to 3.15) but did at 3-13 weeks (−15.95, −31.52 to −0.39) and 3-12 months (−27.0, −36.11 to −17.89). Moderate certainty evidence showed that SNRIs reduced disability from back pain at 3-13 weeks (−3.55, −5.22 to −1.88) and disability due to osteoarthritis at two weeks or less (−5.10, −7.31 to −2.89), with low certainty evidence at 3-13 weeks (−6.07, −8.13 to −4.02). TCAs and other antidepressants did not reduce pain or disability from back pain.

Conclusion

Moderate certainty evidence shows that the effect of SNRIs on pain and disability scores is small and not clinically important for back pain, but a clinically important effect cannot be excluded for osteoarthritis. TCAs and SNRIs might be effective for sciatica, but the certainty of evidence ranged from low to very low.

Systematic review registration

PROSPERO CRD42020158521.
Prevalence and associated factors of hypertension in selected urban and rural areas of Dhaka, Bangladesh: findings from SHASTO baseline survey
Authors: Hasan Mehedi , Khan Md Showkat Ali , Sutradhar Ipsita , Hossain Md Mokbul , Hossaine Moyazzam , Yoshimura Yukie , Choudhury Sohel Reza , Sarker Malabika , Mridha Malay Kanti
Published: January 2021

Objective

We implemented this study to report the prevalence and associated risk factors of hypertension among adult men and women aged >30 years residing in selected urban and rural areas of Dhaka division, Bangladesh.

Design

Cross-sectional study.

Setting

Two urban (Dhaka city north and Dhaka city south) and two rural (Narsinghdi and Gazipur district) areas of the Dhaka division.

Participants

A total of 4856 male and female participants were included in the final analysis, of whom 2340 (48.2%) were from urban and 2516 (51.8%) were from rural areas.

Primary outcome

Hypertension was the dependent variable for this study and was operationally defined as systolic blood pressure >140 mm of Hg and/or diastolic blood pressure >90 mm of Hg, and/or persons with already diagnosed hypertension.

Results

The overall prevalence of hypertension was 31.0%, and the prevalence was higher among urban participants (urban: 36.9%, rural: 30.6%). Age (across all categories), female (urban—adjusted OR (AOR): 1.3, 95% CI: 1.0 to 1.5 and rural—AOR: 1.7, 95% CI: 1.4 to 2.1)), higher educational status (urban—AOR: 1.7, 95% CI: 1.3 to 2.2 and rural—AOR: 2.1, 95% CI: 1.5 to 3.1), inadequate physical activity (urban—AOR: 1.3, 95% CI: 1.0 to 1.7 and rural—AOR: 1.5, 95% CI: 1.2 to 1.9) and overweight/obesity (urban—AOR: 2.7, 95% CI: 2.1 to 3.3 and rural—AOR: 2.1, 95% CI: 1.7 to 2.5) were associated with hypertension in both urban and rural areas. Women who were not currently married during the survey had higher odds of hypertension only in the rural areas (rural—AOR: 1.8, 95% CI: 1.3 to 2.4), and respondents who were not working during the survey had higher odds of hypertension only in the urban areas (AOR: 1.7, 95% CI: 1.0 to 2.6).

Conclusion

Since the prevalence of hypertension was high in urban and rural areas, the government of Bangladesh should consider implementing hypertension prevention programmes focusing young population of Dhaka division. In addition, early screening programmes and management of hypertension need to be strengthened for people with hypertension in both the areas.
Association of smoking reduction and mortality: protocol for a systematic review and meta-analysis of longitudinal observational studies
Authors: Aubin Henri-Jean , Ali Oicheih Laetitia , Gabriel Sonia , Berlin Ivan
Published: January 2021

Introduction

Strong evidence shows that smoking cessation decreases mortality. Much less is known regarding the association between reduction in cigarettes per day (CPD) and mortality. The primary aim of this systematic review is to compare the mortality risk between smokers achieving a sustained reduction of CPD and smokers maintaining their smoking rate. The secondary aims are to compare the mortality risk between smokers achieving complete, sustained smoking cessation and (1) smokers maintaining their smoking rate and (2) smokers who achieved a sustained reduction in smoking rate.

Methods and analysis

MEDLINE, Web of Sciences and Embase will be searched using a prespecified search strategy, up to 23 November 2020, and will be limited to studies published in English and in French. Longitudinal observational studies using individual data including smokers with at least two distant CPD assessments and a follow-up period of systematic mortality data recording will be included. The main outcome will be the all-cause mortality. The secondary outcome will be specific mortality. The Newcastle-Ottawa Scale will be used to assess the risk of bias of individual studies. Outcomes will be analysed using HRs. All other outcomes’ effect size reported in included studies will be converted in HRs using validated methods.

Ethics and dissemination

We intend to publish the results of our review in a peer-reviewed journal and to present the findings at national and international meetings and conferences.

PROSPERO registration number

CRD42019138354.
Protocol for a non-randomised feasibility study evaluating a codesigned patient safety guide in primary care
Authors: Morris Rebecca L , Gallacher Kay , Hann Mark , Rolfe Carly , Small Nicola , Giles Sally J , Sanders Caroline , Campbell Stephen M
Published: January 2021

Introduction

Patients and carers should be active partners in patient safety with healthcare professionals and be empowered to use personalised approaches to identify safety concerns and work together to prevent them. This protocol paper details a study to examine the feasibility of a multicomponent intervention to involve patients and/or carers in patient safety in primary care in the UK.

Methods and analysis

This is a two-phase, non-randomised feasibility mixed methods pragmatic study of a patient safety guide for primary care (PSG-PC). 8 general practices will recruit 120 patient and/or carer participants. All patient and/or carer participants will receive the PSG-PC. It will examine the feasibility and acceptability of the PSG-PC in primary care settings in patients aged 18 years or older who attend appointments at general practice with health professionals four or more times per year as either patients or carers. It will identify secondary outcomes for improving patient safety, health status and patient empowerment, and reducing health service utilisation over 6 months between baseline and 6-month follow-ups. The findings will inform whether a main effectiveness trial is feasible and, if so, how it should be designed, and how many patients and practices will be needed. The study will be undertaken between January 2020 and September 2021.

Ethics and dissemination

Ethical approval was obtained from the National Health Service London-West London and Gene Therapy Advisory Committee Research Ethics Committee (reference: 19/LO/1289). Research findings will be disseminated with participating general practices and shared in a range of different ways to engage different audiences, including presenting at international and national conferences, publishing in open-access, peer-reviewed journals and facilitating dissemination workshops within local communities with patients, carers and healthcare professionals.

Trial registration number

ISRCTN90222092.
Medication adherence, self-efficacy and health literacy among patients with glaucoma: a mixed-methods study protocol
Authors: Achilleos Maria , Merkouris Anastasios , Charalambous Andreas , Papastavrou Evridiki
Published: January 2021

Introduction

As the world population ages, glaucoma is becoming an increasingly significant cause of blindness. A key component in the management of glaucoma is the use of prescribed medications and the adherence to treatment. However, there is evidence of low adherence to prescribed medication in chronic diseases, such as glaucoma. This study aims to explore the level of medication adherence, self-efficacy, social support and health literacy among the patients with glaucoma and to determine if there are any correlations between them. The ultimate aim is to use the information to develop an educational programme for patients with glaucoma at a later stage.

Methods and analysis

This is a mixed-methods study which includes two stages: a descriptive study (stage 1) and focus group discussions (stage 2). Sample: Patients with glaucoma or ocular hypertension, using at least one kind of drops, from two ophthalmology clinics. Selected measures include: The Glaucoma Treatment Compliance Assessment Tool, The European Health Literacy Survey Questionnaire, The Glaucoma Medication Self-Efficacy Questionnaire and The Multidimensional Scale of Perceived Social Support. Two focus groups will be used for the collection of qualitative data, aiming to enrich the study with the patients’ experiences. The data will be analysed with SPSS, using descriptive and inferential statistics for stage 1 whereas content analysis will be used for the data from the focus group discussions (stage 2).

Ethics and dissemination

Permission to conduct the study was received from the National Bioethics Committee and the board of management of the two ophthalmology clinics. All participants will be informed fully on the purpose and methods of the study. Consent forms will be signed and at any time participants will have the right to withdraw. Confidentiality and the protection of data will be respected at all times.
“I just wear it and I become normal”: a qualitative study of Tanzanian women’s experiences with long-term vaginal pessary use for stress urinary incontinence
Authors: Nissen Karina Holm , Shayo Benjamin C , Rasch Vibeke , Masenga Gileard G , Linde Ditte Søndergaard
Published: January 2021

Introduction

Previous research has shown that vaginal pessaries are a cost-effective treatment for women worldwide suffering from stress urinary incontinence. However, little is known about African women’s experiences with vaginal pessary use. The aim of this study was to understand the experiences of vaginal pessary use among Tanzanian women who had received long-term pessary treatment for stress urinary incontinence.

Methods

15 semi-structured, individual interviews were conducted over a 2-month period in 2019 with Tanzanian women living in the Kilimanjaro Region who suffered from stress urinary incontinence and who had been using a pessary for at least 18 months. The interview transcripts were analysed using qualitative content analysis.

Results

The primary motivation for seeking treatment were discomfort from symptoms, social consequences and low quality of life. Perceived benefits from pessary use included improved quality of life with reacquired abilities to perform daily activities, participate in social gatherings, feeling symptom relief and improved sexual relations. Further, some women saw pessary treatment as superior to other locally available treatment options. Perceived barriers for pessary use included shame, husband’s disapproval, limited access to treatment and lack of knowledge among the women as well as healthcare personnel.

Conclusion

Vaginal pessaries are well-perceived as a long-term treatment method among Tanzanian women suffering from stress urinary incontinence. This method may have potential to be implemented large scale in Tanzania if combined with basic health education.
Diagnostic and predictive accuracy of the Clinical Frailty Scale among hospitalised older medical patients: a systematic review and meta-analysis protocol
Authors: Leahy Aoife , O’Connor Margaret , Condon Jennifer , Heywood Sarah , Shanahan Elaine , Peters Catherine , Galvin Rose
Published: January 2021

Introduction

Frailty is a common condition affecting older adults and is associated with increased mortality and adverse outcomes. Identification of older adults at risk of adverse outcomes is central to subsequent resource planning and targeted interventions. This systematic review and meta-analysis will examine the: (1) diagnostic accuracy of the Clinical Frailty Scale (CFS) in identifying hospitalised adults ≥65 years with frailty and a medical diagnosis compared with the reference standard Frailty Index or Frailty Phenotype and (2) predictive value of the CFS in determining those at increased risk of subsequent adverse outcomes.

Methods and analysis

We will include cross-sectional, retrospective and prospective cohort studies, and randomised controlled trials that assess either the diagnostic accuracy of the CFS when compared with the reference standard Frailty Index/Frailty Phenotype or the predictive validity of the CFS to predict subsequent adverse outcomes in hospitalised adults over 65 years with medical complaints. Adverse outcomes include falls, functional decline, unplanned Emergency Department attendance, emergency rehospitalisation, nursing home admission or death. A systematic search will be conducted in Embase, AMED, MEDLINE (Ebsco, Ovid, Pubmed), CINAHL, PsycINFO, Cochrane Library. Studies will be limited to those published from 2005 to 30 October 2019. Two independent reviewers will screen all titles and abstracts to identify relevant studies. The methodological quality of studies will be independently assessed using the Quality Assessment of Diagnostic Accuracy Studies-2. A CFS score of >4 will be used to identify frailty. We will construct 2×2 tables and determine true positives, true negatives, false positives and false negatives for each study when compared with the reference standard and for each adverse outcome. A bivariate random effects model will be applied to generate pooled summary estimates of sensitivity and specificity.

Ethics and dissemination

Ethical approval is not required for this systematic review. We will disseminate our findings through a peer-reviewed journal.
Investigating the use of a two-stage attention-aware convolutional neural network for the automated diagnosis of otitis media from tympanic membrane images: a prediction model development and validation study
Authors: Cai Yuexin , Yu Jin-Gang , Chen Yuebo , Liu Chu , Xiao Lichao , M Grais Emad , Zhao Fei , Lan Liping , Zeng Shengxin , Zeng Junbo , Wu Minjian , Su Yuejia , Li Yuanqing , Zheng Yiqing
Published: January 2021

Objectives

This study investigated the usefulness and performance of a two-stage attention-aware convolutional neural network (CNN) for the automated diagnosis of otitis media from tympanic membrane (TM) images.

Design

A classification model development and validation study in ears with otitis media based on otoscopic TM images. Two commonly used CNNs were trained and evaluated on the dataset. On the basis of a Class Activation Map (CAM), a two-stage classification pipeline was developed to improve accuracy and reliability, and simulate an expert reading the TM images.

Setting and participants

This is a retrospective study using otoendoscopic images obtained from the Department of Otorhinolaryngology in China. A dataset was generated with 6066 otoscopic images from 2022 participants comprising four kinds of TM images, that is, normal eardrum, otitis media with effusion (OME) and two stages of chronic suppurative otitis media (CSOM).

Results

The proposed method achieved an overall accuracy of 93.4% using ResNet50 as the backbone network in a threefold cross-validation. The F1 Score of classification for normal images was 94.3%, and 96.8% for OME. There was a small difference between the active and inactive status of CSOM, achieving 91.7% and 82.4% F1 scores, respectively. The results demonstrate a classification performance equivalent to the diagnosis level of an associate professor in otolaryngology.

Conclusions

CNNs provide a useful and effective tool for the automated classification of TM images. In addition, having a weakly supervised method such as CAM can help the network focus on discriminative parts of the image and improve performance with a relatively small database. This two-stage method is beneficial to improve the accuracy of diagnosis of otitis media for junior otolaryngologists and physicians in other disciplines.
Which Exercise for Low Back Pain? (WELBack) trial predicting response to exercise treatments for patients with low back pain: a validation randomised controlled trial protocol
Authors: Macedo Luciana G , Hodges Paul W. , Bostick Geoff , Hancock Mark , Laberge Maude , Hanna Steven , Spadoni Greg , Gross Anita , Schneider Julia
Published: January 2021

Introduction

Exercise therapy is the most recommended treatment for chronic low back pain (LBP). Effect sizes for exercises are usually small to moderate and could be due to the heterogeneity of people presenting with LBP. Thus, if patients could be better matched to exercise based on individual factors, then the effects of treatment could be greater. A recently published study provided evidence of better outcomes when patients are matched to the appropriate exercise type. The study demonstrated that a 15-item questionnaire, the Lumbar Spine Instability Questionnaire (LSIQ), could identify patients who responded best to one of the two exercise approaches for LBP (motor control and graded activity). The primary aim of the current study isill be to evaluate whether preidentified baseline characteristics, including the LSIQ, can modify the response to two of the most common exercise therapies for non-specific LBP. Secondary aims include an economic evaluations with a cost-effectiveness analysis.

Methods and analysis

Participants (n=414) will be recruited by primary care professionals and randomised (1:1) to receive motor control exercises or graded activity. Participants will undergo 12 sessions of exercise therapy over an 8-week period. The primary outcome will be physical function at 2 months using the Oswestry Disability Index. Secondary outcomes will be pain intensity, function and quality of life measured at 2, 6 and 12 months. Potential effect modifiers will be the LSIQ, self-efficacy, coping strategies, kinesiophobia and measures of nociceptive pain and central sensitisation. We will construct linear mixed models with terms for participants (fixed), treatment group, predictor (potential effect modifier), treatment group×predictor (potential effect modifier), physiotherapists, treatment group×physiotherapists and baseline score for the dependent variable.

Ethics and dissemination

This study received ethics approval from the Hamilton Integrate Research Ethics Board. Results will be submitted for publication in peer-reviewed journals.

Trial registration number

NCT04283409.
Knowledge of symptoms, time to presentation and barriers to medical help-seeking among Omani women diagnosed with breast cancer: a cross-sectional study
Authors: Al-Azri Mohammed , Al-Baimani Khalid , Al-Awaisi Huda , Al-Mandhari Zahid , Al-Khamayasi Jasem , Al-Lawati Yaseen , Panchatcharam Sathiya Murthi
Published: January 2021

Objective

To identify knowledge of breast cancer (BC) symptoms, time taken to consult a doctor and factors contributing to delays in medical help-seeking.

Design

A cross-sectional study of Omani women diagnosed with BC.

Setting

The two main teaching hospitals in Oman: Royal Hospital and Sultan Qaboos University Hospital.

Participants

Adult Omani women recently diagnosed with BC.

Tools

The Breast Module of the Cancer Awareness Measure and the International Cancer Benchmarking Partnership questionnaire were used to collect data.

Results

A total of 300 women with BC participated (response rate: 91.0%). The mean age at diagnosis was 43.0±12.50 years and 33.5% were diagnosed at stage III or IV. Although most women (74.4%) recognised breast/armpit lumps to be a symptom of BC, less than half identified other symptoms, including breast/armpit pain (44.0%), changes in the position of the nipple (36.2%), redness (31.7%), fatigue (26.3%), weight loss (23.4%) and loss of appetite (20.8%). While most (91.6%) were aware that BC could be cured if detected early, only 66.4% sought medical help within a month of developing symptoms. Initial responses to symptoms included informing husbands (40.2%) or family members (36.5%). Barriers to seeking medical help included feeling scared (68.9%) and worried about what the doctor might find (62.8%). Highly educated women were more likely to recognise the following as BC symptoms: changes in nipple position (OR: 0.16, 95% CI 0.03 to 0.81), breast pain (OR: 0.10, 95% CI 0.01 to 0.86) and unexplained weight loss (OR: 0.18, 95% CI 0.04 to 0.88) (all p<0.05).

Conclusions

Although many Omani women with BC were aware of the importance of early diagnosis, most demonstrated inadequate knowledge of symptoms, did not prioritise seeking medical help and reported emotional barriers to help-seeking. More educational measures are needed to improve symptom recognition and address help-seeking barriers to minimise delays in diagnosis.
358 The relationship between serum biomarkers of traumatic brain injury (TBI) and magnetic resonance imaging (MRI) in patients discharged from the emergency department (ED) with a normal acute CT
Authors: Whitehouse Daniel , Richter Sophie , Czeiter Endre , Winzeck Stefan , Kornaropoulos Evgenios N , Das Tilak , Vyvere Thijs Vande , Verheyden Jan , Williams Guy B , Correia Marta M , Wang Kevin , Menon David K , Büki András , Newcombe Virginia FJ ,   CENTER-TBI MRI Sub-Study Participants and Investigators
Published: January 2021

Aims/Objectives/Background

CT remains the neuroimaging of choice in patients with TBI, however the relative lack of sensitivity as compared to MRI for certain traumatic lesion types, including diffuse axonal injury (DAI), could lead to missing important intracranial findings.1 Serum biomarkers may allow screening of ED patients, highlighting those who will benefit from MRI and offer a pathway for further imaging in mild TBI patients.

Methods/Design

Patients discharged from ED with a panel of 6 biomarkers (GFAP, NFL, NSE, S100B, t-tau and UCH-L1), acute CT < 24 hrs of injury and acute MRI, were extracted from the CENTER-TBI core dataset.2 Mann Whitney U test to compare median biomarker levels in relation to +ve or –ve MRI. Unadjusted Area Under ROC (AUC) calculated for detection of MRI abnormality.

Results/Conclusions

80 patients met inclusion criteria, 45 (56%) male, median age 36.5 yr [IQR 24.5–51.3], median GCS 15 [IQR 15–15]. 17/80 (21.25%) had MRI abnormalities. 1 intraventricular haemorrhage, 2 traumatic subarachnoid haemorrhages, 3 intraparenchymal haemorrhages and 13 DAI. Of the biomarkers (median): GFAP (0.28 vs 1.88 ng/ml, p = 0.002), NSE (13.08 vs 15.19 ng/ml, p= 0.013), S100B (0.06 vs 0.12 µg/L, p=0.002), t-tau (0.82 vs 1.58 pg/ml, p=0.002), UCH-L1 (22.33 vs 57.68 pg/ml p<0.001) were significantly raised in patients with MRI abnormality. Serum NFL concentration was not significant (5.80 vs 8.18 pg/ml, p=0.096). AUC [95% CI] for detection of MRI abnormality: GFAP (0.75 [0.61–0.89]), NFL (0.63 [0.48–0.79]), NSE (0.70 [0.55–0.85]), S100B (0.75 [0.61–0.90]), tau (0.75 [0.61–0.89]), UCH-L1 (0.82 [0.69–0.95])

The results demonstrate potential utility in several acute serum biomarkers for screening of patients with a negative CT. Fair discrimination for detection of MRI pathology in this cohort was demonstrated by GFAP, NSE, S100B, total tau and UCH-L1. Further prospective analysis is required to assess the utility for biomarkers to determine MRI requirement in an ED population.

References

Metting Z, Rödiger LA, De Keyser J, et al. Structural and functional neuroimaging in mild-to-moderate head injury. Lancet Neurol 2007;6:699–710. doi:10.1016/S1474-4422(07)70191-6

Maas AIR, Menon DK, Steyerberg EW, et al. Collaborative European neurotrauma effectiveness research in traumatic brain injury (CENTER-TBI): A prospective longitudinal observational study. Neurosurgery 2015;76:67–80. doi:10.1227/NEU.0000000000000575
122 Penthrox: a service evaluation for methoxyflurane use in an emergency department setting
Authors: Ingham Jack , Roberts Gareth
Published: January 2021

Aims/Objectives/Background

In Manchester Royal Infirmary, a major trauma centre, there are many patient presentations which require fast acting analgesia. Often these presentations, such as shoulder dislocations, require conscious sedation in order to be safely, effectively and humanely treated.

Penthrox was introduced to the emergency department in December 2019. It was hoped that it would be used as an alternative to conscious sedation in patients requiring procedures. It was postulated that by having another analgesic method available, patients would have a greater likelihood of being discharged without the requirement for conscious sedation. This would therefore not require waiting for a Resus bed and therefore reduce length of stay in the department.

Methods/Design

Data was prospectively gathered for patients who received Penthrox in the months of December 2019 to July 2020 using a questionnaire that was filled in by clinicians.

Audit forms were collated as well as attendance data (including length of stay) for shoulder dislocations Dec 19 - Feb 19.

Pain scores were subjectively scored out of 10 and, using t-tests, compared for significance.

Length of stay, checklist completion, progression to concious sedation, further pain relief requirements and indications were also analysed.

Results/Conclusions

Subjectively reported pain scores were significantly reduced when comparing before and during procedure (<0.001, 95% CI of a reduction of 1.959 to 5.113) and also before and 10 mins after procedure (p= <0.001, 95% CI 3.96 to 6.33). The distributions of pain scores are demonstrated in the violin plot below.

There was no significant association between checklist completion and progression to concious sedation.

Difference between length of stay did not quite meet statistical significance (mean = 163.62 using penthrox, mean = 225 without penthrox. p = 0.06).

There were no significant adverse events.

In conclusion Penthrox is a safe and welcome addition to the ED formulary.
206 Emergency department clinical leads’ experiences of implementing primary care services where GPs work in or alongside emergency departments in the UK: a qualitative study
Authors: Edwards Michelle , Cooper Alison , Davies Freya , Carson-Stevens Andrew , Hughes Thomas , Porter Alison , Snooks Helen , Edwards Adrian
Published: January 2021

Aims/Objectives/Background

We aim to describe ED clinical leads’ experiences of implementing and delivering ‘primary care services’ and ‘emergency medicine services’ where GPs were integrated into the ED team. NHS England policy has promoted services in which patients presenting to EDs with non-urgent problems are directed to general practitioners (GPs) and other primary care clinicians working within or alongside EDs to address increasing demand. Our findings describe variation in the ways that these primary care services are implemented and the ways in which GPs work within them. We also highlight successes and challenges in implementing such services.

Methods/Design

We conducted interviews with ED clinical leads in England (n=19) and Wales (n=2). We used framework analysis to analyse interview transcripts and explore differences across ‘primary care services’, ‘emergency medicine services’ and emergency departments without primary care services.

Results/Conclusions

In EDs with separate primary care services, success was reported with a distinct workforce of primary care clinicians, who improved waiting times and flow by seeing primary care-type patients in a timely way, using fewer investigations, and enabling ED doctors to focus on more acutely unwell patients. Some challenges were: aligning services with the policy guidance, inconsistent demand for primary care, accessible community primary care services, difficulties recruiting GPs, lack of funding, difficulties agreeing governance protocols and establishing effective streaming pathways. Where GPs were integrated into an ED workforce success was reported as managing the demand for both emergency and primary care and reducing admissions.

To support successful and sustainable primary care services in or alongside EDs, policy makers and commissioners should consider varied ways that GPs can be employed to manage local demand and also local contextual factors such as the ability to recruit and retain GPs, sustainable funding, clear governance frameworks, training, support and guidance for all staff.
207 Patients’motivations and expectations when seeking urgent care at emergency departments and acceptability of primary care streaming: a realist study
Authors: Edwards Michelle , Price Delyth , Hepburn Julie , Harrington Barbara , Evans Bridie , Cooper Alison , Edwards Adrian
Published: January 2021

Aims/Objectives/Background

We aim to explain the contexts and mechanisms that influence patients’ motivations and expectations when accessing urgent care at an ED and their acceptability of being streamed to a primary care clinician working in or alongside the ED. Recent healthcare policy has encouraged the implementation of primary care services in or alongside emergency departments whereby patients with low acuity illness are streamed to a primary care clinician after a brief initial assessment. Our findings describe patients’ motivations, expectations, and acceptability of primary care streaming and their level of satisfaction.

Methods/Design

We recruited 24 patients to be interviewed after visiting an emergency department for one of five low acuity complaints. 12 patients were streamed to ED clinicians and 11 were streamed to primary care clinicians. We carried out semi-structured realist style interviews by telephone and carried out a realist analysis to create theories to explain motivations to attend, acceptability of streaming and satisfaction with care.

Results/Conclusions

Motivations for attending the ED included patients’ perception of their complaint as an emergency which needed immediate treatment, and previous experience of receiving care at the ED. Acceptability of primary care streaming was related to patients’ past experiences accessing primary care services, their trust in initial assessment processes and their expectation to be seen by ‘expert clinicians’ on the ‘same day’. When patients’ expectations of waiting times, level of investigations and general quality of care were met or exceeded, they reported acceptability to being streamed to a primary care clinician and were satisfied with their care. Understanding why patients attend the ED for urgent care needs and their experience of primary care streaming is essential to addressing increasing ED demand and improving efficiency.
104 Management of sports-related concussion in UK emergency departments: a multi-centre study
Authors: Rashid Haroon , Dobbin Nick , Mishra Smarak
Published: January 2021

Aims/Objectives/Background

It is necessary for those working in emergency departments to have adequate knowledge and delivery of current sport-related concussion (SRC) management protocols including identifying patients with concussion, managing their symptoms, giving appropriate advice with regards to return to play and referring those at risk of further injuries to an appropriate service.

This study aimed to establish the current practice, knowledge base and views towards SRC management of emergency department clinicians who have trained or are currently training in emergency medicine in the North West of England.

Methods/Design

This study was a multi centre, cross sectional study of 111 emergency department clinicians (EDCs) working across 15 centres in the North West of England A 21 item online survey was issued. The key questions focused on the advice given to patients on discharge, the importance of cognitive and physical rest, and knowledge of GRTP.

Results/Conclusions

Approximately, 37% of the population responded to the invitation, with 111 responses included in this study. Only 27% of total respondents were aware of the Consensus Statements of Concussion in Sport guidelines, whilst 45% were unaware of any SRC guidelines. 57% of respondents had heard of a graded return to play (GRTP) protocol. Physical rest following an SRC was advised by 95% of respondents with 61% advising concomitant cognitive rest and 42% of respondents providing specific written advice. 90% of clinicians had not received any SRC training.

There is a lack of knowledge amongst EDCs in the North West of England in managing and providing discharge advice according to recommendations for patients with SRC. This is likely a consequence of the limited training that these clinicians have received in managing SRC and suggests further work needs to be undertaken to educate EDCs on current SRC management guidance to ensure appropriate care and discharge advice is given to patients.