bluuebunny/crossref_metadata_2025 huggingface dataset:
Abnormal neurodevelopment outcome in case of neonatal hyperekplexia secondary to missense mutation inGLRBgene
Authors: Gupta Naveen Parkash , Verma Vinita , Chopra Saurabh , Choudhury Vivek
Published: December 2020

Hyperekplexia is an exaggerated startle to external stimuli associated with a generalised increase in tone seen in neonates with both sporadic and genetic predisposition. This is an uncommon neurological entity that is misdiagnosed as seizure. A 28-days-old infant was admitted to us with characteristic intermittent generalised tonic spasm being treated as a seizure disorder. The infant had characteristic stiffening episode, exaggerated startle and non-habituation on tapping the nose. Hyperekplexia was suspected and confirmed by genetic testing (mutation in the β subunit of glycine was found). Initial improvement was seen with the use of clonazepam, which was not sustained. At the age of 4.5 years, the child is still having neurobehavioural issues like hyperactivity and sensory hyper-responsiveness. Usually, hyperekplexia is benign in nature. We report a case of hyperekplexia with non-sense mutation in the β subunit ofGlyRgene having abnormal neurodevelopmental findings at 4.5 years.
Expression of the NEK7/NLRP3 inflammasome pathway in patients with diabetic lower extremity arterial disease
Authors: Cai HuaiQiu , Wang Peng , Zhang Bo , Dong XiaoQiu
Published: December 2020

Introduction

The NLRP3 inflammasome is closely related to diabetes and atherosclerosis. Recent studies suggest NIMA-related kinase 7 (NEK7) is necessary for NLRP3 inflammasome activation during potassium efflux. However, the expression of the NEK7/NLRP3 inflammasome pathway in diabetic lower extremity arterial disease (DLEAD) is unclear. The present study aimed to explore whether the NEK7/NLRP3 inflammasome pathway is involved in the pathogenesis of DLEAD.

Research design and methods

The serum levels of interleukin-1β (IL-1β) and IL-18 in the control group (n=39), diabetes without lower extremity artery diseases group (n=39) and DLEAD group (n=85) were measured. H&E and Von Kossa staining were used to observe the vasculature of amputated feet from patients with diabetic foot. Furthermore, immunohistochemical staining, immunofluorescence and western blot were used to detect the expression of NEK7 and the NLRP3 inflammasome.

Results

The serum IL-1β level in the DLEAD group was significantly increased compared with that in the control group and diabetes without lower extremity artery disease group. The serum IL-18 level was significantly higher in the DLEAD group and diabetes without lower extremity artery disease group than in the control group. H&E staining showed that the subintimal tissue of the arteries of patients with diabetic foot were highly thickened and exhibited irregular atherosclerotic plaques, and the arterial lumen was nearly occluded. Von Kossa staining showed dense brown-black calcium salt deposits in the vascular mesangium. Moreover, the expression of NEK7 and the NLRP3 inflammasome was significantly increased in the vascular cells of patients with diabetic foot, especially in vascular smooth muscle cells.

Conclusion

The NEK7/NLRP3 inflammasome pathway might be involved in the pathogenesis of DLEAD.
‘Dark matter’, second waves and epidemiological modelling
Authors: Friston Karl , Costello Anthony , Pillay Deenan
Published: December 2020

Recent reports using conventional Susceptible, Exposed, Infected and Removed models suggest that the next wave of the COVID-19 pandemic in the UK could overwhelm health services, with fatalities exceeding the first wave. We used Bayesian model comparison to revisit these conclusions, allowing for heterogeneity of exposure, susceptibility and transmission. We used dynamic causal modelling to estimate the evidence for alternative models of daily cases and deaths from the USA, the UK, Brazil, Italy, France, Spain, Mexico, Belgium, Germany and Canada over the period 25 January 2020 to 15 June 2020. These data were used to estimate the proportions of people (i) not exposed to the virus, (ii) not susceptible to infection when exposed and (iii) not infectious when susceptible to infection. Bayesian model comparison furnished overwhelming evidence for heterogeneity of exposure, susceptibility and transmission. Furthermore, both lockdown and the build-up of population immunity contributed to viral transmission in all but one country. Small variations in heterogeneity were sufficient to explain large differences in mortality rates. The best model of UK data predicts a second surge of fatalities will be much less than the first peak. The size of the second wave depends sensitively on the loss of immunity and the efficacy of Find-Test-Trace-Isolate-Support programmes. In summary, accounting for heterogeneity of exposure, susceptibility and transmission suggests that the next wave of the SARS-CoV-2 pandemic will be much smaller than conventional models predict, with less economic and health disruption. This heterogeneity means that seroprevalence underestimates effective herd immunity and, crucially, the potential of public health programmes.
Relationship between parental overweight and obesity and childhood metabolic syndrome in their offspring: result from a cross-sectional analysis of parent–offspring trios in China
Authors: Yang Zhaogeng , Li Yanhui , Dong Bin , Gao Di , Wen Bo , Ma Jun
Published: December 2020

Objective

Metabolic syndrome (MS) and its components are observed to emerge in childhood and may continue into adulthood. The study aimed to investigate the association between parental overweight and risk of childhood MS and its components in their offspring.

Methods

Data were obtained from a cross-sectional survey conducted in Chinese children and adolescents; a total of 11 784 children aged 7–18 years were included in this study; child outcomes were obtained from objective measurements and parental data were obtained from questionnaires; MS was defined according to the modified criteria of Adult Treatment Panel Ⅲ; correlation between parental overweight and offspring MS was assessed via multivariate logistic regression models adjusted for potential covariates.

Results

3476 (29.5%) children were found to have overweight fathers, 1041 (8.8%) had overweight mothers and 852 (7.2%) had both overweight parents. The prevalence of MS was 7.1% in total, 8.2% in boys and 5.9% in girls; children with overweight parents had a higher prevalence of MS and its components (except for elevated glucose) compared with children with normal-weight parents. Children with overweight fathers, mothers and both parents had 2.17 times (95% CI: 1.65–2.85), 2.89 times (95% CI: 2.03–4.11) and 2.81 times (95% CI: 1.91–4.15) higher risk of MS, respectively. Children with overweight mothers were likely to have a higher risk of MS compared with children with overweight fathers. Parental overweight was positively correlated with higher risk of MS, abdominal obesity and low HDL-C both in boys and girls.

Conclusion

Parental overweight was strongly associated with increased risk of MS in their offspring, the risk was highest in children with both parents to be overweight. Maternal overweight seems to have a stronger correlation with offspring MS than paternal overweight. Parental overweight is one of the factors for identifying metabolic dysfunction risk in their offspring and other factors need to be considered as well.
Drug Use in Street Sex worKers (DUSSK) study: results of a mixed methods feasibility study of a complex intervention to reduce illicit drug use in drug dependent female sex workers
Authors: Patel Rita , Redmond Niamh M , Kesten Joanna M , Linton Myles-Jay , Horwood Jeremy , Wilcox David , Munafo Jess , Coast Joanna , Macleod John , Jeal Nicola
Published: December 2020

Objectives

The majority of female street-based sex workers (SSWs) are dependent on illicit drugs and sell sex to fund their drug use. They typically face multiple traumatic experiences, starting at a young age, which continue through sex work involvement. Their trauma-related symptoms tend to increase when drug use is reduced, hindering sustained reduction. Providing specialist trauma care to address post-traumatic stress disorder (PTSD) alongside drug treatment may therefore improve treatment outcomes. Aims to (1) evaluate recruitment and retention of participants; (2) examine intervention experiences and acceptability; and (3) explore intervention costs using a mixed methods feasibility study.

Setting

Female SSW charity premises in a large UK inner city.

Participants

Females aged 18 years or older, who have sold sex on the street and used heroin and/or crack cocaine at least once a week in the last calendar month.

Intervention

Female SSW-only drug treatment groups in a female SSW-only setting delivered by female staff. Targeted PTSD screening then treatment of positive diagnoses with eye movement desensitisation and reprocessing (EMDR) therapy by female staff from a specialist National Health Service trauma service.

Results

(1) Of 125 contacts, 11 met inclusion criteria and provided informed consent, 4 reached the intervention final stage, (2) service providers said working in collaboration with other services was valuable, the intervention was worthwhile and had a positive influence on participants. Participants viewed recruitment as acceptable and experienced the intervention positively. The unsettled nature of participant’s lives was a key attendance barrier. (3) The total cost of the intervention was £11 710, with staff costs dominating.

Conclusions

Recruitment and retention rates reflected study inclusion criteria targeting women with the most complex needs. Two participants received EMDR demonstrating that the three agencies working together was feasible. Staff heavy costs highlight the importance of supporting participant attendance to minimise per participant costs in a future trial.
Collaboration between patient organisations and a clinical research sponsor in a rare disease condition: learnings from a community advisory board and best practice for future collaborations
Authors: Roennow Annelise , Sauvé Maureen , Welling Joep , Riggs Robert J , Kennedy Ann Tyrrell , Galetti Ilaria , Brown Edith , Leite Catarina , Gonzalez Alex , Portales Guiraud Alexandra Paula , Houÿez François , Camp Rob , Gilbert Annie , Gahlemann Martina , Moros Lizette , Luna Flores Jose Luis , Schmidt Friedrich , Sauter Wiebke , Finnern Henrik
Published: December 2020

IntroductionTransparent collaborations between patient organisations (POs) and clinical research sponsors (CRS) can identify and address the unmet needs of patients and caregivers. These insights can improve clinical trial participant experience and delivery of medical innovations necessary to advance health outcomes and standards of care. We share our experiences from such a collaboration undertaken surrounding the SENSCIS®clinical trial (NCT02597933), and discuss its impact during, and legacy beyond, the trial.

SummaryWe describe the establishment of a community advisory board (CAB): a transparent, multiyear collaboration between the scleroderma patient community and a CRS. We present shared learnings from the collaboration, which is split into three main areas: (1) the implementation and conduct of the clinical trial; (2) analysis and dissemination of the results; and (3) aspects of the collaboration not related to the trial.

1. The scleroderma CAB reviewed and provided advice on trial conduct and reporting. This led to the improvement and optimisation of trial procedures; meaningful, patient-focused adaptations were made to address challenges relevant to scleroderma-associated interstitial lung disease patients.

2. To ensure that results of the trial were accessible to lay audiences and patients, written lay summaries were developed by the trial sponsor with valuable input from the CAB to ensure that language and figures were understandable.

3. The CAB and the CRS also collaborated to co-develop opening tools for medication blister packs and bottles. In addition, to raise disease awareness among physicians, patients and caregivers, educational materials to improve diagnosis and management of scleroderma were co-created and delivered by the CAB and CRS.

ConclusionsThis collaboration between POs and a CRS, in a rare disease condition, led to meaningful improvements in patient safety, comfort and self-management and addressed information needs. This collaboration may serve as a template of best practice for future collaborations between POs, research sponsors and other healthcare stakeholders.
How accurate are digital symptom assessment apps for suggesting conditions and urgency advice? A clinical vignettes comparison to GPs
Authors: Gilbert Stephen , Mehl Alicia , Baluch Adel , Cawley Caoimhe , Challiner Jean , Fraser Hamish , Millen Elizabeth , Montazeri Maryam , Multmeier Jan , Pick Fiona , Richter Claudia , Türk Ewelina , Upadhyay Shubhanan , Virani Vishaal , Vona Nicola , Wicks Paul , Novorol Claire
Published: December 2020

Objectives

To compare breadth of condition coverage, accuracy of suggested conditions and appropriateness of urgency advice of eight popular symptom assessment apps.

Design

Vignettes study.

Setting

200 primary care vignettes.

Intervention/comparator

For eight apps and seven general practitioners (GPs): breadth of coverage and condition-suggestion and urgency advice accuracy measured against the vignettes’ gold-standard.

Primary outcome measures

(1) Proportion of conditions ‘covered’ by an app, that is, not excluded because the user was too young/old or pregnant, or not modelled; (2) proportion of vignettes with the correct primary diagnosis among the top 3 conditions suggested; (3) proportion of ‘safe’ urgency advice (ie, at gold standard level, more conservative, or no more than one level less conservative).

Results

Condition-suggestion coverage was highly variable, with some apps not offering a suggestion for many users: in alphabetical order, Ada: 99.0%; Babylon: 51.5%; Buoy: 88.5%; K Health: 74.5%; Mediktor: 80.5%; Symptomate: 61.5%; Your.MD: 64.5%; WebMD: 93.0%. Top-3 suggestion accuracy was GPs (average): 82.1%±5.2%; Ada: 70.5%; Babylon: 32.0%; Buoy: 43.0%; K Health: 36.0%; Mediktor: 36.0%; Symptomate: 27.5%; WebMD: 35.5%; Your.MD: 23.5%. Some apps excluded certain user demographics or conditions and their performance was generally greater with the exclusion of corresponding vignettes. For safe urgency advice, tested GPs had an average of 97.0%±2.5%. For the vignettes with advice provided, only three apps had safety performance within 1 SD of the GPs—Ada: 97.0%; Babylon: 95.1%; Symptomate: 97.8%. One app had a safety performance within 2 SDs of GPs—Your.MD: 92.6%. Three apps had a safety performance outside 2 SDs of GPs—Buoy: 80.0% (p<0.001); K Health: 81.3% (p<0.001); Mediktor: 87.3% (p=1.3×10-3).

Conclusions

The utility of digital symptom assessment apps relies on coverage, accuracy and safety. While no digital tool outperformed GPs, some came close, and the nature of iterative improvements to software offers scalable improvements to care.
A smartphone app for sedentary behaviour change in cardiac rehabilitation and the effect on hospital admissions: the ToDo-CR randomised controlled trial study protocol
Authors: Patterson Kacie , Davey Rachel , Keegan Richard , Niyonsenga Theophile , Mohanty Itismita , van Berlo Sander , Freene Nicole
Published: December 2020

Introduction

Cardiac rehabilitation (CR) is recommended for secondary prevention of cardiovascular disease and reducing the risk of repeat cardiac events. Physical activity is a core component of CR; however, studies show that participants remain largely sedentary. Sedentary behaviour is an independent risk factor for all-cause mortality. Strategies to encourage sedentary behaviour change are needed. This study will explore the effectiveness and costs of a smartphone application (Vire) and an individualised online behaviour change program (ToDo-CR) in reducing sedentary behaviour, all-cause hospital admissions and emergency department visits over 12 months after commencing CR.

Methods and analysis

A multicentre, assessor-blind parallel randomised controlled trial will be conducted with 144 participants (18+ years). Participants will be recruited from three phase-II CR centres. They will be assessed on admission to CR and randomly assigned (1:1) to one of two groups: CR plus the ToDo-CR 6-month programme or usual care CR. Both groups will be re-assessed at 6 months and 12 months for the primary outcome of all-cause hospital admissions and presentations to the emergency department. Accelerometer-measured changes in sedentary behaviour and physical activity will also be assessed. Logistic regression models will be used for the primary outcome of hospital admissions and emergency department visits. Methods for repeated measures analysis will be used for all other outcomes. A cost-effectiveness analysis will be conducted to evaluate the effects of the intervention on the rates of hospital admissions and emergency department visits within the 12 months post commencing CR.

Ethics and dissemination

This study received ethical approval from the Australian Capital Territory Health (2019.ETH.00162), Calvary Public Hospital Bruce (20–2019) and the University of Canberra (HREC-2325) Human Research Ethics Committees (HREC). Results will be disseminated through peer-reviewed academic journals. Results will be made available to participants on request.

Trial registration number

ACTRN12619001223123.
Factors influencing palliative care referral for hospitalised patients with heart failure: an exploratory, randomised, multi-institutional survey of hospitalists and cardiologists
Authors: Abedini Nauzley Christy , Guo Gaorui , Hummel Scott L , Bozaan David , Beasley Michael , Cowger Jennifer , Chopra Vineet
Published: December 2020

Objective

To identify factors influencing cardiologists’ and hospitalists’ decisions regarding palliative care referral among hospitalised patients with advanced heart failure.

Design

An exploratory, randomised vignette-based survey.

Setting

Cardiology and hospitalist divisions at three Michigan State institutions and the Society of Hospital Medicine’s Michigan Chapter.

Participants

145 hospitalists and 64 cardiologists.

Outcome measures

Primary outcomes included participants’ reports of their likelihood of referring a standardised patient with an acute heart failure exacerbation with multiple prior hospital admissions and acute renal failure to palliative care (scale of 0%–100%) after the initial stem and after being cued with three randomised vignette modifiers, including the presence versus the absence of continuity with an outpatient cardiologist; the presence versus the absence of documented advance care planning; and the patient voicing that he is accepting of his severe illness versus wanting everything done. Adjusted generalised linear models and predictive margins were used to evaluate the impact of each randomised modifier on referral decisions. An interaction term evaluated the effect of provider specialty on outcomes. Secondary outcomes included participants’ reports of their general practices around palliative care delivery to hospitalised patients with heart failure.

Results

Response rate was 31.3%. Predictive margins from generalised linear models demonstrated a statistically significantly higher likelihood of referral to inpatient palliative care if the patient lacked an outpatient cardiologist (mean difference: 6.3% (95% CI 1.8% to 10.8%)); had prior advance care planning documentation (mean difference: 9.7% (95% CI 4.4% to 15.0%)); and was accepting of illness severity (mean difference: 29.6% (95% CI 24.8% to 34.4%)). No interaction effect was noted based on provider specialty. Most hospitalists and cardiologists were unaware of palliative care guidelines for patients with heart failure (74.3% vs 70.3%, p=0.71).

Conclusions

A number of patient and provider factors influence palliative care referral decisions in hospitalised patients with advanced heart failure.
Availability and readiness to provide sexually transmitted infections and HIV testing and counselling services in Nepal: evidence from comprehensive health facility survey
Authors: Acharya Kiran , Thapa Rajshree , Bhattarai Navaraj , Bam Kiran , Shrestha Bhagawan
Published: December 2020

Objective

We assessed the availability and readiness of health facilities to provide sexually transmitted infections (STI) and HIV testing and counselling (HTC) services in Nepal.

Design

This was a cross-sectional study.

Setting

We used data from the most recent nationally representative Nepal Health Facility Survey (NHFS) 2015. A total of 963 health facilities were surveyed with 97% response rate.

Primary and secondary outcome measures

The primary outcome of this study was to assess the availability and readiness of health facilities to provide STI and HTC services using the WHO Service Availability and Readiness Assessment (SARA) manual.

Results

Nearly three-fourths (73.8%) and less than one-tenth (5.9%) of health facilities reported providing STI and HTC services, respectively. The mean readiness score of STI and HTC services was 26.2% and 68.9%, respectively. The readiness scores varied significantly according to the managing authority (private vs public) for both STI and HTC services. Interestingly, health facilities with external supervision had better service readiness scores for STI services that were almost four points higher than compared with those facilities with no external supervision. Regarding HTC services, service readiness was lower at private hospitals (32.9 points lower) compared to government hospitals. Unlike STI services, the readiness of facilities to provide HTC services was higher (4.8 point higher) at facilities which performed quality assurance.

Conclusion

The facility readiness for HTC service is higher than that for STI services. There are persistent gaps in staff, guidelines and medicine and commodities across both services. Government of Nepal should focus on ensuring constant supervision and quality assurance, as these were among the determining factors for facility readiness.
Association of short-term exposure to ambient PM2.5with hospital admissions and 30-day readmissions in end-stage renal disease patients: population-based retrospective cohort study
Authors: Wyatt Lauren H , Xi Yuzhi , Kshirsagar Abhijit , Di Qian , Ward-Caviness Cavin , Wade Timothy J , Cascio Wayne E , Rappold Ana G
Published: December 2020

Objectives

To examine the effect of short-term exposure to ambient fine particulate matter (PM2.5) on all-cause, cardiovascular and respiratory-related hospital admissions and readmissions among patients receiving outpatient haemodialysis.

Design

Retrospective cohort study.

Setting

Inpatient hospitalisation claims identified from the US Renal Data System in 530 US counties.

Participants

All patients receiving in-centre haemodialysis between 2008 and 2014.

Primary and secondary outcome measures

Risk of all-cause, cardiovascular and respiratory-related hospital admissions and 30-day all-cause and cause-specific readmission following an all-cause, cardiovascular, and respiratory-related discharges. Readmission risk was evaluated for early (1–7 days postdischarge) and late (8–30 days postdischarge) readmission time periods. Relative risk is expressed per 10 μg/m3of PM2.5.

Results

Same-day ambient PM2.5was associated with increased hospital admission risk for cardiovascular causes (0.9%, 95% CI 0.2 to 1.7). Greater PM2.5-related associations were observed with 30-day readmission risk. Early-readmission risk was increased by 1.6%–1.8% following all-cause (1.6%, 95% CI 0.6% to 2.6%), cardiovascular (1.8%, 95% CI 0.4% to 3.2%) and respiratory (1.8%, 95% CI 0.4% to 3.2%) discharges; while late-readmission risk increased by 1.2%–1.3% following all-cause and cardiovascular discharges. PM2.5-related associations with readmission risk were greatest for certain cause-specific readmissions ranging 4.0%–6.5% for dysrhythmia and conduction disorder, heart failure, chronic obstructive pulmonary disease, other non-cardiac chest pain or respiratory syndrome and pneumonia. Following all-cause discharges, the cause-specific early-readmission risk was increased by 6.5% (95% CI 3.5% to 9.6%) for pneumonia, 4.8% (95% CI 2.3% to 7.4%) for dysrhythmia and conduction disorder, 3.7% (95% CI 1.4% to 6.0%) for heart failure and 2.7% (95% CI 1.2% to 4.2%) for other non-cardiac chest pain or respiratory syndrome-related causes.

Conclusions

Daily ambient PM2.5was associated with an increased risk of cardiovascular admissions and 30-day readmissions following cardiopulmonary-related discharges in a vulnerable end-stage renal disease population. In the first week following discharge, greater PM2.5-related risk of rehospitalisation was identified for some diagnoses.
Associations between e-health questionnaire responses, health checks and graduation: Finnish register-based study of 2011–2012 university entrants
Authors: Seilo Noora , Paldanius Susanna , Autio Reija , Kunttu Kristina , Kaila Minna
Published: December 2020

Objective

To evaluate the association between health and study-related factors measured by an Electronic Health Questionnaire (eHQ), participation in a health examination process and graduation in a university student population.

Design

Nationwide, retrospective, register-based cohort study with a 6-year follow-up.

Setting

Student health care in Finland. Finnish Student Health Service (FSHS) provides statutory student health services to university students in Finland. The health examination process of FSHS includes the eHQ provided annually to university entrants and a subsequent health check when necessary based on students’ eHQ response.

Participants

A national cohort of university entrants from the 2011–2012 academic year (n=14 329, n (female)=8075, n (male)=6254).

Outcome measures

The primary outcome measure was graduation, measured based on whether a student had completed a bachelor’s, licentiate or master’s degree during the 6-year follow-up.

Results

Some 72% of the women and 60% of the men had graduated during the follow-up. The predictors in the eHQ associated with non-graduation differed by sex. Among the women’s low enthusiasm about studies (OR 2.6, 95% CI 1.9 to 3.6), low engagement with studies (OR 2.5, 95% CI 1.8 to 3.4) and daily smoking (OR 1.9, 95% CI 1.4 to 2.6) were the strongest predictors to non-graduation. Among the men, low engagement with studies (OR 3.7, 95% CI 2.5 to 5.5) and obesity (body mass index≥35) (OR 4.0, 95% CI 1.9 to 8.8) were the strongest predictors to non-graduation. Not attending the health check when referred was associated with non-graduation in both sexes: the OR for not graduating was 1.6 (95% CI 1.3 to 1.9) in women and 1.3 (95% CI 1.0 to 1.6) in men.

Conclusions

Engagement and enthusiasm about studying in the first year are important predictors of graduation and therefore a potential intervention target. Health promotion initiatives conducted early in the studies may have a positive effect on students’ academic achievement.
Effect of a tailored multidimensional intervention on the care burden among family caregivers of stroke survivors: study protocol for a randomised controlled trial
Authors: Elsheikh Mahmoud Ahmed , Moriyama Michiko , Rahman Md Moshiur , Kako Mayumi , El-Monshed Ahmed Hashem , Zoromba Mohamed , Zehry Hamada , Khalil Maha Hazem , Amr Mostafa
Published: December 2020

Introduction

Caring for stroke survivors creates high levels of care burden among family caregivers. Previous initiatives at alleviating the care burden have been unsuccessful. The proposed study aims to evaluate the effect of a tailored multidimensional intervention on the care burden among family caregivers of stroke survivors. Based on the perceived needs of family caregivers, this intervention takes into account scientific recommendations to combine three different approaches: skill-building, psychoeducation and peer support.

Methods and analysis

Using a prospective, randomised, open-label, parallel-group design, 110 family caregivers will be enrolled from Dakahlia Governorate, Egypt between December 2019 and May 2020, and randomly assigned to either the intervention group or the control group. The tailored multidimensional intervention will be administered for 6 months, including three home visits, six home-based telephone calls and one peer support session. The primary outcome is the care burden as measured using the Zarit Burden Interview. Secondary outcomes include changes in the family caregivers’ perceived needs (Family Needs Questionnaire-Revised), coping strategies (Brief-Coping Orientation to Problems Experienced) and quality of life (WHO Quality of Life-BREF). Outcomes evaluation will be conducted at baseline (T0), month 3 (T1) and month 6 (T2). Independent t-test will be performed to compare the mean values of study variables between the two groups at both T1 and T2. After adjusting for confounding variables, analysis of covariance will be used to assess the effect of the intervention. In addition, repeated measures analysis of variance will be conducted to assess changes in effect over time.

Ethics and dissemination

This study was approved by the Research Ethics Committee of the Faculty of Nursing, Mansoura University, Mansoura, Egypt (P.0195). The results will be published in a scientific peer-reviewed journal, and findings will be disseminated at the local and international levels.

Trial registration number

NCT04211662.
Utilisation of healthcare services for respiratory tract infections in patients with and without diabetes in Qatar: a cross-sectional study
Authors: Islam Nazmul , Chivese Tawanda , Alam M Fasihul
Published: December 2020

Objective

People with diabetes mellitus have a high risk of acquiring respiratory tract infections (RTIs), yet little is known about their utilisation of healthcare services compared with people without diabetes. This study aimed to compare the utilisation of healthcare services for RTIs between individuals with and without diabetes attending primary healthcare centres (PHCCs) in Qatar.

Design

A retrospective cross-sectional study was conducted using an electronic database of all individuals who had a diagnosis of RTI.

Setting

PHCCs in Qatar from July 2015 to December 2017.

Participants

Participants in the study were all adult individuals (aged ≥18 years) who visited the primary healthcare facilities and were diagnosed with an RTI during the study period.

Primary and outcome measures

For each participant, visits to the healthcare facility, antibiotic use and use of other medications were extracted from the electronic database and compared between participants with and without a diabetes diagnosis.

Results

A total of 32 857 participants were included, of whom 7407 (22.5%) had a diabetes diagnosis. Results from a negative binomial regression indicate that diabetes diagnosis was significantly associated with increased visits to the healthcare facility (incidence rate ratio (IRR) 1.10, 95% CI 1.076 to 1.134, p<0.001), antibiotic use (IRR 1.09, 95% CI 1.046 to 1.145, p<0.001) and use of other medications (IRR 1.11, 95% CI 1.078 to 1.143, p<0.001).

Conclusions

A diabetes diagnosis among patients with RTI was associated with higher utilisation of healthcare services. Given the added costs to the healthcare system, prevention of diabetes will have additional benefits to the healthcare system, apart from diabetes-associated costs alone.
Prevalence of domestic violence against women in informal settlements in Mumbai, India: a cross-sectional survey
Authors: Daruwalla Nayreen , Kanougiya Suman , Gupta Apoorwa , Gram Lu , Osrin David
Published: December 2020

Objectives

Domestic violence against women harms individuals, families, communities and society. Perpetrated by intimate partners or other family members, its overlapping forms include physical, sexual and emotional violence, control and neglect. We aimed to describe the prevalence of these forms of violence and their perpetrators in informal settlements in Mumbai.

Design

Cross-sectional survey.

Setting

Two large urban informal settlement areas.

Participants

5122 women aged 18–49 years.

Primary and secondary outcome measures

Prevalence and perpetrators in the last year of physical, sexual and emotional domestic violence, coercive control and neglect. For each of these forms of violence, responses to questions about individual acts and composite estimates.

Results

In the last year, 644 (13%) women had experienced physical domestic violence, 188 (4%) sexual violence and 963 (19%) emotional violence. Of ever-married women, 13% had experienced physical or sexual intimate partner violence in the last year. Most physical (87%) and sexual violence (99%) was done by partners, but emotional violence equally involved marital family members. All three forms of violence were more common if women were younger, in the lowest socioeconomic asset quintile or reported disability. 1816 women (35%) had experienced at least one instance of coercive control and 33% said that they were afraid of people in their home. 10% reported domestic neglect of their food, sleep, health or children’s health.

Conclusions

Domestic violence against women remains common in urban informal settlements. Physical and sexual violence were perpetrated mainly by intimate partners, but emotional violence was attributed equally to partners and marital family. More than one-third of women described controlling behaviours perpetrated by both intimate partners and marital family members. We emphasise the need to include the spectrum of perpetrators and forms of domestic violence—particularly emotional violence and coercive control—in data gathering.

Trial registration number

ISRCTN84502355; Pre-results.
Antimicrobial use across six referral hospitals in Tanzania: a point prevalence survey
Authors: Seni Jeremiah , Mapunjo Siana G , Wittenauer Rachel , Valimba Richard , Stergachis Andy , Werth Brian J , Saitoti Samir , Mhadu Noel H , Lusaya Edgar , Konduri Niranjan
Published: December 2020

Objective

To delineate the prevalence and factors associated with antimicrobial use across six referral hospitals in Tanzania using WHO point prevalence survey (PPS) methodology to inform hospital-specific antimicrobial stewardship programmes.

Design

Cross-sectional analytical study.

Setting

Six referral hospitals in Tanzania.

Participants

Patients irrespective of age and gender (n=948) admitted in the six referral hospital wards before 8:00 hours on each day of the survey were included in December 2019. Using the WHO PPS methodology, data on hospitals, wards, patients, antibiotics, and indications for antibiotics were collected.

Outcome measures

We analysed the prevalence of antibiotic use by referral hospital, ward, indication and patient characteristics as the main outcomes. We also described adherence to the Tanzania Standard Treatment Guidelines (STG) and WHO’s AWaRe categorisation of antibiotics.

Results

Approximately 62.3% of inpatients were prescribed antibiotics, predominantly from the Access group of antibiotics (ceftriaxone, metronidazole or ampicillin–cloxacillin). The overall adherence of antibiotic prescriptions to the Tanzania STG was high (84.0%), with the exception of Sekou Toure Regional Referral Hospital (68.0%) and Maweni Regional Referral Hospital (57.8%). The most common indication for antibiotic prescriptions was community-acquired infections (39.8%). Children less than 2 years of age (OR 1.73, 95% CI 1.02 to 2.92, p=0.039); admission to surgical wards (OR 4.90, 95% CI 2.87 to 8.36, p <0.001); and admission to paediatric wards (OR 3.93, 95% CI 2.16 to 7.15, p <0.001) were associated with increased odds of antibiotic use. Only 2 of 591 patients were prescribed antibiotics based on culture and antimicrobial susceptibility testing results.

Conclusions

Empirical use of antibiotics is common, and the Access group of antibiotics is predominantly prescribed in children less than 2 years and patients admitted to surgical and paediatric wards. Lack of utilisation of antimicrobial susceptibility testing services in these hospitals requires urgent interventions. Routine monitoring of antibiotic use is recommended to be part of antibiotic stewardship programmes in Tanzania.
Detailing sexual outcomes after treatment of localised prostate cancer with focal therapy using various energy sources: protocol for a mixed-methods study
Authors: Fiard Gaelle , Kelly Daniel , Yap Tet , Emberton Mark
Published: December 2020

Introduction

Focal therapy has emerged as a promising treatment option for men with localised prostate cancer. However, most of the evaluation of postoperative function has taken place at a relatively high, non-granular level. Most of the data we use to provide informed consent for our patients is obtained from retrospective series, or derived from prospective studies whose primary outcome was oncological. Finally, most studies have focused on erectile function and overlooked other, presumably important, elements of male sexual function. The present study aims at studying in-depth the sexual consequences of focal therapy with various energy sources.

Methods and analysis

This will be a mixed-methods research study based on a retrospective and prospective cohort, recruited in parallel. The retrospective cohort will consist of patients treated with focal irreversible electroporation, and the prospective cohort of patients treated with three focal therapy energies. Participants will be recruited from two UK urology centres, one National Health Service and one private. On consent, patients will fill in self-administered validated questionnaires (International Index of Erectile Function-15 (IIEF-15), Male Sexual Health Questionnaire-Ejaculatory Dysfunction-Short Form (MSHQ-EjD-SF)) and semistructured interviews will be organised to collect patients’ expectations and postoperative changes in domains such as erection, ejaculation, orgasm, libido/sexual desire, masculinity/virility, penile morphology, pain or discomfort, regret, shame, cancer-related stress, overall impact and partner satisfaction. An exploratory thematic analysis will be performed to detail recurring themes that will be grouped into clusters of experiences. We will then be able to find clusters of agreement and disagreement that will be illustrated using exemplar patient quotations.

Ethics and dissemination

Ethical approval was obtained (Regional Ethics Committee reference 20/NW/0335), as well as Health Research Authority approval. Results will be published in open-access peer-reviewed journals. Findings will also be translated into patient information resources (leaflets, online information sheets).

Trial registration number

ISRCTN11634296; Pre-results.
Effects of a single bout of walking on postprandial triglycerides in men of Chinese, European and Japanese descent: a multisite randomised crossover trial
Authors: Nagayama Chihiro , Burns Stephen F , Stensel David J , Thackray Alice E , Takahashi Masaki , Miyashita Masashi
Published: December 2020

Introduction

Elevated non-fasting triglyceride (TG) concentrations are a risk factor for cardiovascular diseases but can be reduced after acute exercise. Ethnic-based differences in the magnitude of postprandial lipaemia and the extent that acute exercise reduces postprandial TG are poorly characterised across some ethnicities including those of East Asian origin. This paper describes the protocol of a multisite randomised crossover study comparing the effect of acute walking on postprandial TG in two groups of East Asian men with European men.

Methods and analysis

Twenty Japanese, 20 Singaporean Chinese and 20 white British healthy men (21–39 years) recruited from Japan, Singapore and the UK, respectively, will complete two, 2-day trials. Fasted and postprandial venous blood samples and arterial blood pressure measurements will be taken over 6 hours the day after either: (1) 60-min treadmill walking; or (2) a rest day of normal living. The primary outcome is the difference in postprandial TG among ethnic groups after rest and walking. Secondary outcomes include cholesterol, glucose, insulin, ketone bodies, preheparin lipoprotein lipase, C-reactive protein and systolic/diastolic blood pressure.

Ethics and dissemination

The study was approved by the Ethics Review Committee on Research with Human Subjects of Waseda University and the Nanyang Technological University Institutional Review Board. Relevant approval will be obtained from the UK site. Research findings will be disseminated through peer-reviewed journal publication and health conferences.

Trial registration number

UMIN000038625.
Exercise intervention and sexual function in advanced prostate cancer: a randomised controlled trial
Authors: Galvão Daniel A , Taaffe Dennis R , Chambers Suzanne K , Fairman Ciaran M , Spry Nigel , Joseph David , Newton Robert U
Published: December 2020

Objectives

Treatments for prostate cancer such as androgen deprivation therapy (ADT), surgery and radiation therapy can adversely affect sexual, urinary and bowel function. Preliminary research has demonstrated the efficacy of exercise to preserve sexual function in men with localised prostate cancer receiving ADT, though this has yet to be investigated in a metastatic setting. We examined the effects of a 12-week exercise programme comprising resistance, aerobic and flexibility training on sexual health and function in men with advanced prostate cancer.

Methods

Patients with prostate cancer (70.0±8.4 year; body mass index 28.7±4.0 kg/m2) with bone metastases (rib/thoracic spine, 66.7%; lumbar spine, 43.9%; pelvis, 75.4%; femur, 40.4%; humerus, 24.6%; other sites, 70.2%) were randomly assigned to supervised exercise 3 days/week (n=28) or usual care (n=29). Sexual health and function were assessed using the International Index of Erectile Function, the Expanded Prostate Cancer Index Composite and the EORTC-PR25 at baseline and 12 weeks.

Results

Patients attended 89% of planned sessions and there were no adverse events. After adjusting for baseline values, there was no significant difference between groups for any measure of sexual function and activity (p>0.05). Additionally, there was no significant difference between groups for urinary and bowel function assessed by the EORTC-PR25 (p>0.05).

Conclusions

A short-term programme of supervised exercise does not appear to enhance indices of sexual health and function in men with advanced prostate cancer. Limitations of the intervention included the conservative modular exercise programme, which deliberately avoided loading bone metastatic sites.

Trial registration number

ACTRN12611001158954.
A distributed interpolative sigma-delta interface for fluxgate sensor
Authors: Dong Changchun , Chen Yanbo , Jiang Zhanpeng , Ren Mingyuan , Lu Xuebin , Han Xiaowei
Published: December 2020

This paper presents a sigma-delta interface for fluxgate sensor based on a single-loop high-order modulation. A feedforward summation loop structure can reduce the linearity overload in integrators and the swing of integration signals. A Local feedback branch is proposed to realize the zero of noise transfer function (NTF) optimization and enhance noise shaping performance within signal band. The interface is fabricated in a standard 0.5 [Formula: see text]m CMOS process and the active circuit area is about 13 mm2. The chip consumes 120 mW from a 10 V supply with a sampling clock of 250 k Hz. The average noise floor of the digital fluxgate is about −115 dBV/Hz[Formula: see text] over a 100 Hz bandwidth.
Multiple soliton, fusion, breather, lump, mixed kink-lump and periodic solutions to the extended shallow water wave model in (2+1)-dimensions
Authors: Ismael Hajar F. , Seadawy Aly , Bulut Hasan
Published: December 2020

In this paper, we consider the shallow water wave model in the (2+1)-dimensions. The Hirota simple method is applied to construct the new dynamics one-, two-, three-, [Formula: see text]-soliton solutions, complex multi-soliton, fusion, and breather solutions. By using the quadratic function, the one-lump, mixed kink-lump and periodic lump solutions to the model are obtained. The Hirota bilinear form variable of this model is derived at first via logarithmic variable transform. The physical phenomena to this model are explored. The obtained results verify the proposed model.
EAR CANAL INSERTION-TYPE PIEZOELECTRIC BONE CONDUCTION ACTUATOR OF BRIDGE STRUCTURE
Authors: KIM DO YEON , NA SUNG DAE , SEONG KI WOONG , KIM MYOUNG NAM
Published: December 2020

Hearing loss in people is increasing because of a rise in the usage of wireless audio multimedia devices. Hearing aids are used as representative hearing rehabilitation devices. Bone conduction hearing aids are recommended for problems in the eardrum and middle ear. Bone conduction is classified according to the driving method into two types, electromagnetic and piezoelectric. Electromagnetic bone conduction causes skin disease and aesthetic problems due to transplantation, high power consumption, and external interference. Piezoelectric bone conduction converts electrical energy into mechanical vibrations, and the characteristics change linearly with size. However, the driving force of ear canal insertion of the piezoelectric body is limited because of the ear canal anatomy. In this paper, a piezoelectric actuator with a bridge structure inserted into the ear canal is proposed. The proposed method is that the displacement amplification ratio was derived using the formula of a bridge-type structure, and the displacement and resonance frequency were derived by finite element analysis (FEA) using different variables. The piezoelectric actuator was fabricated on the basis of FEA simulation results and verified through an artificial mastoid for stimulation in the ear canal. It is expected that the proposed piezoelectric actuator can be used in the various fields for sound and precision control.
Underlying Electrochemical Activity Mechanisms on Tunable Electronic Structures of Graphene Quantum Dots Doped with Nitrogen and Sulfur Heteroatoms
Authors: Guo Qian , Feng Jianguang , Liu Haiying , Yu Liyan , Dong Lifeng
Published: December 2020

Doping heteroatoms into graphene quantum dots (GQDs) is an efficient way to tune electronic structures. Herein, electronic mechanism of GQDs doped with N and S is studied by density functional theory (DFT). The formation energies, electronic structures, and electrostatic potentials of pristine and co-doped GQDs are calculated to reveal effects of different doping types on electronic properties. The geometry configuration of N and S bonding groups also plays an important role in tuning electronic structures of doped GQDs. The synergistic effect of N and N/S co-doping is mainly to reduce the highest occupied molecular orbital (HOMO) and the lowest unoccupied molecular orbital (LUMO) gap of the GQD structure. It is found that the introduction of S-containing groups can enhance positive area around N and increase atomic charge density of C atoms connected to N, which indicates that heteroatom co-doped GQDs have improved electron transports and can tune their electronic properties. In order to understand their oxygen reduction reaction (ORR) mechanisms, oxygen adsorption energies are calculated based on different structures of doped GQDs. Therefore, this work will provide valuable information on understanding the relationship between heteroatom dopants and electronic properties of N/S co-doped GQDs for the applications in nanoelectronic devices.