bluuebunny/crossref_metadata_2025 huggingface dataset:
Upper-Extremity Perceptual-Motor Training Improves Whole-Body Reactive Agility Among Elite Athletes With History of Sport-Related Concussion
Authors: Wilkerson Gary B. , Nabhan Dustin C. , Crane Ryan T.
Published: January 2021

Context: Sport-related concussion (SRC) elevates risk for subsequent injury, which may relate to impaired perceptual-motor processes that are potentially modifiable. Objective: To assess a possible upper-extremity (UE) training effect on whole-body (WB) reactive agility performance among elite athletes with history of SRC (HxSRC) and without such history of SRC. Design: Cohort study. Setting: Residential training center. Participants: Elite athletes (12 males and 8 females), including 10 HxSRC and 10 without such history of SRC. Intervention: One-minute training sessions completed 2 to 3 times per week over a 3-week period involved verbal identification of center arrow direction for 10 incongruent and 10 congruent flanker test trials with simultaneous reaching responses to deactivate illuminated buttons. Main Outcome Measures: Pretraining and posttraining assessments of UE and WB reactive responses included flanker test conflict effect (incongruent minus congruent reaction time) and WB lateral average asymmetry derived from reaction time, speed, acceleration, and deceleration in opposite directions. Discrimination was assessed by receiver operating characteristic analysis, and training effect was assessed by repeated-measures analysis of variance. Results: Pretraining discrimination between HxSRC and without such history of SRC was greatest for conflict effect ≥80 milliseconds and WB lateral average asymmetry ≥18%. Each athlete completed 6 training sessions, which improved UE mean reaction time from 767 to 646 milliseconds (P < .001) and reduced mean conflict effect from 96 to 53 milliseconds (P = .039). A significant group × trial interaction was evident for WB lateral average asymmetry (P = .004), which was reduced from 24.3% to 12.5% among those with HxSRC. Conclusions: Suboptimal perceptual-motor performance may represent a subtle long-term effect of concussion that is modifiable through UE training, which appears to improve WB reactive capabilities.
ITIH4 acts as a protease inhibitor by a novel inhibitory mechanism
Authors: Pihl Rasmus , Jensen Rasmus K. , Poulsen Emil C. , Jensen Lisbeth , Hansen Annette G. , Thøgersen Ida B. , Dobó József , Gál Péter , Andersen Gregers R. , Enghild Jan J. , Thiel Steffen
Published: January 2021

ITIH4 forms complexes with proteases upon cleavage that inhibit proteolysis by a novel inhibitory mechanism.
Gene therapy for tuberous sclerosis complex type 2 in a mouse model by delivery of AAV9 encoding a condensed form of tuberin
Authors: Cheah Pike-See , Prabhakar Shilpa , Yellen David , Beauchamp Roberta L. , Zhang Xuan , Kasamatsu Shingo , Bronson Roderick T. , Thiele Elizabeth A. , Kwiatkowski David J. , Stemmer-Rachamimov Anat , György Bence , Ling King-Hwa , Kaneki Masao , Tannous Bakhos A. , Ramesh Vijaya , Maguire Casey A. , Breakefield Xandra O.
Published: January 2021

Gene therapy for tuberous sclerosis type 2 proved beneficial in a mouse model of the disease, extending life span.
Amorphization mechanism of SrIrO
3
electrocatalyst: How oxygen redox initiates ionic diffusion and structural reorganization
Authors: Wan Gang , Freeland John W. , Kloppenburg Jan , Petretto Guido , Nelson Jocienne N. , Kuo Ding-Yuan , Sun Cheng-Jun , Wen Jianguo , Diulus J. Trey , Herman Gregory S. , Dong Yongqi , Kou Ronghui , Sun Jingying , Chen Shuo , Shen Kyle M. , Schlom Darrell G. , Rignanese Gian-Marco , Hautier Geoffroy , Fong Dillon D. , Feng Zhenxing , Zhou Hua , Suntivich Jin
Published: January 2021

The transformation from crystalline SrIrO
3
to active amorphous iridium oxide electrocatalyst occurs via the lattice oxygen redox.
Structural basis for the regulation of nucleosome recognition and HDAC activity by histone deacetylase assemblies
Authors: Lee Jung-Hoon , Bollschweiler Daniel , Schäfer Tillman , Huber Robert
Published: January 2021

Cryo-EM studies of the yeast HDAC complex with and without nucleosome reveal mechanistic insight into chromatin modification.
Tunable intraband optical conductivity and polarization-dependent epsilon-near-zero behavior in black phosphorus
Authors: Biswas Souvik , Whitney William S. , Grajower Meir Y. , Watanabe Kenji , Taniguchi Takashi , Bechtel Hans A. , Rossman George R. , Atwater Harry A.
Published: January 2021

Tunable BP heterostructures enable observation of the intraband optical conductivity and active control of optical dispersion.
Crystal orientation dictated epitaxy of ultrawide-bandgap 5.4- to 8.6-eV α-(AlGa)
2
O
3
on m-plane sapphire
Authors: Jinno Riena , Chang Celesta S. , Onuma Takeyoshi , Cho Yongjin , Ho Shao-Ting , Rowe Derek , Cao Michael C. , Lee Kevin , Protasenko Vladimir , Schlom Darrell G. , Muller David A. , Xing Huili G. , Jena Debdeep
Published: January 2021

Crystalline oxides spanning very broad 5.4- to 8.6-eV bandgaps are successfully grown on sapphire by MBE.
A smartphone-read ultrasensitive and quantitative saliva test for COVID-19
Authors: Ning Bo , Yu Tao , Zhang Shengwei , Huang Zhen , Tian Di , Lin Zhen , Niu Alex , Golden Nadia , Hensley Krystle , Threeton Breanna , Lyon Christopher J. , Yin Xiao-Ming , Roy Chad J. , Saba Nakhle S. , Rappaport Jay , Wei Qingshan , Hu Tony Y.
Published: January 2021

An isolation-free smartphone-based saliva assay can diagnose COVID-19 cases and quantify viral load within 15 min.
Establishment and lineage dynamics of the SARS-CoV-2 epidemic in the UK
Authors: du Plessis Louis , McCrone John T. , Zarebski Alexander E. , Hill Verity , Ruis Christopher , Gutierrez Bernardo , Raghwani Jayna , Ashworth Jordan , Colquhoun Rachel , Connor Thomas R. , Faria Nuno R. , Jackson Ben , Loman Nicholas J. , O’Toole Áine , Nicholls Samuel M. , Parag Kris V. , Scher Emily , Vasylyeva Tetyana I. , Volz Erik M. , Watts Alexander , Bogoch Isaac I. , Khan Kamran ,   COVID-19 Genomics UK (COG-UK) Consortium, Aanensen David M. , Kraemer Moritz U. G. , Rambaut Andrew , Pybus Oliver G.
Published: January 2021

Lineage dynamics

The scale of genome-sequencing efforts for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is unprecedented. The United Kingdom has contributed more than 26,000 sequences to this effort. This volume of data allowed du Plessis
et al.
to develop a detailed picture of the influxes of virus reaching U.K. shores as the pandemic developed during the first months of 2020 (see the Perspective by Nelson). Before lockdown, high travel volumes and few restrictions on international travel allowed more than 1000 lineages to become established. This accelerated local epidemic growth and exceeded contact tracing capacity. The authors were able to quantify the abundance, size distribution, and spatial range of the lineages that were transmitted. Transmission was highly heterogeneous, favoring some lineages that became widespread and subsequently harder to eliminate. This dire history indicates that rapid or even preemptive responses should have been used as they were elsewhere where containment was successful.

Science
, this issue p.
708
; see also p.
680
T resident helper cells promote humoral responses in the lung
Authors: Swarnalekha Nivedya , Schreiner David , Litzler Ludivine C. , Iftikhar Saadia , Kirchmeier Daniel , Künzli Marco , Son Young Min , Sun Jie , Moreira Etori Aguiar , King Carolyn G.
Published: January 2021

Analysis of CD4
+
T cell heterogeneity in the lung uncovers a Bcl6-dependent subset that supports mucosal antibody production.
T
RH
cells, helpers making an impact in their local community
Authors: Schattgen Stefan A. , Thomas Paul G.
Published: January 2021

T resident helper cells (T
RH
), a T cell subset with follicular helper and resident memory properties, regulate B cell responses in nonlymphoid organs (see the related Research Articles by

Swarnalekha
et al
.

and

Son
et al
.

).
Fifteen-minute consultation: How to spot serious heart disease in the newborn
Authors: Menahem Samuel , Sehgal Arvind
Published: January 2021

Congenital heart disease (CHD) is common and important as it remains a leading cause of neonatal morbidity and appreciable mortality. Prenatal diagnosis, the presence of a murmur, cyanosis, tachypnoea and/or poor or differential peripheral pulses raise the suspicion of CHD aided by differential pre/postductal saturations. Yet even serious CHD may not be considered when such clues are absent. Nevertheless, there are clinical cues which may alert the clinician to the possibility of a significant CHD which may lead to an early and accurate diagnosis and appropriate intervention to achieve best results. This paper addresses these issues which become especially difficult if caring for infants away from facilities provided by tertiary centres. Tachypnoea on the first postnatal day is generally non-cardiac in origin. Exceptions include large arteriovenous fistulae and/or ‘pump’ (ventricular) failure. In addition, attention is drawn to two important confounding factors in the newborn, namely the patency of the ductus arteriosus and the initially high pulmonary vascular resistance, both of which alter and may mask the clinical findings of a serious cardiac abnormality. An appreciation of the physiological changes that occur in early infancy will aid the clinician’s understanding of CHD as it affects the newborn.
Case for change: a standardised inpatient paediatric early warning system in England
Authors: Roland Damian , Stilwell Philippa Anna , Fortune Peter-Marc , Alexander John , Clark Simon J , Kenny Simon
Published: January 2021

Most children in hospital who are clinically deteriorating are monitored regularly, and their treatment is escalated effectively. However a small, but significant, number of deteriorating children experience suboptimal outcomes because of a failure to recognise and respond to acute deterioration early enough leading to unintended harm. Tragically this occasionally can have fatal consequences. Investigations into these rare events highlight common themes of missed early signs of deterioration in children, prompting regulatory agencies to suggest paediatric early warning systems (PEWS) to aid clinical practice. In England, track and trigger tools (TTT), which are one facet of PEWS have been widely rolled out but in a heterogeneous fashion. The evidence for TTT is mixed but they are complex interventions and current outcomes do not fully define the entirety of their potential impact. This article explains the rationale behind the decision of the NHS England and NHS Improvement, Royal College of Paediatrics and Child Health and Royal College of Nursing to implement a standardised inpatient PEWS as part of a system-wide paediatric observations tracking system in England and how this fits into a wider programme of activity.
Population-based surveillance of severe microcephaly and congenital Zika syndrome in Canada
Authors: Morris Shaun K , Farrar Daniel S , Miller Steven P , Ofner Marianna , Bitnun Ari , Nelson Chantal R M , Shevell Michael , Moore Aideen M , Tataryn Joanne , Evans Jane A , Zipursky Amy R , Moore Hepburn Charlotte
Published: January 2021

Purpose

To estimate the minimum incidence of congenital Zika syndrome (CZS) and severe microcephaly in Canada and describe key clinical, epidemiological, aetiological and outcome features of these conditions.

Methods

Two separate national surveillance studies were conducted on CZS and severe microcephaly using the well-established Canadian Paediatric Surveillance Program from 2016 to 2019. Over 2700 paediatricians across Canada were surveyed monthly and asked to report demographic details, pregnancy and travel history, infant anthropometry, clinical features and laboratory findings of newly identified cases. Reports were reviewed to assign an underlying aetiology of severe microcephaly. Incidence rates were estimated using monthly live birth denominators.

Results

Thirty-four infants met the case definition for severe microcephaly and <5 met the case definition for CZS. The associated minimum incidence rates were 4.5 per 100 000 live births for severe microcephaly and 0.1–0.5 per 100 000 live births for CZS. Of severe microcephaly cases, 53% were attributed to genetic causes, 15% to infectious or ischaemic causes and 32% to unknown causes. The median head circumference-for-age Z-score at birth was −3.2 (IQR −3.8 to −2.6), and catch-up growth was often not achieved. Common clinical features included intracranial abnormalities (n=23), dysmorphology (n=19) and developmental delays (n=14). Mothers of infants with non-genetic aetiologies travelled during pregnancy more often (10/16) than mothers of infants with genetic aetiologies (<5/18; p<0.01).

Conclusion

Severe microcephaly and CZS are both rare in Canada. Minimum incidence rates can be used as a baseline against which novel or re-emergent causes of severe microcephaly or CZS can be compared.
Severe ischaemic gangrene of scalp in an extreme preterm: a fatal case of combined aetiology
Authors: Pérez-Iranzo Antonio , Olaya Alamar Vicente , Mira Ferrer Luz M , Nos Colom Andrea
Published: January 2021

A 24+5-week preterm neonate with a severe scalp lesion was admitted to the neonatal intensive care unit (NICU) after caesarean section due to maternal chorioamnionitis (MC). An Arabin pessary had been inserted in addition to a previous cervical cerclage due to cervix insufficiency at 21+5 weeks of pregnancy (wp). At 23+5 wp, preterm rupture of membranes was evidenced. Both devices were kept to provide fetal viability. On 24+4 wp, she developed MC. Urgent caesarean section was performed. Transvaginal manual manipulation was required during the procedure. On NICU, she presented severe shock which required high-dose vasopressors and blood products. Following surgical repair, a bilateral grade IV intracranial haemorrhage was evidenced. Subsequently, it was agreed to withdraw life support. We hypothesise that MC and local infection could have acted as predisposing factors, with the presence of a pessary in the setting causing uterine contractions and its manipulation acting as a precipitating factor.
Successful treatment of severe COVID-19 pneumonia and hyperinflammatory syndrome with tocilizumab
Authors: Gentile Giorgio , Davies Rebecca , Manfreda Valeria Maria , Ul Abideen Zain
Published: January 2021

As of 28 October 2020, there are over 44 000 000 confirmed COVID-19 infections and over 1 000 000 deaths worldwide, including 945 367 infections and 45 765 deaths in the UK. Acute respiratory distress syndrome occurs in 50% of patients with secondary haemophagocytic lymphohistiocytosis, a hyperinflammatory syndrome characterised by a surge of cytokines, including interleukin 6 (IL-6). Here we describe the case of the first patient with severe COVID-19 pneumonia successfully treated with tocilizumab, a humanised monoclonal antibody against the IL-6 receptor, in the UK. Early treatment (after 7–10 days from the onset of symptoms) with tocilizumab could (1) reduce the risk of requiring non-invasive or invasive ventilation; (2) offer a chance of survival to people who are not fit for escalation or have refused to be ventilated; and (3) potentially increase the chance of survival in some patients who are already ventilated but fail to improve with supportive treatment.
Adjuvant radiotherapy in the treatment of dedifferentiated liposarcoma of the spermatic cord: a rare entity
Authors: Pereira Kayla Pires , Rodrigues Mónica , Roda Domingos , Alves Paula
Published: January 2021

Dedifferentiated liposarcoma (DDL) of the spermatic cord is a very rare entity in which management is remarkably controversial due to scarce literature. Although the actual standard of care is surgery via radical inguinal orchiectomy, adjuvant therapies like radiotherapy have demonstrated improved local control, particularly in cases with higher risk for local recurrence and worse prognosis. The role of adjuvant chemotherapy remains questionable in this subset of patients. On literature review, the most important prognostic factors for survival outcomes were surgical margin status, histological grade and the presence of metastases prior to the initial surgery. In this report, we discuss the case of a 59-year-old man with DDL of the spermatic cord that was treated with surgery followed by adjuvant radiotherapy. We also provide a comprehensive literature review about the management of this entity.
Screening first-degree relatives of glaucoma patients reveals barriers to participation
Authors: Shroff Sujani , Gu Sophie Z , Vardhan S Ashok , Mani Iswarya , Aziz Kanza , P Namperumalsamy , Datta Dipankar , Friedman David S
Published: January 2021

Purpose

To report the results of a glaucoma screening campaign targeting first-degree relatives of glaucoma patients in South India.

Methods

1598 glaucoma patients were contacted via letter or letter and phone call and asked to bring their siblings and children to a glaucoma screening. Participants underwent standardised eye examinations and completed questionnaires that assessed barriers to participation and awareness of glaucoma risk. Two-proportion z-tests were used to compare categorical data. Costs associated with the screening were recorded.

Results

206 probands (12.9%) attended the screening along with 50 siblings and children. Probands were nearly twice as likely to attend if they had been contacted via both letter and phone call rather than letter only. Over half of probands reported that their relatives could not participate because they did not live in the region, and one-fifth reported that their relatives had other commitments. Fifty-eight per cent of the siblings and children who attended did not know that they were at increased risk for glaucoma due to their family history, and 32.0% did not know that the relative who had invited them to the screening had glaucoma. Thirteen siblings and children (26.0% of those who attended) were found to have findings concerning for glaucoma. The average cost per first-degree relative who was screened was INR2422 (£26).

Conclusion

Participation in this glaucoma screening campaign was poor. The major barrier to participation was distance from the screening site and associated indirect costs. Better strategies for bringing first-degree relatives in for examinations are needed.
Selfie consents, remote rapport, and Zoom debriefings: collecting qualitative data amid a pandemic in four resource-constrained settings
Authors: Reñosa Mark Donald C , Mwamba Chanda , Meghani Ankita , West Nora S , Hariyani Shreya , Ddaaki William , Sharma Anjali , Beres Laura K , McMahon Shannon
Published: January 2021

In-person interactions have traditionally been the gold standard for qualitative data collection. The COVID-19 pandemic required researchers to consider if remote data collection can meet research objectives, while retaining the same level of data quality and participant protections. We use four case studies from the Philippines, Zambia, India and Uganda to assess the challenges and opportunities of remote data collection during COVID-19. We present lessons learned that may inform practice in similar settings, as well as reflections for the field of qualitative inquiry in the post-COVID-19 era. Key challenges and strategies to overcome them included the need for adapted researcher training in the use of technologies and consent procedures, preparation for abbreviated interviews due to connectivity concerns, and the adoption of regular researcher debriefings. Participant outreach to allay suspicions ranged from communicating study information through multiple channels to highlighting associations with local institutions to boost credibility. Interviews were largely successful, and contained a meaningful level of depth, nuance and conviction that allowed teams to meet study objectives. Rapport still benefitted from conventional interviewer skills, including attentiveness and fluency with interview guides. While differently abled populations may encounter different barriers, the included case studies, which varied in geography and aims, all experienced more rapid recruitment and robust enrollment. Reduced in-person travel lowered interview costs and increased participation among groups who may not have otherwise attended. In our view, remote data collection is not a replacement for in-person endeavours, but a highly beneficial complement. It may increase accessibility and equity in participant contributions and lower costs, while maintaining rich data collection in multiple study target populations and settings.
Residential mobility for a national cohort of New Zealand-born children by area socioeconomic deprivation level and ethnic group
Authors: Robertson Oliver , Nathan Kim , Howden-Chapman Philippa , Baker Michael George , Atatoa Carr Polly , Pierse Nevil
Published: January 2021

Objectives

The aims of this study are to describe area deprivation levels and changes that occur during residential moves involving New Zealand children from birth to their fourth birthday, and to assess whether these changes vary by ethnicity.

Design

Longitudinal administrative data.

Setting

Children born in New Zealand from 2004 to 2018.

Participants

All (565 689) children born in New Zealand with at least one recorded residential move.

Outcome measures

A longitudinal data set was created containing lifetime address histories for our cohort. This was linked to the New Zealand Deprivation Index, a measure of small area deprivation. Counts of moves from each deprivation level to each other deprivation level were used to construct transition matrices.

Results

Children most commonly moved to an area with the same level of deprivation. This was especially pronounced in the most and least deprived areas. The number of moves observed also increased with deprivation. Māori and Pasifika children were less likely to move to, or remain in low-deprivation areas, and more likely to move to high-deprivation areas. They also had disproportionately high numbers of moves.

Conclusion

While there was evidence of mobility between deprivation levels, the most common outcome of a move was no change in area deprivation. The most deprived areas had the highest number of moves. Māori and Pasifika children were over-represented in high-deprivation areas and under-represented in low-deprivation areas. They also moved more frequently than the overall population of 0 to 3 year olds.
Impact of transitional care interventions on hospital readmissions in older medical patients: a systematic review
Authors: Fønss Rasmussen Lisa , Grode Louise Bang , Lange Jeppe , Barat Ishay , Gregersen Merete
Published: January 2021

Objectives

To identify and synthesise available evidence on the impact of transitional care interventions with both predischarge and postdischarge elements on readmission rates in older medical patients.

Design

A systematic review.

Method

Inclusion criteria were: medical patients ≥65 years or mean age in study population of ≥75 years; interventions were transitional care interventions between hospital and home with both predischarge and postdischarge components; outcome was hospital readmissions. Studies were excluded if they: included other patient groups than medical patients, included patients with only one diagnosis or patients with only psychiatric disorders. PubMed, The Cochrane Library, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Web of Science were searched from January 2008 to August 2019. Study selection at title level was undertaken by one author; the remaining selection process, data extraction and methodological quality assessment were undertaken by two authors independently. A narrative synthesis was performed, and effect sizes were estimated.

Result

We identified 1951 records and included 11 studies: five randomised trials, four non-randomised controlled trials and two pre–post cohort studies. The 11 studies represent 15 different interventions and 29 outcome results measuring readmission rates within 7–182 days after discharge. Twenty-two of the 29 outcome results showed a drop in readmission rates in the intervention groups compared with the control groups. The most significant impact was seen when interventions were of high intensity, lasted at least 1 month and targeted patients at risk. The methodological quality of the included studies was generally poor.

Conclusion

Transitional care interventions reduce readmission rates among older medical patients although the impact varies at different times of outcome assessment. High-quality studies examining the impact of interventions are needed, preferably complimented by a process evaluation to refine and improve future interventions.

PROSPERO registration number

CRD42019121795.
Establishing the safety of waterbirth for mothers and babies: a cohort study with nested qualitative component: the protocol for the POOL study
Authors: Milton Rebecca , Sanders Julia , Barlow Christian , Brocklehurst Peter , Cannings-John Rebecca , Channon Sue , Gale Christopher , Holmes Abigail , Hunter Billie , Paranjothy Shantini , Lugg-Widger Fiona V , Milosevic Sarah , Morantz Leah , Plachcinski Rachel , Nolan Mary , Robling Michael
Published: January 2021

Introduction

Approximately 60 000 (9/100) infants are born into water annually in the UK and this is likely to increase. Case reports identified infants with water inhalation or sepsis following birth in water and there is a concern that women giving birth in water may sustain more complex perineal trauma. There have not been studies large enough to show whether waterbirth increases these poor outcomes. The POOL Study (ISRCTN13315580) plans to answer the question about the safety of waterbirths among women who are classified appropriate for midwifery-led intrapartum care.

Methods and analysis

A cohort study with a nested qualitative component. Objectives will be answered using retrospective and prospective data captured in electronic National Health Service (NHS) maternity and neonatal systems. The qualitative component aims to explore factors influencing pool use and waterbirth; data will be gathered via discussion groups, interviews and case studies of maternity units.

Ethics and dissemination

The protocol has been approved by NHS Wales Research Ethics Committee (18/WA/0291) the transfer of identifiable data has been approved by Health Research Authority Confidentiality Advisory Group (18CAG0153).

Study findings and innovative methodology will be disseminated through peer-reviewed journals, conferences and events. Results will be of interest to the general public, clinical and policy stakeholders in the UK and will be disseminated accordingly.
Developing a clinical prediction rule for repeated consultations with functional somatic symptoms in primary care: a cohort study
Authors: Holtman Gea A , Burger Huibert , Verheij Robert A , Wouters Hans , Berger Marjolein Y , Rosmalen Judith GM , Verhaak Peter FM
Published: January 2021

Objectives

Patients who present in primary care with chronic functional somatic symptoms (FSS) have reduced quality of life and increased health care costs. Recognising these early is a challenge. The aim is to develop and internally validate a clinical prediction rule for repeated consultations with FSS.

Design and setting

Records from the longitudinal population-based (‘Lifelines’) cohort study were linked to electronic health records from general practitioners (GPs).

Participants

We included patients consulting a GP with FSS within 1 year after baseline assessment in the Lifelines cohort.

Outcome measures

The outcome is repeated consultations with FSS, defined as ≥3 extra consultations for FSS within 1 year after the first consultation. Multivariable logistic regression, with bootstrapping for internal validation, was used to develop a risk prediction model from 14 literature-based predictors. Model discrimination, calibration and diagnostic accuracy were assessed.

Results

18 810 participants were identified by database linkage, of whom 2650 consulted a GP with FSS and 297 (11%) had ≥3 extra consultations. In the final multivariable model, older age, female sex, lack of healthy activity, presence of generalised anxiety disorder and higher number of GP consultations in the last year predicted repeated consultations. Discrimination after internal validation was 0.64 with a calibration slope of 0.95. The positive predictive value of patients with high scores on the model was 0.37 (0.29–0.47).

Conclusions

Several theoretically suggested predisposing and precipitating predictors, including neuroticism and stressful life events, surprisingly failed to contribute to our final model. Moreover, this model mostly included general predictors of increased risk of repeated consultations among patients with FSS. The model discrimination and positive predictive values were insufficient and preclude clinical implementation.
Associations between oral sex practices and frequent mouthwash use in heterosexuals: a cross-sectional survey in Melbourne, Australia
Authors: Phillips Tiffany R , Fairley Christopher K , Bradshaw Catriona S , Tabesh Marjan , Maddaford Kate , Hocking Jane S , Chow Eric PF
Published: January 2021

Objective

This study aimed to determine the frequency of mouthwash use and its association to oral sex practice in heterosexuals.

Design

A cross-sectional study.

Setting

Data obtained from a sexual health clinic in Victoria, Australia, between March 2019 and April 2019.

Participants

Heterosexual men and women attending the sexual health clinic answered a survey using computer-assisted self-interview.

Primary and secondary outcome measures

Univariable and multivariable logistic regression were performed to examine the association between frequent mouthwash use (ie, daily or weekly mouthwash use) and oral sex practices (including tongue kissing, fellatio, cunnilingus and insertive rimming).

Results

There were 681 heterosexuals included in the analysis: 315 (46.3%) men and 366 (53.7%) women. Of participants, 302 (44.3%) used mouthwash frequently, 173 (25.4%) used mouthwash infrequently and 206 (30.2%) never used mouthwash. There was no significant difference in the proportion of frequent mouthwash users between men and women (46.4% of men vs 42.6% of women; p=0.329). The proportion of frequent mouthwash users increased with increasing age groups (39.3% in ≤24 years, 45.2% in 25–34 years and 52.8% in ≥35 years or older; ptrend=0.039) with those aged ≥35 years having a 1.80 times (95% CI: 1.12 to 2.89) higher odds of being a frequent mouthwash user than those aged ≤24 years. There were no significant associations between frequent mouthwash users had sexually transmitted infection (STI) risk after adjusting for age and country of birth.

Conclusion

Older heterosexuals are more likely to use mouthwash. Given the high proportion and associations of mouthwash use in heterosexuals, future investigations related to oral STIs in this group should include mouthwash use.
Does pain influence force steadiness? A protocol for a systematic review
Authors: Arvanitidis Michail , Falla Deborah , Sanderson Andy , Martinez-Valdes Eduardo
Published: January 2021

Introduction

Performing contractions with minimum force fluctuations is essential for everyday life as reduced force steadiness impacts on the precision of voluntary movements and functional ability. Several studies have investigated the effect of experimental or clinical musculoskeletal pain on force steadiness but with conflicting findings. The aim of this systematic review is to summarise the current literature to determine whether pain, whether it be clinical or experimental, influences force steadiness.

Methods and analysis

This protocol for a systematic review was informed and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols and the Cochrane Handbook for Systematic Reviews of Interventions. Key databases will be searched from inception to 31 August 2020, including MEDLINE, EMBASE, PubMed, CINAHL Plus, ZETOC and Web of Science. Grey literature and key journals will be also reviewed. Risk of bias will be assessed with the Newcastle-Ottawa tool, and the quality of the cumulative evidence assessed with the Grading of Recommendations, Assessment, Development and Evaluation guidelines. If homogeneity exists between groups of studies, meta-analysis will be conducted. Otherwise, a narrative synthesis approach and a vote-counting method will be used, while the results will be presented as net increases or decreases of force steadiness.

Ethics and dissemination

The findings will be presented at conferences and the review will be also submitted for publication in a refereed journal. No ethical approval was required.

PROSPERO registration number

CRD42020196479
Optimal cut-off value of elevated cardiac troponin concentrations for myocardial injury predicts clinical outcomes in adult patients with COVID-19: a dose–response analysis protocol for systematic review
Authors: Zhou Chenghui , Pei Hanjun , Gao Yiming , Zhang Yulin , Cao Liang , Fang Zhongrong , Song Jiangping
Published: January 2021

Introduction

Acute myocardial injury in patients with COVID-19 infection has been recognised as one important complication associated with in-hospital mortality. The potential dose–response effect of cardiac troponin (cTn) concentrations on adverse clinical outcomes has not been systematically studied. Hence, we will conduct a comprehensive dose–response meta-analysis to quantitatively evaluate the relationship between elevated cTn concentrations and in-hospital adverse clinical outcomes in patients with COVID-19.

Methods

We will search PubMed, EMBASE, Cochrane Library and ISI Knowledge via Web of Science databases, as well as preprint databases (medRxiv and bioRxiv), from inception to October 2021, to identify all retrospective and prospective cohorts and randomised controlled studies using related keywords. The primary outcome will be all-cause mortality during hospitalisation. The secondary outcome will be major adverse event (MAE). To conduct a dose–response meta-analysis of the potential linear or restricted cubic spline regression relationship between elevated cTn concentrations and all-cause mortality or MAE, studies with three or more categories of cTn concentrations will be included. Univariable or multivariable meta-regression and subgroup analyses will be conducted to compare elevated and non-elevated categories of cTn concentration. Sensitivity analyses will be used to assess the robustness of our results by removing each included study at one time to obtain and evaluate the remaining overall estimates of all-cause mortality or MAE.

Ethics and dissemination

In accordance with the Institutional Review Board/Independent Ethics Committee of Fuwai Hospital, ethical approval was waived for this systematic review protocol. This meta-analysis will be disseminated through a peer-reviewing process for journal publication and conference communication.

PROSPERO registration number

CRD42020216059.
Improving SCD compliance in trauma patients at Kings County Hospital Center: a quality improvement report
Authors: Hamid Safraz , Gallo Marin Benjamin , Smith Leanna , Agyeman-Kagya Kwasi , George Christopher , Wetzler Tara , Badami Abbasali , Gendy Adam , Roudnitsky Valery
Published: January 2021

Venous thromboembolism (VTE) is the fourth most commonly reported complication in trauma patients. For these patients, thromboprophylaxis is a standard of care. Patient compliance with sequential compression devices (SCDs), a form of mechanical VTE prophylaxis, has been a focus of efforts to improve patient safety. At our institution, a baseline audit in July 2020 revealed that patients admitted to the trauma floors have poor compliance with the use of SCDs. In this quality improvement project, we developed a patient education intervention to improve SCD compliance. We distributed an informational flyer to patients and led short educational sessions on VTE risk factors and proper SCD use. Our aim was to increase our SCD compliance rate by 30% in 4 weeks. We used three plan-do-study-act (PDSA) cycles to implement and refine our intervention. We measured SCD compliance during morning and afternoon patient observations and generated run charts to understand how our cycles were leading to change. After a 4-week period, we did not achieve our aim, but increased our overall compliance from 45% to 60% and sustained this improvement throughout our PDSA cycles. Morning compliance was lower than afternoon compliance both at baseline (45% vs 48.5%) and at the end the project (45% vs 53%). Our results suggest that patient education should be coupled with interventions that address other barriers to SCD compliance.
Transcatheter tricuspid valve replacement in patients with severe tricuspid regurgitation
Authors: Lu Fang-Lin , An Zhao , Ma Ye , Song Zhi-Gang , Cai Cheng-Liang , Li Bai-Ling , Zhou Guang-Wei , Han Lin , Wang Jun , Bai Yi-Fan , Liu Xiao-Hong , Wang Jia-Feng , Meng Xu , Zhang Hai-Bo , Yang Jian , Dong Nian-Guo , Hu Sheng-Shou , Pan Xiang-Bin , Cheung Anson , Qiao Fan , Xu Zhi-Yun
Published: January 2021

Objective

Tricuspid regurgitation (TR) is a common valvular heart disease with unsatisfactory medical therapeutics and high surgical mortality. The present study aims to evaluate the safety and effectiveness of transcatheter tricuspid valve replacement (TTVR) in high-risk patients with severe TR.

Methods

This was a compassionate multicentre study. Between September 2018 and November 2019, 46 patients with TR who were not suitable for surgery received compassionate TTVR under general anaesthesia and the guidance of trans-oesophageal echocardiography and fluoroscopy in four institutions. Access to the tricuspid valve was obtained via a minimally invasive thoracotomy and transatrial approach. Patients’ data at baseline, before discharge, 30 days and 6 months after the procedure were collected.

Results

All patients had severe TR with vena contracta width of 12.6 (11.0, 14.5) mm. Procedural success (97.8%) was achieved in all but one case with right ventricle perforation. The procedural time was 150.0 (118.8, 180.0) min. Intensive care unit time was 2.0 (1.0, 4.0) days. 6-month mortality was 17.4%. Device migration occurred in one patient (2.4%) during follow-up. Transthoracic echocardiography at 6 months after operation showed TR was significantly reduced (none/trivial in 33, mild in 4 and moderate in 1) and the primary safety end point was achieved in 38 cases (82.6%). Patients suffered from peripheral oedema and ascites decreased from 100.0% and 47.8% at baseline to 2.6% and 0.0% at 6 months.

Conclusions

The present study showed TTVR was feasible, safe and with low complication rates in patients with severe TR.
Comparison of serratus anterior plane block with epidural and paravertebral block in critically ill trauma patients with multiple rib fractures
Authors: Bhalla Paul I , Solomon Stuart , Zhang Ray , Witt Cordelie E , Dagal Arman , Joffe Aaron M
Published: January 2021

Background

Pain from rib fractures is associated with significant pulmonary morbidity. Epidural and paravertebral blocks (EPVBs) have been recommended as part of a multimodal approach to rib fracture pain, but their utility is often challenging in the trauma intensive care unit (ICU). The serratus anterior plane block (SAPB) has potential as an alternative approach for chest wall analgesia.

Methods

This retrospective study compared critically injured adults sustaining multiple rib fractures who had SAPB (n=14) to EPVB (n=25). Patients were matched by age, body mass index, American Society of Anesthesiology Physical Status, whether the patient required intubation, number of rib fractures and injury severity score. Outcome measures included hospital length of stay, ICU length of stay, preblock and post block rapid shallow breathing index (RSBI) in intubated patients, pain scores and morphine equivalent doses administered 24-hour preblock and post-block in non-intubated patients, and mortality.

Results

There were no demographic differences between the two groups after matching. Nearly all of the patients who received either SAPB or EPVB demonstrated a reduction in RSBI or pain scores. The preblock RSBI was higher in the serratus anterior plane block group, but there was no difference between any of the other outcome measures.

Discussion

This retrospective study of our institutional data suggests no difference in efficacy between the serratus anterior plane block and neuraxial block for traumatic rib fracture pain in critically ill patients, but the sample size was too small to show statistical equivalence. Serratus anterior plane block is technically easier to perform with fewer theoretical contraindications compared with traditional neuraxial block. Further study with prospective comparative trials is warranted.

Level of evidence

Retrospective matched cohort; Level IV.
Predictive analytics on Engineer Manual 385 effectiveness of reducing number and severity of mishaps
Authors: Arias Scott , Li Huimin , Zhang Chengyi , Jiang Aiyin
Published: January 2021

The United States Army Corps of Engineering Manual 385 (EM 385) has become a vital part of construction operations on all Department of Defense (DOD) construction projects to create a safer work environment. With tremendous effort on developing and enforcing the EM 385, the question of whether the EM 385 provides any value for project safety is critical to the construction industry at large. This study looks for causation between the EM 385 and mishap reduction by isolating three dependent variables and a variety of explanatory variables. The data was compiled using both the OSHA Data Initiative (ODI) and the Federal Spending Database. A structural equation is developed to conduct multiple regression analysis assuming EM 385 will reduce the number of mishaps and the severity of mishaps. However, the result shows the effectiveness of EM 385 on reducing the number and severity of mishaps is not significant.
Laboratory evaluation of cracking resistance for asphalt mixtures modified with nanoclay and nanocellulose
Authors: Johnson Thomas , Bala Nura , Bayat Alireza , Hashemian Leila
Published: January 2021

Cracking failure is one of the major distress modes associated with asphalt pavement. Asphalt modification has been identified as an effective method to improve pavement performance. In this study, nanomaterials including bentonite and halloysite nanoclays and nanocellulose are added to PG 64-28 straight run asphalt binder for modification. The potential of these nanomaterials for improving the cracking performance of asphalt pavements at intermediate pavement service temperatures is investigated. Rheological evaluation is conducted using a dynamic shear rheometer (DSR), and the cracking resistance of the asphalt mixtures is determined through indirect tension asphalt cracking test (IDEAL-CT). A high-shear mixer is used to disperse the nanomaterial in the asphalt and the field emission scanning electron microscope (FESEM) analysis shows a relatively good dispersion of the nanomaterials. Furthermore, the results of the IDEAL-CT show an improvement in cracking test index by as much as 47%–114% through nanomaterial modification.
Four-dimensional Brane–Chern–Simons Gravity and Cosmology
Authors: Gómez F. , Lepe S. , Salgado P.
Published: January 2021

From the field equations corresponding to a four-dimensional brane embedded in the five-dimensional spacetime of the Einstein–Chern–Simons theory for gravity, we find cosmological solutions that describe an accelerated expansion for a flat universe. Apart from a quintessence-type evolution scheme, we obtain a transient phantom evolution, which is not ruled out by the current observational data. Additionally, a bouncing solution is shown. The introduction of a kinetic term in the action shows a de Sitter behavior although the energy density is not constant. A quintessence behavior is also found. We conjecture on a possible geometric origin of dark energy coming from this action.
The Toxicity and Attenuation Methods of Toxic Chinese Materia Medica for its Reasonable Application: A Review
Authors: Xiang Jun-Yan , Chi Yan-Yu , Han Jin-Xin , Xiang Hongyu , Xie Qiuhong
Published: January 2021

Over a millennia, traditional Chinese medicine (TCM) has been used to treat various diseases in China. In recent years, more and more Chinese materia medica (CMM) have been studied in scientific research projects, applied in clinical practice, and their extracts have even appeared in some health products. However, the toxicity of some CMM is often overlooked, including hepatotoxicity, nephrotoxicity, neurotoxicity, cardiotoxicity, etc. In this review, the toxic components and their toxicological mechanisms of some toxic CMM were listed according to the chemical structure classification of toxic components. Afterwards, the traditional methods (processing and compatibility) and modern methods (structural modification, biotransformation, etc.) of attenuation of CMM were discussed. Since ancient times, it has been said that “fight fire with fire, fight poison with poison,” and toxic CMM are of great significance in the treatment of difficult and severe diseases. The rational application of toxic CMM and their components in clinical practice was also exemplified in this review. While the pharmacological effects of TCMs have been emphasized, the scientific attenuation and rational application of toxic components should be concerned. We hope this review can provide a reference for future related research.
6,7,4′-Trihydroxyflavanone Prevents Methamphetamine-Induced T Cell Deactivation by Protecting the Activated T Cells from Apoptosis
Authors: Lee Hyun-Su , Jeong Gil-Saeng
Published: January 2021

Methamphetamine (METH) is an extremely addictive drug that has raised serious public health concerns recently. METH addiction not only results in neuronal cytotoxicity, but it also affects immune cell activity, including T lymphocytes. 6,4,7[Formula: see text]-trihydroxyflavanone (THF), isolated from Dalbergia odorifera, has been studied for its antibacterial activity, but evidence for whether THF has an anti-cytotoxic and protective effect on T cell activation exposed to METH is lacking. In this study, results showed that treatment with THF was not cytotoxic to Jurkat T cells but dose-dependently mitigated the cytotoxicity induced by exposure to METH. The Western blot results demonstrating pre-treatment with THF maintained the expression of anti-apoptotic proteins and phosphorylation of PI3K/Akt/mTOR downregulated by treatment with METH. Furthermore, we found that decreased expression of IL-2 and CD69 by METH exposure was partially restored, and viability was significantly prevented by pre-treatment with THF in activated T cells. These findings were involved in re-elevated expression of anti-apoptotic proteins as well as recovered pathways including MAPK/PI3K/Akt/mTOR in activated T cells pre-exposed to METH. Our results suggest beneficial effects of THF against the cytotoxic and immune-modulating effect of METH on T cells and therapeutic potential of THF for patients with immunodeficiency caused by METH addiction.
Higher-order rational soliton solutions for the fifth-order modified KdV and KdV equations
Authors: Pei Zhi-Jie , Zhang Hai-Qiang
Published: January 2021

In this paper, we construct the generalized perturbation ([Formula: see text], [Formula: see text])-fold Darboux transformation of the fifth-order modified Korteweg-de Vries (KdV) equation by the Taylor expansion. We use this transformation to derive the higher-order rational soliton solutions of the fifth-order modified KdV equation. We find that these higher-order rational solitons admit abundant interaction structures. We graphically present the dynamics behaviors from the first- to fourth-order rational solitons. Furthermore, by the Miura transformation, we obtain the complex rational soliton solutions of the fifth-order KdV equation.