bluuebunny/crossref_metadata_2025 huggingface dataset:
Using Virtual Reality–Based Rehabilitation in Sarcopenic Older Adults in Rural Health Care Facilities—A Quasi-Experimental Study
Authors: Chen Guan-Bo , Lin Che-Wei , Huang Hung-Ya , Wu Yi-Jhen , Su Hung-Tzu , Sun Shu-Fen , Tuan Sheng-Hui
Published: February 2021

Because of a shortage of health care providers, providing rehabilitation in health care facilities is difficult. Virtual reality–based rehabilitation is effective in older populations. There are only a few studies among patients with sarcopenia. This is a quasi-experimental, single-group, pretest–posttest design evaluating the clinical effectiveness of virtual reality–based progressive resistance training among residents aged over 60 years with sarcopenia in rural care facilities. The authors used Oculus Rift with headsets to provide the virtual reality–based progressive resistance training. The authors administered the program twice per week, 30 min per session, for 12 weeks. The primary outcomes were dominant handgrip strength, walking speed, and appendicular skeletal muscle mass index. Data from 30 participants were analyzed. Significant improvements in handgrip strength and walking speed were observed. Although an increasing trend in appendicular skeletal muscle mass index was observed, it did not reach statistical significance. The authors concluded that the virtual reality–based progressive resistance training is partially effective in older sarcopenic adults in health care facilities.
A Magnetic Resonance Imaging–Compatible Device to Perform In Vivo Anterior Knee Joint Loading
Authors: Park-Braswell Kyoungyoun , Shultz Sandra J. , Schmitz Randy J.
Published: February 2021

Context: Greater anterior knee laxity (AKL) is associated with impaired sensory input and decreased functional knee stability. As functional magnetic resonance imaging (MRI) is the gold standard for understanding brain function, methods to load the anterior cruciate ligament in the MRI environment could further our understanding of the ligament’s sensory role in knee joint stability. Objective: To design and validate an MRI-compatible anterior knee joint loading device. Design: Descriptive laboratory study. Setting: University laboratory study. Participants: Sixteen healthy and physically active females participated (age = 23.4 [3.7] y; mass = 64.4 [8.4] kg). Interventions: The AKL was assessed by a commercially available arthrometer. The AKL was also assessed with a custom-made, MRI-compatible device that produced anterior knee joint loading in a manner similar to the commercial arthrometer while obtaining dynamic structural MRI data. Main Outcome Measurements: The AKL (in millimeters) at 133 N of loading was assessed with the commercial knee arthrometer. Anterior displacement of the tibia relative to the femur obtained at 133 N of loading was measured from dynamic MRI data obtained during usage of the custom device. Pearson correlations were used to examine relationships between the 2 measures. The 95% limits of agreement compared the absolute differences between the 2 devices. Results: There was a 3.2-mm systematic difference between AKL (6.3 [1.6] mm) and anterior tibial translation (3.2 [1.0] mm) measures. There was a significant positive correlation between values obtained from the commercial arthrometer and the MRI-compatible device values (r = .553, P = .026). Conclusions: While systematic differences were observed, the MRI-compatible anterior knee joint loading device anteriorly translated the tibia relative to the femur in a similar manner to a commercial arthrometer design to stress the anterior cruciate ligament. Such a device may be beneficial in future functional magnetic resonance imaging study of anterior cruciate ligament mechanoreception.
Race and Socioeconomic Composition of the High Schools of National Football League Players
Authors: White Kristopher , Wilson Kathryn , Walton-Fisette Theresa A. , Yim Brian H. , Donnelly Michele K.
Published: February 2021

This work built upon previous research examining meritocracy in elite sport by examining the socioeconomic and racial composition of the high schools of 1,881 players on National Football League (NFL) rosters in 2016. The NFL player data from pro-football-reference.com and perceived race data coded from player pictures are matched to school data for 23,785 public high schools in the Common Core of Data and 3,333 private high schools in the Private School Universe Survey. Using t tests of differences in group averages and General Linear Model analysis of variance, the authors found large statistically significant racial disparities within the NFL with Black NFL players attending high schools with an average of twice as many students in poverty and five times as many Black students than the high schools attended by White NFL players. Overall, NFL players attended high schools with lower socioeconomic status student bodies than the general student population, suggesting more meritocracy. However, analysis by player race shows the difference driven by the racial composition of the NFL compared with the general student population, suggesting this meritocracy is more complex; Black NFL players attended higher socioeconomic status schools with more White students than the general Black student population, and White NFL players attended higher socioeconomic status schools with fewer Black students than the general White student population.
Dynamic flows create potentially habitable conditions in Antarctic subglacial lakes
Authors: Couston Louis-Alexandre , Siegert Martin
Published: February 2021

Earth’s geothermal flux drives vigorous flows that can suspend microorganisms and sediment in isolated Antarctic subglacial lakes.
Soft pumps for soft robots
Authors: He Qiguang , Cai Shengqiang
Published: February 2021

A light and portable soft electro-pneumatic pump could power future soft robots.
Platelets release mitochondrial antigens in systemic lupus erythematosus
Authors: Melki Imene , Allaeys Isabelle , Tessandier Nicolas , Lévesque Tania , Cloutier Nathalie , Laroche Audrée , Vernoux Nathalie , Becker Yann , Benk-Fortin Hadrien , Zufferey Anne , Rollet-Labelle Emmanuelle , Pouliot Marc , Poirier Guy , Patey Natacha , Belleannee Clemence , Soulet Denis , McKenzie Steven E. , Brisson Alain , Tremblay Marie-Eve , Lood Christian , Fortin Paul R. , Boilard Eric
Published: February 2021

Platelets are a source of extracellular DNA and mitochondrial antigens in systemic lupus erythematosus.
Nybomycin Inhibits both Fluoroquinolone-Sensitive and Fluoroquinolone-Resistant Escherichia coli DNA Gyrase
Authors: Shiriaev Dmitrii I. , Sofronova Alina A. , Berdnikovich Ekaterina A. , Lukianov Dmitrii A. , Komarova Ekaterina S. , Marina Valeriya I. , Zakalyukina Yuliya V. , Biryukov Mikhail V. , Maviza Tinashe P. , Ivanenkov Yan A. , Sergiev Petr V. , Osterman Ilya A. , Dontsova Olga A.
Published: February 2021

Bacterial type II topoisomerases, DNA gyrase and topoisomerase IV, are targets of many antibiotics, including fluoroquinolones (FQs). Unfortunately, a number of bacterial species easily acquire resistance to FQs by mutations in either DNA gyrase or topoisomerase IV genes.
Hospital Outbreak of Fluconazole-Resistant Candida parapsilosis: Arguments for Clonal Transmission and Long-Term Persistence
Authors: Fekkar Arnaud , Blaize Marion , Bouglé Adrien , Normand Anne-Cécile , Raoelina Audrey , Kornblum Dimitri , Kamus Laure , Piarroux Renaud , Imbert Sébastien
Published: February 2021

The worldwide emergence of multidrug-resistant pathogenic fungi is a threat to human health. At this very moment, an emergence of
Candida parapsilosis
isolates harboring a resistance to fluconazole, one of the most popular antifungal drugs, is being described in several countries.
In Vitro
and
In Vivo
Characterization of Tebipenem, an Orally Active Carbapenem, against Biothreat Pathogens
Authors: Clayton Nicholas P. , Jain Akash , Halasohoris Stephanie A. , Pysz Lisa M. , Lembirik Sanae , Zumbrun Steven D. , Kane Christopher D. , Hackett Michael J. , Pfefferle Denise , Smiley M. Autumn , Anderson Michael S. , Heine Henry , Meister Gabriel T. , Pucci Michael J.
Published: February 2021

Bacillus anthracis
and
Yersinia pestis
, the causative pathogens for anthrax and plague, respectively, along with
Burkholderia mallei
and
Burkholderia pseudomallei
are potential bioterrorism threats. Tebipenem pivoxil hydrobromide (TBP HBr) (formerly SPR994) is an orally available prodrug of tebipenem, a carbapenem with activity versus multidrug-resistant (MDR) Gram-negative pathogens, including quinolone-resistant and extended-spectrum-β-lactamase-producing
Enterobacterales
.
Regulated Cleavage of Glycan Strands by the Murein Hydrolase SagB in Staphylococcus aureus Involves a Direct Interaction with LyrA (SpdC)
Authors: Willing Stephanie , Schneewind Olaf , Missiakas Dominique
Published: February 2021

Peptidoglycan is assembled on the
trans
side of the plasma membrane from lipid II precursors into glycan chains that are cross-linked at stem peptides. In
S. aureus
, SagB, a membrane-associated
N
-acetylglucosaminidase, cleaves polymerized glycan chains to their physiological length.
Analytical Sensitivity of the Abbott BinaxNOW COVID-19 Ag Card
Authors: Perchetti Garrett A. , Huang Meei-Li , Mills Margaret G. , Jerome Keith R. , Greninger Alexander L.
Published: February 2021

Multiple rapid antigen (Ag) tests for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have recently received emergency-use authorization (EUA) from the U.S. Food and Drug Administration (FDA).
Draft Genome Sequence of the Community-Associated Staphylococcus aureus Sequence Type 88 Strain LVP-7, Isolated from an Ocular Infection
Authors: Nadig Savitha , Murthy Sneha , Vandanashree Muralidharan , Subramanya Hosahalli S. , Gopal Balasubramanian , Vembar Shruthi
Published: February 2021

We report a
de novo
-assembled draft genome sequence of the Indian
Staphylococcus aureus
sequence type 88 (ST88) strain LVP-7, isolated from an ocular infection. The genome harbors a Panton-Valentine leukocidin phage, a type V staphylococcal cassette chromosome
mec
element, the delta-hemolysin-converting Newman phage ΦNM3, and the pathogenicity island SaPI3, encoding the superantigen enterotoxin B.
Near-Complete Genome Sequences of Vesicular Stomatitis Virus Isolates from the 2020 Outbreak in Kansas
Authors: Doerksen Tyler , Bird Edward , Henningson Jamie , Palinski Rachel
Published: February 2021

Here, we report the near-complete genome sequences of vesicular stomatitis virus (VSV) serotype Indiana isolates from the 2020 U.S. outbreak. The sequences were obtained from swabs collected from Kansas horses in July and August. The four genome sequences help improve our understanding of VSV outbreak dynamics in the United States.
Supplemental Material: Volcanic carbon cycling in East Lake, Newberry Volcano, Oregon, USA
Authors: Brumberg Hilary , Varekamp Johan , al. et
Published: February 2021

Details on the laboratory, data analysis, modeling methods, and equipment specifications, including methods and results of the two box models showing seasonal carbon cycling in East Lake, and raw data from the main text figures.
Changes over time in quality of life of school-aged children born extremely preterm: 1991–2005
Authors: Peart Stacey , Cheong Jeanie Ling Yoong , Roberts Gehan , Davis Noni , Anderson Peter J , Doyle Lex W
Published: February 2021

Objective

To compare health-related quality of life (HRQOL) at 8 years in children born extremely preterm (EP) with contemporaneous term-born controls over three epochs: 1991–92, 1997 and 2005.

Design

Prospective recruitment of geographic cohorts across three distinct eras. Utilities were calculated from the parent-completed Health Utilities Index (HUI), version 2 (1991–92 and 1997 cohorts) and version 3 (2005 cohort). Differences in utilities >0.05 are clinically important.

Setting

The state of Victoria, Australia.

Patients

475 EP (<28 weeks’ gestation) and 570 term controls.

Main outcome measures

Utilities of children born EP compared with term controls within each era, and paired differences between an EP and matched controls compared across eras.

Results

Overall, 86% of survivors had utility data at 8 years of age; 475 EP and 570 controls. In all eras, parent-reported utilities were lower for children born EP compared with controls (difference in medians (95% CIs); 1991–92, −0.053 (–0.071 to –0.035); 1997, –0.053 (−0.072 to –0.034); 2005, –0.082 (−0.097 to –0.068)). Mean differences (MD) between EP children and matched controls within each era were lower in the 2005 cohort compared with both the 1991–92 cohort (MD −0.054, 95% CI −0.097 to –0.010) and the 1997 cohort (MD −0.053, 95% CI −0.097 to –0.009).

Conclusion

Children born EP in the postsurfactant era have clinically important reductions in parent-reported HRQOL compared with controls, which may be worsening over time.
Parents’ perspectives on conflict in paediatric healthcare: a scoping review
Authors: Parsons Emily , Darlington Anne-Sophie
Published: February 2021

Background

Conflict in paediatric healthcare is becoming increasingly prevalent, in particular relation to paediatric end of life. This is damaging to patients, families, professionals and healthcare resources. Current research has begun to explore perspectives of healthcare professionals (HCPs), but the parental views on conflict are lacking.

Objectives

This scoping review explores parental views on conflict during a child’s end of life. In addition, parental views are mapped onto HCPs’ views.

Methods

A search was completed of the databases CINAHL, PubMed, Web of Science, Embase and Medline between 1997 and 2019, focused on parents of children with involvement with palliative or end-of-life care referring to conflict or disagreements.

Results

The review found 10 papers that included parental views on conflict. Data on conflict were categorised into the following seven themes: communication breakdown, trust, suffering, different understanding of ‘best interest’, disagreements over treatment, spirituality and types of decision-making. In particular, parental expertise, perspectives on suffering and ways of making decisions were significant themes. A subset of themes mirror those of HCPs. However, parents identified views of conflict unique to their perspective.

Conclusions

Parents identified important themes, in particular their perspective of what constitutes suffering and ‘best interest’. In addition, parents highlight the importance of being recognised as an expert.
Clinical characteristics, treatment and outcomes of paediatric COVID-19: a systematic review and meta-analysis
Authors: Irfan Omar , Muttalib Fiona , Tang Kun , Jiang Li , Lassi Zohra S , Bhutta Zulfiqar
Published: February 2021

Objective

Compare paediatric COVID-19 disease characteristics, management and outcomes according to World Bank country income level and disease severity.

Design

Systematic review and meta-analysis.

Setting

Between 1 December 2019 and 8 January 2021, 3350 articles were identified. Two reviewers conducted study screening, data abstraction and quality assessment independently and in duplicate. Observational studies describing laboratory-confirmed paediatric (0–19 years old) COVID-19 were considered for inclusion.

Main outcomes and measures

The pooled proportions of clinical findings, treatment and outcomes were compared according to World Bank country income level and reported disease severity.

Results

129 studies were included from 31 countries comprising 10 251 children of which 57.4% were hospitalised. Mean age was 7.0 years (SD 3.6), and 27.1% had a comorbidity. Fever (63.3%) and cough (33.7%) were common. Of 3670 cases, 44.1% had radiographic abnormalities. The majority of cases recovered (88.9%); however, 96 hospitalised children died. Compared with high-income countries, in low-income and middle-income countries, a lower proportion of cases were admitted to intensive care units (ICUs) (9.9% vs 26.0%) yet pooled proportion of deaths among hospitalised children was higher (relative risk 2.14, 95% CI 1.43 to 3.20). Children with severe disease received antimicrobials, inotropes and anti-inflammatory agents more frequently than those with non-severe disease. Subgroup analyses showed that a higher proportion of children with multisystem inflammatory syndrome (MIS-C) were admitted to ICU (47.1% vs 22.9%) and a higher proportion of hospitalised children with MIS-C died (4.8% vs 3.6%) compared with the overall sample.

Conclusion

Paediatric COVID-19 has a favourable prognosis. Further severe disease characterisation in children is needed globally.
Changing trends in glaucoma surgery within Australia
Authors: Sun Michelle T , Madike Reema , Huang Sonia , Cameron Cassie , Selva Dinesh , Casson Robert J , Wong Christopher X
Published: February 2021

Background

Limited data are available on glaucoma surgical trends in Australia.

Methods

Nationwide study of glaucoma surgery in Australia over 17-year period from 2001 to 2018. The Australian Institute of Health, Welfare and Ageing hospitalisation database was used to review age- and gender-specific trends in glaucoma surgeries from 2001 to 2018 in Australian public and private hospitals.

Results

Although there was an increase in the absolute number of trabeculectomy procedures from 2926 to 3244 over the 17-year study period, this represented a decline in the age-standardised and gender-standardised number of trabeculectomy procedures from 15.1 to 13.2 procedures per 100 000 persons. However, during this same period, there was a dramatic increase in the number of glaucoma drainage devices (GDD) from 119 to 3262 procedures, representing an age-standardised and gender-standardised increase from 0.6 to 13.3 procedures per 100 000 persons. Negative binomial regression analysis revealed a decrease in trabeculectomy procedures of 1.1% per year, while there was increase in GDD insertions of 16.3% per year (p<0.001 for both). When stratified by age group, there was a statistically significant interaction in both trabeculectomy and GDD rates by age groups over time (p<0.001 for both). Trabeculectomy procedures decreased to a greater extent in those aged >60 years, compared with stable or increasing rates in younger age groups. GDD insertion rates demonstrated a progressively greater increase in older compared with younger age groups.

Conclusion

Our findings demonstrate changing trends in the surgical management of advanced glaucoma in Australia, likely reflecting updated evidence regarding the role of GDD surgeries.
Protocol for a gallbladder cancer registry study in China: the Chinese Research Group of Gallbladder Cancer (CRGGC) study
Authors: Ren Tai , Li Yongsheng , Zhang Xi , Geng Yajun , Shao Ziyu , Li Maolan , Wu Xiangsong , Wang Xu-An , Liu Fatao , Wu Wenguang , Shu Yijun , Bao Runfa , Gong Wei , Dong Ping , Dang Xueyi , Liu Chang , Liu Changjun , Sun Bei , Liu Jun , Wang Lin , Hong Defei , Qin Renyi , Jiang Xiaoqing , Zhang Xuewen , Xu Junmin , Jia Jianguang , Yang Bo , Li Bing , Dai Chaoliu , Cao Jingyu , Cao Hong , Tao Feng , Zhang Zaiyang , Wang Yi , Jin Huihan , Cai Hongyu , Fei Zhewei , Gu Jianfeng , Han Wei , Feng Xuedong , Fang Lu , Zheng Linhui , Zhu Chunfu , Wang Kunhua , Zhang Xueli , Li Xiaoyong , Jin Chong , Qian Yeben , Cui Yunfu , Xu Yuzhen , Wang Xiang , Liu Houbao , Hua Yawei , Liu Chao , Hao Jihui , Wang Chuanlei , Li Qiyun , Li Xun , Liu Jiansheng , Li Mingzhang , Qiu Yudong , Wu Buqiang , Zheng Jinfang , Chen Xiaoliang , Zhu Haihong , Hua Kejun , Yan Maolin , Wang Peng , Zang Hong , Ma Xiaoming , Hong Jian , Liu Yingbin
Published: February 2021

Introduction

Gallbladder cancer (GBC), the sixth most common gastrointestinal tract cancer, poses a significant disease burden in China. However, no national representative data are available on the clinical characteristics, treatment and prognosis of GBC in the Chinese population.

Methods and analysis

The Chinese Research Group of Gallbladder Cancer (CRGGC) study is a multicentre retrospective registry cohort study. Clinically diagnosed patient with GBC will be identified from 1 January 2008 to December, 2019, by reviewing the electronic medical records from 76 tertiary and secondary hospitals across 28 provinces in China. Patients with pathological and radiological diagnoses of malignancy, including cancer in situ, from the gallbladder and cystic duct are eligible, according to the National Comprehensive Cancer Network 2019 guidelines. Patients will be excluded if GBC is the secondary diagnosis in the discharge summary. The demographic characteristics, medical history, physical examination results, surgery information, pathological data, laboratory examination results and radiology reports will be collected in a standardised case report form. By May 2021, approximately 6000 patient with GBC will be included. The clinical follow-up data will be updated until 5 years after the last admission for GBC of each patient. The study aimed (1) to depict the clinical characteristics, including demographics, pathology, treatment and prognosis of patient with GBC in China; (2) to evaluate the adherence to clinical guidelines of GBC and (3) to improve clinical practice for diagnosing and treating GBC and provide references for policy-makers.

Ethics and dissemination

The protocol of the CRGGC has been approved by the Committee for Ethics of Xinhua Hospital, Shanghai Jiao Tong University School of Medicine (SHEC-C-2019–085). All results of this study will be published in peer-reviewed journals and presented at relevant conferences.

Trial registration number

NCT04140552, Pre-results.
Illness perception in patients with chronic kidney disease and kidney failure: a scoping review protocol
Authors: Ng Jia Hwei , Vialet Jaclyn , Diefenbach Michael A
Published: February 2021

Introduction

Patient education is a crucial component in the management of chronic kidney disease (CKD); however, many education programmes do not tailor to patients’ disease-related belief and emotional reactions. According to Leventhal’s self-regulation model, such beliefs and reactions, known as illness perceptions, are a part of patients’ understanding of their disease and treatment-related actions. The existing research of illness perception in the field of nephrology has been heterogenous in terms of study outcomes and in study population; and the evidence of how illness perceptions affect behavioural and decisional outcomes is limited. This scoping review aims to map and summarise the evidence of published literature on illness perception among patients with CKD not yet treated by dialysis and kidney failure.

Methods and analysis

This study bases its approach on Joanna Brigg’s Institute Guidelines on scoping review methods. The search strategy was developed together with a medical information specialist. Searches will be performed on acceptance of publication in the following databases: PubMed, EMBASE, PsycINFO via Ovid, Scopus and the Cumulative Index to Nursing and Allied Health Literature. Searches will be run without incorporating a date restriction in order to capture content from the databases’ inception to present day. Search terms including ‘illness perception’, ‘kidney disease’ and ‘kidney failure’ will be screened in titles and abstracts. Two independent researchers will screen the abstracts and full text for full eligibility. We will include studies focusing on illness perception of patients with CKD with estimated glomerular filtration rate <60 mL/min/1.73 m2, kidney failure or recipients of kidney transplant. We will exclude patients <18 years of age, patients with acute kidney injury and non-English articles. All demographic data, study design and study findings will be collected and analysed using a data abstraction tool.

Ethics and dissemination

This study does not require internal review board approval. We will present the findings of this scoping review in a peer-reviewed journal.
Association between sensory impairment and suicidal ideation and attempt: a cross-sectional analysis of nationally representative English household data
Authors: Khurana Maitri , Shoham Natalie , Cooper Claudia , Pitman Alexandra Laura
Published: February 2021

Objectives

Sensory impairments are associated with worse mental health and poorer quality of life, but few studies have investigated whether sensory impairment is associated with suicidal behaviour in a population sample. We investigated whether visual and hearing impairments were associated with suicidal ideation and attempt.

Design

National cross-sectional study.

Setting

Households in England.

Participants

We analysed data for 7546 household residents in England, aged 16 and over from the 2014 Adult Psychiatric Morbidity Survey.

Exposures

Sensory impairment (either visual or hearing), Dual sensory impairment (visual and hearing), visual impairment, hearing impairment.

Primary outcome

Suicidal ideation and suicide attempt in the past year.

Results

People with visual or hearing sensory impairments had twice the odds of past-year suicidal ideation (OR 2.06; 95% CI 1.17 to 2.73; p<0.001), and over three times the odds of reporting past-year suicide attempt (OR 3.12; 95% CI 1.57 to 6.20; p=0.001) compared with people without these impairments. Similar results were found for hearing and visual impairments separately and co-occurring.

Conclusions

We found evidence that individuals with sensory impairments are more likely to have thought about or attempted suicide in the past year than individuals without.
Defining precision health: a scoping review protocol
Authors: Ryan Jillian C , Viana John Noel , Sellak Hamza , Gondalia Shakuntla , O"Callaghan Nathan
Published: February 2021

Introduction

Precision health is a nascent field of research that would benefit from clearer operationalisation and distinction from adjacent fields like precision medicine. This clarification is necessary to enable precision health science to tackle some of the most complex and significant health problems that are faced globally. There is a pressing need to examine the progress in human precision health research in the past 10 years and analyse this data to first, find similarities and determine discordances in how precision health is operationalised in the literature and second, identify gaps and future directions for precision health research.

Methods and analysis

To define precision health and map research in this field, a scoping review will be undertaken and reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses - Scoping Review Extension guidelines. Systematic searches of scientific databases (Medline, Embase, Scopus, Web of Science and PsycINFO) and grey literature sources (Google Scholar, Google Patents) identified 8053 potentially eligible articles published from 1 January 2010 to 30 June 2020. Following removal of duplicates, a total of 3190 articles were imported for screening. Article data will be extracted using a customised extraction template on Covidence and analysed descriptively using narrative synthesis.

Ethics and dissemination

Ethics approval is not required. Findings will be disseminated through professional networks, conference presentations and publication in a scientific journal.
Protocol for a randomised feasibility study of Point-Of-care HIV viral load testing to Enhance Re-suppression in South Africa: the POwER study
Authors: Dorward Jienchi , Sookrajh Yukteshwar , Ngobese Hope , Lessells Richard , Sayed Fathima , Bulo Elliot , Moodley P , Samsunder Natasha , Lewis Lara , Tonkin-Crine Sarah , Drain Paul K , Hayward Gail , Butler Christopher C , Garrett Nigel
Published: February 2021

Introduction

Access to HIV viral load testing remains difficult for many people on antiretroviral therapy (ART) in low-income and middle-income countries. Weak laboratory and clinic systems often delay the detection and management of viraemia, which can lead to morbidity, drug resistance and HIV transmission. Point-of-care testing could overcome these challenges. We aim to assess whether it is feasible to conduct a randomised trial of point-of-care viral load testing to manage viraemia.

Methods and analysis

We will conduct an open-label, single-site, individually randomised, feasibility study of Point-Of-care HIV viral load testing to Enhance Re-suppression, in Durban, South Africa. We will enrol approximately 100 people living with HIV who are aged ≥18 years, receiving first-line ART but with recent viraemia ≥1000 copies/mL, and randomise them 1:1 to receive point-of-care viral load or standard laboratory viral load monitoring, after 12 weeks. All participants will continue to receive care from public sector healthcare workers following South African HIV management guidelines. Participants with persistent viraemia ≥1000 copies/mL will be considered for switching to second-line ART. We will compare the proportion in each study arm who achieve the primary outcome of viral suppression <50 copies/mL at 24 weeks after enrolment. Additional outcomes include proportions retained in the study, proportions with HIV drug resistance, time to viral load results and time to switching to second-line ART. We will assess implementation of point-of-care viral load testing using process evaluation data, and through interviews and focus groups with healthcare workers.

Ethics and dissemination

University of Oxford Tropical Research Ethics Committee and the Biomedical Research Ethics Committee of the University of KwaZulu-Natal have approved the study. We will present results to stakeholders, and through conferences and open-access, peer-reviewed journals.

Trial registration number

PACTR202001785886049.
Palliative sedation outside a palliative care unit
Authors: Mercadante Sebastiano , Villari Patrizia , David Fabrizio
Published: February 2021

Purpose

The need of acute transition from an intensive care setting to an end-of-life setting requires collaboration and experience. Variable information exists on palliative sedation in traditional palliative care settings, including home care, hospices or palliative care units.

Materials

Four cases which required a rapid decision-making to alleviate suffering in patients close to death are described.

Results

Despite having different clinical pathways leading to intensive but medically non-beneficial treatments, patients were converted to a rapid transition of care in the unit where they had been admitted, due to different logistic reasons. An appropriate discussion with relatives about the short prognosis and the need to sedate for controlling suffering in the last hours of life was fundamental in preventing further suffering with intensive treatments.

Conclusions

These clinical notes suggest that palliative care and end-of-life measures should be also expanded in other settings, where palliative care issues are traditionally not properly assessed, implementing the collaboration with other colleagues with different clinical extractions.
Bed downtime: the novel use of a quality metric allows inpatient providers to improve patient flow from the emergency department
Authors: Bodnar Benjamin , Kane Erin M , Rupani Hetal , Michtalik Henry , Billioux Veena G , Pleiss Ashley , Huffman Linda , Kobayashi Kimiyoshi , Toteja Rohit , Brotman Daniel J , Herzke Carrie
Published: February 2021

Background

Emergency department (ED) boarding time is associated with increased length of stay (LOS) and inpatient mortality. Despite the documented impact of ED boarding on inpatient outcomes, a disparity continues to exist between the attention paid to the issue by inpatient and ED providers. A perceived lack of high yield strategies to address ED boarding from the perspective of the inpatient provider may discourage involvement in improvement initiatives on the subject. As such, further work is needed to identify inpatient metrics and strategies to address patient flow problems, and which may improve ED boarding time.

Methods

After initial system analysis, our multidisciplinary quality improvement (QI) group defined the process time metric ‘bed downtime’—the time from which a bed is vacated by a discharged patient to the time an ED patient is assigned to that bed. Using the Lean Sigma QI approach, this metric was targeted for improvement on the internal medicine hospitalist service at a tertiary care academic medical centre.

Interventions

Interventions included improving inpatient provider awareness of the problem, real-time provider notification of empty beds, a weekly retrospective emailed performance dashboard and the creation of a guideline document for admission procedures.

Results

This package of interventions was associated with a 125 min reduction in mean bed downtime for incoming ED patients (254 min to 129 min) admitted to the intervention unit.

Conclusion

Use of the bed downtime metric as a QI target was associated with marked improvements in process time during our project. The use of this metric may enhance the ability of inpatient providers to participate in QI efforts to improve patient flow from the ED. Further study is needed to determine if use of the metric may be effective at reducing boarding time without requiring alterations to LOS or discharge patterns.
Pilot study investigating diagnostic utility of serum MMP-1 and TGF-β1 in asthma in ‘real world’ clinical practice in India
Authors: Prabha Aswani , Lokesh Komarla Sundararaja , Chaya S K , Jayaraj B S , Malamardi Sowmya , Subbarao M V S S T , Beck Sarah C , Krishna Mamidipudi Thirumala , Mahesh Padukudru Anand
Published: February 2021

Aims

At a tissue level, matrix metalloproteinase-1 (MMP-1) and transforming growth factor-beta 1 (TGF-β1) contribute to allergic airway inflammation, tissue remodelling and disease severity in asthma via different pathways. Their peripheral blood levels and role in diagnosis and therapeutic monitoring has not been adequately explored. We investigated the association between MMP-1 and TGF-β in moderate and severe persistent asthma and evaluated their performance characteristics by constructing receiver operating characteristic curves.

Methods

Serum MMP-1 and TGF-β1 were measured using ELISA in 75 adults; moderate persistent asthma (n=25), severe persistent asthma (n=25) and healthy community controls (n=25). Severity of asthma was determined as per Global Initiative for Asthma guidelines. Subjects were followed up for 3 months and treatment responsiveness was assessed by spirometry and symptom response.

Results

Serum MMP-1 and TGF-β1 were significantly elevated in asthmatics compared with controls (p<0.0001 and p<0.01). While serum MMP-1 was elevated in severe asthma compared with moderate asthma (p<0.05), TGF-β1 was lower in severe asthma compared with moderate asthma (p<0.05). The performance characteristics of serum MMP-1 and TGF-β1 were promising in this cohort with sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 82%, 100%, 100% and 99% and 62%, 100%, 100% and 97.8%, respectively; sensitivity of MMP-1 being superior.

Conclusion

This pilot study showed that serum MMP-1 and TGF-β1 levels are elevated in chronic asthma and may serve as a useful adjunct in differentiating moderate from severe asthma. A large multicentre study in well characterised cohort of asthmatics is warranted to investigate their role in diagnosis and therapeutic monitoring.
RapidEGFRevaluation from used H&E, IHC and FISH diagnostic slides with the Idylla platform
Authors: Nunnari Josè , Graziano Paolo , Muscarella Lucia Anna , Rossi Antonio , Grillo Lucia Rosalba , Montrone Giuseppe , Di Lorenzo Angela , Bronzini Monica , Leone Alvaro
Published: February 2021

Aims

Diagnostic tumour samples are mandatory for morphologic and molecular diagnosis of non-small cell lung cancer (NSCLC) to establish the best therapeutic approach. In the presence of small tumour tissue sample, the pathologist needs to make responsible choices to achieve a correct diagnosis and save material for subsequent molecular evaluations. Nevertheless, in some instances, the diagnostic process can lead to tissue depletion. The automated Idylla epidermal growth factor receptor (EGFR) mutation test has been developed to rapidly process formalin-fixed paraffin-embedded (FFPE) pathologic material, without previous DNA extraction. This study aimed to test whether this platform is suitable for the reuse of H&E, immunohistochemistry (IHC) and fluorescence in situ hybridisation (FISH) diagnostic slides.

Methods

A training set of 19 FFPE tissues with knownEGFRstatus was revaluated on H&E slides. Fourteen of them were also tested using IHC and FISH treated specimens. An additional series of 25 H&E, IHC or FISH slides of NSCLC cases tested forEGFRmutation at an external institution was blindly assessed as a validation cohort.

Results

Combining the two sets, 32 of 32 classical ex19dels and p.L858R were correctly identified. Three uncommon mutations (p.G719X, p.L861Q and ex20ins) were also detected. Four discrepancies were related to rare ex19del/ins not included in the Idylla list of detectable mutations. Two p.T790M variants were missed on one FFPE and two H&E slides but were detected using IHC and FISH sections from the same FFPE blocks.

Conclusions

The IdyllaEGFRmutation test is highly reliable using differently treated tumour specimens and should be validated in larger studies.
Vaccine ethics: an ethical framework for global distribution of COVID-19 vaccines
Authors: Jecker Nancy S , Wightman Aaron G , Diekema Douglas S
Published: February 2021

This paper addresses the just distribution of vaccines against the SARS-CoV-2 virus and sets forth an ethical framework that prioritises frontline and essential workers, people at high risk of severe disease or death, and people at high risk of infection. Section I makes the case that vaccine distribution should occur at a global level in order to accelerate development and fair, efficient vaccine allocation. Section II puts forth ethical values to guide vaccine distribution including helping people with the greatest need, reducing health disparity, saving the most lives and promoting narrow social utility. It also responds to objections which claim that earlier years have more value than later years. Section III puts forth a practical ethical framework to aid decision-makers and compares it with alternatives.
Complete flow control using transient concurrent rapid ventricular pacing or intravenous adenosine and afferent arterial balloon occlusion during transvenous embolization of cerebral arteriovenous malformations: case series
Authors: Waqas Muhammad , Dossani Rimal H , Vakharia Kunal , Rai Hamid H , Chin Felix , Tso Michael K , Rajah Gary B , Snyder Kenneth V , Davies Jason M , Levy Elad I , Iyer Vijay S , Siddiqui Adnan H
Published: February 2021

Background

There are no reports that describe complete flow control using concurrent transient rapid ventricular pacing or intravenous (IV) adenosine and afferent arterial balloon flow arrest to aid transvenous embolization of cerebral arteriovenous malformations (AVM). We describe our experience with the use of this technique in patients undergoing transvenous AVM embolization.

Methods

Consecutive patients in whom transvenous embolization was attempted at our institute between January 2017 and July 2019 were included. Anatomical AVM features, number of embolization stages, technique of concurrent transient rapid ventricular pacing and afferent arterial balloon flow arrest, complications, and clinical and radiological outcomes were recorded and tabulated.

Results

Transvenous AVM embolization was attempted in 12 patients but abandoned in two patients for technical reasons. Complete embolization was achieved in 10 patients, five of whom had infratentorial AVMs. All 10 had a single primary draining vein. Rapid ventricular pacing was used in nine cases; IV adenosine injection was used in one case to achieve cardiac standstill. Complete AVM nidus obliteration was achieved with excellent neurologic outcome in nine cases, with transvenous embolization alone in two cases, and with staged transarterial followed by transvenous embolization in the others. Two patients developed hemorrhagic complications intraprocedurally. One patient was managed conservatively and the other operatively with AVM excision and hematoma evacuation; both made an excellent recovery without any neurologic deficits at 3 months.

Conclusion

Complete flow control using concurrent transient rapid ventricular pacing with afferent arterial balloon flow arrest technique is safe and feasible for transvenous embolization of select AVMs.
Is a picture-perfect thrombectomy necessary in acute ischemic stroke?
Authors: Chen Ching-Jen , Chalhoub Reda , Ding Dale , Kumar Jeyan S , Ironside Natasha , Kellogg Ryan T , Worrall Bradford B , Southerland Andrew M , Jabbour Pascal , Wolfe Stacey Q , Arthur Adam S , Goyal Nitin , Fragata Isabel , Maier Ilko , Matouk Charles , Grossberg Jonathan A , Kan Peter , Schirmer Clemens M , Crowley R Webster , Ares William J , Ogilvy Christopher S , Rai Ansaar T , Levitt Michael R , Mokin Maxim , Guerrero Waldo R , Mascitelli Justin R , Yoo Albert J , Williamson Richard , Grande Andrew Walker , Crosa Roberto Javier , Webb Sharon , Psychogios Marios N , Starke Robert M , Spiotta Alejandro M , Park Min S
Published: February 2021

Background

The benefit of complete reperfusion (modified Thrombolysis in Cerebral Infarction (mTICI) 3) over near-complete reperfusion (≥90%, mTICI 2c) remains unclear. The goal of this study is to compare clinical outcomes between mechanical thrombectomy (MT)-treated stroke patients with mTICI 2c versus 3.

Methods

This is a retrospective study from the Stroke Thrombectomy and Aneurysm Registry (STAR) comprising 33 centers. Adults with anterior circulation arterial vessel occlusion who underwent MT yielding mTICI 2c or mTICI 3 reperfusion were included. Patients were categorized based on reperfusion grade achieved. Primary outcome was modified Rankin Scale (mRS) 0–2 at 90 days. Secondary outcomes were mRS scores at discharge and 90 days, National Institutes of Health Stroke Scale score at discharge, procedure-related complications, and symptomatic intracerebral hemorrhage.

Results

The unmatched mTICI 2c and mTICI 3 cohorts comprised 519 and 1923 patients, respectively. There was no difference in primary (42.4% vs 45.1%; p=0.264) or secondary outcomes between the unmatched cohorts. Reperfusion status (mTICI 2c vs 3) was also not predictive of the primary outcome in non-imputed and imputed multivariable models. The matched cohorts each comprised 191 patients. Primary (39.8% vs 47.6%; p=0.122) and secondary outcomes were also similar between the matched cohorts, except the 90-day mRS which was lower in the matched mTICI 3 cohort (p=0.049). There were increased odds of the primary outcome with mTICI 3 in patients with baseline mRS ≥2 (36% vs 7.7%; p=0.011; pinteraction=0.014) and a history of stroke (42.3% vs 15.4%; p=0.027; pinteraction=0.041).

Conclusions

Complete and near-complete reperfusion after MT appear to confer comparable outcomes in patients with acute stroke.
Necessity is the mother of invention: how the COVID-19 pandemic could change medical student placements for the better
Authors: Stout Rebecca C , Roberts Sophie , Maxwell-Scott Hector , Gothard Philip
Published: February 2021

COVID-19 led to the widespread withdrawal of face-to-face hospital-based clinical placements, with many medical schools switching to online learning. This precipitated concern about potential negative impact on clinical and interprofessional skill acquisition. To overcome this problem, we piloted a 12-week COVID-19 safe face-to-face clinical placement for 16 medical students at the Hospital for Tropical Diseases, London, during the first wave of the COVID-19 pandemic. COVID-19 infection control measures necessitated that students remained in ‘social bubbles’ for placement duration. This facilitated an apprenticeship-style teaching approach, integrating students into the clinical team for placement duration. Team-based learning was adopted to develop and deliver content. Teaching comprised weekly seminars, experiential ward-based attachments and participation in quality improvement and research projects. The taught content was evaluated through qualitative feedback, reflective practice, and pre-apprenticeship and post-apprenticeship confidence questionnaires across 17 domains. Students’ confidence improved in 14 of 17 domains (p<0.05). Reflective practice indicated that students valued the apprenticeship model, preferring the longer clinical attachment to existent shorter, fragmented clinical placements. Students described improved critical thinking, group cohesion, teamwork, self-confidence, self-worth and communication skills. This article describes a framework for the safe and effective delivery of a longer face-to-face apprenticeship-based clinical placement during an infectious disease pandemic. Longer apprenticeship-style attachments have hidden benefits to general professional training, which should be explored by medical schools both during the COVID-19 pandemic and, possibly, for any future clinical placements.
Multiple breath washout (MBW) testing using sulfur hexafluoride: reference values and influence of anthropometric parameters
Authors: Trinkmann Frederik , Maros Máté , Roth Katharina , Hermanns Arne , Schäfer Julia , Gawlitza Joshua , Saur Joachim , Akin Ibrahim , Borggrefe Martin , Herth Felix J F , Ganslandt Thomas
Published: February 2021

Background

Multiple breath washout (MBW) using sulfur hexafluoride (SF6) has the potential to reveal ventilation heterogeneity which is frequent in patients with obstructive lung disease and associated small airway dysfunction. However, reference data are scarce for this technique and mostly restricted to younger cohorts. We therefore set out to evaluate the influence of anthropometric parameters on SF6-MBW reference values in pulmonary healthy adults.

Methods

We evaluated cross-sectional data from 100 pulmonary healthy never-smokers and smokers (mean 51 (SD 20), range 20–88 years). Lung clearance index (LCI), acinar (Sacin) and conductive (Scond) ventilation heterogeneity were derived from triplicate SF6-MBW measurements. Global ventilation heterogeneity was calculated for the 2.5% (LCI2.5) and 5% (LCI5) stopping points. Upper limit of normal (ULN) was defined as the 95th percentile.

Results

Age was the only meaningful parameter influencing SF6-MBW parameters, explaining 47% (CI 33% to 59%) of the variance in LCI, 32% (CI 18% to 47%) in Sacin and 10% (CI 2% to 22%) in Scond. Mean LCI increases from 6.3 (ULN 7.4) to 8.8 (ULN 9.9) in subjects between 20 and 90 years. Smoking accounted for 2% (CI 0% to 8%) of the variability in LCI, 4% (CI 0% to 13%) in Sacin and 3% (CI 0% to 13%) in Scond.

Conclusion

SF6-MBW outcome parameters showed an age-dependent increase from early adulthood to old age. The effect was most pronounced for global and acinar ventilation heterogeneity and smaller for conductive ventilation heterogeneity. No influence of height, weight and sex was seen. Reference values can now be provided for all important SF6-MBW outcome parameters over the whole age range.

Trial registration number

NCT04099225.