bluuebunny/crossref_metadata_2025 huggingface dataset:
Magnetic field diffusion in ferromagnetic materials: fractional calculus approaches
Authors: Hristov Jordan
Published: August 2021

The paper addresses diffusion approximations of magnetic field penetration of ferromagnetic materials with emphasis on fractional calculus applications and relevant approximate solutions. Examples with applications of time-fractional semi-derivatives and singular kernel models (Caputo time fractional operator) in cases of field independent and field-dependent magnetic diffusivities have been developed: Dirichlet problems and time-dependent boundary condition (power-law ramp). Approximate solutions in all theses case have been developed by applications of the integral-balance method and assumed parabolic profile with unspecified exponents. Tow version of the integral method have been successfully implemented: SDIM (single integration applicable to time-fractional semi-derivative model) and DIM (double-integration model to fractionalized singular memory models). The fading memory approach in the sense of the causality concept and memory kernel effect on the model constructions have been discussed.
Static and Cyclic Behavior of Welded DH36 Steel and Its Application at Low Temperatures
Authors: Zhao Weidong , Feng Guoqing , Leira Bernt Johan , Ren Huilong
Published: August 2021

The mechanical properties of welded DH36 steel at low temperatures are important to the safety of structures in Polar areas. The purpose of the study is to investigate the static and cyclic behavior of welded DH36 steel at low temperatures based on tensile and fatigue tests. The ductile to brittle transition and fatigue ductile to brittle transition of welded DH36 steel occurred at low temperatures. Finally, some relevant applications of the results within the context of polar engineering and design are discussed in the last part of the present study.
Socio-Inspired Multi-Cohort Intelligence and Teaching-Learning-Based Optimization for Hydraulic Fracturing Parameters Design in Tight Formations
Authors: Muther Temoor , Syed Fahad Iqbal , Dahaghi Amirmasoud Kalantari , Negahban Shahin
Published: August 2021

Hydraulic fracturing is one of the revolutionary technologies widely applied to develop tight hydrocarbon reservoirs. Moreover, hydraulic fracture design optimization is an essential step to optimize production from tight reservoirs. This study presents the implementation of three new socio-inspired algorithms on hydraulic fracturing optimization. The work integrates reservoir simulation, artificial neural networks, and preceding optimization algorithms to attain the optimized fractures. For this study, a tight gas production dataset is initially generated numerically for a defined set of the fracture half-length, fracture height, fracture width, fracture conductivity, and the number of fractures’ values. Secondly, the generated dataset is trained through a neural network to predict the effects of preceding parameters on gas production. Lastly, three new socio-inspired algorithms including cohort intelligence (CI), multi-cohort intelligence (multi-CI), and teaching learning-based optimization (TLBO) are applied to the regressor output to obtain optimized gas production performance with the combination of optimum fracture design parameters. The results are then compared with the traditionally used optimizers including particle swarm optimization (PSO) and genetic algorithm (GA). The results demonstrated that the multi-CI and TLBO converge at the global best position more often with a success rate of at least 95% as compared to CI, PSO, and GA. Moreover, the CI, PSO, and GA are found to stuck many times at the local maximum. This concludes that the multi-CI and TLBO are good alternatives to PSO and GA considering their high performance in determining the optimum fracture design parameters in comparison.
Applying Different Artificial Intelligence Techniques in Dynamic Poisson’s Ratio Prediction Using Drilling Parameters
Authors: Siddig Osama , Gamal Hany , Elkatatny Salaheldin , Abdulraheem Abdulazeez
Published: August 2021

Rock geomechanical properties impact wellbore stability, drilling performance, estimation of in situ stresses, and design of hydraulic fracturing. One of these properties is Poisson’s ratio which is measured from lab testing or derived from well logs, the former is costly, time-consuming, and does not provide continuous information, and the latter may not be always available. An alternative prediction technique from drilling parameters in real time is proposed in this paper. The novel contribution of this approach is that the drilling data is always available and obtained from the first encounter with the well. These parameters are easily obtainable from drilling rig sensors such as rate of penetration (ROP), weight on bit (WOB), and torque. Three machine-learning methods were utilized: support vector machine (SVM), functional network (FN), and random forest (RF). Dataset (2905 data points) from one well were used to build the models, while a dataset from another well with 2912 data points was used to validate the constructed models. Both wells have diverse lithology consists of carbonate, shale, and sandstone. To ensure optimal accuracy, sensitivity and optimization tests on various parameters in each algorithm were performed. The three machine-learning tools provided good estimations; however, SVM and RF yielded close results, with correlation coefficients of 0.99 and the average absolute percentage error (AAPE) values were mostly less than 1%. While in FN the outcomes were less efficient with correlation coefficients of 0.92 and AAPE around 3.8%. Accordingly, the presented approach provides an effective tool for Poisson's ratio prediction on a real-time basis at no additional expense. In addition, the same approach could be used in other rock mechanical properties.
Energy Demand Reduction in the Built Environment Using Shallow Geothermal Integrated Energy Systems—A Comprehensive Review: Part I. Design Consideration of Ground Heat Exchanger
Authors: Balaji K.
Published: August 2021

The research collection aims at finding the various possible opportunities for the effective integration of shallow geothermal energy (SGE) to decrease the energy demand in the built environment and to reduce emission associated with it. The integration of SGE with heat pump using pipe network is extensively reviewed. The open-loop and closed-loop (vertical, horizontal, energy piles) pipe networks are the most common type of ground heat exchanging methods. The objective of the review is to improve the heat exchanger effectiveness through various design aspects according to the local climatic conditions. This comprehensive review part I contains the research details pertaining to the last two decades about ground heat exchangers (geometrical aspects, borehole material, grout material, thermal response test, analytical and numerical models). Also, the factors influencing the ground heat exchanger’s performance such as heat transfer fluid (HTF), groundwater flow, and soil properties are discussed in detail. This paper highlights the recent research findings and potential research points in the ground heat exchanger.
The development of tonal duration in Mandarin-speaking children
Authors: Yang Jie , Davis Barbara L. , Diehl Randy L.
Published: August 2021

Developmental changes in suprasegmental tonal duration were investigated in monolingual Mandarin-speaking children. Tone durations were acoustically measured in five- and eight-year-old children and adults. Children's tone duration and variability decreased with age. Five-year-olds produced significantly longer tone durations than adults. Adult-like duration patterns existed in all children: Tone 4 was the shortest and tone 3 the longest. Duration differences between tones 2 and 3 became larger between five- and eight-year-olds. Results suggest a prolonged process of tone development beyond establishing phonological contrasts, which can be viewed as a hybrid of physiological production capacities and perceptual learning for maximal contrastivity.
Developing a Pedagogy of Restorative Physical Education
Authors: Hemphill Michael A. , Lee Yongsun , Ragab Sarah , Rinker Jeremy , Dyson Omari L.
Published: August 2021

Purpose: The purpose of this study was to examine the process of developing an alternative physical education program using restorative justice practices as a transformative approach to social–emotional learning. Method: This study utilizes qualitative case study methods to examine the implementation process and short-term outcomes. Data sources include focus group interviews, student journals, observations, and reflective field notes. Trustworthiness of the findings are supported by triangulation, peer debriefings, prolonged engagement, and external program reviews. Results: The implementation of social and emotional learning was substantiated by student engagement with four class goals in which they aimed to participate in physical education as “champions,” “heroes,” “achievers,” and “peacemakers.” Restorative pedagogy included restorative chats, listening circles, community circles, and healing circles. Conclusion: This study suggests that transformative curriculum, such as restorative justice, offers a transformative approach to social and emotional learning that is applicable to physical education.
A Collaborative Approach to Manuscript Revisions and Responses to Reviewer Comments
Authors: Richards K. Andrew R. , Hemphill Michael A. , Flory Sara B.
Published: August 2021

While there are benefits to collaborative research, navigating group dynamics can also bring challenges, particularly for doctoral students and early career academics who are new to the research process. These dynamics extend beyond initial manuscript submission and include processes associated with interpreting reviewer comments, deciding upon and making revisions, and developing clear author response documents through the revision process. Herein, the authors overview one systematic and replicable approach to managing revisions. Steps include (a) read, set aside, and return to the reviewer comments; (b) document initial reactions to comments; (c) collectively review the comments and decide upon direction; (d) coordinate revisions to the manuscript; (e) craft final response statements; and (f) prepare a resubmission cover letter to the editor. Recommendations will be provided for approaching the revision, including how to revise the manuscript to highlight edits, and suggestions for tone and approach, particularly when disagreeing with a reviewer.
Vaccine nationalism and the dynamics and control of SARS-CoV-2
Authors: Wagner Caroline E. , Saad-Roy Chadi M. , Morris Sinead E. , Baker Rachel E. , Mina Michael J. , Farrar Jeremy , Holmes Edward C. , Pybus Oliver G. , Graham Andrea L. , Emanuel Ezekiel J. , Levin Simon A. , Metcalf C. Jessica E. , Grenfell Bryan T.
Published: August 2021

Stockpiling and control

A triumph that has emerged from the catastrophe of the severe acute respiratory syndrome coronavirus 2 pandemic has been the rapid development of several potent vaccines. However, 18 months into the pandemic and more than 6 months after vaccine approval, wealthy countries remain the major beneficiaries. Wagner
et al
. model the consequences of vaccine stockpiling in affluent countries on disease rates in lower- and middle-income countries and the consequences for the eruption of new variants that could jeopardize the early success of vaccines. For countries that can readily access vaccines, it would be better to share vaccines equitably to lower disease burdens in countries with less access, reduce the cost of having to be constantly vigilant for case imports, and minimize virus evolution. —CA
Selective inhibition of IL-6 trans-signaling by a miniaturized, optimized chimeric soluble gp130 inhibits T
H
17 cell expansion
Authors: Heise Denise , Derrac Soria Alicia , Hansen Selina , Dambietz Christine , Akbarzadeh Mohammad , Berg Anna F. , Waetzig Georg H. , Jones Simon A. , Dvorsky Radovan , Ahmadian Mohammad R. , Scheller Jürgen , Moll Jens M.
Published: August 2021

Smaller, more selective molecular traps of IL-6 trans-signaling complexes may treat autoimmunity.
Inactivation of Transcriptional Regulator FabT Influences Colony Phase Variation of Streptococcus pneumoniae
Authors: Zhang Jinghui , Ye Weijie , Wu Kaifeng , Xiao Shengnan , Zheng Yuqiang , Shu Zhaoche , Yin Yibing , Zhang Xuemei
Published: August 2021

Streptococcus pneumoniae
is a major human pathogen, and its virulence factors and especially the capsular polysaccharide have been extensively studied. In addition to virulence components that are present on its cell surface that directly interact with the host,
S. pneumoniae
undergoes a spontaneous and reversible phase variation that allows survival in different host environments.
A Novel Aquaporin Subfamily Imports Oxygen and Contributes to Pneumococcal Virulence by Controlling the Production and Release of Virulence Factors
Authors: Hu Qingqing , Tong Huichun , Wang Jing , Ge Pupu , Zhu Lin , Liu Cuihua , Zhang Jing-ren , Dong Xiuzhu
Published: August 2021

Pneumococcus is the leading cause of community-acquired pneumonia, bacteremia, and meningitis. This work reports that a novel aquaporin subfamily represented by pneumococcal Pn-AqpC functions as an oxygen porin facilitating O
2
influx into cells.
Hidden Viral Sequences in Public Sequencing Data and Warning for Future Emerging Diseases
Authors: Kawasaki Junna , Kojima Shohei , Tomonaga Keizo , Horie Masayuki
Published: August 2021

Monitoring the spread of viral infections and identifying novel viruses capable of infecting humans through animal reservoirs are necessary to control emerging viral diseases. Massive amounts of sequencing data collected from various animals are publicly available, and these data may contain sequences originating from a wide variety of viruses.
Toxin Induction or Inhibition of Transcription or Translation Posttreatment Increases Persistence to Fluoroquinolones
Authors: Lemma Annabel S. , Brynildsen Mark P.
Published: August 2021

Overabundances of toxins have been shown to increase the antibiotic tolerances of bacteria. Largely, these effects have been attributed to the abilities of toxins to inhibit bacterial growth before and during antibiotic exposure.
Investigating the Chemolithoautotrophic and Formate Metabolism of Nitrospira moscoviensis by Constraint-Based Metabolic Modeling and
13
C-Tracer Analysis
Authors: Lawson Christopher E. , Mundinger Aniela B. , Koch Hanna , Jacobson Tyler B. , Weathersby Coty A. , Jetten Mike S. M. , Pabst Martin , Amador-Noguez Daniel , Noguera Daniel R. , McMahon Katherine , Lücker Sebastian
Published: August 2021

Nitrospira
spp. are globally abundant nitrifying bacteria in soil and aquatic ecosystems and in wastewater treatment plants, where they control the oxidation of nitrite to nitrate. Despite their critical contribution to nitrogen cycling across diverse environments, detailed understanding of their metabolic network and prediction of their function under different environmental conditions remains a major challenge.
Distinct Persistence Fate of Mycobacterium tuberculosis in Various Types of Cells
Authors: Chen Xi , Cao Xiaojian , Lei Yingying , Reheman Aikebaier , Zhou Wei , Yang Bing , Zhang Weipan , Xu Weize , Dong Shuang , Tyagi Rohit , Fu Zhen F. , Cao Gang
Published: August 2021

As an intracellular pathogen,
Mycobacterium tuberculosis
could avoid host cell immune clearance using multiple strategies for its long-term survival. Understanding these processes could facilitate the development of new approaches to restrict intracellular
M. tuberculosis
survival.
Embracing Metagenomic Complexity with a Genome-Free Approach
Authors: Coleman Izaak , Korem Tal
Published: August 2021

A central paradigm in microbiome data analysis, which we term the genome-centric paradigm, is that a linear (nonbranching) DNA sequence is the ideal representation of a microbial genome. This representation is natural, as microbes indeed have nonbranching genomes.
Successful management of small cell neuroendocrine carcinoma of the ureter with neoadjuvant chemotherapy and adjuvant chemoradiation: case report and literature review
Authors: Farooq Mudasir , Daniel Sherin , Joel Anjana , Thampi John Nirmal
Published: August 2021

Neuroendocrine tumours (NETs) of the urinary tract are rare, and the urinary bladder is the the most common primary site. Primary ureteric NET is rarer with under 80 cases reported in the literature thus far. Most of these tumours are of the high-grade small cell neuroendocrine carcinoma subtype, which has a worse prognosis. Neoadjuvant chemotherapy has a proven role in the management of NET of the bladder as it downstages the tumour, which may add to significant recurrence-free survival and overall survival. We report the successful management of a patient with locally advanced small cell neuroendocrine carcinoma of the ureter, who had a pathological complete response after neoadjuvant chemotherapy with etoposide and cisplatin. He subsequently received adjuvant chemotherapy followed by radiation and is recurrence-free at a follow-up of 1 year.
Chronic intestinal psuedo-obstruction and MIDD, a rare cause of acute abdomen: implications in emergency surgery
Authors: Underwood Kirk , Drysdale Henry , Nguyen Giang , Nagra Sonalmeet
Published: August 2021

Chronic intestinal pseudo-obstruction (CIPO) is a condition typified by the failure of the small bowel to propel contents in the absence of physical obstruction. CIPO is diagnosed after eliminating other causes, presenting a diagnostic challenge in emergency surgery. We report a case of a 32-year-old man with a rare mitochondrial disorder, Maternally inherited diabetes and deafness (MIDD), who presented to our hospital acutely unwell with peritonitis. Laparotomy revealed distended small bowel with no transition point, and turbid fluid with no macroscopic source. Postoperatively he had severe electrolyte and vitamin deficiencies. The diagnosis of CIPO leading to paralytic ileus and bacterial translocation was established and managed with aggressive electrolyte and vitamin replacement. He was discharged day 12 post operatively after a prolonged ileus with follow-up from a quaternary metabolic unit. We discuss here the challenges and gold standard in the emergency management of CIPO.
A case ofMycobacterium fortuitumprosthetic joint infection successfully treated medically without prosthesis explantation or joint debridement
Authors: Ramanathan Maya , Ayoade Folusakin
Published: August 2021

A 58-year-old man with a history of end-stage degenerative joint disease developed a postsurgical infection at the right hip 4 weeks after hip replacement surgery. He underwent surgical washout of the right hip without opening the joint capsule. Arthrocentesis returned positive forMycobacterium fortuitum. He was started on antibiotics with the recommendation to remove the prosthesis. The prosthesis was retained. Based on antimicrobial susceptibilities, he was treated with 4 weeks of intravenous therapy using cefoxitin and amikacin and later switched to oral ciprofloxacin and doxycycline for 5 additional months. Eighteen months from his initial hip replacement surgery, he continues to do well. Joint aspiration culture is important to make a diagnosis of prosthetic joint infection (PJI) when periprosthetic culture is not available. In the absence of serious systemic or comorbid joint conditions, PJI due toM. fortuitumcan be managed medically without having to remove the prosthesis or debride the joint.
Case of labial sclerosing polycystic adenoma with ductal carcinoma in situ (DCIS)
Authors: Makarla Soumya , Bavle Radhika M , Venugopal Reshma , Muniswamappa Sudhakara
Published: August 2021

Minor salivary gland tumours are enigmatic in their behaviour and presentations. Histopathological diagnosis of these tumours encompasses a large spectrum. Conventionally, small nodular tumours of the upper lip or the labial mucosa are generally adenomas, frequently pleomorphic adenomas. Here, we describe a case of a solitary nodular tumour, occurring in the upper labial mucosa, diagnosed as sclerosing polycystic adenoma (SPA) with intraductal epithelial proliferation of high grade. This is a rare lesion, which has entered into the category of salivary gland tumours recently in the 2017 WHO categorisation. We report a case of paucicystic SPA with intraductal epithelial proliferations in the labial minor salivary gland of a 56-year-old woman, which might be the first report of a case occurring in the upper labial mucosa.
Bleeding duodenal ulcer with ovarian torsion—a rare presentation in neonates
Authors: Patra Saikat , Kalamdani Pavan , Kalathingal Thaslima , Mondkar Jayashree
Published: August 2021

Massive upper gastrointestinal bleed is an emergency in newborns. Common causes are coagulopathy and thrombocytopenia. Stress-induced duodenal ulcer has also been reported as an unusual cause for massive upper gastrointestinal bleed. Managing such cases requires correct diagnosis and prompt treatment to prevent catastrophic complications. We report a case of bleeding duodenal ulcer probably secondary to ovarian torsion.
Thoracoabdominal impalement injury during pregnancy
Authors: Aquino Charisse Anne F , Banal-Silao Maria Jesusa B
Published: August 2021

Trauma has emerged as the leading cause of death during pregnancy. Penetrating abdominal trauma in pregnancy requires a rigorous clinical evaluation to establish a complete assessment of obstetric and non-obstetric lesions. In the case of major trauma, treatment is essentially carried out in a trauma centre with a multidisciplinary team to improve maternal and fetal prognosis. This is a case of a 20-year-old primigravid woman, 33 weeks and 4 days age of gestation, who was admitted for impaled foreign body. She was brought to the emergency department for a penetrating wound of the chest and abdomen after being accidentally impaled by a metre-long, inch-thick steel rod. Emergency laparotomy, caesarean section and thoracotomy were performed. The aim of this report is to discuss the assessment, management and role of the multidisciplinary team in the management of a pregnant trauma patient.
Transcricothyroid injection of local anaesthesia: a serious complication
Authors: Li Anna , D'Costa Jason
Published: August 2021

Transcricothyroid membrane (CTM) injection of local anaesthesia is widely used during bronchoscopic procedures. It is an effective way of delivering topical anaesthesia, and has been shown to reduce patient discomfort, improve clinician satisfaction and reduce overall sedation requirements. Risks from this procedure are uncommon and usually minor. Localisation of the CTM is usually performed clinically by palpation of anatomical landmarks and can vary depending on clinician skillset and experience. Clinical identification may be less accurate compared with ultrasound guidance in identifying puncture site, however, ultrasound is not always readily available and seldom used for this purpose. This case describes a rare complication following attempted local anaesthetic infiltration into the cricothyroid space, after clinical identification of puncture site. An obstructive fluid-filled mass formed around the site of injection on the right vocal cord; resulting in airway compromise, abandonment of procedure and subsequent intubation.
Abdominotransanal resection of a strangulated rectal carcinosarcoma
Authors: Manlubatan Sofia Isabel Tamesa , Lopez Marc Paul Jose , Maglangit Sittie Aneza Camille Amad , Ozoa Gabriel Miguel
Published: August 2021

This is a case of a 75-year-old man who presented with a 7-month history of a reducible rectal mass. The patient came to the emergency department with a prolapsed necrotic bowel involving a strangulated segment with the rectal mass. He underwent an abdominotransanal resection through a combined abdominal and perineal approach. His postoperative course was unremarkable. Histopathological and immunohistochemical studies showed a rectal carcinosarcoma. Because of a state-mandated lockdown due to the COVID-19 pandemic, the patient failed to follow-up. He was later seen to have metastatic progression. Owing to the poor functional status of the patient, the shared decision of the multidisciplinary team, the patient and his family was to manage him with palliative intent.
Gustatory and olfactory dysfunctions in hospitalised patients with COVID-19 pneumonia: a prospective study
Authors: Inciarte Alexy , Cardozo Celia , Chumbita Mariana , Alcubilla Pau , Torres Berta , González Cordón Ana , Rico Veronica , Aguero Daiana , García-Pouton Nicole , Hernández-Meneses Marta , Albiach Laia , Meira Fernanda , De la Mora Lorena , Linares laura , Puerta-Alcalde Pedro , Macaya Irene , Mensa Josep , Laguno Montse , Ambrosioni Juan , Ramos Angela , Morata Laura , Bodro Marta , Moreno-García Estela , Moreno Antonio , Sola Montse , Rojas Jhon , Leal Lorna , Torres Manuel , Garcia-Vidal Carolina , Martínez Jose Antonio , Alobid Isam , Soriano Alex , Garcia Felipe
Published: August 2021

Importance

Identifying undetected clinical signs is imperative in the prevention of SARS-CoV-2.

Objective

To establish the prevalence of clinical gustatory and olfactory dysfunctions in patients with COVID-19 pneumonia. Clinical outcomes and recovery rates associated with gustatory and olfactory dysfunctions were also assessed.

Design

A prospective study was performed in 80 patients admitted to Hospital Clínic of Barcelona (Spain) for COVID-19 pneumonia. Patients were re-evaluated in the ward daily until discharge. Gustatory and olfactory dysfunction symptoms were retrospectively collected from emergency room (ER) charts after first assessments. Follow-up was performed in telemedicine consultation.

Setting

The single-centre study was performed in a hospitalisation ward at a university hospital.

Participants

Consecutive patients meeting hospitalisation criteria for COVID-19 pneumonia were eligible. Study exclusion criteria were patients who could not speak, had previous gustatory and olfactory dysfunctions or whose PCR tests for SARS-CoV-19 were negative.

Interventions

Systematic assessment of gustatory and olfactory symptoms with standardised questions.

Outcome(s)

Prevalence of gustatory and olfactory dysfunctions in patients with COVID-19 pneumonia.

Results

Of the 80 study subjects, 62.5% were male and the median age was 57 years. Half of the cohort (n=40) presented with comorbidities. The prevalence of chemosensitive disorder was 73.8% (n=59) (95% CI: 63.8 to 83.8), although self-reported symptoms were recorded in only 26.3% (n=21) of patients in the ER. Gustatory and olfactory dysfunctions were observed in 58.8% (n=47) and 55% (n=44) of cases, respectively. They were also the first symptoms in 25% (n=20) of patients. Anosmia was associated with ageusia, OR: 7, 95% CI: 2.3 to 21.8, p=0.001). No differences in clinical outcomes were observed when patients with and without gustatory and olfactory dysfunctions were compared. Recovery rates were 20% (n=10) and 85% (n=42) at days 7 and 45, respectively.

Conclusion

The prevalence of gustatory and olfactory dysfunctions in COVID-19 pneumonia was much higher than in self-report. Presence of gustatory and olfactory dysfunctions was not a predictor of clinical outcomes.
Prediction models for hospital readmissions in patients with heart disease: a systematic review and meta-analysis
Authors: Van Grootven Bastiaan , Jepma Patricia , Rijpkema Corinne , Verweij Lotte , Leeflang Mariska , Daams Joost , Deschodt Mieke , Milisen Koen , Flamaing Johan , Buurman Bianca
Published: August 2021

Objective

To describe the discrimination and calibration of clinical prediction models, identify characteristics that contribute to better predictions and investigate predictors that are associated with unplanned hospital readmissions.

Design

Systematic review and meta-analysis.

Data source

Medline, EMBASE, ICTPR (for study protocols) and Web of Science (for conference proceedings) were searched up to 25 August 2020.

Eligibility criteria for selecting studies

Studies were eligible if they reported on (1) hospitalised adult patients with acute heart disease; (2) a clinical presentation of prediction models with c-statistic; (3) unplanned hospital readmission within 6 months.

Primary and secondary outcome measures

Model discrimination for unplanned hospital readmission within 6 months measured using concordance (c) statistics and model calibration. Meta-regression and subgroup analyses were performed to investigate predefined sources of heterogeneity. Outcome measures from models reported in multiple independent cohorts and similarly defined risk predictors were pooled.

Results

Sixty studies describing 81 models were included: 43 models were newly developed, and 38 were externally validated. Included populations were mainly patients with heart failure (HF) (n=29). The average age ranged between 56.5 and 84 years. The incidence of readmission ranged from 3% to 43%. Risk of bias (RoB) was high in almost all studies. The c-statistic was <0.7 in 72 models, between 0.7 and 0.8 in 16 models and >0.8 in 5 models. The study population, data source and number of predictors were significant moderators for the discrimination. Calibration was reported for 27 models. Only the GRACE (Global Registration of Acute Coronary Events) score had adequate discrimination in independent cohorts (0.78, 95% CI 0.63 to 0.86). Eighteen predictors were pooled.

Conclusion

Some promising models require updating and validation before use in clinical practice. The lack of independent validation studies, high RoB and low consistency in measured predictors limit their applicability.

PROSPERO registration number

CRD42020159839.
Non-lesional treatment options for tremor in idiopathic Parkinson syndrome: a protocol for a systematic literature review
Authors: Pedrosa Carrasco Anna Julia , Mügge Felicitas , Pedrosa David José
Published: August 2021

Introduction

Idiopathic Parkinson syndrome (iPS) is one of the most common neurodegenerative disorders characterised by the triad of bradykinesia, rigidity and tremor. Tremor at rest predominantly at one side is often perceived by patients as severely disabling and yet ranges among the most difficult symptoms to treat. In medically refractory cases, lesional approaches have proven to be effective alternatives. However, to date, there is no comprehensive analysis of non-surgical therapies to manage iPS-patients’ tremor. We therefore present a detailed study protocol for a systematic literature review assessing efficacy/effectiveness and safety of non-lesional treatments for tremor in iPS.

Methods and analysis

We will search three electronic databases (MEDLINE, EMBASE and PsycINFO) using a combination of title/abstract keywords. Additionally, hand-searched reference and citation lists of key reviews identified through the search strategy will be screened. Eligible studies should investigate the efficacy/effectiveness and safety of therapeutic options for tremor in iPS excluding lesional interventions. Publications will be independently assessed for inclusion criteria by two investigators and study information summarised using a standardised template including quality assessment according to the QualSyst tool. We will provide a narrative synthesis of results and conduct a meta-analysis whenever possible.

Ethics and dissemination

We commit to present contemporary evidence on the efficacy/effectiveness and safety of non-lesional interventions for tremor in iPS in a future publication. We aim to compile rich data of published studies to inform healthcare professionals in order to ultimately improve patient outcomes.

PROSPERO registration number

CRD42020202911).
Understanding the diagnoses and medical care experience of patients with new daily persistent headache: a qualitative study in Spain
Authors: Palacios-Ceña Domingo , Talavera Blanca , Gómez-Mayordomo Víctor , Garcia-Azorin David , Gallego-Gallego María , Cuadrado María Luz , Guerrero-Peral Ángel Luis
Published: August 2021

Objective

To explore the experiences of patients suffering from new daily persistent headache (NDPH) regarding the diagnostic process, treatment and medical care.

Design

A qualitative phenomenological study was conducted.

Setting

A specialised headache unit at two university hospitals in Spain between February 2017 and December 2018.

Participants

Patients diagnosed with NDPH according to the International Classification of Headache disorders (third beta edition).

Methods

Purposeful sampling was performed. Data were collected using unstructured and semistructured interviews, researchers’ field notes and patients’ drawings. An inductive thematic analysis was used to identify significant emerging themes from interviews, field notes and descriptions of patients’ drawings. Also, Guillemin’s proposal was used to analyse the contents of drawings.

Results

Nineteen patients with a mean age of 45.3 were recruited. Four main themes emerged: (1) Seeking a diagnosis, patients visit many doctors without receiving a clear answer and their diagnosis is delayed; (2) Self-medication—minimising pill intake, medication is ineffective, and therefore, some patients discontinue treatment, or are flexible with how they take medication; (3) Trying other non-pharmacological options, many patients turn to other therapies and complementary and/or alternative therapies as a second option, however these are ineffective and (4) Medical care, with two subthemes, referrals and lacking continuity of care, and building the doctor–patient relationship. Patients describe how the referral breaks the continuity of care, and how they identify the traits of a doctor who is approachable and which behaviours the doctor should avoid when caring for patients.

Conclusions

An in-depth knowledge of the beliefs and expectations of patients with NDPH will allow the professional to establish a relationship of trust, which will improve the patients’ knowledge of which therapies are the most appropriate, and to establish expectations based on the relationship with the doctor, and not only on patients’ beliefs.
Perceptions of a short animated film on adverse childhood experiences: a mixed methods evaluation
Authors: Ford Kat , Bellis Mark A , Isherwood Kate R , Hughes Karen E
Published: August 2021

Objectives

An evaluation of a short animated film on adverse childhood experiences (ACEs) to explore attitudes and sentiment towards the film including, for a subsample of professionals, associations between attitudes and personal experience of ACEs.

Design

Mixed-method exploratory design.

Setting

Professionals and the general public.

Participants

A short online survey with 239 professionals. Interaction and user sentiment towards with the film on social media (Twitter, YouTube).

Primary and secondary outcome measures

Survey: participants’ attitudes towards the film including feelings invoked, learning gained and ACE count prevalence. Twitter user and YouTube viewer sentiment (positive, negative or neutral) and interaction (likes, retweets or comments) with the film.

Results

Attitudes to the film were positive: 94.1% and 93.7%, respectively, agreed that it provided a helpful explanation of ACEs and trusted that the film was credible. Of those who reported ACE exposure, 88.9% agreed that those with ACEs would benefit from watching the film. Despite 50.6% reporting that the film had made them feel sad or upset, the majority (66.4%) reported they found the film hopeful or encouraging. Across 358 publicly available tweets from 313 users, 39.1% of tweets expressed positive sentiment, with only 1.4% negative (59.5% neutral). However, there was no association between tweet sentiment and interaction. Thirteen YouTube versions of the film received 171 812 views, 97.3% (n=889/914) ratings were positive (ie, ‘thumbs up’).

Conclusions

Despite being emotionally arousing, many professionals reflected positive impacts of the film including a perceived increased ability to discuss ACEs. Public sentiment demonstrated a positive reaction to and acceptability of the film. Understanding the professional and public response to materials developed to increase ACE awareness, such as the film explored here, is important given the growing number of international movements which seek to increase ACE awareness, prevent ACEs and mitigate their lifelong negative effects.
Serological surveys to estimate cumulative incidence of SARS-CoV-2 infection in adults (Sero-MAss study), Massachusetts, July–August 2020: a mail-based cross-sectional study
Authors: Snyder Teah , Ravenhurst Johanna , Cramer Estee Y , Reich Nicholas G , Balzer Laura , Alfandari Dominique , Lover Andrew A
Published: August 2021

Objectives

To estimate the seroprevalence of anti-SARS-CoV-2 IgG and IgM among Massachusetts residents and to better understand asymptomatic SARS-CoV-2 transmission during the summer of 2020.

Design

Mail-based cross-sectional survey.

Setting

Massachusetts, USA.

Participants

Primary sampling group: sample of undergraduate students at the University of Massachusetts, Amherst (n=548) and a member of their household (n=231).

Secondary sampling group: sample of graduate students, faculty, librarians and staff (n=214) and one member of their household (n=78). All participants were residents of Massachusetts without prior COVID-19 diagnosis.

Primary and secondary outcome measures

Prevalence of SARS-CoV-2 seropositivity. Association of seroprevalence with variables including age, gender, race, geographic region, occupation and symptoms.

Results

Approximately 27 000 persons were invited via email to assess eligibility. 1001 households were mailed dried blood spot sample kits, 762 returned blood samples for analysis. In the primary sample group, 36 individuals (4.6%) had IgG antibodies detected for an estimated weighted prevalence in this population of 5.3% (95% CI: 3.5 to 8.0). In the secondary sampling group, 10 participants (3.4%) had IgG antibodies detected for an estimated adjusted prevalence of 4.0% (95% CI: 2.2 to 7.4). No samples were IgM positive. No association was found in either group between seropositivity and self-reported work duties or customer-facing hours. In the primary sampling group, self-reported febrile illness since February 2020, male sex and minority race (Black or American Indian/Alaskan Native) were associated with seropositivity. No factors except geographic regions within the state were associated with evidence of prior SARS-CoV-2 infection in the secondary sampling group.

Conclusions

This study fills a critical gap in estimating the levels of subclinical and asymptomatic infection. Estimates can be used to calibrate models estimating levels of population immunity over time, and these data are critical for informing public health interventions and policy.
Ethical considerations in quality improvement: key questions and a practical guide
Authors: Hunt David Francis , Dunn Michael , Harrison Guy , Bailey Jill
Published: August 2021

Quality improvement (QI) provides a rigorous and innovative approach to improving patient"s lives in the healthcare system. Still, it can pose challenges in understanding what ethical considerations apply to some projects to minimise the possibility of patient harm or prevent other ethical wrongs and potential staff burden. While many commentaries discuss the extent to which QI ethics should match research ethics, there is minimal literature regarding what QI project teams should do when considering ethics at the planning stage. This paper provides a practical walkthrough of some of the ethical considerations across the breadth of QI projects, starting from some of the key questions when planning a QI project and a guide for the different ethical considerations that may apply.
Research participation in palliative medicine—benefits and barriers for patients and families: rapid review and thematic synthesis
Authors: Chatland Laura Emma , Harvey Catherine , Kelly Kirsten , Paradine Sharon , Bhagat Meena , Hudson Briony F
Published: August 2021

Background

Research is essential for gathering evidence to inform best practice and clinical decision making, for developing and testing new treatments and services in palliative and end-of-life care (PEoLC). The participation of patients, carers and family members is essential, however, personal and ethical concerns are often cited by professionals as barriers to recruitment. There is evidence that patients and family members can benefit from participation in PEoLC research.

Aim

To synthesise the evidence regarding patients’, family members’ and carers’ experiences of participating in PEoLC research. To identify recommendations for enhancing the experience of participants.

Design

A qualitative rapid review and thematic synthesis.

Data sources

MEDLINE, PsycINFO and PubMed were searched from 2010 to 2020. Studies reporting patients’, family members’ or carers’ experiences of participating in PEoLC research were included.

Results

4 studies were included and 7 themes identified relating to the benefits of, and barriers to, participation in PEoLC research. Both altruistic and personal benefits of participation were reported. Barriers (negative aspects) to participation included feeling overwhelmed, practical issues, reminders of being a patient, not seeing the research as relevant to them and unmet needs.

Conclusions

A number of benefits (positive aspects) surround participation in PEoLC research. However, several barriers (negative aspects) can prevent or discourage participation. This review has identified recommendations for research teams to enhance the experience, and number of people who those participating in research in this field.
The ‘Surprise question’ in heart failure: a prospective cohort study
Authors: Gonzalez-Jaramillo Valentina , Arenas Ochoa Luisa Fernanda , Saldarriaga Clara , Krikorian Alicia , Vargas John Jairo , Gonzalez-Jaramillo Nathalia , Eychmüller Steffen , Maessen Maud
Published: August 2021

Objective

The Surprise Question (SQ) is a prognostic screening tool used to identify patients with limited life expectancy. We assessed the SQ’s performance predicting 1-year mortality among patients in ambulatory heart failure (HF) clinics. We determined that the SQ’s performance changes according to sex and other demographic (age) and clinical characteristics, mainly left ventricular ejection fraction (LVEF) and the New York Heart Association (NYHA) functional classifications.

Methods

We conducted a prospective cohort study in two HF clinics. To assess the performance of the SQ in predicting 1-year mortality, we calculated the sensitivity, specificity, positive and negative likelihood ratios, and the positive and negative predictive values. To illustrate if the results of the SQ changes the probability that a patient dies within 1 year, we created Fagan’s nomograms. We report the results from the overall sample and for subgroups according to sex, age, LVEF and NYHA functional class.

Results

We observed that the SQ showed a sensitivity of 85% identifying ambulatory patients with HF who are in the last year of life. We determined that the SQ’s performance predicting 1-year mortality was similar among women and men. The SQ performed better for patients aged under 70 years, for patients with reduced or mildly reduced ejection fraction, and for patients NYHA class III/IV.

Conclusions

We consider the tool an easy and fast first step to identify patients with HF who might benefit from an advance care planning discussion or a referral to palliative care due to limited life expectancy.
Biomechanical analysis of force distribution in one-handed and two-handed adult chest compression: a randomised crossover observational study
Authors: Kao Chia-Lung , Tsou Jui-Yi , Hong Ming-Yuan , Chang Chih-Jan , Chi Chih-Hsien
Published: August 2021

Introduction

The standard method of chest compression for adults is a two-handed procedure. One-handed external chest compression (ECC) is used in some situations such as during transport of patients who had an out-of-hospital cardiac arrest, but the quality of one-handed ECC is still not well known. The distribution of force is related to the quality of chest compression and may affect the risk of injury. This study aimed to determine the differences in the quality and potential safety concern between one-handed ECC and two- handed ECC.

Methods

In this randomised crossover study, participants recruited from National Cheng Kung University Hospital and the ambulance team from the fire bureau were asked to perform one-handed and two-handed ECC on the Resusci Anne manikin according to standard 2015 ECC guidelines. The MatScan Pressure Measurement system was used to investigate the compression pressure and force distribution.

Results

Two-handed ECC had better results than one-handed ECC in terms of the median (IQR) depth (51.00 (41.50–54.75) mm vs 42.00 (27.00–49.00) mm, p=0.018), the proportion of depth accuracy (82.05% (13.95%–99.86%) vs 11.17% (0.00%–42.13%), p=0.028) and the proportion of incomplete recoil (0.23% (0.01%–0.44%) vs 2.42% (0.60%–4.21%), p=0.002). The maximum force (45.72 (36.10–80.84) kgf vs 35.64 (24.13–74.34) kgf, p<0.001) and ulnar–radial force difference (7.13 (−16.58 to 21.07) kgf vs 23.93 (11.19–38.74) kgf, p<0.001) showed statistically significant differences. The perceived fatigue of two-handed ECC versus one-handed ECC was 5.00 (3.00–6.00) vs 6.00 (5.00–8.00), p<0.001.

Conclusion

The quality of one-handed ECC, based on depth and recoil, is worse than that of standard two-handed ECC. The pressure and force distribution of one-handed ECC result in greater ulnar pronation of the hand than that of two-handed ECC. One-handed ECC more easily causes operator fatigue. Acknowledging these findings and adjusting training for one-handed ECC would potentially improve the quality of cardiopulmonary resuscitation during transport.
Localisation in focal epilepsy: a practical guide
Authors: Chowdhury Fahmida A , Silva Rui , Whatley Benjamin , Walker Matthew C
Published: August 2021

The semiology of epileptic seizures reflects activation, or dysfunction, of areas of brain (often termed the symptomatogenic zone) as a seizure begins and evolves. Specific semiologies in focal epilepsies provide an insight into the location of the seizure onset zone, which is particularly important for presurgical epilepsy assessment. The correct diagnosis of paroxysmal events also depends on the clinician being familiar with the spectrum of semiologies. Here, we summarise the current literature on localisation in focal epilepsies using illustrative cases and discussing possible pitfalls in localisation.