bluuebunny/crossref_metadata_2025 huggingface dataset:
Cancer in HIV-positive and HIV-negative adolescents and young adults in South Africa: a cross-sectional study
Authors: Dhokotera Tafadzwa , Bohlius Julia , Egger Matthias , Spoerri Adrian , Ncayiyana Jabulani Ronnie , Naidu Gita , Olago Victor , Zwahlen Marcel , Singh Elvira , Muchengeti Mazvita
Published: October 2021

Objective

To determine the spectrum of cancers in adolescents and young adults (AYAs) living with and without HIV in South Africa.

Design

Cross-sectional study with cancer records provided by the National Cancer Registry (NCR) and HIV records from the National Health Laboratory Service (NHLS).

Setting and participants

The NHLS is the largest provider of pathology services in the South African public sector. The NCR is a division of the NHLS. We included AYAs (aged 10–24 years) diagnosed with cancer by public health sector laboratories between 2004 and 2014 (n=8479). HIV status was obtained through record linkages and text mining.

Primary and secondary outcomes

We determined the spectrum of cancers by HIV status in AYAs. We used multivariable logistic regression to describe the association of cancer in AYAs with HIV, adjusting for age, sex, ethnicity and calendar period. We imputed (post hoc) the HIV status for AYA with unknown HIV status.

Results

8479 AYAs were diagnosed with cancer, HIV status was known for 45% (n=3812). Of those whose status was known, about half were HIV positive (n=1853). AYAs living with HIV were more likely to have Kaposi’s sarcoma (adjusted OR (aOR) 218, 95% CI 89.9 to 530), cervical cancer (aOR 2.18, 95% CI 1.23 to 3.89), non-Hodgkin’s lymphoma (aOR 2.12, 95% CI 1.69 to 2.66) and anogenital cancers other than cervix (aOR 2.73, 95% CI 1.27 to 5.86) than AYAs without HIV. About 44% (n=1062) of AYAs with HIV-related cancers had not been tested for HIV.

Conclusions

Targeted HIV testing for AYAs diagnosed with cancer, followed by immediate start of antiretroviral therapy, screening for cervical precancer and vaccination against human papilloma virus is needed to decrease cancer burden in AYAs living with HIV in South Africa.
‘Doctors can’t be doctors all of the time’: a qualitative study of how general practitioners and medical students negotiate public-professional and private-personal realms using social media
Authors: Marshal Megan , Niranjan Vikram , Spain Eimear , MacDonagh Joe , O'Doherty Jane , O'Connor Raymond , O'Regan Andrew
Published: October 2021

Objective

The objective of this study is to explore the experiences and perspectives of general practitioners’ and medical students’ use of, and behaviour on, social media and to understand how they negotiate threats to professional and personal life on social media.

Design

A two-phase qualitative design was used, consisting of semistructured interviews and follow-up vignettes, where participants were asked to respond to vignettes that involved varying degrees of unprofessional behaviour. Data were analysed using template analysis.

Setting and participants

Participants were general practitioner tutors and third year medical students who had just completed placement on the University of Limerick longitudinal integrated clerkship. Five students and three general practitioners affiliated with the medical school were invited to participate in one-to-one interviews.

Results

Three overarching themes, each containing subthemes were reported. ‘Staying in contact and up to date’ outlines how social media platforms provide useful resources and illustrates the potential risks of social media. ‘Online persona’ considers how social media has contributed to changing the nature of interpersonal relationships. ‘Towards standards and safety’ raises the matter of how to protect patients, doctors and the medical profession.

Conclusion

Guidance is required for students and medical practitioners on how to establish reasonable boundaries between their personal and professional presence on social media and in their private life so that poorly judged use of social media does not negatively affect career prospects and professional efficacy.
Feasibility of a multifaceted implementation intervention to improve attendance at diabetic retinopathy screening in primary care in Ireland: a cluster randomised pilot trial
Authors: Riordan Fiona , Murphy Aileen , Dillon Christina , Browne John , Kearney Patricia M , Smith Susan M , McHugh Sheena M
Published: October 2021

Objectives

Diabetic retinopathy screening (DRS) uptake is suboptimal in many countries with limited evidence available on interventions to enhance DRS uptake in primary care. We investigated the feasibility and preliminary effects of an intervention to improve uptake of Ireland’s national DRS programme, Diabetic RetinaScreen, among patients with type 1 or type 2 diabetes.

Design/setting

We conducted a cluster randomised pilot trial, embedded process evaluation and cost analysis in general practice, July 2019 to January 2020.

Participants

Eight practices participated in the trial. For the process evaluation, surveys were conducted with 25 staff at intervention practices. Interviews were conducted with nine staff at intervention practices, and 10 patients who received the intervention.

Interventions

The intervention comprised practice reimbursement, an audit of attendance, electronic prompts targeting professionals, General Practice-endorsed patient reminders and a patient information leaflet. Practices were randomly allocated to intervention (n=4) or wait-list control (n=4) (usual care).

Outcomes

Staff and patient interviews explored their perspectives on the intervention. Patient registration and attendance, including intention to attend, were measured at baseline and 6 months. Microcosting was used to estimate intervention delivery cost.

Results

The process evaluation identified that enablers of feasibility included practice culture and capacity to protect time, systems to organise care, and staff skills, and workarounds to improve intervention ‘fit’. At 6 months, 22/71 (31%) of baseline non-attenders in intervention practices subsequently attended screening compared with 15/87 (17%) in control practices. The total delivery cost across intervention practices (patients=363) was €2509, averaging €627 per practice and €6.91 per audited patient. Continuation criteria supported proceeding to a definitive trial.

Conclusions

The Improving Diabetes Eye screening Attendance intervention is feasible in primary care; however, consideration should be given to how best to facilitate local tailoring. A definitive trial of clinical and cost-effectiveness is required with preliminary results suggesting a positive effect on uptake.

Trial registration number

NCT03901898.
Psychosocial work factors and sick leave risk after a terrorist bomb attack: a survey and registry-based longitudinal study of governmental employees in Norway
Authors: Dale Maria Teresa Grønning , Nissen Alexander , Berthelsen Mona , Gjessing Håkon Kristian , Heir Trond
Published: October 2021

Objectives

Studies show that social support may reduce the negative psychological effects of terror. The aim was to explore the effects of the psychosocial work environment on sick leave risk among governmental employees after a workplace bomb attack.

Design

We linked longitudinal survey data collected at 10 and 22 months after the bombing with registry data on doctor-certified sick leave collected from 42 months before the attack to 33 months after the attack. ORs and rate ratios were estimated with mixed effects hurdle models.

Setting

The bombing of the government ministries in Oslo, Norway, 22 July 2011.

Participants

We identified 1625 participants from a cohort of 3520 employees working in the ministries during the bombing in 2011.

Results

After adjustment for confounders, social support from coworkers reduced the odds of sick leave (OR 0.80, 95% CI 0.68 to 0.93), and there was marginal evidence for reduced odds with support from superior (OR 0.87, 95% CI 0.87 to 1.03). A social work climate, an innovative climate and a human resource primacy climate (HRP) reduced the sick leave risk (eg, HRP OR 0.77, 95% CI 0.66 to 0.90). The hurdle model found no associations between psychosocial support at work and the duration of sick leave.

Conclusions

Psychosocial support at work can enhance employees’ work ability after terror and reduce the sick leave risk by more than 20%. However, a supportive psychosocial work environment did not reduce the duration of sickness absence. The protective role of psychosocial work factors on sick leave may be most significant when employees are at work and interact with their work environment.
Barriers and facilitators to accessing health and social care services for people living in homeless hostels: a qualitative study of the experiences of hostel staff and residents in UK hostels
Authors: Armstrong Megan , Shulman Caroline , Hudson Briony , Stone Patrick , Hewett Nigel
Published: October 2021

Introduction

The number of people living in homeless hostels in the UK has steadily increased over the past decade. Despite people experiencing homelessness often having considerable health problems and a range of complex needs frequently in association with addictions, the experiences of hostel staff and residents especially in relation to accessing health and social care support have seldom been explored. The aim of this paper is to identify the barriers and facilitators to accessing health and social care services for people living in homeless hostels.

Design

Exploratory qualitative baseline data were collected as part of an intervention to facilitate palliative care in-reach into hostels.

Setting/participants

Interviews were conducted with 33 participants; 18 homeless hostel managers/support staff and 15 people experiencing homelessness, from six homeless hostels in London and Kent.

Results

Three themes were identified (1) internal and external service barriers to health and social care access due to stigma, lack of communication and information sharing from services and assumptions around capacity and the role of the hostel, (2) the impact of lack of health and social care support on hostel staff leading to burnout, staff going beyond their job role and continuous support given to residents, (3) potential facilitators to health and social care access such in-reach and support from those who understand this population and hostel staff training.

Discussion

Residents have multiple complex needs yet both hostel staff and residents face stigma and barriers accessing support from external services. Positive relationships were described between hostel residents and staff, which can be an essential step in engaging with other services. People experiencing homelessness urgently need better access to person-centred, trauma-informed support ideally via in-reach from people who understand the needs of the population.
Assessing and predicting adolescent and early adulthood common mental disorders using electronic primary care data: analysis of a prospective cohort study (ALSPAC) in Southwest England
Authors: Smith Daniel , Willan Kathryn , Prady Stephanie L , Dickerson Josie , Santorelli Gillian , Tilling Kate , Cornish Rosie Peggy
Published: October 2021

Objectives

We aimed to examine agreement between common mental disorders (CMDs) from primary care records and repeated CMD questionnaire data from ALSPAC (the Avon Longitudinal Study of Parents and Children) over adolescence and young adulthood, explore factors affecting CMD identification in primary care records, and construct models predicting ALSPAC-derived CMDs using only primary care data.

Design and setting

Prospective cohort study (ALSPAC) in Southwest England with linkage to electronic primary care records.

Participants

Primary care records were extracted for 11 807 participants (80% of 14 731 eligible). Between 31% (3633; age 15/16) and 11% (1298; age 21/22) of participants had both primary care and ALSPAC CMD data.

Outcome measures

ALSPAC outcome measures were diagnoses of suspected depression and/or CMDs. Primary care outcome measure were Read codes for diagnosis, symptoms and treatment of depression/CMDs. For each time point, sensitivities and specificities for primary care CMD diagnoses were calculated for predicting ALSPAC-derived measures of CMDs, and the factors associated with identification of primary care-based CMDs in those with suspected ALSPAC-derived CMDs explored. Lasso (least absolute selection and shrinkage operator) models were used at each time point to predict ALSPAC-derived CMDs using only primary care data, with internal validation by randomly splitting data into 60% training and 40% validation samples.

Results

Sensitivities for primary care diagnoses were low for CMDs (range: 3.5%–19.1%) and depression (range: 1.6%–34.0%), while specificities were high (nearly all >95%). The strongest predictors of identification in the primary care data for those with ALSPAC-derived CMDs were symptom severity indices. The lasso models had relatively low prediction rates, especially in the validation sample (deviance ratio range: −1.3 to 12.6%), but improved with age.

Conclusions

Primary care data underestimate CMDs compared to population-based studies. Improving general practitioner identification, and using free-text or secondary care data, is needed to improve the accuracy of models using clinical data.
Exploring linkages between climate change and sexual health: a scoping review protocol
Authors: Logie Carmen H , Toccalino Danielle , Reed Anna Cooper , Malama Kalonde , Newman Peter A , Weiser Sheri , Harris Orlando , Berry Isha , Adedimeji Adebola
Published: October 2021

Introduction

The effects of climate change and associated extreme weather events (EWEs) present substantial threats to well-being. EWEs hold the potential to harm sexual health through pathways including elevated exposure to HIV and other sexually transmitted infections (STIs), disrupted healthcare access, and increased sexual and gender-based violence (SGBV). The WHO defines four components of sexual health: comprehensive sexuality education; HIV and STI prevention and care; SGBV prevention and care; and psychosexual counselling. Yet, knowledge gaps remain regarding climate change and its associations with these sexual health domains. This scoping review will therefore explore the linkages between climate change and sexual health.

Methods and analysis

Five electronic databases (MEDLINE, EMBASE, PsycINFO, Web of Science, CINAHL) will be searched using text words and subject headings (eg, Medical Subject Headings (MeSH), Emtree) related to sexual health and climate change from the inception of each database to May 2021. Grey literature and unpublished reports will be searched using a comprehensive search strategy, including from the WHO, World Bank eLibrary, and the Centers for Disease Control and Prevention. The scoping review will consider studies that explore: (a) climate change and EWEs including droughts, heat waves, wildfires, dust storms, hurricanes, flooding rains, coastal flooding and storm surges; alongside (b) sexual health, including: comprehensive sexual health education, sexual health counselling, and HIV/STI acquisition, prevention and/or care, and/or SGBV, including intimate partner violence, sexual assault and rape. Searches will not be limited by language, publication year or geographical location. We will consider quantitative, qualitative, mixed-methods and review articles for inclusion. We will conduct thematic analysis of findings. Data will be presented in narrative and tabular forms.

Ethics and dissemination

There are no formal ethics requirements as we are not collecting primary data. Results will be published in a peer-reviewed journal and shared at international conferences.
Type 1 diabetes incidence trends in children and adolescents aged 0–14 years in Europe: a systematic review and meta-analysis protocol
Authors: Díez‐Fernández Ana , Ruiz-Grao Marta Carolina , Mesas Arthur Eumann , Martinez-Vizcaino Vicente , Garrido-Miguel Miriam
Published: October 2021

Introduction

Monitoring type 1 diabetes (T1D) trends across most European countries using objectively measured data and how this incidence has evolved over the past three decades should be considered a public health priority. This study protocol provides a standardised and transparent methodology to assess TD1 trends among 0–14-year-old children and adolescents across Europe from 1994 to 2021.

Methods and analysis

This protocol is guided by the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols and the Cochrane Collaboration Handbook. The literature search will be conducted using MEDLINE, Embase, CINAHL and Web of Science databases from 1994 to 2021. Observational cohort studies providing incidence rates for European children and adolescents diagnosed with T1D aged ≤14.9 years and studies written in English, Spanish or Portuguese will be included. The risk of bias of the included studies will be assessed using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies from the National Heart, Lung, and Blood Institute. Subgroup analyses will be performed based on gender, age, study year, country or European region. Metaregression analysis will be conducted using economic and geographic variables, such as gross national income of the country or geographic latitude.

Ethics and dissemination

The systematic review based on this protocol will provide a comprehensive description of T1D incidence trends in children and adolescents across Europe from 1994 to 2021. The results will be disseminated in a peer-reviewed journal and in mass media. This study will exclusively use data from published research, so institutional ethical approval is not required.

PROSPERO registration number

CRD42021239480.
End-stage organ disease–Healthcare utilisation: Impact of palliative medicine
Authors: Hum Allyn , Yap Chun Wei , Koh Mervyn Yong Hwang
Published: October 2021

Objectives

Although patients living with end-stage organ disease (ESOD) suffer unmet needs from the physical and emotional burdens of living with chronic illness, they are less likely to receive palliative care.

The aims of the study were to determine if palliative care referrals reduced healthcare utilisation and if impact on healthcare utilisation was dependent on the timing of the referral.

Methods

Patients with ESOD who received palliative care support were matched with those who did not using coarsened exact matching and propensity score matching, and compared in this retrospective cohort study. Primary outcomes of interests were reduction in all-cause emergency department (ED) visits and costs, reduction in all-cause tertiary hospital admissions, length of hospital stay and inpatient hospital costs.

Results

Patients with ESOD referred to palliative care experienced a reduction in the frequency of all cause ED visits and inpatient hospital admissions. Significant impact of a palliative care referral was at 3 months, rather than 1 month prior to death with a greater reduction in the frequency of ED visits, inpatient hospital admissions, length of stay and charges (pall <0.05). The most common ESOD referred to palliative care for 1110 matched patients was end-stage renal failure (57.7%), and least commonly for respiratory failure (7.6%).

Conclusion

Palliative care can reduce healthcare utilisation, with reduction greatest when the referral is timed earlier in the disease trajectory. Cost savings can be judiciously redirected to the development of palliative care resources for integrated support of patients and caregivers.
A severe case of Legionnaire’s Disease connected with the BBC outbreak in 1988
Authors: Richards N. C. G. , McKinley K. P.
Published: October 2021

On 1 May 1988 a senior Naval Officer, serving at HMS Warrior, was admitted to RAF Halton where a diagnosis of Legionnaire’s disease was made. He suffered severe pneumonia and neurological symptoms, and although he eventually responded to treatment, he still suffers sequelae. On 19 April, he was in the vicinity of the BBC at the time of the outbreak of Legionnaire’s disease. His clinical findings are reported in this article along with a brief history and discussion of the diagnosis and prevention of Legionnaire’s disease.
Practical Occupational Medicine: Astronaut Selection; A Diver’s perspective from 300 m below sea level to 300 km above
Authors: Brooks G. J.
Published: October 2021

In 1989, public selection of a team of four astronauts for the Anglo-Soviet Juno space mission took place. In this article, the author, a Navy Medical Officer, relates his experiences of taking part and discusses the rationale behind the exhaustive protocol of medical investigations involved.
Expedition ‘Idraren Draren’
Authors: Yeoman L. P.
Published: October 2021

In May 1990 a team of 12 personnel from the Royal Naval Medical Service flew to Marrakech and were then transported by truck to the village of Imlil to commence a 12-day trek into the High Atlas Mountains with the primary aim of ascending the summit of Mount Toubkal and encircling the Toubkal Massif. It was then the intention to get off the tourist tracks and to experience life among the Berber tribes, and to trek part of the high Atlas range.
Early return to work following highly selective vagotomy
Authors: Tulloch D. N. , Dewar E. P.
Published: October 2021

In the Royal Navy, after surgery, the time that servicemen spend away from work and the level of duty to whch they return are decisions made by the surgeon, not the general practitioner.

In a prospective study, we have thus been able to assess the acceptability of return to full duty at decreasing intervals after highly selected vagotomy (HSV).

Seventy-eight service men who underwent HSV for duodenal ulcer were studied in three periods, 1978–1980, 1981–1982, 1983–1986, each with a shorter interval to return to duty.

There were no differences in the rates of ulcer recurrence, incisional hernia, or ability to perform full duties.

After HSV the mean time to return to full duties for each group was 29.3, 16.4, and 4.2 weeks, respectively. Every patient returned to full duties at 28 days was able to perform any assigned task whether at sea or ashore.
A Pilot Trial of treatment of Acute Inversion Sprains to the ankle by ankle supports
Authors: Milford P. I. , Dunleavy P. J.
Published: October 2021

A simple study is described, which suggests that the Aircast bracing system may usefully shorten recovery time from severe ankle sprains in military personnel.
The effect of hand immersion on body temperature when wearing impermeable clothing
Authors: Allsopp A. J. , Poole Kerry A.
Published: October 2021

The effects of hand immersion on body temperature have been investigated in men wearing impermeable NBC clothing. Six men worked continuously at a rate of approximately 490 J.sec−1 in an environmental temperature of 30°C. Each subject was permitted to rest for a period of 20 minutes when their aural temperature reached 37.5°C, and again on reaching 38°C, and for a third time on reaching 38.5°C (three rest periods in total). Each subject completed three experimental conditions whereby, during the rest periods they either:

a.

Did not immerse their hands (control).

b.

Immersed both hands in a water bath set at 25°c.

c.

Immersed both hands in water at 10°C.

Physiological measures of core temperature, skin temperature and heart rate were recorded at intervals throughout the experiment.

Measures of mean aural temperature and mean skin temperature were significantly (P<0.05) reduced if hands were immersed during these rest periods, compared to non immersion. As a result, the total work time of subjects was extended when in the immersed conditions by some 10–20 minutes within the confines of the protocol.

It is concluded that this technique of simple hand immersion may be effective in reducing heat stress where normal routes to heat loss are compromised.
Stress and infection
Authors: Riddell D. I.
Published: October 2021

The pattern of infective episodes during Royal Marines training over a four-year period has been established. There were 4,529 attendances at the Sickbay with apparent infective episodes. Peaks of infection tended to follow three or more nights in the field suggesting that the resistance to infective insult was lessened following these field exercises.

The highest incidence of infection occurred during the final weeks of training when the physical and mental pressures were greatest, during the Commando course. This often manifested itself as skin sepsis. A judiciously-placed week of less stressful activity led to a major reduction in all infections at this stage of training.

This is evidence that physical and mental stress may lead to infective episodes. The phenomenon is being more fully investigated by the Institute of Naval Medicine.
An audit of resuscitation and anaesthesia during Operation ‘Safe Haven’
Authors: Rudland S. V. , Tighe S. Q. M. , Pethybridge R. J. , Loxdale P. H.
Published: October 2021

The Royal Navy combined Surgical Support Team deployed for six weeks to Northern Iraq. Eighteen casualties of civilian and military trauma required active resuscitation, 10 of whom were under the age of 16. Three died. Triage of multiple casualties was necessary on three occasions. The principles of Advanced Trauma Life Support (ATLS) were adopted and the experience is described under the ABCDE headings of the primary survey. Deficiencies of training and equipment are identified. Seventy one anaesthetics, administered to 52 patients, were audited prospectively in detail. Systolic blood pressure was significantly higher with isoflurane and controlled ventilation (ICV), compared with halothane and trichloroethylene (HTCV) (P<0.05). ICV patients recovered more quickly than with HTCV (P<0.05), but were significantly older and heavier (P<0.05). Isoflurane should replace the standard halothane/trichloroethylene combination. Controlled ventilation or ketamine anaesthesia allowed satisfactory SpO2 on air alone. With controlled ventilation, anaesthesia was entirely satisfactory for children down to 6.5 kg. Local anaesthetic procedures were useful. The entire anaesthetic drug cost was only £127. Three patients received a degree of intensive care. Recommendations are made to improve future outcome, but sophisticated resuscitation, anaesthesia and monitoring is now possible in the front line.
Rhegmatogenous retinal detachment in Royal Naval personnel: A retrospective study
Authors: Low C. D. T. , Jeffrey M. N.
Published: October 2021

A retrospective study was conducted to assess the various factors thought to influence the outcome of retinal detachment in RN personnel. A description of retinal detachment and its management, aimed at non-specialists, is given in the introduction.

In the study period eight Servicemen had rhegmatogenous retinal detachments. All underwent conventional detachment surgery, but two required two further operations including vitrectomy. Important features of each patient’s detachment are discussed, as is post-operative progress. All patients spent a considerable time away from duty and three were discharged from the Service on medical grounds.

Poor outcome could be related to myopia, trauma, delay in presentation to primary care, the number of operations performed and to post-operative complications.

Advice is given regarding assessment and management of suspected cases by non-specialists. It is hoped that reporting this study will increase awareness within the RN of retinal detachment as a sight-threatening condition.
The obstetric course of elderly primigravidae—a review
Authors: McNeill Love R. M. C.
Published: October 2021

An increasingly large number of women are now delaying the start of their families until they reach the age of 35 years or older. They are then known as elderly primigravidae in obstetric parlance. This paper reviews recent literature and reports on a retrospective survey conducted by the author of such women at an RAF hospital and presents the findings concerning their ante-natal, intra-partum, post-partum and neonatal outcomes.
Diagnosis, progression, prognostic indication and classification of periodontal disease: A review (Part 1)
Authors: Priestland C. R.
Published: October 2021

This review is divided into a series of three papers. In the first, the prevalence of periodontal disease and the diagnostic problems in screening for high risk groups of patients will be reviewed. The difficulties encountered in differentiating between disease activity and historical evidence of past disease will also be considered along with the wide variation in disease progression rates. Having discussed diagnosis and disease activity markers, an accepted classification of periodontal diseases will be described. In the second paper, those periodontal diseases described as Gingivitis will be discussed. Finally in the third paper, Periodontitis will be reviewed with some emphasis being placed on the involvement of the periodontal tissues in systemic diseases.
Sick bay attendances by Royal Navy women at sea
Authors: Dorrell M. G.
Published: October 2021

Sick bay attendances in a warship have been monitored over a three-month period whilst on deployment. Women made 22% of all attendances. This was a significant reduction from over 50% in the ship’s first mixed manned deployment. The attendance rate per 100 persons at risk was 180 for females and 69 for men. Female specific problems accounted for 21% of their attendances.
Aspects of neurological decompression illness: A view from Bethesda
Authors: Broome J. R.
Published: October 2021

A minority of divers with neurological decompression illness (DCI) fail to improve with recompression treatment. This is particularly seen in cases where features of severe spinal cord injury develop soon after surfacing. Haemorrhage into the spinal cord is implicated in the pathogenesis of these cases, and evidence is presented that supports the view that the bleeding coincides with shrinkage of autochthonous bubbles. The role of hyperbaric oxygen therapy in the treatment of spinal cord DCI is discussed with reference to posssible benefit in ischaemia-reperfusion (I-R) injury. Similarities and differences between the tissue injury of dysbaric and conventional spinal cord injury are outlined. The implications of advances in drug therapy for conventional spinal cord trauma are considered in the context of their potential application to treat neurological DCI.
Thrombophilia: Some recent advances in understanding
Authors: James C. M.
Published: October 2021

Thrombophilia is a term with many definitions although the majority include criteria such as thrombosis under the age of 45; recurrent thromboembolism and a positive family history. It reflects a disturbance in the normal delicate balance between pro- and anti-coagulation such as to favour inappropriate thrombosis. This review concentrates on the newly described phenomenon of activated protein C resistance while reviewing the natural anticoagulant system. It will also briefly examine the indications for ‘thrombophilia’ screening and the implications for individuals found to have an abnormality of their natural anticoagulants.
Is Testicular Cancer an Occupational Disease? A Case-Control Study of Royal Naval Personnel
Authors: Ryder S. J. , Crawford P. I. , Pethybridge R. J.
Published: October 2021

Testicular cancer is the commonest malignancy arising in men actively serving in the Royal Navy. This study, which includes a literature review of the aetiology of the disease, is designed to determine the relative risk of developing testicular cancer in various occupational groups within the Service by means of a Case-Control study. All cases of testicular cancer occurring in serving personnel between 1976 and June 1994, inclusive, were identified. One hundred and ten cases were found. Four randomly selected controls were matched on the basis of date of birth and length of service to each case. Results reveal statistically significant increased Odds Ratios for members of the Fleet Air Arm (OR=1.90 95% CI: 1.04–3.48), Air Engineers (OR=2.32 95% CI: 1.20–4.48) and the Aircraft Handling sub-speciality (OR=7.31 95% CI: 1.81–29.53). It is speculated that exposure to glycol ethers in aviation fuel may be the causative mechanism. No associations were found in relation to ionising radiation exposures or length of time served in nuclear submarines.
Prevention of Heat Strain by Immersing the Hands and Forearms in Water
Authors: House J. R. , Holmes Cathy , Allsopp A. J.
Published: October 2021

The effectiveness of hand immersion in water at 10°C, 20°C and 30°C as a technique for reducing heat strain in Royal Navy (RN) personnel has been investigated at the Institute of Naval Medicine (INM). Four subjects exercised at a moderate work rate, whilst wearing fire fighting clothing in an environmental chamber at 40°C. The subjects reached heat strain safety limits within 45 minutes of commencing work at which point they rested in the heat for 30 minutes whilst they underwent one of four experimental conditions: without intervention (control); or with their hands immersed in water at 10°C, 20°C or 30°C. The experiment was repeated on a further three days so that the subjects undertook each experimental condition in a balanced randomised order. During the control condition without hand immersion the subjects were unable to cool. Immersion of the hands in water (at 10°C, 20°C or 30°C) significantly (P<0.05) lowered body core (auditory canal) temperature within ten minutes. Assessing the effectiveness of this technique by the initial rates of core temperature reduction, revealed that immersion of the hands was more effective the colder the water. Following 20 minutes of hand immersion mean core temperature had dropped from 38.5C to: 36.9(standard deviation 0.19)°C, 37.3(0.18)°C, and 37.8(0.10)°C, in 10°C, 20°C and 30°C water respectively. Cooling powers estimated from changes in mean body temperature were 334, 307 and 113 watts using 10°C, 20°C and 30°C water respectively. These results indicate that hand immersion in water at a temperature of between 10°C and 30°C is an efficient means of cooling heat stressed personnel who have been exercising. This simple and effective technique may be applied to many industrial and military tasks to reduce heat strain, lower the risk of heat injury, and increase safe total work times in the heat. For the RN, hand immersion could be used in fire fighting, damage control and NBC operations where personnel alternately work and rest.
Fits, Faints and Funny Turns
Authors: Edmondstone W. M.
Published: October 2021

Episodes of alteration of consciousness are a common reason for referral to hospital. This article discusses the differential diagnosis with particular emphasis on the first epileptic seizure. It stresses the importance of an accurate witness history and the comparative lack of value of investigations.
Aeromedical evacuation in Bosnia
Authors: Dashfield A. K. , Smith H. R. , Young P. C.
Published: October 2021

The objective of this study was to assess the value of aeromedical evacuation when compared to road ambulance transportation in predominantly trauma patients in a rural area. Uniquely, trauma was the most common presenting condition (75%), distances to secondary care facilities were long and road routes were poor with a risk of being mined. Data were collected of all British aeromedical flights in Multi-National Division Southwest, Bosnia-Herzegovina, over a six-month period, and benefit to the patient was assessed by a panel of experts when compared to calculated road ambulance evacuation. Sixty-nine patients were evacuated by air on 57 flights and transported to a secondary care facility for further management. The panel of experts found that only 15 of the 69 patients (22%) had benefited from aeromedical evacuation. This study again shows the low benefit to the patient from indiscriminate use of aeromedical evacuation, despite the air ambulance being operated in apparently ideal conditions of a high percentage of trauma, a rural setting and poor road communications. Crew safety and the high costs further highlight the need to devise a system that can screen out unnecessary flights and identify those patients who would benefit most.
Taking full advantage of the diverse assemblage of data at hand to produce time series of abundance: a case study on Atlantic salmon populations of Brittany
Authors: Lebot Clément , Arago Marie-Andrée , Beaulaton Laurent , Germis Gaëlle , Nevoux Marie , Rivot Etienne , Prévost Etienne
Published: October 2021

Estimation of abundance with wide spatiotemporal coverage is essential to the assessment and management of wild populations. But, in many cases, data available to estimate abundance time series have diverse forms, variable quality over space and time and they stem from multiple data collection procedures. We developed a hierarchical Bayesian modelling (HBM) approach that take full advantage of the diverse assemblage of data at hand to estimate homogeneous time series of abundances irrespective of the data collection procedure. We apply our approach to the estimation of adult abundances of 18 Atlantic salmon (Salmo salar) populations of Brittany (France) from 1987 to 2017 using catch statistics, environmental covariates, and fishing effort. Additional data of total or partial abundance collected in four closely monitored populations are also integrated into the analysis. The HBM framework allows the transfer of information from the closely monitored populations to the others. Our results reveal no clear trend in the abundance of adult returns in Brittany over the period studied.
The protective effect of apelin-13 on cardiorenal toxicity induced by cyclophosphamide
Authors: Kutlay Özden , Aktan Arzu Keskin , Aslan Esra
Published: October 2021

Cyclophosphamide is a chemotherapeutic drug that is widely used in the clinic and can cause multi-organ toxicity. Apelin-13 is an endogenous adipocytokine with antioxidant properties. Therefore, this study investigated the possibility of apelin-13 being a potential therapeutic agent on cardiac toxicity and nephrotoxicity caused by cyclophosphamide. In this study, a total of four groups were formed with eight rats in each group. Group I: the control group was administered only saline (i.p.). Group II: cyclophosphamide, a single dose of 200 mg/kg (i.p.) on day 7. Group III: apelin-13 (15 μg/kg), for 7 days (i.p.). Group IV: administered apelin-13 (15 μg/kg) (i.p.) for 7 days and a single dose of cyclophosphamide (200 mg/kg) (i.p.) on day 7, the rats were sacrificed on day 8. Lactate dehydrogenase, cardiac troponin I (cTnI), creatine kinase MB (CK-MB), aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), malondialdehyde, creatinine, and blood urea nitrogen were found to be high in the cyclophosphamide group; however, these values were reduced with apelin-13 administration. Antioxidant enzymes such as superoxide dismutase (SOD), glutathione peroxidase (GPx), catalase, and reduced glutathione (GSH) decreased in the cyclophosphamide group, and apelin-13 increased these enzyme activities. In addition, histopathological examinations also supported the results obtained. The findings of this study showed that apelin-13 has a protective effect against cardiorenal toxicity caused by cyclophosphamide.
Some Quot schemes in tilted hearts and moduli spaces of stable pairs
Authors: Rota Franco
Published: October 2021

For a smooth projective variety [Formula: see text], we study analogs of Quot schemes using hearts of non-standard [Formula: see text]-structures of [Formula: see text]. The technical framework uses families of [Formula: see text]-structures as studied in A. Bayer, M. Lahoz, E. Macrì, H. Nuer, A. Perry and P. Stellari, Stability conditions in families, preprint (2019), arXiv:1902.08184. We provide several examples and suggest possible directions of further investigation, as we reinterpret moduli spaces of stable pairs, in the sense of M. Thaddeus, Stable pairs, linear systems and the Verlinde formula, Invent. Math. 117(2) (1994) 317–353; D. Huybrechts and M. Lehn, Stable pairs on curves and surfaces, J. Algebraic Geom. 4(1) (1995) 67–104, as instances of Quot schemes.
Fault Detection Method of CNC Machine Tool Based on Wavelet Transform
Authors: Liu Junying
Published: October 2021

In order to overcome the problems of low detection accuracy and long detection time of traditional fault detection methods for CNC machine tools, a new fault detection method for CNC machine tools based on wavelet transform is proposed in this paper. In order to improve the effectiveness of running fault detection of CNC machine tools, a wavelet transform method is used to extract the features of the running fault signals of CNC machine tools. According to the feature extraction results, the convolution calculation of the continuous wavelet transform is used to complete the fault detection of CNC machine tool according to the scale result of fault signal. The experimental results show that, compared with traditional fault detection methods, the detection accuracy and efficiency of this method is significantly better: the highest detection accuracy is 97%, and the lowest detection time is only 1.1s.
Design and Implementation of Low Power and Area Efficient Architecture for High Performance ALU
Authors: Penchalaiah Usthulamuri , Kumar V. G. Siva
Published: October 2021

Digital Signal Processors (DSP) have a ubiquitous presence in almost all civil and military signal processing applications, including mission critical environments like nuclear reactors, process control etc. Arithmetic and Logic units (ALU), being the heart of any digital signal processor, play critical and decisive roles in achieving the required parameter benchmarks and the overall efficiency and robustness of the digital signal processor. State of the art research has shown successful traction with the performance requirements of critical Multiply-Accumulate (MAC) parameters, like reduced power consumption, small electronic real estate footprint and reduction in delay with the associated design complexity. Judicious placement of its building blocks, namely, the truncated multiplier and half-sum carry generation-sum carry generation (HSCG-SCG) adder in the architectural design of ALU and the type of adder and multiplier circuits selected are the core decisions that decide the overall performance of the ALU. To overcome the drawback and to improve the performance further, this work proposes a new architecture for the square root (SQRT) carry select adder (CSLA) using half-sum generation (HSG), half-carry generation (HCG), full-sum generation (FSG) and full-carry generation (FCG) blocks. The proposed design contains N-bit architecture, and comparative results are considered for 8-bit, 16-bit and 32-bit combinations. All the designs are implemented in the Xilinx ISE environment and the results show that better area, power, and delay performance compared to the state of art methods.
Gravitational lensing by a black hole in Poincaré gauge theory of gravity
Authors: Zamani S. , Akhshabi S.
Published: October 2021

In this paper, by using a recently found black hole solution in the framework of the Poincaré gauge theory of gravity, we study gravitational lensing for a system where the lens is a static spherically symmetric black hole. By analyzing the equations of motion for light rays in a spacetime with torsion, we derive the deflection angle as the light emitted from a source pass through near the black hole and numerically solve the resulting integral. We also study the effects of torsion on the position of images. The results show that the presence of torsion slightly alters both the deflection angle and position of images in this setup.
D5-brane in AdS black holes with nonzero gauge flux
Authors: Nagasaki Koichi
Published: October 2021

We find the probe D5-brane solution on the black hole space–time which is asymptomatically [Formula: see text]. These black holes have spherical, hyperbolic and toroidal structures. Depending on the gauge flux on the D5-brane, the D5-brane behaves differently. By adding the fundamental string, the potential energy of the interface solution and the Wilson loop is given in the case of nonzero gauge flux.
The second-class current decays τ → πη(η′)ντ in the NJL model including the interaction of mesons in the final state
Authors: Volkov M. K. , Nurlan K. , Pivovarov A. A.
Published: October 2021

The effect of the interaction of mesons in the final state is additionally considered within the description of [Formula: see text] decays. This interaction is taken into account at the level of production of intermediate pions. One of them, in turn, might be transited into [Formula: see text] or [Formula: see text] mesons. Our results do not exceed the experimentally established branching fractions, and they are in agreement with the results of other theoretical studies.
A Double Bit Approximate Adder Providing a New Design Perspective for Gate-Level Design
Authors: Maroof Naeem , Al-Zahrani Ali Y.
Published: October 2021

In the modern Block-chain and Artificial Intelligence era, energy efficiency has become one of the most important design concerns. Approximate computing is a new and an evolving field promising to provide energy-accuracy trade-off. Several applications are tolerant to small degradation in results, and hence tasks like image and video processing are candidates to benefit from Approximate Computing. In this paper, we propose a new design approach for designing approximate adders and further optimize the accuracy and cost metrics. Our approach is based on minimizing the errors while cascading more than one 1-bit adder. We insert [Formula: see text] on specific locations to achieve a reasonable circuit minimization and reduce the [Formula: see text] cost. We compare our design with exact adder and relevant state-of-the-art approximate adders. Through analysis and simulations, we show that our approach provides higher accuracy and far better performance compared with other designs. The proposed double bit approximate adder provides more than 25% savings in gate count compared with the exact adder, has a mean absolute error of 0.25 which is lowest among all the reference approximate adders and reduces the power-delay product by more than 60% compared to the exact adder. When employed for image filtering, the proposed design provides a [Formula: see text] of 96%, a [Formula: see text] of 95% and a [Formula: see text] of 91% relative to the actual results, while the second best approximate adder only achieves 64%, 54% and 71% of these image quality metrics, respectively.
Interval Estimation in Lifetime Distributions Using Progressively Type II Censored Data
Authors: Baklizi Ayman
Published: October 2021

In this paper, we developed a method for constructing confidence intervals for the parameters of lifetime distributions based on progressively type II censored data. The method produces closed form expressions for the bounds of the confidence intervals for several special cases of parameters and lifetime distributions. Closed form approximations are derived for the intervals for the parameters of the location or scale families of distributions. The method is illustrated with several examples and analyses of real data sets are included to illustrate the application of the method.