bluuebunny/crossref_metadata_2025 huggingface dataset:
National early warning score to predict intensive care unit transfer and mortality in COVID‐19 in a French cohort
Authors: Pokeerbux Mohammad Ryadh , Yelnik Cécile M. , Faure Emmanuel , Drumez Elodie , Bruandet Amélie , Labreuche Julien , Assaf Ady , Goffard Anne , Garabedian Charles , Poissy Julien , Desbordes Jacques , Garrigue Delphine , Scherpereel Arnaud , Faure Karine , Lambert Marc ,   Lille Covid‐team
Published: March 2021

Background

No risk stratification tool has been validated in hospitalised patients with coronavirus disease 2019 (COVID‐19), despite a high rate of intensive care requirement and in‐hospital mortality. We aimed to determine whether the National Early Warning Score (NEWS) at admission can accurately predict in‐hospital mortality and ICU transfer.

Methods

This was a retrospective cohort study from January 24 to April 16, 2020, at Lille University Hospital. All consecutive adult patients with laboratory‐confirmed COVID‐19 who were initially admitted to non‐ICU wards were included. The primary outcome was a composite criterion consisting of ICU transfer or in‐hospital mortality. We evaluated the prognostic performance of NEWS by calculating the area under (AUC) the receiver operating characteristic curve, the optimal threshold value of NEWS, and its association with the primary outcome.

Results

Of the 202 COVID‐19 patients, the median age was 65 (interquartile range 52‐78), 38.6% were women and 136 had at least one comorbidity. The median NEWS was 4 (2‐6). A total of 65 patients were transferred to the ICU or died in the hospital. Compared with patients with favourable outcome, these patients were significantly older, had more comorbidities and higher NEWS. The AUC for NEWS was 0.68 (0.60‐0.77) and the best cutoff value was 6. Adjusted odds ratio for NEWS ≥ 6 as an independent predictor was 3.78 (1.94‐7.09).

Conclusions

In hospitalised COVID‐19 patients, NEWS was an independent predictor of ICU transfer and in‐hospital death. In daily practice, NEWS ≥ 6 at admission may help to identify patients who are at risk to deteriorate.
Awareness and attitude of healthcare workers towards Telehealth in Cairo, Egypt
Authors: Shouman Sara , Emara Tamer , Saber Heba Gamal , Allam Mohamed Farouk
Published: March 2021

Background

Telehealth is delivering health care services remote from health‐care facilities using telecommunications. Egypt is aiming for Universal Health Coverage; this increases the demand for telehealth in routine health services.

Objective

To measure the awareness of telehealth health care workers of primary health care units and to evaluate the effect of an orientation programme on primary health care workers’ awareness and acceptance of the application of telehealth.

Methodology

This was an intervention study amongst health care workers. A self‐administrated valid questionnaire for health care workers was designed, the questionnaire consists of different domains of knowledge in addition to advantages, disadvantages, security and necessity perceptions. Each domain consists of Likert scale questions of 5 points. The questions were scored as the worst answer (1) and the best (5). A total of 109 questionnaires were filled by participants who spent at least 6 months in primary health care units. Then the health care workers attended an orientation programme and the questionnaire was re‐filled once more. A total of 104 was recollected. Ethical issues were considered.

Results

50.5% of the health care workers were aware of telehealth; 66.7% of health care workers with master's degree were aware of telehealth in comparison to 31.8% amongst those with a diploma, 64.3% of physicians were aware of telehealth, while 29.6 of nurses were aware [Correction added on 08 April 2021 after first online publication: '9.6%' has been amended to '29.6%' in the preceding sentence]. The score of knowledge and attitude increased from 130 ± 23.538 to 156.49 ± 18.456 after the educational programme.

Conclusion

Half of the health care workers were aware of telehealth; the orientation improved the Healthcare Workers’ knowledge and attitude.
Practical use of β‐carotene‐loaded nanoemulsion as a functional colorant in sausages made from goat meat surimi‐like material
Authors: Chaijan Manat , Srirattanachot Kesinee , Nisoa Mudtorlep , Cheong Ling‐Zhi , Panpipat Worawan
Published: March 2021

The potential applicability of β‐carotene‐loaded nanoemulsion (CNE) as a natural colorant in non‐smoked sausage made from goat meat surimi‐like material (GMS) was elucidated. The effect of CNE content (0–30 g 100 g−1) on the physicochemical characteristic, oxidative stability and β‐carotene remaining during cold storage (4 °C) was determined. The higher the CNE, the greater the a*, b* and redness index with the lower L*, and colour likeness score. CNE content had a little impact on the moisture content, aw and pH of sausages over storage period. However, the expressible drip, breaking force and deformation were largely influenced by the CNE content. All CNE‐containing sausages displayed a superior oxidative stability to control. Among CNE‐incorporated samples, the lowest lipid oxidation and β‐carotene degradation were noticeable in the sausage with 10 g 100 g−1 CNE. Thus, the CNE at 10 g 100 g−1 was a promising functional colorant for emulsion sausage made from GMS.
Egg white proteins and β‐cyclodextrin: effective cryoprotectant mixture against oxidative changes in the myofibrillar proteins of Culter alburnus
Authors: Walayat Noman , Rincón Miguel Ángel , Niaz Sobia , Nawaz Asad , Niaz Nadia , Zahid Farooq Muhammad , Ahmad Ishtiaq , Wang Pengkai , Zhang Zhongli
Published: March 2021

The effect of egg white protein (EWP) and β‐cyclodextrin (β‐CD) mixture was analysed on the myofibrillar proteins (MP) of Culter alburnus during a frozen storage at −18 °C for 60 days. Different proportions of EWP:β‐CD mixture (0%, 2%, 4% and 6%) were added into MP to analyse their effect against oxidative changes. During the study, sulphydryl contents and Ca‐ATPase activity (0.297 to 0.136 mmol g−1) decreased. Moreover, protein denaturation also prompted the surface hydrophobicity (11.47 to 32.06 μg) and carbonyls (26.36 to 49 mg.28 nmol mg−1) of control MP. A significant decline was observed in emulsifying properties. Besides, EWP:β‐CD showed remarkable stability against oxidative changes, by significantly reducing the carbonyls (26.26 to 37.69 nmol mg−1) and surface hydrophobicity (11.51 to 20.31 μg) and also the decline of Ca‐ATPase activity (0.29 to 0.19 mmol g−1). It can be concluded that EWP:β‐CD (6%) is an efficient approach against oxidative changes in MP from Culter alburnus.
Brown rice proteins as delivery system of phenolic and volatile compounds of raspberry juice
Authors: Kelemen Vanja , Pichler Anita , Ivić Ivana , Buljeta Ivana , Šimunović Josip , Kopjar Mirela
Published: March 2021

Development of novel food ingredients with health benefits as well as desired sensory attributes is of great importance for food industry. For that purpose, complexes (BRP/R) between brown rice proteins (amounts varied; 2%, 6% and 10%) and raspberry juice were prepared. Obtained complexes were evaluated for the amount of volatile compounds, phenolic content, anthocyanin content and antioxidant activity. Those parameters depended on proteins amount. The highest adsorption of total phenolics and anthocyanins (18.18 mg g−1 and 4.59 mg g−1, respectively) was observed on complexes obtained with the lowest amount of proteins (2%). Regarding volatiles, dominant flavour note in raspberry juice was berry (40% of overall flavour), followed by citrus and woody notes (each around 18%), while dominant flavour note on complexes was citrus note (60%) followed by green note (15%). These results suggest an efficient plant‐based approach to produce value‐added protein‐based complexes with possible utility as food colourant and flavouring.
Sex, camouflage, marvelous adaptations: A writing assignment that inspires
Authors: Palmer A. Richard
Published: March 2021

Writing assignments offer valuable student learning experiences in both live and online courses. But concerns about the challenges and extra work of marking, and about plagiarism, often deter instructors from using them. I used a writing assignment successfully over 20 years in a one‐term invertebrate biology course, despite enrolments exceeding 100. Structured to maximally engage students yet minimize marking load, the assignment often yielded gems of stories for use in subsequent lectures. The Annotated Bibliography assignment asks students: (a) to précis the justification, main results, and significance of three papers from the primary scientific literature in under 250 words each, and (b) to provide a short (150 word) summary of the broader story connecting the three papers. Students liked this assignment because they could choose any aspect of the biology of any invertebrate genus. This inspired them to explore the literature out of personal interest. It's appealing for instructors, because annotations are compact and therefore easy to read, mark, and inspect for plagiarism. It is appealing to host universities, because it generates extensive use of library resources and motivates students to learn how to use them, and online taxonomic databases, effectively. Here I provide: (a) instructions for this assignment, (b) a straightforward marking rubric, (c) two examples of excellent submissions, and (d) comments on the risk and extent of plagiarism. Appendices provide: detailed instructions, a sample annotation with comments to guide student writing, an online submission web page, an online administrator web page, and PHP scripts for both web pages. Finally, I summarize topics and taxa from nearly 2,000 submissions. The five most popular taxa were cephalopods, insects, malacostracan crustaceans, gastropods, and arachnids. Although aspects of sex or reproduction, and camouflage or mimicry were the most popular topics, one paper on extreme limb movements in stomatopods was cited the most.
Securing sexual justice for people with intellectual disability: A systematic review and critical appraisal of research recommendations
Authors: Ginn Hannah G.
Published: March 2021

Background

People with intellectual disability contend with significant restrictions to their sexual expression and partnered relationships. This review examines the types of recommendations scholars offer in their qualitative research involving participants with intellectual disability discussing sexuality and intimate relationships.

Method

A systematic review of peer‐reviewed studies published between 1972 and July 2018 yielded a sample of 26 studies. Thematic analysis was used to taxonomize scholars’ recommendations.

Results

Six distinct forms of recommendations were identified. The most frequently offered and most strongly emphasized recommendation across studies aimed to change individuals with intellectual disability. In contrast, a minority of studies prioritized engaging individuals as informants, eliciting individuals’ wishes, enabling relationships and fostering ideological change. No studies placed the greatest weight on promoting systems change.

Conclusions

Recommendations in the literature have predominantly emphasized individual as opposed to environmental changes. I consider the ramifications of this and argue for a reorientation towards systems change.
Composition of uterine milk and its changes with gestational period in red stingrays (Hemitrygon akajei)
Authors: Kina Taito , Masuda Tetsuya , Asahina Kiyoshi , Suzuki Miwa
Published: March 2021

Uterine milk is secreted in the uterus for embryo nutrition in several elasmobranch species and may contribute to rapid embryonic growth, but the details of its composition and its functions are poorly understood. In this study, to explore the roles of uterine milk for embryos, its components throughout the gestational period were analysed in detail. Uterine milk was collected from pregnant red stingrays (Hemitrygon akajei) in the early, middle and late gestational periods, respectively (n= 3 for each period). The crude composition, constituent proteins and fatty acids in the milk were analysed. The uterine milk was rich in proteins throughout the gestational period, whereas lipids dramatically increased in the middle period and reduced slightly towards the late period. Some proteins potentially associated with nutrition, cartilage growth and embryonic immunity were found. Several enzymes related to central metabolism were also detected. The constituent fatty acids in the middle and late periods were similar to those in the egg yolks of elasmobranchs, except for C18:2, which was rich only in the uterine milk. The most abundant fatty acid in the milk was C16:1, which could function as a lipokine to promote lipid metabolism in the embryo. This study's data suggest that uterine milk may be secreted in addition to the egg yolk in elasmobranchs to support rapid and healthy embryonic growth.
Arterial stiffness in acute COVID‐19 and potential associations with clinical outcome
Authors: Schnaubelt S. , Oppenauer J. , Tihanyi D. , Mueller M. , Maldonado‐Gonzalez E. , Zejnilovic S. , Haslacher H. , Perkmann T. , Strassl R. , Anders S. , Stefenelli T. , Zehetmayer S. , Koppensteiner R. , Domanovits H. , Schlager O.
Published: March 2021

Background

Coronavirus disease 2019 (COVID‐19) interferes with the vascular endothelium. It is not known whether COVID‐19 additionally affects arterial stiffness.

Methods

This case–control study compared brachial‐ankle pulse wave (baPWV) and carotid‐femoral pulse wave velocities (cfPWV) of acutely ill patients with and without COVID‐19.

Results

Twenty‐two COVID‐19 patients (50% females, 77 [67–84] years) were compared with 22 age‐ and sex‐matched controls. In COVID‐19 patients, baPWV (19.9 [18.4–21.0] vs. 16.0 [14.2–20.4], P = 0.02) and cfPWV (14.3 [13.4–16.0] vs. 11.0 [9.5–14.6], P = 0.01) were higher than in the controls. In multiple regression analysis, COVID‐19 was independently associated with higher cfPWV (β = 3.164, P = 0.004) and baPWV (β = 3.532, P = 0.003). PWV values were higher in nonsurvivors. In survivors, PWV correlated with length of hospital stay.

Conclusion

COVID‐19 appears to be related to an enhanced PWV reflecting an increase in arterial stiffness. Higher PWV might be related to an increased length of hospital stay and mortality.
Distinct roles of red‐blood‐cell‐derived and wall‐derived mechanisms in metabolic regulation of blood flow
Authors: Fry Brendan C. , Secomb Timothy W.
Published: March 2021

Objective

A theoretical model is used to analyze combinations of RBC‐derived and wall‐derived (RBC‐independent) mechanisms for metabolic blood flow regulation, with regard to their oxygen transport properties.

Methods

Heterogeneous microvascular network structures are derived from observations in rat mesentery and hamster cremaster. The effectiveness of metabolic blood flow regulation using combinations of RBC‐dependent and RBC‐independent mechanisms is simulated in these networks under conditions of reduced oxygen delivery and increased oxygen demand.

Results

Metabolic regulation by a wall‐derived mechanism results in higher predicted total blood flow rate and number of flowing vessels, and lower tissue hypoxic fraction, than regulation by combinations of RBC‐derived and wall‐derived signals. However, a combination of RBC‐derived and wall‐derived signals results in a higher predicted median tissue PO2 than either mechanism acting alone.

Conclusions

Model results suggest complementary roles for RBC‐derived and wall‐derived mechanisms of metabolic flow regulation, with the wall‐derived mechanism responsible for avoiding hypoxia, and the RBC‐derived mechanism responsible for maintaining PO2 levels high enough for optimal tissue function.
An ERF121 transcription factor from Brassicaoleracea is a target for the conserved TAL‐effectors from different Xanthomonascampestris pv. campestris strains
Authors: Zlobin Nikolay , Lebedeva Marina , Monakhova Yuliya , Ustinova Vera , Taranov Vasiliy
Published: March 2021

Transcription activator‐like effectors (TALEs), which induce the expression of specific plant genes to promote infection, are the main pathogenic determinants of various Xanthomonas bacteria. However, investigation of TALEs from Xanthomonas campestris pv. campestris, which causes black rot disease of crucifers, received little attention. In this study, we used PCR‐based amplification followed by SMRT amplicon sequencing to identify TALE genes in several X. campestris pv. campestris strains. Computational prediction in conjunction with quantitative reverse transcription PCR analysis was used to find their targets in the Brassica oleracea genome. Transcription factor ERF121, from the AP2/ERF family, was identified as target gene for the conserved TALEs from multiple X. campestris pv. campestris strains. Several members of this family from diverse plants were previously identified as targets of TALEs from different Xanthomonas species. We propose that TALE‐dependent activation of AP2/ERF transcription factors promotes susceptibility to Xanthomonas through the misregulation of plant defence pathways.
Workplace Preference among Farmworkers: Piece Rate, Pesticides, and the Perspective of Fruit and Vegetable Harvesters
Authors: Soper Rachel
Published: March 2021

Farmworkers in US agriculture encounter structural vulnerability. They are economic refugees, fleeing starvation. After risking their lives to cross the border and find work, they continue to be marginalized in society, and constantly fear deportation. Although farmwork is hazardous, it is necessary to be able to support themselves and their families. Research has found that although farmworkers are aware of the health side effects that result from exposure to pesticides, they continue to labor in conventional fields because not working is viewed as a larger risk. This study adds to that literature by asking farmworkers about preference for working in organic or conventional production. Even when organic is an option, farmworkers prefer conventional production when they earn more money in conventional. Because of their extreme economic vulnerability, the possibility of earning less income to work in a safer environment is viewed as undesirable. Rather than changing wage structure to incentivize working in organic agriculture, what is needed, in addition to more political protection for farmworkers, is increased regulation of pesticides. All agricultural workplaces should be made less toxic.
Partners in Design
Authors: Sukel Kayt
Published: March 2021

New artificial intelligence and machine learning applications are found in many popular CAD platforms today and will be even more capable in the near future. As AI/ML solutions become more pervasive in different areas of the mechanical engineering arena, many design engineers are asking how these new tools will change the engineering profession.
Boundary Friction in Bearings at Low Loads
Authors: Tichvinsky L. M. , Fischer E. G.
Published: March 2021

The paper describes bearing tests performed in the region of semifluid or boundary lubrication. Bearings 2 1/2 in. in diameter mounted in a rigid housing were loaded lightly and their performance studied in an attempt to correlate it with various physical properties of the bearing and journal materials. In this connection special consideration was given to journal surface finish and its measurement.
The Influence of Hyperbolic Notches on the Transverse Flexure of Elastic Plates
Authors: Lee George H.
Published: March 2021

This paper considers the solution of the two problems of the infinite plate, with two symmetrically disposed hyperbolic notches, subjected to (a) transverse bending and (b) twisting. The transverse-bending moments and torsional couples are so applied that the narrow section between the notches transmits the bending moment or the torsional couple. Using the Poisson-Kirchhoff theory, finite expressions were obtained for the deflection and stress in each problem.
A Rational Definition of Yield Strength
Authors: Osgood W. R.
Published: March 2021

Explicitly or implicitly the yield strength of a material is often used as a measure of incipient structural damage. With the yield strength determined by conventional methods, however, it cannot be said in general for two structural elements geometrically alike but of different materials that similar loads, producing maximum stresses equal to the yield strengths in the two cases, are simply related to the yield strengths. A definition of yield strength is proposed in this paper which often has the advantage that, for geometrically similar structures of different materials, loads producing maximum stresses equal to the yield strength are proportional to the yield strength.
Convergence of Hardy Cross’s Balancing Process
Authors: Oldenburger Rufus
Published: March 2021

It can be shown easily that the Cross method of structural analysis may be applied to a given structure in such a manner that the process does not converge. In this paper the author gives necessary and sufficient conditions for the convergence of the Cross method, and exhibits a convergent process of balancing any given structure. In particular he shows that a balancing process can be described by real linear transformation, that is, by a matrix of real numbers, and that the process converges in the sense of this paper if and only if the infinite power of this matrix exists and is zero. The study is restricted to the case of a continuous beam.
Linear and Nonlinear Ultrasonic Techniques for Monitoring Stress-Induced Damages in Concrete
Authors: Castellano Anna , Fraddosio Aguinaldo , Piccioni Mario Daniele , Kundu Tribikram
Published: March 2021

When stress in concrete exceeds certain threshold value, microcracks are nucleated, these microcracks can propagate and coalesce forming macrocracks, resulting in the gradual decay of the mechanical properties of concrete and eventual failure of the concrete structures. For safety concerns, one needs to develop suitable nondestructive testing methods capable of detecting past overloads of concrete structures during its service life. In this work, the stress-induced damage in concrete is monitored using ultrasonic techniques, exploiting the coupling between the stress level experienced by concrete and its wave propagation parameters. Cyclic compression tests with increasing maximum load level have been performed on specimens made of concrete with coarse-grained (CG) aggregates. Experimental results have been analyzed by two different ultrasonic methods—the linear and the nonlinear ultrasonic techniques. In linear ultrasonic technique, the stress level experienced by the specimens is related to the variations in signal amplitude and velocity of ultrasonic waves. In nonlinear ultrasonic method, the sideband peak count (SPC) technique is used for revealing the stress-induced damage corresponding to each load step. In comparison to linear ultrasonic parameters, the nonlinear ultrasonic parameter SPC-I appears to be more sensitive to the variations of the internal material structures during both loading and unloading phases. Moreover, the SPC technique has shown to be capable of identifying both the initial damage due to the evolution and nucleation of microcracks at the microscopic scale, and the subsequent damages induced by high overload, resulting in an irreversible degradation of the mechanical properties.
Alkali-Tuning Hemin-Derived Pore-Rich Fe–N–C: A Remarkable and Durable Electrocatalyst Toward Oxygen Reduction in Alkaline and Acid Condition
Authors: Xu Huaxing , Wang Rui , Zhou Na
Published: March 2021

Exploring highly efficient and durable nonprecious materials to change commercial Pt/C toward oxygen reduction reaction (ORR) is critical to the large-scale application of electrochemical conversion systems. In this study, a novel KOH-tuning strategy is reported to prepare the hemin-derived iron and nitrogen dual-doped carbon electrocatalyst for ORR. In the fabrication process, the KOH solvent plays three roles: (i) replacing toxic dimethylformamide (DMF) to achieve the environmentally friendly dissolution; (ii) converting insoluble hemin into soluble hematin porcine to ensure the uniform dispersion; and (iii) adjusting the chemical composition and crystal structure to accelerate the reduction reaction. The experimental investigation demonstrates that the surface chemical composition and the graphitization degree of the carbon tuned by 0.01 M KOH are improved, resulting in better activity and selectivity than the catalyst without KOH. Furthermore, the half-wave potential of the developed catalyst is more effective and more durable than Pt/C in alkaline and acidic conditions. This alkaline tuning strategy provides an effective and promising approach to develop high-performance catalysts toward ORR.
Eigenfrequency optimisation of free violin plates
Authors: Gonzalez Sebastian , Salvi Davide , Antonacci Fabio , Sarti Augusto
Published: March 2021

We discuss how the modal response of violin plates changes as their shape varies. Starting with an accurate 3D scan of the top plate of a historic violin, we develop a parametric model that controls a smooth shaping of the interior of the plate, while guaranteeing that the boundary is the same as the original violin. This allows us to generate a family of violin tops whose shape can be smoothly controlled through various parameters that are meaningful to a violin maker: from the thickness in different areas of the top to the location, angle, and dimensions of the bass bar. We show that the interplay between the different parameters affects the eigenmodes of the plate frequencies in a nonlinear fashion. We also show that, depending on the parameters, the ratio between the fifth and the second eigenfrequencies can be set to match that used by celebrated violin makers of the Cremonese school. As the parameterisation that we define can be readily understood by violin makers, we believe that our findings can have a relevant impact on the violin making community, as they show how to steer geometric modifications of the violin to balance the eigenfrequencies of the free plates.
Electroacupuncture regulates the DREAM/NF-κB signalling pathway and ameliorates cyclophosphamide-induced immunosuppression in mice
Authors: Huang Zhihua , Hu Zhiping , Ouyang Juan , Huang Cheng
Published: March 2021

Background:

Immune responses inhibit invasion by pathogens and antigens. Thus, it is important to promote the immune response in immunosuppressed patients.

Objective:

To examine whether electroacupuncture (EA) promotes the immune response by regulating the downstream regulatory element antagonist modulator / nuclear factor kappa B (DREAM/NF-κB) signalling pathway in a mouse model of cyclophosphamide (CP)-induced immunosuppression, and determine the most effective frequency.

Methods:

Twenty-four Kunming mice were intraperitoneally injected with CP to establish an immunosuppression model and six mice were injected with the same volume of normal saline as a control. The 24 mice were randomly divided into four groups: manual acupuncture, 2 Hz EA treatment, 100 Hz EA treatment and alternating 2/100 Hz EA treatment. After EA treatment for 3 days, immune response, natural killer (NK) cell toxicity and the expression of cytokines and DREAM/NF-κB were assessed.

Results:

EA treatment, especially at alternating 2/100 Hz frequency, improved spleen and thymus indices, increased lactate dehydrogenase and acid phosphatase levels, promoted concanavalin A- and lipopolysaccharide-induced splenocyte proliferation, increased NK cell toxicity and ameliorated CP-induced immunosuppression in mice. Additionally, 2/100 Hz EA treatment increased interleukin (IL)−2, IL-6, IL-12, tumour necrosis factor-α and interferon-γ levels and decreased IL-10 levels in CP-induced immunosuppressed mice. Finally, it was found that 2/100 Hz EA treatment increased p-IκBα and NF-κB expression and decreased DREAM and IκBα expression, suggesting that this treatment activates the NF-κB signalling pathway.

Conclusion:

2/100 Hz EA treatment might be an effective way to enhance immune responses in CP-induced immunosuppressed mice.
Acupuncture in sham device controlled trials may not be as effective as acupuncture in the real world: a preliminary network meta-analysis of studies of acupuncture for hot flashes in menopausal women
Authors: Kim Tae-Hun , Lee Myeong Soo , Alraek Terje , Birch Stephen
Published: March 2021

Background:

Randomised controlled trials of acupuncture performed using sham interventions to control for the placebo effect have mostly used two types of sham techniques: techniques with minimal insertion of acupuncture needles with no additional stimulation (shallow needling control) and techniques with sham acupuncture devices that do not penetrate the skin (sham device control). To achieve successful blinding, sham device controlled acupuncture trials also use the acupuncture base unit in the verum acupuncture group, but in the shallow needling control trials this is not necessary for the verum acupuncture treatment.

Objective:

In this study, we analysed the estimated comparative effectiveness of these two verum acupuncture modalities in studies of acupuncture for menopausal hot flashes that used two types of sham control treatments.

Methods:

We conducted a network meta-analysis that included randomised controlled trials of acupuncture for hot flashes. Electronic databases, including Medline, Embase, Cochrane Library and AMED, were searched through March 2017. Data were extracted using a predefined data extraction tool by two independent reviewers. The risk of bias was assessed using the Cochrane risk of bias tool for randomised controlled trials. A five-node network meta-analysis was conducted based on the frequentist framework.

Results:

Eight studies were included in this review. From the network meta-analysis, we found that verum acupuncture in the shallow needling controlled trials was more effective than verum acupuncture in the sham device controlled trials (SMD −7.27, 95% CI−9.11 to −5.43). Significant heterogeneity and inconsistency were not observed among the included studies or the comparisons.

Conclusions:

From this preliminary analysis, we found that different types of verum acupuncture may have different effect sizes with respect to the severity of menopausal hot flashes.
Hyponatraemia due to hypothyroidism: a rare side effect from pomalidomide
Authors: Qureshi Anum , Rhee Ji Hyun
Published: March 2021

Pomalidomide is an immunomodulatory drug used for relapsed and refractory multiple myeloma (RRMM). Hypothyroidism is an uncommon side effect of pomalidomide. We present a 70-year-old male patient with RRMM on daratumumab, pomalidomide and dexamethasone, who presented with 2 weeks of fatigue. Laboratory values showed sodium of 120 mEq/L, plasma osmolarity of 256 mOsm/kg, urine osmolarity of 648 mOsm/kg and urine sodium of 93 mEq/L. Adrenocorticotropic hormone (ACTH) stimulation test was within normal limits. Thyroid-stimulating hormone (TSH) was 88.6 IU/mL (0.380–4.700 IU/mL), total triiodothyronine (TT3) <21 ng/mL (0.8–2 ng/mL), free thyroxine (fT4) 0.10 ng/dL (0.93–1.70 ng/dL) and free triiodothyronine (fT3) <0.5 pg/mL (2.3–4.2 pg/mL). Antithyroid peroxidase antibody was 726 IU/mL (<9 IU/mL). TSH 1 year ago was 2.88 IU/mL and TT3 was 1.06 ng/mL. He was started on levothyroxine with improvement in his symptoms, sodium level and thyroid functions. The most likely culprit was pomalidomide. Checking thyroid functions before and periodically while on pomalidomide is important in screening for this possible side effect.
Lifetime risk and years lost to type 1 and type 2 diabetes in Denmark, 1996–2016
Authors: Carstensen Bendix , Rønn Pernille Falberg , Jørgensen Marit Eika
Published: March 2021

Introduction

Lifetime risk and lifetime lost to diabetes are measures of current diabetes burden in a population. We aimed at quantifying these measures in the Danish population.

Research design and methods

We modeled incidence and mortality of type 1 diabetes (T1D) and type 2 diabetes (T2D) and non-diabetes mortality based on complete follow-up of the entire population of Denmark in 1996–2016. A multistate model with these transition rates was used to assess the lifetime risk of diabetes, as well as the difference in expected lifetime between persons with type 1 and T2D and persons without.

Results

In 2016, the lifetime risk of T1D was 1.1% and that for T2D 24%, the latter a 50% increase from 1996. For 50-year-old persons, the lifetime lost was 6.6 years for T1D and 4.8 years for T2D. These figures have been declining over the study period.

At 2016, the total foreseeable lives lost in Denmark among patients with T1D were 182 000 years, and those among patients with T2D were 766 000 years, corresponding to 6.6 and 3.0 years per person, respectively.

Conclusion

At the individual level, improvements in the disease burden for both T1D and T2D have occurred. At the population level, the increasing number of patients with T2D has contributed to a large increase in the total loss of lifetime.
Does remote patient monitoring reduce acute care use? A systematic review
Authors: Taylor Monica L , Thomas Emma E , Snoswell Centaine L , Smith Anthony C , Caffery Liam J
Published: March 2021

Objective

Chronic diseases are associated with increased unplanned acute hospital use. Remote patient monitoring (RPM) can detect disease exacerbations and facilitate proactive management, possibly reducing expensive acute hospital usage. Current evidence examining RPM and acute care use mainly involves heart failure and omits automated invasive monitoring. This study aimed to determine if RPM reduces acute hospital use.

Methods

A systematic literature review of PubMed, Embase and CINAHL electronic databases was undertaken in July 2019 and updated in October 2020 for studies published from January 2015 to October 2020 reporting RPM and effect on hospitalisations, length of stay or emergency department presentations. All populations and disease conditions were included. Two independent reviewers screened articles. Quality analysis was performed using the Joanna Briggs Institute checklist. Findings were stratified by outcome variable. Subgroup analysis was undertaken on disease condition and RPM technology.

Results

From 2050 identified records, 91 studies were included. Studies were medium-to-high quality. RPM for all disease conditions was reported to reduce admissions, length of stay and emergency department presentations in 49% (n=44/90), 49% (n=23/47) and 41% (n=13/32) of studies reporting each measure, respectively. Remaining studies largely reported no change. Four studies reported RPM increased acute care use. RPM of chronic obstructive pulmonary disease (COPD) was more effective at reducing emergency presentation than RPM of other disease conditions. Similarly, invasive monitoring of cardiovascular disease was more effective at reducing hospital admissions versus other disease conditions and non-invasive monitoring.

Conclusion

RPM can reduce acute care use for patients with cardiovascular disease and COPD. However, effectiveness varies within and between populations. RPM’s effect on other conditions is inconclusive due to limited studies. Further analysis is required to understand underlying mechanisms causing variation in RPM interventions. These findings should be considered alongside other benefits of RPM, including increased quality of life for patients.

PROSPERO registration number

CRD42020142523.
Cost analysis of staged versus simultaneous bilateral total knee and hip arthroplasty using a propensity score matching
Authors: Hou Ji-Fei , Hu Chuan , Zhang Yun , Tian Li-Qi , Liu Yan-Zheng , Zhang Chi , Li Jing
Published: March 2021

Background

Total joint arthroplasty (TJA), including total knee arthroplasty (TKA) and total hip arthroplasty (THA), is required for many patients. This study aimed to evaluate the medical costs, length of stay (LOS), blood transfusion and in-hospital complications in patients undergoing simultaneous and staged TJA.

Methods

All patients who underwent primary bilateral TJA from 2013 to 2018 in our institute were included. The propensity score matching analysis was performed between simultaneous and staged TJA patients. The difference in medical costs, LOS, blood transfusion and in-hospital complications was compared between simultaneous and staged groups.

Results

Except for materials fees and general therapy fees, medical costs (bed fees, general therapy fees, nursing care fees, check-up and laboratory test fees, surgical fees and drug fees) were significantly lower in the simultaneous TKA, THA and TJA group. The total average medical costs in simultaneous and staged TKA groups were $15 385 and $16 729 (p<0.001), respectively; THA groups were $14 503 and $16 142 (p=0.016), respectively; TJA groups were $15 389 and $16 830 (p<0.001), respectively. The highest and lowest costs were materials fees and nursing care fees. No significant differences were found for five common comorbidities and postoperative complications between the two subgroups. The simultaneous groups had a shorter LOS and the differences from the staged group for TKA, THA and the TJA group were 8, 6 and 8 days, respectively. The incidence of blood transfusion is higher for simultaneous groups and the difference from the staged group for TKA, THA and TJA is 32.69%, 18% and 29.3%, respectively.

Conclusions

Our results indicate that simultaneous TKA and THA with a shorter LOS would cost fewer (costs incurred during hospitalisation) than staged TKA and THA. Complication rates were not affected by the choice for staged or simultaneous arthroplasty, but the incidence of blood transfusion was higher in the simultaneous groups.
Flash glucose monitoring in gestational diabetes mellitus: study protocol for a randomised controlled trial
Authors: Majewska Agata , Stanirowski Paweł , Wielgoś Mirosław , Bomba-Opoń Dorota
Published: March 2021

Introduction

Gestational diabetes mellitus (GDM) is a glucose intolerance occurring in 3%–10% of pregnant women and being a risk factor for multiple maternal and fetal complications. The risk of perinatal complications is proportional to the level of maternal hyperglycaemia. Proper glycaemic control is therefore one of the key elements of GDM therapy. Until recently, determination of blood glucose concentration was performed using glucose meters, which involved multiple fingerpricks. Nowadays, due to the flash glucose monitoring (FGM) availability, it is possible to collect measurements at any time without routine puncturing. The aim of the presented study is to assess the impact of FGM on the efficacy of treatment in population of patients diagnosed with GDM.

Methods and analysis

This is a prospective, randomised study, that will recruit 100 women at 24–28 weeks of gestation at the 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Poland. Women diagnosed with GDM, who will meet the inclusion criteria, will be individually randomised to the FGM or self-monitoring of blood glucose groups. Further on, clinical and laboratory results of the mother and their newborns will be collected for analysis during the course of pregnancy. Primary outcome is mean glycaemia result in each group after 1 month analysis and percentage of results in the target glycaemic range. The secondary objectives will be to compare the two groups for maternal and neonatal outcomes in conjunction with long-term glycaemic control using blood glycated haemoglobin and fructosamine serum concentrations.

Ethics and dissemination

The study is exempt from regional ethics review due to its nature of quality improvement in patient care. The study has been approved by the Bioethics Committee at the Medical University of Warsaw and the patient privacy protection boards governing over the recruitment sites. Results of the study will be presented in peer-reviewed journals and at conferences.

Trial registration number

NCT04422821.
Preschool HABIT-ILE: study protocol for a randomised controlled trial to determine efficacy of intensive rehabilitation compared with usual care to improve motor skills of children, aged 2–5 years, with bilateral cerebral palsy
Authors: Sakzewski Leanne , Reedman Sarah , McLeod Kate , Thorley Megan , Burgess Andrea , Trost Stewart , Ahmadi Matthew , Rowell David , Chatfield Mark , Bleyenheuft Yannick , Boyd Roslyn N
Published: March 2021

Introduction

Young children with bilateral cerebral palsy (BCP) often experience difficulties with gross motor function, manual ability and posture, impacting developing independence in daily life activities, participation and quality of life. Hand Arm Bimanual Intensive Training Including Lower Extremity (HABIT-ILE) is a novel intensive motor intervention integrating upper and lower extremity training that has been developed and tested in older school-aged children with unilateral and BCP. This study aims to compare an adapted preschool version of HABIT-ILE to usual care in a randomised controlled trial.

Methods and analysis

60 children with BCP aged 2–5 years, Gross Motor Function Classification System (GMFCS) II–IV will be recruited. Children will be stratified by GMFCS and randomised using concealed allocation to either receive Preschool HABIT-ILE or usual care. Preschool HABIT-ILE will be delivered in groups of four to six children, for 3 hours/day for 10 days (total 30 hours). Children receiving Preschool HABIT-ILE be provided a written home programme with the aim of achieving an additional 10 hours of home practice (total dose 40 hours). Outcomes will be assessed at baseline, immediately following intervention and then retention of effects will be tested at 26 weeks. The primary outcome will be the Peabody Developmental Motors Scales–Second Edition to evaluate gross and fine motor skills. Secondary outcomes will be gross motor function (Gross Motor Function Measure-66), bimanual hand performance (Both Hands Assessment), self-care and mobility (Pediatric Evaluation of Disability Inventory-Computer Adapted Test), goal attainment (Canadian Occupational Performance Measure), global performance of daily activities (ACTIVLIM-CP), cognition and adaptive function (Behavior Rating Inventory of Executive Function—Preschool Version), habitual physical activity (ActiGraph GT3X+) and quality of life (Infant Toddler Quality of Life Questionnaire and Child Health Utility Index-9). Analyses will follow standard principles for RCTs using two-group comparisons on all participants on an intention-to-treat basis. Comparisons between groups for primary and secondary outcomes will be conducted using regression models.

Ethics and dissemination

Ethics approval has been granted by the Medical Research Ethics Committee Children’s Health Queensland Hospital and Health Service Human Research Ethics Committee (HREC/19/QCHQ/59444) and The University of Queensland (2020000336/HREC/19/QCHQ/59444).

Trial registration number

ACTRN126200000719.
Urban–rural differences in overweight and obesity among 25–64 years old Myanmar residents: a cross-sectional, nationwide survey
Authors: Thapa Rupa , Dahl Cecilie , Aung Wai Phyo , Bjertness Espen
Published: March 2021

Objectives

To investigate whether urban–rural location and socioeconomic factors (income, education and employment) are associated with body mass index (BMI) and waist–hip ratio (W/H-ratio), and to further explore if the associations between urban–rural location and BMI or W/H-ratio could be mediated through variations in socioeconomic factors.

Design

Cross-sectional, WHO STEPS survey of non-communicable disease risk factors.

Setting

Urban and rural areas of Myanmar.

Participants

A total of 8390 men and women aged 25 to 64 years included during the study period from September to December 2014. Institutionalised people (Buddhist monks and nuns, hospitalised patients) and temporary residents were excluded.

Results

The prevalence of overweight and obesity was higher in the urban areas and increased with increasing socioeconomic status (SES) score. Mean BMI was higher among urban residents (ß=2.49 kg/m2; 95% CI 2.28 to 2.70; p<0.001), individuals living above poverty line, that is, ≥US$1.9/day (ß=0.74 kg/m2; 95% CI 0.43 to 1.05; p<0.001), and those with high education attainment (ß=1.48 kg/m2; 95% CI 1.13 to 1.82; p<0.001) when adjusting for potential confounders. Similarly, greater W/H-ratio was observed in participants living in an urban area, among those with earnings above poverty line, and among unemployed individuals. The association between urban–rural location and BMI was found to be partially mediated by a composite SES score (9%), income (17%), education (16%) and employment (16%), while the association between urban–rural location and W/H-ratio was found to be partially mediated by income (12%), education (6%) and employment (6%).

Conclusion

Residents living in urban locations had higher BMI and greater W/H-ratio, partially explained by differences in socioeconomic indicators, indicating that socioeconomic factors should be emphasised in the management of overweight and obesity in the Myanmar population. Furthermore, new national or subnational STEPS surveys should be conducted in Myanmar to observe the disparity in trends of the urban–rural differential.
Retrospective review of nicotine exposures in California from 2012 to 2018 and analysis of the impacts of e-cigarette regulations
Authors: Driller Gabrielle , Plasencia Emily , Apollonio Dorie E
Published: March 2021

Objectives

To review the association between US e-cigarette regulations and the number of reported nicotine exposures, and identify higher-risk products

Design

Retrospective review of de-identified medical records.

Setting

California

Participants

Cases reported to California Poison Control System in 2012–2018.

Primary and secondary outcome measures

Suspected nicotine toxicity; route of exposure and product characteristics.

Results

We examined 5277 exposures, of which 3033 involved combustible cigarettes, 1489 involved e-cigarettes and 818 involved other substances (ie, chewing tobacco, nicotine patches, nicotine lozenges, hookah, etc). Implementation of the Child Nicotine Poisoning Prevention Act of 2015 was not significantly associated with reduced exposures. Exposures for e-cigarettes increased significantly after the 2017 Food and Drug Administration Compliance Policy (p=0.003, coefficient (coeff)=0.61). Total exposures for all tobacco and nicotine products also increased significantly after the policy change (p=0.01, coeff=1.26). Nicotine exposure outcomes classified as being of minor and moderate severity increased significantly after implementation of the 2017 Compliance Policy (p=0.004, coeff=0.54 and p=0.002, coeff=0.56, respectively). Ingestion was the most common route of exposure (87.7%), followed by inhalation (8.1%), dermal (6.5%), ocular (2.1%) and other (intranasal, rectal, sublingual and unknown) routes (0.2%); some cases reported multiple routes of exposure. Exposure cases involving e-cigarettes fell into three problem categories: product design, labelling and the appeal of flavours.

Conclusions

Our analysis found that despite previous studies suggesting that the Child Nicotine Poisoning Prevention Act appeared to have reduced exposures for e-cigarettes, there was no significant change in exposures after its implementation. In contrast, there was a 30% increase in California e-cigarette exposures following the 2017 Compliance Policy. We conclude that current regulations are insufficient to reduce nicotine toxicities due to e-cigarette use.