bluuebunny/crossref_metadata_2025 huggingface dataset:
Violencia y exclusión en J. G. Herder
Authors:   Universidad Veracruzana, Rodriguez Barraza Adriana
Published: August 2021

Se pretende dar cuenta de la legitimación que hace J. G. Herder de la violencia y exclusión como el modo natural de relaciones entre las diversas culturas; se ha empleado como estrategia metodológica recoger las principales tesis de su obra Ensayo sobre el origen del lenguaje. En análisis del texto ayudará a la comprensión acerca de la necesidad de la exclusión y violencia para preservar la cohesión interna de las culturas. Se busca ofrecer una perspectiva más del autor. Esta perspectiva menos estudiada de nuestro autor, hace que posteriormente sea leído y retomado, como en el caso de Gadamer, con un pretendido carácter universal y como un apóstol de la gran justicia o equidad de la Historia, sin embargo, a nuestro modo de ver no sólo pone las bases de la diferenciación, sino de la subordinación y claro desprecio entre propio y extraño, lo culto y lo bárbaro, donde la identidad, cultura y alma del pueblo tan puras, auténticas y distintas no deja espacio para ningún otro que no las posea naturalmente. Esta perspectiva muestra las tensiones, luces y sombras de los problemas que suscita la convivencia entre distintas y distantes culturas. Para ello partiremos fundamentalmente de la noción de circulo, esta noción que plantea y predetermina, nos ayudará a entender mejor sus postulados, entre más estrecho sea el circulo y el radio de acción de una lengua y un pueblo, más se fortalece hacia el interior y en contraposición de lo exterior, fuera del círculo es nada incluso el círculo ya lo predetermina.
Experimental realization of an active non-reciprocal metamaterial using an eigen-structure assignment control strategy
Authors: Zhou H. , Baz A.
Published: August 2021

This paper presents a class of active non-reciprocal metamaterials (ANMMs) in an attempt to control the flow of acoustic waves along a one-dimensional acoustic duct. The proposed method distinguishes itself from the available approaches where the non-reciprocities are generated either actively or passively by various sources of nonlinearities, circulators and gyroscopic/gyrator components, and/or spatiotemporal modulation. The proposed method relies in its operation on a controller that is designed by simultaneous allocation of both the eigenvalues and eigenvectors. In other words, the entire eigen-structure of the closed-loop system is assigned as deemed necessary. Conventionally, the placement of the eigenvalues has been employed to enhance both the damping and response of the system. However, in this study, the focus is placed on adjusting the eigenvectors in a way that enables the spatial control and redistribution of the wave propagation along the acoustic duct in order to produce any desirable non-reciprocal behavior. During this entire process, the system continues to behave in a linear fashion. The theory governing the operation of this proposed approach is introduced, and a comprehensive experimental validation effort is presented to demonstrate the basic features, non-reciprocal behavior, and control characteristics. Generalization of the presented strategies to two-dimensional acoustic systems is a natural extension of the present work.
A Longitudinal Analysis Examining the Associations of Tummy Time With Active Playtime, Screen Time, and Sleep Time
Authors: Buchanan Limin , Xu Huilan , Hewitt Lyndel , Taki Sarah , Wen Li Ming
Published: August 2021

Background: Evidence links tummy time (ie, the time spent in awake prone positioning that is encouraged and supervised by an adult) to infants’ health outcomes such as gross motor and total development. However, the associations between tummy time and other movement and sleep behaviors as the child develops remain unknown. The aim of this study was to examine whether early introduction and practice of tummy time within the first 6 months of age were associated with active and outdoor playtime, screen time, and nocturnal sleep time of children when they were 12 and 24 months old. Methods: A longitudinal analysis was conducted using data extracted from an Australian trial. Using telephone surveys with mothers, demographic data were collected from third trimester of pregnancy and tummy time data were collected at 6 months of age. Data on playtime, screen time, and nocturnal sleep duration as dependent variables were collected at 12 and 24 months of age. Multiple logistic regression models were built to investigate the associations. Results: Children who started tummy time within 4 weeks of age were more likely to have >10 hours sleep at night at 12 months (adjusted odds ratio 1.54, 95% confidence interval, 1.08–2.19). They were more likely to have >3 hours per day of outdoor play and have <1 hour per day of screen time at 24 months. Children who practiced tummy time every day were more likely to have >2 hours per day of active play at 12 months and have <1 hour per day of screen time at 24 months. Conclusions: Starting tummy time earlier and frequently was associated with more favorable movement and sleep of young children at 12 and 24 months of age.
Transnational Stereotypes in Professional Wrestling during the Early Twentieth Century in Spain
Authors: García-Martí Carlos , Sánchez-García Raúl
Published: August 2021

This paper analyzes how professional wrestling expanded stereotyped race, national, and class images toward the Spanish public in the first two decades of the twentieth century. The professional wrestling circuit of music halls, theaters, and circuses helped connect a myriad of grappling practices spanning different national traditions. Nonetheless, it also helped convey different racial, ethnic, and national images within a frame of social class divide at a time of rampant imperialism and colonial domination. In this context, Spain experimented with a short-lived wrestling mania, with several international wrestling tournaments and jujutsu exhibitions before World War I. In these tournaments, both fighters and patrons exploited racial stereotypes as a way to better sell the activity to the paying audience, connecting with, but also reinforcing, the perceptions that populated the collective imagination about different people, due to ethnicity or nationality linked also to social class.
Efficient derivation of human trophoblast stem cells from primed pluripotent stem cells
Authors: Wei Yanxing , Wang Tianyu , Ma Lishi , Zhang Yanqi , Zhao Yuan , Lye Kathryn , Xiao Lu , Chen Chunlin , Wang Zhijian , Ma Yanlin , Zhou Xiaohua , Sun Fei , Li Weili , Dunk Caroline , Li Siliang , Nagy Andras , Yu Yanhong , Pan Guangjin , Lye Stephen J. , Shan Yongli
Published: August 2021

A simple and efficient strategy to generate human trophoblast stem cells is reported to aid investigations of early placentation.
Protein detection in blood with single-molecule imaging
Authors: Mao Chih-Ping , Wang Shih-Chin , Su Yu-Pin , Tseng Ssu-Hsueh , He Liangmei , Wu Annie A. , Roden Richard B. S. , Xiao Jie , Hung Chien-Fu
Published: August 2021

A single-molecule imaging approach detects individual disease-specific protein molecules in blood samples.
Multiperiodic orbits from interacting soft spots in cyclically sheared amorphous solids
Authors: Keim Nathan C. , Paulsen Joseph D.
Published: August 2021

Small groups of hysteretic elements can explain how a system returns to a previous state only after multiple driving cycles.
Stochastic gene expression drives mesophyll protoplast regeneration
Authors: Xu Mengxue , Du Qingwei , Tian Caihuan , Wang Ying , Jiao Yuling
Published: August 2021

Isolating protoplasts allows stochastic gene expression to enable regeneration of differentiated cells at a low frequency.
Segmentations in fins enable large morphing amplitudes combined with high flexural stiffness for fish-inspired robotic materials
Authors: Hannard Florent , Mirkhalaf Mohammad , Ameri Abtin , Barthelat Francois
Published: August 2021

Segmentation is key to the combined flexural stiffness and morphing efficiency in fish fins.
Biorobotic insights into neuromechanical coordination of undulatory swimming
Authors: Tytell Eric D. , Long John H.
Published: August 2021

Skin sensors on an eel-like robot couple external hydrodynamic pressure with internal neural patterns for robust swimming.
Iron-Fueled Life in the Continental Subsurface: Deep Mine Microbial Observatory, South Dakota, USA
Authors: Casar C. P. , Momper L. M. , Kruger B. R. , Osburn M. R.
Published: August 2021

We investigated iron cycling potential among microbial communities inhabiting iron-rich fracture fluids to a depth of 1.5 km in the continental crust. A previous study found no iron cycling potential in the communities despite the iron-rich nature of the system.
Beneficial Cyanosphere Heterotrophs Accelerate Establishment of Cyanobacterial Biocrust
Authors: Nelson Corey , Garcia-Pichel Ferran
Published: August 2021

The advancement of biocrust restoration methods for cyanobacterial biocrusts has been largely achieved through trial and error. Successes and failures could not always be traced back to particular factors. The investigation and application of foundational microbial interactions existing within biocrust communities constitute a crucial step toward informed and repeatable biocrust restoration methods.
Acquisition of the L452R Mutation in the ACE2-Binding Interface of Spike Protein Triggers Recent Massive Expansion of SARS-CoV-2 Variants
Authors: Tchesnokova Veronika , Kulasekara Hemantha , Larson Lydia , Bowers Victoria , Rechkina Elena , Kisiela Dagmara , Sledneva Yulia , Choudhury Debarati , Maslova Iryna , Deng Kai , Kutumbaka Kirthi , Geng Hao , Fowler Curtis , Greene Dina , Ralston James , Samadpour Mansour , Sokurenko Evgeni
Published: August 2021

We report that there is a recent global expansion of numerous independent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants with mutation L452R in the receptor-binding domain (RBD) of the spike protein. The massive emergence of L452R variants was first linked to lineage B.1.427/B.1.429 (clade 21C) that has been spreading in California since November and December 2020, originally named CAL.20C and currently variant of interest epsilon.
The Fall in Antibody Response to SARS-CoV-2: a Longitudinal Study of Asymptomatic to Critically Ill Patients Up to 10 Months after Recovery
Authors: Peghin Maddalena , De Martino Maria , Fabris Martina , Palese Alvisa , Visintini Erica , Graziano Elena , Gerussi Valentina , Bontempo Giulia , D’Aurizio Federica , Biasotto Alessia , Sartor Assunta , Pipan Corrado , Marzinotto Stefania , Curcio Francesco , Bouza Emilio , Isola Miriam , Tascini Carlo
Published: August 2021

The aim of this study was to assess the long-term dynamics and factors associated with the serological response against the severe acute respiratory syndrome coronavirus 2 after primary infection. A prospective longitudinal study was conducted with monthly serological follow-up during the first 4 months, and then at 6, 8, and 10 months after the disease onset of all recovered adult in- and outpatients with coronavirus disease 2019 (COVID-19) attending Udine Hospital (Italy) during the first wave (from March to May 2020).
The Balance between p53 Isoforms Modulates the Efficiency of HIV-1 Infection in Macrophages
Authors: Breton Yann , Barat Corinne , Tremblay Michel J.
Published: August 2021

As of today, HIV-1 infection is still considered a global pandemic without a functional cure, partly because of the presence of stable viral reservoirs. Macrophages constitute one of these cell reservoirs, contributing to the viral persistence.
Human Basigin (CD147) Does Not Directly Interact with SARS-CoV-2 Spike Glycoprotein
Authors: Ragotte Robert J. , Pulido David , Donnellan Francesca R. , Hill Michelle L. , Gorini Giacomo , Davies Hannah , Brun Juliane , McHugh Kirsty , King Lloyd D. W. , Skinner Katherine , Miura Kazutoyo , Long Carole A. , Zitzmann Nicole , Draper Simon J.
Published: August 2021

Reducing the mortality and morbidity associated with COVID-19 remains a global health priority. Vaccines have proven highly effective at preventing infection and hospitalization, but efforts must continue to improve treatment options for those who still become seriously ill.
Honeybee Exposure to Veterinary Drugs: How Is the Gut Microbiota Affected?
Authors: Baffoni Loredana , Alberoni Daniele , Gaggìa Francesca , Braglia Chiara , Stanton Catherine , Ross Paul R. , Di Gioia Diana
Published: August 2021

This study investigates the impact of the three most widely used antibiotics in the beekeeping sector (oxytetracycline, tylosin, and sulfonamides) on the honeybee gut microbiota and on the spread of antibiotic resistance genes. The research represents an advance to the present literature, considering that the tylosin and sulfonamides effects on the gut microbiota have never been studied.
Precision Response to the Rise of the SARS-CoV-2 B.1.1.7 Variant of Concern by Combining Novel PCR Assays and Genome Sequencing for Rapid Variant Detection and Surveillance
Authors: Zelyas Nathan , Pabbaraju Kanti , Croxen Matthew A. , Lynch Tarah , Buss Emily , Murphy Stephanie A. , Shokoples Sandy , Wong Anita , Kanji Jamil N. , Tipples Graham
Published: August 2021

Different strains, or variants, of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, the virus that causes COVID-19) have emerged that have higher levels of transmission, less susceptibility to our immune response, and possibly cause more severe disease than previous strains of the virus. Rapid detection of these variants of concern is important to help contain them and prevent them from spreading widely within the population.
Mild and Severe SARS-CoV-2 Infection Induces Respiratory and Intestinal Microbiome Changes in the K18-hACE2 Transgenic Mouse Model
Authors: Seibert Brittany , Cáceres C. Joaquín , Cardenas-Garcia Stivalis , Carnaccini Silvia , Geiger Ginger , Rajao Daniela S. , Ottesen Elizabeth , Perez Daniel R.
Published: August 2021

The COVID-19 pandemic has resulted in millions of deaths. The host’s respiratory and intestinal microbiome can affect directly or indirectly the immune system during viral infections.
Unique Gut Microbiome in HIV Patients on Antiretroviral Therapy (ART) Suggests Association with Chronic Inflammation
Authors: Ishizaka Aya , Koga Michiko , Mizutani Taketoshi , Parbie Prince Kofi , Prawisuda Diki , Yusa Nozomi , Sedohara Ayako , Kikuchi Tadashi , Ikeuchi Kazuhiko , Adachi Eisuke , Koibuchi Tomohiko , Furukawa Yoichi , Tojo Arinobu , Imoto Seiya , Suzuki Yutaka , Tsutsumi Takeya , Kiyono Hiroshi , Matano Tetsuro , Yotsuyanagi Hiroshi
Published: August 2021

Chronic inflammation is a hallmark of HIV infection and is associated with the development and progression of age-related comorbidities. Although the gastrointestinal tract is a major site of HIV replication and CD4+T-cell depletion, the role of HIV-associated imbalance of gut microbiome in chronic inflammation is unclear.
COVID-19-related diffuse leukoencephalopathy with microbleeds and persistent coma: a case report with good clinical outcome
Authors: Witvoet Elbert Hans , Jiang Feng Yan , Laumans Willemijn , de Bruijn Sebastiaan Franciscus Titus Maria
Published: August 2021

A 60-year-old patient presented with respiratory distress, after recently being tested COVID-19 positive and was mechanically ventilated for 15 days. After cessation of sedation, he remained in deep comatose state, without any reaction on pain stimuli (Glasgow Coma Score 3). MRI of the brain showed diffuse leukoencephalopathy and multiple (>50) microbleeds. Diffuse COVID-19-associated leukoencephalopathy with microhaemorrhages is associated with a poor prognosis. However, 3 months later, our patient showed a remarkable recovery and was able to walk independently. This case report shows COVID-related leukoencephalopathy and intracerebral microbleeds, even with persistent comatose state, may have a favourable clinical outcome and prolonged treatment should be considered in individual cases.
Macular infarction in presumed rickettsial retinitis with late vascular remodelling
Authors: Aggarwal David , Takkar Brijesh , Basu Soumyava
Published: August 2021

A middle-aged man had been diagnosed as retinitis and treated with steroids previously. The patient had developed macular infarction in the course of illness. We diagnosed him to have rickettsial retinitis on the basis of clinical features and positive Weil-Felix test. The patient’s condition improved after treatment with oral antibiotics. The vasculature of the infarcted macula showed partial reperfusion late in the course of follow-up.
Transient acetylcholine receptor-related myasthenia gravis, post multisystem inflammatory syndrome in children (MIS-C) temporally associated with COVID-19 infection
Authors: Essajee Farida , Lishman Juanita , Solomons Regan , Abraham Deepthi Raju , Goussard Pierre , Van Toorn Ronald
Published: August 2021

We report on a unique case of a 7-year-old girl with new onset ocular myasthenia gravis shortly after recovery from multisystem inflammatory syndrome in children (MIS-C) temporally associated with SARS-CoV-2 infection. The diagnosis of myasthenia gravis was based on suggestive symptoms of fatigable bilateral orbital ptosis, diplopia, positive ocular cold compression test and serum acetylcholine receptor antibody positivity, as well as a favourable treatment response to pyridostigmine. The addition of corticosteroids and methotrexate resulted in complete resolution of the ocular signs.
Pituitary microadenoma with hypopituitarism presenting as hyponatremia
Authors: Manappallil Robin George , Veetil Pradeep Puthen , Babu Harish , Khan Sadab Raza
Published: August 2021

The incidence of pituitary adenoma has been increasing these days. Majority of the cases are incidental findings on imaging; and these patients may be asymptomatic without any laboratory abnormalities. However, a non-functional sellar mass can initially present with hypopituitarism. The patient being described is an elderly female who presented with severe hyponatraemia. She has history of recurrent admissions for hyponatraemia in the past. Her biochemical evaluation revealed hypopituitarism and magnetic resonance imaging of brain showed pituitary microadenoma. Hyponatraemia as a presenting feature of hypopituitarism due to pituitary microadenoma is an uncommon scenario.
Medication adherence in cardiovascular medicine
Authors: Simon Steven T , Kini Vinay , Levy Andrew E , Ho P Michael
Published: August 2021

Cardiovascular disease is the leading cause of death globally. While pharmacological advancements have improved the morbidity and mortality associated with cardiovascular disease, non-adherence to prescribed treatment remains a significant barrier to improved patient outcomes. A variety of strategies to improve medication adherence have been tested in clinical trials, and include the following categories: improving patient education, implementing medication reminders, testing cognitive behavioral interventions, reducing medication costs, utilizing healthcare team members, and streamlining medication dosing regimens. In this review, we describe specific trials within each of these categories and highlight the impact of each on medication adherence. We also examine ongoing trials and future lines of inquiry for improving medication adherence in patients with cardiovascular diseases.
Evaluation of an intervention targeted with predictive analytics to prevent readmissions in an integrated health system: observational study
Authors: Marafino Ben J , Escobar Gabriel J , Baiocchi Michael T , Liu Vincent X , Plimier Colleen C , Schuler Alejandro
Published: August 2021

Objectives

To determine the associations between a care coordination intervention (the Transitions Program) targeted to patients after hospital discharge and 30 day readmission and mortality in a large, integrated healthcare system.

Design

Observational study.

Setting

21 hospitals operated by Kaiser Permanente Northern California.

Participants

1 539 285 eligible index hospital admissions corresponding to 739 040 unique patients from June 2010 to December 2018. 411 507 patients were discharged post-implementation of the Transitions Program; 80 424 (19.5%) of these patients were at medium or high predicted risk and were assigned to receive the intervention after discharge.

Intervention

Patients admitted to hospital were automatically assigned to be followed by the Transitions Program in the 30 days post-discharge if their predicted risk of 30 day readmission or mortality was greater than 25% on the basis of electronic health record data.

Main outcome measures

Non-elective hospital readmissions and all cause mortality in the 30 days after hospital discharge.

Results

Difference-in-differences estimates indicated that the intervention was associated with significantly reduced odds of 30 day non-elective readmission (adjusted odds ratio 0.91, 95% confidence interval 0.89 to 0.93; absolute risk reduction 95% confidence interval −2.5%, −3.1% to −2.0%) but not with the odds of 30 day post-discharge mortality (1.00, 0.95 to 1.04). Based on the regression discontinuity estimate, the association with readmission was of similar magnitude (absolute risk reduction −2.7%, −3.2% to −2.2%) among patients at medium risk near the risk threshold used for enrollment. However, the regression discontinuity estimate of the association with post-discharge mortality (−0.7% −1.4% to −0.0%) was significant and suggested benefit in this subgroup of patients.

Conclusions

In an integrated health system, the implementation of a comprehensive readmissions prevention intervention was associated with a reduction in 30 day readmission rates. Moreover, there was no association with 30 day post-discharge mortality, except among medium risk patients, where some evidence for benefit was found. Altogether, the study provides evidence to suggest the effectiveness of readmission prevention interventions in community settings, but further research might be required to confirm the findings beyond this setting.
Who do phone surveys miss, and how to reduce exclusion: recommendations from phone surveys in nine Indian states
Authors: Nagpal Karan , Mathur Mitali Roy , Biswas Abhilash , Fraker Andrew
Published: August 2021

Computer-assisted telephone interviews (CATI) through mobile phones are a low-cost, rapid and safe way to collect data. However, decisions for how such mobile phone surveys are designed and implemented, and their data analysed, can have implications for the sample reached, and in turn affect the generalisability of sample estimates. In this practice paper, we propose a framework for extending the use of CATI–mobile phone surveys in India, which can be applied broadly to future surveys conducted using this method. Across the stages of design, implementation and analysis, we outline challenges in ensuring that the data collected through such surveys are representative and provide recommendations for reducing non-coverage and non-response errors, thereby enabling practitioners in India to use CATI–mobile phone surveys to estimate population statistics with lower bias. We support our analysis by drawing on primary data that we collected in five mobile phone surveys across nine Indian states in 2020. Our recommendations can help practitioners in India improve the representativeness of data collected through mobile phone surveys and generate more accurate estimates.
Breast feeding and infant development in a cohort with sibling pair analysis: the Japan Environment and Children’s Study
Authors: Sanefuji Masafumi , Senju Ayako , Shimono Masayuki , Ogawa Masanobu , Sonoda Yuri , Torio Michiko , Ichimiya Yuko , Suga Reiko , Sakai Yasunari , Honjo Satoshi , Kusuhara Koichi , Ohga Shouichi
Published: August 2021

Objectives

To investigate the association between breast feeding and infant development during the first year of life using sibling comparison.

Design

Nationwide prospective birth cohort study with sibling pair analysis.

Setting

15 regional centres that participated in the Japan Environment and Children’s Study.

Participants

This study included 77 119 children (singleton, term birth and no malformation/severe diseases) whose mothers were registered between January 2011 and March 2014, including 3521 duos or trios of siblings.

Primary outcome measures

The primary outcome was developmental delay at 6 and 12 months of age, assessed using the Japanese translation of the Ages and Stages Questionnaires, third edition. Multivariable regression analyses adjusted for confounders were performed to estimate the risk ratios of delay associated with any or exclusive breast feeding. Pairs of siblings discordant for statuses were selected, and conditional regression analyses were conducted with a matched cohort design.

Results

Developmental delay was identified in 6162 (8.4%) and 10 442 (14.6%) children at 6 and 12 months of age, respectively. Any breast feeding continued until 6 months or 12 months old was associated with reduced developmental delay at 12 months of age (adjusted risk ratio (95% CI): 0.81 (0.77 to 0.85) and 0.81 (0.78 to 0.84), respectively). Furthermore, exclusive breast feeding until 3 months was associated with reduced developmental delay at 12 months of age (adjusted risk ratio, 0.86 (95% CI 0.83 to 0.90)). In sibling pair analysis, the association between any breast feeding until 12 months and reduced developmental delay at 12 months of age persisted (adjusted risk ratio, 0.64 (95% CI 0.43 to 0.93)).

Conclusions

The present study demonstrated the association of continuous breast feeding with reduced developmental delay at 1 year of age using sibling pair analysis, in which unmeasured confounding factors are still present but less included. This may provide an argument to promote breastfeeding continuation.
What do doctors understand by spiritual health? A survey of UK general practitioners
Authors: Whitehead Orla , Jagger Carol , Hanratty Barbara
Published: August 2021

Background

In the UK, doctors’ regulatory and professional bodies require general practitioners (GPs) to consider discussing spiritual health as part of the consultation. However, spiritual health is not defined in guidance, and it is unknown what individual doctors understand by the term.

Research question

What do GPs understand by the term ‘spiritual health’?

Aim

To explore how GPs understand and define spiritual health.

Design and setting

Survey of GPs in England 9 April 2019–21 May 2019.

Method

A mixed-methods online survey asked practising GPs in England qualitative free text questions—‘What does the term ‘Spiritual Health’ mean to you?’ and ‘Any comments?’ after five vignettes about discussing spiritual health with patients. These were subject to thematic analysis using a priori themes from the literature on GP definitions of spiritual health, and on attitudes towards the topic.

Participants

177 practising GPs in England.

Results

177 GPs responded to the survey. Understanding of spiritual health fitted into three themes: self-actualisation and meaning, transcendence and relationships beyond the self, and expressions of spirituality. A full range of views were expressed, from a minority who challenged their role in spiritual health, through to others enthusiastic about its place in healthcare.

Conclusion

Spirituality and religiosity are understood by English GPs to be distinct concepts. A consensus definition of spiritual health incorporating the themes identified by working doctors, may be helpful to support GPs to follow the recommended guidance in their practice.
Detection of intracranial hypertension in children using optical coherence tomography: a systematic review
Authors: Rufai Sohaib R , Hisaund Michael , Jeelani Noor ul Owase , McLean Rebecca J
Published: August 2021

Objectives

To evaluate the diagnostic capability of optical coherence tomography (OCT) in children aged under 18 years old with intracranial hypertension (IH).

Design

Systematic review.

Methods

We conducted a systematic review using the following platforms to search the keywords ‘optical coherence tomography’ and ‘intracranial hypertension’ from inception to 2 April 2020: Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE, PubMed and Web of Science, without language restrictions. Our search returned 2729 records, screened by two independent screeners. Studies were graded according to the Oxford Centre for Evidence-Based Medicine and National Institutes of Health Quality Assessment Tool for observational studies.

Results

Twenty-one studies were included. Conditions included craniosynostosis (n=354 patients), idiopathic IH (IIH; n=102), space-occupying lesion (SOL; n=42) and other pathology (n=29). OCT measures included optic nerve parameters, rim parameters (notably retinal nerve fibre layer thickness) and retinal parameters. Levels of evidence included 2b (n=13 studies), 3b (n=4) and 4 (n=4). Quality of 10 studies was fair and 11 poor. There was inconsistency in OCT parameters and reference measures studied, although OCT did demonstrate good diagnostic capability for IH in craniosynostosis, IIH and SOL.

Conclusions

This systematic review identified various studies involving OCT to assist diagnosis and management of IH in children with craniosynostosis, IIH, SOL and other pathology, in conjunction with established clinical measures of intracranial pressure. However, no level 1 evidence was identified. Validating prospective studies are, therefore, required to determine optimal OCT parameters in this role and to develop formal clinical guidelines.

PROSPERO registration number

CRD42019154254.
Multicentre observational study on practice of ventilation in brain injured patients: the VENTIBRAIN study protocol
Authors: Robba Chiara , Citerio Giuseppe , Taccone Fabio S , Galimberti Stefania , Rebora Paola , Vargiolu Alessia , Pelosi Paolo
Published: August 2021

Introduction

Mechanical ventilatory is a crucial element of acute brain injured patients’ management. The ventilatory goals to ensure lung protection during acute respiratory failure may not be adequate in case of concomitant brain injury. Therefore, there are limited data from which physicians can draw conclusions regarding optimal ventilator management in this setting.

Methods and analysis

This is an international multicentre prospective observational cohort study. The aim of the ‘multicentre observational study on practice of ventilation in brain injured patients’—the VENTIBRAIN study—is to describe the current practice of ventilator settings and mechanical ventilation in acute brain injured patients. Secondary objectives include the description of ventilator settings among different countries, and their association with outcomes. Inclusion criteria will be adult patients admitted to the intensive care unit (ICU) with a diagnosis of traumatic brain injury or cerebrovascular diseases (intracranial haemorrhage, subarachnoid haemorrhage, ischaemic stroke), requiring intubation and mechanical ventilation and admission to the ICU. Exclusion criteria will be the following: patients aged <18 years; pregnant patients; patients not intubated or not mechanically ventilated or receiving only non-invasive ventilation. Data related to clinical examination, neuromonitoring if available, ventilator settings and arterial blood gases will be recorded at admission and daily for the first 7 days and then at day 10 and 14. The Glasgow Outcome Scale Extended on mortality and neurological outcome will be collected at discharge from ICU, hospital and at 6 months follow-up.

Ethics and dissemination

The study has been approved by the Ethic committee of Brianza at the Azienda Socio Sanitaria Territoriale-Monza. Data will be disseminated to the scientific community by abstracts submitted to the European Society of Intensive Care Medicine annual conference and by original articles submitted to peer-reviewed journals.

Trial registration number

NCT04459884.
Single-centre, open-label, randomised, trial to compare rapid molecular point-of-care streptococcal testing to standard laboratory-based testing for the management of streptococcal pharyngitis in children: study protocol
Authors: Pernica Jeffrey M , Smaill Fiona , Kam April J , Bartholomew Amy , Doan Quynh , Smieja Marek , Khan Sarah , Sung Melani , Thabane Lehana , Goldfarb David M
Published: August 2021

Introduction

Streptococcal pharyngitis, which commonly occurs in children, should be treated with antibiotics. Clinical prediction rules to differentiate streptococcal pharyngitis from viral infection are not recommended in children. Rapid point-of-care (POC) antigen tests have limited sensitivity and so are not often used in Canadian paediatric emergency departments (EDs). Standard paediatric practice is to rely on laboratory-based testing, which often results in a delay before the results can be communicated to the patient; this may impede appropriate prescribing, decrease caregiver satisfaction and delay recovery. The objective of this study is to determine whether a novel rapid molecular POC assay for streptococcal pharyngitis leads to more appropriate antibiotic use in children seeking care in a paediatric ED than standard laboratory-based testing.

Methods and analysis

A randomised, superiority, open-label, trial with two parallel groups. Children presenting to a tertiary paediatric ED at least 3 years of age who have a throat swab ordered for diagnosis of streptococcal pharyngitis will be eligible; those who have taken antibiotics within 72 hours prior to presentation and those with additional active infections will be excluded. The primary study outcome will be appropriate antibiotic treatment at 3–5 days postenrolment. Secondary outcomes include time to symptom resolution, caregiver satisfaction, caregiver/child absenteeism, number of subsequent healthcare visits, clinician satisfaction and incremental cost-effectiveness of POC testing. A total of 352 participants will be needed.

Ethics and dissemination

All study documentation has been approved by the Hamilton Integrated Research Ethics board and informed consent will be obtained from all participants. Data from this trial will be presented at major conferences and published in peer-reviewed publications to facilitate collaborations with networks of clinicians experienced in the dissemination of clinical guidelines.

Trial registration number

NCT04247243.
Efficacy of therapeutic fasting and plant-based diet in patients with rheumatoid arthritis (NutriFast): study protocol for a randomised controlled clinical trial
Authors: Hartmann Anika M , Dell"Oro Melanie , Kessler Christian S , Schumann Dania , Steckhan Nico , Jeitler Michael , Fischer Jan Moritz , Spoo Michaela , Kriegel Martin A , Schneider Jochen G , Häupl Thomas , Kandil Farid I , Michalsen Andreas , Koppold-Liebscher Daniela A
Published: August 2021

Background

Previous studies have shown beneficial effects of therapeutic fasting and plant-based dietary interventions on disease activity in patients with rheumatoid arthritis (RA) for a duration of up to 1 year. To date, the effects of such interventions on the gut microbiome and on modern diagnostic markers in patients with RA have not been studied. This trial aims to investigate the clinical effects of therapeutic fasting and a plant-based diet in patients with RA, additionally considering current immunological diagnostic tools and microbiome analyses.

Methods/design

This trial is an open-label, single-centre, randomised, controlled, parallel-group clinical trial. We will randomly assign 84 patients with RA under a stable standard therapy to either (1) therapeutic fasting followed by a plant-based dietary intervention or (2) to a conventional nutritional counselling focusing on an anti-inflammatory dietary pattern according to the recommendations of the Deutsche Gesellschaft für Ernährung (German society for nutrition). Primary outcome parameter is the group difference from baseline to 12 weeks on the Health Assessment Questionnaire (HAQ). Other secondary outcomes include established clinical criteria for disease activity and treatment response in RA (Disease Activity Score 28, Simple Disease Activity Index, ACR-Response Criteria), changes in self-reported health and physical functional ability, mood, stress, quality of life, dietary behaviour via 3-day food records and a modified Food Frequency Questionnaire, body composition, changes in the gut microbiome, metabolomics and cytometric parameters. Outcomes will be assessed at baseline and day 7, after 6 weeks, 12 weeks and after 6 months.

Ethics and dissemination

Ethical approval to process and analyse data, and to publish the results was obtained through the institutional review board of Charité-Universitätsmedizin Berlin. Results of this trial will be disseminated through peer-reviewed publications and scientific presentations.

Trial registration number

NCT03856190.
Sexually transmitted infections and prior antibiotic use as important causes for negative urine cultures among adults presenting with urinary tract infection symptoms to primary care clinics in Zimbabwe: a cross-sectional study
Authors: Olaru Ioana D , Chisenga Mutsawashe , Yeung Shunmay , Mabey David , Marks Michael , Chonzi Prosper , Masunda Kudzai PE , Machiha Anna , Ferrand Rashida A , Kranzer Katharina
Published: August 2021

Objective

Urinary tract infections (UTIs) are common in primary care. The yield of urine cultures in patients with UTI symptoms can be considerably different between high-income and low-income settings. This study aimed to explore possible causes of negative urine cultures in patients presenting with symptoms of UTI to primary health clinics in Harare.

Design

Cross-sectional study.

Setting

Nine primary health clinics in Harare, Zimbabwe.

Participants

Adults presenting with symptoms of UTIs between March and July 2020.

Primary outcome measures

Urine samples underwent dipstick testing, microscopy, culture, and testing for sexually transmitted infections (STIs) using GeneXpert and for the presence of antibiotic residues using an antibiotic bioassay. The primary outcomes were the number and proportion of participants with evidence of STIs, prior antibiotic exposure, leucocyturia and UTIs.

Results

The study included 425 participants with a median age of 37.3 years, of whom 275 (64.7%) were women. Leucocyturia was detected in 130 (30.6%, 95% CI 26.2% to 35.2%) participants, and 96 (22.6%, 95% CI 18.7% to 26.9%) had a positive urine culture for a uropathogen.Chlamydia trachomatis,Neisseria gonorrhoeaeandTrichomonas vaginaliswere detected in 43/425 (10.1%, 95% CI 7.4% to 13.4%), 37/425 (8.7%, 95% CI 6.2% to 11.8%) and 14/175 (8.0%, 95% CI 4.4% to 13.1%) participants, respectively. Overall, 89 (20.9%, 95% CI 17.2% to 25.1%) participants reported either having taken prior antibiotics or having had a positive urine bioassay. In 170 (40.0%, 95% CI 35.3% to 44.8%) participants, all of the tests that were performed were negative.

Conclusions

This study found a high prevalence of STIs and evidence of prior antimicrobial use as possible explanations for the low proportion of positive urine cultures.
Loddon Mallee healthcare worker COVID-19 study—protocol for a prospective cohort study examining the health and well-being of rural Australian healthcare workers during the COVID-19 pandemic
Authors: McEvoy Mark , Parker Carol , Crombie Angela , Skinner Timothy C , Begg Stephen , Faulkner Peter , McEvoy Anne , Bamforth Laura , Caccaviello Gabriel
Published: August 2021

Introduction

The COVID-19 pandemic is creating immense psychosocial disturbance. While global, broad-based research is being conducted, little is known about the effects of the COVID-19 pandemic on health and well-being or how protective and resilience factors influence the human response in Australian rural and regional communities. Rural and regional communities often have less resources to deal with such public health emergencies and face additional environmental adversity. Healthcare workers, including those in rural and regional areas, have felt the immediate impacts of COVID-19 in a multitude of ways and these impacts will continue for years to come. Therefore, this study aims to describe and understand the impacts of the COVID-19 pandemic on the rural and regional healthcare workforce within the Loddon Mallee region, Victoria, Australia.

Methods and analysis

This prospective cohort of rural and regional healthcare workers will be recruited and followed over 3 years to examine the effects of the COVID-19 pandemic on their health and well-being. Self-administered online questionnaires will be administered every 6 months for a 36-month period. Multiple outcomes will be assessed; however, the primary outcomes are emotional health and well-being and psychological resilience. Emotional health and well-being will be measured using validated instruments that will assess multiple domains of the emotional health and well-being continuum.

Linear and logistic regression and latent growth curve modelling will be used to examine the association between baseline and follow-up participant emotional health, well-being and resilience while adjusting for potentially time-varying confounding variables. Participant characteristics measured at baseline will also be tested for association with incident health, morbidity, mortality and health service utilisation outcomes at follow-up.

Ethics and dissemination

Ethical approval has been obtained through the Bendigo Health Human Research Ethics Committee. The study findings will be disseminated through international conferences, international peer-reviewed journals and social media.

Trial registration number

ACTRN12620001269921.
Impact of the COVID-19 pandemic on radiology appointments in a tertiary children’s hospital: a retrospective study
Authors: Langan Dean , Shelmerdine Susan , Taylor Andrew , Bryant William A , Booth John , Sebire Neil J , Arthurs Owen , Cortina-Borja Mario
Published: August 2021

In this retrospective observational study, we evaluated the impact of the COVID-19 pandemic in London on paediatric radiology activity, as a surrogate of overall hospital activity. We showed a large reduction in overall outpatient imaging activity: 49 250 records occurred in the 371 days post COVID-19 period compared with an expected 67 806 records pre COVID-19 period, representing 18 556 ‘missed’ records. Governmental restrictions were associated with reductions in activity, with the largest reduction in activity during tiers 3 and 4 restrictions. Rescheduling such missed outpatients’ appointments represents considerable resource planning and the associated clinical impact on paediatric healthcare remains to be determined.
Percutaneous cervical cordotomy for chest wall pain from mesothelioma in the setting of neuromyelitis
Authors: McMorrow Fintan , Owen Margaret
Published: August 2021

A 75-year-old man presented to our Interventional Cancer Pain service for consideration of a percutaneous cervical cordotomy (PCC) to control severe chest wall pain secondary to malignant mesothelioma. His medical history included a neuroinflammatory disorder, neuromyelitis optica, for which he had previously had a prolonged hospital admission, with ongoing neurological deficit. Little information is available regarding the safety of PCC in a patient with this condition, specifically the risk of neurological relapse, and we were initially wary about going ahead. After discussion with the patient’s neurology team and other UK experts and with the patient’s informed consent, we proceeded to PCC with additional steroid cover. No adverse neurological symptoms were encountered perioperatively or postoperatively and the patient had an excellent analgesic result. As this combination of circumstances has not to our knowledge been documented, we wished to present this case and discuss the factors affecting our decision and management.
In-programme leadership development for psychiatric higher trainees: The Royal College of Psychiatrists’ Leadership and Management Fellow Scheme
Authors: Bagepalli-Krishnan Deepa , Gibson Russell , Goyal Satnam , Ko Ba Min (Adam) , Till Alex , Crimlisk Helen
Published: August 2021

Introduction

The Royal College of Psychiatrists’ (RCPsych) Leadership and Management Fellow Scheme was established to develop and support a new cohort of medical leaders within psychiatry. Sponsored and mentored by a trainee's local education provider, the scheme combines a high-impact national leadership and management training programme, with a novel in-programme apprenticeship model, where Fellows gain local leadership experience.

Method

An internal review team conducted a mixed-methods evaluation of feedback from Fellows and Mentors on the scheme’s structure, delivery, provision of individual leadership development and the impact fellows had on their teams and the organisations within which they were embedded.

Results

With a response rate of 67% (n=20) from Fellows and 30% (n=7) from Mentors, a clear benefit from the scheme was observed, alongside opportunities for improvement. Strengths of the scheme included the bespoke in-programme design, mentoring from a senior medical leader, networking opportunities, and experiential learning through local leadership experience, which additionally promoted medical engagement within organisations. Opportunities for improvement included strengthening existing offers, particularly mentoring relationships and enhancing the network established between fellows.

Conclusions

A bespoke, uniprofessional and in-programme leadership and management fellow scheme can play an important role in the development of future medical leaders within psychiatry.
Intracranial perianeurysmal cysts: case series and review of the literature
Authors: Liang Ee Shern , Efendy Michael , Winter Craig , Coulthard Alan
Published: August 2021

Background

Intracranial perianeurysmal cysts are a rare finding associated with cerebral aneurysms. Patients may present with symptoms secondary to mass effect from perianeurysmal cysts requiring drainage. These lesions can masquerade as neoplasms if dedicated vascular imaging is not performed, leading to misdiagnosis.

Method

A retrospective search of our database was done for intracranial aneurysms that have been treated between 1998 and 2020. A literature search was then performed on PubMed and Google Scholar with the search terms ‘aneurysm’, ‘intracranial/intracerebral’, ‘cyst’, and ‘perianeurysmal cyst’. Patient demographics, aneurysms and cysts characteristics were then summarized as a table and in the discussion.

Results

Three cases where intracranial aneurysm had associated perianeurysmal cysts were found in our database. Combined with the available literature a total of 19 cases of perianeurysmal cysts have thus far been reported since this entity was first described in 2002. A significant number of perianeurysmal cysts (5/19) required intervention. In 5/19 cases the patient presented with a perianeurysmal cyst without a history of subarachnoid hemorrhage. Of the 10 cases where aneurysm follow-up was reported there were 5 cases where there was aneurysm recurrence necessitating re-treatment.

Conclusion

Significant variability exists in the patient demographics, aneurysm and cyst characteristics of perianeurysmal cysts. This suggests that there is no single unified etiology and pathogenesis. These lesions are a rare finding and at present do not appear to carry diagnostic or prognostic significance. Management of perianeurysmal cysts is case-dependent and intervention should be considered when treating the related aneurysm, especially in patients with secondary symptoms.