bluuebunny/crossref_metadata_2025 huggingface dataset:
Photographing My Mother's ‘Deathbed Scene’
Authors: Welldon Dan
Published: January 2021

I describe the process by which I prepared to photograph my mother's deathbed scene. My researches led me to realize that a reluctance to document death is a very recent phenomenon. Famous deathbed paintings tended to be grand canvasses, or closer, more intimate paintings of the artist's loved ones. In capturing my mother's deathbed scene I chose a synthesis of these two styles, presenting a wider view of the scene in the tones of a textured palette of a painting, but with an intimate feel.
Listening to children: Evaluation of a positive parenting programme through art‐based research
Authors: Mateos Ainoa , Balsells M. Àngels , Fuentes‐Peláez Nuria , Rodrigo María José
Published: January 2021

This paper presents data from a unique programme evaluation of the parenting programme titled ‘Learning together, growing as a family’ applied in 14 cities in Spain and targeting families at risk of neglectful behaviour. The programme evaluation is based on the voices of children using the qualitative methodology of art‐based research. Eighty‐six children 6–12 years of age were interviewed in groups. The outcomes of the evaluation reveal that children perceive improvements in the parental competencies of their parents and in themselves and that these changes serve as a catalyst for positive family change.
Identification and quantification of CI Reactive Blue 19 dye degradation product in soil
Authors: Feng Chengcheng , Sui Xinyi , Ankeny Mary Ann , Vinueza Nelson R.
Published: January 2021

Landfills are becoming the most common way to dispose textiles. The presence of different types of dyes and finishes on textiles fabrics can become an important source of pollution during the degradation process, due to the fact that these chemicals can leach to the soil. The biodegradation of dyes from dyed fabrics is not fully understood, and what can leach into the soil can be more toxic. In this study, cotton fabrics were dyed with CI Reactive Blue 19 (RB19) and biodegraded in soil in a laboratory‐controlled environment for a 90‐day time interval by using the ASTM D 5988‐18 method. A modified QuEChERS (quick, easy, cheap, effective, rugged, and safe) extraction method, in combination with liquid chromatography‐mass spectrometry (LC‐MS) analysis, was applied to soil containing RB19 after the degradation process. An unknown degradation product, with a mass‐to‐charge ratio (m/z) of 393, found in the soil was characterised and confirmed, via high‐resolution MS and tandem MS, to be CI Acid Blue 25 (AB25). To quantify the confirmed unknown product extracted from the degraded soil sample, a quantitation method was developed using high‐performance liquid chromatography‐diode array detector‐mass spectrometry (HPLC‐DAD‐MS). The quantitation method provided excellent linearity (R2 = 0.9990 ± 0.0006), accuracy (mean percentage error = 5.17 ± 1.88), precision (mean percentage coefficient of variation = 4.73 ± 4.16), and sensitivity (lower limit of quantitation = 1.29 ± 0.47 µg/mL) for nine concentrations ranging from 0.5 to 40 µg/mL.
Establishing a clinical high‐risk program in Tunisia, North Africa: A pilot study in early detection and identification
Authors: Ventura Joseph , Jouini Lamia , Aissa Amina , Larnaout Amine , Nefzi Rahma , Ghazzai Malek , Jelili Sélima , Fekih‐Romdhane Feten , Ouali Uta , Nacef Fethi
Published: January 2021

Background

Early identification and prevention research has provided huge advances in our understanding of early screening and identification of young people at clinical high‐risk (CHR). Most of these procedures were developed in high‐income countries, yet middle‐income countries in North Africa such as Tunisia can benefit from these empirically‐based assessment approaches.

Methods

Using established procedures, nine Tunisian psychiatric raters were trained on structured assessments: the CAARMS, BPRS, and SCID to high standards of interrater reliability. These raters developed a clinical high‐risk program (CHiRP) in Tunisia and recruited 10 patients who were exhibiting possible signs of CHR. These patients were evaluated to determine if they met criteria for a CHR group, such as Attenuated Psychosis.

Results

Trained raters met the following interrater reliability criteria for the CAARMS and BPRS (ICC = .80 or greater) and the SCID (Kappa = .75 or greater). Of 10 pilot patients, six were classified as CHR and belonging to the Attenuated Psychosis Group. One of the six patients converted to psychosis 3 months after study entry for a conversion rate of 17% which is comparable with currently published rates globally.

Discussion

The first CHR program has been established in Tunisia, a middle‐income country using methods developed in high income countries. Efforts aimed at assembling a group of prevention‐oriented psychiatrists, obtaining administrative support, and training raters to high levels of interrater reliability were successful. The feasibility was demonstrated for screening, assessing, treating, and following‐up of 10 CHR patients suggesting that conversion rates are comparable to those of Western and European countries.
Temporal complementarity in activity‐density of two arthropod macro‐detritivore taxa
Authors: De Smedt Pallieter , Proesmans Willem , Baeten Lander
Published: January 2021

Macro‐detritivores are important fragmenters performing a first step in the ecosystem process of nutrient cycling. Woodlice and millipedes are important representatives of this group and their ecology and niche requirements are often regarded as very similar. However, it is unclear whether there is a difference in temporal activity throughout the year between both groups, possibly leading to temporal complementarity for leaf litter breakdown, and whether patterns of temporal variation in activity are consistent across different habitat types.

We studied year‐round pitfall‐trap data of woodlice and millipedes from an old sand quarry with a high habitat heterogeneity.

Our results indicate that there is high temporal complementarity between both detritivore taxa, with millipede activity‐density peaking in spring, while woodlice showing a peak in summer. Interestingly, timing of activity depended on habitat openness. Millipedes peak first in open habitat and later in closed habitat, while woodlice showed the opposite pattern.

Temporal turnover in community composition was high and of similar magnitude as spatial turnover in community composition across this relatively small scale of our study area.

We conclude that, although woodlice and millipedes show comparable habitat preferences, their temporal activity patterns show the potential for temporal complementarity for litter breakdown.
Kruppel‐like factor 15 regulates fuel switching between glucose and fatty acids in brown adipocytes
Authors: Nabatame Yuko , Hosooka Tetsuya , Aoki Chikako , Hosokawa Yusei , Imamori Makoto , Tamori Yoshikazu , Okamatsu‐Ogura Yuko , Yoneshiro Takeshi , Kajimura Shingo , Saito Masayuki , Ogawa Wataru
Published: January 2021

Aims/Introduction

Brown adipose tissue (BAT) utilizes large amounts of fuel for thermogenesis, but the mechanism by which fuel substrates are switched in response to changes in energy status is poorly understood. We have now investigated the role of Kruppel‐like factor 15 (KLF15), a transcription factor expressed at a high level in adipose tissue, in the regulation of fuel utilization in BAT.

Materials and Methods

Depletion or overexpression of KLF15 in HB2 differentiated brown adipocytes was achieved by adenoviral infection. Glucose and fatty acid oxidation were measured with radioactive substrates, pyruvate dehydrogenase complex activity was determined with a colorimetric assay, and gene expression was examined by reverse transcription and real‐time polymerase chain reaction analysis.

Results

Knockdown of KLF15 in HB2 cells attenuated fatty acid oxidation in association with downregulation of the expression of genes related to this process including Acox1 and Fatp1, whereas it increased glucose oxidation. Expression of the gene for pyruvate dehydrogenase kinase 4 (PDK4), a negative regulator of pyruvate dehydrogenase complex, was increased or decreased by KLF15 overexpression or knockdown, respectively, in HB2 cells, with these changes being accompanied by a respective decrease or increase in pyruvate dehydrogenase complex activity. Chromatin immunoprecipitation showed that Pdk4 is a direct target of KLF15 in HB2 cells. Finally, fasting increased expression of KLf15, Pdk4 and genes involved in fatty acid utilization in BAT of mice, whereas refeeding suppressed Klf15 and Pdk4 expression.

Conclusions

Our results implicate KLF15 in the regulation of fuel switching between glucose and fatty acids in response to changes in energy status in BAT.
Determining the material intensities of buildings selected by random sampling: A case study from Vienna
Authors: Lederer Jakob , Fellner Johann , Gassner Andreas , Gruhler Karin , Schiller Georg
Published: January 2021

Many studies calculate the material stock of buildings by using material intensities and reference values for building dimensions. Often, they lack a clear definition of and transparency in the selection of buildings to be analyzed, as well as adequate description for the determination of the material intensities of buildings. This article presents a randomized selection of buildings and determination of their material intensities using the case study of Vienna. On the basis of a digital geo‐information building model, buildings were categorized according to their age, use, and volume. From each category, samples were randomly selected and their material intensities as well as different building dimensions were determined based on building documents such as plans. The building dimensions were used to express the material intensities related to different reference values. The 256 objects analyzed correspond to a sample size of 0.11% relative to the total number and 0.22% relative to the total gross volume of objects in Vienna. Although the total material intensities were comparable to other studies, the material intensities of insulation materials in older buildings were found to be higher in this study because of a higher representativeness of the data used. In addition, the expression of the material intensities related to different reference values such as area or volume of buildings improved comparability with other studies. Nevertheless, further research is required, particularly concerning the selection of representative samples of buildings.
Aortic dissection during pregnancy and puerperium: A Japanese nationwide survey
Authors: Tanaka Hiroaki , Kamiya Chizuko A. , Horiuchi Chinami , Morisaki Hiroko , Tanaka Kayo , Katsuragi Shinji , Hayata Eijiro , Hasegawa Junichi , Nakata Masahiko , Sekizawa Akihiko , Ishiwata Isamu , Ikeda Tomoaki
Published: January 2021

Aim

This study aimed to characterize the incidence and clinical significance of pregnancy‐related aortic dissection using a large‐scale survey in Japan.

Methods

A questionnaire requesting the detailed information included in the clinical charts of pregnancy‐related aortic dissection cases (without any personally identifying information) was designed between 2013 and 2017 and administered to 407 perinatal centers in Japan. The response rate was 70.5%. Seventeen cases of pregnancy‐related aortic dissection were identified.

Results

Maternal death due to aortic dissection was observed in nine patients (56.2%) while seven survived (43.8%). Dissection occurred during the postpartum period in 10 cases (62.5%), the third trimester in 4 (25.0%), labor in 1 (6.2%), and the second trimester in 1 (6.2%). The most common underlying diseases were: Marfan syndrome (25.0%), Loeys‐Dietz syndrome (6.2%), hypertension (6.2%), and Takayasu aortitis (6.2%). Stanford type A aortic dissection was associated with maternal death during both pregnancy and the postpartum period. However, deceased patients showed lower rates of pre‐diagnosed connective tissue disease than did survivors.

Conclusions

The mortality rate of aortic dissection that occurred during pregnancy or postnatal periods was more than 50%. Aortic dissection occurred more frequently in the postnatal period than during pregnancy, and less frequently in women previously diagnosed with connective tissue disease than in women without any medical history of aortic disorders. If symptoms suggestive of aortic dissection, such as severe back pain, are observed, even after the end of pregnancy, exhaustive diagnostic examinations should be carried out.
Micro‐CT imaging of Onchocerca infection of Simulium damnosum s.l. blackflies and comparison of the peritrophic membrane thickness of forest and savannah flies
Authors: Hall M. J. R. , Martín‐Vega D. , Clark B. , Ghosh D. , Rogers M. , Pigoli D. , Veriegh F. B. D. , Tetteh‐Kumah A. , Osei‐Atweneboana M. Y. , Cheke R. A.
Published: January 2021

Onchocerciasis is a neglected tropical disease (NTD) caused by Onchocerca Diesing 1841 (Spirurida: Onchocercidae) nematodes transmitted by blackflies. It is associated with poverty and imposes a significant health, welfare and economic burden on many tropical countries. Current methods to visualize infections within the vectors rely on invasive methods. However, using micro‐computed tomography techniques, without interference from physical tissue manipulation, we visualized in three dimensions for the first time an L1 larva of an Onchocerca species within the thoracic musculature of a blackfly, Simulium damnosum s.l. Theobald 1903 (Diptera: Simuliidae), naturally infected in Ghana. The possibility that thicker peritrophic membranes in savannah flies could account for their lower parasite loads was not supported, but there were limits to our analysis. While there were no statistically significant differences between the mean thicknesses of the peritrophic membranes, in the anterior, dorsal and ventral regions, of forest and savannah blackflies killed 34–48 min after a blood‐meal, the thickness of the peritrophic membrane in the posterior region could not be measured. Micro‐computed tomography has the potential to provide novel information on many other parasite/vector systems and impactful images for public engagement in health education.
Neuropathology of genetically defined malformations of cortical development—A systematic literature review
Authors: Brock Stefanie , Cools Filip , Jansen Anna C.
Published: January 2021

Aims

Malformations of cortical development (MCD) include a heterogeneous spectrum of clinical, imaging, molecular and histopathological entities. While the understanding of genetic causes of MCD has improved with the availability of next‐generation sequencing modalities, genotype‐histopathological correlations remain limited. This is the first systematic review of molecular and neuropathological findings in patients with MCD to provide a comprehensive overview of the literature.

Methods

A systematic review was performed between November 2019 and February 2020. A MEDLINE search was conducted for 132 genes previously linked to MCD in order to identify studies reporting macroscopic and/or microscopic findings in patients with a confirmed genetic cause.

Results

Eighty‐one studies were included in this review reporting neuropathological features associated with pathogenic variants in 46 genes (46/132 genes, 34.8%). Four groups emerged, consisting of (1) 13 genes with well‐defined histological‐genotype correlations, (2) 27 genes for which neuropathological reports were limited, (3) 5 genes with conflicting neuropathological features, and (4) 87 genes for which no histological data were available. Lissencephaly and polymicrogyria were reported most frequently. Associated brain malformations were variably present, with abnormalities of the corpus callosum as most common associated feature.

Conclusions

Neuropathological data in patients with MCD with a defined genetic cause are available only for a small number of genes. As each genetic cause might lead to unique histopathological features of MCD, standardised thorough neuropathological assessment and reporting should be encouraged. Histological features can help improve the understanding of the pathogenesis of MCD and generate hypotheses with impact on further research directions.
Supratentorial ependymoma with YAP1:FAM118B fusion: A case report
Authors: Wang Jian , Wang Liang , Fu Lin , Li Qing‐Chang , Qiu Xue‐Shan , Wang En‐Hua , Yu Juan‐Han
Published: January 2021

We report a case of a 26‐year‐old Chinese man who had experienced three grand mal seizures in the past two months. Magnetic resonance imaging revealed a relatively well‐circumscribed lesion in the left frontal lobe. A craniotomy with total excision of the tumor was performed. Histopathological investigations confirmed a grade 2 ependymoma according to the World Health Organization classification. Genetic analysis revealed a tumor harboring FAM118B fusion to YAP1, and no other genetic alterations or methylation of the O6‐methylguanine‐DNA methyltransferase gene promoter were detected. This is the second case report of ependymoma with YAP1:FAM118B fusion.
A Bayesian Network Model for Seismic Risk Analysis
Authors: Zhang Y. , Weng W.G.
Published: January 2021

Earthquakes are one of the most unpredictable natural disasters. A series of secondary and derived disaster events may occur afterwards and lead to even more consequences. In such situations, a seismic risk analysis that takes into account secondary and derived disaster events is vital in reducing the risks of such disasters. The absence of a holistic seismic risk analysis model—one that takes into account the derived disaster events—may mean that the serious consequences of the disaster chains set off by earthquakes are neglected. This article proposes a comprehensive seismic risk analysis that enables a better understanding of seismic disaster chains and rescue scenarios. The approach is based on a Bayesian network constructed using scenario‐based methods. The final network structure is achieved by learning parameters. To determine the critical secondary disasters and the key emergency‐response measures, probability adaptation and updating using the Bayesian model were performed. The practical application of the model is illustrated using the Wenchuan earthquake and the Jiuzhaigou earthquake in China. The two examples show that the model can be used to predict the potential effects of secondary disasters and the final seismic losses. The results of the model can help decisionmakers gain a comprehensive understanding of seismic risk and implement practical emergency‐rescue measures to reduce risk and losses.
Identity Leadership in a Crisis: A 5R Framework for Learning from Responses to COVID‐19
Authors: Haslam S. Alexander , Steffens Niklas K. , Reicher Stephen D. , Bentley Sarah V.
Published: January 2021

The COVID‐19 pandemic is the greatest global crisis of our lifetimes, and leadership has been critical to societies’ capacity to deal with it. Here effective leadership has brought people together, provided a clear perspective on what is happening and what response is needed, and mobilized the population to act in the most effective ways to bring the pandemic under control. Informed by a model of identity leadership (Haslam, Reicher & Platow, 2020), this review argues that leaders’ ability to do these things is grounded in their ability to represent and advance the shared interests of group members and to create and embed a sense of shared social identity among them (a sense of “us‐ness”). For leaders, then, this sense of us‐ness is the key resource that they need to marshal in order to harness the support and energy of citizens. The review discusses examples of the successes and failures of different leaders during the pandemic and organizes these around five policy priorities related to the 5Rs of identity leadership: readying, reflecting, representing, realizing, and reinforcing. These priorities and associated lessons are relevant not only to the management of COVID‐19 but to crisis management and leadership more generally.
A model ensemble approach to determine the humus building efficiency of organic amendments in incubation experiments
Authors: Gasser Anton A. , Diel Julius , Nielsen Kerstin , Mewes Paul , Engels Christof , Franko Uwe
Published: January 2021

Organic amendments are important to sustain soil organic matter (SOM) and soil functions in agricultural soils. Information about the contribution of organic amendments to SOM can be derived from incubation experiments. In this study, data from 72 incubated organic amendments including plant residues, digestates and manure were analysed. The incubation data was compiled from three experimental setups with varying incubation times, soils and incubation temperatures, in which CO2 release was measured continuously. The analysis of the incubation data was performed with an approach relying on conceptual parts of C‐TOOL, CCB, Century, ICBM, RothC and Yasso which are all well‐approved first‐order carbon models that differ in structure and abstraction level. All models are an approximation of reality, whereby each model differs in understanding of the processes involved in soil carbon dynamics. To accumulate the advantages from each model a model ensemble was performed for each substrate. With the ability of each carbon model to compute the distribution of carbon into specific SOM pools a new approach for evaluating organic amendments in terms of humus building efficiency is presented that, depends on the weighted model fit of each ensemble member. Depending on the organic substrate added to the soil, the time course of CO2 release in the incubation studies was predicted with different accuracy by the individual model concepts. Averaging the output of the individual models leads to more robust prediction of SOM dynamics. The EHUM value is easy to interpret and the results are in accordance with the literature.
Detection and analysis of blood donors seropositive for syphilis
Authors: Attie Adriana , de Almeida‐Neto Cesar , S. Witkin Steven , Derriga Juliana , Nishiya Anna S. , Ferreira Jerenice E. , Costa Natalia de Souza Xavier , Alves Salles Nanci , Facincani Tila , Levi Jose E. , Sabino Ester C. , Rocha Vanderson , Mendrone‐Jr Alfredo , Ferreira Suzete C.
Published: January 2021

Background

The increasing incidence of syphilis worldwide has called attention to the risk of transmission by transfusion.

Aims

To determine the prevalence of active syphilis in blood donors and characterise the serological profile of syphilis‐positive donors.

Methods

Samples positive for Treponema pallidum using the chemiluminescent microparticle immunoassay (CMIA) during blood donor screening from 2017 to 2018 were tested by the Venereal Disease Research Laboratory (VDRL) non‐treponemal test and for anti‐T. pallidum IgM by ELISA (Immunoassay Enzyme test for detection of IgM antibodies). The INNO‐LIA Syphilis test (Line Immuno Assay solid test for confirmation antibodies to Treponema pallidum) was performed as a confirmatory test on samples that were positive on ELISA‐IgM but negative on VDRL. ELISA‐IgM (+) samples were also tested for T. pallidum DNA in sera by real‐time polymerase chain reaction (PCR).

Results

Of 248 542 samples screened, 1679 (0.67%) were positive for syphilis by CMIA. Further analysis was performed on 1144 (68.1%) of these samples. Of those tested, 16% were ELISA IgM(+)/VDRL(+), 16.5% were ELISA IgM(−)/VDRL(+), 4.1% were ELISA IgM(+)/VDRL(−), and 63.4% were ELISA IgM (−)/VDRL(−). The INNO‐LIA Syphilis test results were 33 (3%) positive, 2 (0.2%) undetermined and 12 (1%) negative. Of the 230 EIA‐IgM(+) samples (20.1%), 5 (2.2%) were PCR positive. The prevalence of active syphilis in 2017 and 2018 was 0.1% and 0.07%, respectively, and overall prevalence of serologic markers for syphilis was highest among male, unmarried, 25–34‐year‐olds with a high school education and who were first‐time donors.

Conclusion

There is a risk of transfusion‐transmitted syphilis in blood banks that exclusively use the VDRL test for donor screening, as is currently the situation in some Brazilian blood centres, as well as in other blood centres around the world.
Acoustic imaging using unknown random sources
Authors: Prunty Aaron C. , Snieder Roel K. , Sens-Schönfelder Christoph
Published: January 2021

We investigate the feasibility of imaging localized velocity contrasts within a nonattenuating acoustic medium using volume-distributed random point sources. We propose a simple, two-step processing flow that utilizes the linear sampling method to invert for the target locations directly from the recorded waveforms. We present several proof-of-concept experiments using Monte Carlo simulations to generate independent realizations of band limited “white noise” sources, which are randomly distributed in both time and space. Despite the unknown and random character of the illumination on the imaging targets, we show that it is possible to image strong velocity contrasts directly from multiply scattered coda waves in the recorded data. We benchmark the images obtained from the random-source experiments with those obtained by a standard application of the linear sampling method to analogous controlled-source experiments.
Development of optically controlled “living electrodes” with long-projecting axon tracts for a synaptic brain-machine interface
Authors: Adewole Dayo O. , Struzyna Laura A. , Burrell Justin C. , Harris James P. , Nemes Ashley D. , Petrov Dmitriy , Kraft Reuben H. , Chen H. Isaac , Serruya Mijail D. , Wolf John A. , Cullen D. Kacy
Published: January 2021

Engineered neuronal microtissue with bundled axons was grown, controlled using light, and implanted as a living neural interface.
Exosomal delivery of NF-κB inhibitor delays LPS-induced preterm birth and modulates fetal immune cell profile in mouse models
Authors: Sheller-Miller Samantha , Radnaa Enkhtuya , Yoo Jae-Kwang , Choi Kyungsun , Kim Youngeun , Kim Yu Na , Kim Eunsoo , Richardson Lauren , Choi Chulhee , Menon Ramkumar
Published: January 2021

Exosomes engineered to cargo anti-inflammatory drug delay infection-induced preterm birth by reducing fetal inflammatory response.
Observation of electron-induced characteristic x-ray and bremsstrahlung radiation from a waveguide cavity
Authors: Vassholz Malte , Salditt Tim
Published: January 2021

Using a waveguide as an x-ray anode, x-ray emission can be increased in certain directions, based on the Purcell effect.
Evolution of forelimb musculoskeletal function across the fish-to-tetrapod transition
Authors: Molnar J. L. , Hutchinson J. R. , Diogo R. , Clack J. A. , Pierce S. E.
Published: January 2021

Musculoskeletal models of the first vertebrate limbs reveal adaptations for propulsion, but not weight support.
Wearable plasmonic-metasurface sensor for noninvasive and universal molecular fingerprint detection on biointerfaces
Authors: Wang Yingli , Zhao Chen , Wang Jingjing , Luo Xuan , Xie Lijuan , Zhan Shijie , Kim Jongmin , Wang Xiaozhi , Liu Xiangjiang , Ying Yibin
Published: January 2021

A wearable plasmonic-electronic sensor can noninvasively extract and “fingerprint” various molecules inside human body.
Revisiting evidence for widespread seismicity in the upper mantle under Los Angeles
Authors: Yang Lei , Liu Xin , Beroza Gregory C.
Published: January 2021

Previously reported widespread seismicity in the mantle under Los Angeles is likely a processing artifact.
Randomized Controlled Trial of the Electrocardiographic Effects of Four Antimalarials for Pregnant Women with Uncomplicated Malaria on the Thailand-Myanmar Border
Authors: Saito Makoto , Yotyingaphiram Widi , Cargill Zillah , Gilder Mary Ellen , Min Aung Myat , Phyo Aung Pyae , San Thi Dar , Poe Hilda , Chu Cindy , White Nicholas J. , Nosten François , McGready Rose
Published: January 2021

Quinoline antimalarials cause drug-induced electrocardiograph QT prolongation, a potential risk factor for torsade de pointes. The effects of currently used antimalarials on the electrocardiogram (ECG) were assessed in pregnant women with malaria.
Automated detection of patients with dementia whose symptoms have been identified in primary care but have no formal diagnosis: a retrospective case–control study using electronic primary care records
Authors: Ford Elizabeth , Sheppard Joanne , Oliver Seb , Rooney Philip , Banerjee Sube , Cassell Jackie A
Published: January 2021

Objectives

UK statistics suggest only two-thirds of patients with dementia get a diagnosis recorded in primary care. General practitioners (GPs) report barriers to formally diagnosing dementia, so some patients may be known by GPs to have dementia but may be missing a diagnosis in their patient record. We aimed to produce a method to identify these ‘known but unlabelled’ patients with dementia using data from primary care patient records.

Design

Retrospective case–control study using routinely collected primary care patient records from Clinical Practice Research Datalink.

Setting

UK general practice.

Participants

English patients aged >65 years, with a coded diagnosis of dementia recorded in 2000–2012 (cases), matched 1:1 with patients with no diagnosis code for dementia (controls).

Interventions

Eight coded and nine keyword concepts indicating symptoms, screening tests, referrals and care for dementia recorded in the 5 years before diagnosis. We trialled machine learning classifiers to discriminate between cases and controls (logistic regression, naïve Bayes, random forest).

Primary and secondary outcomes

The outcome variable was dementia diagnosis code; the accuracy of classifiers was assessed using area under the receiver operating characteristic curve (AUC); the order of features contributing to discrimination was examined.

Results

93 426 patients were included; the median age was 83 years (64.8% women). Three classifiers achieved high discrimination and performed very similarly. AUCs were 0.87–0.90 with coded variables, rising to 0.90–0.94 with keywords added. Feature prioritisation was different for each classifier; commonly prioritised features were Alzheimer’s prescription, dementia annual review, memory loss and dementia keywords.

Conclusions

It is possible to detect patients with dementia who are known to GPs but unlabelled with a diagnostic code, with a high degree of accuracy in electronic primary care record data. Using keywords from clinic notes and letters improves accuracy compared with coded data alone. This approach could improve identification of dementia cases for record-keeping, service planning and delivery of good quality care.
Preferences for life-sustaining treatment in Korean adults: a cross-sectional study
Authors: Youn HyunChul , Lee Suk-young , Jung Han-yong , Kim Shin-Gyeom , Kim Seung‑Hyun , Jeong Hyun-Ghang
Published: January 2021

Objectives

Life-sustaining treatment is any treatment that serves to prolong life without reversing the underlying medical conditions, and includes cardiopulmonary resuscitation, mechanical ventilation, haemodialysis and left ventricular assist devices. This study aimed to investigate the thoughts on life-sustaining treatment of Koreans and to assess the factors associated with deciding to not receive life-sustaining treatment if they develop a terminal disease.

Design

Cross-sectional study.

Setting

Guro-gu centre for dementia from 1 May 2018 to 31 December 2019.

Participants

In total, 150 individuals participated in this study.

Outcome measures

The questionnaire consisted of self-report items with some instructions, demographic characteristics, thoughts on life-sustaining treatment and psychosocial scales. The preferences of the participants were investigated on the assumption that they develop terminal cancer. The psychosocial scales included the Generalised Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), Connor–Davidson Resilience Scale and Multidimensional Scale of Perceived Social Support (MSPSS).

Results

We classified our participants into two groups: individuals who wanted to receive life-sustaining treatment (IRLT) and individuals who wanted to not receive life-sustaining treatment (INLT). There were twice as many participants in the INLT group than there were in the IRLT. In making this decision, the INLT group focused more on physical and mental distress. Additionally, 32.7% of participants responded that terminal status was an optimal time for this decision, but more participants want to decide it earlier. The GAD-7 and PHQ-9 scores were significantly higher in the INLT group than in the IRLT group. However, the INLT group had significantly lower MSPSS family scores.

Conclusion

Our findings can help assess issues regarding advance directives and life-sustaining treatment, and will be a reference for designing future studies on this issue.
Does the UKCAT predict performance in medical and dental school? A systematic review
Authors: Greatrix Rachel , Nicholson Sandra , Anderson Susan
Published: January 2021

Objectives

For the first time, this systematic review provides a summary of the literature exploring the relationship between performance in the UK Clinical Aptitude Test (UKCAT) and assessments in undergraduate medical and dental training.

Design

In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis, relevant studies were identified through systematic literature searches. Electronic searches were carried out on EBSCO, EMBASE, Educational Resources Information Centre, SCOPUS, Web of Knowledge. Studies which included the predictive validity of selection criteria including some element of the UKCAT were considered.

Results

22 papers were identified for inclusion in the study. Four studies describe outcomes from dental programmes with limited results reported. 18 studies reported on relationships between the UKCAT and performance in undergraduate medical training. Of these, 15 studies reported relationships between the UKCAT cognitive tests and undergraduate medical assessments. Weak relationships (r=0.00–0.29) were observed in 14 of these studies; four studies reported some moderate relationships (r=0.30–0.49). The strongest relationships with performance in medical school were observed for the UKCAT total score and the verbal reasoning subtest. Relationships with knowledge-based assessments scores were higher than those for assessments of skills as the outcome. Relationships observed in small (single and double centre studies) were larger than those observed in multicentre studies.

Conclusion

The results indicate that UKCAT scores predict performance in medical school assessments. The relationship is generally weak, although noticeably stronger for both the UKCAT total score and the verbal reasoning subtest. There is some evidence that UKCAT continues to predict performance throughout medical school. We recommend more optimal approaches to future studies. This assessment of existing evidence should assist medical/dental schools in their evaluation of selection processes.
Randomised controlled trial to assess efficacy of pelvic floor muscle training on bowel symptoms after low anterior resection for rectal cancer: study protocol
Authors: Asnong Anne , D"Hoore André , Van Kampen Marijke , Devoogdt Nele , De Groef An , Sterckx Kim , Lemkens Hilde , Wolthuis Albert , Van Molhem Yves , Van Geluwe Bart , Debrun Lynn , Geraerts Inge
Published: January 2021

Introduction

Radical surgery after a total mesorectal excision (TME) for rectal cancer often results in a significant decrease in the patient’s quality of life, due to functional problems such as bowel, urinary and sexual dysfunction. The effect of pelvic floor muscle training (PFMT) on these symptoms has been scarcely investigated. We hypothesise that the proportion of successful patients will be significantly higher in the intervention group, receiving 12 weeks of PFMT, compared with the control group without treatment. The primary outcome of this trial is the severity of bowel symptoms, measured through the Low Anterior Resection Syndrome questionnaire, 4 months after TME or stoma closure. Secondary outcomes are related to other bowel and urinary symptoms, sexual function, physical activity and quality of life.

Methods and analysis

This research protocol describes a multicentre single blind prospective, randomised controlled trial. Since January 2017, patients treated for rectal cancer (n=120) are recruited after TME in three Belgian centres. One month following surgery or, in case of a temporary ileostomy, 1 month after stoma closure, patients are randomly assigned to the intervention group (n=60) or to the control group (n=60). The assessments concern the preoperative period and 1, 4, 6, 12 and 24 months postoperatively.

Ethics and dissemination

The study will be conducted in accordance with the Declaration of Helsinki. Ethics approval was granted by the local Ethical Committee of the University Hospitals Leuven (s59761) and positive advice from the others centres has been obtained. Dissemination of the results will be accomplished via guidelines and (non-)scientific literature for professionals as well as organisation of patient symposia.

Trial registration number

NTR6383.
Research Evaluation Alongside Clinical Treatment in COVID-19 (REACT COVID-19): an observational and biobanking study
Authors: Burke Hannah , Freeman Anna , Dushianthan Ahilanandan , Celinski Michael , Batchelor James , Phan Hang , Borca Florina , Kipps Christopher , Thomas Gareth J , Faust Saul N , Sheard Natasha , Williams Sarah , Fitzpatrick Paul , Landers Dónal , Wilkinson Tom
Published: January 2021

Introduction

The COVID-19 pandemic caused by SARS-CoV-2 places immense worldwide demand on healthcare services. Earlier identification of patients at risk of severe disease may allow intervention with experimental targeted treatments, mitigating the course of their disease and reducing critical care service demand.

Methods and analysis

This prospective observational study of patients tested or treated for SARS-CoV-2, who are under the care of the tertiary University Hospital Southampton NHS Foundation Trust (UHSFT), captured data from admission to discharge; data collection commenced on 7 March 2020. Core demographic and clinical information, as well as results of disease-defining characteristics, was captured and recorded electronically from hospital clinical record systems at the point of testing. Manual data were collected and recorded by the clinical research team for assessments which are not part of the structured electronic healthcare record, for example, symptom onset date. Thereafter, participant records were continuously updated during hospital stay and their follow-up period. Participants aged >16 years were given the opportunity to provide consent for excess clinical sample storage with optional further biological sampling. These anonymised samples were linked to the clinical data in the Real-time Analytics for Clinical Trials platform and were stored within a biorepository at UHSFT.

Ethics and dissemination

Ethical approval was obtained from the HRA Specific Review Board (REC 20/HRA/2986) for waiver of informed consent for the database-only cohort; the procedures conform with the Declaration of Helsinki. The study design, protocol and patient-facing documentation for the biobanking arm of the study have been approved by North West Research Ethics Committee (REC 17/NW/0632) as an amendment to the National Institute for Health Research Southampton Clinical Research Facility-managed Southampton Research Biorepository. This study will be published as peer-reviewed articles and presented at conferences, presentations and workshops.
Environmentally sustainable emergency medicine
Authors: Spruell Timothy , Webb Hannah , Steley Zoe , Chan James , Robertson Alexander
Published: January 2021

Emergency clinicians worldwide are demonstrating increasing concern about the effect of climate change on the health of the populations they serve. The movement for sustainable healthcare is being driven by the need to address the climate emergency. Globally, healthcare contributes significantly to carbon emissions, and the healthcare sector has an important role to play in contributing to decarbonisation of the global economy. In this article, we consider the implications for emergency medicine of climate change, and suggest ways to improve environmental sustainability within emergency departments. We identify examples of sustainable clinical practice, as well as outlining research proposals to address the knowledge gap that currently exists in the area of provision of environmentally sustainable emergency care.
Universal interventions for suicide prevention in high-income Organisation for Economic Co-operation and Development (OECD) member countries: a systematic review
Authors: Ishimo Marie-Claire , Sampasa-Kanyinga Hugues , Olibris Brieanne , Chawla Mitulika , Berfeld Noami , Prince Stephanie A , Kaplan Mark S , Orpana Heather , Lang Justin J
Published: January 2021

Introduction

To examine the effectiveness of universal suicide prevention interventions on reducing suicide mortality in high-income Organisation for Economic Co-operation and Development (OECD) member countries.

Methods

We implemented a comprehensive search strategy across three electronic databases: MEDLINE (Ovid), PsycINFO (Ovid) and Embase (Ovid). All studies using time-series, retrospective, prospective, pre–post or cross-sectional study designs were included. Studies were required to examine suicide mortality as the outcome of interest. To help organise the results, studies were grouped into six broad categories of universal interventions consistent with the World Health Organization (WHO) Comprehensive Mental Health Action Plan. A narrative synthesis of results was used to describe the findings.

Results

Of the 15 641 studies identified through the search strategy, 100 studies were eligible in the following categories: law and regulation reforms (n=66), physical barriers (n=13), community-based interventions (n=9), communication strategies (n=4), mental health policies and strategies (n=7), and access to healthcare (n=1). Overall, 100% (13/13) of the included physical barrier interventions resulted in a significant reduction in suicide mortality. Although only 70% (46/66) of the law and regulation reform interventions had a significant impact on reducing suicide, they hold promise due to their extended reach. Universal suicide prevention interventions seem to be more effective at reducing suicide among males than females, identifying a need to stratify results by sex in future studies.

Conclusions

These findings suggest that universal suicide prevention interventions hold promise in effectively reducing suicide mortality in high-income OECD countries.
Distinct latent profiles based on neurobehavioural, physical and psychosocial functioning of former National Football League (NFL) players: an NFL-LONG Study
Authors: Brett Benjamin L , Walton Samuel R , Kerr Zachery Y , Nelson Lindsay D , Chandran Avinash , Defreese J D , Echemendia Ruben J , Guskiewicz Kevin M , Meehan III William P , McCrea Michael A
Published: January 2021

Objective

To identify subgroups of former National Football League (NFL) players using latent profile analysis (LPA) and examine their associations with total years of participation (TYP) and self-reported lifetime sport-related concussion history (SR-CHx).

Methods

Former NFL players (N=686) aged 50–70 years, with an average 18.0 TYP (±4.5) completed a questionnaire. SR-CHx distributions included: low (0–3; n=221); intermediate (4–8; n=209) and high (9+; n=256). LPA measures included: Quality of Life in Neurological Disorders Emotional–Behavioral Dyscontrol, Patient Reported Outcomes Measurement Information System Cognitive Function, Emotional Support, Self-Efficacy, Meaning and Purpose, Physical Function, Pain Interference, Participation in Social Roles and Activities, Anxiety, Depression, Fatigue, and Sleep Disturbance. Demographic, medical/psychiatric history, current psychosocial stressors, TYP and SR-CHx were compared across latent profiles (LPs).

Results

A five profile solution emerged: (LP1) global higher functioning (GHF; 26.5%); (LP2) average functioning (10.2%); (LP3) mild somatic (pain and physical functioning) concerns (22.0%); (LP4) somatic and cognitive difficulties with mild anxiety (SCA; 27.5%); LP5) global impaired functioning (GIF; 13.8%). The GIF and SCA groups reported the largest number ofe- medical/psychiatric conditions and higher psychosocial stressor levels. SR-CHx was associated with profile group (χ2(8)=100.38, p<0.001); with a higher proportion of GIF (72.6%) and SCA (43.1%) groups reporting being in the high SR-CHx category, compared with GHF (23.1%), average (31.4%) and somatic (27.8%) groups. TYP was not significantly associated with group (p=0.06), with greater TYP reported by the GHF group.

Conclusions

Five distinct profiles of self-reported functioning were identified among former NFL players. Several comorbid factors (ie, medical/psychiatric diagnoses and psychosocial stressors) and SR-CHx were associated with greater neurobehavioural and psychosocial dysfunction.
Woven EndoBridge device for ruptured aneurysms: perioperative results of a US multicenter experience
Authors: Cortez Gustavo M , Akture Erinc , Monteiro Andre , Arthur Adam S , Peterson Jeremy , Dornbos David , Jabbour Pascal , Gooch M Reid , Sweid Ahmad , Tjoumakaris Stavropoula I , Delgado Almandoz Josser E , Kayan Yasha , Rai Ansaar T , Boo SoHyun , Fiorella David , Vachhani Jay , Foreman Paul , Cress Marshall , Siddiqui Adnan H , Waqas Muhammad , Aghaebrahim Amin , Sauvageau Eric , Hanel Ricardo A
Published: January 2021

Background

The Woven EndoBridge (WEB) device is approved in the USA for treatment of unruptured wide-neck bifurcation aneurysms. However, the safety and effectiveness of the WEB device in the treatment of ruptured intracranial aneurysms is not clear. We aim to evaluate the perioperative safety and effectiveness of the WEB device in patients with ruptured intracranial aneurysms.

Methods

This retrospective study, conducted at eight centers in the USA, included patients with ruptured intracranial aneurysms treated with the WEB device in the setting of subarachnoid hemorrhage (SAH). Safety outcomes included intraoperative complications such as vessel perforation, thromboembolic events, and postoperative hemorrhagic or thromboembolic complications based on radiologic imaging. The primary effectiveness outcome was adequate (complete and neck remnant) aneurysm occlusion, according to the Raymond–Roy classification.

Results

A total of 91 patients with 94 ruptured intracranial aneurysms were included (mean age 57.7±15.2 years; 68.1% women; 82.9% wide-necked). Aneurysms were located in the anterior communicating artery (42/94, 44.6%), middle cerebral artery (16/94, 17%), and basilar artery (15/94, 16%). Adequate occlusion was achieved in 48.8% (41/84) and 80.0% (40/50) at discharge and last follow-up (mean of 3.4 months), respectively. At discharge, procedural-related morbidity was 3.3% (3/91) and there was no procedure-related mortality. No re-rupture or delayed aneurysm rupture was observed.

Conclusions

This study demonstrates the perioperative safety and effectiveness of the WEB device for the treatment of patients with ruptured intracranial aneurysms in the setting of SAH, with low periprocedural morbidity and mortality. Long-term follow-up is warranted.