bluuebunny/crossref_metadata_2025 huggingface dataset:
Circulating melanin‐containing cells and neutrophils with phagocytized melanin granules in a horse with disseminated melanoma
Authors: Conrado Francisco O. , Iapoce Nicholas , Batista‐Linhares Mainity , Lopez Sharleen , Matthews Morgan H. , McKinney Caroline A. , Rothacker Caitlin
Published: November 2020

An 18‐year‐old, grey, Thoroughbred Cross gelding was referred to the Cummings School of Veterinary Medicine at Tufts University following a 3‐week history of low‐grade fever of unknown origin, distal limb swelling, and weight loss. Clinical examination identified a few black, round, smooth nodules along the ventral aspect of the proximal tail. Transabdominal ultrasound showed a markedly enlarged heterogenous spleen, hyperechoic liver nodules, and evidence of peritonitis with fibrin deposition. A mature neutrophilia was noted on complete blood count with variable numbers of phagocytized granules within neutrophils. The granules did not stain with Perl's Prussian blue, and were intensely positive when stained with Fontana‐Mason, consistent with melanin. On necropsy, the spleen occupied approximately one‐third of the abdominal cavity and was diffusely firm with abundant black pigment on cut section. The medullary space of the 18th thoracic vertebra was also diffusely blackened. The splenic, mediastinal, and tracheobronchial lymph nodes were five times the normal size and diffusely pigmented. The final anatomic diagnosis was disseminated malignant melanoma with extensive splenic involvement and hemolymphatic and vascular neoplastic dissemination. To the authors' knowledge, this is the first full report to identify circulating neutrophils containing phagocytized melanin granules, which confirmed an antemortem diagnosis of disseminated melanoma.
Absolute Nodal Coordinate Formulation With Vector-Strain Transformation for High Aspect Ratio Wings
Authors: Otsuka Keisuke , Wang Yinan , Makihara Kanjuro
Published: November 2020

High aspect ratio wings are potential candidates for use in atmospheric satellites and civil aircraft as they exhibit a low induced drag, which can reduce the fuel consumption. Owing to their slender and light weight configuration, such wings undergo highly flexible aeroelastic static and dynamic deformations that cannot be analyzed using conventional linear analysis methods. An aeroelastic analysis framework based on the absolute nodal coordinate formulation (ANCF) can be used to analyze the static and dynamic deformations of high aspect ratio wings. However, owing to the highly nonlinear elastic force, the statically deformed wing shape during steady flight cannot be efficiently obtained via static analyses. Therefore, an ANCF with a vector-strain transformation (ANCF-VST) was proposed in this work. Considering the slender geometry of high aspect ratio wings, the nodal vectors of an ANCF beam element were transformed to the strains. In this manner, a constant stiffness matrix and reduced degrees-of-freedom could be generated while capturing the highly flexible deformations accurately. The ANCF-VST exhibited superior convergence performance and accuracy compared to those of analytical approaches and other nonlinear beam formulations. Moreover, an aeroelastic analysis flow coupling the ANCF-VST and an aerodynamic model based on the unsteady vortex lattice method was proposed to perform the static and dynamic analyses successively. The proposed and existing aeroelastic frameworks exhibited a good agreement in the analyses, which demonstrated the feasibility of employing the proposed framework to analyze high aspect ratio wings.
A Novel Error Compensation Method for Multistage Machining Processes Based on Differential Motion Vector Sets of Multiple Contour Points
Authors: Zhu Mengrui , Ge Guangyan , Feng Xiaobing , Du Zhengchun , Yang Jianguo
Published: November 2020

Modeling the variation propagation based on the stream of variation (SoV) methodology for multistage machining processes (MMPs) has been investigated intensively in the past two decades; however, little research is conducted on the variation reduction and the existing work fails to be applied to irregular features caused by the machining-induced variation varying with the positions of the contour points on the machined surface. This paper proposes a novel error compensation method for MMPs by modifying the tool path to reduce variation for general features. The method based on differential motion vector (DMV) sets of multiple contour points is presented to represent the deviation of the irregular feature. Then, the conventional stream of variation (SoV) model is further extended to more accurately describe variation propagation for irregular features considering the actual datum-induced variations and the varying machining-induced variations, especially the deformation errors for the low stiffness workpiece. Based on the extended SoV model and error equivalence mechanism, the datum error and fixture error are transformed to the equivalent tool path error. Then, the original tool path is modified through shifting the machine zero points of machine tools with no need for changing the original G code and workpiece setup. A real cutting experiment validates the effectiveness of the proposed error compensation method for MMPs with an average precision improvement of over 60%. The application of the extended SoV model significantly contributes to compensating more complex error sources for MMPs, such as the clamp force, the internal residual stress, etc.
Nano Cellulose Fibers and Graphene Oxide Coating on Polyolefin Separator With Uniform Li+ Transportation Channels for Long-Life and High-Safety Li Metal Battery
Authors: Dai Dongmei , Chen Yixuan , Chen Boran , Qiu Jinxu , Li Bao , Wang Bao
Published: November 2020

The lithium anode could greatly increase the energy density of the cell, but inevitable lithium dendrites hinder its application. A powerful coating layer can effectively suppress the growth of dendrite by promoting a fast and uniform Li+ flux. Here, a polyolefin separator coated with a layer of nano cellulose fiber (NCF) and graphene oxide (GO) is designed to restrain the growth of Li-dendrite and accommodate thermal shrinkage resistance. The results of electrochemical impedance spectroscopy showed that the NCF/GO coating with a mass ratio of 3:5 showed the highest value of ionic conductivity. The Li/separator/Li symmetrical battery with NCF/GO coated separator can work for 65 h during continuous charging before the voltage dropping down to zero, which is about 40% longer than the battery with bare polyolefin separator. In addition, the NCF/GO coating layer can also increase the retention capacity ratio of a cell by more than 10% in the 100 charge/discharge cycles. In this paper, the as-prepared NCF/GO coating separator provides a reference for designing a long-life and safety battery with Li-anode by effectively inhibiting the lithium dendrite.
Tendon Actuated Continuous Structures in Planar Parallel Robots: A Kinematic Analysis
Authors: Lilge Sven , Nuelle Kathrin , Boettcher Georg , Spindeldreier Svenja , Burgner-Kahrs Jessica
Published: November 2020

The use of continuous and flexible structures instead of rigid links and discrete joints is a growing field of robotics research. Recent work focuses on the inclusion of continuous segments in parallel robots to benefit from their structural advantages, such as a high dexterity and compliance. While some applications and designs of these novel parallel continuum robots have been presented, the field remains largely unexplored. Furthermore, an exact quantification of the kinematic advantages and disadvantages when using continuous structures in parallel robots is yet to be performed. In this paper, planar parallel robot designs using tendon actuated continuum robots instead of rigid links and discrete joints are proposed. Using the well-known 3-RRR manipulator as a reference design, two parallel continuum robots are derived. Inverse and differential kinematics of these designs are modeled using constant curvature assumptions, which can be adapted for other actuation mechanisms than tendons. Their kinematic performances are compared to the conventional parallel robot counterpart. On the basis of this comparison, the advantages and disadvantages of using continuous structures in parallel robots are quantified and analyzed. Results show that parallel continuum robots can be kinematic equivalent and exhibit similar kinematic performances in comparison to conventional parallel robots depending on the chosen design.
Coaching on the Talent Pathway: Understanding the Influence of Developmental Experiences on Coaching Philosophy
Authors: Williams Graham G. , MacNamara Áine
Published: November 2020

There is compelling evidence supporting the critical role of high-quality coaching practice in supporting talented youth athletes through and beyond the talent pathway. The purpose of this study was to explore the coaching philosophies of ex-talent pathway athletes and how the meaning and purpose of their coaching in a talent pathway was influenced by their previous pathway experience. Nine participants were purposefully sampled based on their prior involvement as a youth athlete in a talent pathway and current involvement coaching in a talent pathway. The participants identified how their pathway experience influenced their coaching philosophy and applied coaching practice. Specifically, the participants described how their own youth sport experience influenced their current coaching practice through the formation of a developmental coaching philosophy, through their applied coaching practice orientated towards supporting individual development, and by using their previous pathway experience to support coaching success. These findings suggest that the philosophy underpinning talent pathway coaches’ practice was influenced by their own pathway experience, and the purpose of their practice was orientated to positively impact youth development for and beyond sport. Thus, talent pathways in sport have the capability to be recognised as positively influencing the developmental experiences of future coaching practitioners.
Preexisting and de novo humoral immunity to SARS-CoV-2 in humans
Authors: Ng Kevin W. , Faulkner Nikhil , Cornish Georgina H. , Rosa Annachiara , Harvey Ruth , Hussain Saira , Ulferts Rachel , Earl Christopher , Wrobel Antoni G. , Benton Donald J. , Roustan Chloe , Bolland William , Thompson Rachael , Agua-Doce Ana , Hobson Philip , Heaney Judith , Rickman Hannah , Paraskevopoulou Stavroula , Houlihan Catherine F. , Thomson Kirsty , Sanchez Emilie , Shin Gee Yen , Spyer Moira J. , Joshi Dhira , O’Reilly Nicola , Walker Philip A. , Kjaer Svend , Riddell Andrew , Moore Catherine , Jebson Bethany R. , Wilkinson Meredyth , Marshall Lucy R. , Rosser Elizabeth C. , Radziszewska Anna , Peckham Hannah , Ciurtin Coziana , Wedderburn Lucy R. , Beale Rupert , Swanton Charles , Gandhi Sonia , Stockinger Brigitta , McCauley John , Gamblin Steve J. , McCoy Laura E. , Cherepanov Peter , Nastouli Eleni , Kassiotis George
Published: November 2020

Antibodies predating infection

Immunological memory after infection with seasonal human coronaviruses (hCoVs) may potentially contribute to cross-protection against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Ng
et al.
report that in a cohort of 350 SARS-CoV-2–uninfected individuals, a small proportion had circulating immunoglobulin G (IgG) antibodies that could cross-react with the S2 subunit of the SARS-CoV-2 spike protein (see the Perspective by Guthmiller and Wilson). By contrast, COVID-19 patients generated IgA, IgG, and IgM antibodies that recognized both the S1 and S2 subunits. The anti-S2 antibodies from SARS-CoV-2–uninfected patients showed specific neutralizing activity against both SARS-CoV-2 and SARS-CoV-2 S pseudotypes. A much higher percentage of SARS-CoV-2–uninfected children and adolescents were positive for these antibodies compared with adults. This pattern may be due to the fact that children and adolescents generally have higher hCoV infection rates and a more diverse antibody repertoire, which may explain the age distribution of COVID-19 susceptibility.

Science
, this issue p.
1339
; see also p.
1272
Versatile and multivalent nanobodies efficiently neutralize SARS-CoV-2
Authors: Xiang Yufei , Nambulli Sham , Xiao Zhengyun , Liu Heng , Sang Zhe , Duprex W. Paul , Schneidman-Duhovny Dina , Zhang Cheng , Shi Yi
Published: November 2020

Nanobodies that neutralize

Monoclonal antibodies that bind to the spike protein of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) show therapeutic promise but must be produced in mammalian cells and need to be delivered intravenously. By contrast, single-domain antibodies called nanobodies can be produced in bacteria or yeast, and their stability may enable aerosol delivery. Two papers now report nanobodies that bind tightly to spike and efficiently neutralize SARS-CoV-2 in cells. Schoof
et al.
screened a yeast surface display of synthetic nanobodies and Xiang
et al.
screened anti-spike nanobodies produced by a llama. Both groups identified highly potent nanobodies that lock the spike protein in an inactive conformation. Multivalent constructs of selected nanobodies achieved even more potent neutralization.

Science
, this issue p.
1473
, p.
1479
Enhancing the use of stakeholder analysis for policy implementation research: towards a novel framing and operationalised measures
Authors: Balane Marysol Astrea , Palafox Benjamin , Palileo-Villanueva Lia M , McKee Martin , Balabanova Dina
Published: November 2020

Background

Policy is shaped and influenced by a diverse set of stakeholders at the global, national and local levels. While stakeholder analysis is a recognised practical tool to assess the positions and engagement of actors relevant to policy, few empirical studies provide details of how complex concepts such as power, interest and position are operationalised and assessed in these types of analyses. This study aims to address this gap by reviewing conceptual approaches underlying stakeholder analyses and by developing a framework that can be applied to policy implementation in low-and-middle income countries.

Methods

The framework was developed through a three-step process: a scoping review, peer review by health policy experts and the conduct of an analysis using key informant interviews and a consensus building exercise. Four characteristics were selected for inclusion: levels of knowledge, interest, power and position of stakeholders related to the policy.

Result

The framework development process highlighted the need to revisit how we assess the power of actors, a key issue in stakeholder analyses, and differentiate an actor’s potential power, based on resources, and whether they exercise it, based on the actions they take for or against a policy. Exploration of the intersections between characteristics of actors and their level of knowledge can determine interest, which in turn can affect stakeholder position on a policy, showing the importance of analysing these characteristics together. Both top-down and bottom-up approaches in implementation must also be incorporated in the analysis of policy actors, as there are differences in the type of knowledge, interest and sources of power among national, local and frontline stakeholders.

Conclusion

The developed framework contributes to health policy research by offering a practical tool for analysing the characteristics of policy actors and tackling the intricacies of assessing complex concepts embedded in the conduct of stakeholder analyses.
Assessing inequalities in geographical access to emergency medical services in metropolitan Lisbon: a cross-sectional and ecological study
Authors: Silva Katielle Susane do Nascimento , Padeiro Miguel
Published: November 2020

Objectives

Studies have suggested that material deprivation is strongly associated with negative health outcomes, and lower usage of various levels of healthcare. We aim to analyse geographical access to emergency medical services (EMSs) and hospital emergency units by EMS in relation to deprivation in the Lisbon Metropolitan Area (LMA), Portugal.

Design

This study estimates road network-based access times from the centroids of statistical sections (census block groups equivalent) to locations of EMS and hospital emergency services. Each statistical section has been linked to a Material Deprivation Index (MDI). A non-parametric analysis of variance (ANOVA) was undertaken to compare MDI-linked statistical sections in terms of access to emergency care. Geographical access analysis was conducted for 2018.

Primary outcome measure

Road network-based access time (in minutes) for EMSs to statistical sections and then on to emergency units in hospitals.

Results

Overall, 82.4% of the LMA population is located less than a 10 min drive from an EMS without transport, and 99.1% from an EMS with transport. Travel time from EMS with transport to hospital is potentially less than 20 min for 95.2% of the population. However, 63.1% of residents living beyond a 30 min threshold (total time from emergency call to hospital arrival) are in areas with very high MDI (18.8% in high MDI, 13.3% in medium MDI, 4.7% in low MDI, 0% in very low MDI). Kruskal-Wallis ANOVA confirms discrepancies in access times between better-off and poorer areas.

Conclusion

Poorer areas experience worse geographical access to EMS and hospital emergency units. More research is needed to explore the quality of services and their outcomes, and to refine the analysis by focusing on specific vulnerable groups.
Association between vitamin D and uterine fibroids: a study protocol of an open-label, randomised controlled trial
Authors: Sheng Bo , Song Yizuo , Liu Yi , Jiang Chenchen , Zhu Xueqiong
Published: November 2020

Introduction

Uterine fibroids are the most common pelvic benign tumour with no satisfactory long-term medical treatment. Recent studies have demonstrated that vitamin D significantly inhibited the growth of fibroids in vitro, vivo and a small-sample clinical trial. Therefore, the aim of this randomised clinical trial (RCT) is to evaluate whether supplementation with vitamin D could reduce the risk and inhibit the growth of uterine fibroids in reproductive stage women.

Methods and analysis

The open-label, RCT comprises two parts, including parts I and II. In part I, 2230 vitamin D deficiency or vitamin D insufficiency patients without uterine fibroids will be randomly assigned to two groups: intervention group (according to the level of serum 25-hydroxyvitamin D3, receive 1600 or 800 IU/day of vitamin D3 for 2 years) and control group (followed up at the same time points). By using gynaecological ultrasound examinations, the incidence of uterine fibroids will be employed to measure the outcome in different groups. In part II, 360 uterine fibroids patients with vitamin D deficiency or vitamin D insufficiency will be randomly assigned to intervention group or control group. According to the level of serum 25-hydroxyvitamin D3, 180 patients will receive 1600 or 800 IU/day of vitamin D3 for 2 years. Control group will receive regular follow-up. The outcome measure will be conducted using gynaecological ultrasound examinations to detect the growth of uterine fibroids in each group.

Ethics and dissemination

This study has been approved by the institutional review board of the Second Affiliated Hospital of Wenzhou Medical University (No. LCKY2018-35).

Trial registration numbers

NCT03586947 and NCT03584529.
Feasibility and acceptability of e-PROMs data capture and feedback among patients receiving haemodialysis in the Symptom monitoring WIth Feedback Trial (SWIFT) pilot: protocol for a qualitative study in Australia
Authors: Duncanson Emily , Bennett Paul N , Viecelli Andrea , Dansie Kathryn , Handke William , Tong Allison , Palmer Suetonia , Jesudason Shilpanjali , McDonald Stephen P , Morton Rachael L
Published: November 2020

Introduction

People receiving haemodialysis experience a high symptom burden and impaired quality of life. The use of patient-reported outcome measures (PROMs) is increasing in nephrology care, however their acceptability, utility and impacts are not well understood.

Methods and analysis

We describe a protocol for a qualitative study to evaluate the feasibility and acceptability of electronic-PROMs (e-PROMs) data capture and feedback in haemodialysis following the pilot Symptom monitoring WIth Feedback Trial (SWIFT). SWIFT involves linkage of e-PROMs data, including symptoms and health-related quality of life, to the Australia and New Zealand Dialysis and Transplant Registry with feedback to patients’ treating nephrologists and nurse unit managers. Focus groups and semistructured interviews will be conducted with nephrologists (n=15), dialysis nurses (n=24) and patients receiving haemodialysis (n=24) from six dialysis units in Australia. Question topics will include the technical and clinical feasibility and acceptability of e-PROMs reporting and feedback (including the barriers and enablers to uptake) and perceived impact on patient care and outcomes. Transcripts will be analysed thematically and guided by Normalisation Process Theory.

Ethics and dissemination

Ethics approval was obtained from the relevant hospital Human Research Ethics Committees (HREC/18/CALHN/481; HREC/MML/54599). The findings from the SWIFT pilot and qualitative evaluation will inform the implementation of the SWIFT main trial, and more broadly, the use of e-PROMs in clinical settings and registries.

Trial registration number

ANZCTRN12618001976279.
Using discrete choice experiments to design interventions for heterogeneous preferences: protocol for a pragmatic randomised controlled trial of a preference-informed, heterogeneity-focused, HIV testing offer for high-risk populations
Authors: Ostermann Jan , Njau Bernard , Hobbie Amy , Mtuy Tara , Masaki Martha L , Shayo Aisa , van Zwetselaar Marco , Masnick Max , Flaherty Brian , Brown Derek S , Mühlbacher Axel C , Thielman Nathan M
Published: November 2020

Introduction

Approximately one million undiagnosed persons living with HIV in Southern and Eastern Africa need to test for HIV. Novel approaches are necessary to identify HIV testing options that match the heterogeneous testing preferences of high-risk populations. This pragmatic randomised controlled trial (PRCT) will evaluate the efficacy of a preference-informed, heterogeneity-focused HIV counselling and testing (HCT) offer, for improving rates of HIV testing in two high-risk populations.

Methods and analysis

The study will be conducted in Moshi, Tanzania. The PRCT will randomise 600 female barworkers and 600 male Kilimanjaro mountain porters across three study arms. All participants will receive an HIV testing offer comprised of four preference-informed testing options, including one ‘common’ option—comprising features that are commonly available in the area and, on average, most preferred among study participants—and three options that are specific to the study arm. Options will be identified using mixed logit and latent class analyses of data from a discrete choice experiment (DCE). Participants in Arm 1 will be offered the common option and three ‘targeted’ options that are predicted to be more preferred than the common option and combine features widely available in the study area. Participants in Arm 2 will be offered the common option and three ‘enhanced’ options, which also include HCT features that are not yet widely available in the study area. Participants in Arm 3, an active control arm, will be offered the common option and three predicted ‘less preferred’ options. The primary outcome will be uptake of HIV testing.

Ethics and dissemination

Ethical approval was obtained from the Duke University Health System IRB, the University of South Carolina IRB, the Ethics Review Committee at Kilimanjaro Christian Medical University College, Tanzania’s National Institute for Medical Research, and the Tanzania Food & Drugs Authority (now Tanzania Medicines & Medical Devices Authority). Findings will be published in peer-reviewed journals. The use of rigorous DCE methods for the preference-based design and tailoring of interventions could lead to novel policy options and implementation science approaches.

Trial registration number

NCT02714140.
Associations of myeloperoxidase, interleukin-17A and heparin-binding EGF-like growth factor levels with in-stent restenosis after percutaneous coronary intervention: a single-centre case–control study in China
Authors: Jiang Hua , Zhang Hongmei , Yang Ying , Yang Xuezhou
Published: November 2020

Objectives

To investigate the changes in serum myeloperoxidase (MPO), interleukin (IL)-17A and heparin-binding EGF-like growth factor (HB-EGF) levels before and after percutaneous coronary intervention (PCI), and to evaluate the associations of MPO, IL-17A and HB-EGF levels with the 1-year restenosis rate.

Design

Case–control study.

Settings

Xiangyang Central Hospital between January 2012 and December 2017.

Participants

Patients with coronary heart disease who underwent PCI.

Interventions

Not applicable.

Primary and secondary outcome measures

Not applicable.

Results

Finally, 407 and 132 patients were included in the control and in-stent restenosis (ISR) groups, respectively. The general clinical characteristics of the patients were not significantly different between the two groups. The MPO, IL-17A and HB-EGF levels were not significantly different between the two groups at baseline but significantly increased after PCI. The ISR group showed higher levels of MPO, IL-17A and HB-EGF compared with the control group at all postoperative time points. Multivariable analysis showed that MPO, IL-17A and HB-EGF were associated with increased ISR [MPO (OR=1.003; 95% CI: 1.001 to 1.005; p=0.002), IL-17A (OR=1.015; 95% CI: 1.009 to 1.020; p<0.0001) and HB-EGF (OR=2.256; 95% CI: 1.103 to 4.009; p=0.002)]. All three factors had sensitivity and specificity ≥68% for ISR.

Conclusions

HB-EGF could be used for the detection of ISR after PCI and could be of use for the prediction of ISR, but the value of MPO and IL-17A might be more limited. This will have to be validated in future studies.
Epidemiology and disease burden of complex wounds for inpatients in China: an observational study from Sichuan province
Authors: Jiang Qingling , Dumville Jo C , Cullum Nicky , Pan Jay , Liu Zhenmi
Published: November 2020

Objectives

To investigate the period prevalence of complex wounds among the overall inpatients, and the impact of complex wounds on inpatient health expense and length of hospital stay (LOS).

Design

An observational study.

Setting

6056 healthcare institutions across Sichuan province in China.

Participants

This study included 4 033 763 people admitted to healthcare institutions during 1 September 2018 and 31 December 2018.

Results

The point prevalence of complex wounds was 4.07 per 1000 among inpatients in Sichuan. The most common complex wounds were pressure ulcers (1.47 per 1000 among inpatients). Older, male, Han ethnic groups and retired people were most likely to suffer from complex wounds. The median LOS was longer for those with complex wounds as their main condition of treatment compared with all-cause admissions in Sichuan (12 days compared with 7 days; p<0.001). The median cost of care for people with complex wounds was higher than for admission for any cause (¥6500.18 compared with ¥3337.16; p<0.001). People with pressure ulcers had the longest LOS, while people with ulcers related to diabetes incurred the highest costs.

Conclusions

Complex wounds, especially pressure ulcers, are common in Sichuan province and their presence is associated with significantly longer lengths of hospital stay and higher medical costs. Additionally, this study only included admitted inpatients during the sampling time period, hence the prevalence of complex wounds may be underestimated. The high prevalence rate and heavy direct and indirect disease burden of complex wounds indicate that health policies for early detection and prevention of complex wounds in elders are urgently needed.
Protocol for a prospective descriptive prevalence study of catatonia in an acute mental health unit in urban South Africa
Authors: Zingela Zukiswa , Stroud Louise , Cronje Johan , Fink Max , van Wyk Stephanus
Published: November 2020

Introduction

Catatonia arises from serious mental, medical, neurological or toxic conditions. The prevalence range depends on the setting and the range is anything from 7% to 63% in other countries. South African prevalence rates are currently unknown. The proposed study is a quantitative descriptive study using the Bush Francis Catatonia Screening Instrument as a screening tool with a data capturing information sheet to extract clinical information from patient folders. The study will investigate: (1) prevalence of catatonia, (2) clinical and demographic correlates associated with catatonia, (3) predictors of catatonia, (4) response to treatment and (5) subjective experience of catatonia.

Methods and analysis

The setting is an acute mental health unit (MHU) within a regional, general medical hospital in Nelson Mandela Bay, South Africa, which accepts referrals from within the hospital and from outlying clinics. Participants will be recruited from inpatients in the MHU from beginning of September 2020 to end of August 2021. Most admissions are involuntarily, under the Mental Health Care Act of 2002 with an age range of 13 to over 65 years. Participants who screen positive for catatonia will be followed up after discharge for 3 months to measure outcomes. Primary outcomes will include the 12-month prevalence rate of catatonia, descriptive and other data on presentation and assessment of catatonia in the MHU. Secondary outcomes will include data on treatment response, participants’ report of their subjective experience of catatonia and predictors of catatonia. Descriptive statistics, multivariate binomial logistic regression and univariate analyses will be conducted to evaluate associations between catatonia and clinical or demographic data which could be predictors of catatonia. Survival analysis will be used to examine the time to recovery after diagnosis and initiation of treatment. The 95% CI will be used to demonstrate the precision of estimates. The level of significance will be p≤0.05.

Ethics and dissemination

The study has received ethical approval from the Research and Ethics Committees of the Eastern Cape Department of Health, Walter Sisulu University and Nelson Mandela University. The results will be disseminated as follows: at various presentations and feedback sessions; as part of a PhD thesis in Psychology at Nelson Mandela University; and in a manuscript that will be submitted to a peer-reviewed journal.
Advancing a health equity agenda across multiple policy domains: a qualitative policy analysis of social, trade and welfare policy
Authors: Townsend Belinda , Friel Sharon , Freeman Toby , Schram Ashley , Strazdins Lyndall , Labonte Ronald , Mackean Tamara , Baum Fran
Published: November 2020

Objective

While there is urgent need for policymaking that prioritises health equity, successful strategies for advancing such an agenda across multiple policy sectors are not well known. This study aims to address this gap by identifying successful strategies to advance a health equity agenda across multiple policy domains.

Design

We conducted in-depth qualitative case studies in three important social determinants of health equity in Australia: employment and social policy (Paid Parental Leave); macroeconomics and trade policy (the Trans Pacific Partnership agreement); and welfare reform (the Northern Territory Emergency Response). The analysis triangulated multiple data sources included 71 semistructured interviews, document analysis and drew on political science theories related to interests, ideas and institutions.

Results

Within and across case studies we observed three key strategies used by policy actors to advance a health equity agenda, with differing levels of success. The first was the use of multiple policy frames to appeal to a wide range of actors beyond health. The second was the formation of broad coalitions beyond the health sector, in particular networking with non-traditional policy allies. The third was the use of strategic forum shopping by policy actors to move the debate into more popular policy forums that were not health focused.

Conclusions

This analysis provides nuanced strategies for agenda-setting for health equity and points to the need for multiple persuasive issue frames, coalitions with unusual bedfellows, and shopping around for supportive institutions outside the traditional health domain. Use of these nuanced strategies could generate greater ideational, actor and institutional support for prioritising health equity and thus could lead to improved health outcomes.
Raising awareness for dementia risk reduction through a public health campaign: a pre-post study
Authors: Heger Irene , Köhler Sebastian , van Boxtel Martin , de Vugt Marjolein , Hajema KlaasJan , Verhey Frans , Deckers Kay
Published: November 2020

Objectives

Evaluate the effect of a health promotion campaign aimed at increasing awareness about dementia risk reduction in middle-aged community-dwelling individuals in the Netherlands.

Design

A 10-month public health campaign using mass media and community participation, supported by eHealth. Population-level difference in awareness before and after the campaign, including variation between demographic groups, was assessed in two independent cross-sectional samples from the same target population.

Setting

The public health campaign was launched in the Province of Limburg, the Netherlands, targeting all inhabitants aged 40–75 years old. Three specific districts within the Province were chosen for an additional community participation approach, in which local stakeholders were invited to support the campaign.

Results

No pre- (n=590) post- (n=602) difference was observed in people agreeing to the statement that dementia risk reduction is possible (X2(1)=1.27, p=0.260). For the individual lifestyle factors, physical activity (7.6% increase (X2(1)=7.48, p=0.006)) and healthy diet (10.5% increase (X2(1)=12.37, p≤0.001)) were identified more often as being protective against dementia after the campaign. Of all risk/protective factors assessed, cognitive activity was identified most often at both preassessment (79.4%) and postassessment (80.4%), but there was no increase in awareness (X2(1)=0.17, p=0.677). Self-reported exposure to the campaign was associated with greater awareness and motivation for behavioural change (X2(1)=6.52, p=0.011). Compared with mass media only, the addition of community participation resulted in better recognition of campaign material and the eHealth platform.

Conclusions

This study was not able to reach a population-level increase of awareness of dementia risk reduction. Two out of the three lifestyle factors that formed the foundation of the campaign were identified more often after the campaign. Those reported having been exposed to the campaign were more aware and more inclined towards behavioural change.
Acute stress of the healthcare workforce during the COVID-19 pandemic evolution: a cross-sectional study in Spain
Authors: Mira José Joaquín , Carrillo Irene , Guilabert Mercedes , Mula Aurora , Martin-Delgado Jimmy , Pérez-Jover Maria Virtudes , Vicente Maria Asunción , Fernández César
Published: November 2020

Objectives

To determine the volume of health professionals who suffered distress due to their care of patients with COVID-19 and to analyse the direction in which the response capacity of the professionals to face future waves of COVID-19 is evolving.

Design

A cross-sectional study.

Setting

Primary care and hospitals in Spain.

Participants

A non-randomised sample of 685 professionals (physicians, nurses and other health staff).

Primary and secondary outcome measures

Frequency and intensity of stress responses measured by the Acute Stress of Health Professionals Caring COVID-19 Scale (EASE). Variation of stress responses according to the number of deaths per day per territory and the evolutionary stage of the COVID-19 outbreak measured by the Kruskal-Wallis and the Mann-Whitney U tests.

Results

The average score on the EASE Scale was 11.1 (SD 6.7) out of 30. Among the participants, 44.2% presented a good emotional adjustment, 27.4% a tolerable level of distress, 23.9% medium–high emotional load and 4.5% extreme acute stress. The stress responses were more intense in the most affected territories (12.1 vs 9.3, p=0.003) and during the disillusionment phase (12.7 vs 8.5 impact, 10.2 heroic and 9.8 honeymoon, p=0.000).

Conclusions

The pandemic has affected the mental health of a significant proportion of health professionals which may reduce their resilience in the face of future waves of COVID-19. The institutional approaches to support the psychological needs of health professionals are essential to ensure optimal care considering these results.
Integrated diagnostic pathway for patients referred with suspected OSA: a model for collaboration across the primary–secondary care interface
Authors: Devani Nikesh , Aslan Tom , Leske Fiona , Mansell Stephanie K , Morgan Sarah , Mandal Swapna
Published: November 2020

Background

Obstructive sleep apnoea (OSA) presents a major healthcare challenge with current UK data suggesting that only 22% of individuals have been diagnosed and treated. Promoting awareness and improving access to diagnostics are fundamental in addressing these missing cases and the recognised complications associated with untreated OSA. Diagnosis usually occurs in secondary care with data from our trust revealing long wait times to undertake tests, reach a diagnosis and start treatment. This places a considerable time and emotional burden on the patient and a financial and logistical burden on the hospital.

Methods

We introduced an integrated community-based pathway for the diagnosis of OSA. This comprised a monthly clinic run from within a local general practice (GP) supported by a ‘virtual multidisciplinary team’ run by the hospital specialist team. Prospective collection of process, outcome and patient satisfaction data was compared with traditional hospital-based pathway data collected retrospectively.

Setting

A central London teaching hospital and GPs within a local commissioning neighbourhood.

Results

Between January 2018 and February 2019, 70 were patients referred and managed along the community pathway. Compared with the hospital pathway, data demonstrated a significant reduction in the time taken: from referral to perform a sleep test (29 vs 181 days, p<0.0001), to make a diagnosis (40 vs 230 days, p<0.0001) and commence treatment (127 vs 267, p<0.0001). Patient satisfaction in the community pathway was higher across all domains (p<0.05), fewer hospital outpatient appointments were required and cost estimates suggested an overall saving of up to £290 could be achieved for each patient.

Conclusion

An integrated community-based pathway results in more timely diagnosis of OSA within a local setting while maintaining specialist input from the hospital team. It is favoured by patients and can reduce unnecessary appointments in secondary care.
Obstructive sleep apnoea, intermittent hypoxia and heart failure with a preserved ejection fraction
Authors: Sanderson John E , Fang Fang , Lu Mi , Ma Chen Yao , Wei Yong Xiang
Published: November 2020

Obstructive sleep apnoea (OSA) is recognised to be a potent risk factor for hypertension, coronary heart disease, strokes and heart failure with a reduced ejection fraction. However, the association between OSA and heart failure with a preserved ejection fraction (HFpEF) is less well recognised. Both conditions are very common globally.

It appears that there are many similarities between the pathological effects of OSA and other known aetiologies of HFpEF and its postulated pathophysiology. Intermittent hypoxia induced by OSA leads to widespread stimulation of the sympathetic nervous system, renin–angiotensin–aldosterone system and more importantly a systemic inflammatory state associated with oxidative stress. This is similar to the consequences of hypertension, diabetes, obesity and ageing that are the common precursors to HFpEF. The final common pathway is probably via the development of myocardial fibrosis and structural changes in collagen and myocardial titin that cause myocardial stiffening. Thus, considering the pathophysiology of OSA and HFpEF, OSA is likely to be a significant risk factor for HFpEF and further trials of preventive treatment should be considered.
Efficacy of a live intranasal vaccine against parainfluenza type 3 and bovine respiratory syncytial virus in young calves with maternally derived antibodies
Authors: Metcalfe Lucy , Chevalier Mathieu , Tiberghien Marie‐Pascale , Jolivet Edmond , Huňady Milan , Timothy Sioned , Philippe‐Reversat Corinne
Published: November 2020

Trial design

Two randomised controlled vaccination trials with artificial challenges were carried out in addition to a serological survey of levels of maternally derived antibodies (MDA) to parainfluenza type 3 virus (PI3V) and bovine respiratory syncytial virus (BRSV) in European calves.

Participants

Ten‐day‐old calves with and without MDA were included in the two vaccine trials.

Interventions

Intranasal administration of a bivalent modified live (PI3V/BRSV) vaccine followed by artificial challenge approximately three months post vaccination.

Objective

The study aimed to assess the efficacy of a modified live respiratory vaccine, Bovalto Respi Intranasal (Boehringer Ingelheim). In order to assess the interference of MDA, both seropositive and seronegative calves were used.

Randomisation

PI3V and BRSV serological status was determined seven days before vaccination; calves without maternal antibodies became the MDA− vaccinates. Calves with MDA were ranked according to individual titres and allocated alternately to MDA+ vaccinate and MDA+ control groups.

Blinding

Treatment was carried out by the unblinded study director. Animal care and veterinary examinations were conducted by personnel unaware of the treatments received. The serological survey used blood samples obtained from calves on commercial farms in five European countries, Germany, Spain, Italy, Ireland and the UK, to determine the levels of MDA to PI3V and BRSV in calves approximately two weeks of age.

Results

A total of 36 calves were included in the two challenge studies and 32 of these completed the challenge studies. Twenty‐one calves were included in the PI3V challenge study, with six of six MDA− and six of seven MDA+ vaccinated calves and five of five MDA+ unvaccinated control calves being challenged with PI3V. Fifteen calves were included in the BRSV challenge study, with five of five MDA− and five of five MDA+ vaccinated calves and five of five MDA+ unvaccinated control calves being challenged with BRSV.

Outcome

For both challenges, clinical scores and nasal shedding were significantly higher in control animals compared with vaccinates (PI3V challenge: clinical scores P=0.001, nasal shedding P=0.001; BRSV challenge: clinical scores P=0.016, nasal shedding P=0.002) and not significantly different between MDA+ and MDA− vaccinated animals for both challenges (P>0.05). A total of 254 samples from six countries were tested in the serological survey of MDA.

Conclusion

The results of the challenge studies demonstrated the efficacy of the vaccine in the presence of BRSV and PI3V MDA under laboratory conditions. The field assessment confirmed that the MDA titres in the MDA+ calves corresponded to those typically found on farms.
Multiple origins of feeding head larvae by the Early Cambrian
Authors: Strathmann Richard R.
Published: November 2020

In many animals the head develops early, most of the body axis later. A larva composed mostly of the developing front end therefore can attain mobility and feeding earlier in development. Fossils, functional morphology, and inferred homologies indicate that feeding head larvae existed by the Early Cambrian in members of three major clades of animals: ecdysozoans, lophotrochozoans, and deuterostomes. Some of these early larval feeding mechanisms were also those of juveniles and adults (the lophophore of brachiopod larvae and possibly the ciliary band of the dipleurula of hemichordates and echinoderms); some were derived from structures that previously had other functions (appendages of the nauplius). Trochophores that swim with a preoral band of cilia, the prototroch, originated before divergence of annelids and molluscs, but evidence of larval growth and thus a prototrochal role in feeding is lacking for molluscs until the Ordovician. Feeding larvae that definitely originated much later, as in insects, teleost fish, and amphibians, develop all or nearly all of what will become the adult body axis before they begin feeding. On present evidence, head larvae, including feeding head larvae, evolved multiple times early in the evolution of bilaterian animals and never since.
Non-linear equation in the re-summed next-to-leading order of perturbative QCD: the leading twist approximation
Authors: Contreras Carlos , Levin Eugene , Meneses Rodrigo , Sanhueza Michael
Published: November 2020

In this paper, we use the re-summation procedure, suggested in Ducloué et al. (JHEP 1904:081, 2019), Salam (JHEP 9807:019 1998), Ciafaloni et al. (Phys Rev D 60:1140361999) and Ciafaloni et al. (Phys Rev D 68:114003, 2003), to fix the BFKL kernel in the NLO. However, we suggest a different way to introduce the non-linear corrections in the saturation region, which is based on the leading twist non-linear equation. In the kinematic region: $$\tau \,\equiv \,r^2 Q^2_s(Y)\,\le \,1$$

τ

≡

r
2

Q
s
2

(
Y
)

≤

1

, where r denotes the size of the dipole, Y its rapidity and $$Q_s$$

Q
s

the saturation scale, we found that the re-summation contributes mostly to the leading twist of the BFKL equation. Assuming that the scattering amplitude is small, we suggest using the linear evolution equation in this region. For $$\tau \,>\,1$$

τ

>

1

we are dealing with the re-summation of $$(\bar{\alpha }_S\,\ln \tau )^n$$

(

α

¯

S

ln
τ
)

n

and other corrections in NLO approximation for the leading twist. We find the BFKL kernel in this kinematic region and write the non-linear equation, which we solve analytically. We believe the new equation could be a basis for a consistent phenomenology based on the CGC approach.
Toward Quantifying Ambiguities in Artistic Images
Authors: Wang Xi , Bylinskii Zoya , Hertzmann Aaron , Pepperell Robert
Published: November 2020

It has long been hypothesized that perceptual ambiguities play an important role in aesthetic experience: A work with some ambiguity engages a viewer more than one that does not. However, current frameworks for testing this theory are limited by the availability of stimuli and data collection methods. This article presents an approach to measuring the perceptual ambiguity of a collection of images. Crowdworkers are asked to describe image content, after different viewing durations. Experiments are performed using images created with Generative Adversarial Networks, using the Artbreeder website. We show that text processing of viewer responses can provide a fine-grained way to measure and describe image ambiguities.