bluuebunny/crossref_metadata_2025 huggingface dataset:
Teaching empathy to medical students
Authors: McNally Gemma , Haque Enam , Sharp Sarah , Thampy Harish
Published: December 2022

Background

Empathy is a core skill essential to patient‐centred care. Yet a decline in empathy throughout undergraduate medical education is well recognised. The mainstay of existing teaching approaches to foster medical students' empathic ability has largely focused on the cognitive domain of empathy within the context of communication skills learning. However, there is growing evidence for educational initiatives that better evoke students' affective emotional responses.

Approach

A student‐led educational initiative was created to enhance medical students' understanding of empathy through undertaking different experiential approaches. Eight medical students were invited to participate in an empathy workshop that involved two experiential approaches: personal simulation, and patient narrative, selected given their expected focus on the affective domain.

Evaluation

A subsequent focus group discussion explored students' reactions, learning, and intended future change in practice. Discussions were coded and analysed for descriptive themes. Both initiatives were reported to generate students' empathic responses. Personal simulation evoked more affective domains whilst patient narratives additionally created cognitive empathic insight into the impact of the patient's condition. Students also reported intended changes to their future consulting practices.

Conclusions

Although this is a small‐scale exploration of medical students' experiences of empathy‐related teaching initiatives, it offers insight into how each initiative could target different aspects of empathy. Data support the use of even brief experiential teaching to improve medical students' empathy during their undergraduate training. We provide recommendations for clinical educators who are considering designing similar initiatives within their undergraduate medical curricula.
Another history of global financial markets: Local stock market integration since 1913 from a network perspective
Authors: Bastidon Cécile , Bordo Michael , Parent Antoine , Weidenmier Marc Daniel
Published: December 2022

We examine local and global equity market integration since 1900 using network methods. The analysis uncovers a new stylised fact about equity market integration over the past 120 years. Local equity market integration generally increases over the entire sample period. This finding is at odds with much of the existing literature that describes long‐run market integration as following a U‐shape pattern. Global stock market integration peaks in 1913 followed by disintegration during the Great Depression and Bretton Woods periods. Then it rebounds and achieves the highest level of integration during the recent period of globalisation that began in the early 1970s. We argue that this U‐shape pattern is the by‐product of the interaction of the network effects of the monotonic decrease in local distances (decrease in information costs, accelerated in the past decades) and network connectivity (which varies inversely with the control over international financial transactions).
Modelling, Simulation and Navigation of a Two-Wheel Mobile Robot using Pure Pursuit Controller
Authors: Nawawi Sophan Wahyudi , Abdeltawab Amr Ahmed Abdelsattar , Samsuria Noor Erlia Nasha , Sirkunan Navein a/l
Published: December 2022

Recently, the field of mobile robotics have witnessed an unprecedented expansion due to their vast applications that range from surveillance and construction to planetary exploration and emergency rescue operations. Their tasks became more and more complex that their autonomy became essential in the majority of the applications which means that devising controllers that suit different scenarios and situations is of importance. In this project, we aim to control the velocity of a modelled 2-wheel differential drive robot by using a PSO optimized PID controller. In addition to speed control, in order for a robot to move to specific waypoints by itself, a path planning algorithm has to be implemented. Pure pursuit, a simple yet efficient path tracking method for nonholonomic ground vehicles is utilized.
Instagram Influencers Credibility Dimensions and Purchase Intention of Followers: Empirical Evidence
Authors: Kumar Kancharla Laveen , Venugopal Pulidindi , Devi S. Anjani , Aswinipriya S. , Rao Ch. Vinoda
Published: December 2022

The advent of SMIs has primarily altered the means business connect with their prospects and customers. Currently, many SNSs enables SMIs to endorse the products, share opinions, provide feedback, and communicate with their followers either publicly or privately. This research aims to determine the mediating effect of loyalty of followers towards the influencer and ascribed opinion leadership on SMIs dimensions (expertise, trustworthiness, and attractiveness) and purchase intention relationship from the perspective of Instagram users in India. To measure the objective, the study acquired responses from 250 Indian Instagram users in the age group of 18-24. Results indicated that the purchase intention of followers is positively influenced by expertise, trustworthiness, ascribed opinion leadership, and loyalty of followers towards the influencer dimensions. Here, ascribed opinion leadership and loyalty of followers towards the influencer acts as an effective arbitrator between SMIs dimensions (expertise, trustworthiness, and attractiveness) and purchase intention relationship. The study suggests that before engaging SMI to promote the brand, the companies should understand the perception of followers towards the influencer in terms of expertise, attractiveness, and trustworthiness dimensions.
Body Size on Cinema: A Critical Discourse Analysis on Contemporary Indonesian Cinema
Authors: Afifulloh M. , Wijayanti Nurvita
Published: December 2022

This article discusses how a fat body in a film is used as a metaphor for a deviant, dangerous, and irresponsible personality through the various narratives occupied by the characters in the film. This research is qualitative research with the main data source is Imperfect film released in 2020. The approach used is a combination of film studies and Sara Mills' critical discourse analysis. The results of the study show that although Imperfect promotes gender equality in society, the narrative that is built still position fat bodies and black skin as non-ideal, especially for woman. Furthermore, Imperfect film positions fat women as a subculture group that struggles as well as agents of change. In conclusion, this study provides an understanding of how the cinematic discourse on size and weight in the context of the structure of the wider community is related to gender issues and films as popular media still have not placed a positive side on weight and skin color, especially in Indonesian society.
Analysis on Electrochemical CO2 Reduction by Diamond Doping Technology
Authors: Zeng Xiangyong , Zhao Yang , Chen Naichao , He Ping
Published: December 2022

Mitigating the massive emissions of greenhouse gases is one of the main measures taken to resolve the current growing climate problems. The electrochemical reduction of carbon dioxide to economically valuable chemical fuels has attracted the intensive attention of scholars. This review provides an overview of the application of conductive diamond in electrocatalytic reduction and outlines the improvement of electrochemical properties by employing metal particles to modify the surface. Meanwhile, the carbon-based electrode materials represented by glassy carbon and diamond-like carbon also have broad research value. Emphasis is placed on the electrochemical properties of boron-doped, transition metal modification, and co-doped diamond film electrodes with appropriate extensions. The carbon-chain compounds produced by the reduction reaction are also briefly described, mainly using formic acid and ethanol as examples, and focusing on the switchable selectivity of the multi-carbon products. In addition, the development directions of electrochemical reduction technology are prospected.
Partitioned Active Learning for Heterogeneous Systems
Authors: Lee Cheolhei , Wang Kaiwen , Wu Jianguo , Cai Wenjun , Yue Xiaowei
Published: December 2022

Active learning is a subfield of machine learning that focuses on improving the data collection efficiency in expensive-to-evaluate systems. Active learning-applied surrogate modeling facilitates cost-efficient analysis of demanding engineering systems, while the existence of heterogeneity in underlying systems may adversely affect the performance. In this article, we propose the partitioned active learning that quantifies informativeness of new design points by circumventing heterogeneity in systems. The proposed method partitions the design space based on heterogeneous features and searches for the next design point with two systematic steps. The global searching scheme accelerates exploration by identifying the most uncertain subregion, and the local searching utilizes circumscribed information induced by the local Gaussian process (GP). We also propose Cholesky update-driven numerical remedies for our active learning to address the computational complexity challenge. The proposed method consistently outperforms existing active learning methods in three real-world cases with better prediction and computation time.
Clustering-Based Detection of Debye–Scherrer Rings
Authors: Sirhindi Rabia , Khan Nazar
Published: December 2022

Calibration of the X-ray powder diffraction (XRPD) experimental setup is a crucial step before data reduction and analysis, and requires correctly extracting individual Debye–Scherrer rings from the 2D XRPD image. This problem is approached using a clustering-based machine learning framework, thus interpreting each ring as a cluster. This allows automatic identification of Debye–Scherrer rings without human intervention and irrespective of detector type and orientation. Various existing clustering techniques are applied to XRPD images generated from both orthogonal and nonorthogonal detectors, and the results are visually presented for images with varying inter-ring distances, diffuse scatter, and ring graininess. The accuracy of predicted clusters is quantitatively evaluated using an annotated gold standard and multiple cluster analysis criteria. These results demonstrate the superiority of density-based clustering for the detection of Debye–Scherrer rings. Moreover, the given algorithms impose no prior restrictions on detector parameters such as sample-to-detector distance, alignment of the center of diffraction pattern, or detector type and tilt, as opposed to existing automatic detection approaches.
Anomalous Adverse Effect of Mass Velocity on Convective Flow Boiling in Small-Diameter Microfin Tubes
Authors: Lin Lingnan , Kedzierski Mark A.
Published: December 2022

Recent studies report an anomalous phenomenon, particularly for small diameter microfin tubes, where the flow boiling heat transfer coefficient decreases with increasing mass velocity in the convective regime, which is contrary to that found for smooth tubes and larger diameter microfin tubes. This paper presents a critical literature review and mechanistic analysis of the anomalous phenomenon. Our analysis suggests that the anomalous phenomenon is a result of the transition of annular flow pattern from “flooded-groove” (film thickness > fin height) to “in-groove” (film thickness < fin height). The latter is associated with lower degree of turbulence, smaller wetted area, and therefore smaller heat transfer coefficient than the former. We speculated that the in-groove annular flow only occurs for small diameter tubes where the liquid film is relatively uniform, while larger tubes tend to remain flooded at the tube-bottom until dryout. This may explain the tendency of the anomalous phenomenon to occur in small diameter tubes.
Experimental and Numerical Investigations on Fabrication of Surface Microstructures Using Mask Electrolyte Jet Machining and Duckbill Nozzle
Authors: Wu Ming , Hazak Arshad Muhammad , Kumar Saxena Krishna , Reynaerts Dominiek , Guo Zhongning , Liu Jiangwen
Published: December 2022

The consistency in the fabrication of microsurface structures on large workpieces remains a challenge for existing production techniques. Mask electrolyte jet machining (MEJM) is a hybrid mask-based electrochemical machining (ECM) process that combines the flexibility of Jet-ECM to flush the electrochemical by-products and the high throughput processing feature of through-mask electrochemical micromachining (TMEMM). In the present study, a duckbill-shaped nozzle is employed in the MEJM for the batch fabrication of microsurface structures which facilitates more uniform current density distribution over the entire machining area, resulting in better consistency. With a larger slit length, the duckbill nozzle will not only cover more processing area but also facilitates more uniform current density distribution over the entire machining area, resulting in a better consistency for batch fabrication. Thresholds of the ratio of slit length to the machining area were derived from a quantitative analysis, namely the efficient threshold and the performance threshold. The slit length of the duckbill nozzle should be at least twice as large as the machining area to wipe out any observable deviation on current density distribution in the machining area. An efficient and high-performance numerical simulation framework with a virtual gap concept is developed for the mask-based ECM processes to simulate microcavity profiles and associated current density distribution. The concept of a virtual gap is proposed to solve the simulation dilemma of elements being consumed in the mask-based ECM process. Quantitative analyses were carried out to study how the virtual gap influences the electric current density distribution in the interelectrode gap. A virtual gap smaller than 100 nm is recommended. Guidelines on how to ensure a smooth electric field transition across the coarse and fine-meshed zones are presented by conducting a quantitative analysis. As an example, this work has successfully fabricated several cavity arrays with different processing parameters. Both the experimental results and the numerical simulation frameworks are easy-to-implement and easy-to-extend for all the mask-based ECM processes.
Retired Lithium-Ion Battery Pack Disassembly Line Balancing Based on Precedence Graph Using a Hybrid Genetic-Firework Algorithm for Remanufacturing
Authors: Cong Liang , Zhou Kai , Liu Weiwei , Li Ronghua
Published: December 2022

Electric vehicle production is subjected to high manufacturing cost and environmental impact. Disassembling and remanufacturing the lithium-ion power packs can highly promote electric vehicle market penetration by procuring and regrouping reusable modules as stationary energy storage devices and cut life-cycle cost and environmental impact. Disassembly efficiency is crucial for battery remanufacturing companies in reverse supply chains. However, disassembly planning suffers from high computational complexity and inferior solutions. This paper developed a multi-objective mathematical model and presented a novel hybrid genetic-firework algorithm based on the precedence graph for obtaining solutions to disassemble the electric vehicle power pack into module levels in an efficient manner. The objectives for the model include not only smoothness of working stations, cycle time, and economic returns, but also consider operation safety and energy consumption. The proposed hybrid algorithm explored the performance of the novel solution searching mechanism of combining the firework and genetic algorithms. The proposed approach is compared with the commonly used multi-objective evolutionary algorithms in the literature, showing its feasibility and effectiveness.
Manganese-coordinated mRNA vaccines with enhanced mRNA expression and immunogenicity induce robust immune responses against SARS-CoV-2 variants
Authors: Fan Na , Chen Kepan , Zhu Rong , Zhang Zhongwei , Huang Hai , Qin Shugang , Zheng Qian , He Zhongshan , He Xi , Xiao Wen , Zhang Yupei , Gu Yongjun , Zhao Changchun , Liu Yongmei , Jiang Xin , Li Shuaicheng , Wei Yuquan , Song Xiangrong
Published: December 2022

It is urgent to develop more effective mRNA vaccines against the emerging severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants owing to the immune escape. Here, we constructed a novel mRNA delivery system [IC8/Mn lipid nanoparticles (IC8/Mn LNPs)]with high immunogenicity, via introducing a stimulator of interferon genes (STING) agonist [manganese (Mn)] based on a newly synthesized ionizable lipid (IC8). It was found that Mn can not only promote maturation of antigen-presenting cells via activating STING pathway but also improve mRNA expression by facilitating lysosomal escape for the first time. Subsequently, IC8/Mn LNPs loaded with mRNA encoding the Spike protein of SARS-CoV-2 Delta or Omicron variant (IC8/Mn@D or IC8/Mn@O) were prepared. Both mRNA vaccines induced substantial specific immunoglobulin G responses against Delta or Omicron. IC8/Mn@D displayed strong pseudovirus neutralization ability, T helper 1–biased immune responses, and good safety. It can be concluded that IC8/Mn LNPs have great potential for developing Mn-coordinated mRNA vaccines with robust immunogenicity and good safety.
An orbitofrontal cortex–anterior insular cortex circuit gates compulsive cocaine use
Authors: Chen Yang , Wang Guibin , Zhang Wen , Han Ying , Zhang Libo , Xu Hubo , Meng Shiqiu , Lu Lin , Xue Yanxue , Shi Jie
Published: December 2022

Compulsive drug use, a cardinal symptom of drug addiction, is characterized by persistent substance use despite adverse consequences. However, little is known about the neural circuit mechanisms behind this behavior. Using a footshock-punished cocaine self-administration procedure, we found individual variability of rats in the process of drug addiction, and rats with compulsive cocaine use presented increased neural activity of the anterior insular cortex (aIC) compared with noncompulsive rats. Chemogenetic manipulating activity of aIC neurons, especially aIC glutamatergic neurons, bidirectionally regulated compulsive cocaine intake. Furthermore, the aIC received inputs from the orbitofrontal cortex (OFC), and the OFC-aIC circuit was enhanced in rats with compulsive cocaine use. Suppression of the OFC-aIC circuit switched rats from punishment resistance to sensitivity, while potentiation of this circuit increased compulsive cocaine use. In conclusion, our results found that aIC glutamatergic neurons and the OFC-aIC circuit gated the shift from controlled to compulsive cocaine use, which could serve as potential therapeutic targets for drug addiction.
Exposure to gun violence among the population of Chicago community violence interventionists
Authors: Hureau David M. , Wilson Theodore , Jackl Hilary M. , Arthur Jalon , Patterson Christopher , Papachristos Andrew V.
Published: December 2022

Gun violence is a leading cause of premature death and a driver of racial disparities in life expectancy in the United States. Community-based interventions are the foremost policy strategy for reducing gun violence without exacerbating harm associated with criminal justice approaches. However, little is known about the interventionist workforce. In 2021, we used a researcher-guided survey to obtain a near-census of Chicago violence interventionists (
n
 = 181, 93% response rate). Workers were mostly male (84%) and Black (80.9%), with a mean age of 43.6 years. Interventionists commonly experienced work-related exposure to violence and direct victimization. A total of 59.4% witnessed someone being shot at, whereas 32.4% witnessed a victim struck by gunfire. During work hours, 19.6% were shot at, while 2.2% were nonfatally shot. Single-year rates of gun violence victimization exceeded those of Chicago police. Results suggest that investment in community violence intervention should prioritize improving worker safety and reducing violence exposure while developing support for vulnerable frontline practitioners.
Touch IoT enabled by wireless self-sensing and haptic-reproducing electronic skin
Authors: Li Dengfeng , Zhou Jingkun , Yao Kuanming , Liu Sitong , He Jiahui , Su Jingyou , Qu Qing’ao , Gao Yuyu , Song Zhen , Yiu Chunki , Sha Chuanlu , Sun Zhi , Zhang Binbin , Li Jian , Huang Libei , Xu Chenyu , Wong Tsz Hung , Huang Xingcan , Li Jiyu , Ye Ruquan , Wei Lei , Zhang Zhengyou , Guo Xu , Dai Yuan , Xie Zhaoqian , Yu Xinge
Published: December 2022

Tactile sensations are mainly transmitted to each other by physical touch. Wireless touch perception could be a revolution for us to interact with the world. Here, we report a wireless self-sensing and haptic-reproducing electronic skin (e-skin) to realize noncontact touch communications. A flexible self-sensing actuator was developed to provide an integrated function in both tactile sensing and haptic feedback. When this e-skin was dynamically pressed, the actuator generated an induced voltage as tactile information. Via wireless communication, another e-skin could receive this tactile data and run a synchronized haptic reproduction. Thus, touch could be wirelessly conveyed in bidirections between two users as a touch intercom. Furthermore, this e-skin could be connected with various smart devices to form a touch internet of things where one-to-one and one-to-multiple touch delivery could be realized. This wireless touch presents huge potentials in remote touch video, medical care/assistance, education, and many other applications.
Ultrashort 15-nm flexible radio frequency ITO transistors enduring mechanical and temperature stress
Authors: Hu Qianlan , Zhu Shenwu , Gu Chengru , Liu Shiyuan , Zeng Min , Wu Yanqing
Published: December 2022

Flexible radio frequency (RF) transistors play an important role in the fast-growing wearable smart sensors for data communication. However, the scaling capability and high-speed performance of the flexible transistor are far below the counterparts on rigid substrates, impeding the gigahertz high-speed applications. Here, we address the scaling and performance bottlenecks in flexible transistors by demonstrating natively flexible RF indium tin oxide transistors with deeply scaled 15-nm-long channel, capable of operating in the 10-GHz frequency range. The record-high cutoff frequency of 11.8 GHz and maximum oscillation frequency of 15 GHz can rival those on rigid substrates. Furthermore, the robustness of flexible RF transistors was examined, capable of enduring heavy-duty 10,000 bending cycles at 1-mm radius and extreme thermal stress from cryogenic temperature of 4.3 K and high temperature of 380 K.
Extremophile-based biohybrid micromotors for biomedical operations in harsh acidic environments
Authors: Zhang Fangyu , Li Zhengxing , Duan Yaou , Luan Hao , Yin Lu , Guo Zhongyuan , Chen Chuanrui , Xu Mingyao , Gao Weiwei , Fang Ronnie H. , Zhang Liangfang , Wang Joseph
Published: December 2022

The function of robots in extreme environments is regarded as one of the major challenges facing robotics. Here, we demonstrate that acidophilic microalgae biomotors can maintain their swimming behavior over long periods of time in the harsh acidic environment of the stomach, thus enabling them to be applied for gastrointestinal (GI) delivery applications. The biomotors can also be functionalized with a wide range of cargos, ranging from small molecules to nanoparticles, without compromising their ability to self-propel under extreme conditions. Successful GI delivery of model payloads after oral administration of the acidophilic algae motors is confirmed using a murine model. By tuning the surface properties of cargos, it is possible to modulate their precise GI localization. Overall, our findings indicate that multifunctional acidophilic algae-based biomotors offer distinct advantages compared to traditional biohybrid platforms and hold great potential for GI-related biomedical applications.
An ultralong-acting tenofovir ProTide nanoformulation achieves monthslong HBV suppression
Authors: Das Srijanee , Wang Weimin , Ganesan Murali , Fonseca-Lanza Franchesca , Cobb Denise A. , Bybee Grace , Sun Yimin , Guo Lili , Hanson Brandon , Cohen Samuel M. , Gendelman Howard E. , Osna Natalia A. , Edagwa Benson J. , Poluektova Larisa Y.
Published: December 2022

Treatment of chronic hepatitis B virus (HBV) requires lifelong daily therapy. However, suboptimal adherence to the existing daily therapy has led to the need for ultralong-acting antivirals. A lipophilic and hydrophobic ProTide was made by replacing the alanyl isopropyl ester present in tenofovir alafenamide (TAF) with a docosyl phenyl alanyl ester, now referred to as M1TFV. NM1TFV and nanoformulated TAF (NTAF) nanocrystals were formulated by high-pressure homogenization. A single intramuscular injection of NM1TFV, but not NTAF, delivered at a dose of TFV equivalents (168 milligrams per kilogram) demonstrated monthslong antiviral activities in both HBV-transgenic and human hepatocyte transplanted TK-NOG mice. The suppression of HBV DNA in blood was maintained for 3 months. Laboratory experiments on HBV-transfected HepG2.2.15 cells affirmed the animal results and the critical role of docosanol in the sustained NM1TFV antiviral responses. These results provide clear “proof of concept” toward an emerging therapeutic paradigm for the treatment and prevention of HBV infection.
Reconstructing backwater hydrodynamics from fluvial-deltaic deposits using stratigraphic inversion: An example from the Tullig Sandstone, Western Irish Namurian Basin, County Clare, Ireland
Authors: Wu Chenliang , Nittrouer Jeffrey A. , Barefoot Eric A. , Burmeister Kurtis C.
Published: December 2022

Fluvial-deltaic systems are subject to non-uniform backwater flow where rivers approach receiving basins. This hydrodynamic condition results in sediment aggradation on the channel bed and enhanced downstream fining. In turn, this impacts river channel dynamics, including lateral migration rates and the propensity for avulsion. The imprint of non-uniform flow on stratigraphy has been reported from field, numerical modeling, and experimental studies. This work provides key observations for evaluating the impact of non-uniform flow spanning length scales from those of sediment grains to delta lobes. However, reconstructing paleohydraulic conditions of non-uniform flow from fluvial-deltaic settings remains a challenge. Non-uniform flow is a defining characteristic of fluvial-deltaic environments, but most existing relations linking hydrology and the depositional record rely on the assumption of steady and uniform flow. Herein, we present a novel stratigraphic inversion technique, combining it with morphodynamic modeling and statistical analyses, to evaluate how backwater conditions manifest in the stratigraphy of the Tullig Sandstone, an ancient fluvial-deltaic deposit of the Western Irish Namurian Basin. Our analyses refine estimates of channel properties, including flow depth and bed slope, and are validated by field measurements of sandstone-facies properties, including grain size and stratal architecture. For example, bed sediment fines down-dip, commensurate with increasing cross set and bed thicknesses. These patterns indicate bed aggradation and are consistent with reconstructed morphodynamic conditions. This study pinpoints the extent of non-uniform flow and its influence on fluvial-deltaic stratigraphy and provides a framework for improving reconstruction techniques used to interpret the paleohydrology of ancient fluvial-deltaic systems.
An Inequilateral Triangle: Russia−United States−China in a New Geopolitical Environment
Authors: Rogov S. M.
Published: December 2022

The author offers a general comparative overview of the relations of three key countries—Russia, China, and the United States. A new geopolitical picture of the world is presented with three centers of power. The triangle evolves, changing the potential of each of its sides. The three-party relationships are not equipollent. China is building up its economic, nuclear, and political potential, turning into a peer competitor of the United States on the world stage. Russia competes with the United States only in the military-strategic sphere. That is why US foreign policy today is aimed at “double containment” of both Russia and China. At the same time, Washington seeks to rely on its allies both in Europe, strengthening NATO, and in the Indo−Pacific region, pursuing a “latticework” strategy. This promises a long-term confrontation between the US angle and the Chinese and Russian angles of the triangle.
Keto-Analogs of Arylidene-Imidazolones as Fluorogenic Dyes
Authors: Sokolov A. I. , Gorshkova A. A. , Baleeva N. S. , Baranov M. S.
Published: December 2022

Abstract

We report a series of (Z)-2-acetyl-4-benzyliden-1-methyl-1Н-imidazol-5(4Н)-ones with a pronounced solvent-dependent intensity of fluorescence variation. The introduction of the 2-acetyl group allows one to shift the absorption and emission maxima to the long-wavelength region. We have shown that these compounds can be used for staining the endoplasmic reticulum for fluorescent microscopy.
Protocol for a case–control prospective study to investigate the impact ofHepaticEncephalopathy onNutritional Intake andSarcopenia status in patients with end-stageLIVer disease: HENS-LIV study
Authors: Towey Jennifer , Ngonadi Chiemelie , Rajoriya Neil , Holt Andrew , Greig Carolyn , Armstrong Matthew J
Published: December 2022

Introduction

Hepatic encephalopathy (HE) is a debilitating symptom of end-stage liver disease (ESLD), but there remains a paucity of evidence regarding its impact on nutritional status, nutritional intake, compliance with nutritional support and resultant muscle health and function. Malnutrition and sarcopenia are associated with increased morbidity and mortality in patients with ESLD. The aim of the current case–control study is to prospectively investigate the impact of HE on nutritional intake and sarcopenia status in patients with ESLD.

Methods and analysis

Patients with ESLD, with HE (n=10) and without HE (n=10) will be recruited at the outpatient liver unit, University Hospital Birmingham, UK. All patients will undergo clinical assessment at baseline and again at 6–8 weeks (in-line with their routine clinical follow-up), to assess the impact of HE on reported nutritional intake, nutritional status and sarcopenia/physical functional status. Standard medical, dietetic and home-based exercise physiotherapy care will continue for all participants as determined by their clinical team. Two methods of assessing nutritional intake will include the 24-hour food recall and 3-day food diaries. Assessment of sarcopenia status will be undertaken using anthropometry (mid-arm muscle circumference (MAMC)) and ultrasound imaging of the quadriceps muscle group. Markers of physical function (hand grip strength; chair rise time), frailty (Liver Frailty Index (LFI)), physical activity (accelerometery) and exercise capacity (Duke Activity Status Index (DASI)) will be assessed at both clinic visits.

Ethics and dissemination

The study is approved by Wales Research Ethics Committee 2 and Health Research Authority (REC reference: 21/WA/0216). Recruitment into the study commenced November 2021. The findings will be disseminated through peer-reviewed publications and international presentations.

Trial registration number

RRK7156.
Impact of the COVID-19 pandemic on prescription refills for immune-mediated inflammatory disorders: a time series analysis (January 2019 to January 2021) using the English Prescribing Dataset
Authors: Barrett Ravina , Barrett Rob , Lin Sharon X , Culliford David , Fraser Simon , Edwards Christopher John
Published: December 2022

Objective

To investigate monthly prescription refills for common immunosuppressive/immunomodulatory therapy (sulfasalazine, hydroxychloroquine, azathioprine, methotrexate, leflunomide) prescriptions in England during the complete first wave of the COVID-19 pandemic. Secondary analysis examined unit cost analysis and regional use.

Design and setting

A national cohort of community-based, primary care patients who anonymously contribute data to the English Prescribing Dataset, dispensed in the community in England, were included. Descriptive statistics and interrupted time series analysis over 25 months (14 months before, 11 months after first lockdown) were evaluated (January 2019 to January 2021, with March 2020 as the cut-off point).

Outcome measures

Prescription reimbursement variance in period before the pandemic as compared with after the first lockdown.

Results

Fluctuation in monthly medicines use is noted in March 2020: a jump is observed for hydroxychloroquine (Mann-Whitney, SE 14.652, standardised test statistic 1.911, p value=0.059) over the study period. After the first lockdown, medicines use fluctuated, with wide confidence intervals. Unit-cost prices changed substantially: sulfasalazine 33% increase, hydroxychloroquine 98% increase, azathioprine 41% increase, methotrexate 41% increase, leflunomide 20% decrease. London showed the least quantity variance, suggesting more homogeneous prescribing and patient access compared with Midlands and East of England, suggesting that some patients may have received medication over/under requirement, representing potential resource misallocation and a proxy for adherence rates. Changepoint detection revealed four out of the five medicines’ use patterns changed with a strong signal only for sulfasalazine in March/April 2020.

Conclusions

Findings potentially present lower rates of adherence because of the pandemic, suggesting barriers to care access. Unit price increases are likely to have severe budget impacts in the UK and potentially globally. Timely prescription refills for patients taking immunosuppressive/immunomodulatory therapies are recommended. Healthcare professionals should identify patients on these medicines and assess their prescription-day coverage, with planned actions to flag and follow-up adherence concerns in patients.
Evaluating the feasibility and acceptability of a safety protocol to mitigate SARS-CoV-2 transmission risks when participating in full-capacity live mass events: a cross-sectional survey and interview-based study
Authors: Dallera Giulia , Alaa Aos , El-Osta Austen , Kreindler Jack , Harris Matthew
Published: December 2022

Objective

Investigate the feasibility and acceptability of a novel COVID-19 safety protocol combining professionally witnessed home-based videoed pre-event testing and a data-driven risk assessment model that was piloted at the Standon Calling Festival in July 2021.

Design

Observational study using a sequential explanatory mixed-methods design involving a survey, personal interviews and group discussions with a cross section of participants.

Setting

Standon Calling Festival, Hertfordshire, England.

Participants

4726 adults who attended Standon Calling and consented to participate in the study.

Results

Nearly a quarter (23.1%; 1093) attendees (women 65%, men 35%) responded to the postevent survey. Eleven participants were interviewed before thematic saturation was reached. The majority (81.0%) of respondents found the at-home testing protocol convenient and of reasonable cost (73.6%). Confidence in the test result was enhanced due to professional-supported videoing (76.2%), whereas 72.6% had confidence in the security of the data. Videoed self-testing helped 45.0% of respondents to feel more confident in their lateral flow testing technique. The majority (85.5%) felt safer at the event and 93.7% agreed that the protocol did not interfere with their enjoyment of the event. Themes generated from interviews showed that the protocol could be applied to other disease areas and events, but there were concerns that over-reliance on test results alone could lead some people to have a false sense of security around the safety of the live event.

Conclusions

Our study showed that a protocol that combines professionally witnessed home-based videoed pre-event testing is highly acceptable and feasible, and it can inform decision making and support the safe reopening of live mass events at full capacity. Although COVID-19 is now considered endemic in the UK, this protocol can be of value for other countries where the live events industry remains heavily impacted. Risk modelling should be tested and evaluated at future events to further increase the robustness of this protocol.
Impact of selective licensing schemes for private rental housing on mental health and social outcomes in Greater London, England: a natural experiment study
Authors: Petersen Jakob , Alexiou Alexandros , Brewerton David , Cornelsen Laura , Courtin Emilie , Cummins Steven , Marks Dalya , Seguin Maureen , Stewart Jill , Thompson Kevin , Egan Matt
Published: December 2022

Objectives

To assess primary impact of selective Licensing (SL), an area-based intervention in the private rented housing market, on individual self-reported anxiety and neighbourhood mental health (MHI—Mental Healthcare Index) and secondary impacts on antisocial behaviour (ASB), population turnover and self-reported well-being.

Design

Difference-in-difference (DiD) was used to evaluate effects of SL schemes initiated 2012–2018. 921 intervention areas (lower super output areas) were matched 3:1 using propensity scores derived from sociodemographic and housing variables (N=3.684 including controls). Average treatment effect on treated (ATT) was calculated for multiple time period DiD in area-level analyses. Canonical DiD was used for individual-level analysis by year of treatment initiation while adjusting for age, sex, native birth and occupational class.

Setting

Intervention neighbourhoods and control areas in Greater London, UK, 2011–2019.

Participants

We sampled 4474 respondents renting privately in intervention areas (N=17 347 including controls) in Annual Population Survey and obtained area-level MHI population data.

Interventions

Private landlords in SL areas must obtain a licence from the local authority, allow inspection and maintain minimum housing standards.

Results

ATT after 5 years was significantly lower for MHI (−7.5%, 95% CI −5.6% to −8.8%) than controls. Antidepressant treatment days per population reduced by −5.4% (95% CI −3.7% to −7.3), mental health benefit receipt by −9.6% (95% CI −14% to −5.5%) and proportion with depression by −12% (95% CI −7.7% to −16.3%). ASB reduced by −15% (95% CI −21% to −8.2%). Population turnover increased by 26.5% (95% CI 22.1% to 30.8%). Sensitivity analysis suggests overlap with effects of London 2012 Olympic regeneration. No clear patterns were observed for self-reported anxiety.

Conclusions

We found associations between SL and reductions in area-based mental healthcare outcomes and ASB, while population turnover increased. A national evaluation of SL is feasible and necessary.
Prevalence of and factors associated with multimorbidity among 18 101 adults in the South East Asia Community Observatory Health and Demographic Surveillance System in Malaysia: a population-based, cross-sectional study of the MUTUAL consortium
Authors: Tan Michelle M C , Prina A Matthew , Muniz-Terrera Graciela , Mohan Devi , Ismail Roshidi , Assefa Esubalew , Keinert Ana Á M , Kassim Zaid , Allotey Pascale , Reidpath Daniel , Su Tin Tin
Published: December 2022

Objectives

To assess the prevalence and factors associated with multimorbidity in a community-dwelling general adult population on a large Health and Demographic Surveillance System (HDSS) scale.

Design

Population-based cross-sectional study.

Setting

South East Asia Community Observatory HDSS site in Malaysia.

Participants

Of 45 246 participants recruited from 13 431 households, 18 101 eligible adults aged 18–97 years (mean age 47 years, 55.6% female) were included.

Main outcome measures

The main outcome was prevalence of multimorbidity. Multimorbidity was defined as the coexistence of two or more chronic conditions per individual. A total of 13 chronic diseases were selected and were further classified into 11 medical conditions to account for multimorbidity. The conditions were heart disease, stroke, diabetes mellitus, hypertension, chronic kidney disease, musculoskeletal disorder, obesity, asthma, vision problem, hearing problem and physical mobility problem. Risk factors for multimorbidity were also analysed.

Results

Of the study cohort, 28.5% people lived with multimorbidity. The individual prevalence of the chronic conditions ranged from 1.0% to 24.7%, with musculoskeletal disorder (24.7%), obesity (20.7%) and hypertension (18.4%) as the most prevalent chronic conditions. The number of chronic conditions increased linearly with age (p<0.001). In the logistic regression model, multimorbidity is associated with female sex (adjusted OR 1.28, 95% CI 1.17 to 1.40, p<0.001), education levels (primary education compared with no education: adjusted OR 0.63, 95% CI 0.53 to 0.74; secondary education: adjusted OR 0.60, 95% CI 0.51 to 0.70; tertiary education: adjusted OR 0.65, 95% CI 0.54 to 0.80; p<0.001) and employment status (working adults compared with retirees: adjusted OR 0.70, 95% CI 0.60 to 0.82, p<0.001), in addition to age (adjusted OR 1.05, 95% CI 1.05 to 1.05, p<0.001).

Conclusions

The current single-disease services in primary and secondary care should be accompanied by strategies to address complexities associated with multimorbidity, taking into account the factors associated with multimorbidity identified. Future research is needed to identify the most commonly occurring clusters of chronic diseases and their risk factors to develop more efficient and effective multimorbidity prevention and treatment strategies.
Clinical outcome using a modified treat-and-extend protocol for neovascular age-related macular degeneration
Authors: Vofo Brice Nguedia , Cnaany Yaacov , Chowers I
Published: December 2022

Aim

To compare outcome between patients treated using a modified treat-and-extend (mT&E) protocol and patients treated using a conventional T&E protocol.

Methods

A retrospective cohort study of two groups of treatment-naïve neovascular age-related macular degeneration patients within a single centre were evaluated. One group treated using the conventional T&E protocol, with visual acuity, dilated fundus examination (DFE) and optical coherence tomography (OCT) performed at each visit. The second group treated using the mT&E protocol in which visual acuity and DFE were performed only every three visits. The main outcome measures were time spent per clinical visit, visual and anatomical outcomes measured for 36 months.

Results

The T&E and mT&E groups included 135 eyes in 116 patients and 119 eyes in 94 patients, respectively, with similar baseline characteristics. At 36 months, the number of injections administered (7.9±2.9 vs 8.1±2.3 injections, respectively; p=0.55), the percentage of eyes that gained ≥15 Early Treatment for Diabetic Retinopathy Study (ETDRS) letters (23% vs 25.2%, respectively; p=0.39) and the percentage of eyes that lost ≥15 ETDRS letters (21.5% vs 17.7%; p=0.43, respectively) were similar between the T&E and mT&E groups. However, waiting and contact time were reduced during the OCT-only visits compared with the full visits, with an average of 41 min saved per patient encounter.

Conclusions

Both protocols yielded similar visual and anatomical outcomes. However, the mT&E protocol reduced the number of full visits, with considerably less time spent at the clinic.
Adaptation and validation of the Chinese version of the Central Sensitisation Inventory in patients with chronic pain
Authors: Liang Dongfeng , Yu Xiangli , Guo Xiaojie , Zhang Jie
Published: December 2022

Background

The 25-item Central Sensitisation Inventory (CSI-25) is a patient-reported instrument used to screen patients at risk of central sensitisation, a pathophysiological mechanism implicated in many chronic pain syndromes.

Aims

To adapt and validate a Chinese version of the CSI-25 in the Chinese population.

Methods

The Chinese CSI-25 was developed by the translation of the original English version, back translation, cultural adaptation and revision using the Delphi method. The Chinese CSI-25 was administered to 237 patients with chronic pain and 55 healthy controls. Structural validity (confirmatory factor analysis), construct validity (correlations with other instruments), test–retest reliability and internal consistency were evaluated.

Results

Confirmatory factor analysis extracted four main factors (‘physical symptoms’, ‘emotional distress’, ‘headache/jaw symptoms’ and ‘urological symptoms’). The Chinese CSI-25 score was positively correlated with the Pain Catastrophic Scale (PCS) total score (r=0.709), PCS subscale scores (r=0.630–0.695), Brief Pain Inventory (BPI) mean item score (r=0.773), BPI total score (r=0.773) and the number of painful sites (r=0.636). The Chinese CSI-25 had excellent test–retest reliability (intragroup correlation coefficient=0.975) and good internal consistency (Cronbach’s α=0.930 in the overall population and 0.882 in the chronic pain population).

Conclusions

The Chinese CSI-25 had excellent test–retest reliability and satisfactory structural validity and construct validity. This instrument could potentially be used in China as a self-report questionnaire in both clinical practice and research settings.
Badminton-related eye injuries: a systematic review
Authors: Hoskin Annette K , Watson Stephanie , Kamalden Tengku A
Published: December 2022

Objectives

To report the nature of badminton-related eye injuries in the published literature.

Methods

A review of the literature with key word and MeSH terms: ‘Eye injury’, ‘Ocular trauma’, ‘Badminton’ ‘Shuttlecock’ using CENTRAL, MEDLINE, EMBASE and Informit Health Collection databases. Papers were reviewed to assess the circumstances of the injury, patient demographics and clinical data.

Results

19 studies from 1974 to 2020 from 12 countries reported 378 monocular badminton-related eye injuries from 378 patients with a male-to-female ratio of 2.5:1. A closed globe injury was sustained in 97% of eyes and a shuttlecock responsible for 85% of injuries. Doubles play, the shuttlecock and a lack of eye protection were associated with eye injury.

Conclusion

Vision impairment was associated with the majority of badminton-related eye injuries, and doubles play, the shuttlecock and a lack of eye protection were risk factors.
Addressing a gap: a qualitative analysis of Scotland’s Drowning and Incident Review process
Authors: McAvoy Carlene , Jagnoor Jagnoor , Hoe Connie
Published: December 2022

Objectives

Drowning is a leading cause of fatalities worldwide and Scotland carries a disproportionate number of drownings compared with its UK neighbours. Drowning data captured in Scotland are often incomplete and the Drowning and Incident Review (DIR) is a new process designed to help improve the capture of data and help inform future preventative measures. The aim of this study was to explore the perspectives and views of key stakeholders on the facilitators and barriers of implementing the DIR as well as areas for its future sustainability.

Methods

A qualitative approach was used with in-depth interviews using key participants. Participants were identified using purposive sampling, through use of a stakeholder analysis. Participants watched a hypothetical DIR and then participated in a semistructured interview. Questions focused on DIR facilitators, barriers and areas for future sustainability. Qualitative data were then analysed using thematic analysis.

Results

A total of 14 participants took part in the study. Results found: three facilitator themes (addresses a gap, design of DIR, safe space), four barrier themes (representation, resource, legal concerns, control concerns) and four areas for future sustainability (the voluntary nature, framework agreement, political prioritisation and the human element). These themes were then discussed within this paper in relation to findings from research on similar review processes.

Conclusion

The research was the first of its kind and the findings are therefore extremely important to provide a first exploration and insight into facilitators and barriers of the DIR as well as areas for its future sustainability.