bluuebunny/crossref_metadata_2025 huggingface dataset:
Global incidence proportion of intraventricular haemorrhage of prematurity: a meta-analysis of studies published 2010–2020
Authors: Lai Grace Y , Shlobin Nathan , Garcia Roxanna M , Wescott Annie , Kulkarni Abhaya V , Drake James , Dizon Maria LV , Lam Sandi K
Published: December 2021

Objective

To investigate differences and calculate pooled incidence of any intraventricular haemorrhage (IVH), severe IVH (Grade III/IV, sIVH) and ventriculoperitoneal shunt (VPS) placement in preterm infants across geographical, health and economic regions stratified by gestational age (GA).

Design

MEDLINE, Embase, CINAHL and Web of Science were searched between 2010 and 2020. Studies reporting rates of preterm infants with any IVH, sIVH and VPS by GA subgroup were included. Meta-regression was performed to determine subgroup differences between study designs and across United Nations geographical regions, WHO mortality strata and World Bank lending regions. Incidence of any IVH, sIVH and VPS by GA subgroups<25, <28, 28–31, 32–33 and 34–36 weeks were calculated using random-effects meta-analysis.

Results

Of 6273 publications, 97 met inclusion criteria. Incidence of any IVH (37 studies 87 993 patients) was: 44.7% (95% CI 40.9% to 48.5%) for GA <25 weeks, 34.3% (95% CI 31.2% to 37.6%) for GA <28 weeks, 17.4% (95% CI 13.8% to 21.6%) for GA 28–31 weeks, 11.3% (95% CI 7.3% to 17.0%) for GA32–33 weeks and 4.9% (95% CI 1.4% to 15.2%) for GA 34–36 weeks. Incidence of sIVH (49 studies 328 562 patients) was 23.7% (95% CI 20.9% to 26.7%) for GA <25 weeks, 15.0% (95% CI 13.1% to 17.2%) for GA <28 weeks, 4.6% (95% CI 3.5% to 6.1%) for GA 28–31 weeks, 3.3% (95% CI 2.1% to 5.1%) for GA 32–33 weeks and 1.8% (95% CI 1.2% to 2.8%) for GA 34–36 weeks. Europe had lower reported incidence of any IVH and sIVH relative to North America (p<0.05). Proportion of VPS across all GA groups was 8.4% (95% CI 4.7% to 14.7%) for any IVH and 17.2% (95% CI 12.2% to 26.2%) for sIVH. Heterogeneity was high (I2>90%) but 64%–85% of the variance was explained by GA and study inclusion criteria.

Conclusions

We report the first pooled estimates of IVH of prematurity by GA subgroup. There was high heterogeneity across studies suggesting a need for standardised incidence reporting guidelines.
Biodegradeable temporising matrix use in a traumatic chest wound
Authors: Carrington-Windo Eliot , Leong Sam , Ibrahim Nader , Pope-Jones Sophie
Published: December 2021

The Welsh Centre for Burns and Plastic Surgery is responsible for a population of 10 million people in Wales and England. We describe the use of biodegradable temporising matrix (BTM) in a large traumatic chest wound in a 23-year-old woman. BTM is a synthetic dermal substitute and has been utilised to achieve soft tissue coverage in complex wounds. This wound was sustained after the patient fell from a tractor into a large silage rake, resulting in injuries to her chest and limbs. Following meticulous debridement, her resulting full thickness skin defect measured 30 × 30 cm extending from the sternal notch to the upper abdomen, with bone, muscle and breast tissue exposure. The central chest area is complex to reconstruct due to the contours of the breasts and tendency to contracture following skin graft reconstruction. We demonstrate the first reported use of BTM for breast reconstruction, as far as we are aware.
Gonioscopy-assisted transluminal trabeculotomy is an effective surgical treatment for uveitic glaucoma
Authors: Belkin Avner , Chaban Yuri Valere , Waldner Derek , Samet Saba , Ahmed Iqbal Ike K , Gooi Patrick , Schlenker Matthew B
Published: December 2021

Background

To assess the efficacy and safety of gonioscopy-assisted transluminal trabeculotomy (GATT) in uveitic glaucoma (UG).

Methods

A retrospective interventional case series in which 33 eyes of 32 patients with UG underwent GATT with or without concomitant cataract extraction and intraocular lens implantation (CE/IOL) at three Canadian treatment centres from October 2015 to 2020. The main outcome measure was surgical success defined as an intraocular pressure (IOP) ≤18 mm Hg and at least one of the following: IOP within one mm Hg of baseline on fewer glaucoma medications as compared with baseline or a 30% IOP reduction from baseline on the same or fewer medications. Secondary outcome measures were IOP, medication usage and surgical complications.

Results

Mean patient age (mean±SD) was 49±16 years (range: 18–79) and 44% were female. GATT was performed as a standalone procedure in 52% of cases and the remainder were combined with CE/IOL. Surgical success was achieved in 71.8% (SE: 8.7%) of cases. Mean preoperative IOP (±SD) was 31.4±10.8 mm Hg on a median of 4 medications. 59% of patients were on oral carbonic anhydrase inhibitors (CAIs) prior to surgery. After 1 year, average IOP was 13.8 mm Hg on a median 1 medication, with 6% of patients being on oral CAIs. No sight threatening complications occurred during surgery or follow-up.

Conclusion

GATT is an effective surgical strategy in the management of UG. This microinvasive conjunctival-sparing procedure should be considered early in these patients.
Menetrier’s disease exacerbating ulcerative colitis and relieved by gastrectomy
Authors: Kayes Tahrima , Bonnichsen Mark , Willmann Laura , Lorenzo Aldenb , Das Amitabha , El-Haddad Carlos , Househ Zaid , Ng Weng , Ng Watson , Williams Astrid-Jane , Prince David , Connor Susan J
Published: December 2021

Ménétrier’s disease (MD) is a rare gastropathy characterised by giant rugal folds which can present with nausea, vomiting, abdominal pain and protein losing gastropathy. We report a 21-year-old woman with comorbid MD and ulcerative colitis (UC). Management was complicated by limited treatment options for MD, significant symptom burden, worsening nutrition and difficulty determining which disease was the predominant cause of symptoms. Since age 18 the patient experienced recurrent UC flares characterised by diarrhoea, persistent vomiting and corticosteroid dependence. Endoscopic assessment demonstrated concurrent MD and active UC. Octreotide and cetuximab were trialled given persistent hypoalbuminaemia and suspicion for MD associated protein-losing gastropathy. UC management comprised dose-optimised infliximab and methotrexate. Repeat endoscopic assessment demonstrated improvement in UC without corresponding improvement in symptoms or hypoalbuminaemia. Nasojejunal feeding and parenteral nutrition failed to significantly improve nutritional status and accordingly the patient proceeded to radical total gastrectomy. Postoperatively, MD-associated symptoms and hypoalbuminemia resolved completely.
Prospective, observational, single-centre cohort study with an independent control group matched for age and sex aimed at investigating the significance of cholinergic activity in patients with schizophrenia: study protocol of the CLASH-study
Authors: Schick Benedikt , Barth Eberhard , Mayer Benjamin , Weber Claire-Louise , Hagemeyer Theresa , Schönfeldt-Lecuona Carlos
Published: December 2021

Introduction

Alterations in the cholinergic metabolism may cause various clinical symptoms of schizophrenia. In addition to the ‘monoamine hypothesis,’ neuroinflammation is also discussed as a cause of schizophrenia. To date, there has been no evidence of alterations in the central cholinergic transmitter balance in patients with schizophrenia under clinical conditions. By contrast, studies in critically ill patients have established the measurement of acetylcholinesterase activity as a suitable surrogate parameter of central cholinergic transmitter balance/possible pathophysiological changes. Butyrylcholinesterase activity has been established as a parameter indicating possible (neuro)inflammatory processes. Both parameters can now be measured using a point-of-care approach. Therefore, the primary objective of this study is to investigate whether acetylcholinesterase and butyrylcholinesterase activity differs in patients with various forms of schizophrenia. Secondary objectives address the possible association between acetylcholinesterase and butyrylcholinesterase activity and (1) schizophrenic symptoms using the Positive and Negative Syndrome Scale, (2) the quantity of antipsychotics taken and (3) the duration of illness.

Methods and analysis

The study is designed as a prospective, observational cohort study with one independent control group. It is being carried out at the Department of Psychiatry and Psychotherapy III, Ulm University Hospital, Germany. Patient enrolment started in October 2020, and the anticipated end of the study is in January 2022. The enrolment period was set from October 2020 to December 2021 (extension required due to SARS-CoV-2 pandemic). The sample size is calculated at 50 patients in each group. Esterase activity is measured on hospital admission (acute symptomatology) and after referral to a postacute ward over a period of three consecutive days. The matched control group will be created after reaching 50 patients with schizophrenia. This will be followed by a comprehensive statistical analysis of the data set.

Ethics and dissemination

The study was registered prospectively in the German Clinical Trials Register (DRKS-ID: DRKS00023143,URL:https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00023143) after approval by the ethics committee of the University of Ulm, Germany Trial Code No. 280/20.

Trial registration number

DRKS00023143; Pre-results.
Multicentre, prospective, observational study investigating the most appropriate surgical option that can prevent the recurrence of primary spontaneous pneumothorax after surgery: the PATCH study, protocol
Authors: Kadomatsu Yuka , Yoshioka Hiromu , Shigemitsu Kikuo , Nomata Yuji , Mori Shunsuke , Hijiya Kyoko , Motoyama Hideki , Ichikawa Yasuhisa , Sueyoshi Kuniyo , Okasaka Toshiki , Miyamoto Ei , Kobayashi Masashi , Takahashi Mamoru , Fujinaga Takuji , Takechi Hiroko , Yamagishi Hiroya , Takuwa Teruhisa , Kobayashi Jun , Sakamoto Jin , Taniguchi Tetsuo , Hanaoka Nobuharu , Kubo Yoko , Chen-Yoshikawa Toyofumi F
Published: December 2021

Introduction

Thoracoscopic surgery is performed for refractory or recurrent primary spontaneous pneumothorax (PSP). To reduce postoperative recurrence, additional treatment is occasionally adopted during surgery after bulla resection. However, the most effective method has not been fully elucidated. Furthermore, the preference for additional treatment varies among countries, and its efficacy in preventing recurrence must be evaluated based on settings tailored for the conditions of a specific country. The number of registries collecting detailed data about PSP surgery is limited. Therefore, to address this issue, a prospective multicentre observational study was performed.

Methods and analysis

This multicentre, prospective, observational study will enrol 450 participants aged between 16 and 40 years who initially underwent PSP surgery. Data about demographic characteristics, disease and family history, surgical details, and CT scan findings will be collected. Follow-up must be conducted until 3 years after surgery or in the event of recurrence, whichever came first. Patients without recurrence will undergo annual follow-up until 3 years after surgery. The primary outcome is the rate of recurrence within 2 years after surgery. A multivariate analysis will be performed to compare the efficacy of different surgical options. Then, adverse outcomes correlated with various treatments and the feasibility of treatment methods will be compared.

Ethics and dissemination

This study was approved by the local ethics committee of all participating centres. The findings will be available in 2025, and they can be used as a basis for clinical decision-making regarding appropriate options for the initial PSP surgery.

Trial registration number

NCT04758143.
Bridging the impactibility gap in population health management: a systematic review
Authors: Orlowski Andi , Snow Sally , Humphreys Heather , Smith Wayne , Jones Rebecca Siân , Ashton Rachel , Buck Jackie , Bottle Alex
Published: December 2021

Objectives

Assess whether impactibility modelling is being used to refine risk stratification for preventive health interventions.

Design

Systematic review.

Setting

Primary and secondary healthcare populations.

Papers

Articles published from 2010 to 2020 on the use or implementation of impactibility modelling in population health management, reported with the terms ‘intervenability’, ‘amenability’, and ‘propensity to succeed’ (PTS) and associated with the themes ‘care sensitivity’, ‘characteristic responders’, ‘needs gap’, ‘case finding’, ‘patient selection’ and ‘risk stratification’.

Interventions

Qualitative synthesis to identify themes for approaches to impactibility modelling.

Results

Of 1244 records identified, 20 were eligible for inclusion. Identified themes were ‘health conditions amenable to care’ (n=6), ‘PTS modelling’ (n=8) and ‘comparison or combination with clinical judgement’ (n=6). For the theme ‘health conditions amenable to care’, changes in practice did not reduce admissions, particularly for ambulatory care sensitive conditions, and sometimes increased them, with implementation noted as a possible issue. For ‘PTS modelling’, high costs and needs did not necessarily equate to high impactibility and targeting a larger number of individuals with disorders associated with lower costs had more potential. PTS modelling seemed to improve accuracy in care planning, estimation of cost savings, engagement and/or care quality. The ‘comparison or combination with clinical judgement’ theme suggested that models can reach reasonable to good discriminatory power to detect impactable patients. For instance, a model used to identify patients appropriate for proactive multimorbid care management showed good concordance with physicians (c-statistic 0.75). Another model employing electronic health record scores reached 65% concordance with nurse and physician decisions when referring elderly hospitalised patients to a readmission prevention programme. However, healthcare professionals consider much wider information that might improve or impede the likelihood of treatment impact, suggesting that complementary use of models might be optimum.

Conclusions

The efficiency and equity of targeted preventive care guided by risk stratification could be augmented and personalised by impactibility modelling.
Reperfusion strategy and in-hospital outcomes for ST elevation myocardial infarction in secondary and tertiary hospitals in predominantly rural central China: a multicentre, prospective and observational study
Authors: Zhang You , Wang Shan , Cheng Qianqian , Zhang Junhui , Qi Datun , Wang Xianpei , Zhu Zhongyu , Li Muwei , Hu Dayi , Gao Chuanyu
Published: December 2021

Objectives

To assess differences in reperfusion treatment and outcomes between secondary and tertiary hospitals in predominantly rural central China.

Design

Multicentre, prospective and observational study.

Setting

Sixty-six (50 secondary and 16 tertiary) hospitals in Henan province, central China.

Participants

Patients with ST elevation myocardial infarction (STEMI) within 30 days of symptom onset during 2016–2018.

Primary outcome measures

In-hospital mortality, and in-hospital death or treatment withdrawal.

Results

Among 5063 patients of STEMI, 2553 were treated at secondary hospitals. Reperfusion (82.0% vs 73.0%, p<0.001) including fibrinolytic therapy (70.3% vs 4.4%, p<0.001) were more preformed, whereas primary percutaneous coronary intervention (11.7% vs 68.6%, p<0.001) were less frequent at secondary hospitals. In secondary hospitals, 53% received fibrinolytic therapy 3 hours after onset, and 5.8% underwent coronary angiography 2–24 hours after fibrinolysis. Secondary hospitals had a shorter onset-to-first-medical-contact time (176 min vs 270 min, p<0.001). Adjusted in-hospital mortality (adjusted OR 1.23, 95% CI 0.89 to 1.70, p=0.210) and in-hospital death or treatment withdrawal (adjusted OR 1.18, 95% CI 0.82 to 1.70, p=0.361) were similar between secondary and tertiary hospitals.

Conclusions

With fibrinolytic therapy as the main reperfusion strategy, the reperfusion rate was higher in secondary hospitals, whereas in-hospital outcomes were similar compared with tertiary hospitals. Public awareness, capacity of primary and secondary care institutes to treat STEMI, and establishment of deeper cooperation among different-level healthcare institutes need to further improve.

Trial registration number

NCT02641262.
Pandemic fatigue and attenuated impact of avoidance behaviours against COVID-19 transmission in Hong Kong by cross-sectional telephone surveys
Authors: Gao Huizhi , Du Zhanwei , Tsang Tim K , Xiao Jingyi , Shan Songwei , Liao Qiuyan , Wu Peng , Leung Gabriel M , Cowling Benjamin J
Published: December 2021

Objectives

This study aims to explore the attenuated impact of reported avoidance behaviours adherence on the transmission of COVID-19 through cross-sectional surveys in Hong Kong, in order to make up for the lack of research on avoidance behaviours fatigue.

Design

40 cross-sectional telephone surveys.

Setting

All districts in Hong Kong.

Participants

31 332 Cantonese or English-speaking participants at age of 18 years or above.

Methods

We collected data on behaviours and estimated the average effective reproduction number (Rt) among the Hong Kong adult population during the COVID-19 epidemic wave in November–December 2020 and compared with the preceding epidemic in June–July 2020.

Results

We observed a reduction in adherence to voluntary avoidance behaviours due to pandemic fatigue, but continued adherence to regulated avoidance behaviours. The average Rt during the post-work from home period was higher in November–December wave with estimated Rt of 0.81 (95% CI: 0.75 to 0.87) compared with the June–July wave with an Rt of 0.67 (95% CI: 0.60 to 0.75).

Conclusions

The declined effectiveness of social distancing interventions in reducing COVID-19 transmission was associated with fatigue with voluntary avoidance behaviours in Hong Kong population, implying a need for the government to reinvigorate the public to maintain effective pandemic control.
Association of rheumatoid arthritis and high sodium intake with major adverse cardiovascular events: a cross-sectional study from the seventh Korean National Health and Nutrition Examination Survey
Authors: Bae Jeong-Hyeon , Shin Min-Young , Kang Eun Ha , Lee Yun Jong , Ha You-Jung
Published: December 2021

Objectives

High salt intake has a harmful effect on hypertension; however, the association between major adverse cardiovascular events (MACE) and salt intake is still controversial. Rheumatoid arthritis (RA) is also characterised by excess cardiovascular risk. However, few studies have investigated the combined role of salt intake and RA in MACE in the general Korean population. Here, we evaluated this relationship among the Korean adult population.

Design

Retrospective, cross-sectional.

Setting

Population-based survey in Korea.

Methods

This study was based on the data of the seventh Korean National Health and Nutrition Examination Survey (2016–2018). The estimated 24-hour urinary sodium excretion (24HUNa), a surrogate marker for daily sodium intake, was calculated using the Tanaka equation and was stratified into five groups (<3, 3–3.999, 4–4.999, 5–5.999 and ≥6 g/day). Finally, data from 13 464 adult participants (weighted n=90 425 888) were analysed; all analyses considered a complex sampling design. Multivariable logistic regression for MACE as primary dependent variable was performed and adjusted for potential covariates.

Results

Participants with MACE had higher 24HUNa levels and RA proportion than those without MACE (p<0.001). The association of MACE with 24HUNa was J-shaped with a gradual increase from about 3 g/day. The highest 24HUNa (≥6 g/day) group was significantly associated with increased prevalence of MACE compared with the reference group (3–3.999 g/day) after adjusting for all associated covariates (OR 6.75, 95% CI 1.421 to 32.039). In the multivariate logistic regression analysis, RA (OR 2.05, 95% CI 1.283 to 3.264) and the highest 24HUNa group (OR 6.35, 95% CI 1.337 to 30.147) were significantly associated with MACE even after adjusting for baseline covariates.

Conclusions

These nationally representative data suggest that RA and extremely high sodium intake are associated with MACE in the general adult Korean population. Avoiding extremely high salt intake and considering RA as an important risk factor for MACE might help promote public cardiovascular health.
Haemodynamic effects of a prehospital emergency anaesthesia protocol consisting of fentanyl, ketamine and rocuronium in patients with trauma: a retrospective analysis of data from a Helicopter Emergency Medical Service
Authors: ter Avest Ewoud , Ragavan Dassen , Griggs Joanne , Dias Michael , Mitchinson Sophie A , Lyon Richard
Published: December 2021

Objectives

Prehospital rapid sequence induction (RSI) of anaesthesia is an intervention with significant associated risk. In this study, we aimed to investigate the haemodynamic response over time of a prehospital RSI protocol of fentanyl, ketamine and rocuronium in a heterogeneous population of trauma patients.

Design, setting and participant

We performed a retrospective study of all trauma patients who received a prehospital RSI for trauma by a physician staffed Helicopter Emergency Medical Service in the UK between 1 June 2018 and 1 February 2020.

Primary outcome measure

Primary outcome was defined as the incidence of clinically relevant hypotensive (systolic blood pressure (SBP) or mean arterial pressure (MAP) >20% below baseline, with an absolute SBP <90 mm Hg or MAP <65 mm Hg) or hypertensive (SBP or MAP >20% above baseline) episodes in the first 10 minutes post-RSI.

Results

In total, 322 patients were included. 204 patients (63%) received a full-dose induction of 3 μg/kg fentanyl, 2 mg/kg ketamine and 1 mg/kg rocuronium, whereas 128 patients (37%) received a reduced-dose induction. Blood pressures decreased on average 12 mm Hg (95% CI 7 to 16) in the full-dose group and 6 mm Hg (95% CI 1 to 11) in the reduced-dose group, p=0.10). A hypotensive episode (mean SBP drop 53 mm Hg) was noted in 29 patients: 17 (8.3%) receiving a full dose and 12 (10.2%) receiving a reduced-dose induction, p=0.69. The blood pressure nadir was recorded on average 6–8 min after RSI. A hypertensive episode was present in 22 patients (6.8%). The highest blood pressures were recorded in the first 3 min after RSI.

Conclusion

Prehospital induction of anaesthesia for trauma with fentanyl, ketamine and rocuronium is not related to a significant change in haemodynamics in most patients. However, a (delayed) hypotensive response with a significant drop in SBP should be anticipated in a minority of patients irrespective of the dose regimen chosen.
ParkinSong Online: protocol for a telehealth feasibility study of therapeutic group singing for people with Parkinson’s disease
Authors: Tamplin Jeanette , Morris Meg E , Baker Felicity A , Sousa Tanara Vieira , Haines Simon , Dunn Stephen , Tull Victoria , Vogel Adam P
Published: December 2021

Introduction

Parkinson’s disease can be associated with speech deterioration and low communication confidence which in turn compromises social interaction. Therapeutic singing is an engaging method for combatting speech decline; however, face-to-face delivery can limit access to group singing. The aim of this study is to test the feasibility and acceptability of an online mode of delivery for a Parkinson’s singing intervention (ParkinSong) as well as remote data collection procedures.

Methods and analysis

This ParkinSong Online feasibility trial is a single-arm, pre–post study of online singing delivery and remote data collection for 30 people living with Parkinson’s. The primary outcome measure is feasibility: recruitment, retention, attendance, safety, intervention fidelity, acceptability and associated costs. Secondary outcomes are speech (loudness, intelligibility, quality, communication-related quality of life) and wellbeing (apathy, depression, anxiety, stress, health-related quality of life). This mode of delivery aims to increase the accessibility of singing interventions.

Ethics and dissemination

Ethics approval was obtained from The University of Melbourne Human Research Ethics Committee (2021-14465-16053-3) and the trial has been prospectively registered. Results will be presented at national and international conferences, published in a peer-reviewed journal, and disseminated to the Parkinson’s community, researchers and policymakers.

Trial registration number

ACTRN12621000940875.
Nivolumab-induced exocrine pancreatic insufficiency
Authors: Jones Anna , Rodgers Kay , Jeffrey Debbie , Ali Waqas I , Andreyev HJN
Published: December 2021

Immune checkpoint inhibition is the standard-of-care for many advanced cancers. Side effects of therapy may prevent optimal treatment of the cancer. Management of side effects is dominated by recommendations derived from oncological, not gastroenterological practice. We report a patient who developed pancreatic insufficiency during checkpoint inhibitor therapy with a programmed cell death receptor 1 inhibitor, nivolumab, which if not diagnosed would have prevented ongoing treatment. This is a problem which affects approximately 1 in 100 patients treated with this agent but is rarely recognised. Gastroenterologists need to be aware of the spectrum of gastrointestinal disorders which occur after immunotherapy to treat cancer.
Cash transfer during the COVID-19 pandemic: a multicentre, randomised controlled trial
Authors: Persaud Navindra , Thorpe Kevin E , Bedard Michael , Hwang Stephen W , Pinto Andrew , Jüni Peter , da Costa Bruno R
Published: December 2021

Objective

To evaluate the effect of a one-time cash transfer of $C1000 in people who are unable to physically distance due to insufficient income.

Design

Open-label, multi-centre, randomised superiority trial.

Setting

Seven primary care sites in Ontario, Canada; six urban sites associated with St. Michael’s Hospital in Toronto and one in Manitoulin Island.

Participants

392 individuals who reported trouble affording basic necessities due to disruptions related to COVID-19.

Intervention

After random allocation, participants either received the cash transfer of $C1000 (n=196) or physical distancing guidelines alone (n=196).

Main outcome measures

The primary outcome was the maximum number of symptoms consistent with COVID-19 over 14 days. Secondary outcomes were meeting clinical criteria for COVID-19, SARS-CoV-2 presence, number of close contacts, general health and ability to afford basic necessities.

Results

The primary outcome of number of symptoms reported by participants did not differ between groups after 2 weeks (cash transfer, mean 1.6 vs 1.9, ratio of means 0.83; 95% CI 0.56 to 1.24). There were no statistically significant effects on secondary outcomes of the meeting COVID-19 clinical criteria (7.9% vs 12.8%; risk difference −0.05; 95% CI −0.11 to 0.01), SARS-CoV-2 presence (0.5% vs 0.6%; risk difference 0.00 95% CI −0.02 to 0.02), mean number of close contacts (3.5 vs 3.7; rate ratio 1.10; 95% CI 0.83 to 1.46), general health very good or excellent (60% vs 63%; risk difference −0.03 95% CI −0.14 to 0.08) and ability to make ends meet (52% vs 51%; risk difference 0.01 95% CI −0.10 to 0.12).

Conclusions

A single cash transfer did not reduce the COVID-19 symptoms or improve the ability to afford necessities. Further studies are needed to determine whether some groups may benefit from financial supports and to determine if a higher level of support is beneficial.

Trial registration number

NCT04359264.
Impact of glucocorticoids on the incidence of lupus-related major organ damage: a systematic literature review and meta-regression analysis of longitudinal observational studies
Authors: Ugarte-Gil Manuel Francisco , Mak Anselm , Leong Joanna , Dharmadhikari Bhushan , Kow Nien Yee , Reátegui-Sokolova Cristina , Elera-Fitzcarrald Claudia , Aranow Cinthia , Arnaud Laurent , Askanase Anca D , Bae Sang-Cheol , Bernatsky Sasha , Bruce Ian N , Buyon Jill , Costedoat-Chalumeau Nathalie , Dooley Mary Ann , Fortin Paul R , Ginzler Ellen M , Gladman Dafna D , Hanly John , Inanc Murat , Isenberg David , Jacobsen Soren , James Judith A , Jönsen Andreas , Kalunian Kenneth , Kamen Diane L , Lim Sung Sam , Morand Eric , Mosca Marta , Peschken Christine , Pons-Estel Bernardo A , Rahman Anisur , Ramsey-Goldman Rosalind , Reynolds John , Romero-Diaz Juanita , Ruiz-Irastorza Guillermo , Sánchez-Guerrero Jorge , Svenungsson Elisabet , Urowitz Murray , Vinet Evelyne , van Vollenhoven Ronald F , Voskuyl Alexandre , Wallace Daniel J , Petri Michelle A , Manzi Susan , Clarke Ann Elaine , Cheung Mike , Farewell Vernon , Alarcon Graciela S.
Published: December 2021

Objective

In systemic lupus erythematosus (SLE), disease activity and glucocorticoid (GC) exposure are known to contribute to irreversible organ damage. We aimed to examine the association between GC exposure and organ damage occurrence.

Methods

We conducted a literature search (PubMed (Medline), Embase and Cochrane January 1966–October 2021). We identified original longitudinal observational studies reporting GC exposure as the proportion of users and/or GC use with dose information as well as the occurrence of new major organ damage as defined in the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index. Meta-regression analyses were performed. Reviews, case-reports and studies with <5 years of follow-up, <50 patients, different outcomes and special populations were excluded.

Results

We selected 49 articles including 16 224 patients, 14 755 (90.9%) female with a mean age and disease duration of 35.1 years and of 37.1 months. The mean follow-up time was 104.9 months. For individual damage items, the average daily GC dose was associated with the occurrence of overall cardiovascular events and with osteoporosis with fractures. A higher average cumulative dose adjusted (or not)/number of follow-up years and a higher proportion of patients on GC were associated with the occurrence of osteonecrosis.

Conclusions

We confirm associations of GC use with three specific damage items. In treating patients with SLE, our aim should be to maximise the efficacy of GC and to minimise their harms.
Narrative trajectories of disaster response: ethical preparedness from Katrina to COVID-19
Authors: Iwai Yoshiko , Holdren Sarah , Rosen Leah Teresa , Hu Nina Y
Published: December 2021

While COVID-19 brings unprecedented challenges to the US healthcare system, understanding narratives of historical disasters illuminates ethical complexities shared with COVID-19. In 2005, Hurricane Katrina revealed a lack of disaster preparation and protocol, not dissimilar to the challenges faced by COVID-19 healthcare workers. A case study of Memorial Hospital during Hurricane Katrina reported by journalist-MD Sheri Fink reveals unique ethical challenges at the forefront of health crises. These challenges include disproportionate suffering in structurally vulnerable populations, as seen in COVID-19 where marginalised groups across the USA experience higher rates of disease and COVID-19-related death. Journalistic accounts of Katrina and COVID-19 offer unique perspectives on the ethical challenges present within medicine and society, and analysis of such stories reveals narrative trajectories anticipated in the aftermath of COVID-19. Through lenses of social suffering and structural violence, these narratives reinforce the need for systemic change, including legal action, ethical preparedness and physician protection to ensure high-quality care during times of crises. Narrative Medicine—as a practice of interrogating stories in medicine and re-centering the patient—offers a means to contextualise individual accounts of suffering during health crises in larger social matrices.
Obstructive sleep apnea confers lower mortality risk in acute ischemic stroke patients treated with endovascular thrombectomy: National Inpatient Sample analysis 2010–2018
Authors: Lapow Justin M , Dicpinigaitis Alis J , Pammal Rajkumar S , Coghill Griffin A , Rechester Osher , Feldstein Eric , Nuoman Rolla , Maselli Kristina , Kodi Shyla , Bauerschmidt Andrew , Rosenberg Jon B , Yaghi Shadi , Kaur Gurmeen , Kurian Christeen , Chong Ji Y , Mayer Stephan A , Gandhi Chirag D , Al-Mufti Fawaz
Published: December 2021

Background

Obstructive sleep apnea (OSA) portends increased morbidity and mortality following acute ischemic stroke (AIS). Evaluation of OSA in the setting of AIS treated with endovascular mechanical thrombectomy (MT) has not yet been evaluated in the literature.

Methods

The National Inpatient Sample from 2010 to 2018 was utilized to identify adult AIS patients treated with MT. Those with and without OSA were compared for clinical characteristics, complications, and discharge disposition. Multivariable logistic regression analysis and propensity score adjustment (PA) were employed to evaluate independent associations between OSA and clinical outcome.

Results

Among 101 093 AIS patients treated with MT, 6412 (6%) had OSA. Those without OSA were older (68.5 vs 65.6 years old, p<0.001), female (50.5% vs 33.5%, p<0.001), and non-caucasian (29.7% vs 23.7%, p<0.001). The OSA group had significantly higher rates of obesity (41.4% vs 10.5%, p<0.001), atrial fibrillation (47.1% vs 42.2%, p=0.001), hypertension (87.4% vs 78.5%, p<0.001), and diabetes mellitus (41.2% vs 26.9%, p<0.001). OSA patients treated with MT demonstrated lower rates of intracranial hemorrhage (19.1% vs 21.8%, p=0.017), treatment of hydrocephalus (0.3% vs 1.1%, p=0.009), and in-hospital mortality (9.7% vs 13.5%, p<0.001). OSA was independently associated with lower rate of in-hospital mortality (aOR 0.76, 95% CI 0.69 to 0.83; p<0.001), intracranial hemorrhage (aOR 0.88, 95% CI 0.83 to 0.95; p<0.001), and hydrocephalus (aOR 0.51, 95% CI 0.37 to 0.71; p<0.001). Results were confirmed by PA.

Conclusions

Our findings suggest that MT is a viable and safe treatment option for AIS patients with OSA.
Generalized Rastall’s gravity and its effects on compact objects
Authors: Mota Clésio E. , Santos Luis C. N. , da Silva Franciele M. , Grams Guilherme , Lobo Iarley P. , Menezes Débora P.
Published: December 2021

In this paper, we present a generalization of Rastall’s gravity in which the conservation law of the energy–momentum tensor is altered, and as a result, the trace of the energy–momentum tensor is taken into account together with the Ricci scalar in the expression for the covariant derivative. Afterwards, we obtain the field equations in this theory and solve them by considering a spherically symmetric spacetime. We show that the external solution has two possible classes of solutions with spherical symmetry in the vacuum in generalized Rastall’s gravity, and we analyze one of them explicitly. The generalization, in contrast to constant value [Formula: see text] in general relativity, has a gravitational parameter [Formula: see text] that depends on the Rastall constant [Formula: see text]. As an application, we perform a careful analysis of the effects of the theory on neutron stars using realistic equations of state (EoS) as input. Our results show that important differences on the profile of neutron stars are obtained within two representatives EoS.
COMPLEXITY AND INFORMATION-BASED ANALYSIS OF THE ELECTROENCEPHALOGRAM (EEG) SIGNALS IN STANDING, WALKING, AND WALKING WITH A BRAIN–COMPUTER INTERFACE
Authors: RAMADOSS JANARTHANAN , DAWI NORAZRYANA MAT , RAJAGOPAL KARTHIKEYAN , NAMAZI HAMIDREZA
Published: December 2021

In this paper, we analyzed the variations in brain activation between different activities. Since Electroencephalogram (EEG) signals as an indicator of brain activation contain information and have complex structures, we employed complexity and information-based analysis. Specifically, we used fractal theory and Shannon entropy for our analysis. Eight subjects performed three different activities (standing, walking, and walking with a brain–computer interface) while their EEG signals were recorded. Based on the results, the complexity and information content of EEG signals have the greatest and smallest values in walking and standing, respectively. Complexity and information-based analysis can be applied to analyze the activations of other organs in different conditions.
Parametric Plots of Limit-State Surfaces as a Design Tool in Time-Variant System Reliability
Authors: Savage Gordon J. , Son Young Kap
Published: December 2021

The ability to accurately determine the temporal safe region in time-variant reliability analysis is seminal for reliability-based design. When stochastic excitations are present and discrete-time approaches are invoked, the errors can be large when one uses only one past safe event (and one new failure event) at each time-step. Furthermore, when all previous safe events are accumulated and used, the calculations can be time consuming and the accuracy not ensured. In this paper, a minimal, or a so-called extreme limit-state, surface is obtained to identify the system temporal safe region in an economical manner. To do this, the limit-state surface motion for each failure mode is recorded as a parametric polar plot that provides both magnitude and relative angle of the vectors from the origin to the most-likely failure points (MLFPs) in standard normal space. The angle differences provide correlation and the magnitude differences provide importance. At the component-level, a few logical policies that compare correlation and the magnitude ensure that the safe region is sufficiently recognized. At the system-level, the temporal average of correlations and the magnitudes at the component-level, along with series or parallel system designations, foretells which failure modes are needed to form the system extreme limit-state surface. The impact of the work includes an immediate recognition of the important failure modes and reduced computation for methods such as multi-normal integration. Case studies of both series-system reliability and parallel-system reliability are presented using structural beams excited by stochastic loads and plagued with degrading material properties and dimensions. The accuracy of the extreme LSS is demonstrated cogently. The use of the polar plots as a design tool becomes evident.
Stochastic complex integrals in a two-dimensional flow
Authors: Yamamuro Kouji
Published: December 2021

Two-dimensional flow is considered in the [Formula: see text] plane. A flat plate is placed parallel to the [Formula: see text]-axis. The circulation of the flow is investigated and it is the real part of the stochastic complex integral. In that study, analogs of Karhunen–Loève expansions for stochastic complex integrals are studied.
Multi-Stage Fusion and Multi-Source Attention Network for Multi-Modal Remote Sensing Image Segmentation
Authors: Zhao Jiaqi , Zhou Yong , Shi Boyu , Yang Jingsong , Zhang Di , Yao Rui
Published: December 2021

With the rapid development of sensor technology, lots of remote sensing data have been collected. It effectively obtains good semantic segmentation performance by extracting feature maps based on multi-modal remote sensing images since extra modal data provides more information. How to make full use of multi-model remote sensing data for semantic segmentation is challenging. Toward this end, we propose a new network called

Multi-Stage Fusion and Multi-Source Attention Network ((MS)
2
-Net)

for multi-modal remote sensing data segmentation. The multi-stage fusion module fuses complementary information after calibrating the deviation information by filtering the noise from the multi-modal data. Besides, similar feature points are aggregated by the proposed multi-source attention for enhancing the discriminability of features with different modalities. The proposed model is evaluated on publicly available multi-modal remote sensing data sets, and results demonstrate the effectiveness of the proposed method.
REACT-ION: A Model-based Runtime Environment for Situation-aware Adaptations
Authors: Pfannemüller Martin , Breitbach Martin , Weckesser Markus , Becker Christian , Schmerl Bradley , Schürr Andy , Krupitzer Christian
Published: December 2021

Trends such as the Internet of Things lead to a growing number of networked devices and to a variety of communication systems. Adding self-adaptive capabilities to these communication systems is one approach to reducing administrative effort and coping with changing execution contexts. Existing frameworks can help reducing development effort but are neither tailored toward the use in communication systems nor easily usable without knowledge in self-adaptive systems development. Accordingly, in previous work, we proposed REACT, a reusable, model-based runtime environment to complement communication systems with adaptive behavior. REACT addresses heterogeneity and distribution aspects of such systems and reduces development effort. In this article, we propose REACT-ION—an extension of REACT for situation awareness. REACT-ION offers a context management module that is able to acquire, store, disseminate, and reason on context data. The context management module is the basis for (i) proactive adaptation with REACT-ION and (ii) self-improvement of the underlying feedback loop. REACT-ION can be used to optimize adaptation decisions at runtime based on the current situation. Therefore, it can cope with uncertainty and situations that were not foreseeable at design time. We show and evaluate in two case studies how REACT-ION’s situation awareness enables proactive adaptation and self-improvement.
Developing Action Policies with Q-Learning and Shallow Neural Networks on Reconfigurable Embedded Devices
Authors: Burger Alwyn , Schiele Gregor , King David W.
Published: December 2021

The size of sensor networks supporting smart cities is ever increasing. Sensor network resiliency becomes vital for critical networks such as emergency response and waste water treatment. One approach is to engineer “self-aware” sensors that can proactively change their component composition in response to changes in work load when critical devices fail. By extension, these devices could anticipate their own termination, such as battery depletion, and offload current tasks onto connected devices. These neighboring devices can then reconfigure themselves to process these tasks, thus avoiding catastrophic network failure. In this article, we compare and contrast two types of self-aware sensors. One set uses Q-learning to develop a policy that guides device reaction to various environmental stimuli, whereas the others use a set of shallow neural networks to select an appropriate reaction. The novelty lies in the use of field programmable gate arrays embedded on the sensors that take into account internal system state, configuration, and learned state-action pairs, which guide device decisions to meet system demands. Experiments show that even relatively simple reward functions develop both Q-learning policies and shallow neural networks that yield positive device behaviors in dynamic environments.
Creating assistive technology in disabled communities, five years on
Authors: Ringland Kathryn E. , Wolf Christine T.
Published: December 2021

Five years ago, our paper, "Would You Be Mine: Appropriating Minecraft as an Assistive Technology for Youth with Autism" won Best Paper at ASSETS 2016 (Ringland et al. 2016). In that paper, we reported on our ethnographic engagement with a community for autistic youth called "Autcraft." In Autcraft, we found community members using do-it-yourself (DIY) making activities to transform their Minecraft game into an array of assistive technologies which enhanced their everyday lives. Although centered around the Minecraft game platform, the Autcraft community spans across an array of other social media platforms - such as Twitter, Facebook, YouTube, and Twitch. The creative ethos we found flourishing in Autcraft shares a lineage with past scholarship highlighting how disabled individuals have long adopted, adapted, and appropriated systems in order to serve as assistive devices. Five years on, we take some time here to reflect on what has happened since and what we are looking towards for the future.
Interface Resistance of an SOFC Cathode with a Pr1−xTbxO2−d Active Layer
Authors: Chiba Reiichi , Horie Kazuma , Kawaguchi Rin
Published: December 2021

We investigated the use of Pr1−xTbxO2−d (x = 0.0–1.0) as the active layer material in an SOFC cathode. Pr1−xTbxO2−d (x = 0.0–1.0) was successfully synthesized in a single-phase fluorite structure consisting of a solid solution of Pr6O11 and Tb4O7. When x was between 0.3 and 0.6, the phase transition between room temperature and 800 °C was eliminated. Coin cells with GDC electrolyte, a Pr1−xTbxO2−d (x = 0.0–1.0) active layer and a LaNi0.6Fe0.4O3 (LNF) current collecting layer were fabricated to clarify the effect of this active layer. The interface resistance of these cathodes was measured with an AC impedance method at 800 °C. The cathodes with a Pr1−xTbxO2−d (all compositions) active layer performed better than a reference cathode with no active layer (simply an LNF layer).
Reducing the Self-Discharge Rate of Supercapacitors by Suppressing Electron Transfer in the Electric Double Layer
Authors: Shi Mingwei , Zhang Zailei , Zhao Man , Lu Xianmao , Wang Zhong Lin
Published: December 2021

For supercapacitors, high self-discharge rate is an inevitable issue that causes fast decay of cell voltage and loss of stored energy. Designing supercapacitors with suppressed self-discharge for long-term energy storage has been a challenge. In this work, we demonstrate that substantially reduced self-discharge rate can be achieved by using highly concentrated electrolytes. Specifically, when supercapacitors with 14 M LiCl electrolyte are charged to 0.80 V, the open circuit voltage (OCV) drops to 0.65 V in 24 h. In stark contrast, when the electrolyte concentration is reduced to 1 M, the OCV drops from 0.80 to 0.65 V within only 0.3 h, which was 80 times faster than that with 14 M LiCl. Decreased OCV decay rate at high electrolyte concentration is also confirmed for supercapacitors with different electrolytes (e.g., LiNO3) or at higher charging voltages (1.60 V). The slow self-discharge in highly concentrated electrolyte can be largely attributed to impeded electron transfer between the electrodes and electrolyte due to the formation of hydration clusters and reduced amount of free water molecules, thereby faradaic reactions that cause fast self-discharge are reduced. Our study not only supports the newly revised model about the formation of electric double layer with the inclusion of electron transfer, but also points a direction for substantially reducing the self-discharge rate of supercapacitors.
Synthesis of 3D Hollow Structured MnCo2O4/CNTs Nanocomposite and Its Magnetic Properties
Authors: Yousf Nehad , Elzwawy Amir , Ouda Emtinan , Mansour S. A. , Duraia El Shazly M.
Published: December 2021

In the present contribution, the 3D hollow structure of manganese cobalt oxide/carbon nanotubes (MnCo2O4/CNTs) nanocomposite was successfully synthesized through a co-precipitation procedure followed by post-heat treatment. The as-prepared samples were characterized by X-ray diffraction (XRD), Fourier-transform infrared spectroscopy (FTIR), Field Emission Scanning Electron Microscopy (FESEM), Transmission electron microscopy (TEM), and vibrating sample magnetometer (VSM). Based on the obtained results, the surface of carbon nanotubes was coated uniformly in radial directions by manganese oxide (MnO2) nanosheets forming a flower-shaped structure. In the next step, cobalt oxide precursor was introduced to form MnCo2O4/CNTs nanocomposite. The XRD data confirms the formation of MnCo2O4/CNTs. The estimated values of the strain and the crystallite size based on the Williamson-Hall (W-H) method are calculated as 5.326×10-4 and 16 nm respectively. The fingerprint area of FTIR suggests the successful incorporation of MnO2 and cobalt oxide onto CNTs’ surfaces. The flower-shaped structure in the nanoscale is verified by the FESEM and TEM devices. Furthermore, the magnetic specifications revealed the paramagnetic with a small ferromagnetic component of the aforementioned MnCo2O4/CNTs nanocomposite.