bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of the COVID-19 pandemic and lockdown on the mental and physical health of adults with Prader-Willi syndrome
Authors: Mosbah Helena , Coupaye Muriel , Jacques Flavien , Tauber Maithé , Clément Karine , Oppert Jean-Michel , Poitou Christine
Published: May 2021

Background

Prader-Willi syndrome (PWS) is a neurodevelopmental disorder with hypothalamic dysfunction leading to obesity and behavioral disabilities, including eating disorders (EDs). We evaluated the effects of the COVID-19 infection and lockdown on mental and physical health in PWS. At the end of April, 85 adults with PWS completed a self-administered questionnaire, including lockdown conditions, physical activity (PA), ED, and medical and behavioral outcomes. Body weight was measured at home and self-reported.

Results

Patients (52.9% women, 44.8% disomic) were assessed, with a mean age of 28.05 ± 8.73 years and body mass index (BMI) of 36.76 ± 10.74 kg/m2. Seventy percent lived in the Paris region (France) and were confined with their parents. The mean weight change was 0.96 ± 3.28 kg. We compared patients showing weight loss (n = 39, − 3.30 ± 2.93 kg) to patients showing weight gain (n = 22, + 2.35 ± 1.54 kg): the BMI was lower (34.60 ± 9.18 versus 40.45 ± 9.45 kg/m2, p = 0.02), PA increased (25.6% versus 4.5%, p = 0.04), and EDs improved (51.3% versus 13.6%, p = 0.005). Behavioral disorders increased for 12.9% of the cohort. Three individuals (3.5%) were diagnosed with non-severe COVID-19.

Conclusion

Lockdown during the COVID-19 pandemic was associated with positive effects for most French adults with PWS, with weight loss probably associated with a more favourable environment during this period. We observed no severe forms of COVID-19.
The prevalence of intestinal nematodes among red foxes (Vulpes vulpes) in north-western Poland
Authors: Tylkowska Agnieszka , Pilarczyk Bogumiła , Tomza-Marciniak Agnieszka , Pilarczyk Renata
Published: May 2021

Background

The red fox (Vulpes vulpes) is widely distributed in the Northern Hemisphere and Australia. The presence of nematode-infected foxes in urbanized areas increases the risk of transmission of nematodes to domestic dogs and thus, to humans. The aim of this study was to determine the prevalence and species composition of intestinal nematodiasis in red foxes in Western Pomerania, a province in north-western Poland. The intestinal contents of 620 red foxes killed during a government reduction shooting programme were examined for adult nematodes using the sedimentation and counting technique (SCT).

Results

Intestinal nematodes, including Toxocara canis, Toxascaris leonina, Uncinaria stenocephala and Trichuris vulpis, were found in 77.3% (95% CI 73.8–80.4%) of the examined foxes with a mean infection burden of 20.1 nematode per animal. Male and female foxes had similar infection burdens.

Conclusions

The nematodes are present in high prevalence and intensity among foxes in north-western Poland. Furthermore, this high prevalence of nematodes in foxes may likely constitute a health risk to humans and domestic animals due to increasing fox densities in urban and periurban areas.
Temporal patterns of organ dysfunction after severe trauma
Authors: Eriksson Jesper , Nelson David , Holst Anders , Hellgren Elisabeth , Friman Ola , Oldner Anders
Published: May 2021

Background

Understanding temporal patterns of organ dysfunction (OD) may aid early recognition of complications after trauma and assist timing and modality of treatment strategies. Our aim was to analyse and characterise temporal patterns of OD in intensive care unit-admitted trauma patients.

Methods

We used group-based trajectory modelling to identify temporal trajectories of OD after trauma. Modelling was based on the joint development of all six subdomains comprising the sequential organ failure assessment score measured daily during the first two weeks post trauma. Further, the time for trajectories to stabilise and transition to final group assignments were evaluated.

Results

Six-hundred and sixty patients were included in the final model. Median age was 40 years, and median ISS was 26 (IQR 17–38). We identified five distinct trajectories of OD. Group 1, mild OD (n = 300), median ISS of 20 (IQR 14–27), had an early resolution of OD and a low mortality. Group 2, moderate OD (n = 135), and group 3, severe OD (n = 87), were fairly similar in admission characteristics and initial OD but differed in subsequent OD trajectories, the latter experiencing an extended course and higher mortality. In group 3, 56% of the patients developed sepsis as compared with 19% in group 2. Group 4, extreme OD (n = 40), received most blood transfusions, had the highest proportion of shock at admission and a median ISS of 41 (IQR 29–50). They experienced significant and sustained OD affecting all organ systems and a 28-day mortality of 30%. Group 5, traumatic brain injury with OD (n = 98), had the highest mortality of 35% and the shortest time to death for non-survivors, median 3.5 (IQR 2.4–4.8) days. Groups 1 and 5 reached their final group assignment early, > 80% of the patients within 48 h. In contrast, groups 2 and 3 had a prolonged time to final group assignment.

Conclusions

We identified five distinct trajectories of OD after severe trauma during the first two weeks post-trauma. Our findings underline the heterogeneous course after trauma and describe some potentially important clinical insights that are suggested by the groupings and temporal trajectories.
Effect of intensive care unit-specific virtual reality (ICU-VR) to improve psychological well-being and quality of life in COVID-19 ICU survivors: a study protocol for a multicentre, randomized controlled trial
Authors: Vlake Johan H. , Van Bommel Jasper , Wils Evert-Jan , Korevaar Tim I. M. , Hellemons Merel E. , Schut Anna F. C. , Labout Joost A. M. , Schreuder Lois L. H. , Gommers Diederik , Van Genderen Michel E.
Published: May 2021

Background

The SARS-CoV-2 outbreak has resulted in a tremendous increase in hospital and intensive care unit (ICU) admissions all over the world. Patients with severe coronavirus disease 2019 (COVID-19) warranting ICU treatment usually have prolonged mechanical ventilation and are expected to be prone to develop psychological impairments, such as post-traumatic stress disorder (PTSD), anxiety and depression, which negatively impact quality of life. To date, no effective treatment strategy is available. In the current trial, we aim to assess the effect of an ICU-specific virtual reality (ICU-VR) intervention on psychological well-being and quality of life after COVID-19 ICU treatment.

Methods

In this multicentre, randomized controlled trial, we aim to examine whether COVID-19-specific ICU-VR, offered 3 months after hospital discharge, improves psychological well-being and quality of life. Secondary objectives are, firstly, to examine the intra-group changes in psychological well-being and quality of life and the inter-group differences in psychological well-being and quality of life during follow-up, up to 12 months after hospital discharge, and secondly, to examine patients’ satisfaction with and rating of ICU care and aftercare and patients’ perspectives on ICU-VR. Eighty adult patients treated for COVID-19 in the mixed-surgical ICUs of four hospitals in Rotterdam, the Netherlands, will be included and randomized (1:1) to either early or late ICU-VR between June 29 and December 31, 2020. Patients randomized to early ICU-VR will receive the ICU-VR intervention during an outpatient clinic visit 3 months after hospital discharge, whereas patients randomized to late ICU-VR will receive ICU-VR 6 months after hospital discharge. Primary outcomes of this study are psychological well-being, assessed using the Impact of Event Scale–Revised (IES-R) and the Hospital Anxiety and Depression Scale (HADS), and quality of life, assessed using the European Quality of Life 5 Dimensions (EQ-5D) and RAND-36 questionnaires, up to 6 months after hospital discharge.

Discussion

Currently, an effective treatment for psychological sequelae after ICU treatment for specific illnesses is unavailable. Results from this study will provide insight whether virtual reality is a modality that can be used in ICU aftercare to improve psychological well-being and quality of life, or satisfaction, after ICU treatment for specific illnesses such as COVID-19.

Trial registration

This trial has been retrospectively registered on the Netherlands Trial Register on August 14, 2020 (NL8835).
Effects of different ischemic preconditioning occlusion pressures on muscle damage induced by eccentric exercise: a study protocol for a randomized controlled placebo clinical trial
Authors: Pizzo Junior Eduardo , de Souza Cavina Allysiê Priscilla , Lemos Leonardo Kesrouani , Biral Taíse Mendes , Pastre Carlos Marcelo , Vanderlei Franciele Marques
Published: May 2021

Introduction

Due to its greater generation of muscle strength and less metabolic demand, eccentric exercise has been widely used in rehabilitation and for improving physical fitness. However, eccentric exercise can induce muscle damage by providing structural changes and reduced muscle function, so even with the protection caused by the repeated bout effect from eccentric exercise, it is necessary to seek alternatives to reduce this damage caused by stress. Thus, ischemic preconditioning could represent an aid to reduce the damage muscle or increase the protective effect caused by eccentric exercise.

Objectives

To compare the effects of ischemic preconditioning, using different occlusion pressures, on acute and delayed responses to perceptual outcomes, markers of muscle damage, and performance in post-eccentric exercise recovery.

Methods

A randomized controlled placebo clinical trial will be carried out with 80 healthy men aged 18 to 35 years who will be randomly divided into four groups: ischemic preconditioning using total occlusion pressure, ischemic preconditoning with 40% more than total occlusion pressure, placebo (10 mmHg), and control. The ischemic preconditioning protocol will consist of four cycles of ischemia and reperfusion of five minutes each. All groups will perform an eccentric exercise protocol, and assessments will be carried out before, immediately after, and 24, 48, 72, and 96 h after the end of the eccentric exercise to evaluate creatine kinase, blood lactate, perception of recovery using the Likert scale, being sequentially evaluated, pain by the visual analog scale, pain threshold using a pressure algometer, muscle thickness by ultrasound, muscle tone, stiffness and elasticity by myotonometry, vectors of cell integrity through electrical bioimpedance, and maximal voluntary isometric contraction using the isokinetic dynamometer. The trial was registered at ClinicalTrials.gov (NCT04420819).

Discussion

The present study aims to present an alternative technique to reduce muscle damage caused by eccentric exercise, which is easy to apply and low cost. If the benefits are proven, ischemic preconditioning could be used in any clinical practice that aims to minimize the damage caused by exercise, presenting an advance in the prescription of eccentric exercise and directly impacting on the results of post-exercise recovery.

Trial registration

ClinicalTrials.gov NCT04420819. Registered on 19 May 2020; Last update 24 March 2021.
Mental health specialist video consultations versus treatment as usual in patients with depression or anxiety disorders in primary care: study protocol for an individually randomised superiority trial (the PROVIDE-C trial)
Authors: Haun Markus W. , Tönnies Justus , Krisam Regina , Kronsteiner Dorothea , Wensing Michel , Szecsenyi Joachim , Vomhof Markus , Icks Andrea , Wild Beate , Hartmann Mechthild , Friederich Hans-Christoph
Published: May 2021

Background

Most people with mental disorders, including those with severe and chronic disorders, are treated solely by their general practitioner (GP). Nevertheless, specialised mental health care may be required for specific patients. Notably, the accessibility of mental health specialist care is mainly complicated by (a) long waiting times for an appointment with specialists, (b) long travel distances to specialists, particularly in rural and remote areas, and (c) patients’ reservations about mental health specialist care (including fear of being stigmatised by seeking such care). To mitigate those barriers, technology-based integrated care models have been proposed. The purpose of this study is to examine the effectiveness and cost-effectiveness of a mental health specialist video consultations model versus treatment as usual in patients with depression or anxiety disorders in primary care.

Methods

In an individually randomised, prospective, two-arm superiority trial with parallel group design, N = 320 patients with anxiety and/or depressive disorder will be recruited in general practices in Germany. The intervention includes a newly developed treatment model based on video consultations with focus on diagnostics, treatment planning, and short-term intervention by mental health specialists. We will systematically compare the effectiveness, cost-effectiveness, and adverse effects of this new model with usual care by the GP: the primary outcome is the absolute change in the mean depressive and anxiety symptom severity measured on the Patient Health Questionnaire Anxiety and Depression Scale (PHQ-ADS) from baseline to 6 months after baseline assessment. Follow-up in both groups will be conducted by blinded outcome assessors at 6 months and 12 months after baseline. The main analysis will be based on the intention-to-treat principle. We will optimise the likelihood of treatment effectiveness by strict inclusion criteria for patients, enhanced intervention integrity, and conducting a process evaluation.

Discussion

To the best of our knowledge, this is the first confirmatory study on a video-based, integrated care model for the treatment of anxiety and depressive disorders in GP patients in Germany.

Trial registration

ClinicalTrials.gov, United States National Institutes of Health NCT04316572. Prospectively registered on 20 March 2020.
Phylogroup stability contrasts with high within sequence type complex dynamics of Escherichia coli bloodstream infection isolates over a 12-year period
Authors:   COLIBAFI and SEPTICOLI groups, Royer Guilhem , Darty Mélanie Mercier , Clermont Olivier , Condamine Bénédicte , Laouenan Cédric , Decousser Jean-Winoc , Vallenet David , Lefort Agnès , de Lastours Victoire , Denamur Erick
Published: May 2021

Background

Escherichia coliis the leading cause of bloodstream infections, associated with a significant mortality. Recent genomic analyses revealed that few clonal lineages are involved in bloodstream infections and captured the emergence of some of them. However, data on within sequence type (ST) population genetic structure evolution are rare.

Methods

We compared whole genome sequences of 912E.coliisolates responsible for bloodstream infections from two multicenter clinical trials that were conducted in the Paris area, France, 12 years apart, in teaching hospitals belonging to the same institution (“Assistance Publique-Hôpitaux de Paris”). We analyzed the strains at different levels of granularity, i.e., the phylogroup, the ST complex (STc), and the within STc clone taking into consideration the evolutionary history, the resistance, and virulence gene content as well as the antigenic diversity of the strains.

Results

We found a mix of stability and changes overtime, depending on the level of comparison. Overall, we observed an increase in antibiotic resistance associated to a restricted number of genetic determinants and in strain plasmidic content, whereas phylogroup distribution and virulence gene content remained constant. Focusing on STcs highlighted the pauci-clonality of the populations, with only 11 STcs responsible for more than 73% of the cases, dominated by five STcs (STc73, STc131, STc95, STc69, STc10). However, some STcs underwent dramatic variations, such as the global pandemic STc131, which replaced the previously predominant STc95. Moreover, within STc131, 95 and 69 genomic diversity analysis revealed a highly dynamic pattern, with reshuffling of the population linked to clonal replacement sometimes coupled with independent acquisitions of virulence factors such as thepapgene cluster bearing apapGIIallele located on various pathogenicity islands. Additionally, STc10 exhibited huge antigenic diversity evidenced by numerous O:H serotype/fimHallele combinations, whichever the year of isolation.

Conclusions

Altogether, these data suggest that the bloodstream niche is occupied by a wide but specific phylogenetic diversity and that highly specialized extra-intestinal clones undergo frequent turnover at the within ST level. Additional worldwide epidemiological studies overtime are needed in different geographical and ecological contexts to assess how generalizable these data are.
Anticancer drugs repurposed for Alzheimer’s disease: a systematic review
Authors: Ancidoni Antonio , Bacigalupo Ilaria , Remoli Giulia , Lacorte Eleonora , Piscopo Paola , Sarti Giulia , Corbo Massimo , Vanacore Nicola , Canevelli Marco
Published: May 2021

Background

The relationship between cancer and dementia is triggering growing research interest. Several preclinical studies have provided the biological rationale for the repurposing of specific anticancer agents in Alzheimer’s disease (AD), and a growing number of research protocols are testing their efficacy and safety/tolerability in patients with AD.

Methods

The aim of the present systematic review was to provide an overview on the repurposing of approved anticancer drugs in clinical trials for AD by considering both ongoing and completed research protocols in all phases. In parallel, a systematic literature review was conducted on PubMed, ISI Web, and the Cochrane Library to identify published clinical studies on repurposed anticancer agents in AD.

Results

Based on a structured search on the ClinicalTrials.gov and the EudraCT databases, we identified 13 clinical trials testing 11 different approved anticancer agents (five tyrosine kinase inhibitors, two retinoid X receptor agonists, two immunomodulatory agents, one histone deacetylase inhibitor, and one monoclonal antibody) in the AD continuum. The systematic literature search led to the identification of five published studies (one phase I, three phase II, and one phase IIb/III) reporting the effects of antitumoral treatments in patients with mild cognitive impairment or AD dementia. The clinical findings and the methodological characteristics of these studies are described and discussed.

Conclusion

Anticancer agents are triggering growing interest in the context of repurposed therapies in AD. Several clinical trials are underway, and data are expected to be available in the near future. To date, data emerging from published clinical studies are controversial. The promising results emerging from preclinical studies and identified research protocols should be confirmed and extended by larger, adequately designed, and high-quality clinical trials.
Correction to: Spatial scale in prescribed fire regimes: an understudied aspect in conservation with examples from the southeastern United States
Authors: Mason David S. , Lashley Marcus A.
Published: May 2021

An amendment to this paper has been published and can be accessed via the original article.
An electrical conductivity model of a coastal geothermal field in southeastern China based on 3D magnetotelluric imaging
Authors: Han Qi , Kelbert Anna , Hu Xiangyun
Published: May 2021

The hydrology and geology of the Xinzhou geothermal field in South China and its surrounding area have been well studied. Previous studies have indicated that mantle heat, granite radioactive heat, and partial melting are the likely key thermal sources. However, neither the geometry of the geothermal reservoir nor the groundwater circulation pattern has been fully characterized. Toward that aim, a grid of magnetotelluric (MT) data has been acquired to reveal the subsurface distribution of electrical conductivity and to detect the geothermal reservoir. An analysis of the phase tensors suggests that 3D MT inversion is essential for accurate interpretation of the data. We perform a 3D full-impedance MT inversion and observe pronounced low electrical conductivity zones in the inverse model. We interpret these materials as widely developed granites that form the bedrock, which is cut by a crisscross of faults. The cracks in the bedrock provide pathways for the vertical and lateral movement of the hydrothermal fluid. The geothermal reservoir appears as a prominent high electrical conductivity anomaly beneath the hot spring. A northwest-dipping zone of enhanced electrical conductivity reaching approximately 6–7 km in depth is found in the southeast part of the study area, and it is interpreted as the geothermal reservoir recharge channel. We develop an inferred underground fluid circulation model, informed by the electrical conductivity of the area, in combination with hydrologic data. We suggest that the water supply of the Xinzhou geothermal field mainly comes from meteoric water, which is mixed with the invading seawater and shallow cold groundwater as it rises along the fault. The results of our MT study confirm earlier inferences that the Xinzhou geothermal field belongs to an intraplate deep-circulation type originated from the mantle heat flow.
Stress-dependent elasticity and wave propagation — New insights and connections
Authors: Sripanich Yanadet , Vasconcelos Ivan , Tromp Jeroen , Trampert Jeannot
Published: May 2021

To establish a consistent framework for seismic wave propagation that accommodates the effects of stress changes, it is critical to take into account the different definitions of stress and their corresponding effects on seismic quantities (e.g., wave speeds) as dictated by continuum mechanics. Revisiting this fundamental theoretical foundation, we first emphasize the role of stress within various forms of the wave equation resulting from different choices of stress definitions. Subsequently, using this basis, we investigate connections among existing theories that describe the variation of elastic moduli as a function of changes in stress. We find that there is a direct connection between predicting stress-induced elastic changes with the well-known third-order elasticity tensor and the recently proposed adiabatic pressure derivatives of elastic moduli. However, each of these approaches has different merits and drawbacks in terms of experimental validation as well as in their use. In addition, we investigate the connection with another general approach that relies on micromechanical structures (e.g., cracks and pores). Although this can be done algebraically, it remains unclear as to which definition of stress and which corresponding constitutive relationship should be considered in practical scenarios. We support our analysis with validations using previously published benchmark experimental data.
Fast local primary-and-multiple orthogonalization for surface-related multiple leakage estimation and extraction
Authors: Zhang Dong , Verschuur D. J. (Eric) , Chen Yangkang
Published: May 2021

Surface-related multiple elimination (SRME) has proven to be a robust surface multiple and primary estimation tool for decades. However, surface-related multiple leakage is still commonly observed in SRME-processed results due to imperfect multiple predictions. Usually, adaptive subtraction cannot fully correct for these effects without primary damage. Local primary-and-multiple orthogonalization (LPMO) has recently been proposed to partially mitigate surface multiple leakage, by multiplication of the estimated primaries with a weight function that scales down residual multiples while preserving primaries. The weight function is determined by shaping regularization followed by thresholding and median filtering. Although effective leakage extraction can be achieved, LPMO has a large computational cost due to many conjugate-gradient iterations within the shaping regularization-based inversion framework. Using information on the typical local coherency length of primaries and multiples, a spatially constrained scaled point-by-point division can be used to avoid the iterative inversion within the LPMO method. Based on this, we have adopted a fast LPMO (FLPMO) for surface-related multiple leakage estimation and extraction. Applications on two different field data sets demonstrate the very similar surface multiple leakage extraction performance for LPMO and FLPMO, while showing that the scaled point-by-point division in FLPMO is approximately 40 times faster on real data sets than the shaping regularization-based inversion in LPMO.
The Smarter Sleep educational interventions: an initiative to reduce hypnotic prescribing in in-patient psychiatric care
Authors: Paterson Alastair , Khundakar Martina , Young Anthony , Ling Jonathan , Chakraborty Samantha , Rathbone Adam Pattison , Watson Stuart , Donaldson Tim , Anderson Kirstie N.
Published: May 2021

Aims and method

In-patients on mental health wards are commonly prescribed hypnotics for the long-term management of disturbed sleep. Specific sleep disorders remain underdiagnosed and effective behavioural interventions are underused. We developed a suite of three educational interventions (a video, poster and handbook) about sleep, sleep disorders, the safe prescribing of hypnotics and use of psychological strategies (sleep hygiene and cognitive–behavioural therapy for insomnia, CBTi) using co-design and multiprofessional stakeholder involvement. This controlled before-and-after study evaluated the effectiveness of these interventions across seven in-patient psychiatric wards, examining their impact on hypnotic prescribing rates and staff confidence scores (data collected by retrospective drug chart analysis and survey respectively).

Results

A marked reduction was seen in the percentage of patients prescribed hypnotics on in-patient prescription charts (−24%), with a 41% reduction in the number of hypnotics administered per patient (mean reduction −1.142 administrations/patient).

Clinical implications

These simple educational strategies about the causes and treatment of insomnia can reduce hypnotic prescribing rates and increase staff confidence in both the medical and psychological management of insomnia.
Prospective Statewide Study of Universal Screening for Hereditary Colorectal Cancer: The Ohio Colorectal Cancer Prevention Initiative
Authors: Pearlman Rachel , Frankel Wendy L. , Swanson Benjamin J. , Jones Dan , Zhao Weiqiang , Yilmaz Ahmet , Miller Kristin , Bacher Jason , Bigley Christopher , Nelsen Lori , Goodfellow Paul J. , Goldberg Richard M. , Paskett Electra , Shields Peter G. , Freudenheim Jo L. , Stanich Peter P. , Lattimer Ilene , Arnold Mark , Prior Thomas W. , Haut Mitchell , Kalady Matthew F. , Heald Brandie , Paquette Ian , Draper David J. , Brell Joanna M. , Mahesh Sameer , Weeman Kisa , Bastola Shyamal , Zangmeister Jeffrey , Gowda Aruna , Kencana Filix , Malcolm Albert , Liu Yinong , Cole Sharon , Bane Charles , Li Chaoyang , Rehmus Esther , Pritchard Colin C. , Shirts Brian H. , Jacobson Angela , Cummings Shelly A. , de la Chapelle Albert , Hampel Heather
Published: May 2021

PURPOSE

Hereditary cancer syndromes infer high cancer risks and require intensive surveillance. Identification of high-risk individuals among patients with colorectal cancer (CRC) needs improvement.

METHODS

Three thousand three hundred ten unselected adults who underwent surgical resection for primary invasive CRC were prospectively accrued from 51 hospitals across Ohio between January 1, 2013, and December 31, 2016. Universal Tumor screening (UTS) for mismatch repair (MMR) deficiency was performed for all, and pathogenic germline variants (PGVs) were identified using multigene panel testing (MGPT) in those who met at least one inclusion criterion: MMR deficiency, diagnosed < 50 years, multiple primary tumors (CRC or endometrial cancer), or with a first-degree relative with CRC or endometrial cancer.

RESULTS

Five hundred twenty-five patients (15.9%) had MMR deficiency. Two hundred thirty-four of 3,310 (7.1%; 16% of the 1,462 who received MGPT) had 248 PGVs in cancer susceptibility genes. One hundred forty-two (4.3%) had a PGV in an MMR gene, and 101 (3.1%) had a PGV in a non-MMR gene. Ten with Lynch syndrome (LS) also had a non-MMR PGV and were included in both groups. Two (0.06%) had constitutional MLH1 hypermethylation. Of unexplained MMR-deficient patients, 88.4% (76 of 86) had double somatic MMR mutations. Testing for only MMR genes in MMR-deficient patients would have missed 18 non-MMR gene PGVs (7.3% of total PGVs identified). Had UTS been the only method used to screen for hereditary cancer syndromes, 38.6% (91 of 236) would have been missed, including 6.3% (9 of 144) of those with LS. These results have treatment implications as 5.3% (175 of 3,310) had PGVs in genes with therapeutic targets.

CONCLUSION

UTS alone is insufficient for identifying a large proportion of CRC patients with hereditary syndromes, including some with LS. At a minimum, 7.1% of individuals with CRC have a PGV and pan-cancer MGPT should be considered for all patients with CRC.
Thyroid Function During Pregnancy in A Multiethnic Population in Norway
Authors: Sletner Line , Jenum Anne Karen , Qvigstad Elisabeth , Hammerstad Sara Salehi
Published: May 2021

Context

Ethnic differences in thyroid function during pregnancy have been reported. However, it is unclear if this is equally valid across ethnic groups within multiethnic populations.

Objective

We aimed to assess ethnic differences in thyrotropin (TSH) and free thyroxine (FT4), and the prevalence of thyroid dysfunction and thyroid autoimmunity during pregnancy.

Methods

In a population-based cohort of 785 pregnant women in Oslo, Norway, TSH, FT4, and thyroid peroxidase antibodies (TPO Abs) were measured twice: at gestational week (GW) 15 and 28, and urine iodine concentration at GW 15. Associations were assessed using multivariate linear regression.

Results

We found ethnic differences in TSH levels at both time points, but not for fT4. South Asians had 0.42 mU/L (95% CI, 0.20-0.64) higher TSH than Europeans in GW 15. This difference persisted after adjusting for covariates (including TPO Ab positivity and iodine status), and increased further as pregnancy progressed. In contrast, East Asians had the lowest TSH. No new cases of overt hypothyroidism were detected in early pregnancy, but subclinical hypothyroidism was found in 6.6% among all, highest in South Asians (14.2%). Hyperthyroidism early in pregnancy was observed in 3.7% (almost all subclinical), highest in East Asians (11.9%). The prevalence of TPO Ab positivity was 4%, highest in South Asians (8%).

Conclusion

In a multiethnic population of presumably healthy women, we found ethnic variations in TSH but not FT4 levels throughout pregnancy. South Asians had higher TSH and more subclinical hypothyroidism, not explained by their higher prevalence of TPO Ab positivity. Larger studies are needed to define ethnic- and trimester-specific reference ranges in pregnancy.
Uwarunkowania wykorzystania transportu kolejowego w rozwoju turystyki międzynarodowej
Authors: Pawłowski Kamil
Published: May 2021

Transgraniczne połączenia kolejowe są ważnym elementem turystyki międzynarodowej. Jej rosnące znaczenie znajduje odwzorowanie w stale poszerzanej ofercie przewoźników kolejowych. W rozdziale dokonano analizy dostępnej oferty połączeń transgranicznych w Polsce. Porównano takie parametry, jak: liczba miejsc, czas przejazdu czy cena w oparciu o dostępną siatkę połączeń. Celem opracowania jest zbadanie obecnego stanu połączeń transgranicznych pod kątem wykorzystania ich jako turystycznego środka transportu. W pracy została przedstawiona syntetyczna analiza dostępnych połączeń kolejowych oraz ich porównanie ze sobą. Prezentowane rozważania stanowią próbę odpowiedzi na pytanie, czy transport kolejowy przyczynia się do rozwoju turystyki międzynarodowej. Mogą być traktowane jako inspiracja do badań związanych z tematyką kolei transgranicznej w Polsce.
Determinanty rozwoju turystyki w gminie miejsko-wiejskiej Wleń
Authors: Smyka Agata
Published: May 2021

Celem rozdziału jest identyfikacja i ocena kluczowych determinant rozwoju turystyki w gminie Wleń. Autorka wykorzystała głównie wyniki badań ankietowych, analizę danych statystycznych oraz metodę opisową. Analizy wykazały, że ocena wpływu wybranych czynników na rozwój turystyki jest zdaniem turystów zróżnicowana. Podobnie jak ocena walorów i elementów infrastruktury turystycznej oraz aktywności władz gminy Wleń.
Wpływ „odmrożenia” gospodarki po blokadzie z powodu ­COVID-19 na natężenie ruchu turystycznego w Tatrzańskim Parku Narodowym
Authors: Chrabańska-Czerwińska Alicja
Published: May 2021

W wyniku ogłoszenia światowej pandemii ­COVID-19 w marcu 2020 r. w Polsce ustanowiono tzw. lockdown. Poza uniemożliwieniem bądź ograniczeniem działalności wielu gałęzi gospodarki, zamknięto również czasowo ruch turystyczny oraz rekreacyjny w parkach i lasach. Wiązało się to z brakiem możliwości legalnego wejścia na teren Tatrzańskiego Parku Narodowego. Celem niniejszego rozdziału jest zbadanie, jak czasowe wyłączenie możliwości uprawiania turystyki w Tatrach wpłynęło na natężenie ruchu turystycznego w okresie „odmrażania gospodarki” i późniejszym w oparciu o analizy liczby sprzedanych biletów, ale również zapisków kroniki interwencji TOPR w okresie od maja do września 2019 r. oraz w analogicznym okresie 2020 r.
Ethnic differences in the incidence of clinically diagnosed influenza: an England population-based cohort study 2008-2018
Authors: Davidson Jennifer , Banerjee Amitava , Mathur Rohini , Ramsay Mary , Smeeth Liam , Walker Jemma , McDonald Helen , Warren-Gash Charlotte
Published: May 2021

Background: People of non-White ethnicity have a higher risk of severe outcomes following influenza infection. It is unclear whether this is driven by an increased risk of infection or complications. We therefore aimed to investigate the incidence of clinically diagnosed influenza/influenza-like illness (ILI) by ethnicity in England from 2008-2018.

Methods: We used linked primary and secondary healthcare data (from the Clinical Practice Research Datalink [CPRD] GOLD and Aurum databases and Hospital Episodes Statistics Admitted Patient Care [HES APC]). We included patients with recorded ethnicity who were aged 40-64 years and did not have a chronic health condition that would render them eligible for influenza vaccination. ILI infection was identified from diagnostic codes in CPRD and HES APC. We calculated crude annual infection incidence rates by ethnic group. Multivariable Poisson regression models with random effects were used to estimate any ethnic disparities in infection risk. Our main analysis adjusted for age, sex, and influenza year.

Results: A total of 3,735,308 adults aged 40-64 years were included in the study; 87.6% White, 5.2% South Asian, 4.2% Black, 1.9% Other, and 1.1% Mixed. We identified 102,316 ILI episodes recorded among 94,623 patients. The rate of ILI was highest in the South Asian (9.6 per 1,000 person-years), Black (8.4 per 1,000 person-years) and Mixed (6.9 per 1,000 person-years) ethnic groups. The ILI rate in the White ethnic group was 5.7 per 1,000 person-years. After adjustment for age sex and influenza year, higher incidence rate ratios (IRR) for ILI were seen for South Asian (1.70, 95% CI 1.66-1.75), Black (1.48, 1.44-1.53) and Mixed (1.22, 1.15-1.30) groups compared to White ethnicity.

Conclusions: Our results suggest that influenza infection risk differs between White and non-White groups who are not eligible for routine influenza vaccination.
Experience of Using Information Resources While Teaching the Topic of "The World's Population» in the Course of Geography for the 10th – 11th Grades
Authors: Sukmanova N. , Sukmanova E.
Published: May 2021

The article considers the main elements of the emerging information and educational environment. The reasons for the decline in the attractiveness of geography among schoolchildren are determined. Various approaches to the organization of remote classes with the use of a computer and the use of geoinformation technologies are proposed. As an alternative source of geographical information, images of the Earth from space are presented, made both for the world as a whole, and for individual regions and countries. The authors offer options for tasks using information resources in the context of distance learning of geography in grades 10-11. The techniques of using photos of the world's regions making from space, online statistics on the topics "World population" and "World Regions" are considered. The main types of activities and planned results when working with these resources are analyzed. Information about the use of online population counters in real time is of great interest. Such variants of tasks make it possible to simultaneously analyze natural and socio-economic processes, forming a higher level of spatial thinking.
Nursing leadership in response to the COVID-19 crisis in an Irish independent mental health service
Authors: Kirwan Shane , Cunningham Paddy , Donohue Gráinne , Keogh Brian , Creedon John
Published: May 2021

Mental health nurses have been at the forefront of adjusting practice during the COVID-19 pandemic through novel means, including the delivery of technology-mediated interventions, upskilling on infection control and adapting practice to ever-changing national guidelines. The aim of this article is to describe an Irish mental health service's adaption to the global pandemic from the perspective of the nurse leadership involved. A case study approach was used describing the degree of adjustment and collaborative practice in ‘tackling the spread’ documented with both staff and service users in mind. The case describes how mental health nurses were central to designing and overseeing the implementation and delivery of numerous initiatives across the service. They were also required to respond quickly and sensitively to service users' needs, while remaining true to the core values of mental health nursing practice. As the backbone of our health service, nurses continue to prove their ability to adapt flexibly, operationalise change at high intensity, provide quality care to service users in a professional and compassionate manner while managing their own safety, fears, personal circumstances and mental health.
Clinical supervision provided to mental health nurses in England
Authors: White Edward , Winstanley Julie
Published: May 2021

Background/Aims

Clinical supervision has become widely regarded as a central tenet of professional practice. However, little is known about the basis for claims to the benefits. This study described the features of clinical supervision provision to mental health nurses in England.

Methods

A Freedom of Information Act request was submitted to 52 mental health NHS trusts in England regarding clinical supervision that is available to ∼42 000 mental health nurses. These data underwent content analysis. Each submitted document was read several times and meaningful pieces of content were assigned to one of the 10 major themes that emerged (clinical supervision definitions, discriminated clinical supervision definitions, roles duties and responsibilities, confidentiality, training, evaluations, reporting, templates, references/bibliographies, document size).

Results

All 52 mental health NHS trusts responded. Multiple operational definitions of clinical supervision were reported. For 29 out of the 31 trusts (94%) the length of each clinical supervision session was reportedly 60 minutes, of which nearly 80% (23/29) were held at a frequency of between four and eight sessions a year. Overall, 33 trusts (64%) reported that the supervisors were specifically trained to provide clinical supervision to mental health nurses. Of the 52 trusts, 48 (92%) had a dedicated clinical supervision policy document. Most trusts reported brief in-house evaluations, which were narrowly contained to comply with local clinical supervision policy positions.

Conclusions

Early professional objectives for clinical supervision have since morphed into a de facto managerial staff performance monitoring exercise which may, or may not, have other advantages.
Cardiovascular disease: the gender divide
Authors: Bostock Beverley
Published: May 2021

Cardiovascular disease is often thought of as a condition that mainly affects men. Beverley Bostock analyses the role practice nurses can play in recognising and managing cardiovascular disease in women

Although cardiovascular disease (CVD) is recognised to be a condition that affects men more than women overall, this risks underplaying the significant challenges relating to the diagnosis and management of CVD in women. Women are adversely affected compared to men in terms of diagnosis, acute management and implementation of secondary prevention, and the evidence base for treating women is lacking, due to the low numbers of women included in trials. Hormonal fluctuations throughout a woman's lifetime can also affect CVD risk. GPNs are ideally placed to consider the challenges of recognising and addressing CVD risk in women and to support them with engaging in reducing their lifetime risk.
Positive frozen section during reimplantation increases the risk of treatment failure in two-stage exchange arthroplasty even in patients with normal ESR and CRP
Authors: Qiao Jiang , Xu Chi , Chai Wei , Hao Li-Bo , Zhou Yonggang , Fu Jun , Chen Jiying
Published: May 2021

Aims

It can be extremely challenging to determine whether to perform reimplantation in patients who have contradictory serum inflammatory markers and frozen section results. We investigated whether patients with a positive frozen section at reimplantation were at a higher risk of reinfection despite normal ESR and CRP.

Methods

We retrospectively reviewed 163 consecutive patients with periprosthetic joint infections (PJIs) who had normal ESR and CRP results pre-reimplantation in our hospital from 2014 to 2018. Of these patients, 26 had positive frozen sections at reimplantation. The minimum follow-up time was two years unless reinfection occurred within this period. Univariable and multivariable logistic regression analyses were performed to identify the association between positive frozen sections and treatment failure.

Results

Treatment failure occurred in eight (30.77%) of the 26 PJI patients with positive frozen sections at reimplantation, compared with 13 (9.49%) of 137 patients with negative results. In the multivariate analysis, positive frozen section increased the risk of failure (odds ratio 4.70; 95% confidence interval (CI) 1.64 to 13.45). The mean number of months to reinfection was lower in the positive frozen section group than in the control group (p = 0.041). While there were nine (34.62%) patients with positive frozen section and 25 (18.25%) patients with negative frozen section who had prolonged antibiotic use (p = 0.042), the mean duration of antibiotic use was comparable in two groups. Synovial white blood cell count (p = 0.137) and polymorphonuclear leucocyte percentage (p = 0.454) were not associated with treatment failure in logistic regression model.

Conclusion

Positive frozen section at reimplantation was independently associated with subsequent failure and earlier reinfection, despite normal ESR and CRP levels pre-reimplantation. Surgeons should be aware of the risk of treatment failure in patients with positive frozen sections and carefully consider benefits of reimplantation. Cite this article: Bone Joint J 2021;103-B(5):916–922.
Repeat limited fasciectomy is a safe and effective treatment for recurrence of Dupuytren’s disease
Authors: Ashdown Thomas , Hayter Edward , Morris James A. , Clough Oliver T. , Little Maximillian , Hardman John , Anakwe Raymond E.
Published: May 2021

Aims

The results of surgery for Dupuytren’s disease can be compromised by the potential for disease recurrence and loss of function. Selecting which patients will benefit from repeat surgery, when to operate, and what procedure to undertake requires judgement and an understanding of patient expectations and functional needs. We undertook this study to investigate patient outcomes and satisfaction following repeat limited fasciectomy for recurrent Dupuytren’s disease.

Methods

We prospectively identified all patients presenting with recurrence of Dupuytren’s disease who were selected for surgical treatment with repeat limited fasciectomy surgery between January 2013 and February 2015. Patients were assessed preoperatively, and again at a minimum of five years postoperatively. We identified 43 patients who were carefully selected for repeat fasciectomy involving 54 fingers. Patients with severe or aggressive disease with extensive skin involvement were not included; in our practice, these patients are instead counselled and preferentially treated with dermofasciectomy. The primary outcome measured was change in the Michigan Hand Outcomes Questionnaire (MHQ) score. Secondary outcomes were change in finger range of motion, flexion contracture, Semmes-Weinstein monofilament (SWM) values, and overall satisfaction.

Results

There was a significant improvement in MHQ scores, across all domains, with a mean overall score increase of 24 points (p < 0.001). The summed flexion contracture across the metacarpophalangeal joint (MCPJ) and the proximal interphalangeal joint (PIPJ) reduced from means of 72.0° (SD 15.9°) to 5.6° (SD 6.8°) (p < 0.001). A significant increase in maximal flexion was seen at the MCPJ (p < 0.001) but not the PIPJ (p = 0.550). The mean overall satisfaction score from the visual analogue scale was 8.9 (7.9 to 10.0). Complications were uncommon although five fingers showed reduced sensibility at final follow-up.

Conclusion

Our study shows that repeat limited fasciectomy for selected patients presenting with recurrence of Dupuytren’s disease can be an effective and safe treatment resulting in excellent patient-reported outcomes and levels of satisfaction. Cite this article: Bone Joint J 2021;103-B(5):946–950.
Does performance-based remuneration improve outcomes in the treatment of hip fracture?
Authors: Griffin Xavier L. , Achten Juul , Parsons Nick , Costa Matt L. ,   On behalf of the WHiTE collaborators
Published: May 2021

Aims

The aim of this study was to determine whether national standards of best practice are associated with improved health-related quality of life (HRQoL) outcomes in hip fracture patients.

Methods

This was a multicentre cohort study conducted in 20 acute UK NHS hospitals treating hip fracture patients. Patients aged ≥ 60 years treated operatively for a hip fracture were eligible for inclusion. Regression models were fitted to each of the “Best Practice Tariff” indicators and overall attainment. The impact of attainment on HRQoL was assessed by quantifying improvement in EuroQol five-dimension five-level questionnaire (EQ-5D-5L) from estimated regression model coefficients.

Results

A total of 6,532 patients provided both baseline and four-month EQ-5D-5L, of whom 1,060 participants had died at follow-up. Best practice was achieved in the care of 57% of participants; there was no difference in age, cognitive ability, and mobility at baseline for the overall attainment and non-attainment groups. Attaining at least ‘joint care by surgeon and orthogeriatrician’, ‘delirium assessment’, and ‘falls assessment’ was associated with a large, clinically relevant increase in four months EQ-5D-5L of 0.094 (bootstrapped 95% confidence interval (CI) 0.046 to 0.146).

Conclusion

National standards with enhanced remuneration in hip fracture care results in improvement in individual patients’ HRQoL. Cite this article: Bone Joint J 2021;103-B(5):881–887.