bluuebunny/crossref_metadata_2025 huggingface dataset:
Surgical treatment of persistent right aortic arch with combined ligamentum arteriosum transection and esophageal diverticulum resection in three dogs
Authors: Olson Nicholas J. , Reems Michael R. , Monnet Eric
Published: May 2021

Objective

To describe the treatment of persistent right aortic arch (PRAA) in dogs with combined ligamentum arteriosum (LA) transection and esophageal diverticulum resection.

Animals

Three client owned dogs.

Study Design

Short case series.

Methods

Medical records were reviewed for clinical signs, diagnostic procedures, surgical treatment, post‐operative therapies including medications and feeding regime, outcomes, and follow‐up imaging.

Results

Esophageal resection was performed using a thoracoabdominal (TA) stapler with suture overlay. All dogs recovered well from surgery and did not experience any peri‐ or post‐operative complications. The last follow‐up was performed between 64 and 1004 days post‐operatively. In all cases, regurgitation resolved and did not recur in any dogs. No dogs required medical therapy or dietary modifications. In two cases, follow‐up imaging was performed that revealed marked improvement of esophageal dilation.

Conclusion

Resection of esophageal diverticulum secondary to PRAA utilizing a TA stapler with suture overlay was technically feasible and did not seem associated with early or late complications.
Upgrading municipal lagoons in temperate and cold climates: Total nitrogen removal and phosphorus assimilation at ultra‐low temperatures
Authors: D’Aoust Patrick M. , Vincent Simon , LeBlond Guillaume , Arabgol Raheleh , Hérard Richard , Ahmed Warsama , Guilherme Stéphanie , Kinsley Chris , Delatolla Robert
Published: May 2021

In this study, a municipal lagoon with high wintertime effluent total ammonia nitrogen (TAN) concentrations was upgraded with a pilot‐scale nitrifying‐nitrifying‐denitrifying (NIT‐NIT‐DENIT) moving bed biofilm reactor (MBBR) treatment train to characterize its effluent over wintertime operation, investigate the feasibility of upgrading lagoons to achieve substantial biological total nitrogen removal across ultra‐low temperatures (0.6–3.0) and to investigate nitrification inhibition pathways in facultative lagoon systems at ultra‐low temperatures. Throughout the study, it was observed that the system substantially reduced total nitrogen (TN) and total phosphorus (TP) effluent concentrations by an average of 69.8 ± 24.5% and 74.7 ± 20.1%, respectively. Furthermore, it was observed that sulfide toxicity may play an important role in the inhibition of nitrifying organisms in lagoons. Finally, the MBBR treatment technology has emerged as a suitable and sustainable upgrade technology for existing lagoon and waste stabilization pond facilities operating in temperate, northern and cold climate countries.
COVID‐19 and the UK water sector: Exploring organizational responses through a resilience framework
Authors: Lawson Elizabeth , Bunney Sarah , Cotterill Sarah , Farmani Raziyeh , Melville‐Shreeve Peter , Butler David
Published: May 2021

The unprecedented scale and impact of the COVID‐19 pandemic have required organizations to adapt all facets of their operations. The impact on the UK water sector extends beyond engineering and treatment processes, with social, economic and environmental consequences. Semi‐structured interviews were conducted with executives from 10 UK water companies to investigate the organizational response to the pandemic, and how their response impacted operational delivery. The Safe and SuRe framework was used to structure interview questions and analysis. Emergent themes of changes to customer behaviour, changes to operational practices and industry collaboration were mapped onto the framework and a ripple effect map developed. Lessons learnt highlight a failure to adequately prepare for the scale of the threat, the success of sector‐level collaboration and a need to embrace new ways of working.
Equivalence between angular spectrum-based and multipole expansion-based formulas of the acoustic radiation force and torque
Authors: Gong Zhixiong , Baudoin Michael
Published: May 2021

Two main methods have been proposed to derive the acoustical radiation force and torque applied by an arbitrary acoustic field on a particle: The first one relies on the plane wave angular spectrum decomposition of the incident field (see Sapozhnikov and Bailey [J. Acoust. Soc. Am. 133, 661–676 (2013)] for the force and Gong and Baudoin [J. Acoust. Soc. Am. 148, 3131–3140 (2020)] for the torque), while the second one relies on the decomposition of the incident field into a sum of spherical waves, the so-called multipole expansion (see Silva [J. Acoust. Soc. Am. 130, 3541–3544 (2011)] and Baresch, Thomas, and Marchiano [J. Acoust. Soc. Am. 133, 25–36 (2013)] for the force, and Silva, Lobo, and Mitri [Europhys. Lett. 97, 54003 (2012)] and Gong, Marston, and Li [Phys. Rev. Appl. 11, 064022 (2019)] for the torque). In this paper, we formally establish the equivalence between the expressions obtained with these two methods for both the force and torque.
On causality and aural impulse responses synthesized using the inverse discrete Fourier transform
Authors: Nørgaard Kren Monrad , Allen Jont B. , Neely Stephen T.
Published: May 2021

Causality is a fundamental property of physical systems and dictates that a time impulse response characterizing any causal system must be one-sided. However, when synthesized using the inverse discrete Fourier transform (IDFT) of a corresponding band-limited numerical frequency transfer function, several papers have reported two-sided IDFT impulse responses of ear-canal reflectance and ear-probe source parameters. Judging from the literature on ear-canal reflectance, the significance and source of these seemingly non-physical negative-time components appear largely unclear. This paper summarizes and clarifies different sources of negative-time components through ideal and practical examples and illustrates the implications of constraining aural IDFT impulse responses to be one-sided. Two-sided IDFT impulse responses, derived from frequency-domain measurements of physical systems, normally occur due to the two-sided properties of the discrete Fourier transform. Still, reflectance IDFT impulse responses may serve a number of practical and diagnostic purposes.
Dietary Intake and Gastrointestinal Integrity in Runners Undertaking High-Intensity Exercise in the Heat
Authors: Etxebarria Naroa , Beard Nicole A. , Gleeson Maree , Wallett Alice , McDonald Warren A. , Pumpa Kate L. , Pyne David B.
Published: May 2021

Gastrointestinal disturbances are one of the most common issues for endurance athletes during training and competition in the heat. The relationship between typical dietary intake or nutritional interventions and perturbations in or maintenance of gut integrity is unclear. Twelve well-trained male endurance athletes (peak oxygen consumption = 61.4 ± 7.0 ml·kg−1·min−1) completed two trials in a randomized order in 35 °C (heat) and 21 °C (thermoneutral) conditions and kept a detailed nutritional diary for eight consecutive days between the two trials. The treadmill running trials consisted of 15 min at 60% peak oxygen consumption, 15 min at 75% peak oxygen consumption, followed by 8 × 1-min high-intensity efforts. Venous blood samples were taken at the baseline, at the end of each of the three exercise stages, and 1 hr postexercise to measure gut integrity and the permeability biomarker concentration for intestinal fatty-acid-binding protein, lipopolysaccharide, and lipopolysaccharide-binding protein. The runners self-reported gut symptoms 1 hr postexercise and 3 days postexercise. The heat condition induced large (45–370%) increases in intestinal fatty-acid-binding protein, lipopolysaccharide-binding protein, and lipopolysaccharide concentrations compared with the baseline, but induced mild gastrointestinal symptoms. Carbohydrate and polyunsaturated fat intake 24 hr preexercise were associated with less lipopolysaccharide translocation. Protein, carbohydrate, total fat, and polyunsaturated fat intake (8 days) were positively associated with the percentage increase of intestinal fatty-acid-binding protein in both conditions (range of correlations, 95% confidence interval = .62–.93 [.02, .98]). Typical nutrition intake partly explained increases in biomarkers and the attenuation of symptoms induced by moderate- and high-intensity exercise under both heat and thermoneutral conditions.
Test–Retest Reliability of Single-Leg Time to Stabilization Following a Drop-Landing Task in Healthy Individuals
Authors: Byrne Aaron , Lodge Clare , Wallace Jennifer
Published: May 2021

Context: Single-leg stability has been associated with injury risk and is a key component of many injury prevention interventions. Methods of measuring single-leg stability are varied yet often unreliable. Objective: To establish within- and between-day test–retest reliability for single-leg time to stabilization (SL-TTS) following a drop-landing maneuver of 20 cm in height among a healthy cohort. Design: Test–retest reliability study. Setting: Healthy cohort from a third-level educational institution. Participants: Nineteen (11 females and 8 males) healthy individuals. Main Outcome Measures: The SL-TTS in the vertical plane. Results: The SL-TTS showed good within-day (intraclass correlation coefficient = .715) and excellent between-day (intraclass correlation coefficient = .83) test–retest reliability. The minimal detectable change was calculated as 171.6 ms for within-day contexts and 123.8 ms for between-day contexts. Conclusions: This method of measuring SL-TTS is reliable and could be used to detect changes over time in a healthy cohort. This could be of value to clinicians in injury risk factor identification or assessing the effectiveness of single-leg stability training. However, further research is needed to investigate its reliability in pathological populations.
Supplemental Material: Migmatite and leucogranite in a continental-scale exhumed strike-slip shear zone: Implications for tectonic evolution and initiation of shearing
Authors: Li Shan , Cao shunyun , al. et
Published: May 2021

Analytical methods of Zircon U–Pb geochronology, Major and trace elemental geochemistry, EBSD and cathodoluminescence (CL) analysis and EPMA methodology, Figure S1 present that deformed leucogranite with ductile structures. Figure S2 show Structures of zircons from foliated leucogranites and migmatite. Tables S1–S6 show sample locations, results of zircon dating and geochemistry.
Oxygen saturation reference ranges and factors affecting SpO2 among children living at altitude
Authors: Binene Vanessa , Panauwe Doreen , Kauna Rhondi , Vince John D , Duke Trevor
Published: May 2021

Aims

To determine reference values for oxygen saturation (SpO2) among healthy children younger than 5 years living at moderately high altitude in Papua New Guinea and to determine other factors that influence oxygen saturation levels.

Methods

266 well children living at 1810–2630 m above sea level were examined during immunisation clinic visits, and SpO2 was measured by pulse oximetry. Potential risk factors for hypoxaemia were recorded and analysed by multivariable analysis.

Results

The median SpO2 was 95% (IQR 93%–97%), with a normal range of 89%–99% (2.5–97.5 centiles). On multivariable analysis, younger children, children of parents who smoked, those asleep and babies carried in bilums, a traditional carry bag made of wool or string, had significantly lower SpO2.

Conclusion

The reference range for healthy children living in the highlands of Papua New Guinea was established. Besides altitude, other factors are associated with lower SpO2. Some higher-risk infants (preterm, very low birth weight, recurrent acute lower respiratory infection or chronic respiratory problem) may be more prone to hypoxaemia if they have additive risk factors: if parents smoke or they are allowed to sleep a bilum, as their baseline oxygen saturation may be significantly lower, or their respiratory drive or respiratory function is impaired. These findings need further research to determine the clinical importance.
Intramuscular ancient schwannoma of the axillary nerve
Authors: Moond Vishali , Diwaker Preeti , Golamari Reshma , Jain Rohit
Published: May 2021

We present the case of an adolescent with an intramuscular ancient schwannoma of the axillary nerve which, to the best of our knowledge, has not been reported before. Due to its deep location, intramuscular schwannoma has less clinical signs and hence, is difficult to diagnose. Ancient schwannoma, characterised by degeneration due to long course, is rare and can be mistaken for malignancy due to heterogeneous intensity and degeneration evident on MRI and nuclear atypia on histopathology. It is important to differentiate it from malignancy based on a clinically benign swelling with a long history, well-encapsulated mass on MRI with the split fat sign and absence of significant mitotic activity despite nuclear atypia. The aim of surgery should be enucleation of the tumour while preserving the function of the parent nerve.
Primary leptomeningeal melanoma: the prognostic significance of its genetic signature and embryological origin
Authors: Buckland Ali , Green Celia , Kho Lay Kun , Prentice David
Published: May 2021

Primary leptomeningeal melanomas are rare, comprising less than one percent of all brain tumours. They are aggressive and radioresistant tumours, with a poor prognosis. The mainstay of treatment is complete surgical resection and chemotherapy with limited success. Distinguishing a primary leptomeningeal melanoma from the more common metastatic disease can be difficult, and often requires the use of ancillary molecular testing. Primary central nervous system melanomas, including uveal melanomas, frequently exhibit mutations in GNAQ and GNA11, rare in the cutaneous and mucosal counterparts.

A case of a primary leptomeningeal melanoma of the cerebellopontine angle is described. Molecular studies identified a GNA11 p.Q209L and a KIT p.M541L missense variant, with losses of chromosomes 1p and 3p demonstrated with cytogenetic studies. Complete surgical resection was not possible and leptomeningeal metastatic disease rapidly ensued despite immunotherapy. Further understanding of the molecular signature may translate to improved diagnosis, prognostication and development of targeted therapies.
Erysipelothrix rhusiopathiaeinfection by geese to human transmission
Authors: Meier Simone Martina , Kottwitz Jan , Keller Dagmar I , Albini Sarah
Published: May 2021

Erysipelothrix rhusiopathiaetransmission to human is often occupation-related, but in most cases, a detailed case history is missing. This case report is based on an interdisciplinary approach and includes a thorough medical record. A 58-year-old laboratory technician working on geese necropsy cut open her glove at a rib fragment of a goose and subsequently noticed a slowly progressive, reddish skin alteration in the particular region of the hand. Bacteriological investigations on the geese revealed septicaemia due toE. rhusiopathiaeand therefore substantiated the diagnosis of the patient. The infectious agent could not be cultured from the patient; however, antibiotic susceptibility testing was performed using the goose isolate. An entire follow-up until full recovery of the patient was conducted. Zoonotic infections possibly have a significant impact on certain occupations. This case report analyses a rare but important zoonotic infection to create awareness of this in physicians caring for human patients.
TARP syndrome associated with renal malformation and optic nerve atrophy
Authors: Manotas Hernan , Payán-Gómez César , Roa Maria Fernanda , Piñeros Juan Gabriel
Published: May 2021

Talipes equinovarus, atrial septal defect, Robin sequence and persistent left superior vena cava (TARP) syndrome is a congenital disease caused by mutations in the RBBM10 gene. It has a low prevalence and a high rate of mortality in the neonatal stage. In this case report, we present a case of a 32-week gestational age preterm newborn with a prenatal diagnosis of intrauterine growth restriction, with a persistent left superior vena cava, interatrial communication and a horseshoe kidney. Additionally, postnatal optic nerve atrophy was diagnosed. By using exome sequencing, the pathogenic variant c.1877del; p.his626Lefus*78 was identified in the RMB10 gene. Due to a lack of reports in the medical literature, the phenotype has not fully been described. Here, we report on a patient with TARP syndrome and a previously unreported mutation, c.1877del; p.his627Leufs*78, which is predicted to generate a truncated and/or protein decay of the RBM10 transcript.
First report ofPseudomonas nitroreducenscultured from the lungs of a patient with pneumonia
Authors: Turner Timothy Lee , Wunderink Richard , Ozer Egon , Hauser Alan
Published: May 2021

A man in his 50s with neutropenic fever and multifocal lung opacities was diagnosed with a viral pneumonia. A small number of bacteria grown from bronchoalveolar lavage fluid collected during a repeat bronchoscopy were initially identified asPseudomonas aeruginosaby VITEK-2 and mass spectrometry platforms. Whole-genome sequencing, however, subsequently demonstrated that the bacteria werePseudomonas nitroreducens, representing the first known case ofP. nitroreducenscultured from human lungs.
Autoimmune heparin-induced thrombocytopenia: a rare manifestation of COVID-19
Authors: Julian Katherine , Bucher Donald , Jain Rohit
Published: May 2021

We describe the case of a 65-year-old male who presented to an outside hospital for shortness of breath, nausea and vomiting 8 days after testing positive for COVID-19. Initial workup revealed massive bilateral pulmonary emboli and thrombocytopenia. The patient was then admitted to our hospital, received an inferior vena cava filter and initially started on argatroban for autoimmune heparin-induced thrombocytopenia (HIT) prophylaxis. On hospital stay day 6, labs revealed a diagnosis of HIT in the setting of COVID-19. This case highlights the rare occurrence of a patient developing HIT without heparin exposure and in the setting of a novel infectious agent, COVID-19.
Higher contrast thresholds for vanishing optotype recognition in macular visual fields among glaucoma patients: a structure–function analysis
Authors: Wen Yun , Chen Zidong , Chen Shuo , Tan Kaixin , Kong Yang , Cheng Hui , Yu Minbin
Published: May 2021

Background/aims

We aimed to explore the impact of glaucomatous macular damage, specifically retinal ganglion cell (RGC) loss, on macular pattern vision measured by the vanishing optotype (VO) recognition contrast threshold.

Methods

Seventy-two patients (mean age, 33.51±7.05 years) with primary open-angle glaucoma and 36 healthy controls (mean age, 30.25±6.70 years) were enrolled. VO recognition contrast thresholds of each participant were measured at the 16 preset test locations covering the central 5° visual field (VF). Macular sensitivity (MS) was tested by macular threshold test of Humphrey Field Analyzer. Macular RGC plus inner plexiform layer (GCIPL) thickness was also measured by spectral domain optical coherence tomography.

Results

The VO contrast threshold demonstrated weak-to-moderate correlations (rho=−0.275 to −0.653) with MS (p<0.001). There was a significantly higher VO contrast threshold in glaucoma group (p<0.0001). At similar levels of MS, patients with glaucoma with GCIPL damage showed remarkably higher VO contrast thresholds than those with preserved GCIPL (p=0.0079). The structure–function relationships between VO contrast threshold and GCIPL thickness (rho=−0.725 to −0.802) were remarkably stronger than those between MS and GCIPL thickness (rho=0.210 to 0.448). VO contrast threshold showed stronger correlation with average GCIPL thickness (rho=−0.362 to −0.778) than MS (rho=0.238 to 0.398) at multiple test locations in glaucoma group.

Conclusions

Glaucomatous eyes have higher contrast thresholds for VO recognition in fovea-around VF. Stronger structure–function relationships indicate that VO contrast threshold is more vulnerable to RGC damage.
Fit and filter integrity of a respirator mask after multiple cycles of autoclave
Authors: Desai Nidhi , Naveed Hasan , Koenig Michael , Huber Jörg , Kapur Nikil , Bhutta Mahmood F , Rajak Saul
Published: May 2021

Background

The COVID-19 pandemic has led to profound shortages in personal protective equipment worldwide. The availability of filtering facepiece class 3 (FFP3) respirators could be greatly increased if they could be reused after sterilisation.

Aims

To determine the effects of repeated autoclave cycles on the fit and filter function of the 3M 1863 FFP3 disposable respirator.

Methods

Participants underwent fit tests with 3M 1863 FFP3 respirators. Respirators were subjected to autoclave cycles and a repeat fit test was conducted after each cycle until failure. The filter function of both unused and autoclaved respirators was determined by quantitatively assessing the differential pressures and filter penetration of aerosolised sodium chloride particles. Mask structural inspection was also carried out by light microscopy.

Results

A total of 38 participants were recruited. Repeat fit testing with a new respirator was passed by 30 of 38 (79%) participants in comparison with 31 of 38 (82%) of participants after the respirator had undergone one autoclave cycle. There was fit test failure with further rounds of autoclave. There was no evidence of structural changes after one autoclave cycle, but the nose foam began to separate from the mask following further cycles. Filter efficiency of all 15 autoclaved respirators that underwent filter testing was 97.40% or more. Differential pressure (breathability) of respirators was unaffected by autoclaving.

Conclusions

3M 1863 FFP3 respirator retains good fit and filter function after a single autoclave cycle. Addressing nose foam separation and further testing to EN149 standards would be required before respirators could be considered for reuse.
Toxicoepidemiology of poisoning exhibited in Indian population from 2010 to 2020: a systematic review and meta-analysis
Authors: Mittal Chaitanya , Singh Surjit , Kumar-M Praveen , Varthya Shoban Babu
Published: May 2021

Objective

To determine the prevalence of pesticide, corrosive, drugs, venom and miscellaneous poisoning in India.

Setting

Systematic literature search was done in PubMed Central, Cochrane and Google Scholar databases for studies that satisfied the inclusion criteria. Systematic review and meta-analyses of all observational studies published in the English language from January 2010 to May 2020 were included in this review.

Participants

Patients exposed to poisoning reported to hospitals were included.

Primary and secondary outcome measures

The prevalence of pesticide poisoning was analysed. The prevalence of poisoning due to corrosives, venom, drugs and miscellaneous agents, along with subgroup analysis based on age and region, was also determined. The percentage of persons with poisoning along with 95% CI was analysed.

Results

Pooled analysis of studies revealed that pesticides were the main cause of poisoning in adults, with an incidence of 63% (95% CI 63% to 64%), while miscellaneous agents were the main cause of poisoning in children, with an incidence of 45.0% (95% CI 43.1% to 46.9%), among those presenting to hospitals. Pesticide poisoning was the most prevalent in North India (79.1%, 95% CI 78.4% to 79.9%), followed by South (65.9%, 95% CI 65.3% to 66.6%), Central (59.2%, 95% CI 57.9% to 60.4%), West (53.1%, 95% CI 51.9% to 54.2%), North East (46.9%, 95% CI 41.5% to 52.4%) and East (38.5%, 95% CI 37.3% to 39.7%). The second most common cause of poisoning was miscellaneous agents (18%, 95% CI 18% to 19%), followed by drugs (10%, 95% CI 10% to 10%), venoms (6%, 95% CI 6% to 6%) and corrosives (2%, 95% CI 1% to 2%).

Conclusions

Pesticide poisoning is the most common type of poisoning in adults, while miscellaneous agents remain the main cause of poisoning in children.

PROSPERO registration number

CRD42020199427.
Preconsultation compassion intervention to reduce anxiety among patients referred to a cancer center: protocol for a randomised control trial
Authors: Winn Christine , Generosa Grana , Mazzarelli Anthony , Trzeciak Stephen , Roberts Brian W
Published: May 2021

Introduction

Patients diagnosed with cancer commonly have a high degree of anxiety during an initial oncology consultation, which may interfere with a patient’s ability to retain information required to make informed treatment decisions. A previous study randomised breast cancer survivors (volunteers) to view either (a) a brief video depicting a standard initial consultation from an oncologist or (b) an identical consultation with the addition of compassionate statements from the oncologist, and found the compassionate statements reduced anxiety among the volunteers. However, while compassionate statements reduced anxiety during simulation, it is currently unknown whether watching a video containing compassionate statements from an oncologist prior to an initial oncology consultation will reduce anxiety among patients referred to a cancer centre. The aim of this randomised control trial is to test whether watching a brief video containing compassionate statements from an oncologist, compared with watching a standard introduction video, prior to an initial oncology consultation will reduce the degree of anxiety among patients referred to a cancer centre.

Methods and analysis

This is a prospective, randomised controlled clinical trial at an academic cancer centre. We will enrol adult patients scheduled for an initial oncology consultation. Subjects will be randomly assigned to receive a standard introduction video or enhanced compassion video for viewing prior to the initial oncology consultation. On arrival to the cancer centre, we will measure anxiety severity using the Hospital Anxiety and Depression Scale (HADS). The HADS has two 7-item subscales (HADS anxiety and HADS depression) and is well-validated among oncology patients. We will use Wilcoxon rank-sum test to test for a difference in the HADS subscales between the two video groups.

Ethics and dissemination

The Cooper University Hospital Institutional Review Board approved this study. The results from this randomised control trial will be submitted for publication to a peer-reviewed journal.

Trial registration number

NCT04503681.
Incidence, risk factors and prognostic effect of imaging right ventricular involvement in patients with COVID-19: a dose–response analysis protocol for systematic review
Authors: Zhou Chenghui , Lou Baohui , Li Hui , Wang Xin , Ao Hushan , Duan Fujian
Published: May 2021

Introduction

Emerging evidence has shown that COVID-19 infection may result in right ventricular (RV) disturbance and be associated with adverse clinical outcomes. The aim of this meta-analysis is to summarise the incidence, risk factors and the prognostic effect of imaging RV involvement in adult patients with COVID-19.

Methods

A systematical search will be performed in PubMed, EMBase, ISI Knowledge via Web of Science and preprint databases (MedRxiv and BioRxiv) (until October 2021) to identify all cohort studies in adult patients with COVID-19. The primary outcome will be the incidence of RV involvement (dysfunction and/or dilation) assessed by echocardiography, CT or MRI. Secondary outcomes will include the risk factors for RV involvement and their association with all-cause mortality during hospitalisation. Additional outcomes will include the RV global or free wall longitudinal strain (RV-GLS or RV-FWLS), tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC) and RV diameter. Univariable or multivariable meta-regression and subgroup analyses will be performed for the study design and patient characteristics (especially acute or chronic pulmonary embolism and pulmonary hypertension). Sensitivity analyses will be used to assess the robustness of our results by removing each included study at one time to obtain and evaluate the remaining overall estimates of RV involvement incidence and related risk factors, association with all-cause mortality, and other RV parameters (RV-GLS or RV-FWLS, TAPSE, S’, FAC and RV diameter). Both linear and cubic spline regression models will be used to explore the dose–response relationship between different categories (>2) of RV involvement and the risk of mortality (OR or HR).

Ethics and dissemination

There was no need for ethics approval for the systematic review protocol according to the Institutional Review Board/Independent Ethics Committee of Fuwai Hospital. This meta-analysis will be disseminated through a peer-reviewed journal for publication.

PROSPERO registration number

CRD42021231689.
Cultural considerations in debriefing: a systematic review of the literature
Authors: Palaganas Janice C , Charnetski Matthew , Dowell Sharon , Chan Albert Kam Ming , Leighton Kim
Published: May 2021

Background

Conversations are influenced by cultural perceptions, beliefs and values. Debriefing is a learning conversation. Without cross-cultural engagement or culturally relevant teaching, learning may be compromised and may result in an outcome opposite of that intended.

Objective

This systematic review explores cultural considerations in healthcare simulation debriefing. We sought to explore findings that could help debriefers create culturally responsive and inclusive debriefings.

Study selection

Studies were included if they were peer-reviewed articles in any language and focused on healthcare simulation debriefing and global cultural considerations. Research study methods included qualitative, quantitative or both. The review included any health-related profession and level of learner.

Findings

Three studies met the criteria. The purposes of the three studies were significantly different and did not directly study cultural considerations in debriefing.

Conclusions

The learner–educator relationship is at risk and learning may be negatively impacted without addressing cultural awareness. More studies are needed to fully describe the effect of culture on successful debriefing.
Survival of people with valvular heart disease in a large, English community-based cohort study
Authors: Taylor Clare J , Ordóñez-Mena José M , Jones Nicholas R , Roalfe Andrea K , Myerson Saul G , Prendergast Bernard D , Hobbs FD Richard
Published: May 2021

Objective

Valvular heart disease (VHD) is present in half the population aged >65 years but is usually mild and of uncertain importance. We investigated the association between VHD and its phenotypes with all-cause and cause-specific mortality.

Methods

The OxVALVE (Oxford Valvular Heart Disease) population cohort study screened 4009 participants aged >65 years to establish the presence and severity of VHD. We linked data to a national mortality registry and undertook detailed outcome analysis.

Results

Mortality data were available for 3511 participants, of whom 361 (10.3%) died (median 6.49 years follow-up). Most had some form of valve abnormality (n=2645, 70.2%). In adjusted analyses, neither mild VHD (prevalence 44.9%) nor clinically significant VHD (moderate or severe stenosis or regurgitation; 5.2%) was associated with increased all-cause mortality (HR 1.20, 95% CI 0.96 to 1.51 and HR 1.47, 95% CI 0.94 to 2.31, respectively). Conversely, advanced aortic sclerosis (prevalence 2.25%) and advanced mitral annular calcification (MAC, 1.31%) were associated with an increased risk of death (HR 2.05, 95% CI 1.28 to 3.30 and HR 2.51, 95% CI 1.41 to 4.49, respectively). Mortality was highest for people with both clinically significant VHD and advanced aortic sclerosis or MAC (HR 4.38, 95% CI 1.99 to 9.67).

Conclusions

Advanced aortic sclerosis or MAC is associated with a worse outcome, particularly for patients with significant VHD, but also in the absence of other VHD. Older patients with mild VHD can be reassured about their prognosis. The absence of an association between significant VHD and mortality may reflect its relatively low prevalence in our cohort.
Access to MRI for patients with cardiac pacemakers and implantable cardioverter defibrillators
Authors: Pieri Christopher , Bhuva Anish , Moralee Russell , Abiodun Aderonke , Gopalan Deepa , Roditi Giles H , Moon James C , Manisty Charlotte
Published: May 2021

Objective

To determine provision of MRI for patients with cardiac implantable electronic devices (CIEDs; pacemakers and defibrillators) in England, to understand regional variation and assess the impact of guideline changes.

Methods

Retrospective data related to MRI scans performed in patients with CIED over the preceding 12 months was collected using a structured survey tool distributed to every National Health Service Trust MRI unit in England. Data were compared with similar data from 2014/2015 and with demand (estimated from local CIED implantation rates and regional population data by sustainability and transformation partnerships (STPs)).

Results

Responses were received from 212 of 223 (95%) hospitals in England. 112 (53%) MRI units’ scan patients with MR-conditional CIEDs (10% also scan non-MR conditional devices), compared with 46% of sites in 2014/2015. Total annual scan volume increased over fourfold between 2014 and 2019 (1090 to 4896 scans). There was widespread geographical variation, with five STPs (total population >3·5 million representing approximately 25 000 patients with CIED) with no local provision. There was no correlation between local demand (CIED implantation rates) and MRI provision (scan volume). Complication rates were extremely low with three events nationally in 12 months (0·06% CIED–MRI scans).

Conclusions

Provision of MRI for patients with CIEDs in England increased over fourfold in 4 years, but an estimated 10-fold care gap remains. Almost half of hospitals and 1 in 10 STPs have no service, with no relationship between local supply and demand. Availability of MRI for patients with non-MR conditional devices, although demonstrably safe, remains limited.
Measuring and publishing quality improvement
Authors: Ogrinc Greg
Published: May 2021

Misalignment of measures, measurement and analysis with the goals and methods of quality improvement efforts in healthcare may create confusion and decrease effectiveness. In healthcare, measurement is used for accountability, research, and quality improvement, so distinguishing between these is an important first step. Using a case vignette, this paper focuses on using measurement for improvement to gain insight into the dynamic nature of healthcare systems and to assess the impact of interventions. This involves an understanding of the variation in the data over time. Statistical process control (SPC) charting is an effective and powerful analysis tool for this. SPC provides ongoing assessment of system functioning and enables an improvement team to assess the impact of its own interventions and external forces on the system. Once improvement work is completed, the Standards for Quality Improvement Reporting Excellence (SQUIRE) guidelines is a valuable tool to describe the rationale, context, and study of the interventions. SQUIRE can be used to plan improvement work as well as structure a manuscript for publication in peer-reviewed journals.
Cardiovascular risk factors in gout, psoriatic arthritis, rheumatoid arthritis and ankylosing spondylitis: a cross-sectional survey of patients in Western Sweden
Authors: Landgren Anton Jonatan , Dehlin Mats , Jacobsson Lennart , Bergsten Ulrika , Klingberg Eva
Published: May 2021

Objectives

We aimed to compare traditional (trad) cardiovascular risk factors (CVRFs) among patients with gout, psoriatic arthritis (PsA), rheumatoid arthritis (RA) and ankylosing spondylitis (AS) stratified by sex.

Methods

A survey was sent to patients with gout (n=1589), PsA (n=1200), RA (n=1246) and AS (n=1095). Patients were retrieved from Sahlgrenska University Hospital, the hospitals of Uddevalla and Skövde, and 12 primary care centres in Western Sweden. The prevalence of self-reported trad-CVRFs was compared between diagnoses by age standardisation with the 2018 population of Sweden as the standard population.

Results

In total, 2896 (56.5%) of 5130 patients responded. Hypertension was the most frequently found comorbidity, reported by 65% of patients with gout, 41% with PsA, 43% with RA and 29% with AS. After age standardisation, women and men with gout had significantly more obesity (body mass index ≥30 kg/m2), hypertension, diabetes, hyperlipidaemia and multiple trad-CVRFs, compared with those with PsA, RA and AS. Obesity was significantly more common in PsA than in RA. In women, obesity, hypertension and multiple trad-CVRFs were more frequently reported in PsA than in RA and AS, whereas similar prevalence of CVRFs and coexistence of multiple trad-CVRFs were found in men with PsA, RA and AS.

Conclusions

Women and men with gout had the highest prevalence of trad-CVRFs. Differences in occurrence of CVRFs by sex were found in patients with PsA, RA and AS. In women, patients with PsA had higher occurrence of trad-CVRFs than those with RA and AS, whereas in men the distribution of CVRFs was similar in PsA, RA and AS.
Short-term glucocorticoids reduce risk of chronic NSAID and analgesic use in early methotrexate-treated rheumatoid arthritis patients with favourable prognosis: subanalysis of the CareRA randomised controlled trial
Authors: Pazmino Sofia , Boonen Annelies , De Cock Diederik , Stouten Veerle , Joly Johan , Bertrand Delphine , Westhovens René , Verschueren Patrick
Published: May 2021

Objective

To explore non-steroidal anti-inflammatory drug (NSAID) and analgesic use in early rheumatoid arthritis (eRA) patients with a favourable risk profile initiating methotrexate (MTX) with or without glucocorticoid (GC) bridging.

Methods

Patients with eRA (≤1 year) and favourable risk profile (no erosions, negative rheumatoid factor and anticitrullinated protein antibodiesor low disease activity) in the 2-year CareRA trial were randomised to MTX 15 mg with a step-down GC scheme (COBRA Slim), or MTX without oral GCs, Tight-Step-Up (TSU). Used analgesics were recorded, including frequency, start/end date and indication. Chronic intake (≥90 consecutive days in trial) of NSAIDs, acetaminophen, opioids including tramadol and antidepressants for the indication of musculoskeletal (MSK) pain was considered. Treatments were compared using χ2and analysis of variance with Holm’s correction for multiple testing.

Results

In total, 43 patients were randomised to COBRA Slim and 47 to TSU. At study inclusion, 33/43 (77%) of patients in the COBRA Slim and 32/47 (68%) in the TSU arm had been using analgesics (p=0.5). During the trial, 67 NSAID and analgesics were used for MSK pain in 26/43 (60%) COBRA Slim patients of which 9/43 (21%) daily chronically (DC), while 107 NSAID and analgesics were used in 43/47 (92%) TSU patients, of which 25/47 (53%) DC. The total number of patients on NSAID and analgesics at any time during the study (p<0.01) and chronically (p=0.01) was significantly different between treatment arms. Number of patients on DC NSAIDs was also significantly different (p<0.01) between COBRA Slim 6/43 (14%) and TSU 19/47 (40%).

Conclusion

In eRA patients considered to have a favourable prognosis, initial oral GC bridging resulted in lower chronic NSAID and analgesic use.

Trial registration number

NCT01172639.
Tool to monitor tobacco control policy implementation: the Tobacco Control Scale in Latin America. Adaptation process and pilot study
Authors: Feliu Ariadna , Martinez Cristina , Peruga Armando , Joossens Luk , Bianco Eduardo , Cornejo Marco , Nogueira Sarah O , Fernández Esteve
Published: May 2021

Background

Monitoring tobacco control policy implementation is one of the keys for tobacco consumption reduction in Latin America (LA). This study reports on the adaptation of the Tobacco Control Scale (TCS) for use in LA countries and the level of tobacco control policy implementation in this region according to the scale.

Methods

Ecological cross-sectional survey. The questionnaire to measure tobacco control policies was a translated (into Spanish and Portuguese) and adapted version of the last TCS as used in Europe. The resulting TCS-LA maintains the same structure as the original TCS, with eight policy domains and 100 points (pts) as maximum score; however, four policy domains were adapted because the exact same rationale could not be applied. At least two non-governmental tobacco control experts were contacted per country to answer the TCS-LA.

Results

Informants from 17 out of 18 countries completed the questionnaire. Using the TCS-LA, Panama (70 pts), Uruguay (68 pts) and Ecuador (61 pts) exhibited the strongest tobacco control policies, while Guatemala (32 pts), Bolivia (30 pts) and Dominican Republic (29 pts) have implemented a lower number of tobacco control policies. Eight countries reached 50% of the TCS-LA total possible score, indicating a relatively good implementation level of tobacco control policies.

Conclusions

Panama, Uruguay and Ecuador are the tobacco control policy leaders in LA; however, tobacco control in the region has room for improvement since nine countries have a total score under 50 pts. The TCS is a feasible and adaptable tool to monitor tobacco control in other WHO regions beyond Europe.
Event-triggered Neural Network-Based Adaptive Control for a Class of Uncertain Nonlinear Systems
Authors: Hu Hui , Li Yang , Yi Wei , Wang Yuebiao , Qu Fan , Wang Xiaofeng
Published: May 2021

In the paper, an event triggering adaptive control method based on neural network (NN) is proposed for a class of uncertain nonlinear systems with external disturbances. In order to reduce the network resource utilization, a novel event-triggered condition by the Lyapunov approach is proposed. In addition, the NN controller and adaptive parameters determined by the Lyapunov stability method are updated only at triggered instants to reduce the amount of calculation. Only one NN is used as the controller in the entire system. The stability analysis results of the closed-loop system are obtained by the Lyapunov approach, which shows that all the signals in the systems with bounded disturbance are semi-globally bounded. Zeno behavior is avoided. Finally, the analytical design is confirmed by the simulation results on a two-link robotic manipulator.
KINETIC PHASE TRANSITION IN HONEYBEE FORAGING DYNAMICS: SYNERGY OF INDIVIDUAL AND COLLECTIVE
Authors: TERESHKO VALERY
Published: May 2021

We consider a honeybee colony as a dynamical system gathering information from an environment and accordingly adjusting its behavior. Collective foraging behavior is shown to be triggered by the change of either colony size or profitability of exploited nectar sources. The collective mode provides greater productivity compared to the individual one. The latter does not diminish the importance of individual behavior that ensures the adaptivity of the system. Thus, the transition from the phase of individual behavior to a more complex phase, combining both individual and collective modes, provides the most effective scenario of honeybee colony foraging.
Dorsal Plating for Specific Fracture Pattern of the Distal Radius
Authors: Boretto Jorge G. , Altube Gonzalo , Petrucelli Eliana , Zaidenberg Ezequiel E. , Gallucci Gerardo L. , De Carli Pablo
Published: May 2021

Background: Volar locking plates have provided the capability to repair both simple and complex fractures. However, complications related to the inability to fix or to maintain the fixation of some fracture patterns have been reported with volar locking plates. The purpose of this study was to evaluate the results of dorsal plating treatment for specific pattern of fractures.

Methods: Patients with distal radius fractures were retrospectively evaluated. Inclusion criteria for this study were those related to the patient and treatment (adult patients, internal fixation with dorsal plating, a minimum follow-up of 12 months), and those related to the fracture pattern (displaced central articular fragment, volar distal fracture line not enough to allow volar fixation, displaced dorsal-ulnar fragment, dorsal partial fractures, combination of these patterns). Clinical outcome information including active range of motion, radiographs, PRWE and DASH questionnaires were collected. Complications were recorded.

Results: During a 6-year period, 679 distal radius fractures were treated with open reduction and internal fixation. Of these, 27 patients fulfilled the inclusion criteria. Patients were examined at a median of 34 months’ follow-up. All but pronation, supination, and radial deviation had a statistically significant difference compared to the opposite side. The median score on the DASH was 4.5 and 3.2 on the PRWE. No patient suffered loss of reduction during the follow-up nor were tendon ruptures recorded.

Conclusions: Although most of the distal radius fractures can be treated with volar locking plates, almost 5% of them present specific patterns that are amenable to treatment with dorsal fixation, without postoperative loss of reduction. These specific patterns are: (1) displaced central articular fragment, (2) volar distal fracture with less of 1cm distance from the distal volar edge of the radius, (3) displaced dorso-ulnar fragment, (4) Barton’s fracture, (5) combination of these patterns.
Effect of Diabetes and Hemoglobin A1c on Complications Following Elective Hand Surgery
Authors: Del Core Michael A. , Benage Timothy C. , Ahn Junho , Koehler Daniel , Sammer Douglas , Golden Ann S.
Published: May 2021

Background: Limited research exists investigating the association between diabetes and glycemic control on complications following elective hand surgery. The goal of this research was to assess the incidence of complications within 30 days of elective hand surgery in a large population of diabetic patients compared to a population of non-diabetics. Furthermore, we sought to examine the relationship of glycemic control, as measured by HbA1c, and postoperative complications.

Methods: We performed a retrospective review of electronic medical records at our institution of all patients who underwent elective hand, forearm, or elbow surgery from the dates of January 1st, 2008 to December 31st, 2017. Patients were categorized as diabetic or non-diabetic and most recent HbA1c was documented. Multivariable analysis was employed to compare the incidence of surgical complications within 30 days between the diabetics and non-diabetic populations, adjusting for baseline patient characteristics.

Results: A total of 3,261 patients met the inclusion criteria. There were 646 (20%) diabetic patients and 2,615 (80%) non-diabetic patients. No difference was found in the overall rate of complications between the cohort of diabetic and non-diabetic patients. Additionally, statistical analysis found no difference in the complication rate between insulin and non-insulin controlled diabetics. Rates of complications were stratified based on HbA1c level and statistical analysis found no increased risk of complications with increased hemoglobin A1c value.

Conclusions: In our present study we were not able to demonstrate any significant difference in the 30 day complication rates between and non-diabetics undergoing elective hand surgery. This study attempted to aid in risk stratification of diabetic patients by evaluating preoperative glycemic indices in the form of HbA1c.