bluuebunny/crossref_metadata_2025 huggingface dataset:
Traumatic subdural haematoma: integrating case-based clinical judgement with guidelines
Authors: Samitinjay Aditya , Karri Satya Revanth , Khairkar Praveen , Biswas Rakesh
Published: September 2020

Traumatic brain injury (TBI) is one of the leading causes of mortality and morbidity with a significant loss of functional capacity and a huge socioeconomic burden. Road traffic accidents are the most common (60%) cause followed by falls and violence in India and worldwide. This case discusses the story of a 23-year-old man with severe TBI–subdural haematoma, who presented in a comatose state. The patient was a purported candidate for emergency decompressive surgery as per Brain Trauma Foundation (BTF) guidelines but was managed conservatively. This case questions the plausibility of the BTF guidelines for severe TBI, particularly in rural hospitals in India and how such cases are often managed with clinical judgement based on the review of literature. The patient recovered well with a perfect 8/8 on Glasgow Outcome Scale Extended Score.
Barriers to maternal health services during the Ebola outbreak in three West African countries: a literature review
Authors: Yerger Piper , Jalloh Mohamed , Coltart Cordelia E M , King Carina
Published: September 2020

Introduction

The Ebola virus disease (EVD) outbreak in West Africa, affecting Guinea, Liberia and Sierra Leone from 2014 to 2016, was a substantial public health crisis with health impacts extending past EVD itself. Access to maternal health services (MHS) was disrupted during the epidemic, with reductions in antenatal care, facility-based deliveries and postnatal care. We aimed to identify and describe barriers related to the uptake and provision of MHS during the 2014–2016 EVD outbreak in West Africa.

Methods

In June 2020, we conducted a scoping review of peer-reviewed publications and grey literature from relevant stakeholder organisations. Search terms were generated to identify literature that explained underlying access barriers to MHS. Published literature in scientific journals was first searched and extracted from PubMed and Web of Science databases for the period between 1 January 2014 and 27 June 2020. We hand-searched relevant stakeholder websites. A ‘snowball’ approach was used to identify relevant sources uncaptured in the systematic search. The identified literature was examined to synthesise themes using an existing framework.

Results

Nineteen papers were included, with 26 barriers to MHS uptake and provision identified. Three themes emerged: (1) fear and mistrust, (2) health system and service constraints, and (3) poor communication. Our analysis of the literature indicates that fear, experienced by both service users and providers, was the most recurring barrier to MHS. Constrained health systems negatively impacted MHS on the supply side. Poor communication and inadequately coordinated training efforts disallowed competent provision of MHS.

Conclusions

Barriers to accessing MHS during the EVD outbreak in West Africa were influenced by complex but inter-related factors at the individual, interpersonal, health system and international level. Future responses to EVD outbreaks need to address underlying reasons for fear and mistrust between patients and providers, and ensure MHS are adequately equipped both routinely and during crises.
Cross-sectional study of the association between cataract surgery and age-related macular degeneration in the era of phacoemulsification in the national health and nutrition examination survey 2005–2008
Authors: Zhu Zhuoting , Wang Wei , Liao Huan , Keel Stuart , Zhang Jian , He Mingguang
Published: September 2020

Objective

To determine the association between cataract surgery and age-related macular degeneration (AMD) in a representative US sample.

Design

Population-based, cross-sectional study.

Setting

The US National Health and Nutrition Examination Survey 2005–2008.

Participants

A total of 5401 participants aged ≥40 years had information in cataract surgery status and gradable retinal photographs for right eyes.

Methods

Cataract surgery status was obtained from questionnaire. Non-mydriatic fundus photographs were collected and AMD status was assessed. The associations between AMD and cataract surgery were evaluated in right eyes using logistic regression models.

Results

Of 338 right eyes with any AMD, 107 right eyes (28.9%) had cataract surgery. After adjusting for multiple variables, there were significant associations between cataract surgery and any AMD (OR 1.36; 95% CI 1.03 to 1.81) or late AMD (OR 2.48; 95% CI 1.01 to 6.09). No significant association was found between cataract surgery and early AMD after adjusting for multiple covariates (OR 1.20; 95% CI 0.91 to 1.59).

Conclusion

Our results suggest that cataract surgery is associated with the presence of AMD, particularly for late AMD. Longitudinal studies investigating the risk and progression of AMD after cataract surgery are needed in the era of phacoemulsification.
Cryoablation for advanced non-small cell lung cancer: a protocol for a systematic review
Authors: Duan Hua , Zheng Shu-Yue , Luo Chufan , Fang Xueni , Wang Dan , Pang Haoyue , Wang Man , Chen Yu , Zhou Tian , Li Quanwang , Hu Kaiwen
Published: September 2020

Introduction

National Comprehensive Cancer Network has recommended cryoablation to replace the resection in the treatment of medically operable non-small cell lung cancer (NSCLC). Cryoablation also has been used for the advanced NSCLC in randomised controlled trials. However, they have not been systematically reviewed. Here, we provide a protocol to evaluate the effectiveness and safety of cryoablation in the treatment of advanced NSCLC.

Methods and analyses

We will search PubMed, Embase, the Cochrane Library, Chinese Biomedical Database, China National Knowledge Infrastructure, Wanfang Database and Chinese Scientific Journal Database without language restrictions from inception until 1 February 2020. Trial registers (International Clinical Trials Registry platform, the US National Institutes of Health Ongoing Trials Register and the ISRCTN registry) and reference lists of retrieved articles will also be searched. Two reviewers will independently extract data on participants, interventions, comparisons, outcomes and assess the methodological quality by the Cochrane risk of bias tool. The strength of evidences will be evaluated according to the Grading of Recommendations Assessment, Development and Evaluation approach. Review Manager V.5.3 software will be used for data analyses. Meta-analyses will be performed if the data are sufficiently homogeneous. The primary outcomes will be objective response rate and overall survival. The secondary outcomes will be adverse effects, health-related quality of life, changes of immune indicators and surrogate outcomes (disease control rate, progression-free survival and survival rate).

Ethics and dissemination

Ethics approval is not required, as this study will not involve patients. The results of this study will be submitted to a peer-reviewed journal for publication, to inform both clinical practice and further research.

PROSPERO registration number

CRD42019138660.
My child’s legacy: a mixed methods study of bereaved parents and providers’ opinions about collaboration with NICU teams in quality improvement initiatives
Authors: Bourque Claude Julie , Dahan Sonia , Mantha Ginette , Reichherzer Martin , Janvier Annie
Published: September 2020

Objective

Although stakeholders’ participation in healthcare is increasingly recommended, bereaved parents are often excluded for perceived potential risks to them. The objective of this study is to describe the ongoing involvement and the perspectives of bereaved parents engaged in different types of activities in Neonatal Intensive Care Units and providers who work with them.

Design/methods

Mixed methods convergent analysis.

Setting

Canadian paediatric tertiary care university hospital.

Participants

All bereaved members of the resource parents group (n=8) and most providers who work with them (n=16) answered a satisfaction/needs questionnaires.

Results

Since 2011, eight bereaved parents were involved in a large number of activities mostly related to palliative care (research, education or clinical care initiatives). Three engaged in peer-to-peer support activities while the others preferred activities outside of clinical units and/or without direct interactions with other families. All of them reported that their participation had positive impacts, but two parents also reported a reactivation of traumatic experiences during a medical simulation activity. All participants expressed a desire for further collaboration. Motivation to contribute gravitated around two central themes: helping others and helping themselves. Many wanted to give back, help other families, improve the system and meet with providers who had cared for their child. All stated that this kind of involvement empowered them and gave meaning to their experiences. Providers and researchers all reported positive experiences, mainly due to the unique perspectives of bereaved parents who took part in their projects.

Conclusion(s)

With careful recruitment and supervision, some bereaved parents can become resource parents involved in different types of activities. It is important to understand the positive impacts this type of engagement can have on their healing process and to control the risks related to their participation. Research is needed to develop pertinent tools and measures to evaluate the outcomes and impacts of their participation.
Prevalence of TB symptoms, diagnosis and treatment among people living with HIV (PLHIV) not on ART presenting at outpatient clinics in South Africa and Kenya: baseline results from a clinical trial
Authors: Brennan Alana , Maskew Mhairi , Larson Bruce A , Tsikhutsu Isaac , Bii Margaret , Vezi Lungisile , Fox Matthew , Venter Willem Daniel Francois , Ehrenkranz Peter D , Rosen Sydney
Published: September 2020

Objective

We used screening data and routine clinic records for intervention arm patients in the Simplified Algorithm for Treatment Eligibility (SLATE) trials to describe the prevalence of tuberculosis (TB) symptoms, diagnosis and treatment among people living with HIV (PLHIV), not on antiretroviral therapy (ART) and presenting at outpatient clinics in South Africa and Kenya. We compared the performance of the WHO four-symptom TB screening tool with a baseline Xpert test.

Setting

Outpatient HIV clinics in South Africa and Kenya.

Participants

Eligible patients were non-pregnant, PLHIV, >18 years of age, not on ART, willing to provide written informed consent. A total of 594 patients in South Africa and 240 in Kenya were eligible.

Results

Prevalence of any TB symptom was 38% in Kenya, 35% (SLATE I) and 47% (SLATE II) in South Africa. During SLATE I, 70% of patients in Kenya and 57% in South Africa with ≥1 TB symptom were tested for TB. In SLATE II, 79% of patients with ≥1 TB symptom were tested. Of those, 19% tested positive for TB in Kenya, 15% (SLATE I) and 5% (SLATE II) tested positive in South Africa. Of the 28 patients who tested positive in both trials, 20 initiated TB treatment. The lowest median CD4 counts were among those with active TB (Kenya 124 cells/mm3; South Africa 193 cells/mm3). When comparing the WHO four-symptom screening tool to the Xpert test (SLATE II), we found that increasing the number of symptoms required for a positive screen from one to three or four decreased sensitivity but increased the positive predictive value to >30%.

Conclusions

80% of patients assessed for ART initiation presented with ≥1 TB symptoms. Reconsideration of the ‘any symptom’ rule may be appropriate, with ART initiation among patients with fewer/milder symptoms commencing while TB test results are pending.

Trial registration number

NCT02891135 and NCT03315013.
Medication-related experiences of patients with polypharmacy: a systematic review of qualitative studies
Authors: Eriksen Christian Ulrich , Kyriakidis Stavros , Christensen Line Due , Jacobsen Ramune , Laursen Jannie , Christensen Mikkel Bring , Frølich Anne
Published: September 2020

Background

We aimed to synthesise qualitative studies exploring medication-related experiences of polypharmacy among patients with multimorbidity.

Methods

We systematically searched PubMed, Embase and Cumulative Index to Nursing and Allied Health Literature in February 2020 for primary, peer-reviewed qualitative studies about multimorbid patients’ medication-related experiences with polypharmacy, defined as the use of four or more medications. Identified studies were appraised for methodological quality by applying the Critical Appraisal Skills Programme checklist for qualitative research, and data were extracted and synthesised by the meta-aggregation approach.

Results

We included 13 qualitative studies, representing 499 patients with polypharmacy and a wide range of chronic conditions. Overall, most Critical Appraisal Skills Programme items were reported in the studies. We extracted 140 findings, synthesised these into 17 categories, and developed five interrelated syntheses: (1) patients with polypharmacy are a heterogeneous group in terms of needing and appraising medication information; (2) patients are aware of the importance of medication adherence, but it is difficult to achieve; (3) decision-making about medications is complex; (4) multiple relational factors affect communication between patients and physicians, and these factors can prevent patients from disclosing important information; and (5) polypharmacy affects patients’ lives and self-perception, and challenges with polypharmacy are not limited to practical issues of medication-taking.

Discussion

Polypharmacy poses many challenges to patients, which have a negative impact on quality of life and adherence. Thus, when dealing with polypharmacy patients, it is crucial that healthcare professionals actively solicit individual patients’ perspectives on challenges related to polypharmacy. Based on the reported experiences, we recommend that healthcare professionals upscale communicative efforts and involve patients’ social network on an individualised basis to facilitate shared decision-making and treatment adherence in multimorbidpatients with polypharmacy.
Case for hospital nurse-to-patient ratio legislation in Queensland, Australia, hospitals: an observational study
Authors: McHugh Matthew D , Aiken Linda H , Windsor Carol , Douglas Clint , Yates Patsy
Published: September 2020

Objectives

To determine whether there was variation in nurse staffing across hospitals in Queensland prior to implementation of nurse-to-patient ratio legislation targeting medical-surgical wards, and if so, the extent to which nurse staffing variation was associated with poor outcomes for patients and nurses.

Design

Analysis of cross-sectional data derived from nurse surveys linked with admitted patient outcomes data.

Setting

Public hospitals in Queensland.

Participants

4372 medical-surgical nurses and 146 456 patients in 68 public hospitals.

Main outcome measures

30-day mortality, quality and safety indicators, nurse outcomes including emotional exhaustion and job dissatisfaction.

Results

Medical-surgical nurse-to-patient ratios before implementation of ratio legislation varied significantly across hospitals (mean 5.52 patients per nurse; SD=2.03). After accounting for patient characteristics and hospital size, each additional patient per nurse was associated with 12% higher odds of 30-day mortality (OR=1.12; 95% CI 1.01 to 1.26). Each additional patient per nurse was associated with poorer outcomes for nurses including 15% higher odds of emotional exhaustion (OR=1.15; 95% CI 1.07 to 1.23) and 14% higher odds of job dissatisfaction (OR=1.14; 95% CI 1.02 to 1.28), as well as higher odds of concerns about quality of care (OR=1.12; 95% CI 1.01 to 1.25) and patient safety (OR=1.32; 95% CI 1.11 to 1.57).

Conclusions

Before ratios were implemented, nurse staffing varied considerably across Queensland hospital medical-surgical wards and higher nurse workloads were associated with patient mortality, low quality of care, nurse emotional exhaustion and job dissatisfaction. The considerable variation across hospitals and the link with outcomes suggests that taking action to improve staffing levels was prudent.
Systematic review of depressive, anxiety and post-traumatic stress symptoms among Asian American breast cancer survivors
Authors: Tsai William , Nusrath Sumaiya , Zhu Ruidi
Published: September 2020

Objectives

This paper aimed to review the experience of psychopathology symptoms (ie, depressive, anxiety and post-traumatic stress) and their social, cognitive and affective correlates among Asian American breast cancer survivors. Studies on psychosocial interventions for reducing psychopathology symptoms were also included in this review.

Design

A systematic review was conducted.

Methods

PubMed, PsycINFO and Web of Science were searched from database inception to November 2018. Empirical, peer-reviewed articles on adult women of Asian heritage residing in the USA with breast cancer diagnoses were included in this review. The methodological quality of the included articles was coded.

Results

The search yielded 16 empirical articles, which were all deemed to be of high methodological quality. Eleven studies utilised a quantitative design, two studies utilised a qualitative design and three studies utilised a mixed-methods design. Thirteen were cross-sectional and three were longitudinal in design. Only two intervention studies were identified. Studies showed that Asian American breast cancer survivors endorsed moderate to high levels of depressive symptoms, anxiety and post-traumatic stress symptoms; those who are more acculturated demonstrated lower levels of depressive and anxiety symptoms. Asian American breast cancer survivors with social constraints were more likely to have intrusive thoughts and, in turn, have high levels of psychopathology symptoms. Intervention studies were limited, but the use of community-based participatory research approaches and cultural adaptations were noted strengths of the studies.

Discussion

In addition to discussing clinical implications, we highlight limitations of the literature, including a lack of longitudinal studies and the limited use of standardised diagnostic instruments for assessing psychopathology symptoms among this population. Clarifying the prospective relationships between psychopathology symptoms and their social, cognitive and affective correlates will help inform the development of culturally sensitive psychosocial interventions among Asian American breast cancer survivors.
Are eyes the windows to COVID-19? Systematic review and meta-analysis
Authors: La Distia Nora Rina , Putera Ikhwanuliman , Khalisha Dhiya Farah , Septiana Indah , Ridwan Asri Salima , Sitompul Ratna
Published: September 2020

Objective

To review and critically appraise the ocular manifestation and the presence of SARS-CoV-2 through PCR positivity from ocular samples in COVID-19-related patients. Moreover, to evaluate the time and severity association of ocular manifestation to systemic disease of COVID-19.

Methods and analysis

A systematic literature search from PubMed, ScienceDirect and Google Scholar databases was performed using standardised Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. Selected keywords were related to COVID-19, ocular manifestation and PCR testing of SARS-CoV-2. Studies were assessed for their validity, and the data were extracted by two independent reviewers. Observational, case series and case report studies were included if they met the selection criteria. Meta-analysis was performed to estimate the pooled prevalence of ocular manifestations and PCR positivity from tears.

Results

Thirty-one articles were qualitatively reviewed, and 14 studies were included in the meta-analysis. The pooled prevalence of ocular manifestation among COVID-19-related patients was 0.05 (95% CI 0.02% to 0.08). The overall PCR from tears samples positivity rate from COVID-19-related patients presenting with ocular manifestation was 0.38 (95% CI 0.14% to 0.65). Ocular manifestation could precede systemic manifestation in about 0.28 (95% CI 0.05% to 0.58) of COVID-19-related patients with ocular manifestations. Besides, ocular manifestation was not associated with a severe form of COVID-19.

Conclusion

Although the overall number of ocular manifestation and SARS-CoV-2 PCR positivity rate from ocular samples was very low, around a quarter of COVID-19-related patients with ocular manifestation presented their ocular manifestation earlier than the systemic manifestation regardless of the severity. Interestingly, SARS-CoV-2 PCR was positive from one-third of ocular samples, which could potentially be the source of infection to the respiratory tract and the environment, although the infectivity is yet to be determined.
Comparison of two techniques (intermittent intravenous bolus morphine vs. morphine infusion) for analgesic titration in patients who had advanced cancer with severe pain: a prospective randomised study
Authors: Kumar Vinod , Sirohiya Prashant , Garg Rakesh , Gupta Nishkarsh , Bharti Sachidanand Jee , Velpandian Thirumurthy , Mishra Seema , Bhatnagar Sushma
Published: September 2020

Objective

To compare the analgesic efficacy of two techniques of morphine titration (intermittent intravenous bolus vs infusion) by calculating rescue dosage in a day at 1 week after analgesic titration.

Methods

One hundred and forty cancer patients were randomised into two groups. In group 1, intravenous morphine 1.5 mg bolus given every 10 min until Numerical Rating Scale (NRS) pain score <4 is achieved. Total intravenous dose converted to oral dose (1:1) and administered every 4 hours. In group 2, intravenous bolus morphine 0.05 mg/kg body weight administered followed by 0.025 mg/kg/hour intravenous infusion. The NRS pain score was recorded every 10 min but infusion rate was titrated every 30 min if required. The infusion rate of morphine was doubled if the pain score was unchanged and increased to 50% when NRS was between 4 and baseline. If NRS<4, then infusion at same rate was continued. Once the NRS<4 for two consecutive hours, total intravenous dose for 24 hours was calculated and converted to oral morphine in a ratio of 1:3 and divided into six doses given over 24 hours. For rescue (pain score ≥4) analgesia, one-sixth of the total daily oral dose was prescribed. The primary outcome of this study was to note the number of rescue doses of oral morphine in a day at 1 week.

Results

The rescue dosage in a day at 1-week post discharge from the palliative care unit was significantly higher in group 1 as compared with group 2.

Conclusion

Intravenous infusion morphine may be a better analgesic titration technique for analgesia in patients with advanced cancer.

Trial registration number

CTRI/2018/04/013369.
Inflammatory bowel diseases among first-generation and second-generation immigrants in Denmark: a population-based cohort study
Authors: Agrawal Manasi , Corn Giulia , Shrestha Sarita , Nielsen Nete Munk , Frisch Morten , Colombel Jean-Frederic , Jess Tine
Published: September 2020

Objective

Our objective was to estimate the relative risk of IBD among first-generation and second-generation immigrants in Denmark compared with native Danes.

Design

Using national registries, we established a cohort of Danish residents between 1977 and 2018. Cohort members with known country of birth were followed for Crohn’s disease (CD) and ulcerative colitis (UC) diagnoses. Incidence rate ratios (IRRs) served as measures of relative risk and were calculated by log-linear Poisson regression, using rates among native Danes as reference, stratified by IBD risk in parental country of birth, and among first-generation immigrants by age at immigration and duration of stay in Denmark.

Results

Among 8.7 million Danes, 4156 first-generation and 898 second-generation immigrants were diagnosed with CD or UC. Overall, comparing first-generation immigrants with native Danes, the IRR was 0.80 (95% CI 0.76 to 0.84) for CD and 0.74 (95% CI 0.71 to 0.77) for UC. The IRR of IBD increased with ≥20 years stay in Denmark. The IRR of CD increased with immigration at ≥40 years of age. Comparing second-generation immigrants with native Danes, the IRR of IBD was 0.97 (95% CI 0.91 to 1.04). There was significant interaction with sex, with higher IRR of IBD in male than in female immigrants.

Conclusion

Relative to native Danish men and women, IBD risk among first-generation immigrants was lower, reflected the risk in their parental country of birth and increased with ≥20 years stay in Denmark. For second-generation immigrants, relative risk of IBD was lower only among women. These complex patterns suggest the role of environmental IBD risk factors.
Right ventricle in heart failure with preserved ejection fraction
Authors: Berglund Felix , Piña Pamela , Herrera César J
Published: September 2020

Heart failure with preserved ejection fraction (HFpEF) affects half of all patients with heart failure. While previously neglected, the right ventricle (RV) has sparked interest in recent years as a means for better understanding this condition and as a potential therapeutic target.

Right ventricular dysfunction (RVD) is present in 4%–50% of patients with HFpEF. The RV is intimately connected to the pulmonary circulation, and pulmonary hypertension is commonly implicated in the pathophysiology of RVD. The development of RVD in HFpEF may also be driven by comorbidities, such as chronic obstructive pulmonary disease, obesity, obstructive sleep apnoea and atrial fibrillation. The evaluation of RVD is particularly challenging due to anatomical and structural factors, as well as unique physiological characteristics of this chamber like load and interventricular dependency. Fractional area change, tricuspid annular plane systolic excursion and tricuspid annular systolic velocity are commonly used measurements of RV function. Speckle tracking echocardiography and cardiac magnetic resonance (CMR) are also gaining attention as important tools for the assessment of RV structure, fibre deformation and systolic performance. Further research is needed to confirm the utility and prognostic significance of RV [18F]fluorodeoxyglucose (FDG) positron emission tomography imaging as FDG accumulation is suggested to increase with progressive RVD. Targeted pharmacotherapy with phosphodiesterase inhibitors, guanylate–cyclase stimulators, nitrates and inhaled inorganic nitrites have yet to demonstrate improvement in RVD, compelling the need for evaluation and discovery of novel pharmacological interventions for this entity.
Implementing NGS-basedBRCAtumour tissue testing in FFPE ovarian carcinoma specimens: hints from a real-life experience within the framework of expert recommendations
Authors: Rivera Daniela , Paudice Michele , Gismondi Viviana , Anselmi Giorgia , Vellone Valerio Gaetano , Varesco Liliana
Published: September 2020

Aims

Next Generation Sequencing (NGS)-basedBRCAtumour tissue testing poses several challenges. As a first step of its implementation within a regional health service network, an in-house validation study was compared with published recommendations.

Methods

Epithelial ovarian cancer (EOC) formalin-fixed paraffin-embedded specimens stored in the archives of the eight regional pathology units were selected from a consecutive series of patients with knownBRCAgermline status. Two expert pathologists evaluated tumour cell content for manual macrodissection. DNA extraction, library preparation and NGS analyses were performed blinded to the germinal status. Parameters used in the study were confronted with guidelines for the validation of NGS-based oncology panels and forBRCAtumour tissue testing.

Results

NGS analyses were successful in 66 of 67 EOC specimens, with good quality metrics and high reproducibility among different runs. In all, 19BRCApathogenic variants were identified: 12 were germline and 7 were somatic. A 100% concordance with blood tests was detected for germline variants. ABRCA1variant showed a controversial classification. In different areas of two early stage EOCs showing somatic variants, intratumour heterogeneity not relevant for test results (variant allele frequency >5%) was observed. Compared with expert recommendations, main limitations of the study were absence of controls with known somaticBRCAstatus and exclusion from the validation ofBRCAcopy number variations (CNV).

Conclusions

A close collaboration between pathology and genetics units provides advantages in the implementation ofBRCAtumour tissue testing. The development of tools for designing and interpreting complex testing in-house validation could improve process quality.
A nomogram for predicting mortality in patients with COVID-19 and solid tumors: a multicenter retrospective cohort study
Authors: Liu Chao , Li Li , Song Kehan , Zhan Zhi-Ying , Yao Yi , Gong Hongyun , Chen Yuan , Wang Qun , Dong Xiaorong , Xie Zhibin , Ou Chun-Quan , Hu Qinyong , Song Qibin
Published: September 2020

Background

Individualized prediction of mortality risk can inform the treatment strategy for patients with COVID-19 and solid tumors and potentially improve patient outcomes. We aimed to develop a nomogram for predicting in-hospital mortality of patients with COVID-19 with solid tumors.

Methods

We enrolled patients with COVID-19 with solid tumors admitted to 32 hospitals in China between December 17, 2020, and March 18, 2020. A multivariate logistic regression model was constructed via stepwise regression analysis, and a nomogram was subsequently developed based on the fitted multivariate logistic regression model. Discrimination and calibration of the nomogram were evaluated by estimating the area under the receiver operator characteristic curve (AUC) for the model and by bootstrap resampling, a Hosmer-Lemeshow test, and visual inspection of the calibration curve.

Results

There were 216 patients with COVID-19 with solid tumors included in the present study, of whom 37 (17%) died and the other 179 all recovered from COVID-19 and were discharged. The median age of the enrolled patients was 63.0 years and 113 (52.3%) were men. Multivariate logistic regression revealed that increasing age (OR=1.08, 95% CI 1.00 to 1.16), receipt of antitumor treatment within 3 months before COVID-19 (OR=28.65, 95% CI 3.54 to 231.97), peripheral white blood cell (WBC) count ≥6.93 ×109/L (OR=14.52, 95% CI 2.45 to 86.14), derived neutrophil-to-lymphocyte ratio (dNLR; neutrophil count/(WBC count minus neutrophil count)) ≥4.19 (OR=18.99, 95% CI 3.58 to 100.65), and dyspnea on admission (OR=20.38, 95% CI 3.55 to 117.02) were associated with elevated mortality risk. The performance of the established nomogram was satisfactory, with an AUC of 0.953 (95% CI 0.908 to 0.997) for the model, non-significant findings on the Hosmer-Lemeshow test, and rough agreement between predicted and observed probabilities as suggested in calibration curves. The sensitivity and specificity of the model were 86.4% and 92.5%.

Conclusion

Increasing age, receipt of antitumor treatment within 3 months before COVID-19 diagnosis, elevated WBC count and dNLR, and having dyspnea on admission were independent risk factors for mortality among patients with COVID-19 and solid tumors. The nomogram based on these factors accurately predicted mortality risk for individual patients.
Evaluation of the Minnesota Safe Patient Handling Act: trends in workers’ compensation indemnity claims in nursing home workers before and after enactment of the law
Authors: Rosebush Christina E , Zaidman Brian , Schofield Katherine E , Erickson Darin J , Tschida Breca , Ramirez Marizen , McGovern Patricia M
Published: September 2020

Objectives

The 2007 Minnesota Safe Patient Handling Act aims to protect healthcare workers from injuries caused by lifting and transferring patients. The effectiveness of the law in nursing homes is unknown. This policy evaluation measured changes in patient handling injuries before and after the law was enacted. Additionally, it assessed whether effects of the law were modified by facility levels of staffing and retention.

Methods

Workers’ compensation indemnity claims for years 2005–2016 were matched to annual direct care productive hours and facility characteristics (eg, profit status, hospital affiliation and region) for all Medicaid-certified nursing homes in Minnesota. Trends in patient handling claims were analysed using negative binomial regression with generalised estimating equations. The primary predictors were time period, staff hours per resident day and staff retention.

Results

The patient handling indemnity claim rate declined by 25% in years 4–6 and 38% in years 7–9 following enactment of the law. Claims for all other injuries and illnesses declined by 20% in years 7–9 only. Associations between time period and patient handling claims did not vary by levels of staffing or retention. However, independent of time, facilities with annual retention ≥75% (vs <65%) had a 17% lower patient handling claim rate.

Conclusions

Results suggest the law reduced patient handling claims in nursing homes. However, claim rates were elevated in facilities with low worker retention and those that were non-profit, not hospital-affiliated or in a non-metro area. Facilities with these characteristics may benefit from targeted state grants and consultation efforts.
On causal structure of 4D-Einstein–Gauss–Bonnet black hole
Authors: Dadhich Naresh
Published: September 2020

The recently proposed effective equation of motion for the 4D-Einstein–Gauss–Bonnet gravity admits a static black hole solution that has, like the Rissner–Nordström charged black hole, two horizons instead of one for the Schwarzschild black hole. This means that the central singularity is timelike instead of spacelike. It should though be noted that in$$D\ge 5$$D≥5, the solution always admits only one horizon like the Schwarzshild solution. In the equation defining the horizon, the rescaled Gauss–Bonnet coupling constant appears as a new ‘gravitational charge’ with a repulsive effect to cause in addition to event horizon a Cauchy horizon. Thus it radically alters the causal structure of the black hole.
ARE STOCK MARKETS AND CRYPTOCURRENCIES CONNECTED?
Authors: UMAR MUHAMMAD , HUNG NGO THAI , CHEN SHIHUA , IQBAL AMJAD , JEBRAN KHALIL
Published: September 2020

This study explores the connectedness between cryptocurrencies (Bitcoin, Ethereum, Ripple, Bitcoin cash and Ethereum Operating System) and major stock markets (NYSE composite index, NASDAQ composite index, Shanghai Stock Exchange, Nikkei 225 and Euronext NV). Using the asymmetric dynamic conditional correlation (ADCC) and wavelet coherence approaches, we document a significant time-varying conditional correlation between the majority of the cryptocurrencies and stock market indices and that the negative shocks play a more prominent role than the positive shocks of the same magnitude. Overall, our findings explore potential avenues for diversification for investors across cryptocurrencies and major stock markets.
MEASURING LOW CARBON ENERGY, ECONOMIC AND ENVIRONMENTAL SUSTAINABILITY PERFORMANCE OF BRICS
Authors: LI HAO , BHATTI ZOBIA , ABBAS QAISER , AHMAD ISHTIAQ , IQBAL NADEEM , AZIZ BABAR
Published: September 2020

Formulating a robust low-carbon strategy has now been critical to achieving sustainable economic development amid broad carbon emissions across the BRIC region thanks to rapid industrialization and international trade growth. Developing such a strategy requires measuring actual sustainability performance from the energy, economy and ecological perspectives in this region. Therefore, this study explores the relationship among BRIC countries’ energy, economic and environmental sustainability performance by applying a common weight data envelopment analysis (DEA)-like composite indicator approach. The indicators encompass a comprehensive, latest, appropriate and applicable set of indicators. The results reveal that China and Brazil outperform against other underlined countries of the region in achieving sustainability with an overall index score of 0.96. India stands in ranking on second with a steady and unchanged score in the region, followed by South Africa and Russia, standing in ranking on fourth and fifth, respectively, in this study. Inclusive scores of both countries indicate the actual and robust possible potential for better sustainability performances in the region. This study proposes a policy by lifting the cross-border trade for renewable energy to achieve long-term environmental sustainability in the BRICS region.
Labeled singular knots
Authors: Bataineh Khaled
Published: September 2020

We introduce labeled singular knots and equivalently labeled 4-valent rigid vertex spatial graphs. Labeled singular knots are singular knots with labeled singularities. These knots are considered subject to isotopies preserving the labelings. We provide a topological invariant schema similar to that of Henrich and Kauffman in [A. Henrich and L. H. Kauffman, Tangle insertion invariants for pseudoknots, singular knots, and rigid vertex spatial graphs, Contemp. Math. 689 (2017) 1–10] by inserting rational tangles at the labeled singularities to extend usual knot invariants to our class of singular knots. We show that we can use invariants of labeled singular knots to serve usual singular knots. Labeled framed pseudoknots are also introduced and discussed.
A non-conservation stochastic partial differential equation driven by anisotropic fractional Lévy random field
Authors: Lü Xuebin , Dai Wanyang
Published: September 2020

We study a non-conservation second-order stochastic partial differential equation (SPDE) driven by multi-parameter anisotropic fractional Lévy noise (AFLN) and under different initial and/or boundary conditions. It includes the time-dependent linear heat equation and quasi-linear heat equation under the fractional noise as special cases. Unique existence and expressions of solution to the equation are proved and constructed. An AFLN is defined as the derivative of an anisotropic fractional Lévy random field (AFLRF) in certain sense. Comparing with existing noise systems, our non-Gaussian fractional noises are essentially observed from random disturbances on system accelerations rather than from those on system moving velocities. In the process of proving our claims, there are three folds. First, we consider the AFLRF as the generalized functional of sample paths of a pure jump Lévy process. Second, we build Skorohod integration with respect to the AFLN by white noise approach. Third, by combining this noise analysis method with the conventional PDE solution techniques, we provide solid proofs for our claims.
Thermal Actuation Analysis of Twisted and Coiled Polymer Actuators
Authors: Li Hua , Wu Yannan , Ye Haochen , Xu Yan
Published: September 2020

Twisted and coiled polymer actuators (TCPAs), an emerging class of artificial muscles, exhibit the advantages of large stroke, low hysteresis, low cost, etc. The effect of design parameters on thermal actuation is important for the effective design of TCPAs. In this study, a new model has been developed to describe the effect of geometrical parameters on thermal actuation based on Castigliano’s second theorem. In this model, an equivalent modulus based on its radial bias angle has been introduced from the twisted polymer actuator (TPA)’s equivalent model. The proposed model provides a simple and accurate expression to describe the TCPA’s thermal actuation by using its fundamental characteristic. The proposed model was validated with respect to the experimental data from the literature and subsequently used in the parametric analysis of TCPA. The numerical results show that the amplitude of actuation increases linearly with pitch angle and nonlinearly with spring index.
Impact Response of Sacrificial Cladding Structure with an Alporas Aluminum Foam Core Under Blast Loading
Authors: Elnasri Ibrahim , Zhao Han
Published: September 2020

This paper presents numerical and analytical studies of the response of a sacrificial cladding structure with an Alporas aluminum foam core and a thick mild steel cover and rear plates under blast loading. A suitable numerical model in LS-DYNA based on the coupled Load Blast Enhanced/Multi-Material Arbitrary Lagrangian–Eulerian (LBE/MM-ALE) methods is selected and validated using the experimental data available in the literature. The shock front propagation and micro-inertia effects are responsible for the strength enhancement predicted in the virtual blast test. Two models with different decaying blast loading functions are examined to study the fluid–structure interaction (FSI) effect. The simulation results show that the FSI effect is negligible if the foam core is strain-rate insensitive. Further investigations should be conducted with analytical models if the core material of the sacrificial cladding structures exhibits a strong strain-rate effect (for example, Alporas foam).
The Pricing of Exchange Traded Funds and the Roles of Primary and Secondary Market Participants
Authors: Alexander Gordon J. , Peterson Mark A.
Published: September 2020

We study the pricing of exchange traded funds (ETFs) and the associated arbitrage trading of them in the primary and secondary markets. We find a direct relation between primary and secondary market trading that is consistent with market-makers using the primary market to hedge their inventory risk in the secondary market, as well as to facilitate arbitrage. Such trading in both markets keeps ETF prices in line with their net asset value. We conclude that the existence of the primary market enhances secondary market efficiency.
Trapping and release of helium and deuterium in recrystallized and heavily deformed tungsten after plasma exposure
Authors: Bakaeva A. , Terentyev D. , De Temmerman G. , Cheng L. , Lu G.-H.
Published: September 2020

Interaction of tungsten surface with plasma beam has tremendous importance for development of materials for fusion applications. Trapping and release of Helium (He) and Deuterium (D) in tungsten exposed to high flux plasma with varying He and D content are studied here. Recrystallized and plastically deformed tungsten samples were used to clarify the impact of the material microstructure on trapping and release of plasma components. Thermal desorption spectroscopy measurements were performed to reveal the release stages and quantify the integral desorption of both types of molecules. Comparison of reference and plastically deformed samples was used to clarify the impact of plastic deformation (expressed in the high dislocation density and dislocation networks) on the trapping and release processes. It has been demonstrated that in the mixed beam exposures, the integral He release weakly depends on the He/D ratio, but suddenly grows as the fraction of He/D increases from 80/20 to 100/0. The integral release of D is remarkably enhanced by He seeding in both reference and plastically deformed samples. It is concluded that under the mixed beam exposure conditions, the D release is primary controlled by the He seeding and not by the deformation-induced microstructure.
Targeting FFA1 and FFA4 receptors in cancer-induced cachexia
Authors: Freitas Raquel D. S. , Muradás Thaís C. , Dagnino Ana Paula A. , Rost Fernanda L. , Costa Kesiane M. , Venturin Gianina T. , Greggio Samuel , da Costa Jaderson C. , Campos Maria M.
Published: September 2020

Free fatty acid (FFA) receptors FFA1 and FFA4 are omega-3 molecular targets in metabolic diseases; however, their function in cancer cachexia remains unraveled. We assessed the role of FFA1 and FFA4 receptors in the mouse model of cachexia induced by Lewis lung carcinoma (LLC) cell implantation. Naturally occurring ligands such as α-linolenic acid (ALA) and docosahexaenoic acid (DHA), the synthetic FFA1/FFA4 agonists GW9508 and TUG891, or the selective FFA1 GW1100 or FFA4 AH7614 antagonists were tested. FFA1 and FFA4 expression and other cachexia-related parameters were evaluated. GW9508 and TUG891 decreased tumor weight in LLC-bearing mice. Regarding cachexia-related end points, ALA, DHA, and the preferential FFA1 agonist GW9508 rescued body weight loss. Skeletal muscle mass was reestablished by ALA treatment, but this was not reflected in the fiber cross-sectional areas (CSA) measurement. Otherwise, TUG891, GW1100, or AH7614 reduced the muscle fiber CSA. Treatments with ALA, GW9508, GW1100, or AH7614 restored white adipose tissue (WAT) depletion. As for inflammatory outcomes, ALA improved anemia, whereas GW9508 reduced splenomegaly. Concerning behavioral impairments, ALA and GW9508 rescued locomotor activity, whereas ALA improved motor coordination. Additionally, DHA improved grip strength. Notably, GW9508 restored abnormal brain glucose metabolism in different brain regions. The GW9508 treatment increased leptin levels, without altering uncoupling protein-1 downregulation in visceral fat. LLC-cachectic mice displayed FFA1 upregulation in subcutaneous fat, but not in visceral fat or gastrocnemius muscle, whereas FFA4 was unaltered. Overall, the present study shed new light on FFA1 and FFA4 receptors’ role in metabolic disorders, indicating FFA1 receptor agonism as a promising strategy in mitigating cancer cachexia.
A role for tubular Na+/H+exchanger NHE3 in the natriuretic effect of the SGLT2 inhibitor empagliflozin
Authors: Onishi Akira , Fu Yiling , Patel Rohit , Darshi Manjula , Crespo-Masip Maria , Huang Winnie , Song Panai , Freeman Brent , Kim Young Chul , Soleimani Manoocher , Sharma Kumar , Thomson Scott Culver , Vallon Volker
Published: September 2020

Inhibitors of proximal tubular Na+-glucose cotransporter 2 (SGLT2) are natriuretic, and they lower blood pressure. There are reports that the activities of SGLT2 and Na+-H+exchanger 3 (NHE3) are coordinated. If so, then part of the natriuretic response to an SGLT2 inhibitor is mediated by suppressing NHE3. To examine this further, we compared the effects of an SGLT2 inhibitor, empagliflozin, on urine composition and systolic blood pressure (SBP) in nondiabetic mice with tubule-specific NHE3 knockdown (NHE3-ko) and wild-type (WT) littermates. A single dose of empagliflozin, titrated to cause minimal glucosuria, increased urinary excretion of Na+and bicarbonate and raised urine pH in WT mice but not in NHE3-ko mice. Chronic empagliflozin treatment tended to lower SBP despite higher renal renin mRNA expression and lowered the ratio of SBP to renin mRNA, indicating volume loss. This effect of empagliflozin depended on tubular NHE3. In diabetic Akita mice, chronic empagliflozin enhanced phosphorylation of NHE3 (S552/S605), changes previously linked to lesser NHE3-mediated reabsorption. Chronic empagliflozin also increased expression of genes involved with renal gluconeogenesis, bicarbonate regeneration, and ammonium formation. While this could reflect compensatory responses to acidification of proximal tubular cells resulting from reduced NHE3 activity, these effects were at least in part independent of tubular NHE3 and potentially indicated metabolic adaptations to urinary glucose loss. Moreover, empagliflozin increased luminal α-ketoglutarate, which may serve to stimulate compensatory distal NaCl reabsorption, while cogenerated and excreted ammonium balances urine losses of this “potential bicarbonate.” The data implicate NHE3 as a determinant of the natriuretic effect of empagliflozin.