bluuebunny/crossref_metadata_2025 huggingface dataset:
Deconstruction and Epistemic Violence
Authors: De Schryver Carmen
Published: February 2021

While theorists of epistemic injustice often refer to Gayatri Spivak’s “Can the Subaltern Speak” as an early articulation of the field’s concerns, they have stopped short of engaging deeply with Spivak’s deconstructive take on epistemic violence and her suggestion that this consists in an attribution of subjectivity to historically marginalized speakers. In redressing this oversight, this article makes a case for adopting a broader conception of epistemic harm and exclusion than has been acknowledged in the literature: I argue that the presumption that speakers are subjects can precipitate silencing. For in determining the other who speaks as a subject, one forecloses hospitality to an alterity not already understood according to the subject/object distinction central to Western metaphysics. This deconstructive intervention thus challenges one of the field’s key assumptions, namely, that epistemic harm consists in a failure to treat speakers as subjects, and consequently that generating a more inclusive dialogical climate depends on restoring marginalized individuals to subject status. Folding Spivak’s deconstructive insight into the remedial project of epistemic justice is therefore far from straightforward; nonetheless, I argue that it is consistent with the literature’s demand for a heightened sensitivity vis‐à‐vis the ways marginalized others are routinely harmed in epistemic practices.
Rates and causative pathogens of surgical site infections attributed to liver transplant procedures and other hepatic, biliary, or pancreatic procedures, 2015‐2018
Authors: Chea Nora , Sapiano Mathew R. P. , Zhou Liang , Epstein Lauren , Guh Alice , Edwards Jonathan R. , Allen‐Bridson Katherine , Russo Victoria , Watkins Jennifer , Pouch Stephanie M. , Magill Shelley S.
Published: February 2021

Liver transplant recipients are at high risk for surgical site infections (SSIs). Limited data are available on SSI epidemiology following liver transplant procedures (LTPs). We analyzed data on SSIs from 2015 to 2018 reported to CDC's National Healthcare Safety Network to determine rates, pathogen distribution, and antimicrobial resistance after LTPs and other hepatic, biliary, or pancreatic procedures (BILIs). LTP and BILI SSI rates were 5.7% and 5.9%, respectively. The odds of SSI after LTP were lower than after BILI (adjusted odds ratio = 0.70, 95% confidence interval 0.57‐0.85). Among LTP SSIs, 43.1% were caused by Enterococcus spp., 17.2% by Candida spp., and 15.0% by coagulase‐negative Staphylococcus spp. (CNS). Percentages of SSIs caused by Enterococcus faecium or CNS were higher after LTPs than BILIs, whereas percentages of SSIs caused by Enterobacteriaceae, Enterococcus faecalis, or viridans streptococci were higher after BILIs. Antimicrobial resistance was common in LTP SSI pathogens, including E. faecium (69.4% vancomycin resistant); Escherichia coli (68.8% fluoroquinolone non‐susceptible and 44.7% extended spectrum cephalosporin [ESC] non‐susceptible); and Klebsiella pneumoniae and K. oxytoca (39.4% fluoroquinolone non‐susceptible and 54.5% ESC non‐susceptible). National LTP SSI pathogen and resistance data can help prioritize studies to determine effective interventions to prevent SSIs and reduce antimicrobial resistance in liver transplant recipients.
Scalable Fully Bayesian Gaussian Process Modeling and Calibration With Adaptive Sequential Monte Carlo for Industrial Applications
Authors: Pandita Piyush , Tsilifis Panagiotis , Ghosh Sayan , Wang Liping
Published: February 2021

Gaussian process (GP) regression or kriging has been extensively applied in the engineering literature for the purposes of building a cheap-to-evaluate surrogate, within the contexts of multi-fidelity modeling, model calibration, and design optimization. With the ongoing automation of manufacturing and industrial practices as a part of Industry 4.0, there has been a greater need for advancing GP regression techniques to handle challenges such as high input dimensionality, data paucity or big data problems, these consist primarily of proposing efficient design of experiments, optimal data acquisition strategies, sparsifying covariance kernels, and other mathematical tricks. In this work, our attention is focused on the challenges of efficiently training a GP model, which, to the authors opinion, has attracted very little attention and is to-date poorly addressed. The performance of widely used training approaches such as maximum likelihood estimation and Markov Chain Monte Carlo (MCMC) sampling can deteriorate significantly in high-dimensional and big data problems and can lead to cost deficient implementations of critical importance to many industrial applications. Here, we compare an Adaptive Sequential Monte Carlo (ASMC) sampling algorithm to classic MCMC sampling strategies and we demonstrate the effectiveness of our implementation on several mathematical problems and challenging industry applications of varying complexity. The computational time savings of the ASMC approach manifest in large-scale problems helping us to push the boundaries of applicability and scalability of GPs for model calibration in various domains of the industry, including but not limited to design automation, design engineering, smart manufacturing, predictive maintenance, and supply chain manufacturing.
A Numerical Study on the Evolution of Random Seas With the Occurrence of Rogue Waves
Authors: Zhou Zhuowei , Zhang Ningchuan , Huang Guoxing
Published: February 2021

Numerous numerical and experimental investigations show that rogue waves present much larger probabilities of occurrence than predicted by the linear random wave model, i.e., Gaussian distributed waves. The deviation from normal statistical events excites a continuous concern about rogue wave research. In this study, rogue waves under long-crested and narrow-banded wave trains are checked using the high-order spectral (HOS)-NST model. The JONSWAP wave spectra with random phases are selected as the initial state of the incoming wave trains. Different values of spectral parameters are chosen to reproduce different random sea states with different Benjamin–Feir index (BFI). Numerical results are compared with the classical experimental study and show good agreements. Statistical properties of rogue waves are recounted again within the analysis of exceedance distribution function (EDF) of wave heights and wave crests. Spectral changes are examined, and the monotonic increases with BFI are stressed. However, no bifurcations are observed for BFI near 1. For large BFI, quasi-resonance interactions dominate the wave nonlinearities, and the resulted dynamic excess kurtosis involves initially monotonic enhancement along with space, peaking at around 20–30 wavelengths, but stays at stably high-level values. The quasi-steady-state of dynamic excess kurtosis after full interaction of wave nonlinearities in time and space demonstrates a continuous emergence of rogue waves much more frequent than normality. The changes of excess kurtosis along x are complicated where BFI near 1 and the occurrence of rogue waves might be enhanced even for BFI slightly inferior to 1.
Using viral load and epidemic dynamics to optimize pooled testing in resource-constrained settings
Authors: Cleary Brian , Hay James A. , Blumenstiel Brendan , Harden Maegan , Cipicchio Michelle , Bezney Jon , Simonton Brooke , Hong David , Senghore Madikay , Sesay Abdul K. , Gabriel Stacey , Regev Aviv , Mina Michael J.
Published: February 2021

Simple group testing designs to improve SARS-CoV-2 surveillance in resource-constrained settings are identified using modeling and experimental data.
A Type VI Secretion System Facilitates Fitness, Homeostasis, and Competitive Advantages for Environmental Adaptability and Efficient Nicotine Biodegradation
Authors: Li Jun , Xie Linlin , Qian Shulan , Tang Yuhang , Shen Mingjie , Li Shanshan , Wang Jie , Xiong Lie , Lu Jie , Zhong Weihong
Published: February 2021

Mixtures of various pollutants and the coexistence of numerous species of organisms are usually found in adverse environments. Concerning biodegradation of nitrogen-heterocyclic contaminants, the scientific community has commonly focused on screening functional enzymes that transform pollutants into intermediates of attenuated toxicity or for primary metabolism. Here, we identified dual roles of the T6SS effector TseN in
Pseudomonas
sp. strain JY-Q, which is capable of degrading nicotine.
Detection of Tick-Borne Bacteria from Whole Blood Using 16S Ribosomal RNA Gene PCR Followed by Next-Generation Sequencing
Authors: Rodino Kyle G. , Wolf Matthew J. , Sheldon Sarah , Kingry Luke C. , Petersen Jeannine M. , Patel Robin , Pritt Bobbi S.
Published: February 2021

Reported cases of tick-borne diseases have steadily increased for more than a decade. In the United States, a majority of tick-borne infections are caused by bacteria.
Discovery of a Novel Specific Inhibitor Targeting Influenza A Virus Nucleoprotein with Pleiotropic Inhibitory Effects on Various Steps of the Viral Life Cycle
Authors: Yang Fang , Pang Bo , Lai Kin Kui , Cheung Nam Nam , Dai Jun , Zhang Weizhe , Zhang Jinxia , Chan Kwok-Hung , Chen Honglin , Sze Kong-Hung , Zhang Hongmin , Hao Quan , Yang Dan , Yuen Kwok-Yung , Kao Richard Y.
Published: February 2021

Current influenza antivirals have limitations with regard to their effectiveness and the potential emergence of resistance. Therefore, there is an urgent need for broad-spectrum inhibitors to address the considerable challenges posed by the rapid evolution of influenza viruses that limit the effectiveness of vaccines and lead to the emergence of antiviral drug resistance.
Preconceptual Priming Overrides Susceptibility to Escherichia coli Systemic Infection during Pregnancy
Authors: Prasanphanich Nina Salinger , Gregory Emily J. , Erickson John J. , Miller-Handley Hilary , Kinder Jeremy M. , Way Sing Sing
Published: February 2021

Pregnancy makes women especially vulnerable to infection. The most common cause of bloodstream infection during pregnancy is by a bacterium calledEscherichia coli.
Discovery of Bacterial Fimbria–Glycan Interactions Using Whole-Cell Recombinant Escherichia coli Expression
Authors: Day Christopher J. , Lo Alvin W. , Hartley-Tassell Lauren E. , Argente M. Pilar , Poole Jessica , King Nathan P. , Tiralongo Joe , Jennings Michael P. , Schembri Mark A.
Published: February 2021

Understanding the tropism of pathogens for host and tissue requires a complete understanding of the host receptors targeted by fimbrial adhesins. Furthermore, blocking adhesion is a promising strategy to counter increasing antibiotic resistance and is enabled by the identification of host receptors.
Homeostatic response of Aptian gymnosperms to changes in atmospheric CO2 concentrations
Authors: Mora Germán , Carmo Ana M. , Elliott William
Published: February 2021

The sensitivity of plant carbon isotope fractionation (13Δleaf) to changes in atmospheric CO2 concentrations (Ca) is the subject of heavy debate, with some studies finding no sensitivity, while others show a strong dependency. We tested the hypothesis of photosynthetic homeostasis by using δ13C of n-alkanes, cuticles, and bulk organic matter of gymnosperm-rich rocks (Arundel Clay) from two sites deposited during the Aptian, a time that experienced signifi-cant Ca variations. Our results show no effect of Ca on 13Δleaf, and a relatively constant Ci/Ca (0.64 ± 0.04, 1σ; i—intercellular space), a value that is similar to that of modern gymnosperms. These results suggest that Aptian gymnosperms used homeostatic adjustments with rising Ca, probably involving increased carbon assimilation and/or stomatal closure, a response also found in modern gymnosperms. The similarity between Aptian and modern gymnosperms suggests that the processes responsible for regulating CO2 and water vapor exchange during photosynthesis have remained unaltered in gymnosperms for the past 128 m.y.
Subduction erosion and crustal material recycling indicated by adakites in central Tibet
Authors: Yang Zong-Yong , Wang Qiang , Hao Lu-Lu , Wyman Derek A. , Ma Lin , Wang Jun , Qi Yue , Sun Peng , Hu Wan-Long
Published: February 2021

Subduction erosion is important for crustal material recycling and is widespread in modern active convergent margins. However, such a process is rarely identified in fossil convergent systems, which casts doubt on the importance of subduction erosion through the geological record. We report on ca. 155 Ma Kangqiong (pluton) intrusive rocks of a Mesozoic magmatic arc in the southern Qiangtang terrane, central Tibet. These rocks mainly consist of trondhjemites and tonalites and are similar to slab-derived adakites with mantle-like zircon oxygen isotope compositions (δ18O = 5.2‰–5.6‰), they display more evolved Sr-Nd isotopes and higher Th/ La relative to mid-oceanic ridge basalts from the Bangong-Nujiang suture, and they contain abundant amphibole and biotite. These characteristics indicate magma generation via H2O- fluxed melting of eroded forearc crust debris with subducted oceanic crust at 1.5–2.5 GPa and 700–800 °C. In addition, the intrusions are exposed <20 km north of the Bangong-Nujiang suture. Given the formation of adakites, narrow arc-suture distance, migration of the Jurassic frontal arc toward the continent interior, and other independent geological archives, we suggest that the hydrated forearc crust materials were removed from the overlying plate and carried into the mantle by subduction erosion. Our study provides the first direct magmatic evidence for a subduction erosion process in pre-Cenozoic convergent systems, which confirms an important role for such processes in subduction-zone material recycling.
Endoscopic removal of ectopic dentition in ethmoid sinus
Authors: Wong Amy SM , Virk Jagdeep S , Magarey Matthew J R
Published: February 2021

A 66-year-old woman presented with a 6-month history of unilateral right nasal obstruction and rhinorrhoea not responding to medical therapy. She had a history of dental implantation for an unerupted tooth on the right side 3 years ago. Physical examination including flexible nasendoscopy demonstrated yellow debris in the right middle meatus. CT paranasal sinuses demonstrated a radiopaque lesion in the right anterior ethmoid sinus and resembled the unerupted tooth. The tooth was removed endoscopically from the right nasal cavity without complications. This case highlights the importance of eliciting an accurate dental history and considering ectopic dentition as a differential diagnosis in a patient with unilateral symptoms of sinusitis.
Bilateral temporomandibular joint dislocations post-bronchoscopy in a case of paclitaxel-induced pneumonitis
Authors: Li Anna , Mohammadi Fadak , Crocker Helen
Published: February 2021

This case report presents the unusual complication of bilateral temporomandibular joint dislocation following bronchoscopy, highlighting the importance of recognising it as a differential diagnosis in patients having jaw symptoms. The delayed diagnosis in this case resulted in multiple unsuccessful reduction attempts under sedation, which added to the distress of the patient. Notably, the procedure yielded a rare diagnosis for the patient that intrinsically changed the management of her breast cancer.
Vaccines for older adults
Authors: Cunningham Anthony L , McIntyre Peter , Subbarao Kanta , Booy Robert , Levin Myron J
Published: February 2021

The proportion of the global population aged 65 and older is rapidly increasing. Infections in this age group, most recently with SARS-CoV-2, cause substantial morbidity and mortality. Major improvements have been made in vaccines for older people, either through the addition of novel adjuvants—as in the new recombinant zoster vaccine and an adjuvanted influenza vaccine—or by increasing antigen concentration, as in influenza vaccines. In this article we review improvements in immunization for the three most important vaccine preventable diseases of aging. The recombinant zoster vaccine has an efficacy of 90% that is minimally affected by the age of the person being vaccinated and persists for more than four years. Increasing antigen dose or inclusion of adjuvant has improved the immunogenicity of influenza vaccines in older adults, although the relative effectiveness of the enhanced influenza vaccines and the durability of the immune response are the focus of ongoing clinical trials. Conjugate and polysaccharide pneumococcal vaccines have similar efficacy against invasive pneumococcal disease and pneumococcal pneumonia caused by vaccine serotypes in older adults. Their relative value varies by setting, depending on the prevalence of vaccine serotypes, largely related to conjugate vaccine coverage in children. Improved efficacy will increase public confidence and uptake of these vaccines. Co-administration of these vaccines is feasible and important for maximal uptake in older people. Development of new vaccine platforms has accelerated following the arrival of SARS-CoV-2, and will likely result in new vaccines against other pathogens in the future.
Disparities in pregnancy-related deaths: spatial and Bayesian network analyses of maternal mortality ratio in 54 African countries
Authors: Yaya Sanni , Anjorin Seun Stephen , Adedini Sunday A
Published: February 2021

Background

Maternal mortality remains a public health problem despite several global efforts. Globally, about 830 women die of pregnancy-related death per day, with more than two-third of these cases occurring in Africa. We examined the spatial distribution of maternal mortality in Africa and explored the influence of SDoH on the spatial distribution.

Methods

We used country-level secondary data of 54 African countries collected between 2006 and 2018 from three databases namely, World Development Indicator, WHO’s Global Health Observatory Data and Human Development Report. We performed descriptive analyses, presented in tables and maps. The spatial analysis involved local indicator of spatial autocorrelation maps and spatial regression. Finally, we built Bayesian networks to determine and show the strength of social determinants associated with maternal mortality.

Results

We found that the average prevalence of maternal mortality ratio (MMR) in Africa was 415 per 100 000 live births. Findings from the spatial analyses showed clusters (hotspots) of MMR with seven countries (Guinea-Bissau, Guinea, Sierra Leone, Cote d’Ivoire, Chad and Cameroon, Mauritania), all within the Middle and West Africa. On the other hand, the cold spot clusters were formed by two countries; South Africa and Namibia; eight countries (Algeria, Tunisia, Libya, Ghana, Gabon and Congo, Equatorial Guinea and Cape Verde) formed low–high clusters; thus, indicating that these countries have significantly low MMR but within the neighbourhood of countries with significantly high MMR. The findings from the regression and Bayesian network analysis showed that gender inequities and the proportion of skilled birth attendant are strongest social determinants that drive the variations in maternal mortality across Africa.

Conclusion

Maternal mortality is very high in Africa especially in countries in the middle and western African subregions. To achieve the target 3.1 of the sustainable development goal on maternal health, there is a need to design effective strategies that will address gender inequalities and the shortage of health professionals.
WASH Upgrades for Health in Amhara (WUHA): study protocol for a cluster-randomised trial in Ethiopia
Authors: Wittberg Dionna M , Aragie Solomon , Tadesse Wondyifraw , Melo Jason S , Aiemjoy Kristen , Chanyalew Melsew , Emerson Paul M , Freeman Matthew C , Nash Scott D , Callahan E Kelly , Tadesse Zerihun , Zerihun Mulat , Porco Travis C , Lietman Thomas M , Keenan Jeremy D
Published: February 2021

Introduction

Facial hygiene promotion and environmental improvements are central components of the global trachoma elimination strategy despite a lack of experimental evidence supporting the effectiveness of water, sanitation and hygiene (WASH) measures for reducing trachoma transmission. The objective of the WUHA (WASH Upgrades for Health in Amhara) trial is to evaluate if a comprehensive water improvement and hygiene education programme reduces the prevalence of ocular chlamydia infection in rural Africa.

Methods and analysis

Forty study clusters, each of which had received at least annual mass azithromycin distributions for the 7 years prior to the start of the study, are randomised in a 1:1 ratio to the WASH intervention arm or a delayed WASH arm. The WASH package includes a community water point, community-based hygiene promotion workers, household wash stations, household WASH education books, household soap distribution and a primary school hygiene curriculum. Educational activities emphasise face-washing and latrine use. Mass antibiotic distributions are not provided during the first 3 years but are provided annually over the final 4 years of the trial. Annual monitoring visits are conducted in each community. The primary outcome is PCR evidence of ocular chlamydia infection among children aged 0–5 years, measured in a separate random sample of children annually over 7 years. A secondary outcome is improvement of the clinical signs of trachoma between the baseline and final study visits as assessed by conjunctival photography. Laboratory workers and photo-graders are masked to treatment allocation.

Ethics and dissemination

Study protocols have been approved by human subjects review boards at the University of California, San Francisco, Emory University, the Ethiopian Food and Drug Authority, and the Ethiopian Ministry of Innovation and Technology. A data safety and monitoring committee oversees the trial. Results will be disseminated through peer-reviewed publications and presentations.

Trial registration number

(http://www.clinicaltrials.gov):NCT02754583; Pre-results.
Health impact of monoclonal gammopathy of undetermined significance (MGUS) and monoclonal B-cell lymphocytosis (MBL): findings from a UK population-based cohort
Authors: Lamb Maxine JE , Smith Alexandra , Painter Daniel , Kane Eleanor , Bagguley Timothy , Newton Robert , Howell Debra , Cook Gordon , de Tute Ruth , Rawstron Andrew , Patmore Russell , Roman Eve
Published: February 2021

Objective

To examine mortality and morbidity patterns before and after premalignancy diagnosis in individuals with monoclonal gammopathy of undetermined significance (MGUS) and monoclonal B-cell lymphocytosis (MBL) and compare their secondary healthcare activity to that of the general population.

Design

Population-based patient cohort, within which each patient is matched at diagnosis to 10 age-matched and sex-matched individuals from the general population. Both cohorts are linked to nationwide information on deaths, cancer registrations and Hospital Episode Statistics.

Setting

The UK’s Haematological Malignancy Research Network, which has a catchment population of around 4 million served by 14 hospitals and a central diagnostic laboratory.

Participants

All patients newly diagnosed during 2009–2015 with MGUS (n=2193) or MBL (n=561) and their age and sex-matched comparators (n=27 538).

Main outcome measures

Mortality and hospital inpatient and outpatient activity in the 5 years before and 3 years after diagnosis.

Results

Individuals with MGUS experienced excess morbidity in the 5 years before diagnosis and excess mortality and morbidity in the 3 years after diagnosis. Increased rate ratios (RRs) were evident for nearly all clinical specialties, the largest, both before and after diagnosis, being for nephrology (before RR=4.29, 95% CI 3.90 to 4.71; after RR=13.8, 95% CI 12.8 to 15.0) and rheumatology (before RR=3.40, 95% CI 3.18 to 3.63; after RR=5.44, 95% CI 5.08 to 5.83). Strong effects were also evident for endocrinology, neurology, dermatology and respiratory medicine. Conversely, only marginal increases in mortality and morbidity were evident for MBL.

Conclusions

MGUS and MBL are generally considered to be relatively benign, since most individuals with monoclonal immunoglobulins never develop a B-cell malignancy or any other monoclonal protein-related organ/tissue-related disorder. Nonetheless, our findings offer strong support for the view that in some individuals, monoclonal gammopathy has the potential to cause systemic disease resulting in wide-ranging organ/tissue damage and excess mortality.
Microscopic changes in the spinal extensor musculature in patients experiencing chronic spinal pain: protocol for a systematic review
Authors: Purushotham Shilpa , Stephenson Robert Stanley , Sanderson Andy , Falla Deborah
Published: February 2021

Introduction

Chronic spinal pain (CSP) is the most common musculoskeletal disorder and is a leading cause of disability as per the Global Burden of Diseases. Previous reviews of microscopic changes in the spinal extensor muscles of people with CSP have focused on the lumbar region only and the results have been inconclusive. Therefore, in this protocol, we aim to assess microscopic changes in the extensor muscles of all spinal regions, investigating regionally specific changes in muscle fibre types of the spinal extensor muscles in patients with non-specific CSP.

Methods/analysis

This protocol was designed using Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines. Searches will use the following databases: MEDLINE, Embase, PubMed, CINAHL Plus and Web of Science along with relevant grey literature searches. Two reviewers will conduct the searches, perform data extraction, apply inclusion criteria and conduct risk of bias assessment using Newcastle-Ottawa Scale. Data will be synthesised and analysed independently. If there is sufficient homogeneity, then meta-analysis will be conducted by the reviewers jointly. If not, meta-synthesis or narrative reporting will be performed. The quality of the evidence will be assessed using Grading of Recommendations, Assessment, Development and Evaluation (GRADE) guidelines.

Ethics and dissemination

The results of this study will be submitted for publication to a peer-reviewed journal and will be presented at conferences. Ethical approval for this systematic review was not required due to no patient data being collated.

PROSPERO registration number

CRD42020198087.
Use of the first National Early Warning Score recorded within 24 hours of admission to estimate the risk of in-hospital mortality in unplanned COVID-19 patients: a retrospective cohort study
Authors: Richardson Donald , Faisal Muhammad , Fiori Massimo , Beatson Kevin , Mohammed Mohammed
Published: February 2021

Objectives

Although the National Early Warning Score (NEWS) and its latest version NEWS2 are recommended for monitoring deterioration in patients admitted to hospital, little is known about their performance in COVID-19 patients. We aimed to compare the performance of the NEWS and NEWS2 in patients with COVID-19 versus those without during the first phase of the pandemic.

Design

A retrospective cross-sectional study.

Setting

Two acute hospitals (Scarborough and York) are combined into a single dataset and analysed collectively.

Participants

Adult (≥18 years) non-elective admissions discharged between 11 March 2020 and 13 June 2020 with an index or on-admission NEWS2 electronically recorded within ±24 hours of admission to predict mortality at four time points (in-hospital, 24 hours, 48 hours and 72 hours) in COVID-19 versus non-COVID-19 admissions.

Results

Out of 6480 non-elective admissions, 620 (9.6%) had a diagnosis of COVID-19. They were older (73.3 vs 67.7 years), more often male (54.7% vs 50.1%), had higher index NEWS (4 vs 2.5) and NEWS2 (4.6 vs 2.8) scores and higher in-hospital mortality (32.1% vs 5.8%). The c-statistics for predicting in-hospital mortality in COVID-19 admissions was significantly lower using NEWS (0.64 vs 0.74) or NEWS2 (0.64 vs 0.74), however, these differences reduced at 72hours (NEWS: 0.75 vs 0.81; NEWS2: 0.71 vs 0.81), 48 hours (NEWS: 0.78 vs 0.81; NEWS2: 0.76 vs 0.82) and 24hours (NEWS: 0.84 vs 0.84; NEWS2: 0.86 vs 0.84). Increasing NEWS2 values reflected increased mortality, but for any given value the absolute risk was on average 24% higher (eg, NEWS2=5: 36% vs 9%).

Conclusions

The index or on-admission NEWS and NEWS2 offers lower discrimination for COVID-19 admissions versus non-COVID-19 admissions. The index NEWS2 was not proven to be better than the index NEWS. For each value of the index NEWS/NEWS2, COVID-19 admissions had a substantially higher risk of mortality than non-COVID-19 admissions which reflects the increased baseline mortality risk of COVID-19.
Multidimensional dynamic healthcare personnel (HCP)-centric model from a low-income and middle-income country to support and protect COVID-19 warriors: a large prospective cohort study
Authors: Dutta Usha , Sachan Anurag , Premkumar Madhumita , Gupta Tulika , Sahoo Swapnajeet , Grover Sandeep , Sharma Sugandhi , Lakshmi P V M , Talati Shweta , Biswal Manisha , Suri Vikas , Singh Mini P , Ghai Babita , Chhabra Rajesh , Bharti Bhavneet , Samanta Jayanta , Arora Pankaj , Mohindra Ritin , Malhotra Sunita , Singh Gurmeet , Guru Rashmi Ranjan , Pandey Navin , Koushal Vipin , Kumar Ashok , Bhogal Ranjitpal Singh , Aggarwal Arun K , Goel Kapil , Malhotra Pankaj , Yaddanapudi Narayana , Mahajan Pranay , Thakur J S , Sehgal Rakesh , Ghosh Arnab , Sehgal Inderpaul Singh , Agarwal Ritesh , Jayashree Muralidharan , Bhalla Ashish , Jain Sanjay , Kochhar Rakesh , Chakrabarti Arunaloke , Puri Goverdhan Dutt , Ram Jagat
Published: February 2021

Objectives

Healthcare personnel (HCP) are at an increased risk of acquiring COVID-19 infection especially in resource-restricted healthcare settings, and return to homes unfit for self-isolation, making them apprehensive about COVID-19 duty and transmission risk to their families. We aimed at implementing a novel multidimensional HCP-centric evidence-based, dynamic policy with the objectives to reduce risk of HCP infection, ensure welfare and safety of the HCP and to improve willingness to accept and return to duty.

Setting

Our tertiary care university hospital, with 12 600 HCP, was divided into high-risk, medium-risk and low-risk zones. In the high-risk and medium-risk zones, we organised training, logistic support, postduty HCP welfare and collected feedback, and sent them home after they tested negative for COVID-19. We supervised use of appropriate personal protective equipment (PPE) and kept communication paperless.

Participants

We recruited willing low-risk HCP, aged <50 years, with no comorbidities to work in COVID-19 zones. Social distancing, hand hygiene and universal masking were advocated in the low-risk zone.

Results

Between 31 March and 20 July 2020, we clinically screened 5553 outpatients, of whom 3012 (54.2%) were COVID-19 suspects managed in the medium-risk zone. Among them, 346 (11.4%) tested COVID-19 positive (57.2% male) and were managed in the high-risk zone with 19 (5.4%) deaths. One (0.08%) of the 1224 HCP in high-risk zone, 6 (0.62%) of 960 HCP in medium-risk zone and 23 (0.18%) of the 12 600 HCP in the low-risk zone tested positive at the end of shift. All the 30 COVID-19-positive HCP have since recovered. This HCP-centric policy resulted in low transmission rates (<1%), ensured satisfaction with training (92%), PPE (90.8%), medical and psychosocial support (79%) and improved acceptance of COVID-19 duty with 54.7% volunteering for re-deployment.

Conclusion

A multidimensional HCP-centric policy was effective in ensuring safety, satisfaction and welfare of HCP in a resource-poor setting and resulted in a willing workforce to fight the pandemic.
Demographics, practice patterns and long-term outcomes of patients with non–ST-segment elevation acute coronary syndrome in the past two decades: the CREDO-Kyoto Cohort-2 and Cohort-3
Authors: Takeji Yasuaki , Shiomi Hiroki , Morimoto Takeshi , Yoshikawa Yusuke , Taniguchi Ryoji , Mutsumura-Nakano Yukiko , Yamamoto Ko , Yamaji Kyohei , Tazaki Junichi , Suwa Satoru , Inoko Moriaki , Takeda Teruki , Shirotani Manabu , Ehara Natsuhiko , Ishii Katsuhisa , Inada Tsukasa , Onodera Tomoya , Shinoda Eiji , Yamamoto Takashi , Tamura Takashi , Nakatsuma Kenji , Sakamoto Hiroki , Ando Kenji , Soga Yoshiharu , Furukawa Yutaka , Sato Yukihito , Nakagawa Yoshihisa , Kadota Kazushige , Komiya Tatsuhiko , Minatoya Kenji , Kimura Takeshi
Published: February 2021

Objectives

To evaluate patient characteristics and long-term outcomes in patients with non–ST-segment elevation acute coronary syndrome (NSTEACS) in the past two decades.

Design

Multicenter retrospective study.

Setting

The Coronary REvascularization Demonstrating Outcome Study in Kyoto (CREDO-Kyoto) percutaneous coronary intervention (PCI)/coronary artery bypass grafting (CABG) Registry Cohort-2 (2005–2007) and Cohort-3 (2011–2013).

Participants

3254 patients with NSTEACS who underwent first coronary revascularisation.

Primary and secondary outcome measures

The primary outcome was all-cause death. The secondary outcomes were cardiovascular death, cardiac death, sudden cardiac death, non-cardiovascular death, non-cardiac death, myocardial infarction, definite stent thrombosis, stroke, hospitalisation for heart failure, major bleeding, any coronary revascularisation and target vessel revascularisation.

Results

Patients in Cohort-3 were older and more often had heart failure at admission than those in Cohort-2. The prevalence of PCI, emergency procedure and guideline-directed medical therapy was higher in Cohort-3 than in Cohort-2. In patients who received PCI, the prevalence of transradial approach, drug-eluting stent use and intravascular ultrasound use was higher in Cohort-3 than in Cohort-2. There was no change in 3-year adjusted mortality risk from Cohort-2 to Cohort-3 (HR 1.00, 95% CI 0.83 to 1.22, p=0.97). Patients in Cohort-3 compared with those in Cohort-2 were associated with lower adjusted risks for stroke (HR 0.65, 95% CI 0.46 to 0.92, p=0.02) and any coronary revascularisation (HR 0.76, 95%CI 0.66 to 0.87, p<0.001), but with higher risk for major bleeding (HR 1.25, 95% CI 1.06 to 1.47, p=0.008). The unadjusted risk for definite stent thrombosis was lower in Cohort-3 than in Cohort 2 (HR 0.29, 95% CI 0.11 to 0.67, p=0.003).

Conclusions

In the past two decades, we did not find improvement for mortality in patients with NSTEACS. We observed a reduction in the risks for definite stent thrombosis, stroke and any coronary revascularisation, but an increase in the risk for major bleeding.
Impairment in activities of daily living and readmission in older patients with heart failure: a cohort study
Authors: Nguyen Tan Van , Dang Huyen Thanh , Burns Mason Jenner , Dao Hiep HH , Nguyen Tu Ngoc
Published: February 2021

Objectives

This study aims to investigate the prevalence of impairment of activities of daily living (ADLs) in older patients with heart failure (HF), and to examine the impact of ADL impairment on readmission after discharge.

Design and settings

A prospective cohort study was conducted in patients aged ≥65 years with HF admitted to a tertiary hospital in Vietnam from August 2016 to June 2017. Difficulties with six ADLs were assessed by a questionnaire. Participants were classified into two categories (with and without ADL impairment). The associations of ADL impairment with 3-month readmission were examined using logistic regression models.

Results

There were 180 participants (mean age 80.6±8.2, 50% female) and 26.1% were classified as having ADL impairment. The most common impaired activity was bathing (21.1%), followed by transferring (20.0%), toileting (12.2%), dressing (8.9%), eating (3.3%), and continence (2.8%). During 3-month follow-up, 32.8% of the participants were readmitted to hospitals (55.3% in participants with ADL impairment, 24.8% in those without ADL impairment, p<0.001). ADL impairment significantly increased the risk of 3-month readmission (adjusted OR 2.75, 95% CI 1.25 to 6.05, p=0.01).

Conclusions

In summary, ADL impairment was common in older hospitalised patients with HF and was associated with increased readmission. These findings suggest further studies on ADL assessment and intervention during transition care for older patients with HF after discharge to prevent readmission.
Palliative and end-of-life care in care homes: protocol for codesigning and implementing an appropriate scalable model of Needs Rounds in the UK
Authors: Macgregor Aisha , Rutherford Alasdair , McCormack Brendan , Hockley Jo , Ogden Margaret , Soulsby Irene , McKenzie Maisie , Spilsbury Karen , Hanratty Barbara , Forbat Liz
Published: February 2021

Introduction

Palliative and end-of-life care in care homes is often inadequate, despite high morbidity and mortality. Residents can experience uncontrolled symptoms, poor quality deaths and avoidable hospitalisations. Care home staff can feel unsupported to look after residents at the end of life. Approaches for improving end-of-life care are often education-focused, do not triage residents and rarely integrate clinical care. This study will adapt an evidence-based approach from Australia for the UK context called ‘Palliative Care Needs Rounds’ (Needs Rounds). Needs Rounds combine triaging, anticipatory person-centred planning, case-based education and case-conferencing; the Australian studies found that Needs Rounds reduce length of stay in hospital, and improve dying in preferred place of care, and symptoms at the end of life.

Methods and analysis

This implementation science study will codesign and implement a scalable UK model of Needs Rounds. The Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework will be used to identify contextual barriers and use facilitation to enable successful implementation. Six palliative care teams, working with 4–6 care homes each, will engage in two phases. In phase 1 (February 2021), stakeholder interviews (n=40) will be used to develop a programme theory to meet the primary outcome of identifying what works, for whom in what circumstances for UK Needs Rounds. Subsequently a workshop to codesign UK Needs Rounds will be run. Phase 2 (July 2021) will implement the UK model for a year. Prospective data collection will focus on secondary outcomes regarding hospitalisations, residents’ quality of death and care home staff capability of adopting a palliative approach.

Ethics and dissemination

Frenchay Research Ethics Committee (287447) approved the study. Findings will be disseminated to policy-makers, care home/palliative care practitioners, residents/relatives and academic audiences. An implementation package will be developed for practitioners to provide the tools and resources required to adopt UK Needs Rounds.

Registration details

Registration details:ISRCTN15863801.
Enhancing care of children with complex healthcare needs: an improvement project in a community health organisation in Ireland
Authors: Brenner Maria , Doyle Amanda , Begley Thelma , Doyle Carmel , Hill Katie , Murphy Maryanne
Published: February 2021

Background

Integration of care for children with complex care needs is developing slowly internationally. There remains wide variation in the governance of, and access to, care for these children and their families.

Local problem

There was a need to develop a service that would have a specific remit for organising the overall management and governance of the care of these children in the community.

Method

A bespoke model was established specifically to support the needs of children with complex healthcare needs (CHNs). The sole focus of the team is to provide the highest standard of care to these children and their families, and to enable families to remain central to decision-making.

Intervention

The service for children with CHNs was established in August 2017 with the appointment of a service manager and case managers. A comprehensive training and education programme was put in place to support care to the children and their families.

Results

The service is viewed as delivering high-quality care. Parents and stakeholders highlighted the value placed within the service on individualised care, specialist knowledge and the importance of advocacy.

Conclusions

The model recognises the exceptional lives these children and families live, given the complexities and challenges they have to overcome on a daily basis. The team have built a specialist knowledge and skill set in supporting families and others involved in the care of the child, as they are solely employed and dedicated to the provision of care to children with CHNs. The corporate governance structures seem strong and stand up to scrutiny very well in terms of parents’ and stakeholders’ perspectives and in the context of published international best practice.
Physicians’ views on the usefulness and feasibility of identifying and disclosing patients’ last phase of life: a focus group study
Authors: Owusuaa Catherine , van Beelen Irene , van der Heide Agnes , van der Rijt Carin C D
Published: February 2021

Objectives

Accurate assessment that a patient is in the last phase of life is a prerequisite for timely initiation of palliative care in patients with a life-limiting disease, such as advanced cancer or advanced organ failure. Several palliative care quality standards recommend the surprise question (SQ) to identify those patients. Little is known about physicians’ views on identifying and disclosing the last phase of life of patients with different illness trajectories.

Methods

Data from two focus groups were analysed using thematic analysis with a phenomenological approach.

Results

Fifteen medical specialists and general practitioners participated. Participants thought prediction of patients’ last phase of life, i.e. expected death within 1 year, is important. They seemed to find that prediction is more difficult in patients with advanced organ failure compared with cancer. The SQ was considered a useful prognostic tool; its use is facilitated by its simplicity but hampered by its subjective character. The medical specialist was considered mainly responsible for prognosticating and gradually disclosing the last phase. Participants’ reluctance to such disclosure was related to uncertainty around prognostication, concerns about depriving patients of hope, affecting the physician–patient relationship, or a lack of time or availability of palliative care services.

Conclusions

Physicians consider the assessment of patients’ last phase of life important and support use of the SQ in patients with different illness trajectories. However, barriers in disclosing expected death are prognostic uncertainty, possible deprivation of hope, physician–patient relationship, and lack of time or palliative care services. Future studies should examine patients’ preferences for those discussions.
Early palliative care and quality of dying and death in patients with advanced cancer
Authors: Mah Kenneth , Chow Brittany , Swami Nadia , Pope Ashley , Rydall Anne , Earle Craig , Krzyzanowska Monika , Le Lisa , Hales Sarah , Rodin Gary , Hannon Breffni , Zimmermann Camilla
Published: February 2021

Objective

Early palliative care (EPC) in the outpatient setting improves quality of life for patients with advanced cancer, but its impact on quality of dying and death (QODD) and on quality of life at the end of life (QOL-EOL) has not been examined. Our study investigated the impact of EPC on patients’ QODD and QOL-EOL and the moderating role of receiving inpatient or home palliative care.

Method

Bereaved family caregivers who had provided care for patients participating in a cluster-randomised trial of EPC completed a validated QODD scale and indicated whether patients had received additional home palliative care or care in an inpatient palliative care unit (PCU). We examined the effects of EPC, inpatient or home palliative care, and their interactions on the QODD total score and on QOL-EOL (last 7 days of life).

Results

A total of 157 caregivers participated. Receipt of EPC showed no association with QODD total score. However, when additional palliative care was included in the model, intervention patients demonstrated better QOL-EOL than controls (p=0.02). Further, the intervention by PCU interaction was significant (p=0.02): those receiving both EPC and palliative care in a PCU had better QOL-EOL than those receiving only palliative care in a PCU (mean difference=27.10, p=0.002) or only EPC (mean difference=20.59, p=0.02).

Conclusion

Although there was no association with QODD, EPC was associated with improved QOL-EOL, particularly for those who also received inpatient care in a PCU. This suggests a long-term benefit from early interdisciplinary palliative care on care throughout the illness.

Trial registration number

ClinicalTrials.gov Registry (#NCT01248624).
Bespoke 3D printed eye cover for teen with rhabdomyosarcoma
Authors: O’Sullivan Aidan , Duffy Ed , O’Sullivan Kevin , Cronin Una , Lyons Emma , O’Sullivan Leonard , Twomey Feargal
Published: February 2021

Background

We report a case of using 3D printing to create a bespoke eye cover for an 18-year-old man with left maxillary alveolar rhabdomyosarcoma. Further, the patient had proptosis causing chemosis and subsequent conjunctival abrasions. This had been managed by taping a large dressing around the eye for a number of weeks previously.

Methods

A 3D scanner was used to capture the surface topography of the patients face. The data were imported into a CAD package and used as a guide to create a bespoke eye cover. The final design was 3D printed in a biocompatible material for use by the patient.

Results

The scan, modelling, and printing of the bespoke cover was completed successfully in less than 72 hours.

Conclusion

3D printing offers a method to create bespoke solutions for patients in palliative care to meet rare and difficult clinical challenges.
Carbonic anhydrase IX: a regulator of pH and participant in carcinogenesis
Authors: Aldera Alessandro Pietro , Govender Dhirendra
Published: February 2021

Carbonic anhydrase IX (CAIX) is a transmembrane metalloenzyme which is upregulated in tumour cells under hypoxic conditions. CAIX expression is induced by the accumulation of hypoxia-inducible factor-1α and has several downstream effects, including acidification of the extracellular pH, loss of cellular adhesion and increased tumour cell migration. CAIX is upregulated in a variety of solid organ tumours and has prognostic implications. High CAIX protein expression is a marker of poor prognosis in breast, lung, ovarian and bladder carcinomas. Conversely, low expression is an indicator of poor prognosis in clear cell renal cell carcinoma (CCRCC). CAIX immunohistochemistry is useful diagnostically to identify metastatic CCRCC, and the recently recognised clear cell papillary renal cell carcinoma. There is much interest in targeting CAIX with monoclonal antibodies and small molecule inhibitors. There are several small molecule inhibitors under development which have shown promising results in clinical trials. In this paper, we provide an overview of the role of CAIX in tumourigenesis and outline its use as a prognostic, diagnostic and therapeutic biomarker.