bluuebunny/crossref_metadata_2025 huggingface dataset:
Splinter haemorrhages and brain infarcts as an unusual presentation of sarcoidosis
Authors: Ayub Shazeen , Hawari Rand , Mahmood-Rao Hamzah
Published: June 2021

We present an interesting case of a healthy 47-year-old woman who presented to the acute take with symptoms of visual apraxia, splinter haemorrhages and extreme fatigue. This was a diagnostic challenge with other unusual features to this case, which includes brain infarcts on MRI, raised troponin and oeosinophilia. Naturally endocarditis was the top differential but this was ruled out by serial negative blood cultures and a negative transthoracic echocardiogram. Several medical specialties were involved and the initial working diagnosis was ANCA vasculitis (oeosinophilic granulomatosis with polyangiitis). Early administration of intravenous steroids clouded our judgement further and sarcoidosis was not thought as a possible differential. We illustrate the immensely challenging and complicated clinical course involving multiple specialties and investigations. In the end, a complete steroid wean was required to reach an accurate histological diagnosis.
Aggressive angiomyxoma of left buttock
Authors: Akram Hassan , Tran Deanna , Rehman Rafey , Al-Wahab Zaid
Published: June 2021

Aggressive angiomyxoma (AA) is a rare mesenchymal tumour that is characterised by increased incidence in women compared with men, local invasion to the surrounding tissue and high recurrence rate. A premenopausal woman presented to clinic with pelvic pressure, intermittent tingling in the thigh and pressure emptying the bladder. CT scan, vaginal and gluteal biopsies, and MRI scan were performed to conclude a final diagnosis of AA. The patient underwent complete resection of the mass. The mass tested positive for oestrogen receptor and progesterone receptor. The patient received leuprolide postoperatively to prevent recurrence. AA should be considered as a differential diagnosis for a pelvic and perineal mass. Patients should be warned of high recurrence rate, necessity of surgical removal and long-term hormonal treatment.
Mild trauma causing cervical fracture through transverse foramen leading to a vertebral arteriovenous fistula
Authors: Andersen Mikkel Schou , Krone Willy , Munthe Sune
Published: June 2021

Vertebral arteriovenous fistula (vAVF) is an uncommon vascular disease defined as abnormal connections between the vertebral artery or its branches extracranially with nearby venous structures. This case report outlines the case of a man in his late 70s presenting with C1–C3 fractures after a mild trauma falling down a small staircase. CT angiogram (CTA) gave suspicion of vertebral artery dissection and pseudoaneurysm; however, digital subtraction angiography revealed a fracture-induced vAVF successfully treated endovascularly with coils. In conclusion, cervical fractures involving the transverse foramen regardless of trauma mechanism should result in a CTA. Endovascular treatment with ipsilateral vertebral artery closure is preferred due to its feasibility and safety.
Heterozygous deletion in exon 6 ofSTEXgene causing ataxia with oculomotor apraxia type 2 (AOA-2) with ovarian failure
Authors: Kinkar Jiwan Shriram , Jameel Patel Zeeshan , Kumawat Banshi Lal , Kalbhor Priyanka
Published: June 2021

Ataxia with oculomotor apraxia type 2 (AOA2), recently renamed as ATX-SETX, is an autosomal recessive, progressive neurodegenerative disorder belonging to inherited cerebellar ataxias. The pathogenic variants of theSETXgene have been implicated in ATX-SETX. We report the case of a 21-year-old woman presenting with ataxia, oculomotor apraxia and dystonia. She had elevated serum α-fetoprotein (AFP), follicle stimulating hormone (FSH) and luteinising hormone (LH) levels and moderate cerebellar atrophy. On further evaluation, she was found to have premature ovarian failure as well. Multiplex ligation-dependent probe amplification detected a heterozygous deletion in exon 6 of theSETXgene. A combination of cerebellar ataxia, oculomotor apraxia with elevated AFP and cerebellar atrophy are highly suggestive of ATX-SETX. In rare instances, it may be associated with premature ovarian failure with elevated FSH and LH levels, necessitating hormonal survey and fertility evaluation in all patients with ATX-SETX.
Life-threatening presentation of a parahiatal hernia after esophagectomy: a case report and review of the literature
Authors: Plourde Camille , Comeau Émilie
Published: June 2021

A woman presented to our hospital with acute abdominal pain 7 months following an oesophagectomy. A chest X-ray revealed a new elevation of the left diaphragm. CT demonstrated a large left diaphragmatic hernia incarcerated with non-enhancing transverse colon and loops of small bowel. She deteriorated rapidly into obstructive shock and was urgently brought to the operating room for a laparotomy. The diaphragmatic orifice was identified in a left parahiatal position, consistent with a parahiatal hernia. Incarcerated necrotic transverse colon and ischaemic loops of small bowel were resected, and the diaphragmatic defect was closed primarily. Because of haemodynamic instability, the abdomen was temporarily closed, and a second look was performed 24 hours later, allowing anastomosis and definitive closure. Parahiatal hernias are rare complications following surgical procedures and can lead to devastating life-threatening complications, such as an obstructive shock. Expeditious diagnosis and management are required in the acute setting.
Lipoprotein(a) as a unique primary risk factor for early atherosclerotic peripheral arterial disease
Authors: Mayo John , Hoffman Thomas , Smith Ryan , Kellicut Dwight
Published: June 2021

Elevated plasma lipoprotein(a) is a relatively common condition that contributes to many cardiovascular diseases. However, the awareness and testing for this condition remain low. Herein, we present a case of an otherwise healthy and active man who developed symptoms of peripheral arterial disease starting at age 49, and was found to have hyper-lipoprotein(a) as his only notable risk factor. Diagnosis was not made until years later, after an extensive workup. Upon further screening, he was also found to have subclinical coronary and carotid artery atherosclerotic disease. The patient was treated with aspirin, statin, niacin and angioplasty to bilateral superficial femoral arteries with good symptom resolution. Early screening of his son also revealed a similarly elevated lipoprotein(a) level. It is important to raise awareness of this condition and its relationship to early-onset peripheral arterial disease so patients and their families can be appropriately identified, counselled and treated.
Categorising patient concerns using natural language processing techniques
Authors: Fairie Paul , Zhang Zilong , D'Souza Adam G , Walsh Tara , Quan Hude , Santana Maria J
Published: June 2021

Objectives

Patient feedback is critical to identify and resolve patient safety and experience issues in healthcare systems. However, large volumes of unstructured text data can pose problems for manual (human) analysis. This study reports the results of using a semiautomated, computational topic-modelling approach to analyse a corpus of patient feedback.

Methods

Patient concerns were received by Alberta Health Services between 2011 and 2018 (n=76 163), regarding 806 care facilities in 163 municipalities, including hospitals, clinics, community care centres and retirement homes, in a province of 4.4 million. Their existing framework requires manual labelling of pre-defined categories. We applied an automated latent Dirichlet allocation (LDA)-based topic modelling algorithm to identify the topics present in these concerns, and thereby produce a framework-free categorisation.

Results

The LDA model produced 40 topics which, following manual interpretation by researchers, were reduced to 28 coherent topics. The most frequent topics identified were communication issues causing delays (frequency: 10.58%), community care for elderly patients (8.82%), interactions with nurses (8.80%) and emergency department care (7.52%). Many patient concerns were categorised into multiple topics. Some were more specific versions of categories from the existing framework (eg, communication issues causing delays), while others were novel (eg, smoking in inappropriate settings).

Discussion

LDA-generated topics were more nuanced than the manually labelled categories. For example, LDA found that concerns with community care were related to concerns about nursing for seniors, providing opportunities for insight and action.

Conclusion

Our findings outline the range of concerns patients share in a large health system and demonstrate the usefulness of using LDA to identify categories of patient concerns.
Evidence for the effects of viewing visual artworks on stress outcomes: a scoping review
Authors: Law Mikaela , Karulkar Nikita , Broadbent Elizabeth
Published: June 2021

Objective

To review the existing evidence on the effects of viewing visual artworks on stress outcomes and outline any gaps in the research.

Design

A scoping review was conducted based on the Joanna Briggs Institute methodology for scoping reviews and using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. Two independent reviewers performed the screening and data extraction.

Data sources

Medline, Embase, APA PsycINFO, Cochrane CENTRAL, Scopus, Google Scholar, Google, ProQuest Theses and Dissertations Database, APA PsycExtra and Opengrey.eu were searched in May 2020.

Eligibility criteria

Studies were included if they investigated the effects of viewing at least one visual artwork on at least one stress outcome measure. Studies involving active engagement with art, review papers or qualitative studies were excluded. There were no limits in terms of year of publication, contexts or population types; however, only studies published in the English language were considered.

Data extraction and synthesis

Information extracted from manuscripts included: study methodologies, population and setting characteristics, details of the artwork interventions and key findings.

Results

14 primary studies were identified, with heterogeneous study designs, methodologies and artwork interventions. Many studies lacked important methodological details and only four studies were randomised controlled trials. 13 of the 14 studies on self-reported stress reported reductions after viewing artworks, and all of the four studies that examined systolic blood pressure reported reductions. Fewer studies examined heart rate, heart rate variability, cortisol, respiration or other physiological outcomes.

Conclusions

There is promising evidence for effects of viewing artwork on reducing stress. Moderating factors may include setting, individual characteristics, artwork content and viewing instructions. More robust research, using more standardised methods and randomised controlled trial designs, is needed.

Registration details

A protocol for this review is registered with the Open Science Framework (osf.io/gq5d8).
Sex differences in type and occurrence of adverse reactions to opioid analgesics: a retrospective cohort study
Authors: Lopes Guilherme S , Bielinski Suzette , Moyer Ann M , Jacobson Debra J , Wang Liwei , Jiang Ruoxiang , Larson Nicholas B , Miller Virginia M , Zhu Ye , Cavanaugh Dana C , St Sauver Jennifer
Published: June 2021

Objectives

Sex as a biological variable affects response to opioids. However, few reports describe the prevalence of specific adverse reactions to commonly prescribed opioids in men and women separately. A large cohort was used to investigate sex differences in type and occurrence of adverse reactions associated with use of codeine, tramadol, oxycodone and hydrocodone.

Design

Retrospective cohort study.

Setting

Participants in the Right Drug, Right Dose, Right Time (RIGHT) Study.

Participants

The medical records of 8457 participants in the RIGHT Study who received an opioid prescription between 1 January 2004 and 31 December 2017 were reviewed 61% women, 94% white, median age (Q1–Q3)=58 (47–66).

Primary and secondary outcome measures

Adverse reactions including gastrointestinal, skin, psychiatric and nervous system issues were collected from the allergy section of each patient’s medical record. Sex differences in the risk of adverse reactions due to prescribed opioids were modelled using logistic regression adjusted for age, body mass index, race and ethnicity.

Results

From 8457 participants (of which 449 (5.3%) reported adverse reactions), more women (6.5%) than men (3.4%) reported adverse reactions to at least one opioid (OR (95% CI)=2.3 (1.8 to 2.8), p<0.001). Women were more likely to report adverse reactions to tramadol (OR (95% CI)=2.8 (1.8 to 4.4), p<0.001) and oxycodone (OR (95% CI)=2.2 (1.7 to 2.9), p<0.001). Women were more likely to report gastrointestinal (OR (95% CI)=3.1 (2.3 to 4.3), p<0.001), skin (OR (95% CI)=2.1 (1.4 to 3.3), p=0.001) and nervous system issues (OR (95% CI)=2.3 (1.3 to 4.2), p=0.004).

Conclusions

These findings support the importance of sex as a biological variable to be factored into pain management studies.
Effects of cancer treatment on household impoverishment: a multicentre cross-sectional study in China
Authors: Fu Wenqi , Shi Jufang , Zhang Xin , Liu Chengcheng , Sun Chengyao , Du Yupeng , Wang Hong , Liu Chaojie , Lan Li , Zhao Min , Yang Li , Bao Burenbatu , Cao Sumei , Zhang Yongzhen , Wang DeBin , Li Ni , Chen Wanqing , Dai Min , Liu Guoxiang , He Jie
Published: June 2021

Objectives

To determine the incidence and intensity of household impoverishment induced by cancer treatment in China.

Design

Average income and daily consumption per capita of the households and out-of-pocket payments for cancer care were estimated. Household impoverishment was determined by comparing per capita daily consumption against the Chinese poverty line (CPL, US$1.2) and the World Bank poverty line (WBPL, US$1.9) for 2015. Both pre-treatment and post-treatment consumptions were calculated assuming that the households would divert daily consumption money to pay for cancer treatment.

Participants

Cancer patients diagnosed initially from 1 January 2015 to 31 December 2016 who had received cancer treatment subsequently. Those with multiple cancer diagnoses were excluded.

Data sources

A household questionnaire survey was conducted on 2534 cancer patients selected from nine hospitals in seven provinces through two-stage cluster/convenience sampling.

Findings

5.89% (CPL) to 12.94% (WBPL) households were impoverished after paying for cancer treatment. The adjusted OR (AOR) of post-treatment impoverishment was higher for older patients (AOR=2.666–4.187 for ≥50 years vs <50 years, p<0.001), those resided in central region (AOR=2.619 vs eastern, p<0.01) and those with lower income (AOR=0.024–0.187 in higher income households vs the lowest 20%, p<0.001). The patients without coverage from social health insurance had higher OR (AOR=1.880, p=0.040) of experiencing post-treatment household impoverishment than those enrolled with the insurance for urban employees. Cancer treatment is associated with an increase of 5.79% (CPL) and 12.45% (WBPL) in incidence of household impoverishment. The median annual consumption gap per capita underneath the poverty line accumulated by the impoverished households reached US$128 (CPL) or US$212 (WBPL). US$31 170 395 (CPL) or US$115 238 459 (WBPL) were needed to avoid household impoverishment induced by cancer treatment in China.

Conclusions

The financial burden of cancer treatment imposes a significant risk of household impoverishment despite wide coverage of social health insurance in China.
Protocol for the cost-effectiveness of parenteral iron and oral iron therapy for first-line management of anaemia among pregnant women in a natural programme setting in Gujarat
Authors: Saha Somen , Desai Bharat , Fancy Manish , Puwar Tapasvi , Saxena Deepak , Shah Komal , Pandya Apurvakumar
Published: June 2021

Introduction

Maternal anaemia is a major public health issue in India. The government of India recommends parenteral iron to manage moderate and severe grades of anaemia. In contrast to its clinical efficacy, the cost-effectiveness of intravenous iron sucrose and ferric carboxymaltose is not yet established in Indian context. This article illustrates the protocol of health technology assessment to evaluate the cost-effectiveness of intravenous therapy on the improvement of haemoglobin concentration over oral therapy.

Methods and analysis

The study will be carried out in two districts of Gujarat state. The study participants will be selected by a proportionate sampling method from the rural, tribal, desert and coastal region of the districts. Data will be collected over 1 year on key outcome indicators using a mixed-method approach. Key informant interviews will be conducted, and cost data will be gathered to perform cost-effectiveness analysis.

Ethics and dissemination

This study is approved by the Technical Appraisal Committee of Health Technology Assessment India, Department of Health Research and Institutional Ethics Committee of the Indian Institute of Public Health, Gandhinagar.
SPIRIT-PRO Extension explanation and elaboration: guidelines for inclusion of patient-reported outcomes in protocols of clinical trials
Authors: Calvert Melanie , King Madeleine , Mercieca-Bebber Rebecca , Aiyegbusi Olalekan , Kyte Derek , Slade Anita , Chan An-Wen , Basch E , Bell Jill , Bennett Antonia , Bhatnagar Vishal , Blazeby Jane , Bottomley Andrew , Brown Julia , Brundage Michael , Campbell Lisa , Cappelleri Joseph C , Draper Heather , Dueck Amylou C , Ells Carolyn , Frank Lori , Golub Robert M , Griebsch Ingolf , Haywood Kirstie , Hunn Amanda , King-Kallimanis Bellinda , Martin Laura , Mitchell Sandra , Morel Thomas , Nelson Linda , Norquist Josephine , O'Connor Daniel , Palmer Michael , Patrick Donald , Price Gary , Regnault Antoine , Retzer Ameeta , Revicki Dennis , Scott Jane , Stephens Richard , Turner Grace , Valakas Antonia , Velikova Galina , von Hildebrand Maria , Walker Anita , Wenzel Lari
Published: June 2021

Patient-reported outcomes (PROs) are used in clinical trials to provide valuable evidence on the impact of disease and treatment on patients’ symptoms, function and quality of life. High-quality PRO data from trials can inform shared decision-making, regulatory and economic analyses and health policy. Recent evidence suggests the PRO content of past trial protocols was often incomplete or unclear, leading to research waste. To address this issue, international, consensus-based, PRO-specific guidelines were developed: the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT)-PRO Extension. The SPIRIT-PRO Extension is a 16-item checklist which aims to improve the content and quality of aspects of clinical trial protocols relating to PRO data collection to minimise research waste, and ultimately better inform patient-centred care. This SPIRIT-PRO explanation and elaboration (E&E) paper provides information to promote understanding and facilitate uptake of the recommended checklist items, including a comprehensive protocol template. For each SPIRIT-PRO item, we provide a detailed description, one or more examples from existing trial protocols and supporting empirical evidence of the item’s importance. We recommend this paper and protocol template be used alongside the SPIRIT 2013 and SPIRIT-PRO Extension paper to optimise the transparent development and review of trial protocols with PROs.
Combination adherence strategy to support HIV antiretroviral therapy and pre-exposure prophylaxis adherence during pregnancy and breastfeeding: protocol for a pair of pilot randomised trials
Authors: Saidi Friday , Mutale Wilbroad , Freeborn Kellie , Rosenberg Nora E , Graybill Lauren Aiko , Maman Suzanne , Amico K. Rivet , Mollan Katie R , Phanga Twambilile , Milala Beteniko , Hill Lauren M , Gottwalt Allison M , Phiri Sam , Kalua Thoko , Chi Benjamin H
Published: June 2021

Introduction

To realise the expected gains from prevention of mother-to-child HIV transmission initiatives, adherence to preventative and therapeutic antiretroviral regimens is critical and interventions deployable in busy programmatic settings with a high HIV burden are needed. Based on formative research, we developed an approach that integrates patient-centred counselling and engagement of an adherence supporter for pregnant and breastfeeding women initiating HIV treatment (ie, antiretroviral therapy (ART)) or biomedical HIV prevention (ie, pre-exposure prophylaxis (PrEP)).

Methods

Tonse Pamodzi 2 is a pilot study designed to provide acceptability, fidelity and clinical outcomes data on a set of behavioural interventions for adherence support. The study comprises two parallel randomised trials, enrolling HIV-positive pregnant women initiating ART (Trial 1, n=100) and HIV-negative pregnant women with risk of HIV acquisition and willing to initiate PrEP (Trial 2, n=200). Within each trial, participants are randomised 1:1 to either the intervention or control group. The Tonse Pamodzi adherence intervention comprises patient-centred counselling (adapted Integrated Next Step Counseling(iNSC)) and external adherence support tailored to the clinical context (ie, for ART or PrEP). Participants randomly assigned to the control group receive standard counselling based on local HIV guidelines. Participants are followed for 6 months. To assess intervention acceptability, we will employ a mixed method approach to describe participant engagement, satisfaction, and discussion content. We will audit and score recorded counselling sessions to evaluate the implementation fidelity of iNSC sessions. We will also assess clinical outcomes at 3 and 6 months for both Trial 1 (retention in care and viral suppression of HIV) and Trial 2 (retention in care, and plasma and intracellular tenofovir drug concentrations).

Ethics and dissemination

The study protocol was approved by the Malawi National Health Science Research Committee (19/05/2334) and the University of North Carolina at Chapel Hill Institutional Review Board (19-1060).

Trial registration number

NCT04330989.
‘Give Us The Tools!’: development of knowledge transfer tools to support the involvement of patient partners in the development of clinical trial protocols with patient-reported outcomes (PROs), in accordance with SPIRIT-PRO Extension
Authors: Cruz Rivera Samantha , Stephens Richard , Mercieca-Bebber Rebecca , Retzer Ameeta , Rutherford Claudia , Price Gary , Slade Anita , Aiyegbusi Olalekan Lee , Edge Philip , Roberts Lesley , Gosden Lesley , Verdi Rav , Wilson Roger , Calvert Melanie
Published: June 2021

Objectives

(a) To adapt the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT)-patient-reported outcome (PRO) Extension guidance to a user-friendly format for patient partners and (b) to codesign a web-based tool to support the dissemination and uptake of the SPIRIT-PRO Extension by patient partners.

Design

A 1-day patient and public involvement session.

Participants

Seven patient partners.

Methods

A patient partner produced an initial lay summary of the SPIRIT-PRO guideline and a glossary. We held a 1-day PPI session in November 2019 at the University of Birmingham. Five patient partners discussed the draft lay summary, agreed on the final wording, codesigned and agreed the final content for both tools. Two additional patient partners were involved in writing the manuscript. The study compiled with INVOLVE guidelines and was reported according to the Guidance for Reporting Involvement of Patients and the Public 2 checklist.

Results

Two user-friendly tools were developed to help patients and members of the public be involved in the codesign of clinical trials collecting PROs. The first tool presents a lay version of the SPIRIT-PRO Extension guidance. The second depicts the most relevant points, identified by the patient partners, of the guidance through an interactive flow diagram.

Conclusions

These tools have the potential to support the involvement of patient partners in making informed contributions to the development of PRO aspects of clinical trial protocols, in accordance with the SPIRIT-PRO Extension guidelines. The involvement of patient partners ensured the tools focused on issues most relevant to them.
Lessons from countries implementing find, test, trace, isolation and support policies in the rapid response of the COVID-19 pandemic: a systematic review
Authors: Chung Sheng-Chia , Marlow Sushila , Tobias Nicholas , Alogna Alessio , Alogna Ivano , You San-Lin , Khunti Kamlesh , McKee Martin , Michie Susan , Pillay Deenan
Published: June 2021

Objective

To systematically learn lessons from the experiences of countries implementing find, test, trace, isolate, support (FTTIS) in the first wave of the COVID-19 pandemic.

Design, data sources and eligibility criteria

We searched MEDLINE (PubMed), Cochrane Library, SCOPUS and JSTOR, initially between 31 May 2019 and 21 January 2021. Research articles and reviews on the use of contact tracing, testing, self-isolation and quarantine for COVID-19 management were included in the review.

Data extraction and synthesis

We extracted information including study objective, design, methods, main findings and implications. These were tabulated and a narrative synthesis was undertaken given the diverse research designs, methods and implications.

Results

We identified and included 118 eligible studies. We identified the core elements of an effective find, test, trace, isolate, support (FTTIS) system needed to interrupt the spread of a novel infectious disease, where treatment or vaccination was not yet available, as pertained in the initial stages of the COVID-19 pandemic. We report methods used to shorten case finding time, improve accuracy and efficiency of tests, coordinate stakeholders and actors involved in an FTTIS system, support individuals isolating and make appropriate use of digital tools.

Conclusions

We identified in our systematic review the key components of an FTTIS system. These include border controls, restricted entry, inbound traveller quarantine and comprehensive case finding; repeated testing to minimise false diagnoses and pooled testing in resource-limited circumstances; extended quarantine period and the use of digital tools for contact tracing and self-isolation. Support for mental or physical health and livelihoods is needed for individuals undergoing self-isolation/quarantine. An integrated system with rolling-wave planning can best use effective FTTIS tools to respond to the fast-changing COVID-19 pandemic. Results of the review may inform countries considering implementing these measures.
Suicidal behaviours and moderator support in online health communities: a scoping review
Authors: Perry Amanda , Pyle Denise , Lamont-Mills Andrea , du Plessis Carol , du Preez Jan
Published: June 2021

Objectives

Online support can be a crucial source of support for individuals experiencing suicidal behaviours, with forum moderators being pivotal in terms of the role they play in times of personal mental health emergencies. This study identified what is empirically known about the professional practices of health professionals who are online mental health forum moderators and provide support to individuals experiencing suicidal behaviours.

Design

The Levac, Colquhoun and O’Brien extension of the Arksey and O’Malley scoping review framework was used.

Search strategy

The Psychology Collection (EBSCO), PsycINFO (EBSCO), Web of Science, Taylor and Francis Online, SAGE Journals and Science Direct databases were searched for articles that featured a result relating to an online forum; included participants who worked as online moderators or facilitators and focused on suicide or self-harm. Results were limited to peer-reviewed articles published in English from 1990 onwards. As a quality assurance measure, grey literature (nonacademic literature) was not included. Reference lists of included articles were hand-searched.

Results

There were 397 articles initially identified after applying inclusion and exclusion criteria, with five articles included for synthesis. All articles received a moderate quality rating. Only one article featured a moderator who was a qualified health professional; the moderators in the remaining articles were volunteers who undertook preservice training. We found that there is little research that examines the professional working practices of online moderators who support individuals experiencing suicidal behaviours.

Conclusions

The dearth of research focusing on the professional practices of online forum moderators is cause for concern given that individuals experiencing suicidal behaviours are increasingly turning to online forums when in crisis. Future research should focus on online moderators’ practice through interviewing moderators about their professional practices and by examining online moderator practice as it occurs in situ.
Coronavax: preparing community and government for COVID-19 vaccination: a research protocol for a mixed methods social research project
Authors: Attwell Katie , Carlson Samantha , Tchilingirian Jordan , Harper Tauel , McKenzie Lara , Roberts Leah , Rizzi Marco , Westphal Darren , Effler Paul , Hughes Catherine , Swift Valerie , Blyth Christopher C
Published: June 2021

Introduction

Ahead of the implementation of a COVID-19 vaccination programme, the interdisciplinary Coronavax research team developed a multicomponent mixed methods project to support successful roll-out of the COVID-19 vaccine in Western Australia. This project seeks to analyse community attitudes about COVID-19 vaccination, vaccine access and information needs. We also study how government incorporates research findings into the vaccination programme.

Methods and analysis

The Coronavax protocol employs an analytical social media study, and a qualitative study using in-depth interviews with purposively selected community groups. Participant groups currently include healthcare workers, aged care workers, first responders, adults aged 65+ years, adults aged 30–64 years, young adults aged 18–29 years, education workers, parents/guardians of infants and young children (<5 years), parents/guardians of children aged 5–18 years with comorbidities and parents/guardians who are hesitant about routine childhood vaccines. The project also includes two studies that track how Australian state and Commonwealth (federal) governments use the study findings. These are functional dialogues (translation and discussion exercises that are recorded and analysed) and evidence mapping of networks within government (which track how study findings are used).

Ethics and dissemination

Ethics approval has been granted by the Child and Adolescent Health Service Human Research Ethics Committee (HREC) and the University of Western Australia HREC. Study findings will be disseminated by a series of journal articles, reports to funders and stakeholders, and invited and peer-reviewed presentations.
Working towards a comprehensive understanding of HPV and cervical cancer among Indigenous women: a qualitative systematic review
Authors: Sethi Sneha , Poirier Brianna , Canfell Karen , Smith Megan , Garvey Gail , Hedges Joanne , Ju Xiangqun , Jamieson Lisa M
Published: June 2021

Rationale

Indigenous peoples carry a disproportionate burden of infectious diseases and cancers and are over-represented among the socially disadvantaged of most countries. Human papillomavirus (HPV) is a risk factor and causative agent of cervical, oropharyngeal and other cancers. Recent literature shows evidence of Indigenous populations being at increased risk of HPV infections and its associated cancers.

Objective

This is a qualitative systematic review. The objective of this study was to explore the experiences and barriers Indigenous women face in relation to HPV awareness, knowledge and cervical screening, in order to better understand factors that may mitigate against or facilitate prevention efforts for HPV infection and associated cancers.

Methods

Two investigators independently searched MEDLINE, PubMed, SCOPUS and Web of Science databases (for articles published from inception until 30 June 2020) using a prespecified search strategy to identify qualitative studies on narratives of Indigenous women regarding HPV infection awareness, knowledge and cervical screening, across all geographic and income-level settings. Using a ‘meta-study’ approach, a social ecological model of cervical screening, infection and associated cancer prevention among Indigenous populations was formulated.

Results

Five core themes were identified and formulated within the social ecological model; intrapersonal factors, interpersonal factors, institutional/organisational factors, sociocultural/community factors and public policy. These collectively formed the proposed social ecological model of HPV infection awareness and cervical cancer prevention among Indigenous women. This model has been synthesised by taking into account personal stories of Indigenous women and healthcare workers, thus offering a more nuanced, organised, structured and culturally sensitive approach to policy translation.

Conclusion

The social ecological model of HPV infection awareness and cervical cancer prevention among Indigenous women offers a holistic and practical approach for Indigenous health policy makers. It clearly addresses the high risk of Indigenous populations at a global level in experience of both HPV infection and HPV-related cancers.

PROSPERO registration number

CRD42020207643.
PEP-CoV protocol: a PEP flute-self-care randomised controlled trial to prevent respiratory deterioration and hospitalisation in early COVID-19
Authors: Mollerup Annette , Larsen Sofus Christian , Bennetzen Anita Selmer , Henriksen Marius , Simonsen Mette Kildevaeld , Weis Nina , Kofod Linette Marie , Heitmann Berit Lilienthal
Published: June 2021

Introduction

Infection with SARS-CoV-2 may progress to severe pulmonary disease, COVID-19. Currently, patients admitted to hospital because of COVID-19 have better prognosis than during the first period of the pandemic due to improved treatment. However, the overall societal susceptibility of being infected makes it pivotal to prevent severe courses of disease to avoid high mortality rates and collapse of the healthcare systems. Positive expiratory pressure (PEP) self-care is used in chronic pulmonary disease and has been shown to prevent pneumonia in a high-risk cohort of patients with leukaemia. PEP flute self-care to prevent respiratory deterioration and hospitalisation in early COVID-19: a randomised trial (The PEP-CoV trial) examines the effectiveness on respiratory symptoms and need of hospital admission by regular PEP flute use among non-hospitalised individuals with confirmed SARS-CoV-2 infection and COVID-19 symptoms.

Methods and analysis

In this randomised controlled trial, we hypothesise that daily PEP flute usage as add-on to usual care is superior to usual care as regards symptom severity measured by the COPD Assessment Test (CAT) at 30-day follow-up (primary outcome) and hospital admission through register data (secondary outcome). We expect to recruit 400 individuals for the trial. Participants in the intervention group receive a kit of 2 PEP flutes and adequate resistances and access to instruction videos. A telephone hotline offers possible contact to a nurse. The eight-item CAT score measures cough, phlegm, chest tightness, dyspnoea, activities of daily living at home, feeling safe at home despite symptoms, sleep quality and vigour. The CAT score is measured daily in both intervention and control arms by surveys prompted through text messages.

Ethics and dissemination

The study was registered prospectively at www.clinicaltrials.gov on 27 August 2020 (NCT04530435). Ethical approval was granted by the local health research ethics committee (Journal number: H-20035929) on 23 July 2020. Enrolment of participants began on 6 October 2020. Results will be published in scientific journals.

Trial registration number

NCT04530435; Pre-results.
Repurposing bromocriptine for Aβ metabolism in Alzheimer’s disease (REBRAnD) study: randomised placebo-controlled double-blind comparative trial and open-label extension trial to investigate the safety and efficacy of bromocriptine in Alzheimer’s disease with presenilin 1 (PSEN1) mutations
Authors: Kondo Takayuki , Banno Haruhiko , Okunomiya Taro , Amino Yoko , Endo Kayoko , Nakakura Akiyoshi , Uozumi Ryuji , Kinoshita Akemi , Tada Harue , Morita Satoshi , Ishikawa Hidehiro , Shindo Akihiro , Yasuda Ken , Taruno Yosuke , Maki Takakuni , Suehiro Takashi , Mori Kohji , Ikeda Manabu , Fujita Koji , Izumi Yuishin , Kanemaru Kazutomi , Ishii Kenji , Shigenobu Kazue , Kutoku Yumiko , Sunada Yoshihide , Kawakatsu Shinobu , Shiota Shunji , Watanabe Toshifumi , Uchikawa Osamu , Takahashi Ryosuke , Tomimoto Hidekazu , Inoue Haruhisa
Published: June 2021

Introduction

Alzheimer’s disease (AD) is one of the most common causes of dementia. Pathogenic variants in the presenilin 1 (PSEN1) gene are the most frequent cause of early-onset AD. Medications for patients with AD bearing PSEN1 mutation (PSEN1-AD) are limited to symptomatic therapies and no established radical treatments are available. Induced pluripotent stem cell (iPSC)-based drug repurposing identified bromocriptine as a therapeutic candidate for PSEN1-AD. In this study, we used an enrichment strategy with iPSCs to select the study population, and we will investigate the safety and efficacy of an orally administered dose of bromocriptine in patients with PSEN1-AD.

Methods and analysis

This is a multicentre, randomised, placebo-controlled trial. AD patients with PSEN1 mutations and a Mini Mental State Examination-Japanese score of ≤25 will be randomly assigned, at a 2:1 ratio, to the trial drug or placebo group (≥4 patients in TW-012R and ≥2 patients in placebo). This clinical trial consists of a screening period, double-blind phase (9 months) and extension phase (3 months). The double-blind phase for evaluating the efficacy and safety is composed of the low-dose maintenance period (10 mg/day), high-dose maintenance period (22.5 mg/day) and tapering period of the trial drug. Additionally, there is an open-labelled active drug extension period for evaluating long-term safety. Primary outcomes are safety and efficacy in cognitive and psychological function. Also, exploratory investigations for the efficacy of bromocriptine by neurological scores and biomarkers will be conducted.

Ethics and dissemination

The proposed trial is conducted according to the Declaration of Helsinki, and was approved by the Institutional Review Board (K070). The study results are expected to be disseminated at international or national conferences and published in international journals following the peer-review process.

Trial registration number

jRCT2041200008,NCT04413344.
NHS CHECK: protocol for a cohort study investigating the psychosocial impact of the COVID-19 pandemic on healthcare workers
Authors: Lamb Danielle , Greenberg Neil , Hotopf Matthew , Raine Rosalind , Razavi Reza , Bhundia Rupa , Scott Hannah , Carr Ewan , Gafoor Rafael , Bakolis Ioannis , Hegarty Siobhan , Souliou Emilia , Rafferty Anne Marie , Rhead Rebecca , Weston Danny , Gnanapragasam Sam , Marlow Sally , Wessely Simon , Stevelink Sharon
Published: June 2021

Introduction

The COVID-19 pandemic has had profound effects on the working lives of healthcare workers (HCWs), but the extent to which their well-being and mental health have been affected remains unclear. This longitudinal cohort study aims to recruit a cohort of National Health Service (NHS) HCWs, conducting surveys at regular intervals to provide evidence about the prevalence of symptoms of mental disorders, and investigate associated factors such as occupational contexts and support interventions available.

Methods and analysis

All staff, students and volunteers working in the 18 participating NHS Trusts in England will be sent emails inviting them to complete a survey at baseline, with email invitations for the follow-up surveys sent 6 months and 12 months later. Opening in late April 2020, the baseline survey collects data on demographics, occupational/organisational factors, experiences of COVID-19, validated measures of symptoms of poor mental health (eg, depression, anxiety, post-traumatic stress disorder), and constructs such as resilience and moral injury. These surveys will be complemented by in-depth psychiatric interviews with a sample of HCWs. Qualitative interviews will also be conducted, to gain deeper understanding of the support programmes used or desired by staff, and facilitators and barriers to accessing such programmes.

Ethics and dissemination

Ethical approval for the study was granted by the Health Research Authority (reference: 20/HRA/210, IRAS: 282686) and local Trust Research and Development approval. Cohort data are collected via Qualtrics online survey software, pseudonymised and held on secure university servers. Participants are aware that they can withdraw from the study at any time, and there is signposting to support services if participants feel they need it. Only those consenting to be contacted about further research will be invited to participate in further components. Findings will be rapidly shared with NHS Trusts, and via academic publications in due course.
Associations of atrial fibrillation with renal function decline in patients with chronic kidney disease
Authors: Chen Tz-Heng , Chu Yuan-Chia , Ou Shuo-Ming , Tarng Der-Cherng
Published: June 2021

Background

Chronic kidney disease (CKD) is known to increase the risk of atrial fibrillation (AF) development, but the relationship between AF and subsequent renal function decline in patients with CKD is not well understood. In this study, we explored the role of AF on renal outcomes among patients with CKD.

Methods

In a retrospective hospital-based cohort study, we identified patients with CKD aged ≥20 years from 1 January 2008 to 31 December 2018. The patients were divided into AF and non-AF groups. We matched each patient with CKD and AF to two non-AF CKD controls according to propensity scores. The outcomes of interest included estimated glomerular filtration rate (eGFR) decline of ≥20%, ≥30%, ≥40% and ≥50%, and end-stage renal disease (ESRD).

Results

After propensity score matching, 6731 patients with AF and 13 462 matched controls were included in the analyses. Compared with the non-AF group, the AF group exhibited greater risks of eGFR decline ≥20% (HR 1.43; 95% CI 1.33 to 1.53), ≥30% (HR 1.50; 95% CI 1.36 to 1.66), ≥40% (HR 1.62; 95% CI 1.41 to 1.85) and ≥50% (HR 1.82; 95% CI 1.50 to 2.20), and ESRD (HR 1.22; 95% CI 1.12 to 1.34). Higher CHA2DS2-VASc scores were associated with greater risks of eGFR decline and ESRD.

Conclusions

In patients with CKD, AF was associated with greater risks of subsequent renal function decline. CHA2DS2-VASc scores may be a useful risk stratification scheme for predicting the risk of renal function decline.
Risk factors for venous thromboembolism and atherosclerotic cardiovascular disease: do they differ in patients with rheumatoid arthritis?
Authors: Ozen Gulsen , Pedro Sofia , Schumacher Rebecca , Simon Teresa , Michaud Kaleb
Published: June 2021

Objective

Venous thromboembolism (VTE) is an increasing concern in rheumatoid arthritis (RA) with little known about risk factors. We aimed to compare risk factors for unprovoked VTE and atherosclerotic cardiovascular disease (ASCVD) in patients with RA and to assess subsequent ASCVD risk after an unprovoked VTE.

Methods

People with RA participating in a US-wide longitudinal observational registry from 1998 to 2018 were assessed for incident unprovoked VTE (deep venous thrombosis and pulmonary emboli not associated with cancer, recent surgery, hospitalisation, fracture and pregnancy) and ASCVD (myocardial infarction and stroke) validated from hospital/death records. Risk factors for VTE and ASCVD and the risk of ASCVD after an unprovoked VTE were determined using Cox proportional hazards models.

Results

During median (IQR) 4 (1.5–7) years of follow-up in 31 366 patients with RA, 539 unprovoked VTE and 1648 ASCVD events were identified. The adjusted models showed increased VTE and ASCVD risk with older age, male sex, comorbidities, prior fracture, worse disability, higher disease activity and glucocorticoids. Traditional cardiovascular disease risk factors were common in both ASCVD and VTE but only increased ASCVD risk with obesity as the exception (VTE HR (95% CI), 1.46 (1.13–1.87)) and ASCVD, 0.58 (0.50–0.68)). ASCVD risk doubled after an unprovoked VTE (HR (95% CI), 2.05 (1.43–2.95)).

Conclusion

Our findings suggest that unprovoked VTE is mediated by inflammation of RA and may be considered a spectrum of pan-cardiovascular syndrome.
Ecological considerations for species distribution modelling of euphausiids in the Northeast Pacific Ocean
Authors: Evans Rhian , Gauthier Stéphane , Robinson Clifford L.K.
Published: June 2021

Euphausiids are a keystone species in marine food webs of the Northeast Pacific Ocean, important for forage fish, commercial fish species and marine predators such as seabirds and whales. Ecosystem-based fisheries management relies on realistic lower-trophic-level information for forecasting under future changing climate scenarios. We synthesised information from quantitative modelling studies analysing the relationship between euphausiids and their environment for two species of euphausiids that dominate assemblages in this region — Euphausia pacifica and Thysanoessa spinifera. Studies analysed suggest that variables reflecting the physical and biological environment in situ, features reflecting the geomorphic marine landscape, and large-scale climate indices all significantly affect euphausiid biomass and distribution. Temperature was the most tested predictor variable in the euphausiid models reviewed; however, it was significant in fewer models than other variables tested. We review and compare model structures, predictor variable selection and temporal lag phases to develop recommendations for species distribution modelling of euphausiids in the Northeast Pacific Ocean. We believe the results from this review will be applicable globally across regions with similar climates where euphausiids are numerous and can be adapted for different species and environments.
The superconducting dome for holographic doped Mott insulator with hyperscaling violation
Authors: Cai Wenhe , Sin Sang-Jin
Published: June 2021

We reconsider the holographic model featuring a superconducting dome on the temperature-doping phase diagram with a modified view on the role of the two charges. The first type charge with density $$\rho _{A}$$

ρ
A

make the Mott insulator, and the second one with $$\rho _{B}$$

ρ
B

is the extra charge by doping, so that the complex scalar describing the cooper pair condensation couples only with the second charge. We point out that the key role in creating the dome is played by the three point interaction $$-c \chi ^{2} F_{\mu \nu }G^{\mu \nu }$$

-
c

χ
2

F

μ
ν

G

μ
ν

. The Tc increases with their coupling. We also consider the effect of the quantum critical point hidden under the dome using the geometry of hyperscaling violation. Our results show that the dome size and optimal temperature increase with z whatever is $$\theta $$
θ
, while we get bigger $$\theta $$
θ
for larger (smaller) dome depending on $$z>2$$

z
>
2

($$z<2$$

z
<
2

). We also point out that the condensate increases for bigger value of $$\theta $$
θ
but for smaller value of z.