bluuebunny/crossref_metadata_2025 huggingface dataset:
Health care provided to immigrants in a humanitarian aid center in Spain
Authors: Ponce Blandón José Antonio , Ruiz Sánchez Elena , Romero Castillo Rocío , Pabón Carrasco Manuel , Lomas Campos María de las Mercedes
Published: May 2021

Objective

Objective of this study is to explore the most prevalent pathologies of the population received in the Spanish coast and to know the nursing prehospital interventions required, as well as the treatments applied and their follow‐ups.

Design and Measures

A descriptive and retrospective study.

Sample

A total of 481 immigrants cared for by the Red Cross in the study period.

Results

Dermatological pathologies were more frequent in men (32.1). In women, the most prevalent pathology was headache (19%). According to age, dermatological pathologies prevail in those over 18 years of age (31.9%) and in children, respiratory pathologies (42.9%). Relationships were found statistically significant between gender and type of disease and between specifying or not nursing interventions (p < .001). Age was also related to the type of diagnosis and the type of nursing interventions to be carried out (p < .001).

Conclusion

In general, a good state of health was considered in the migrants, concluding that knowing the pathologies or activities to be carried out according to the sociodemographic variables would help improve the quality of the assistance.
Visual Regimes of Mobility Photographic Exhibitions on Refugees during the Financial Crisis in Greece
Authors: Topali Pinelopi
Published: May 2021

This article explores how photographic images of refugees in modern Greece condition national imagination and construct new ethnopolitical moral fantasies. It also examines how repetitive images of suffering in photographic exhibitions become constitutive of a new regime of mobility in the country during the financial and refugee crisis. I argue that refugees’ images articulate kinship and gender norms, national archetypes, ethnic hierarchies, and ideas of mobility and rootedness. They bind together northern European landscapes and resistant Mediterranean subjects and weave new and old visualities into a single mobility aesthetic that reinvents national memory and initiates new political moralities.
Resounding Participatory Ethnography: Ethnographic Dialogue in Dialogue
Authors: Panopoulos Panayotis , Scaldaferri Nicola , Feld Steven
Published: May 2021

This dialogue explores issues in contemporary sonic, sensory, and visual ethnography, including dialogic editing and collaborative projects between anthropology and art. It focuses on how the multimedia ethnography When the Trees Resound: Collaborative Media Research on an Italian Festival (2019) breaks the silence of earlier studies of an Italian community festival by emphasizing listening to multiple sounds and voices through field sound recordings and dialogic photographic imaging, writing, and editing. In doing so, a ritual of communal effort with roots in peasant labor, performative masculinity, and social opposition and protest becomes a site of experimental scholarship on participatory and performative ethnography.
The Picture as a Moving Image
Authors: Su Aaron
Published: May 2021

For some longtime locals in Shanghai, China, street propaganda’s periodic renovations muddle the distinction between still and moving images. When the cyclic changing of propaganda pieces began to acquire filmic qualities for those who bore witness, they made recourse to these narrative and episodic properties to critique their experiences of political instability. Their discourses implicate media forms as genres of experiencing political transformation. Moreover, their refusal of still images in favor of fungible, overlapping filmic sequences lends ethnographic texture to ongoing scholarly debates about how to historicize the nonlinear development of contemporary Chinese politics, especially under the analytic of “postsocialism.”
Effectiveness of intravenous fluid resuscitation in hypotensive cats: 82 cases (2012–2019)
Authors: Chalifoux Nolan V. , Hess Rebecka S. , Silverstein Deborah C.
Published: May 2021

Objective

To evaluate the effectiveness of intravenous fluid resuscitation in hypotensive cats in an emergency room setting. Secondary objectives were to investigate changes in heart rate (HR) and body temperature (BT) in response to fluid resuscitation, and the association of these changes with patient survival.

Design

Retrospective study.

Setting

University teaching hospital.

Animals

Eighty‐two cats with confirmed hypotension.

Interventions

None.

Measurements and main results

Medical records from 2012 to 2019 were searched for cats that had documented systemic arterial hypotension (blood pressure measured using a Doppler ultrasonic flow probe [DBP] < 90 mm Hg) on presentation to the emergency room. Data collected included patient characteristics and DBP, HR, and BT before and after fluid resuscitation, type and volume of fluids administered, and outcome. The median DBP before and after resuscitative fluid therapy in all cats was 65 mm Hg (range, 20–85 mm Hg) and 80 mm Hg (range, 20–128 mm Hg), respectively (P < 0.001). However, only 30 cats (37%) were classified as responders to fluid resuscitation (DBP ≥ 90 mm Hg following bolus therapy). The mean HR and median BT before resuscitative fluid therapy was 159/min and 36.7°C. Following fluid resuscitation, where measured, the mean HR and median BT was 154/min (P = 1.00) and 35.9°C (P = 1.00). No significant differences in HR and BT were identified between responders and non‐responders. Cats had a low survival rate of 7%. All survivors (n = 5) were initially bradycardic (HR < 160/min), compared to only 45% of non‐survivors (P = 0.4).

Conclusions

Bolus fluid resuscitation effectively increases blood pressure in hypotensive cats; however, it does not result in normalization of blood pressure, HR, or BT in the majority of cases.
Proximodistal and caudocranial position of the insertion of the patellar ligament on the tibial tuberosity and patellar ligament length of normal stifles and stifles with grade II medial patellar luxation in small‐breed dogs
Authors: Feldmane Liene , Theyse Lars F. H.
Published: May 2021

Objective

To assess the role of the proximodistal and caudocranial relative position of the patellar ligament insertion on the tibia and patellar ligament length‐to‐patellar length ratio (PLL:PL) in small‐breed dogs with and without grade II medial patellar luxation (MPL).

Study Design

Retrospective study.

Sample Population

Dogs weighing ≤15 kg, including 43 stifles with MPL and 34 control stifles.

Methods

The proximodistal and caudocranial relative position of the patellar ligament insertion was determined as a ratio using the vertical (VTT) and horizontal distance (HTT) between the tibial tuberosity insertion and the tibial plateau divided by the tibial plateau length (TPL). In addition, PLL:PL and tibial plateau angle (TPA) were determined.

Results

The VTT:TPL ratio was lower in affected stifles (95% CI: 0.86–0.94) than in the control group (0.93–1.01; p = .01). No other difference was identified between affected and normal stifles.

Conclusion

The only difference identified in this study consisted of a more proximal position of the patellar ligament insertion in the stifles of small‐breed dogs with grade II MPL.

Clinical Significance

The more proximal position of the patellar ligament insertion will result in a more proximal position of the patella in the trochlear groove and may contribute to the development of MPL. Potentially, this will also affect the risk of recurrence of MPL after surgical treatment.
Persecution of Minorities in Algeria: What Fuels the Maltreatment?
Authors: Gabbay Shaul M.
Published: May 2021

Algeria, the largest country in Africa, has nearly a uniform population. Arab Sunni Muslims comprise fully 99% of the 42 million strong-populace. Why, then, does its government grapple with fears of separatist movements from its own Sunni population? Further, why does it use suppression and persecution to hold down its meager minority populations that includes ethnic, cultural, religious, and linguistic denizens whose combined numbers total just 1% and who pose no serious threat to the powerful and often highly corrupt government and military force? The answer may lie in the rise of fundamentalist Islam, a movement that strives to make theocracy and Sharia law replace the current democratic government system. This balance of pleasing and thus containing the fundamentalist movement, which has consumed much of the Middle East and North Africa, has made its mark felt in Algeria and could threaten to destabilize one of the continent’s most powerful nations.
Rotor Unbalance Kind and Severity Identification by Current Signature Analysis with Adaptative Update to Multiclass Machine Learning Algorithms
Authors: Ávila S. L. , Schaberle H. M. , Youssef S. , Pacheco F. S. , Penz C. A.
Published: May 2021

The health of a rotating electric machine can be evaluated by monitoring electrical and mechanical parameters. As more information is available, it easier can become the diagnosis of the machine operational condition. We built a laboratory test bench to study rotor unbalance issues according to ISO standards. Using the electric stator current harmonic analysis, this paper presents a comparison study among Support-Vector Machines, Decision Tree classifies, and One-vs-One strategy to identify rotor unbalance kind and severity problem – a nonlinear multiclass task. Moreover, we propose a methodology to update the classifier for dealing better with changes produced by environmental variations and natural machinery usage. The adaptative update means to update the training data set with an amount of recent data, saving the entire original historical data. It is relevant for engineering maintenance. Our results show that the current signature analysis is appropriate to identify the type and severity of the rotor unbalance problem. Moreover, we show that machine learning techniques can be effective for an industrial application.
Molecular Dynamics Simulations of Shock Propagation and Spallation in Amorphous Polymers
Authors: Dewapriya M. A. N. , Miller R. E.
Published: May 2021

We conducted large-scale molecular dynamics (MD) simulations of shock wave propagation and spallation in amorphous polyurethane and polyurea. First, we computed the shock Hugoniot of the polymers using the multiscale shock technique and compared them with available experimental data to establish the upper limit of the shock pressure that can be accurately modeled using a non-reactive interatomic force field. Subsequently, we simulated shock wave propagation in the polymers, varying the shock particle velocity from 0.125 km/s to 2 km/s. A remarkable similarity in the shock behavior of polyurethane and polyurea was observed. The spall strength of each sample was computed by two methods: (a) the indirect method (based on the free surface velocity history)—accessible in experiments and (b) a direct method (based on the atomic stresses in the region of spallation)—accessible only through MD. The results reveal that the tensile strength computed from the indirect method is consistently smaller than the value obtained from the direct method. Moreover, the strength computed from the indirect method shows a noticeable agreement with the fracture nucleation stress. Our results provide novel molecular-level insights into the spallation mechanisms of amorphous polymers, which could facilitate the design of polymers for structural barrier applications.
Experimental Investigation on a Novel Composite Salt Gradient Solar Pond With an East–West Side Reflector
Authors: Sathish Dhandapani , Jegadheeswaran Selvaraj
Published: May 2021

A salt gradient solar pond (SGSP) acts as an eco-friendly and cost-efficient device for storing thermal energy storage. It is crucial to enrich the efficiency of the SGSP to boost its thermal energy storage. It can be efficaciously achieved with the application of salt mixtures, reflectors, and by the usage of a glazed layer. This current study investigates the hexagonal composite salinity gradient solar pond (HCSGSP) augmented with a dual inclined reflector and a triple-layer transparent cover. A micro-solar pond having a hexagonal cross section was fabricated and experimented at Coimbatore, India, having a datum and surface area of 1 m and 0.679 m2, respectively. The novel usage of composite salt (sodium chloride 30%, magnesium chloride 10%, and potassium chloride 60%) led to the enhancement of the daily average temperature of pond. The pond’s upper portion was packed with a triple-layer glazed cover which shows an uplift of thermal energy and the pond is provided with inclined reflectors made of plywood fixed with mirrors on the east–west direction. The purpose of the mirrors is to increase the solar radiation intensity during the diurnal period and also it acts as an insulator which minimizes the heat losses during the nocturnal period. Energy balance numerical equations were formulated for all layers in the pond and temperature variation was determined mathematically and experimentally. The maximum thermal efficiencies of the top convective, middle non-convective, and bottom convective layers of reformed solar pond were measured to be 23.44%, 30.68%, and 35.63%, respectively, whereas they were 1.32%, 12.32%, and 23.44%, respectively, in the case of conventional pond. Furthermore, the research provides insight into the impact of shading owing to sidewalls, which has a significant impact on the incident solar radiation and storage of thermal energy in the novel solar pool.
Reevaluation of Spectral Parameters and Neutron Fluxes in IC-7 Irradiation Channel of TRIGA MARK I IPR-R1 Research Nuclear Reactor
Authors: Jaćimović Radojko , Menezes Maria Ângela de Barros Correia
Published: May 2021

The core configuration of the Training Research Isotopes General Atomics (TRIGA) MARK I IPR-R1 nuclear research reactor at Nuclear Technology Development Centre (CDTN), Belo Horizonte, Brazil, has been modified six times since the first criticality and the neutron fluxes have been determined using experimental and semitheoretical methodologies determining the neutron fluxes in different irradiation channels and devices, applying different procedures and materials. This reactor operates at 100 kW; however, after new configuration for 250 kW in 2001, the carousel no longer rotates during irradiations aiming at preserving the rotation mechanism. In 2003, the spectral parameters were determined experimentally by the “Cd-ratio for multimonitor” in five specific channels aiming at the application of neutron activation analysis (NAA) k0-standardized method. The determinations were repeated applying the same procedure in 2016, 2018, and 2019. Values for thermal and epithermal neutron fluxes as well as f and α spectral parameters were determined. The experimental results for certified reference material BCR-320R were calculated by the k0-method of NAA, using the spectral parameters for irradiation channel IC-7 obtained in 2003, 2016, 2018, and 2019 and evaluated by En-score. The values showed that the differences in the results compared to those in 2003 were lower than 2.5%, inside the uncertainty of the method. It shows that the k0-method installed in CDTN is reliable and useful for various purposes. The results of the spectral parameter f presented small differences, in a period of 16 years, pointing out the stability of operation of the reactor TRIGA MARK I IPR-R1.
Factors influencing surface carbon contamination in ambient-pressure x-ray photoelectron spectroscopy experiments
Authors: Comini Nicolo’ , Huthwelker Thomas , Diulus J. Trey , Osterwalder Jürg , Novotny Zbynek
Published: May 2021

Carbon contamination is a notorious issue that has an enormous influence on surface science experiments, especially in near-atmospheric conditions. While it is often mentioned in publications when affecting an experiment’s results, it is more rarely analyzed in detail. We performed ambient-pressure x-ray photoelectron spectroscopy experiments toward examining the build-up of adventitious carbon species (both inorganic and hydrocarbons) on a clean and well-prepared surface using large-scale (50 × 10 mm2) rutile TiO2(110) single crystals exposed to water vapor and liquid water. Our results highlight how various factors and environmental conditions, such as beam illumination, residual gas pressure and composition, and interaction with liquid water, could play roles in the build-up of carbon on the surface. It became evident that beam-induced effects locally increase the amount of carbon in the irradiated area. Starting conditions that are independent of light irradiation determine the initial overall contamination level. Surprisingly, the rate of beam-induced carbon build-up does not vary significantly for different starting experimental conditions. The introduction of molecular oxygen in the order of 10 mbar allows for fast surface cleaning during x-ray illumination. The surface carbon contamination can be completely removed when the oxygen partial pressure is comparable to the partial pressure of water vapor in the millibar pressure range, as was tested by exposing the TiO2(110) surface to 15 mbar of water vapor and 15 mbar of molecular O2 simultaneously. Furthermore, our data support the hypothesis that the progressive removal of carbon species from the chamber walls by competitive adsorption of water molecules takes place following repeated exposure to water vapor. We believe that our findings will be useful for future studies of liquid-solid interfaces using tender x rays, where carbon contamination plays a significant role.
Lexical and syntactic gemination in Italian consonants—Does a geminate Italian consonant consist of a repeated or a strengthened consonant?
Authors: Di Benedetto Maria-Gabriella , Shattuck-Hufnagel Stefanie , De Nardis Luca , Budoni Sara , Arango Javier , Chan Ian , DeCaprio Alec
Published: May 2021

Two types of consonant gemination characterize Italian: lexical and syntactic. Italian lexical gemination is contrastive, so that two words may differ by only one geminated consonant. In contrast, syntactic gemination occurs across word boundaries and affects the initial consonant of a word in specific contexts, such as the presence of a monosyllabic morpheme before the word. This study investigates the acoustic correlates of Italian lexical and syntactic gemination, asking if the correlates for the two types are similar in the case of stop consonants. Results confirmed previous studies showing that duration is a prominent gemination cue, with a lengthened consonant closure and a shortened pre-consonant vowel for both types. Results also revealed the presence, in about 10%–12% of instances, of a double stop-release burst, providing strong support for the biphonematic nature of Italian geminated stop consonants. Moreover, the timing of these bursts suggests a different planning process for lexical vs syntactic geminates. The second burst, when present, is accommodated within the closure interval in syntactic geminates, while lexical geminates are lengthened by the extra burst. This suggests that syntactic gemination occurs during a post-lexical phase of production planning, after timing has already been established.
Passive underwater acoustic identification tags using multi-layered shells
Authors: Satish Aprameya , Sabra Karim G.
Published: May 2021

The development of pre-deployed underwater infrastructures to aid in autonomous underwater vehicle (AUV) navigation is of keen interest, with the increased use of AUVs for undersea operations. Previous literature has introduced a class of passive underwater acoustic markers, termed acoustic identification (AID) tags [Satish, Trivett, and Sabra, J. Acoust. Soc. Am. 147(6), EL517–EL522 (2020)], which are inexpensive to construct, simple to deploy, and reflect unique engineered acoustic signatures that can be detected by an AUV instrumented with high-frequency sonar systems. An AID tag is built of multi-layer shells with different acoustic properties and thicknesses to generate a unique acoustic signature, composed of the multiple reflections created by the layer interfaces, thus akin to an “acoustic barcode.” AID tags can be used as geospatial markers to highlight checkpoints in AUV trajectories or mark areas of interest underwater. This article investigates the optimization of the AID tag's design using energy based metrics and evaluates the detectability of an AID tag in the presence of interfering signals, such as clutter using matched-filter based techniques. Furthermore, experimental results of AID tags interrogated by a standard high-frequency sonar are presented to provide proof of concept of AID tag detection in a reverberant water tank.
Accounting for finance is key for climate mitigation pathways
Authors: Battiston Stefano , Monasterolo Irene , Riahi Keywan , van Ruijven Bas J.
Published: May 2021

Investors' expectations can hamper a low-carbon transition
Resolving multifrequential oscillations and nanoscale interfacet communication in single-particle catalysis
Authors: Suchorski Y. , Zeininger J. , Buhr S. , Raab M. , Stöger-Pollach M. , Bernardi J. , Grönbeck H. , Rupprechter G.
Published: May 2021

Imaging reactions across facets

Metal nanoparticles used in heterogeneous catalysis can bear different facets with different reaction kinetics. Suchorski
et al.
used field electron microscopy with high spatial (∼2 nanometers) and time (∼2 milliseconds) resolution to study hydrogen oxidation on a curved rhodium crystal that displayed individual nanofacets. They also performed field ion microscopy of the water products. Periodic formation and depletion of subsurface oxygen blocked or allowed hydrogen adsorption, respectively, and led to oscillatory kinetics that could frequency lock between facets but at different frequencies. Surface reconstructions could also induce collapse of spatial coupling of oscillations.

Science
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High Genetic Diversity in Predominantly Clonal Populations of the Powdery Mildew FungusPodosphaera leucotrichafrom U.S. Apple Orchards
Authors: Gañán-Betancur Lederson , Peever Tobin L. , Evans Kate , Amiri Achour
Published: May 2021

Understanding the population biology and epidemiology of plant pathogens is essential to develop effective strategies for controlling plant diseases. Herein, we gathered insights into the population biology ofP. leucotrichapopulations from conventional and organic apple orchards in the United States.
Methanogenesis in the Digestive Tracts of the Tropical Millipedes Archispirostreptus gigas (Diplopoda, Spirostreptidae) and Epibolus pulchripes (Diplopoda, Pachybolidae)
Authors: Horváthová Terézia , Šustr Vladimír , Chroňáková Alica , Semanová Stanislava , Lang Kristina , Dietrich Carsten , Hubáček Tomáš , Ardestani Masoud M. , Lara Ana C. , Brune Andreas , Šimek Miloslav
Published: May 2021

Methane (CH4) is the second most important atmospheric greenhouse gas after CO2and is believed to account for 17% of global warming. Methanogens are a diverse group of archaea and can be found in various anoxic habitats, including digestive tracts of plant-feeding animals.
Supplemental Material: New insights into the formation and emplacement of impact melt rocks within the Chicxulub impact structure, following the 2016 IODP-ICDP Expedition 364
Authors: Graaff Sietze J. de , al. et
Published: May 2021

Appendix S1, containing all geochemical data and specific core depths of all samples and geochemical results for geologic reference materials presented in the article. Figures S1–S3, containing thinsection photographs of representative pre-impact lithologies.
Systematic review of high-flow nasal cannula versus continuous positive airway pressure for primary support in preterm infants
Authors: Bruet Shaam , Butin Marine , Dutheil Frederic
Published: May 2021

Introduction

We conducted a meta-analysis of trials that compared efficacy and safety of high-flow nasal cannula (HFNC) with continuous positive airway pressure (CPAP) as primary respiratory support in preterm infants and a study of the impact of clinical relevant parameters.

Methods

Databases were searched for randomised controlled trials comparing HFNC with CPAP as primary respiratory support in preterm infants. Treatment failure was considered as primary outcome and adverse events as secondary outcomes. We calculated risk ratios (RRs) in intention-to-treat analysis and random-effects meta-analyses of risks were conducted.

Results

We included 10 studies for a total of 1830 patients. Meta-analysis demonstrated an RR of treatment failure multiplied by 1.34 using HFNC compared with CPAP (RR=1.34, 95% CI 1.01 to 1.68, I2=16.2%). Secondary outcome meta-analysis showed no difference in intubation rates (RR=0.90, 95% CI 0.66 to 1.15) and a lower rate of nasal trauma using HFNC compared with CPAP (RR=0.48, 95% CI 0.31 to 0.65, I²=0.0%). Meta-regressions did not show any influence of gestational age and weight at birth, HFNC flow rate, type of CPAP generator or use of surfactant.

Conclusions

Despite a higher risk of treatment failure, considering no difference in intubation rates and a lower rate of nasal trauma using HFNC compared with CPAP, we suggest that HFNC should be used as primary respiratory support in preterm infants.
Metallic foreign body adjacent to the round window: a rare cause for chronic tympanic membrane perforation with hearing loss
Authors: Leedman Samuel Robert , Kuthubutheen Jafri
Published: May 2021

Welding injuries to the tympanic membrane (TM) or middle ear are rare but can cause significant damage. These injuries occur when a hot spark or molten slag drops directly into the external auditory canal and through the action of gravity (because the ear is upright during such an injury), then risks burning through the TM. This can lead to a multitude of adverse consequences including chronic TM perforation, secondary purulent otorrhoea, facial palsy, taste disturbance, vertigo and hearing loss. We present the case of a welding injury to the right TM, resulting in a chronic perforation and hearing loss. The patient required surgical intervention for removal of the metallic foreign body and repair of the TM. The patient obtained a good surgical result with no sensorineural hearing loss. This is a preventable occupational injury, which can be avoided by use of ear protection and increased awareness of this potential risk.
Dorsal root ganglion stimulation lead fractures: potential mechanisms and ways to avoid
Authors: Chauhan Gaurav , Roth Brandon I , Mekhail Nagy
Published: May 2021

Dorsal root ganglion stimulation (DRGS) therapy is a rapidly emerging tool being used by pain physicians in the treatment of chronic pain. Complex regional pain syndrome (CRPS), a debilitating disease whose mechanism is still has yet to be fully elucidated, is a common pathology targeted by DRGS therapy, often better results than traditional spinal cord stimulation. DRGS therapy, however, is not bereft of complications. Lead migration and fracture are two examples in particular that are among the most common of these complications. The authors report an unusual case of lost efficacy due to lead fractures in patients with CRPS treated with DRGS. The case report narrates identification, management and probable mechanism of DRGS lead fracture. The structural instability of DRGS leads can yield distressing symptoms at any point during the therapy, and physicians should be cognisant of the complications of DRGS therapy.
Optic disc and peripapillary vessel density measured with optical coherence tomography angiography and its associations in Chinese adults: a large population-based study
Authors: Zhu Ming Ming , Choy Bonnie N K , You Qi Sheng , Chan Jonathan Cheuk Hung , Ng Alex L K , Shih Kendrick , Cheung Janice Jing Chee , Wong Jasper Ka Wai , Shum Jennifer , Ni Michael Y , Lai Jimmy Shiu-Ming , Leung Gabriel M , Wong Ian Y
Published: May 2021

Purpose

To investigate the optic disc and peripapillary vessel density, as well as its ocular and systemic associations, in healthy eyes among adult Chinese population.

Methods

A population-based cross-sectional eye survey was conducted on Chinese adults residing in Hong Kong. 1891 eyes from 1891 participants who completed 4.5×4.5 mm optical coherence tomography angiography scans were recruited. Among the 1891 eyes, 404 were excluded due to low scan quality, optic disc or retinal disorders and non-Chinese ethnicity. The vessel densities (VDs) at nerve fibre layer plexus (NFLP) at both optic disc and peripapillary were collected for analysis. Multiple linear regression analysis was performed to determine the ocular and systemic associations of NFLP VD.

Results

The study included 1487 participants (men: 41.2%) with a mean age of 48.8±15.4 years. The mean NFLP VD of the whole en face image, inside disc and peripapillary region was 53.8%, 42.7% and 60.3%, respectively. In the multivariable model, decreased NFLP VDs were significantly associated with older age, male gender, longer axial length (AL) and lower Signal Strength Index.

Conclusions

This large population-based cross-sectional study provided quantitative data of optic disc and peripapillary NFLP VD which may serve as a normative reference for clinical use. Apart from age, gender and AL, the scan signal strength also should be taken into consideration during the assessment of NFLP VD.
A scoping review of paediatric latent tuberculosis infection care cascades: initial steps are lacking
Authors: Campbell Jeffrey I , Sandora Thomas J , Haberer Jessica E
Published: May 2021

Background and objectives

Identifying and treating children with latent tuberculosis infection (TB infection) is critical to prevent progression to TB disease and to eliminate TB globally. Diagnosis and treatment of TB infection requires completion of a sequence of steps, collectively termed the TB infection care cascade. There has been no systematic attempt to comprehensively summarise literature on the paediatric TB infection care cascade.

Methods

We performed a scoping review of the paediatric TB infection care cascade. We systematically searched PubMed, Cumulative Index to Nursing and Allied Health Literature, Cochrane and Embase databases. We reviewed articles and meeting abstracts that included children and adolescents ≤21 years old who were screened for or diagnosed with TB infection, and which described completion of at least one step of the cascade. We synthesised studies to identify facilitators and barriers to retention, interventions to mitigate attrition and knowledge gaps.

Results

We identified 146 studies examining steps in the paediatric TB infection care cascade; 31 included children living in low-income and middle-income countries. Most literature described the final cascade step (treatment initiation to completion). Studies identified an array of patient and caregiver-related factors associated with completion of cascade steps. Few health systems factors were evaluated as potential predictors of completion, and few interventions to improve retention were specifically tested.

Conclusions

We identified strengths and gaps in the literature describing the paediatric TB infection care cascade. Future research should examine cascade steps upstream of treatment initiation and focus on identification and testing of at-risk paediatric patients. Additionally, future studies should focus on modifiable health systems factors associated with attrition and may benefit from use of behavioural theory and implementation science methods to improve retention.
When technology precedes regulation: the challenges and opportunities of e-pharmacy in low-income and middle-income countries
Authors: Miller Rosalind , Wafula Francis , Onoka Chima A , Saligram Prasanna , Musiega Anita , Ogira Dosila , Okpani Ikedichi , Ejughemre Ufuoma , Murthy Shrutika , Garimella Surekha , Sanderson Marie , Ettelt Stefanie , Allen Pauline , Nambiar Devaki , Salam Abdul , Kweyu Emmanuel , Hanson Kara , Goodman Catherine
Published: May 2021

The recent growth of medicine sales online represents a major disruption to pharmacy markets, with COVID-19 encouraging this trend further. While e-pharmacy businesses were initially the preserve of high-income countries, in the past decade they have been growing rapidly in low-income and middle-income countries (LMICs). Public health concerns associated with e-pharmacy include the sale of prescription-only medicines without a prescription and the sale of substandard and falsified medicines. There are also non-health-related risks such as consumer fraud and lack of data privacy. However, e-pharmacy may also have the potential to improve access to medicines. Drawing on existing literature and a set of key informant interviews in Kenya, Nigeria and India, we examine the e-pharmacy regulatory systems in LMICs. None of the study countries had yet enacted a regulatory framework specific to e-pharmacy. Key regulatory challenges included the lack of consensus on regulatory models, lack of regulatory capacity, regulating sales across borders and risks of over-regulation. However, e-pharmacy also presents opportunities to enhance medicine regulation—through consolidation in the sector, and the traceability and transparency that online records offer. The regulatory process needs to be adapted to keep pace with this dynamic landscape and exploit these possibilities. This will require exploration of a range of innovative regulatory options, collaboration with larger, more compliant businesses, and engagement with global regulatory bodies. A key first step must be ensuring that national regulators are equipped with the necessary awareness and technical expertise to actively oversee this e-pharmacy activity.
The RATIONS (Reducing Activation of Tuberculosis by Improvement of Nutritional Status) study: a cluster randomised trial of nutritional support (food rations) to reduce TB incidence in household contacts of patients with microbiologically confirmed pulmonary tuberculosis in communities with a high prevalence of undernutrition, Jharkhand, India
Authors: Bhargava Anurag , Bhargava Madhavi , Velayutham Banurekha , Thiruvengadam Kannan , Watson Basilea , Kulkarni Bharati , Singh Manjula , Dayal Rakesh , Pathak Rajeev Ranjan , Mitra Anindya , Rade Kiran , Sachdeva KS
Published: May 2021

Introduction

India has the largest burden of cases and deaths related to tuberculosis (TB). Undernutrition is the leading risk factor accounting for TB incidence, while severe undernutrition is a common risk factor for mortality in patients with TB in India. The impact of nutritional supplementation on TB incidence is unknown, while few underpowered studies have assessed its impact on TB mortality. We designed an open-label, field-based cluster randomised trial to assess the impact of nutritional supplementation (with food rations) on TB incidence in a group at higher risk of TB infection and disease, viz household contacts (HHC) of patients with microbiologically confirmed pulmonary TB (PTB) in Jharkhand, a state with a high prevalence of undernutrition.

Methods and analysis

We shall enrol 2800 adult patients with PTB of the national TB programme, across 28 treatment units in 4 districts, and their approximately 11 200 eligible contacts. The sample size has 80% power to detect the primary outcome of 50% reduction in incidence of active TB in HHC over 2 years of follow-up. Patients and HHC in both the arms will undergo nutritional assessment and counselling. Patients will receive monthly food rations (supplying 1200 kcal and 52 g proteins/day) and multivitamins along with antitubercular treatment. The HHC in the intervention arm will receive food rations (supplying 750 kcal and 23 g proteins/day) and multivitamins while HHC in control arm will be on usual diet. The secondary outcomes in HHC will include effects on nutritional status, non-TB infections. Secondary outcomes in patients are effects on TB mortality, adherence, adverse effects, nutritional and performance status. Substudies will examine micronutrient status and effects on dietary intake, body composition, muscle strength and immune function.

Ethics and dissemination

The institutional ethics committee of ICMR-NIRT, Chennai, approved the study (289/NIRT-IEC/2018). The results will be disseminated in publications and presentations.

Trial registration number

Clinical Trial Registry of India: CTRI/2019/08/020490.
Application of a risk stratification tool for familial hypercholesterolaemia in primary care: an observational cross-sectional study in an unselected urban population
Authors: Carvalho Chris , Williams Crystal , Raisi-Estabragh Zahra , Rison Stuart , Patel Riyaz S , Timmis Adam , Robson John
Published: May 2021

Objective

The Familial Hypercholesterolaemia Case Ascertainment Tool (FAMCAT) has been proposed to enhance case finding in primary care. In this study, we test application of the FAMCAT algorithm to describe risks of familial hypercholesterolaemia (FH) in a large unselected and ethnically diverse primary care cohort.

Method

We studied patients aged 18–65 years from three contiguous areas in inner London. We retrospectively applied the FAMCAT algorithm to routine primary care data and estimated the numbers of possible cases of FH and the potential service implications of subsequent investigation and management.

Results

Of the 777 128 patients studied, the FAMCAT score estimated between 11 736 and 23 798 (1.5%–3.1%) individuals were likely to have FH, depending on an assumed FH prevalence of 1 in 250 or 1 in 500, respectively. There was over-representation of individuals of South Asian ethnicity among those likely to have FH, with this cohort making up 41.9%–45.1% of the total estimated cases, a proportion which significantly exceeded their 26% representation in the study population.

Conclusions

We have demonstrated feasibility of application of the FAMCAT as an aid to case finding for FH using routinely recorded primary care data. Further research is needed on validity of the tool in different ethnic groups and more refined consideration of family history should be explored. While FAMCAT may aid case finding, implementation requires information on the cost-effectiveness of additional health services to investigate, diagnose and manage case ascertainment in those identified as likely to have FH.
Modulation of lactate-lysosome axis in dendritic cells by clotrimazole potentiates antitumor immunity
Authors: Wang Zining , Xu Feifei , Hu Jie , Zhang Hongxia , Cui Lei , Lu Wenhua , He Wenzhuo , Wang Xiaojuan , Li Mengyun , Zhang Huanling , Xiong Wenjing , Xie Chunyuan , Liu Yongxiang , Zhou Penghui , Liu Jinyun , Huang Peng , Qin Xiaofeng Frank , Xia Xiaojun
Published: May 2021

Background

Dendritic cells (DCs) play a critical role in antitumor immunity, but the therapeutic efficacy of DC-mediated cancer vaccine remains low, partly due to unsustainable DC function in tumor antigen presentation. Thus, identifying drugs that could enhance DC-based antitumor immunity and uncovering the underlying mechanism may provide new therapeutic options for cancer immunotherapy.

Methods

In vitro antigen presentation assay was used for DC-modulating drug screening. The function of DC and T cells was measured by flow cytometry, ELISA, or qPCR. B16, MC38, CT26 tumor models and C57BL/6, Balb/c, nude, andBatf3−/−mice were used to analyze the in vivo therapy efficacy and impact on tumor immune microenvironment by clotrimazole treatment.

Results

By screening a group of small molecule inhibitors and the US Food and Drug Administration (FDA)-approved drugs, we identified that clotrimazole, an antifungal drug, could promote DC-mediated antigen presentation and enhance T cell response. Mechanistically, clotrimazole acted on hexokinase 2 to regulate lactate metabolic production and enhanced the lysosome pathway andChopexpression in DCs subsequently induced DC maturation and T cell activation. Importantly, in vivo clotrimazole administration induced intratumor immune infiltration and inhibited tumor growth depending on both DCs and CD8+ T cells and potentiated the antitumor efficacy of anti-PD1 antibody.

Conclusions

Our findings showed that clotrimazole could trigger DC activation via the lactate-lysosome axis to promote antigen cross-presentation and could be used as a potential combination therapy approach to improving the therapeutic efficacy of anti-PD1 immunotherapy.
INfluenza Vaccine Indication During therapy with Immune checkpoint inhibitors: a multicenter prospective observational study (INVIDIa-2)
Authors: Bersanelli Melissa , Giannarelli Diana , De Giorgi Ugo , Pignata Sandro , Di Maio Massimo , Clemente Alberto , Verzoni Elena , Giusti Raffaele , Di Napoli Marilena , Aprile Giuseppe , Ermacora Paola , Catino Annamaria , Scotti Vieri , Mazzoni Francesca , Guglielmini Pamela Francesca , Veccia Antonello , Maruzzo Marco , Rossi Ernesto , Grossi Francesco , Casadei Chiara , Ficorella Corrado , Montesarchio Vincenzo , Verderame Francesco , Rizzo Mimma , Guaitoli Giorgia , Fratino Lucia , Accettura Caterina , Mencoboni Manlio , Zustovich Fable , Baldessari Cinzia , Cinieri Saverio , Camerini Andrea , Laera Letizia , Sorarù Mariella , Zucali Paolo Andrea , Guadalupi Valentina , Leonardi Francesco , Tiseo Marcello , Tognetto Michele , Di Costanzo Francesco , Pinto Carmine , Negrini Giorgia , Russo Antonio , Migliorino Maria R , Filetti Marco , Buti Sebastiano
Published: May 2021

Background

Until now, no robust data supported the efficacy, safety and recommendation for influenza vaccination in patients with cancer receiving immune checkpoint inhibitors (ICIs).

Methods

The prospective multicenter observational INfluenza Vaccine Indication During therapy with Immune checkpoint inhibitors (INVIDIa-2) study investigated the clinical effectiveness of influenza vaccination in patients with advanced cancer receiving ICIs, enrolled in 82 Italian centers from October 2019 to January 2020. The primary endpoint was the time-adjusted incidence of influenza-like illness (ILI) until April 30, 2020. Secondary endpoints regarded ILI severity and vaccine safety.

Results

The study enrolled 1279 patients; 1188 patients were evaluable for the primary endpoint analysis. Of them, 48.9% (581) received influenza vaccination. The overall ILI incidence was 8.2% (98 patients). Vaccinated patients were significantly more frequently elderly (p<0.0001), males (p=0.004), with poor European Cooperative Oncology Group performance status (p=0.009), affected by lung cancer (p=0.01), and by other non-cancer comorbidities (p<0.0001) when compared with unvaccinated. ILI incidence was not different basing on influenza vaccination: the time-to-ILI was similar in vaccinated and unvaccinated patients (p=0.62). ILI complications were significantly less frequent for patients receiving the vaccination (11.8% vs 38.3% in unvaccinated, p=0.002). ILI-related intravenous therapies were significantly less frequent in vaccinated patients than in unvaccinated (11.8% vs 29.8%, p=0.027). ILI lethality was, respectively, 0% in vaccinated and 4.3% in unvaccinated patients. Vaccine-related adverse events were rare and mild (1.5%, grades 1–2).

Conclusion

The INVIDIa-2 study results support a positive recommendation for influenza vaccination in patients with advanced cancer receiving immunotherapy.
Euthanasia in persons with advanced dementia: a dignity-enhancing care approach
Authors: Gómez-Vírseda Carlos , Gastmans Chris
Published: May 2021

In current Western societies, increasing numbers of people express their desire to choose when to die. Allowing people to choose the moment of their death is an ethical issue that should be embedded in sound clinical and legal frameworks. In the case of persons with dementia, it raises further ethical questions such as: Does the person have the capacity to make the choice? Is the person being coerced? Who should be involved in the decision? Is the person’s suffering untreatable? The use of Advance Euthanasia Directives (AED) is suggested as a way to deal with end-of-life wishes of persons with dementia. However, in the Netherlands—the only country in which this practice is legal—the experiences of patients, doctors, and relatives have been far from satisfactory.

Our paper analyses this complex ethical challenge from a Dignity-Enhancing Care approach, starting from the Dutch experiences with AED as a case. We first consider the lived experiences of the different stakeholders, seeking out a dialogical-interpretative understanding of care. We aim to promote human dignity as a normative standard for end-of-life care practices. Three concrete proposals are then presented in which this approach can be operationalised in order to deal respectfully with the end-of-life choices of persons with dementia.
Is HbA1c an ideal biomarker of well-controlled diabetes?
Authors: Kaiafa Georgia , Veneti Stavroula , Polychronopoulos George , Pilalas Dimitrios , Daios Stylianos , Kanellos Ilias , Didangelos Triantafyllos , Pagoni Stamatina , Savopoulos Christos
Published: May 2021

HbA1c is a biomarker with a central role in the diagnosis and follow-up of patients with diabetes, although not a perfect one. Common comorbidities encountered in patients with diabetes mellitus, such as renal insufficiency, high output states (iron deficiency anaemia, haemolytic anaemia, haemoglobinopathies and pregnancy) and intake of specific drugs could compromise the sensitivity and specificity of the biomarker. COVID-19 pandemic poses a pressing challenge for the diabetic population, since maintaining optimal blood glucose control is key to reduce morbidity and mortality rates. Alternative methods for diabetes management, such as fructosamine, glycosylated albumin and device-based continuous glucose monitoring, are discussed.
Validation of a machine learning approach to estimate Systemic Lupus Erythematosus Disease Activity Index score categories and application in a real-world dataset
Authors: Alves Pedro , Bandaria Jigar , Leavy Michelle B , Gliklich Benjamin , Boussios Costas , Su Zhaohui , Curhan Gary
Published: May 2021

Objective

Use of the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) in routine clinical practice is inconsistent, and availability of clinician-recorded SLEDAI scores in real-world datasets is limited. This study aimed to validate a machine learning model to estimate SLEDAI score categories using clinical notes and to apply the model to a large, real-world dataset to generate estimated score categories for use in future research studies.

Methods

A machine learning model was developed to estimate an individual patient’s SLEDAI score category (no activity, mild activity, moderate activity or high/very high activity) for a specific encounter date using clinical notes. A training cohort of 3504 encounters and a separate validation cohort of 1576 encounters were created from the OM1 SLE Registry. Model performance was assessed using the area under the receiver operating characteristic curve (AUC), calculated using a binarised version of the outcome that sets the positive class to be those records with clinician-recorded SLEDAI scores >5 and the negative class to be records with scores ≤5. Model performance was evaluated by categorising the scores into the four disease activity categories and by calculating the Spearman’s R value and Pearson’s R value.

Results

The AUC for the two categories was 0.93 for the development cohort and 0.91 for the validation cohort. The model had a Spearman’s R value of 0.7 and a Pearson’s R value of 0.7 when calculated using the four disease activity categories.

Conclusion

The model performs well when estimating SLEDAI score categories using unstructured clinical notes.