bluuebunny/crossref_metadata_2025 huggingface dataset:
Systematization of Presentation of Virtual Cases in a Postdoctoral Program in Orthodontics
Authors: Domínguez Camacho Ángela , Velásquez Cuajar Sergio Andrés
Published: May 2021

Background: Incorporating information and communication technologies (ICTs) as a teaching tool for the postgraduate orthodontics program at Unicoc-Cali, Colombia, has generated a transformative change in the dynamics of the presentation of cases. Purpose: To systematize the learning experience: Presentation of virtual clinical cases carried out by residents of the third and fifth semester of the Orthodontic postgraduate course at Unicoc (Cali-Colombia), during the period 2018-2019. Methods: A database, virtual survey and focus group with residents were carried out. Results: The new methodology allowed an additional 130% of cases presented compared to the previous year. The benefits that the residents found in the virtual methodology were in their order: reduction in waiting times, facilitates the presentation process, streamlines the presentation and improves the flow of patients. Conclusions: The implemented didactic proposal enriches the postgraduate teaching-learning process because the audiovisual resource allows them to leave a useful record for the autonomous study of their own cases and that of their classmates. Their access is flexible in terms of time and space while allowing them to advance their learning at their own pace. The scheme was reproducible by all residents. The didactics allowed the presentations to be shown to other specialists to facilitate the inter-consultation process. The benefits found in the virtual methodology were: reduction in waiting times, facilitates the presentation process, streamlines the presentation and improves the flow of patients.
Virtual Simulators: A Tool for Current Dental Education. Integrative Review
Authors: Morón Araújo Michelle
Published: May 2021

Background: In the wake of the COVID-19 pandemic, the use of virtual reality in education has increased. However, it is necessary to better understand its possibilities, precision, and user perception for the development of dental teaching. Purpose: To analyze current literature about virtual reality simulation and its implementation in dental education. Methods: Articles listed in different databases (PubMed, Cochrane, Javeriana University library catalog, and SciELO) describing studies on the use of virtual simulators in dentistry teaching were identified and reviewed. Articles published between 2010 and 2020 were reviewed. Results: From a total of 1030 titles identified, 13 articles were selected to conduct the integrative review. Most of the articles were evaluations of specific cohorts who received training, mainly related to preclinical activities. Some studies were controlled clinical trials and other qualitative evaluations. Only one study had a two-year longitudinal design. In all cases, the results and perception of virtual reality simulation were positive. Conclusions: The virtual reality simulation methodology shows promising results for dental teaching.
Generation Mechanism of Broadband Whoosh Noise in an Automotive Turbocharger Centrifugal Compressor
Authors: Dehner Rick , Sriganesh Pranav , Selamet Ahmet , Miazgowicz Keith
Published: May 2021

The present study focuses on the acoustics of a turbocharger centrifugal compressor from a spark-ignition internal combustion engine. Whoosh noise is typically the primary concern for this type of compressor, which is loosely characterized by a broadband sound elevation in the 4–13 kHz range. To identify the generation mechanism of broadband whoosh noise, the present study combines three approaches: three-dimensional (3D) computational fluid dynamics (CFD) predictions, experiments, and modal decomposition of 3D CFD results. After establishing the accuracy of predictions, flow structures and time-resolved pressures are closely examined in the vicinity of the main blade leading edge. This reveals the presence of rotating instabilities that may interact with the rotor blades to generate noise. An azimuthal modal decomposition is performed on the predicted pressure field to determine the number of cells and the frequency content of these rotating instabilities. The strength of the rotating instabilities and the frequency range in which noise is generated as a consequence of the rotor-rotating instability interaction correspond well with the qualitative trend of the whoosh noise that is measured several duct diameters upstream of the rotor blades. The variation of the whoosh frequency range between low and high rotational speeds is interpreted through this analysis. It is also found that the whoosh noise primarily propagates along the duct as acoustic azimuthal modes. Hence, the inlet duct diameter, which governs the cut-off frequency for multi-dimensional acoustic modes, determines the lower frequency bound of the broadband noise.
Study on Lifted Flame Stabilization Under Different Background Pressures
Authors: Qin Qiushi , Wu Zhijun , Ferrari Alessandro
Published: May 2021

A numerical experimental investigation is presented for a steady methane lifted flame and a nonreaction jet flow in a co-flow of hot combustion products from lean premixed air-hydrogen combustion. The main objective has been to analyze the dependence of methane jet flame stability on the background pressure: a pressurized vitiated co-flow burner (PVCB) has been used to study the methane lifted flame and nonreaction jet flow under different background pressures (1–1.5 bars). The lifted flame is characterized by a liftoff height, which has been measured with a high-speed camera, and a central jet flow defined by the jet velocity, which has been measured by means of a high-sensitivity Schlieren imaging system. The experimental results show that the liftoff height decreases for an increment in the background pressure (from 1 to 1.5 bar at 1073 K) and in the co-flow temperature (from 1058 K to 1118 K at 1 bar). The standard deviation of the liftoff height also reduces for an increase in either the background pressure or the co-flow temperature, which indicates that the liftoff height is more stable at higher background pressures and co-flow temperatures. As far as the experimental tests on the nonreaction jet flow is concerned, the jet velocity becomes extinct faster as the background pressure rises, which is consistent with the decrease in the liftoff height as the background pressure grows. The evolution of the jet velocity has been proved to be another important factor that affects the liftoff height under different background pressures (physical factor), in addition to the fuel autoignition delay (chemical factor). The simulation data led with a Reynolds-averaged Navier–Stokes (RANS)/probability density function (PDF) model show that an increment in the background pressure makes the temperatures increase and induces a brighter yellow part of lifted flame, which leads to more soot production. This proves that the flame is not completely premixed. On the other hand, the Schlieren images of the non-reaction jet flow highlight that the flame is partially premixed, since the edge of the jet is not well defined, as the jet penetration increases with time. The liftoff height values of the flame in the numerical simulations were found to be generally higher than those measured in the corresponding experiments. This discrepancy was caused by an appreciable radiation heat loss at the thermocouple. A correlation was therefore developed for the thermocouple temperature measurement in order to correct the inaccuracy.
The Effect of Exercise Training on Serum Glucose and Lipid Profiles in Patients With Breast Cancer: A Systematic Review and Meta-Analysis of Randomized Clinical Trials
Authors: Abbasi Fatemeh , Khademi Zeinab , Eslami Rasoul , Milajerdi Alireza
Published: May 2021

Background: Despite several studies on the effects of exercise training on glucose and lipid profiles in patients with breast cancer, no earlier study has systematically summarized their findings. Current systematic review and meta-analysis have been done on earlier clinical trials in this topic. Methods: Relevant studies published up to May 2020 were searched through PubMed, SCOPUS, and Google Scholar using predefined keywords. Studies that examined the effect of exercise training on serum glucose and lipid profiles in adult women with breast cancer were included. Results: A total of 16 studies were included. Combining 10 effect sizes, exercise training had no significant influence on serum fasting plasma glucose concentrations (weighted mean difference [WMD] = 4.87; 95% confidence interval [CI], −4.65 to 14.29). However, it resulted in significant reduction of serum insulin (WMD = −2.37; 95% CI, −3.57 to −1.16) and homeostatic model assessment for insulin resistance (WMD = −0.71; 95% CI, −1.27 to −0.15) in 14 and 8 studies, respectively. Pooling 6 effect sizes, exercise training did not change serum total cholesterol (WMD = −11.99; 95% CI, −32.42 to 8.45), low-density lipoprotein (WMD = −3.21; 95% CI, −10.45 to 4.04), high-density lipoprotein (WMD = 4.13; 95% CI, −6.20 to 14.46), and triglyceride (WMD = −23.34; 95% CI, −66.96 to 20.29) concentrations. Subgroup analyses showed beneficial effects of exercise training on outcomes of interest among studies with higher methodological quality. Conclusion: Current meta-analysis demonstrated significant reductions in serum levels of insulin and insulin resistance following exercise training. However, exercise training had no significant effect on serum levels of fasting plasma glucose, total cholesterol, triglyceride, high-density lipoprotein, and low-density lipoprotein. Further high-quality studies are needed to shed light on this issue.
Neural Mobilization Short-Term Dose Effect on the Lower-Limb Flexibility and Performance in Basketball Athletes: A Randomized, Parallel, and Single-Blinded Study
Authors: Pereira Andreia , Teixeira Cátia , Pereira Karla , Ferreira Leandro , Marques Maria , Silva Anabela G.
Published: May 2021

Context: Neural mobilization is commonly used in sports, and previous studies have suggested that it has a positive impact on lower-limb flexibility and performance. However, studies exploring the effect of neural mobilization dosage are almost nonexistent. Objectives: This study aimed to assess whether 2 distinct dosages of neural gliding mobilization (4 and 8 sets of 10 repetitions) impact the flexibility and performance of both the mobilized and nonmobilized lower limb in basketball athletes differently. Design: Randomized, parallel, and single-blinded study. Setting: Amateur and professional basketball clubs. Participants: Fifty-two basketball athletes (40 men and 12 women), who were distributed into 2 groups; one received 40 (n = 28) and the other 80 repetitions (n = 24) of neural gliding mobilization. Intervention: Neural gliding mobilization applied to a single limb (the dominant limb). Main Outcome Measures: Knee extension angle for hamstring flexibility; hop tests and single-leg vertical jump for performance. Results: There was a significant main effect of time (P < .001), a significant interaction between time and limb for flexibility (P = .003), and a significant interaction between time and limb for the single-leg hop test (P = .032). No other significant main effect for any of the remaining variables was found (P > .05). Conclusions: The application of both 40 repetitions and 80 of neural gliding significantly improved lower-limb flexibility, and one was not superior to the other. Neither one dosage nor the other positively or negatively impacted the lower-limb performance of basketball athletes.
Shedding of Viable Virus in Asymptomatic SARS-CoV-2 Carriers
Authors: Murata Takayuki , Sakurai Aki , Suzuki Masahiro , Komoto Satoshi , Ide Tomihiko , Ishihara Takuma , Doi Yohei
Published: May 2021

A growing number of studies suggest the potential role of asymptomatic SARS-CoV-2 carriers as a major driver of the COVID-19 pandemic; however, virological assessment of asymptomatic infection has largely been limited to reverse transcription-PCR (RT-PCR), which can be persistently positive without necessarily indicating the presence of viable virus (e.g., replication-competent virus). Here, we evaluated the infectivity of asymptomatic SARS-CoV-2 carriers by detecting SARS-CoV-2-induced cytopathic effects on Vero cells using longitudinally obtained nasopharyngeal samples from asymptomatic carriers.
POS1179 POST COVID ARTHRITIS; REACTIVE ARTHRITIS OR RHEUMATIC DISEASE FLARE OR BOTH
Authors: Fayed F. , Abdelkarim E.
Published: May 2021

Background:

Reactive arthritis (ReA) is an emerging arthritis after viral infection especially respiratory and gastrointestinal related viruses. In 2020, SARS-COV2 virus is sweeping worldwide with diverse symptoms and prolonged post-Covid manifestations in which are arthralgia and myalgia are frequently present for days and even months. Interestedly, arthritis in covid era is a part of ReA or a flare of autoimmune disease, it is challenging.(1)

Objectives:

Our objective was to determine the frequency of musculoskeletal symptoms with SARS-COV2 virus and after recovery as well as its relation to autoimmune diseases flares.

Methods:

A Prospective study was done on 241 patients who admitted to the Rheumatology clinic from March 2020 to January 2021, complaining from new onset of musculoskeletal symptoms. Detailed history, Examination of systems including Musculoskeletal, laboratory investigation, past history of existing rheumatic disease, and history of infection with covid 19.

Results:

Among 241 patients with median age 34.4, 36.92% had an existing Rheumatic disease while 63.08% are not. Moreover, 39% of patients had a post history with covid 19 within weeks. The most frequent Musculoskeletal symptoms are myalgia (74.56%), arthralgia (69.36%), and arthritis (10.78%). Furthermore, ReA (Post covid arthritis) accounted (2.07%) especially monoarthritis of Ankle (68.75%) while rheumatic diseases flares (24.48%) as well as new onset rheumatic diseases (39.68%). (p ≤0.001) patients of ReA improved on NSAID and intrarticular injection of glucocorticosteroid.

Conclusion:

Covid 19 is one of environmental triggers for development of rheumatic disease as well as reactive arthritis post viral infections. ReA is commonly affected the Ankle joint mainly monoarthritis and had improved on oral NSAID and intrarticular injection of Glucocorticosteroid.

References:

[1]Schett, G., Manger, B., Simon, D. et al. COVID-19 revisiting inflammatory pathways of arthritis. Nat Rev Rheumatol16, 465–470 (2020).

Disclosure of Interests:

None declared.
POS1127 ULTRASOUND ASSESSMENT OF GOUT LESIONS IN AN ALGERIAN POPULATION WITH ASYMPTOMATIC HYPERURICEMIA
Authors: Bengana B. , Ladjouze-Rezig A. , Ayoub S. , Raaf N. B. , Aimeur C. , Boukabous A. , Lefkir S.
Published: May 2021

Background:

Hyperuricemia is a common biological abnormality, often clinically asymptomatic. However, it can announce a gout and be linked to many diseases such as metabolic syndrome, high blood pressure or kidney disease.

In fact, the majority of learned societies do not recommend any urate lowering therapy (ULT) as long as the hyperuricemia remains asymptomatic. But it turns out that part of the population with asymptomatic hyperuricemia (AH) develops a gout after a few years particularly with genetic predisposition, but also on certain risk factors that need to be confirmed.

By this way, musculoskeletal ultrasound (MUS) can detect “asymptomatic gout” by visualizing signs of urate deposits (UD) in subjects with AH.

Objectives:

Our main objective is already to estimate the prevalence of specific signs of gout in Algerian population with AH and assess the factors exposing to UD.

Methods:

This is a descriptive cross-sectional study from January 2017 to February 2019, with the recruitment of subjects with AH and serum urate level > 60 mg / L, who do not take any ULT and have not associated any chronic inflammatory rheumatism, where we performed a MUS of the knees, metatarsophalangeal joints MTP1, MTP2 and metacarpophalangeal joint MCP2 and MCP3 with the Achilles, patellar and quadricipital tendons.

Results:

We retained 258 subjects with AH, 132 women and 126 men (sex ratio = 0.95), the mean age was 59 years, the mean body mass index (BMI) was 28.4 kg / m2, 42 patients were under diuretics, 37 patients reported being on low-dose of aspirin 100 mg daily.

The mean rate of serum urate levels was 78 ± 10 mg / L, the prevalence of UD found at the MUS was 22% (n = 58), among them 36 % (21/58) had a sign of the double contour DC on the MTP1 and 29% (17/58) on the knee, 7% (4/58) had tophi on the MTP1 and 3% (2/58) had urate aggregates. The factors reported to be linked to UD in the sample were: the male gender (p = 0.0016); the high uric acid level (p= 0.0355); BMI (p = 0.0427); taking diuretics for women (p= 0.0002).

Conclusion:

Through this work, it is clear that elementary ultrasound lesions related to gout disease are common in a population with AH and concerned one fifth of subjects in our study with a higher risk in men and subjects with obesity and high uric acid level, but also in women taking diuretics. These results need to be enhanced with a randomized controlled study in order to better determine the predisposing factors for gout in any subject with AH.

Disclosure of Interests:

None declared.
POS0916 SAFETY OF BIOLOGIC TREATMENTS IN SOLID ORGAN TRANSPLANT RECIPIENTS: A SYSTEMATIC REVIEW
Authors: Frederic M. , Delphine W. V. , Prati C. , Wendling D. , Verhoeven F.
Published: May 2021

Background:

The management of a broad spectrum of autoimmune/inflammatory diseases has been transformed with the development of biological treatments. However, little is known about their use in solid organ transplant recipients, a group of patients with high risk of serious infections and malignancies.

Objectives:

To evaluate complications occurring with biologic treatments in solid-organ transplant recipients.

Methods:

A systematic review of the literature was performed on the PubMed including Medline, Embase and Cochrane databases, up to 01/10/2020, to identify published case reports/series regarding the use of biologic treatments in solid organ transplant recipients in the context of chronic inflammatory diseases. Collected data were patient’s characteristics (age, sex, reason for transplantation, antirejection regimen, type of biological treatment used, autoimmune/inflammatory disease treated, time between transplantation and biotherapy initiation, treatment duration) and their reported complications (deaths, infections, malignancies, graft dysfunction).

Results:

55 papers were included, representing 177 patients (131 liver, 42 kidney, 3 heart, and 1 liver-kidney transplant recipients). Inflammatory bowel diseases represented largely the most common indication of biologic treatment initiation (80.2%), followed by rheumatic diseases (7.3%), hereditary periodic fever syndromes (6.2%) and psoriasis (5.1%). Anti-TNFα were mainly used (81.4%) before anti- α4β7 integrin Vedolizumab (23.7%) and anti-IL1R Anakinra (7.3%). 25/177 patients had several lines of different treatments. Median treatment duration was 13.5 months. Infections occurred in 48 patients (27.1%) through 76 recorded flares (mostly bacterial 68.4% and viral 19.7%). No therapeutic or epidemiological factor was associated with the occurrence of an infection. 16 patients (9.0%) developed malignancies, especially colorectal (4 cases, 2.3%) and skin cancers (4 cases, 2.3%) or Post-transplantation lymphoproliferative disorders (3 cases, 1.7%). Acute graft rejections occurred in 5 patients (2.8%), mostly in kidney transplants (4/5). Among a total of 177 patients, 6 deaths were identified (3.4%).

Conclusion:

This review gathers, to our knowledge, the largest number of published case series/reports about the use of biological treatments in solid organ transplant recipients, providing data about their safety. Caution must be taken about eventual publication bias and the necessity of further head-to-head analysis comparing complications occurring in solid organ transplant recipients cohorts with and without biologic treatments.

Disclosure of Interests:

None declared
POS0045 LEAST SIGNIFICANT CHANGE IN BONE DENSITOMETRY IN PATIENTS WITH OBESITY
Authors: Claire D. , Geoffroy M. , Kanagaratnam L. , Isabelle C. , Hittinger A. , Loïs B. , Clément C. , Salmon J. H.
Published: May 2021

Background:

Dual energy X-ray absoprtiometry is the reference method to mesure bone mineral density (1). Loss of bone mineral density is significant if it exceeds the least significant change. The threshold value used in general population is 0,03 g/cm2 (2). Patients with obesity are known for having a higher bone mineral density due to metabolism and physiopathology characteristics (3,4).

Objectives:

The aim of our study was to determine the least significant change in bone densitometry in patients with obesity.

Methods:

We conducted an interventionnal study in 120 patients with obesity who performed a bone densitometry. We measured twice the bone mineral density at the lumbar spine, the femoral neck and the total hip in the same time (5,6). We determined the least significant change in bone densitometry from each pair of measurements, using the Bland and Altman method. We also determined the least significant change in bone densitometry according to each stage of obesity.

Results:

The least significant change in bone densitometry in patients with obesity is 0,046g/cm2 at the lumbar spine, 0.069 g/cm2 at the femoral neck and 0.06 g/cm2 at the total hip.

Conclusion:

The least significant change in bone densitometry in patients with obesity is higher than in general population. These results may improve DXA interpretation in this specific population, and may personnalize their medical care.

References:

[1]Lees B, Stevenson JC. An evaluation of dual-energy X-ray absorptiometry and comparison with dual-photon absorptiometry. Osteoporos Int. mai 1992;2(3):146-52.

[2]Briot K, Roux C, Thomas T, Blain H, Buchon D, Chapurlat R, et al. Actualisation 2018 des recommandations françaises du traitement de l’ostéoporose post-ménopausique. Rev Rhum. oct 2018;85(5):428-40.

[3]Shapses SA, Pop LC, Wang Y. Obesity is a concern for bone health with aging. Nutr Res N Y N. mars 2017;39:1-13.

[4]Savvidis C, Tournis S, Dede AD. Obesity and bone metabolism. Hormones. juin 2018;17(2):205-17.

[5]Roux C, Garnero P, Thomas T, Sabatier J-P, Orcel P, Audran M, et al. Recommendations for monitoring antiresorptive therapies in postmenopausal osteoporosis. Jt Bone Spine Rev Rhum. janv 2005;72(1):26-31.

[6]Ravaud P, Reny JL, Giraudeau B, Porcher R, Dougados M, Roux C. Individual smallest detectable difference in bone mineral density measurements. J Bone Miner Res. août 1999;14(8):1449-56.

Disclosure of Interests:

None declared.
POS0957 THE PREVALENCE AND FACTORS RELATED TO SLEEP APNOEA IN ANKYLOSING SPONDYLITIS
Authors: Forsblad-D’elia H. , Wiginder A. , Sahlin-Ingridsson C. , Geijer M. , Franklin K. , Blomberg A.
Published: May 2021

Background:

An increased prevalence of obstructive sleep apnoea (OSA) has been suggested in ankylosing spondylitis (AS), but few controlled studies have been performed.

Objectives:

We thus aimed to study the prevalence of OSA in patients with AS compared to controls and to study if disease-related and non-disease-related factors were determinants of OSA in AS patients.

Methods:

One hundred and fifty-five patients with AS were included in the Backbone study that investigates severity and comorbidities in AS. Controls were recruited from the Swedish CardioPulmonary bioImage Study (SCAPIS). Participants were asked to be examined with a home sleep-monitoring device during one night’s sleep to evaluate the presence of OSA. For each AS patient, 45-70 years, four controls were matched for sex, age, weight and height. OSA was defined as an apnoea-hypopnea-index ≥5 events/hour.

Results:

In total, 63/155(40.6%) patients with AS were examined with a home sleep-monitoring device out of which 46 patients were 45-70 years and therefore matched (mean age 57.2±7.5years, 30(65.2%) men) with 179 controls (mean age 57.2±4.5years, 123(68.7%) men). Twenty-two out of 46(47.8%) patients with AS vs. 91/179(50.8%) controls had OSA, p=0.72. No differences measurements evaluating OSA were noted in AS vs. controls. In logistic regression analysis, based on all 63 examined AS-patients, several AS-related variables were associated with OSA but after adjusting for age and sex, only higher age and BMI, remained to be significant determinants of OSA, Table 1.

Table 1.

Univariable and age- and sex-adjusted logistic regression analyses with obstructive sleep apnoea as dependent variable in 63 patients with ankylosing spondylitis.

VariablesUnivariable logistic regression analyses, Odds Ratio (95%CI)PAge- and sex-adjusted logistic regression analyses,
Odds Ratio (95%CI)PSex, male1.9(0.6-5.5)0.251.5(0.4-4.8)0.53Age1.1(1.0-1.2)0.0021.1(1.0-1.2)0.002BMI1.4(1.1-1.7)0.0011.6(1.2- 2.2)0.001Duration of symptoms1.1(1.0-1.1)0.0281.0(0.9-1.1)0.79BASMI1.9(1.3-2.9)0.0021.5(0.9 -2.5)0.87BASFI1.4(1.0-2.0)0.0381.3(0.9-2.0)0.88≥1 Syndesmophyte3.9(1.3-12.2)0.0173.0(0.8-11.3)0.10mSASSS1.0(1.0-1.1)0.0471.0(0.98-1.05)0.25Metabolic syndrome4.3(1.5-12.9)0.0081.4(0.3-6.6)0.69Epworth Sleep Scale1.2(1.0-1-3)0.0231.2(1.0-1.4)0.29

Conclusion:

In this case-control study, patients with AS did not have a higher prevalence of OSA compared to controls. AS patients with OSA had higher BMI and were older compared to patients without OSA.

Disclosure of Interests:

None declared.
Buried Bumper Syndrome: a rare complication during radical chemoradiotherapy for head and neck cancer
Authors: Teo Rachel Pei Jing , Maniam Akash , Boon Ian , Boon Cheng S
Published: May 2021

Patients undergoing radical treatment particularly chemoradiotherapy for cancer of the upper aerodigestive tract frequently experience progressive deterioration in swallow during and immediately after treatment. It is important to identify patients at high risk of compromised feeding early, following diagnosis, so that alternate feeding routes, such as percutaneous endoscopic gastrostomies (PEGs), can be promptly and prophylactically instituted, in keeping with the UK Head and Neck Cancer Guidelines (2016).
Interaction between methadone and clarithromycin as the suspected cause of an opioid toxidrome
Authors: Wallace Blair , Edwardes Daniel , Subbe Christian , Murtaza Muhammed
Published: May 2021

A 40-year-old patient was admitted through the acute medical take with pleuritic chest pain and rigours. He had a medical history of opiate dependence and was receiving 60 mg of methadone once daily. He was diagnosed with a community-acquired pneumonia and treated with amoxicillin and clarithromycin. After administration of only two concomitant doses of methadone and oral clarithromycin, he developed an opioid toxidrome with type-2 respiratory failure, a decreased level of consciousness and pinpoint pupils. The patient was treated with naloxone and his symptoms improved. Retrospectively, it was suspected that an interaction between clarithromycin and methadone might have contributed to the toxidrome. Respiratory failure has not been previously prescribed for this combination of medication and is of high importance for physicians and pharmacists around the world.
Economic evaluation of robot-assisted training versus an enhanced upper limb therapy programme or usual care for patients with moderate or severe upper limb functional limitation due to stroke: results from the RATULS randomised controlled trial
Authors: Fernandez-Garcia Cristina , Ternent Laura , Homer Tara Marie , Rodgers Helen , Bosomworth Helen , Shaw Lisa , Aird Lydia , Andole Sreeman , Cohen David , Dawson Jesse , Finch Tracy , Ford Gary , Francis Richard , Hogg Steven , Hughes Niall , Krebs H I , Price Christopher , Turner Duncan , Van Wijck Frederike , Wilkes Scott , Wilson Nina , Vale Luke
Published: May 2021

Objective

To determine whether robot-assisted training is cost-effective compared with an enhanced upper limb therapy (EULT) programme or usual care.

Design

Economic evaluation within a randomised controlled trial.

Setting

Four National Health Service (NHS) centres in the UK: Queen’s Hospital, Barking, Havering and Redbridge University Hospitals NHS Trust; Northwick Park Hospital, London Northwest Healthcare NHS Trust; Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde; and North Tyneside General Hospital, Northumbria Healthcare NHS Foundation Trust.

Participants

770 participants aged 18 years or older with moderate or severe upper limb functional limitation from first-ever stroke.

Interventions

Participants randomised to one of three programmes provided over a 12-week period: robot-assisted training plus usual care; the EULT programme plus usual care or usual care.

Main economic outcome measures

Mean healthcare resource use; costs to the NHS and personal social services in 2018 pounds; utility scores based on EQ-5D-5L responses and quality-adjusted life years (QALYs). Cost-effectiveness reported as incremental cost per QALY and cost-effectiveness acceptability curves.

Results

At 6 months, on average usual care was the least costly option (£3785) followed by EULT (£4451) with robot-assisted training being the most costly (£5387). The mean difference in total costs between the usual care and robot-assisted training groups (£1601) was statistically significant (p<0.001). Mean QALYs were highest for the EULT group (0.23) but no evidence of a difference (p=0.995) was observed between the robot-assisted training (0.21) and usual care groups (0.21). The incremental cost per QALY at 6 months for participants randomised to EULT compared with usual care was £74 100. Cost-effectiveness acceptability curves showed that robot-assisted training was unlikely to be cost-effective and that EULT had a 19% chance of being cost-effective at the £20 000 willingness to pay (WTP) threshold. Usual care was most likely to be cost-effective at all the WTP values considered in the analysis.

Conclusions

The cost-effectiveness analysis suggested that neither robot-assisted training nor EULT, as delivered in this trial, were likely to be cost-effective at any of the cost per QALY thresholds considered.

Trial registration number

ISRCTN69371850.
Using an integrated knowledge translation or other research partnership approach in trainee-led research: a scoping review protocol
Authors: Cassidy Christine E , Beck Amy Jane , Conway Aislinn , Demery Varin Melissa , Laur Celia , Lewis Krystina B , Ramage Emily R , Nguyen Tram , Steinwender Sandy , Ormel Ilja , Stratton Lillian , Shin Hwayeon Danielle
Published: May 2021

Introduction

Collaborative research approaches, such as co-production, co-design, engaged scholarship and integrated knowledge translation (IKT), aim to bridge the evidence to practice and policy gap. There are multiple benefits of collaborative research approaches, but studies report many challenges with establishing and maintaining research partnerships. Researchers often do not have the opportunity to learn how to build collaborative relationships, and most graduate students do not receive formal training in research partnerships. We are unlikely to make meaningful progress in strengthening graduate and postgraduate training on working collaboratively with the health system until we have a better understanding of how students are currently engaging in research partnership approaches. In response, this scoping review aims to map and characterise the evidence related to using an IKT or other research partnership approach from the perspective of health research trainees.

Methods and analysis

We will employ methods described by the Joanna Briggs Institute and Arksey and O’Malley’s framework for conducting scoping reviews. The reporting will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for scoping reviews checklist. We will include both published and unpublished grey literature and search the following databases: MEDLINE, Embase, CINAHL, PsycINFO, ProQuest Dissertations & Theses Global databases, Google Scholar and websites from professional bodies and other organisations. Two reviewers will independently screen the articles and extract data using a standardised data collection form. We will narratively describe quantitative data and conduct a thematic analysis of qualitative data. We will map the IKT and other research partnership activities onto the Knowledge to Action cycle and IAP2 Levels of Engagement Framework.

Ethics and dissemination

No ethical approval is required for this study. We will share the results in a peer-reviewed, open access publication, conference presentation and stakeholder communications.
Modelling palliative and end-of-life resource requirements during COVID-19: implications for quality care
Authors: Chalk Daniel , Robbins Sara , Kandasamy Rohan , Rush Kate , Aggarwal Ajay , Sullivan Richard , Chamberlain Charlotte
Published: May 2021

Objectives

The WHO estimates that the COVID-19 pandemic has led to more than 1.3 million deaths (1 377 395) globally (as of November 2020). This surge in death necessitates identification of resource needs and relies on modelling resource and understanding anticipated surges in demand. Our aim was to develop a generic computer model that could estimate resources required for end-of-life (EoL) care delivery during the pandemic.

Setting

A discrete event simulation model was developed and used to estimate resourcing needs for a geographical area in the South West of England. While our analysis focused on the UK setting, the model is flexible to changes in demand and setting.

Participants

We used the model to estimate resourcing needs for a population of around 1 million people.

Primary and secondary outcome measures

The model predicts the per-day ‘staff’ and ‘stuff’ resourcing required to meet a given level of incoming EoL care activity.

Results

A mean of 11.97 hours of additional community nurse time, up to 33 hours of care assistant time and up to 30 hours additional care from care assistant night sits will be required per day as a result of out of hospital COVID-19 deaths based on the model prediction. Specialist palliative care demand is predicted to increase up to 19 hours per day. An additional 286 anticipatory medicine bundles per month will be necessary to alleviate physical symptoms at the EoL care for patients with COVID-19: an average additional 10.21 bundles of anticipatory medication per day. An average additional 9.35 syringe pumps could be needed to be in use per day.

Conclusions

The analysis for a large region in the South West of England shows the significant additional physical and human resource required to relieve suffering at the EoL as part of a pandemic response.
Impact of home telemonitoring and management support on blood pressure control in non-dialysis CKD: a systematic review protocol
Authors: Okpechi Ikechi G , Muneer Shezel , Tinwala Mohammed M , Zaidi Deenaz , Hamonic Laura N , Braam Branko , Jindal Kailash , Klarenbach Scott , Padwal Raj S , Shojai Soroush , Thompson Stephanie , Bello Aminu K
Published: May 2021

Introduction

Hypertension is a common public health problem and a key modifiable risk factor for cardiovascular (CV) and chronic kidney disease (CKD). Home blood pressure (BP) telemonitoring (HBPT) and management is associated with improved BP control, accelerated delivery of care and decision-making strategies that can reduce adverse outcomes associated with hypertension. The aim of this paper is to describe the protocol for a systematic review to assess the impact of HBPT interventions used for improving BP control and reducing CV and kidney outcomes in non-dialysis CKD patients.

Methods

We developed this protocol using the Preferred Reporting Items for Systematic reviews and Meta-Analyses for Protocols 2015. We will search empirical databases such as MEDLINE, Embase, Cochrane Library, CINAHL, Web of Science and PsycINFO and grey literature for studies conducted in non-dialysis CKD patients on interventions using HBPT and reporting outcomes related to BP control and other outcomes such as CV events and kidney disease progression. All studies meeting these criteria, in adults and published from inception until 2020 with no language barrier will be included.

Ethics and dissemination

Ethical approval will not be required for this review as the data used will be extracted from already published studies with publicly accessible data. As this study will assess the impact of HBPT on BP control in non-dialysis CKD patients, evidence gathered through it will be disseminated using traditional approaches that includes open-access peer-reviewed publication, scientific presentations and a report. We will also disseminate our findings to appropriate government agencies.

PROSPERO registration number

CRD42020190705).
Fast track to cricket: occupational therapists in hospital palliative medicine
Authors: Miller Mary , Ford Rebecca , Smithers Bronwen
Published: May 2021

The role of occupational therapy in palliative care has been described and unique contributions have been highlighted. This case report describes the support provided by specialist palliative care occupational therapists (OTs) for a patient in an emergency department in a large teaching hospital. This support enabled the patient to return home to die and enabled him to achieve his most important goal, watching ‘The Ashes’ on television.Having specialist palliative care OTs in an acute setting has not been described. Their presence as part of the team helps mitigate the risk of urgent discharge as the specialist OTs provide continuity of care from the hospital setting to follow-up in the community. They help support families in providing care for their dying relative. Communication skills training is vital for the specialist OTs enabling honest and timely conversations including the documentation of do not attempt cardiopulmonary resuscitation discussions.
Knowledge and prevalence of energy drinks consumption in Shanghai, China: a cross-sectional survey of adolescents
Authors: Luo Ruyan , Fu Rao , Dong Lu , Du Zheyi , Sun Wei , Zhao Min , Du Jiang
Published: May 2021

Background

In recent years, energy drinks (EDs) have been widely used among young people around the world. The extensive use of EDs also affects the sleep and exercise of adolescents.

Aims

This study aimed to investigate the consumption of EDs, the knowledge, attitude towards EDs and associated factors of EDs consumption among adolescents in Shanghai, China.

Methods

A total of 4608 adolescents completed a self-administered questionnaire assessing EDs use history, knowledge and attitude towards EDs. Adolescent Self-rating Life Events Checklist (ASLEC) was used to assess their life events. All participants were divided into two groups based on whether they used them or not. t-test and χ2test were used to compare the differences between the two groups, and binary logistic regression analysis was used to investigate the related factors for EDs consumption.

Results

70.5% of the participants reported having ever used EDs. The main avenues to getting information on EDs were from advertisements. 67.56% of them believed that EDs had adverse effects on health. 22.09% of the participants and 31.55% of their parents took a negative attitude towards EDs. Compared with the non-consumption group, participants in the consumption group were likely to be male, with older age, identified EDs more correctly and did not believe EDs had adverse effects, with more positive attitude and higher ASLEC score. Logistic regression results showed that gender, age, attitude of parents and themselves, knowledge of EDs and ASLEC score significantly predicted EDs consumption.

Conclusion

EDs consumption was popular among adolescents in Shanghai, and the tailored intervention programmes need to be developed based on the characteristics of adolescents.
T cell engaging bispecific antibodies targeting CD33 IgV and IgC domains for the treatment of acute myeloid leukemia
Authors: Hoseini Sayed Shahabuddin , Vadlamudi Mallika , Espinosa-Cotton Madelyn , Tran Hoa , Feng Yi , Guo Hong-fen , Xu Hong , Cheung Irene , Cheung Nai-Kong V
Published: May 2021

Background

Acute myeloid leukemia (AML) remains one of the most challenging hematological malignancies. Despite progress in therapeutics, majority of patients succumb to this neoplasm. CD33 is a proven therapeutic target, given its expression on most AML cells. Almost all anti-CD33 antibodies target the membrane distal immunoglobulin V (IgV) domain of the CD33 extracellular domain.

Methods

In this manuscript, we present data on three bispecific antibodies (BsAbs) against the CD33 IgV and membrane proximal immunoglobulin C (IgC) domains. We use in vitro binding and cytotoxicity assays to show the effect of these BsAbs on AML cell lines. We also use immunodeficient mice-bearing leukemias from cell lines and patient-derived xenografts to show the effect of these BsAbs in vivo.

Results

In vitro, the IgV-targeting BsAb had higher binding to AML cell lines using flow cytometry and delivered more potent cytotoxicity in T-cell-dependent cytotoxicity assays; importantly, the IgC domain-targeting outperformed the IgV domain-targeting BsAb in medullary and extramedullary leukemia animal models.

Conclusions

These data support further clinical development of this BsAb for first-in-human phase I clinical trial.
Bridging versus direct endovascular therapy in basilar artery occlusion
Authors: Nappini Sergio , Arba Francesco , Pracucci Giovanni , Saia Valentina , Caimano Danilo , Limbucci Nicola , Renieri Leonardo , Zini Andrea , Inzitari Domenico , Toni Danilo , Mangiafico Salvatore
Published: May 2021

Background

We evaluated safety and efficacy of intravenous recombinant tissue Plasminogen Activator plus endovascular (bridging) therapy compared with direct endovascular therapy in patients with ischaemic stroke due to basilar artery occlusion (BAO).

Methods

From a national prospective registry of endovascular therapy in acute ischaemic stroke, we selected patients with BAO. We compared bridging and direct endovascular therapy evaluating vessel recanalisation, haemorrhagic transformation at 24–36 hours; procedural complications; and functional outcome at 3 months according to the modified Rankin Scale. We ran logistic and ordinal regression models adjusting for age, sex, National Institutes of Health Stroke Scale (NIHSS), onset-to-groin-puncture time.

Results

We included 464 patients, mean(±SD) age 67.7 (±13.3) years, 279 (63%) males, median (IQR) NIHSS=18 (10–30); 166 (35%) received bridging and 298 (65%) direct endovascular therapy. Recanalisation rates and symptomatic intracerebral haemorrhage were similar in both groups (83% and 3%, respectively), whereas distal embolisation was more frequent in patients treated with direct endovascular therapy (9% vs 3%; p=0.009). In the whole population, there was no difference between bridging and direct endovascular therapy regarding functional outcome at 3 months (OR=0.79; 95% CI=0.55 to 1.13). However, in patients with onset-to-groin-puncture time ≤6 hours, bridging therapy was associated with lower mortality (OR=0.53; 95% CI=0.30 to 0.97) and a shift towards better functional outcome in ordinal analysis (OR=0.65; 95% CI=0.42 to 0.98).

Conclusions

In ischaemic stroke due to BAO, when endovascular therapy is initiated within 6 hours from symptoms onset, bridging therapy resulted in lower mortality and better functional outcome compared with direct endovascular therapy.
Energy harvesting from car suspension using a single magnet device
Authors: Chiu Min-Chie , Karkoub Mansour , Her Ming-Guo
Published: May 2021

The need for renewable energy sources and harvesting devices has increased over the years for environmental and economical reasons. Cars, for example, have gone through important transformations over the past decade, which led to the inception of the hybrid type. The idea is to harness some of the dissipated energy and reuse it to operate a vehicle. A lot of energy is dissipated into the environment from the suspension system; therefore, harnessing that energy could be very useful for powering up electrical systems in a car. A magnetic mass-spring system to harvest the vibrational energy dissipated from the car’s suspension system that maximizes electricity generation and minimizes ride discomfort is presented in this work. The comfort level for the passenger via three dimensionless indices, including a regenerated electricity transmissibility, displacement transmissibility performance, and ride comfort performance, is introduced. To maximize the regenerated electricity indicator and minimize the discomfort indices, a multi-objective function based on the above indices and three weighted factors in conjunction with the Simulated Annealing method is used to obtain the optimal physical parameters for the harvesting device. The theoretical developments are demonstrated under constant and varied driving speeds, and the simulation results show that the energy harvester is capable of producing reasonable amounts of electricity while maintaining a good comfort level. In fact, it was shown that the harvester can generate 0.045 V when the car travels at 60 km/h with an acceleration of 0.43 m/s2 and assumed base excitation amplitude of 0.05 m. Higher voltages were achievable with larger base excitation amplitudes and (or) accelerations.
ESS Cryogenic Controls Design
Authors: Arnold P. , Boros M. , Nilsson P.
Published: May 2021

The European Spallation Source (ESS) is a neutron-scattering facility funded and supported in collaboration with 13 European countries in Lund, Sweden. Cryogenic cooling at ESS is vital particularly for the linear accelerator, the hydrogen target moderators, a test stand for cryomodules, the neutron instruments and their sample environments. The paper will focus on the control system design for the different cryogenic subsystems, hardware and software selected, industry and in-house development, advantages and disadvantages of the chosen setup and operational experience. There is also a lessons learned, feedback from providers and stakeholders and an outlook for further development described.
Deriving the dark matter-dark energy interaction term in the continuity equation from the Boltzmann equation
Authors: Ludwick Kevin J. , Sebaugh Holston
Published: May 2021

Dark energy and dark matter are two of the biggest mysteries of modern cosmology, and our understanding of their fundamental nature is incomplete. Many parametrizations of couplings between the two in the continuity equation have been studied in the literature, and observational data from the growth of perturbations can constrain these parametrizations. Assuming standard general relativity with a simple Yukawa-type coupling between dark energy and dark matter fields in the Lagrangian, we use the Boltzmann equation to analytically express and calculate the interaction kernel [Formula: see text] in the continuity equation and compare it to that of a typical parametrization. We arrive at a comparably very small result, as expected. Since the interaction is a function of the dark matter mass, other observational data sets can be used to constrain the mass. This calculation can be modified to account for other couplings of the dark energy and dark matter fields. This calculation required obtaining a distribution function for dark energy that leads to an equation of state parameter that is negative, which neither Bose–Einstein nor Fermi–Dirac statistics can supply, and this is the main result of this paper. Treating dark energy as a quantum scalar field, we use adiabatic subtraction to obtain a finite analytic approximation for its distribution function that assumes the FLRW metric and nothing more.