bluuebunny/crossref_metadata_2025 huggingface dataset:
Retrospective study of comparison of clinical severity and outcome of hospitalised COVID-19 patients during the first and second waves of the pandemic in India
Authors: Kundavaram Abhilash Paul Prabhakar , Selvan Saravanan , Raja Vivek , Mathiyalagan Ponnivalavan , Kanagarajan Rohini , Reddy Narmadha P , Rajendiran Natarajan , Hazra Darpanarayan , Gunasekaran Karthik , Moorthy Mahesh , Lenin Audrin , Mathew Divya , Iyyadurai Ramya , Varghese George M , DJ Christopher , Joy Melvin , Peter John Victor
Published: November 2022

Objectives

To compare the clinical severity and outcome of hospitalised patients during the two waves of the COVID-19 pandemic in India.

Setting

A tertiary care referral hospital in South India.

Participants

Symptomatic SARS CoV-2 reverse transcriptase PCR positive patients presenting to the emergency department during the two waves were recruited. The first wave spanned between April and December 2020 and the second wave between April and May 2021.

Primary and secondary outcome measures

The primary outcome of interest was mortality. Secondary outcomes included illness severity at presentation, need for oxygen therapy, non-invasive ventilation (NIV) and hospital or intensive care unit admission.

Results

The mean (SD) age of the 4971 hospitalised patients in the first wave was similar to the 2293 patients in the second wave (52.5±15.4 vs 52.1±15.1 years, p=0.37). When compared with the first wave, during the second wave, a higher proportion of patients presented with critical illness (11% vs 1.1%, p<0.001) and needed supplemental oxygen therapy (n=2092: 42.1% vs n=1459: 63.6%; p<0.001), NIV (n=643; 12.9% vs n=709; 30.9%; p<0.001) or inotropes/vasoactive drugs (n=108; 2.2% vs n=77: 3.4%; p=0.004). Mortality was higher during the second wave (19.2% vs 9.3%; p<0.001). On multivariable regression analysis, age >60 years (risk ratio, RR 2.80; 95% CI 2.12 to 3.70), D-dimer >1000 ng/mL (RR 1.34; 95% CI 1.15 to 1.55), treatment with supplemental oxygen (RR 14.6; 95% CI 8.98 to 23.6) and presentation during the second wave (RR 1.40; 95% CI 1.21 to 1.62) were independently associated with mortality.

Conclusion

The second wave of the COVID-19 pandemic in India appeared to be associated with more severe presentation and higher mortality when compared with the first wave. Increasing age, elevated D-dimer levels and treatment with supplemental oxygen were independent predictors of mortality.
Can web-based implementation interventions improve physician early diagnosis of cerebral palsy? Protocol for a 3-arm parallel superiority randomised controlled trial and cost–consequence analysis comparing adaptive and non-adaptive virtual patient instructional designs with control to evaluate effectiveness on physician behaviour, diagnostic skills and patient outcomes
Authors: McNamara Lynda , Scott Karen , Boyd Roslyn N , Farmer Elizabeth , Webb Annabel , Bosanquet Margot , Nguyen Kim , Novak Iona
Published: November 2022

Introduction

Cerebral palsy (CP) is the most common childhood physical disability. Accurate diagnosis before 6 months is possible using predictive tools and decision-making skills. Yet diagnosis is typically made at 12–24 months of age, hindering access to early interventions that improve functional outcomes. Change in practice is required for physicians in key diagnostic behaviours. This study aims to close the identified research–practice gap and increase accurate CP diagnosis before 6 months of age through tailored web-based implementation interventions. This trial will determine whether adaptive e-learning using virtual patients, targeting CP diagnostic behaviours and clinical decision-making skills, effectively changes physician behaviour and practice compared with non-adaptive e-learning instructional design or control.

Methods and analysis

This study is a 3-arm parallel superiority randomised controlled trial of two tailored e-learning interventions developed to expedite physician CP diagnosis. The trial will compare adaptive (arm 1) and non-adaptive (arm 2) instructional designs with waitlist control (arm 3) to evaluate change in physician behaviour, skills and diagnostic practice. A sample size of 275 paediatric physicians enables detection of small magnitude effects (0.2) of primary outcomes between intervention comparators with 90% power (α=0.05), allowing for 30% attrition. Barrier analysis, Delphi survey, Behaviour Change Wheel and learning theory frameworks guided the intervention designs. Adaptive and non-adaptive video and navigation sequences utilising virtual patients and clinical practice guideline content were developed, integrating formative key features assessment targeting clinical decision-making skills relative to CP diagnosis.

Physician outcomes will be evaluated based on postintervention key feature examination scores plus preintervention/postintervention behavioural intentions and practice measures. Associations with CP population registers will evaluate real-world diagnostic patient outcomes. Intervention costs will be reported in a cost–consequence analysis from funders’ and societal perspectives.

Ethics and dissemination

Ethics approved from The University of Sydney (Project number 2021/386). Results will be disseminated through peer-reviewed journals and scientific conferences.

Trial registration number

Australian New Zealand Clinical Trials Registry: ACTRN 12622000184774.
Asking youth and adults about child maltreatment: a review of government surveys
Authors: Campeau Aimée , Tanaka Masako , McTavish Jill R , MacMillan Harriet , McKee Chris , Hovdestad Wendy E , Gonzalez Andrea , Afifi Tracie O , Stewart-Tufescu Ashley , Tonmyr Lil
Published: November 2022

Objectives

In this review we: (1) identify and describe nationally representative surveys with child maltreatment (CM) questions conducted by governments in low-income, middle-income and high-income countries and (2) describe procedures implemented to address respondents’ safety and minimise potential distress.

Design

We conducted a systematic search across eight databases from 1 January 2000 to 5 July 2021 to identify original studies with information about relevant surveys. Additional information about surveys was obtained through survey methods studies, survey reports, survey websites or by identifying full questionnaires (when available).

Results

Forty-six studies representing 139 surveys (98 youth and 41 adult) conducted by governments from 105 countries were identified. Surveys implemented a variety of procedures to maximise the safety and/or reduce distress for respondents including providing the option to withdraw from the survey and/or securing confidentiality and privacy for the respondent. In many surveys, further steps were taken such as providing information for support services, providing sensitivity training to survey administrators when interviews were conducted, among others. A minority of surveys took additional steps to empirically assess potential distress experienced by respondents.

Conclusions

Assessing risk and protective factors and developing effective interventions and policies are essential to reduce the burden of violence against children. While asking about experiences of CM requires careful consideration, procedures to maximise the safety and minimise potential distress to respondents have been successfully implemented globally, although practices differ across surveys. Further analysis is required to assist governments to implement the best possible safety protocols to protect respondents in future surveys.
Identifying factors explaining practice variation in secondary stroke prevention in primary care: a cohort study based on all patients with ischaemic stroke in the Stockholm region
Authors: Wolf Maria , Hasselström Jakob K , Carlsson Axel , Euler Mia von , Hasselström Jan
Published: November 2022

Objectives

The aim of this study was to describe the practice variation in dispensation of secondary stroke preventive drugs among patients at different primary care centres (PCCs) in Stockholm region and to identify factors that may explain the variation.

Design

Cohort study using administrative data from the Stockholm region.

Setting

Stockholm Health Care Region, Sweden, serving a population of 2.3 million inhabitants, hospital and PCC data.

Participants

All patients (n=9761) with ischaemic stroke treated in hospital from 1 July 2009 to 30 June 2014 were included. Of these, 7562 patients registered with 187 PCCs were analysed. Exclusion criteria were; deceased patients, age <18, haemorrhagic stroke and/or switching PCC.

Primary and secondary outcome measures

As primary outcome the impact of PCC organisation variables and patient characteristics on the dispensation of statins, antiplatelets, antihypertensives and anticoagulants were analysed. Secondarily, the unadjusted practice variation of preventive drug dispensation of 187 PCCs is described.

Results

There was up to fourfold practice variation in dispensation of all secondary preventive drugs. Factors associated with a lower level of dispensed statins were privately run PCCs (OR 0.91 (95% CI 0.82 to 1.00)) and the patient being woman. Increased statin use was associated with a higher number of specialists in family medicine (OR 1.03 (95% CI 1.01 to 1.05)) and a higher proportion of patients registered with a specific physician (OR 1.37 (95% CI 1.11 to 1.68)). Women had on average a lower number of dispensed antihypertensives.

Conclusions

A high practice variation for dispensation of all secondary preventive drugs was observed. Patient and PCC level factors indicating good continuity of care and high level of general practitioner education were associated with higher use of statins. Findings are of importance to policymakers as well as individual providers of care, and more research and actions are needed to minimise inequality in healthcare.
Cross-sectional study of the knowledge, perception and attitude of first-year university students in Iraq towards SARS-CoV-2 Omicron variant and COVID-19 vaccines
Authors: Abed Mostafa , Al Omari Sarah , Mourad Rida , Al Faraj Achraf
Published: November 2022

Objectives

The aim of this study was to first assess the knowledge and perception of first-year university students in Iraq about COVID-19 in general and SARS-CoV-2 latest variant of concern, and to evaluate the attitudes towards protection measures including vaccination.

Study design

A cross-sectional study was conducted among newly enrolled students at the American University of Iraq-Baghdad. Mann-Whitney U and Kruskal-Wallis tests were used to test an association between the outcomes measured on a 5-point Likert scale and the binary and the categorical independent variables, respectively. χ2test was used to test the association between nominal categorical variables, while Kendall’s τ-b was used for ordinal variables.

Participants

Students (n=432) were invited to fill out a survey specifically tailored to assess their knowledge, perception and attitude towards Omicron variant and COVID-19 vaccines acceptance. 363 students enrolled in various majors participated in this study.

Results

Assessment of COVID-19 knowledge and perception revealed that students still lack reliable info and data about FDA-approved treatment options (70.5%), SARS-CoV-2 variants (96.5%) and approved vaccines. Students’ attitude and practices towards recommended safety measures should be reassessed to better manage the pandemic. Adherence level was shown to be associated with the belief in its capacity to effectively manage the new variant. Interestingly, 85% of the students have received at least one dose of approved vaccine. A significant positive correlation was detected between the level of adherence to recommended precautions and the intention to take a third booster shot if proven effective.

Conclusions

Students’ reliable knowledge about COVID-19 pandemic including the various strains and approved vaccines should be improved to better manage the pandemic and set foundations for a more appropriate approach when another pandemic occurs. Special workshops should be organised to ensure that students and the public have a more trusted source of information about COVID-19.
Adoptive immunotherapy with natural killer cells from peripheral blood CD34+stem cells to prevent hepatocellular carcinoma recurrence after curative hepatectomy: a study protocol for an open-label, single-arm phase I study
Authors: Ohira Masahiro , Kobayashi Tsuyoshi , Tanaka Yuka , Imaoka Yuki , Sato Koki , Imaoka Koki , Nakano Ryosuke , Doskali Marlen , Piao Jinlian , Nakamura Mayuna , Yoshida Tetsumi , Ichinohe Tatsuo , Kawano Reo , Yoshimura Kenichi , Ueda Keiko , Tamura Natsuko , Hirata Taizo , Imamura Michio , Aikata Hiroshi , Tanimine Naoki , Kuroda Shintaro , Tahara Hiroyuki , Ide Kentaro , Ohdan Hideki
Published: November 2022

Introduction

Hepatocellular carcinoma (HCC) remains a major clinical problem as more than half of these cases recur after radical resection. Natural killer (NK) cells are at the forefront of the innate immune system and attack microcarcinomas and circulating tumour cells. The objective of this study was to evaluate the feasibility and toxicity of peripheral blood CD34+stem cell-derived NK cell infusion after radical hepatectomy for HCC.

Methods and analysis

This is an open-label, single-arm, single-centre phase I study. Patients who have undergone initial hepatectomy for HCC with three or more risk factors for recurrence (≥10 ng/mL of Alpha fetoprotein (AFP), ≥360 mAU/mL of PIVKA-II, multiple tumours and ≥3 peripheral blood circulating tumour cells) will be enrolled and be treated with three peripheral blood CD34+stem cell-derived NK cell infusions every 3 months. The primary endpoint will be safety assessment including the type and severity of adverse events, frequency of occurrence and duration of occurrence. The secondary endpoints will include survival, effect of immune response and clinical laboratory test results.

Ethics and dissemination

Ethical approval of the trial was obtained from the Certified Committee for Regenerative Medicine Hiroshima University in Japan. The trial results will be shared with the scientific community at international conferences and by publication in a peer-reviewed journal.

Trial registration number

jRCTb060200020.
Service-level barriers to and facilitators of access to services for the treatment of alcohol use disorder and problematic alcohol use: protocol for a scoping review
Authors: Wolfe Dianna , Hutton Brian , Corace Kimberly , Chaiyakunapruk Nathorn , Ngorsuraches Surachat , Nochaiwong Surapon , Presseau Justin , Grant Alyssa , Suschinsky Kelly , Skidmore Becky , Bartram Mary , Cohen Karen , Garner Gord , DiGioacchino Lisha , Pump Andrew , Peters Brianne , Konefal Sarah , Porath Amy , Thavorn Kednapa
Published: November 2022

Introduction

Prior to the COVID-19 pandemic, substance use health services for treatment of alcohol use disorder and problematic alcohol use (AUD/PAU) were fragmented and challenging to access. The pandemic magnified system weaknesses, often resulting in disruptions of treatment as alcohol use during the pandemic rose. When treatment services were available, utilisation was often low for various reasons. Virtual care was implemented to offset the drop in in-person care, however accessibility was not universal. Identification of the characteristics of treatment services for AUD/PAU that impact accessibility, as perceived by the individuals accessing or providing the services, will provide insights to enable improved access. We will perform a scoping review that will identify characteristics of services for treatment of AUD/PAU that have been identified as barriers to or facilitators of service access from the perspectives of these groups.

Methods and analysis

We will follow scoping review methodological guidance from the Joanna Briggs Institute. Using the OVID platform, we will search Ovid MEDLINE including Epub Ahead of Print and In-Process and Other Non-Indexed Citations, Embase Classic+Embase, APA PsychInfo, Cochrane Register of Controlled Trials, the Cochrane Database of Systematic Reviews and CINAHL (Ebsco Platform). Multiple reviewers will screen citations. We will seek studies reporting data collected from individuals with AUD/PAU or providers of treatment for AUD/PAU on service-level factors affecting access to care. We will map barriers to and facilitators of access to AUD/PAU treatment services identified in the relevant studies, stratified by service type and key measures of inequity across service users.

Ethics and dissemination

This research will enhance awareness of existing evidence regarding barriers to and facilitators of access to services for the treatment of alcohol use disorder and problematic alcohol use. Findings will be disseminated through publications, conference presentations and a stakeholder meeting. As this is a scoping review of published literature, no ethics approval was required.
Scoping review protocol of the use of codesign methods in stroke intervention development
Authors: Singh Hardeep , Nelson Michelle LA , Martyniuk Julia , Colquhoun Heather , Munce Sarah , Cameron Jill I , Kokorelias Kristina Marie , Pakkal Oya , Kuluski Kerry
Published: November 2022

Introduction

Codesign is an emerging research method to enhance intervention development by actively engaging non-researchers (eg, people who have had a stroke, caregivers and clinicians) in research. The involvement of non-researchers in research is becoming increasingly popular within health studies as it may produce more relevant and effective findings. The stroke population commonly exhibits challenges such as aphasia and cognitive changes that may limit their participation in codesign. However, the use of codesign within the stroke literature has not been comprehensively reviewed. This scoping review will determine: (1) what is the extent, range and nature of stroke research that has used codesign methods? (2) What codesign methods have been used to develop stroke interventions? (3) What considerations for codesigning interventions with people who have stroke are not captured in the findings?

Methods and analysis

This is a protocol for a scoping review to identify the literature relating to stroke, and codesign will be conducted on OVID Medline, OVID Embase, OVID PsychINFO, EBSCO CINAHL, the Cochrane Library, Scopus, PEDro-Physiotherapy Evidence Database and Global Index Medicus. Studies of any design and publication date will be included. Title and abstract and full-text review will be conducted independently by two reviewers. Data will be extracted, collated and then summarised descriptively using quantitative (eg, numerical descriptions) and qualitative (eg, textual descriptions) methods. Numerical summaries will map the extent (eg, number of studies), range (eg, types of studies) and nature (eg, types of interventions developed) of the literature on this topic. A thematic analysis will provide insights into the codesign methods (eg, activities, non-researchers), including heterogeneity across and within studies.

Ethics and dissemination

This review protocol does not require ethics approval as data has not been collected/analysed. The findings will highlight opportunities and recommendations to inform future codesign research in stroke and other populations who exhibit similar challenges/disabilities, and they will be disseminated via publications, presentations and stakeholder meetings.

Trial registration numberregistration

Open Science Framework: 10.17605/OSF.IO/NSD2W.
HEART rate variability biofeedback for long COVID symptoms (HEARTLOC): protocol for a feasibility study
Authors: Corrado Joanna , Halpin Stephen , Preston Nick , Whiteside Diana , Tarrant Rachel , Davison Jennifer , Simms Alexander D , O'Connor Rory J , Casson Alexander , Sivan Manoj
Published: November 2022

Introduction

Long COVID (LC), also known as post-COVID-19 syndrome, refers to symptoms persisting 12 weeks after COVID-19 infection. It affects up to one in seven people contracting the illness and causes a wide range of symptoms, including fatigue, breathlessness, palpitations, dizziness, pain and brain fog. Many of these symptoms can be linked to dysautonomia or dysregulation of the autonomic nervous system after SARS-CoV2 infection. This study aims to test the feasibility and estimate the efficacy, of the heart rate variability biofeedback (HRV-B) technique via a standardised slow diaphragmatic breathing programme in individuals with LC.

Methods and analysis

30 adult LC patients with symptoms of palpitations or dizziness and an abnormal NASA Lean Test will be selected from a specialist Long COVID rehabilitation service. They will undergo a 4-week HRV-B intervention using a Polar chest strap device linked to the Elite HRV phone application while undertaking the breathing exercise technique for two 10 min periods everyday for at least 5 days a week. Quantitative data will be gathered during the study period using: HRV data from the chest strap and wrist-worn Fitbit, the modified COVID-19 Yorkshire Rehabilitation Scale, Composite Autonomic Symptom Score, WHO Disability Assessment Schedule and EQ-5D-5L health-related quality of life measures. Qualitative feedback on user experience and feasibility of using the technology in a home setting will also be gathered. Standard statistical tests for correlation and significant difference will be used to analyse the quantitate data.

Ethics and dissemination

The study has received ethical approval from Health Research Authority (HRA) Leicester South Research Ethics Committee (21/EM/0271). Dissemination plans include academic and lay publications.

Trial registration number

NCT05228665.
Impact of a reduced nicotine standard on young adult appeal for menthol and non-menthol cigarettes
Authors: Cohn Amy M , Cassidy Rachel , Denlinger-Apte Rachel , Donny Eric , Villanti Andrea C , Hatsukami Dorothy , Dunn Delaney , Wyatt Riley , Niznik Taylor , Cohen-Davidyan Tamar , Smith Michael , Ehlke Sarah J
Published: November 2022

Introduction

The Food and Drug Administration (FDA) announced its intention to reduce the nicotine content in cigarettes as a strategy to promote cessation and reduce smoking-related harm. A low nicotine product standard will apply to all cigarettes on the market, including menthol cigarettes. In December 2021, the FDA approved a modified risk tobacco product application for menthol and non-menthol flavoured very low nicotine cigarettes (VLNC) from the 22nd Century Group. Notably, experimentation with menthol cigarettes is linked to smoking progression, as well as greater nicotine dependence relative to non-menthol cigarette use. If menthol VLNCs are perceived as more appealing than non-menthol VLNCs, this would indicate that some aspect of menthol may maintain smoking even in the absence of nicotine and FDA’s regulatory authority to ban or restrict the sale of menthol cigarettes should apply to reduced nicotine content of cigarettes. In April 2022, the FDA announced proposed rulemaking to prohibit menthol cigarettes, however it is unclear if a menthol prohibition would apply to VLNCs.

Methods and analysis

This study will recruit 172 young adult menthol smokers (with a specific subsample of n=40 sexual and gender minority young adults) and measure appeal for smoking experimental menthol and non-menthol VLNCs, and the impact of proposed product standards on tobacco product purchasing behaviour using an Experimental Tobacco Marketplace. Appeal across product standards will be assessed in a controlled laboratory and using ecological momentary assessment.

Ethics and dissemination

The protocol was approved by the University of Oklahoma Health Sciences Center Institutional Review Board (#11865). Findings will examine the effects of a reduced nicotine standard and a menthol ban on young adult smoking and will be disseminated through peer-reviewed journal articles and presentations at scientific conferences.

Trial registration number

NCT04340947.
Success and challenges of health systems resilience-enhancing strategies for managing Public Health Emergencies of International Concerns (PHEIC): A systematic review protocol
Authors: Rajapaksha R M Nayani Umesha , Khatri Resham B , Abeysena Chrishantha , Wijesinghe Millawage Supun Dilara , Endalamaw Aklilu , Thomas Toms K , Perera Nadeeka , Rambukwella Roshan , De Silva Gayani , Fernando Mekala , Alemu Yibeltal Assefa
Published: November 2022

Introduction

Health systems resilience is the ability to prepare, manage and learn from a sudden and unpredictable extreme change that impacts health systems. Health systems globally have recently been affected by a number of catastrophic events, including natural disasters and infectious disease epidemics. Understanding health systems resilience has never been more essential until emerging global pandemics. Therefore, the application of resilience-enhancing strategies needs to be assessed to identify the management gaps and give valuable recommendations from the lessons learnt from the global pandemic.

Methods

The systematic review will be reported using the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA-P) protocols guideline. Reporting data on World Health Organization (WHO) health system building blocks and systematic searches on resilience enhancing strategies for the management of Public Health Emergencies of International Concerns (PHEIC) after the establishment of International Health Regulations (IHR) in 2007 will be included. The search will be conducted in PubMed, Scopus, Web of Science and Google Scholar

Ethics and dissemination

Ethics approval and safety considerations are not applicable. Pre-print of the protocol is available online, and the screening of the articles will be done using Rayyan software in a transparent manner. The findings will be presented at conferences and the final review’s findings will be published in a peer-reviewed international journal and will be disseminated to global communities for the application of successful management strategies for the management of future pandemics.

PROSPERO registration number

CRD42022352612;https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022352612
An electronic medical record-based intervention to improve hepatitis A vaccination rates in the emergency department during a regional outbreak
Authors: Bukhsh Miriam A. , Thyagarajan Rama , Todd Brett , Chen Nai-Wei , Qu Lihua , Swaminathan Lakshmi
Published: November 2022

Background

In response to the severe hepatitis A outbreak that occurred in Michigan between August 2016 and September 2019, our multihospital health system implemented an electronic medical record (EMR)-based vaccination intervention across its nine emergency departments (EDs). The objectives were to explore the impact of this intervention on increasing vaccination rates among high-risk individuals and to assess the barriers to use of a computerised vaccine reminder system.

Methods

All patients who were 18 years or older were screened using an electronic nursing questionnaire. If a patient was at high risk based on the questionnaire, an electronic best practice advisory (BPA) would trigger and give the physician or advanced practice provider the option to order the hepatitis A vaccine. We explored the vaccination rates in the 24-month preintervention and the 18-month intervention periods. We then administered a survey to physicians, advanced practice providers and nurses evaluating their perceptions and barriers to use of the EMR intervention.

Results

During the preintervention period, 49 vaccines were ordered (5.5 per 100 000 patient visits) and 32 were administered (3.6 per 100 000 patient visits). During the intervention period, 574 865 patient visits (74.3%) were screened. 2494 vaccines (322 per 100 000 patient visits) were ordered, and 1205 vaccines (155 per 100 000 patients visits) were administered. Physicians and advanced practice providers were initially compliant with the BPA’s use, but compliance declined over time. Surveys revealed that the major barrier to use was lack of time.

Conclusions

EMR screening tools and BPAs can be used in the ED as an effective strategy to vaccinate high-risk individuals. This may be translatable to outbreaks of other vaccine-preventable illnesses like influenza, measles or SARS-CoV-2. Providing ongoing education about the public health initiative and giving feedback to physicians, advanced practice providers and nurses about tool compliance are needed to sustain the improvement over time.
Emergent themes from a quality improvement programme for CLABSI/CAUTI prevention in ICUs amid the COVID-19 pandemic
Authors: Krauss Daniel M , Molefe Ayrin , Hung Louella , Hayes Kristen , Gorman Claudia , Latterner Michael , Henderson Susan , Miller Melissa
Published: November 2022

Objectives

Healthcare-associated infection (HAI) prevention has been difficult for healthcare providers to maintain during the COVID-19 pandemic. This study summarises themes for maintaining infection prevention activities learnt from the implementation of a quality improvement (QI) programme during the pandemic.

Methods

We conducted qualitative analysis of participants’ semistructured exit interviews, self-assessments on HAI prevention activities, participant-created action plans, chat-box discussions during webinars and informal correspondence.

Setting

Intensive care units (ICUs) with elevated rates of central line-associated bloodstream infections (CLABSI) and/or catheter-associated urinary tract infections (CAUTI) participating in the Agency for Healthcare Research and Quality Safety Programme for ICUs: Preventing CLABSI and CAUTI.

Results

Forty-nine ICU teams who participated in the programme between December 2019 and April 2021 found ways to maintain activities such as daily huddles, multidisciplinary rounds, and central line and indwelling urinary catheter monitoring despite barriers, including staff turnover, a lack of time, staff fatigue and pandemic-related guidelines limiting providers’ time around patients. We use four themes to summarise the ICU teams’ adaptations that allowed them to sustain infection prevention activities: (1) Units had CLABSI and CAUTI prevention teams, policies and practices established prior to the pandemic; (2) Units were flexible in their implementation of those policies and practices; (3) Units maintained consistent buy-in for and engagement in HAI prevention activities among both leadership and care teams throughout the pandemic and (4) Units looked to learn from other units in their facility and beyond.

Conclusions

Future shocks such as the pandemic must be anticipated, and the healthcare system must be resilient to the resulting disruptions to HAI prevention activities. This study encountered four themes for successful maintenance of infection prevention activities during the current pandemic: the value of a pre-existing infection prevention infrastructure; a flexibility in approach; broad buy-in for maintaining QI programmes and the facilitation of idea-sharing.
A Thermographic Disease Activity Index for remote assessment of rheumatoid arthritis
Authors: Morales-Ivorra Isabel , Narváez Javier , Gómez-Vaquero Carmen , Moragues Carmen , Nolla Joan M , Narváez José A , Marín-López Manuel Alejandro
Published: November 2022

Objectives

Remote assessment of patients with rheumatoid arthritis (RA) has increased during recent years. However, telematic consultations preclude the possibility of carrying out a physical examination and obtaining objective inflammation. In this study, we developed and validated two novel composite disease activity indexes (Thermographic Disease Activity Index (ThermoDAI) and ThermoDAI-CRP) based on thermography of hands and machine learning, in order to assess disease activity easily, rapidly and without formal joint counts.

Methods

ThermoDAI was developed as the sum of Thermographic Joint Inflammation Score (ThermoJIS), a novel joint inflammation score based on the analysis of thermal images of the hands by machine learning, the Patient Global Assessment (PGA) and, for ThermoDAI-CRP, the C reactive protein (CRP). Construct validity was tested in 146 patients with RA by using Spearman’s correlation with ultrasound-determined grey-scale synovial hypertrophy (GS) and power Doppler (PD) scores, CDAI, SDAI and DAS28-CRP.

Results

Correlations of ultrasound scores with ThermoDAI (GS=0.52; PD=0.56) and ThermoDAI-CRP (GS=0.58; PD=0.61) were moderate to strong, while the correlations of ultrasound scores with PGA (GS=0.35; PD=0.39) and PGA+CRP (GS=0.44; PD=0.46) were weak to moderate. ThermoDAI and ThermoDAI-CRP also showed strong correlations with Clinical Disease Activity Index (ρ>0.83), Simplified Disease Activity Index (ρ>0.85) and Disease Activity Score with 28-Joint Counts-CRP (ρ>0.81) and high sensitivity for detecting active synovitis using remission criteria.

Conclusions

ThermoDAI and ThermoDAI-CRP showed stronger correlations with ultrasound-determined synovitis than PGA and PGA + CRP, thus presenting an opportunity to improve remote consultations with patients with RA.
Symptom evolution in the dying
Authors: Heijltjes Madelon T , van Zuylen Lia , van Thiel Ghislaine JMW , van Delden Johannes JM , van der Heide Agnes
Published: November 2022

Objective

Provide insight in the prevalence of symptoms in patients who are in the last days of life.

Methods

A retrospective descriptive analysis of data on patients who died between 2012 and 2019 at the age of 18 or older in 1 of 20 Dutch healthcare facilities, including hospitals, inpatient hospices and long-term care facilities. We analysed data from 4 hourly registrations in the Care Programme for the Dying Person, to assess for how many patients symptom-related goals of care were not achieved. We looked at the first 4 hours episode after the start of the Care Programme and the last 4 hours episode prior to death.

Results

We analysed records of 2786 patients. In the first 4 hours episode, at least one symptom-related care goal was not achieved for 28.5%–42.8% of patients, depending on the care setting. In the last 4 hours episode, these percentages were 17.5%–26.9%. Care goals concerning pain and restlessness were most often not achieved: percentages varied from 7.3% to 20.9% for pain and from 9.3% to 21.9% for restlessness.

Conclusions

Symptom control at the end of life is not optimal in a substantial minority of patients. Systematic assessment and attention as well as further research on symptom management are of the essence.
MULTIDIMENSIONAL PERSPECTIVE OF FINANCIAL RISK ANALYSIS: EVIDENCE FROM CHINA
Authors: TAN YUNXIA , ULLAH HAFEEZ , CHENG XIAOYUE , ZHANG FAN , WANG ZHUQUAN
Published: November 2022

China faces a critical economic structural transformation with increasing financial instability and uncertainty, necessitating a greater need for accurate measurement of systemic financial risk. In the paper, this work analyses the systemic financial risk in China between 2011 and 2020 based on financial development, fragility and risk indicators and the world economy to construct a comprehensive index of systemic financial risk (CISFR). The results show an upward trend in China’s financial risk in the past 10 years and a mid-to-high level fluctuation in the past five years, mainly driven by risks in the banking system, securities market and real estate market. In 2021–2022, China’s financial system is still in a high-risk stage, and high systemic risks are still an important economic issue. The study’s comprehensive index method can be extended to emerging economies. It reflects the main driving factors of financial risk by assigning weights to basic indicators from a multidimensional perspective, thus providing a reference for policymakers to prevent and control financial risk.
INFLUENCE OF B4C AND TiN ON THE MICROSTRUCTURE AND WEAR BEHAVIOR OF FRICTION STIR PROCESSED AA7075 SURFACE COMPOSITE
Authors: FATHIMA H. Z. AFRA , KEVIN C. K. , KISHORE K. S. , SUDHA J.
Published: November 2022

Friction stir processing (FSP), which was the advancement in the friction stir welding technique, is thought to be an economic approach to alloying in the solid state that can be used to make composites. In this study, FSP was carried out to produce AA7075 (B4[Formula: see text]iN) composite by varying the composition of the reinforcement particles. Microstructural analysis was carried out and the homogenous distribution of the reinforced particles on the surface of AA7075 alloy was ensured. X-ray diffraction studies were carried out to analyze the phases present after fabricating the hybrid surface composites. Microhardness test was performed on the specimens before and after the fabrication process. Grain refinement in the friction stir processed zones was evidently seen in the optical microstructures. The combined effect of the ceramic powders and grain refinement led to increase in the microhardness in the hybrid surface composites compared with the base AA7075 plate. A 33.87% increase in microhardness was observed in the sample AA7075 reinforced with 75% B4C and 25% TiN. Wear testing was carried out at various loads (5, 10, 15 and 20 N) and at different sliding velocities (300, 350, 400 and 450 rpm) and the track distance was maintained at 1000 m. It was observed that the highest wear rate is [Formula: see text] cm3/Nm for the base plate AA7075 and the sample AA7075 reinforced with 50% B4C and 50% TiN shows the lowest wear rate of [Formula: see text] cm3/Nm. It is observed that the addition of B4C and TiN has resulted in a significant improvement in the wear resistance of the AA7075 alloy.
The nonlinear optical properties of AlPc-Cl organic compound using DFT and TD-DFT analysis, as well as filter optical-electrical properties
Authors: Benhaliliba M. , Ahmed A. Ben , Ayeshamariam A.
Published: November 2022

The properties of nonlinear optical (NLO) are examined, and the results confirm the 2.19[Formula: see text]eV HOMO–LUMO mismatch. In the AlPc cluster, certain functional bond lengths and bond angles have been observed. Quantum chemical methods (density functional theory (DFT) and time-dependent density functional theory (TD-DFT)) and vibrational spectra properties of AlPc are studied. An X-ray pattern reveals the crystalline structure along the (242) orientation of AlPc organic thin layer. An ultraviolet-visible (UV–Vis) also shows the frequency selective behavior of the device. The absorbance of such layer exhibits a high value within UV range and two consecutive peaks within the visible range. Spin coating is used to make an organic diode based on the Aluminium phthalocyanine (AlPc-Cl) molecule. Under dark and light conditions, electrical characterization of Ag/AlPc/Si/Au is obtained. The diode’s high rectifying capability (about [Formula: see text] is subsequently discovered. While the height barrier is constant and saturation current is greatly reliant on light, the ideality factor of such a diode increases to 6.9 which confirms the nonideality of such a device. The Cheung–Cheung technique is employed to further the investigation and gain additional data such as series resistance and barrier height.
A Novel Hybrid Forecasting Approach for Customers Churn in Banking Industry
Authors: Rouhani Saeed , Mohammadi Ali
Published: November 2022

Competitive markets and customers’ changing needs in the bank industry necessitate accurately predicting customers who may leave the firm in the near future. Consequently, creating an approach to predict precisely and identify churn-leading causes is a part of retention strategies in customer relationship management. The approach that has been utilized in this research to predict customer churn combines decision tree (DT) and multinomial regression (MR) to classify customers with no limitation of binary classification in the churn prediction context. A customer club dataset of a commercial bank case as a real churn problem is used in this study to benchmark the hybrid forecasting approach against its building blocks. The results showed that the hybrid forecasting approach outperformed DT and MR with an average accuracy of 87.66%, 90.74% micro-average, and 90.44% macro-average of AUC. Further analysis of the model performance per class indicated that the hybrid approach’s misclassification error for the churn class decreased significantly, which is the most costly error in churn problems. Moreover, due to the structure of hybrid forecasting approach, more interoperability is obtained by assessing the impact of features in different segments, resulting in transforming them into actionable insights. The proposed approach is applied to the banking industry to prevent financial loss by detecting leading churn causes. Accordingly, after predicting the risk of customer churn, marketers and managers can determine appropriate actions that will have the most significant retention impact on each customer by applying proactive retention marketing.
Optimized System Identification of Humanoid Robots with Physical Consistency Constraints and Floating-based Exciting Motions
Authors: Lee Astra Chun-Hui , Hsu Huan-Kun , Huang Han-Pang
Published: November 2022

Generally, robots are initially designed via computer-aided software to obtain their parameters. However, the given parameters are not entirely true due to their unmodeled parts; therefore, system identification is needed, and physical conditions are crucial to guarantee feasible solutions. This study uses a quadratic programming regression model accompanied by physical consistency constraints and designs specific exciting motions for humanoid robots. The proposed constraints are designed based on the geometric approximation of link objects, the physically reasonable mass and inertia and the total mass of the robot being correct. The proposed exciting motions include the general walking motion and the single-leg support motion, which enable a more flexible and stable way to cause excitation in the floating-base system. The identified parameters are evaluated on the humanoid robot NINO. Furthermore, the error between the feedback information of the zero moment point and the command information of the center of mass are used for evaluating the identified dynamic parameters. According to the experiments with the proposed exciting motions, the identified parameters are found to be obviously better than the original computer-aided design parameters, especially in the [Formula: see text] direction.
Intelligent Image Processing Technology for Badminton Robot under Machine Vision of Internet of Things
Authors: Ye Haishan
Published: November 2022

The present work aims to promote the development of intelligent image processing technology for badminton robots and optimize the application effect of badminton robots in national fitness. Firstly, the problems and common needs of the badminton robot currently in use are investigated. Secondly, a shuttlecock aerodynamic model is established to simulate the effects of air resistance and gravity on the aerial flight of shuttlecock. Besides, the convolution neural network (CNN) is combined with traditional image processing technology to denoise and recognize the collected shuttlecock images. Finally, the badminton robot vision system is constructed and its performance is tested. The results demonstrate that the image denoising method based on CNN and the traditional image processing method can effectively process and denoise the captured moving image. Under the noise level of [Formula: see text], the peak signal-to-noise ratio index of this method is better than the Gaussian Scale Model, k-Singular Value Decomposition, and Color Names methods, slightly better than that of the Multilayer Perceptron (MLP) network. In terms of the time consumed in processing the same number of pictures, the method reported here takes the least time. But when [Formula: see text], the MLP method has a better denoising effect because the noise is overlarge and the features are not easy to learn. Moreover, the detection accuracy of the optimized Single Shot MultiBox Detector (SSD) method adopted here is 79.0%. This accuracy is 1.7% higher than that of the traditional SSD method, and 2.3% higher than that of Faster Region-Convolutional Neural Network based on Region Proposal Network. The optimized network structure reported here provides a certain idea for the software design of the badminton robot.
An upper bound to the second Hankel determinant for a new class of univalent functions
Authors: Shrigan Mallikarjun G.
Published: November 2022

In this paper, we introduce and investigate a newly-constructed class of univalent functions in the open disk. For this function class, we obtain upper bounds for the second Hankel determinant [Formula: see text].
Numerical approximation of SAV finite difference method for the Allen–Cahn equation
Authors: Chen Hang , Huang Langyang , Zhuang Qingqu , Weng Zhifeng
Published: November 2022

In this paper, the second-order scalar auxiliary variable approach combined with finite difference method is employed for the Allen–Cahn equation that represents a phenomenological model for antiphase domain coarsening in a binary mixture. The second-order backward differentiation formula is used in time. The error estimation of the semi-discrete scheme is derived in the sense of [Formula: see text]-norm. Several numerical simulations in 2D and 3D are demonstrated to verify the accuracy and efficiency of the proposed scheme.
Muscle plasticity is influenced by renal function and caloric intake through the FGF23-vitamin D axis
Authors: Acevedo Luz M. , Vidal Ángela , Aguilera-Tejero Escolástico , Rivero José-Luis L.
Published: November 2022

Skeletal muscle, the main metabolic engine in the body of vertebrates, is endowed with great plasticity. The association between skeletal muscle plasticity and two highly prevalent health problems: renal dysfunction and obesity, which share etiologic links as well as many comorbidities, is a subject of great relevance. It is important to know how these alterations impact on the structure and function of skeletal muscle because the changes in muscle phenotype have a major influence on the quality of life of the patients. This literature review aims to discuss the influence of a nontraditional axis involving kidney, bone, and muscle on skeletal muscle plasticity. In this axis, the kidneys play a role as the main site for vitamin D activation. Renal disease leads to a direct decrease in 1,25(OH)2-vitamin D, secondary to reduction in renal functional mass, and has an indirect effect, through phosphate retention, that contributes to stimulate fibroblast growth factor 23 (FGF23) secretion by bone cells. FGF23 downregulates the renal synthesis of 1,25(OH)2-vitamin D and upregulates its metabolism. Skeletal production of FGF23 is also regulated by caloric intake: it is increased in obesity and decreased by caloric restriction, and these changes impact on 1,25(OH)2-vitamin D concentrations, which are decreased in obesity and increased after caloric restriction. Thus, both phosphate retention, that develops secondary to renal failure, and caloric intake influence 1,25(OH)2-vitamin D that in turn plays a key role in muscle anabolism.