bluuebunny/crossref_metadata_2025 huggingface dataset:
A computational framework for patient-specific surgical planning of type 1 thyroplasty
Authors: Movahhedi Mohammadreza , Geng Biao , Xue Qian , Zheng Xudong
Published: December 2021

A computational framework is proposed for virtual optimization of implant configurations of type 1 thyroplasty based on patient-specific laryngeal structures reconstructed from MRI images. Through integration of a muscle mechanics-based laryngeal posturing model, a flow-structure-acoustics interaction voice production model, a real-coded genetic algorithm, and virtual implant insertion, the framework acquires the implant configuration that achieves the optimal acoustic objectives. The framework is showcased by successfully optimizing an implant that restores acoustic features of a diseased voice resulted from unilateral vocal fold paralysis (UVFP) in producing a sustained vowel utterance. The sound intensity is improved from 62 dB (UVFP) to 81 dB (post-correction).
Self-Perceptions, Parents’ Perceptions, Metaperceptions, and Locomotor Skills in Adolescents With Visual Impairments: A Preliminary Investigation
Authors: Stribing Alexandra , Pennell Adam , Gilbert Emily N. , Lieberman Lauren J. , Brian Ali
Published: December 2021

Individuals with visual impairments (VI) trend toward lower motor competence when compared with peers without VI. Various forms of perception often affects motor competence. Thus, it is important to explore factors that influence forms of perception and their differential effects on motor competence for those with VI. Therefore, the purposes of this study were to explore and describe the differential effects of age, gender, and degree of vision on self-perceptions, parents’ perceptions, metaperceptions, and locomotor skills, and to examine potential associations among all variables with actual locomotor competence for adolescents with VI. Adolescents with VI completed two questionnaires and the Test of Gross Motor Development-Third Edition. Parents completed a parent perception questionnaire. Mann–Whitney U and Kruskal–Wallis H analyses showed no differential effects for gender or age on any dependent measures. Degree of vision affected locomotor skills, but not any other factor. Spearman rho correlations showed significant associations among locomotor and self-perceptions, degree of vision and locomotor, and metaperceptions with parents’ perceptions. Adolescents reported relatively high self-perceptions and metaperceptions; however, their actual locomotor competence and parents’ perceptions were relatively low. Findings may help situate future intervention strategies targeting parents supporting their children’s locomotor skills through self-perceptions.
Twelve-Month Stability of Accelerometer-Measured Occupational and Leisure-Time Physical Activity and Compensation Effects
Authors: Gay Jennifer L. , Buchner David M.
Published: December 2021

Introduction: Little is known about the stability of occupational physical activity (PA) and documented compensation effects over time. Study objectives were to (a) determine the stability of accelerometer estimates of occupational and nonoccupational PA over 6 months and 1 year in adults who do not change jobs, (b) examine PA stability in office workers relative to employees with nonoffice jobs who may be more susceptible to seasonal perturbations in work tasks, and (c) examine the stability data for compensation effects seen at baseline in this sample. Methods: City/county government workers from a variety of labor sectors wore an accelerometer at initial data collection, and at 6 (n = 98) and 12 months (n = 38) following initial data collection. Intraclass correlation coefficients (ICCs) were calculated for accelerometer counts and minutes by intensity, domain, and office worker status. Partial correlation coefficients were examined for compensation effects. Results: ICCs ranged from .19 to .91 for occupational and nonwork activity variables. ICCs were similar by office worker status. In both counts and minutes, greater occupational PA correlated with lower total nonwork PA. However, as minutes of occupational moderate to vigorous physical activity increased, nonoccupational moderate to vigorous physical activity did not decrease. Conclusions: There was moderate to high stability in occupational and nonoccupational PA over 6- and 12-month data collection. Occupational PA stability was greater in nonoffice workers, suggesting that those employees’ PA may be less prone to potential cyclical factors at the workplace. Confirmation of the compensation effect further supports the need for workplace intervention studies to examine changes in all intensities of activity during and outside of work time.
New-onset haemoptysis and associated lung mass in the setting of dental care avoidance during the COVID-19 pandemic
Authors: Palmer Geralyn , Jamous Fady
Published: December 2021

We present a case of new-onset haemoptysis and associated lung lesion on chest imaging in the setting of the COVID-19 pandemic. This was believed to be due to dental care avoidance after tooth fracture and long-term use of temporary dental filler, with subsequent aspiration and bronchial injury. Our patient underwent bronchoscopy due to persistent haemoptysis with findings of mild traumatic injury. She responded to conservative management with no pharmacologic intervention. With time, there was resolution of symptoms and radiographic improvement of the lung lesion. We include a brief discussion on the influence of the COVID-19 pandemic on healthcare avoidance, complications of tooth fracture and the differential diagnosis of a new solitary lung lesion on chest imaging.
Systemic lupus erythematosus presenting with lymphoid interstitial pneumonia as an initial manifestation
Authors: Maeda Akiko , Kinjo Mitsuyo , Kinjo Kiyoshi , Kishaba Tomoo
Published: December 2021

A 25-year-old woman with an extensive travel history developed chronic cough and multiple lung nodules. The lung biopsy revealed lymphoid interstitial pneumonia. The patient later developed cervical lymphadenopathy, arthritis and livedo reticularis, then systemic lupus erythematosus was diagnosed with positive double-stranded DNA and low complement. The patient’s symptoms responded to prednisolone and azathioprine.
Primary chest wall Burkitt lymphoma in a case of HIV infection with immune reconstitution
Authors: Jain Arihant , Arun Vijayalakshmi Aravindan , Bal Amanjit , Malhotra Pankaj
Published: December 2021

Burkitt lymphoma (BL) develops at an increased frequency in patients with HIV irrespective of the CD4 count. Lymph nodes and gastrointestinal tract are common sites of involvement by BL; however, primary chest wall BL is rare. A 52-year-old man on highly active antiretroviral therapy (HAART) for HIV with a CD4 count of 0.204 x 109cells/L presented with a 3-month history of enlarging chest wall mass. PET-CT scan imaging showed a bulky mass involving the musculoskeletal planes of left chest wall with the involvement of underlying pleura. Biopsy with immunohistochemistry confirmed BL. Patient received EPOCH-R (infusional etoposide, vincristine, and doxorubicin with prednisone, cyclophosphamide and rituximab) regime for six cycles along with HAART, attained complete remission (CR) and remains free of BL at 5 years. BL should be considered in the differential diagnosis of soft tissue masses in HIV-infected patients irrespective of their CD4 count.
Dental manifestations of pseudo-vitamin-D deficiency rickets in a paediatric patient
Authors: Rahul Morankar , Gowthaman Keerthana , Tewari Nitesh , Mathur Vijay
Published: December 2021

Vitamin D–resistant rickets shows the resistance to vitamin D (Vit-D) therapy, which traditionally works well in cases with deficiency rickets. The signs start appearing as early as in the first month of life and are characterised by the defective mineralisation at the ends of cartilage and bones despite having normal Vit-D levels in the serum. This case report highlights the dental and maxillofacial manifestations in a 3-year-old girl diagnosed with pseudo-Vit-D deficiency rickets. The report also highlights the variations in the dental manifestations of the condition reported in the literature.
Isolated eyelid chondroid syringoma: a study of two cases
Authors: Walvekar Priyanka V , Jakati Saumya , Bothra Nandini , Kaliki Swathi
Published: December 2021

Chondroid syringoma is a benign mixed tumour arising from the sweat glands which can be apocrine (found throughout the surface of the eyelid) or eccrine with a mean age of presentation being 50 years. Here we report two cases of chondroid syringoma of the upper eyelid, one in a young male patient and the other in an elderly woman. Both cases had well-defined lesions involving upper eyelid in the sub-brow region, underwent excisional biopsy, and histopathological findings were consistent with an apocrine type of chondroid syringoma in one case and eccrine type of chondroid syringoma in the second case. It is important to be aware of this entity as a rare cause of eyelid lesion due to the fact that although it is a benign neoplasm, incomplete excision may be associated with recurrence or malignant transformation.
Transoral laryngeal microsurgery for early-stage laryngeal basaloid squamous cell carcinoma
Authors: Verro Barbara , Saraniti Carmelo
Published: December 2021

A 71-year-old man presented to our otolaryngology clinic with dysphagia and dyspnoea. He had a history of smoking for 40 years. Laryngoscopy showed an exophytic, round mass on the left aryepiglottic fold that was entirely excised by transoral laser CO2 microsurgery. Histological assessment revealed a pT1 basaloid squamous cell carcinoma (BSCC) with free-margin resection. He underwent close follow-up and after 3-year follow-up, the patient was free from disease. Laryngeal BSCC is a rare cancer with poor prognosis due to its late diagnosis and early neck node metastases. We report a rare case of early tumour treated by endoscopic surgery without complications or recurrence of disease. However, knowing this type of cancer and making a correct differential diagnosis are important to guarantee the best therapy and prognosis.
Graves’ disease following administration of second dose of SARS-CoV-2 vaccine
Authors: Goblirsch Timothy James , Paulson Ambika E , Tashko Gerti , Mekonnen Asefa Jejaw
Published: December 2021

The SARS-CoV-2 vaccines have had an overwhelming success in curbing the COVID-19 global pandemic, accounting for countless lives saved. Adverse reactions are inevitable, given the vast scale of vaccination required to mitigate future surges of COVID-19. Hyperthyroid disorders have been reported as potential adverse reactions to SARS-CoV-2 vaccines in two patients with Graves’ disease and a group of adults with subacute thyroiditis occurring in young women healthcare workers. We report a case of clinical Graves’ disease in a woman with a previously stable multinodular goitre that occurred 14 days following her second dose of Pfizer-BioNTech SARS-CoV-2 vaccine.
Ovarian vein thrombosis: a rare but not to be forgotten cause of abdominal pain
Authors: Martins Matilde Matos , Carneiro Carolina , Leitão Susana , Costa Cristina
Published: December 2021

A healthy 38-year-old woman, with no significant medical or surgical history, was referred to the gynaecology emergency department with acute low quadrant abdominal pain and nausea. On examination, painful palpation of right iliac fossa, abdominal guarding and positive Blumberg’s sign were noted. An abdominal-pelvic CT scan showed a hypodense tubular structure with peripheral enhancement to the right of the inferior vena cava, suggestive of thrombosis of the right ovarian vein. The only risk factor identified was the use of the combined contraceptive pill.
Missed diagnosis of lymphoma presenting with humoral hypercalcemia of malignancy due to cessation of oncological workup after negative computed tomography scans
Authors: Altshuler Ellery , Aryan Mahmoud , King William , Otero Rolando
Published: December 2021

Malignancy is the most common cause of hypercalcemia among hospitalised patients and is frequently caused by elevations in parathyroid hormone-related peptide (PTHrP). The most common PTHrP-producing cancers are carcinomas of the head, neck and lung. Hypercalcemia can be the presenting sign of cancer and, in these cases, solid tumours are usually discovered on CT scan. In rare cases, lymphoma may also present with hypercalcemia. CT scan is less sensitive for lymphoma than for most solid tumours and the diagnosis may be missed. We present the case of a 69-year-old woman who presented with hypercalcemia in the setting of severe weight loss and elevated PTHrP. Oncological workup was stopped after unrevealing CT scans and an underlying lymphoma was missed. Our case emphasises the need for a comprehensive oncological workup for patients with unexplained hypercalcemia and elevated PTHrP, even when CT scans are unrevealing.
Delayed presentation of syringomyelia after retrosigmoid craniectomy and resection of vestibular schwannoma: discussion of mechanisms
Authors: Egu Chinedu Brian , Kumaria Ashwin , Paterson Alistair , Robertson Iain
Published: December 2021

We present a case of syringomyelia following retrosigmoid craniectomy and resection of vestibular schwannoma complicated by Cerebrospinal fluid (CSF) leak, multiple infections and CSF diversion procedures. We believe this is the first reported case of syrinx formation after this type of surgery. Potential mechanisms by which the syrinx may have developed are discussed.
Autism spectrum disorder in a child with megalencephaly-capillary malformation-polymicrogyria syndrome (MCAP)
Authors: St John Lily JE , Rao Naveen
Published: December 2021

Megalencephaly-capillary malformation-polymicrogyria syndrome (MCAP) is a rare disorder that arises as a result of a somatic mosaic mutation in the PIK3CA gene. It characteristically presents with postnatal or congenital megalencephaly, cutaneous capillary malformations, postaxial polydactyly and often segmental or focal body overgrowth. We report a 7-year-old boy with known MCAP who was diagnosed at around 10 months old with a mosaic change in the PIK3CA gene. He was found to have hall-mark clinical signs; macrocephaly and four-limb postaxial polydactyly. Since diagnosis, he has had multiple clinical features, most of which typically present in children with MCAP. He has now been diagnosed with autism spectrum disorder (ASD), demand avoidance and is under assessment for attention deficit hyperactivity disorder. Although some cases have been raised to theM-CM Network,to our knowledge this is the first case of ASD in MCAP to be reported in the literature.
Socioeconomic status and risk factors for complications in young people with type 1 or type 2 diabetes: a cross-sectional study
Authors: Wijayaratna Sasini , Lee Arier , Park Hyun Young , Jo Emmanuel , Wu Fiona , Bagg Warwick , Cundy Tim
Published: December 2021

Introduction

Young people with type 2 diabetes (T2D) develop complications earlier than those with type 1 diabetes (T1D) of comparable duration, but it is unclear why. This apparent difference in phenotype could relate to relative inequality.

Research design and methods

Cross-sectional study of young people referred to secondary diabetes services in Auckland, Aotearoa-New Zealand (NZ): 731 with T1D and 1350 with T2D currently aged<40 years, and diagnosed between 15 and 30 years. Outcome measures were risk factors for complications (glycemic control, urine albumin/creatinine ratio (ACR), cardiovascular disease (CVD) risk) in relation to a validated national index of deprivation (New Zealand Deprivation Index (NZDep)).

Results

Young people with T2D were an average 3 years older than those with T1D but had a similar duration of diabetes. 71% of those with T2D were of Māori or Pasifika descent, compared with 24% with T1D (p<0.001). T1D cases were distributed evenly across NZDep categories. 78% of T2D cases were living in the lowest four NZDep categories (p<0.001). In both diabetes types, body mass index (BMI) increased progressively across the NZDep spectrum (p<0.002), as did mean glycated hemoglobin (HbA1c) (p<0.001), the prevalence of macroalbuminuria (p≤0.01), and CVD risk (p<0.001). Adjusting for BMI, diabetes type, and duration and age, multiple logistic regression revealed deprivation was the strongest risk factor for poorly controlled diabetes (defined as HbA1c>64 mmol/mol, >8%); OR 1.17, 95% CI 1.13 to 1.22, p<0.0001. Ordinal logistic regression showed each decile increase in NZDep increased the odds of a higher ACR by 11% (OR 1.11, 95% CI 1.06 to 1.16, p<0.001) following adjustment for BMI, blood pressure, diabetes type and duration, HbA1c, and smoking status. Multiple linear regression indicated a 4% increase in CVD risk for every decile increase in NZDep, regardless of diabetes type.

Conclusions

The apparent more aggressive phenotype of young-onset T2D is at least in part explicable by relative deprivation.
Sex differences over time for glycemic control, pump use and insulin dose in patients aged 10–40 years with type 1 diabetes: a diabetes registry study
Authors: Boettcher Claudia , Tittel Sascha R , Meissner Thomas , Gohlke Bettina , Stachow Rainer , Dost Axel , Wunderlich Sybille , Lowak Iris , Lanzinger Stefanie
Published: December 2021

Introduction

To evaluate sex differences in people with type 1 diabetes concerning changes in glycemic control and trends in insulin pump use and insulin dose over two decades in adolescents and one-and-a-half decades in adults.

Research design and methods

People aged 10–20 years (data years 1999–2018) and 21–40 years (data years 2004–2018) with type 1 diabetes were identified in the Diabetes Prospective Follow-up Registry (DPV). All available patients’ data sets of the respective period were used for linear regression analyses to investigate trends in HbA1c, pump use, insulin doses and body mass index SD scores (BMI-SDS) in females and males. In addition, stratification by migrant background was made for the adolescent group.

Results

In the youth group (n=68 662), both boys and girls showed an HbA1c decrease over the period examined. After stratification for migrant background, an HbA1c convergence between boys and girls was seen in those without migrant background as of 2016. Usage of insulin pumps increased continuously from 3% (boys and girls) to 47% (boys) and 54% (girls), respectively. The daily insulin dose in units per kilogram body weight and day increased continuously from 1999 to 2018. An insulin dose leveling between boys and girls occurred. BMI-SDS consistently increased in girls whereas only slight variations were observed in boys.

The adult group (n=15 380) showed constant HbA1c sex differences from 2004 to 2018 with lower HbA1c level in females. The use of insulin pump therapy rose from 18% to 35% (males) and 30% to 50% (females).

Conclusions

The gap in metabolic control between boys and girls with type 1 diabetes seems to close, but predominantly in adolescents without a migrant background. Improved HbA1c was associated with increased insulin pump use, especially in girls.

In adult patients, sex differences in metabolic control and insulin pump use persist: women show constantly lower HbA1c values and higher insulin pump use.
A guide to systems-level, participatory, theory-informed implementation research in global health
Authors: Seward Nadine , Hanlon Charlotte , Hinrichs-Kraples Saba , Lund Crick , Murdoch Jamie , Taylor Salisbury Tatiana , Verhey Ruth , Shidhaye Rahul , Thornicroft Graham , Araya Ricardo , Sevdalis Nick
Published: December 2021

Implementation research is a multidisciplinary field that addresses the complex phenomenon of how context influences our ability to deliver evidence-informed healthcare. There is increasing realisation of the importance of applying robust implementation research to scale-up life-saving interventions that meet health-related sustainable development goals. However, the lack of high-quality implementation research is impeding our ability to meet these targets, globally. Within implementation research, theory refers to the proposed hypothesis and/or explanation of how an intervention is expected to interact with the local context and actors to bring about change. Although there is increasing interest in applying theory to understand how and why implementation programmes work in real-world settings, global health actors still tend to favour impact evaluations conducted in controlled environments. This may, in part, be due to the relative novelty as well as methodological complexity of implementation research and the need to draw on divergent disciplines, including epidemiology, implementation science and social sciences. Because of this, implementation research is faced with a particular set of challenges about how to reconcile different ways of thinking and constructing knowledge about healthcare interventions. To help translate some of the ambiguity surrounding how divergent theoretical approaches and methods contribute to implementation research, we draw on our multidisciplinary expertise in the field, particularly in global health. We offer an overview of the different theoretical approaches and describe how they are applied to continuously select, monitor and evaluate implementation strategies throughout the different phases of implementation research. In doing so, we offer a relatively brief, user-focused guide to help global health actors implement and report on evaluation of evidence-based and scalable interventions, programmes and practices.
Understanding factors impacting global priority of emergency care: a qualitative policy analysis
Authors: Chipendo Portia I , Shawar Yusra R , Shiffman Jeremy , Razzak Junaid Abdul
Published: December 2021

Introduction

The high burden of emergency medical conditions has not been met with adequate financial and political prioritisation especially in low and middle-income countries. We examined the factors that have shaped the priority of global emergency care and highlight potential responses by emergency care advocates.

Methods

We conducted semistructured interviews with key experts in global emergency care practice, public health, health policy and advocacy. We then applied a policy framework based on political ethnography and content analysis to code for underlying themes.

Results

We identified problem definition, coalition building, paucity of data and positioning, as the main challenges faced by emergency care advocates. Problem definition remains the key issue, with divergent ideas on what emergency care is, should be and what solutions are to be prioritised. Proponents have struggled to portray the urgency of the issue in a way that commands action from decision-makers. The lack of data further limits their effectiveness. However, there is much reason for optimism given the network’s commitment to the issue, the emerging leadership and the existence of policy windows.

Conclusion

To improve global priority for emergency care, proponents should take advantage of the emerging governance structure and build consensus on definitions, generate data-driven solutions, find strategic framings and engage with non-traditional allies.
Eliminating malaria in conflict zones: public health strategies developed in the Sri Lanka Civil War
Authors: Ahmed Abrar , Hounsell Kara Grace , Sadiq Talha , Naguib Mariam , Koswin Kirstyn , Dharmawansa Chetha , Rasan Thavachchelvi , McGahan Anita M
Published: December 2021

Despite the 26-year long civil war, Sri Lanka was declared malaria-free by WHO in 2016. This achievement was the result of nearly 30 years of elimination efforts following the last significant resurgence of malaria cases in Sri Lanka. The resurgence occurred in 1986–1987, when about 600 000 cases of malaria were detected. Obstacles to these efforts included a lack of healthcare workers in conflict zones, a disruption of vector control efforts, gaps in the medication supply chain, and rising malaria cases among the displaced population.

This article seeks to describe the four strategies deployed in Sri Lanka to mitigate the aforementioned obstacles to ultimately achieve malaria elimination. The first approach was the support for disease elimination by the government of Sri Lanka and the Liberation Tamil Tigers of Elam. The second strategy was the balance of centralised leadership of the federal government and the decentralised programme operation at the regional level. The third strategy was the engagement of non-governmental stakeholders to fill in gaps left by the conflict to continue the elimination efforts. The last strategy is the ongoing efforts by the government, military and non-profit organisations to prevent the reintroduction of malaria.

The lessons learnt from Sri Lanka have important implications for malaria-endemic nations that are in conflict such as Ethiopia, Afghanistan, Yemen and Somalia. To accomplish the World Health Assembly goal of reducing the global incidence and mortality of malaria by 90% by 2030, significant efforts are required to lessen the disease burden in conflict zones. In addition to the direct impacts of conflict on population health, conflicts may lead to increased risk of spread of malaria, both within a country and consequently, abroad.
Exploration of implementation, financial and technical considerations within allied health professional (AHP) telehealth consultation guidance: a scoping review including UK AHP professional bodies’ guidance
Authors: Leone Enza , Eddison Nicola , Healy Aoife , Royse Carolyn , Chockalingam Nachiappan
Published: December 2021

Objectives

The COVID-19 pandemic has resulted in a shift to remote consultations, but telehealth consultation guidelines are lacking or inconsistent. Therefore, a scoping review was performed to chart the information in the articles exploring telehealth for the UK allied health professionals (AHPs) and compare them with the UK AHP professional bodies’ guidelines.

Design

Scoping review following Aksey and O’ Malley methodological framework.

Data sources

CINHAL and MEDLINE were searched from inception to March 2021 using terms related to ‘telehealth’, ‘guidelines’ and ‘AHPs’. Additionally, the UK AHP professional bodies were contacted requesting their guidelines.

Study selection

Articles exploring telehealth for patient consultations, written in English and published in peer-reviewed journal or guidelines available from UK AHP professional bodies/their websites were considered eligible for review.

Data extraction

One reviewer extracted data concerning three overarching domains: implementation, financial and technological considerations.

Results

2632 articles were identified through database searches with 21 articles eligible for review. Eight guidelines were obtained from the UK AHP professional bodies with a total of 29 included articles/guidelines. Most articles were published in the last two years; there was variety in telehealth terminology, and most were developed for occupational therapists, physiotherapists and speech and language therapists. Information was lacking about the assessment of telehealth use and effectiveness, barriers and limitations, the logistical management, the family’s and caregiver’s roles and the costs. There was lack of clarity on the AHPs’ registration requirements, costs and coverage, and legal aspects.

Conclusion

This study identified gaps in current guidelines, which showed similarities as well as discrepancies with the guidance for non-AHP healthcare professionals and revealed that the existing guidelines do not adequately support AHPs delivering telehealth consultations. Future research and collaborative work across AHP groups and the world’s leading health institutions are suggested to establish common guidelines that will improve AHP telehealth services.
Medicine treatment of glaucoma in Australia 2012–2019: prevalence, incidence and persistence
Authors: Daniels Benjamin , Healey Paul , Bruno Claudia , Kaan Iain , Zoega Helga
Published: December 2021

Objective

Medical therapy can halt or significantly slow the progression of glaucoma if medicines are used in accordance with the guidelines. We used dispensing claims for a 10% sample of all Australians dispensed publicly subsidised glaucoma medicines to determine the prevalence and incidence of glaucoma medicine treatment and to examine treatment persistence between July 2012 and June 2019.

Methods

We estimated incidence and prevalence per 10 000 population for Australian financial years (1 July to 30 June). We defined prevalence as at least one dispensing of any glaucoma medicine and incidence as a dispensing of any glaucoma medicine with no previous dispensing during the preceding 12 months. We estimated duration of treatment for a cohort initiating glaucoma medicines and used Kaplan-Meier methods to estimate the proportion of people persisting on treatment at 6, 12, 18 and 36 months after initiation. We stratified analyses by the number of repeats prescribed at initiation, age, sex and medicine class.

Results

Prevalence remained stable over the study period at around 180/10 000 people/year; incidence was also stable around 36/10 000/year. Among 34 900 people initiating glaucoma medicines, 37.0% remained on treatment at 6 months from initiation, 29.8% at 12 months and 19.2% at 36 months. Median duration of treatment was 13.2 months (IQR: 2.5—not reached) for people initiating prostaglandin analogues and less than 3 months for those initiating other medicine classes.

Conclusion

Prevalence and incidence of glaucoma treatment have not changed in Australia over the past decade. Persistence to treatment increased with age but remained poor throughout the study period.
Risk factors for death in Welsh infants with a congenital anomaly
Authors: Ho Peter S Y , Quigley Maria , Tucker David F , Kurinczuk Jenny
Published: December 2021

Objectives

To investigate risk factors associated with death of infants with a congenital anomaly in Wales, UK.

Design

A population-based cohort study.

Setting

Data from the Welsh Congenital Anomaly Register and Information Service (CARIS) linked to live births and deaths from the Office for National Statistics.

Patients

All live births between 1998 and 2016 with a diagnosis of a congenital anomaly, which was defined as a structural, metabolic, endocrine or genetic defect, as well as rare disease of hereditary origin.

Main outcome measures

Adjusted ORs (aORs) were estimated for socio-demographic, maternal, infant and intervention factors associated with death in infancy, using logistic regression for all, isolated, multiple and cardiovascular anomalies.

Results

30 424 live births affected by congenital anomalies were identified, including 1044 infants who died by the age of 1 year (infant mortality rate: 16.5 per 10 000 live births, case fatality: 3.4%, 30.3% of all infant deaths). Risk factors for infant death were non-white versus white ethnicity (aOR: 2.25; 95% CI: 1.77–2.86); parous versus nulliparous (aOR: 1.24; 95% CI: 1.08–1.41); smoking during pregnancy versus non-smokers/ex-smokers (aOR: 1.20; 95% CI: 1.02–1.40); preterm versus term birth (aOR: 4.38; 95% CI 3.86–4.98); female versus male infants (aOR: 1.28; 95% CI: 1.13–1.46) and the earlier years of the birth cohort (aOR: 0.96; 95% CI: 0.95–0.98 per yearly increase). Infants with a cardiovascular anomaly who received surgery had a lower odds of death than those who did not (aOR: 0.34; 95% CI: 0.15–0.75). Preterm birth was a significant factor for death for all anomalies but the effect of the other characteristics varied according to anomaly group.

Conclusions

Nearly a third of all infant deaths had an associated anomaly. Improving access to prenatal care, smoking cessation advice, optimising care for preterm infants and surgery may help lower the risk of infant death.
Assessment and classification of peripheral pain in athletes: a scoping review protocol
Authors: Purcell Ciarán , Duignan Ciara , Fullen Brona , Caulfield Brian
Published: December 2021

Pain is often presumed to be part of the sport injury experience. The time-loss definition of injury leads to under-reported athletic pain impacting performance and quality of life. Whilst research regarding the assessment and classification of back pain in athletes is emerging, little has been reported regarding how peripheral pain is assessed and classified in research and practice. Six databases will be searched for relevant articles. Title and abstract screening followed by full-text screening will be completed by two independent reviewers. Data charting will be carried out using a modified standardised form. Descriptive results and frequencies will be reported. Pain measures identified in the studies will be mapped against the IOC Athlete Pain Framework alongside a narrative summary. Published peer-reviewed primary research studies alongside systematic reviews and clinical practice guidelines reporting the assessment or classification of pain in athletes of any age with chronic or acute peripheral pain across all study contexts in the English language on human participants from inception of the databases will be included. The results of this study are part of a body of research which will be used to inform the development of a pain assessment framework. The scoping review will be submitted for peer-reviewed journal publication and presented at sports medicine conferences. This review will inform researchers and clinicians working with athletes in pain how pain assessment and classification is currently conducted and positioned against the IOC Athlete Pain Framework.
Information provision to older patients receiving palliative chemotherapy: a quality study
Authors: Lindhardt Christina Louise , Winther Stine Brændegaard , Pfeiffer Per , Ryg Jesper
Published: December 2021

Objectives

Cancer treatment has become increasingly successful. However, prolonging and preserving life has become an important goal of therapy since many patients generally receive palliative chemotherapy. The perception of life changes when patients are informed, that no curative treatment is possible. This raises new dilemmas for patients with incurable cancer, but only sparse information is available about the thoughts of these patients.

The aim of this study was to explore how older patients experience the information on absence of curative treatment options.

Methods

Qualitative interviews were performed in eleven older patients with incurable upper gastrointestinal cancer receiving first-line palliative chemotherapy. Median age was 74 (65–76) years. We used a qualitative approach to collect data through semistructured individual interviews conducted at the hospital or by telephone interviews by an experienced researcher. The thematic analysis was conveyed by Braun and Clarke.

Results

The interview findings were grouped around three main themes: hope of being cured, hearing but not comprehending, and desired milestones to reach. Further, it was determined that patients hid their feelings and avoided talking about the disease with the health professionals due to fear of being told the truth.

Conclusions

Receiving information about their incurable cancer was an ongoing dilemma for the patients. Following the message, patients shared thoughts about reaching important milestones in life, spending time with their family or hope for a cure to be found.
Losing a child due to a life-limiting diagnosis—parental well-being and quality of life: nationwide survey
Authors: Lykke Camilla , Sjøgren Per , Ekholm Ola
Published: December 2021

Objective

Losing a child is burdensome with potential long-term impact on the parents’ well-being and quality of life. The aim was to investigate parental well-being and quality of life 3–5 years after losing a child due to life-limiting diagnoses and to identify associated factors in order to target future interventions.

Methods

All parents, who lost a child (<18 years) due to life-limiting diagnoses in the period 2012–2014 in Denmark, were invited to complete a self-administered questionnaire. A seven-point Visual Digital Scale (VDS) was used to assess issues of well-being and quality of life including physical health, anxiety, depression and sleep quality which were combined into a cumulative symptom index. Associations were assessed by means of ordinal logistic regression models.

Results

In all, 152 (38%) children were represented by 136 mothers and 57 fathers. Totally, 17.6% of the mothers and 14.0% of the fathers had ≥2 symptoms (assessed by the symptom index). Parents with lower education had 2.11 (95% CI: 1.01 to 4.40) times higher odds of having more symptoms than parents with higher education. Unmarried parents had 2.14 (95% CI: 1.03 to 4.42) times higher odds of having more symptoms than married parents. Ten per cent of the parents reported poor overall quality of life.

Conclusion

According to the VDS, 1 out of 10 parents experienced poor overall quality of life 3–5 years after the loss. Every sixth had two or more symptoms assessed by the symptom index. Associated factors for poor quality of life suggest attention to particularly unmarried parents and parents with lower education.
Epidemiology of cardiomyopathies and incident heart failure in a population-based cohort study
Authors: Brownrigg Jack RW , Leo Vincenzo , Rose Joel , Low Eric , Richards Sarah , Carr-White Gerry , Elliott Perry M
Published: December 2021

Aims

The population prevalence of cardiomyopathies and the natural history of symptomatic heart failure (HF) and arrhythmia across cardiomyopathy phenotypes is poorly understood. Study aims were to estimate the population-diagnosed prevalence of cardiomyopathies and describe the temporal relationship between a diagnosis of cardiomyopathy with HF and arrhythmia.

Methods

People with cardiomyopathy (n=4116) were identified from linked electronic health records (~9 million individuals; 2000–2018) and categorised into hypertrophic cardiomyopathy (HCM), dilated cardiomyopathy (DCM), arrhythmogenic right ventricular cardiomyopathy (ARVC), restrictive cardiomyopathy (RCM) and cardiac amyloidosis (CA). Cardiomyopathy point prevalence, rates of symptomatic HF and arrhythmia and timing relative to a diagnosis of cardiomyopathy were determined.

Results

In 2018, DCM was the most common cardiomyopathy. DCM and HCM were twice as common among men, with the reverse trend for ARVC. Between 2010 and 2018, prevalence increased for ARVC by 180% and HCM by 9%. At diagnosis, more patients with CA (66%), DCM (56%) and RCM (62%) had pre-existing HF compared with ARVC (29%) and HCM (27%). Among those free of HF at diagnosis of cardiomyopathy, annualised HF incidence was greatest in CA and DCM. Diagnoses of all cardiomyopathies clustered around the time of HF onset.

Conclusions

The recorded prevalence of all cardiomyopathies increased over the past decade. Recognition of CA is generally preceded by HF, whereas individuals with ARVC or HCM more often developed HF after their cardiomyopathy diagnosis suggesting a more indolent course or better asymptomatic recognition. The clustering of HF and cardiomyopathy diagnoses suggests opportunities for presymptomatic or earlier diagnosis.
Anatomy of the conduction tissues 100 years on: what have we learned?
Authors: Sánchez-Quintana Damián , Anderson Robert H , Tretter Justin T , Cabrera José Angel , Sternick Eduardo Back , Farré Jerónimo
Published: December 2021

Knowledge of the anatomy of the ‘conduction tissues’ of the heart is a 20th century phenomenon. Although controversies still continue on the topic, most could have been avoided had greater attention been paid to the original descriptions. All cardiomyocytes, of course, have the capacity to conduct the cardiac impulse. The tissues specifically described as ‘conducting’ first generate the cardiac impulse, and then deliver it in such a fashion that the ventricles contract in orderly fashion. The tissues cannot readily be distinguished by gross inspection. Robust definitions for their recognition had been provided by the end of the first decade of the 20th century. These definitions retain their currency. The sinus node lies as a cigar-shaped structure subepicardially within the terminal groove. There is evidence that it is associated with a paranodal area that may have functional significance. Suggestions of dual nodes, however, are without histological confirmation. The atrioventricular node is located within the triangle of Koch, with significant inferior extensions occupying the atrial vestibules and with septal connections. The conduction axis penetrates the insulating plane of the atrioventricular junctions to continue as the ventricular pathways. Remnants of a ring of cardiomyocytes observed during development are also to be found within the atrial vestibules, particularly a prominent retroaortic remnant, although that their role has still to be determined. Application of the initial criteria for nodes and tracts shows that there are no special ‘conducting tissues’ in the pulmonary venous sleeves that might underscore the abnormal rhythm of atrial fibrillation.
Trajectories of alcohol consumption up to 30 years before and after the diagnosis of cardiovascular diseases: a longitudinal case–control study of 12 502 participants
Authors: Ding Chengyi , O'Neill Dara , Britton Annie
Published: December 2021

Background

To examine the longitudinal trajectories of alcohol consumption prior to and following the diagnosis of cardiovascular diseases (CVD).

Methods

We conducted a case–control study of 2501 incident cases of angina, myocardial infarction or stroke and 10 001 matched controls without the condition. Repeated measures of alcohol were centred on the date of diagnosis, spanning up to 30 years before and after CVD onset. Mean trajectories of weekly consumption were estimated using growth curve models.

Results

For trajectories prior to diagnosis, mean volume of alcohol consumed among male cases increased over time, peaking at around 8 years before diagnosis at 95 (95% CI 60 to 130) g/week and declining afterwards. Trajectories following diagnosis showed mean consumption in male cases dropped from 87 (95% CI 54 to 120) g/week to 74 (95% CI 45 to 102) g/week after the date of diagnosis and then slightly rose to 78 (95% CI 40 to 116) g/week at the subsequent 3.5 years, before gradually declining to 31 (95% CI 2 to 61) g/week at 30 years after diagnosis. Mean consumption among female cases remained stable prior to diagnosis (at about 30 g/week), fell marginally to 25 (95% CI 20 to 30) g/week after the date of diagnosis and kept decreasing afterwards. Similar trajectories were obtained in cases and controls.

Conclusions

This is the first attempt to show how patients with CVD change their drinking volume over such a wide time span. Future research needs to establish insight into drinking behaviour in other ways (such as frequency and context) and address the impact of changes in drinking on patients with CVD.
Atrial fibrillation detected at screening is not a benign condition: outcomes in screen-detected versus clinically detected atrial fibrillation. Results from the Prevention of Renal and Vascular End-stage Disease (PREVEND) study
Authors: Zwartkruis Victor W , Geelhoed Bastiaan , Suthahar Navin , Bakker Stephan J L , Gansevoort Ron T , van Gelder Isabelle C , de Boer Rudolf A , Rienstra Michiel
Published: December 2021

Aims

It is unknown whether screen-detected atrial fibrillation (AF) carries cardiovascular risks similar to clinically detected AF. We aimed to compare clinical outcomes between individuals with screen-detected and clinically detected incident AF.

Methods

We studied 8265 participants (age 49 ± 13 years, 50% women) without prevalent AF from the community-based Prevention of Renal and Vascular End-stage Disease (PREVEND) study. By design of the PREVEND study, 70% of participants had a urinary albumin concentration >10 mg/L. Participants underwent 12-lead ECG screening at baseline and every 3 years. AF was considered screen-detected when first diagnosed during a study visit and clinically detected when first diagnosed during a hospital visit. We analysed data from the baseline visit (1997–1998) up to the third follow-up visit (2008). We used Cox regression with screen-detected and clinically detected AF as time-varying covariates to study the association of screen-detected and clinically detected AF with all-cause mortality, incident heart failure (HF) and vascular events.

Results

During a follow-up of 9.8 ± 2.3 years, 265 participants (3.2%) developed incident AF, of whom 60 (23%) had screen-detected AF. The majority of baseline characteristics were comparable between individuals with screen-detected and clinically detected AF. Unadjusted, both screen-detected and clinically detected AF were strongly associated with mortality, incident HF, and vascular events. After multivariable adjustment, screen-detected and clinically detected AF remained significantly associated with mortality (HR 2.21 (95% CI 1.09 to 4.47) vs 2.95 (2.18 to 4.00), p for difference=0.447) and incident HF (4.90 (2.28 to 10.57) vs 3.98 (2.49 to 6.34), p for difference=0.635). After adjustment, screen-detected AF was not significantly associated with vascular events, whereas clinically detected AF was (1.12 (0.46 to 2.71) vs 1.92 (1.21 to 3.06), p for difference=0.283).

Conclusion

Screen-detected incident AF was associated with an increased risk of adverse outcomes, especially all-cause mortality and incident HF. The risk of outcomes was not significantly different between screen-detected AF and clinically detected AF.
Gravitational waves from preheating in Gauss–Bonnet inflation
Authors: El Bourakadi K. , Ferricha-Alami M. , Filali H. , Sakhi Z. , Bennai M.
Published: December 2021

We study gravitational wave production in an expanding Universe during the first stages following inflation, and investigate the consequences of the Gauss–Bonnet term on the inflationary parameters for a power-law inflation model with a GB coupling term. Moreover, we perform the analyses on the preheating parameters involving the number of e-folds $$N_{pre}$$

N

pre

, and the temperature of thermalization $$T_{th},$$

T

th

,

and show that it’s sensitive to the parameters n, and $$\gamma $$
γ
, the parameter $$\gamma $$
γ
is proposed to connect the density energy at the end of inflation to the preheating energy density. We set a correlation of gravitational wave energy density spectrum with the spectral index $$n_{s}$$

n
s

detected by the cosmic microwave background experiments. The density spectrum $$\varOmega _{gw}$$

Ω

gw

shows good consistency with observation for $$\gamma =$$

γ
=

$$10^{3}$$

10
3

and $$10^{6}$$

10
6

. Our findings suggest that the generation of gravitational waves (GWs) during preheating can satisfy the constraints from Planck’s data.
Wavelet-Based Biphase Analysis of Brain Rhythms in Automated Wake–Sleep Classification
Authors: Mohammadi Ehsan , Makkiabadi Bahador , Shamsollahi Mohammad Bagher , Reisi Parham , Kermani Saeed
Published: December 2021

Many studies in the field of sleep have focused on connectivity and coherence. Still, the nonstationary nature of electroencephalography (EEG) makes many of the previous methods unsuitable for automatic sleep detection. Time-frequency representations and high-order spectra are applied to nonstationary signal analysis and nonlinearity investigation, respectively. Therefore, combining wavelet and bispectrum, wavelet-based bi-phase (Wbiph) was proposed and used as a novel feature for sleep–wake classification. The results of the statistical analysis with emphasis on the importance of the gamma rhythm in sleep detection show that the Wbiph is more potent than coherence in the wake–sleep classification. The Wbiph has not been used in sleep studies before. However, the results and inherent advantages, such as the use of wavelet and bispectrum in its definition, suggest it as an excellent alternative to coherence. In the next part of this paper, a convolutional neural network (CNN) classifier was applied for the sleep–wake classification by Wbiph. The classification accuracy was 97.17% in nonLOSO and 95.48% in LOSO cross-validation, which is the best among previous studies on sleep–wake classification.