bluuebunny/crossref_metadata_2025 huggingface dataset:
Haloferax volcanii Immersed Liquid Biofilms Develop Independently of Known Biofilm Machineries and Exhibit Rapid Honeycomb Pattern Formation
Authors: Schiller Heather , Schulze Stefan , Mutan Zuha , de Vaulx Charlotte , Runcie Catalina , Schwartz Jessica , Rados Theopi , Bisson Filho Alexandre W. , Pohlschroder Mechthild
Published: December 2020

This first molecular biological study of archaeal immersed liquid biofilms advances our basic biological understanding of the model archaeon
Haloferax volcanii
. Data gleaned from this study also provide an invaluable foundation for future studies to uncover components required for immersed liquid biofilms in this haloarchaeon and also potentially for liquid biofilm formation in general, which is poorly understood compared to the formation of biofilms on surfaces.
BCG lymphadenitis: a potential complication of immune reconstitution following haematopoietic stem cell transplant
Authors: Tsilifis Christo , Schim van der Loeff Ina , Williams Eleri , Owens Stephen , Powell Steven , Gennery Andrew , Slatter Mary
Published: December 2020

Case report

An MHC class II deficient 2-year-old boy presented with fever and an enlarging left neck mass 100 days post allogeneic haematopoietic stem cell transplant (HSCT). Fever persisted despite treatment with broad-spectrum β-lactam antibiotics. His BCG vaccination site at presentation was quiescent. Ultrasound showed enlarged cervical lymph nodes. An incisional biopsy of the large nodal mass yielded acid-fast bacilli, identified as Mycobacterium bovis by genome sequencing. Treatment with rifampicin, isoniazid and pyridoxine was started. The mass suppurated (figure 1), before healing concurrently with T-lymphocyte reconstitution at approximately day 130 post-HSCT.

Figure 1

Suppurative BCG lymphadenitis following spontaneous rupture.

BCG infection can complicate vaccination in patients with severe combined immunodeficiencies (SCID), including MHC II deficiency1 causing a spectrum ranging from simple adenitis to disseminated disease. BCG immune reconstitution inflammatory syndrome, typically presenting as localised adenitis ipsilateral to vaccination site, is well-described after commencing antiretroviral therapy for HIV and is recognised in patients post-HSCT.2 3 In this case, T-lymphocyte reconstitution restoring the T-lymphocyte mediated response in a previously BCG-vaccinated child is likely to have precipitated both this presentation and its resolution.

Early identification of SCID though newborn screening might prevent vaccine administration to patients at risk of complications.

Questions

How is MHC class II deficiency inherited?

Autosomal dominant

Autosomal recessive

X-linked recessive

Mitochondrial

What role do MHC class II molecules have in the immune response?

Costimulation of naïve CD4+ T-helper lymphocytes to prevent anergy

Initiation of immunoglobulin class-switch recombination in B-lymphocytes

Presentation of antigen to naïve CD4+ T-lymphocytes

Presentation of antigen to naïve CD8+ T-lymphocytes

Which method has been proposed for newborn screening for SCID in the UK?

Absolute lymphocyte count

Detection of T-lymphocyte receptor excision circles (TRECs)

Tandem mass spectrometry to detect toxic metabolites

Immunoassay for CD3 and CD45

Which is the most appropriate treatment for localised BCG disease in immunocompromised children?

Rifampicin and isoniazid

Surgical resection

Surgical resection and instillation of isoniazid

Rifampicin, isoniazid, ethambutol and pyrazinamide

What common side-effect should patients receiving isoniazid be counselled for?

Peripheral neuropathy

Increased seizure frequency

Acute kidney injury

Change in colour of urine

Answers can be found on page 2.
Primary diffuse large B cell lymphoma (DLBCL) of the prostate presenting with lower urinary tract symptoms (LUTS)
Authors: Nusrat Ayesha , Nazim Syed Muhammad
Published: December 2020

Malignant lymphomas of the prostate are very rare tumours and are generally not considered in the clinical or pathological diagnosis of prostatic enlargement. We report a case of a 56-year-old man who presented with long-standing history of low back pain and a 2-month history of voiding lower urinary tract symptoms. He denied any history of urinary retention, trauma, catheterisation or any constitutional symptoms. Examination revealed no lymphadenopathy and hepatosplenomegaly. Digital rectal examination showed an irregular, moderately enlarged nodular prostate. His prostate-specific antigen was 1.54 ng/mL. MRI of the pelvis did not show any focal lesion apart from abnormal signal intensity in the central zone. Bone scan was negative. Transrectal ultrasound-guided prostate biopsy revealed diffuse large B cell lymphoma. Bone marrow biopsy and whole body positron emission tomography/CT were unremarkable. The patient achieved complete remission after receiving six cycles of R-CHOP chemotherapy.
Bilateral microscopic Leydig cell ovarian tumors in the postmenopausal woman
Authors: Langevin Taylor L , Maynard Karen , Dewan Anil
Published: December 2020

A 64-year-old postmenopausal female patient presented with approximately 5 years of intermittent spotting, progressive hirsutism and significantly increased libido and clitoral hypersensitivity with spontaneous orgasms multiple times a day beginning a few months prior. Initial hormone work-up revealed elevated total serum testosterone, androstenedione and 17-hydroxyprogesterone. Luteinising hormone, follicle stimulating hormone, estradiol, dehydroepiandrosterone-sulfate, thyroid stimulating hormone and prolactin were all within normal limits. Initial suspicions suggested an androgen-secreting tumour, likely in the ovary. The lesion was undetectable on transvaginal ultrasound and abdominal–pelvic CT scan. Laparoscopic bilateral salpingo-oophorectomy was performed to remove the likely source of excess androgens. Visible gross lesions were not observed intraoperatively; however, bilateral Leydig (hilus cell) tumours were confirmed by histopathology. Serum testosterone, androstenedione and 17-hydroxyprogesterone levels were normalised postoperatively within 2 weeks and 1 month, respectively.
SMAD4 juvenile polyposis syndrome and hereditary haemorrhagic telangiectasia presenting in a middle-aged man as a large fungating gastric mass, polyposis in both upper and lower GI tract and iron deficiency anaemia, with no known family history
Authors: Chang Wendy , Renaut Patricia , Pretorius Casper
Published: December 2020

Juvenile polyposis syndrome (JPS) and hereditary haemorrhagic telangiectasia (HHT) are rare autosomal dominant diseases, where symptoms manifest at childhood. A 32-year-old man with no family history of JPS or HHT with SMAD4 gene mutation who developed signs and symptoms only at the age of 32, when he was an adult. In this article, we highlight the steps taken to diagnose this rare pathology, explain its pathophysiology and management.
Endoscopic holmium laser fragmentation and retrieval of migrated intravesical prolene mesh
Authors: Dadhwal Rohit , Kumar Sanjay , Dogra Prem Nath , Panaiyadiyan Sridhar
Published: December 2020

A 52-year-old man presented with lower urinary tract symptoms and intermittent haematuria for the last 6 months. He had undergone totally extraperitoneal right inguinal hernia repair a decade ago. The ultrasonography and an X-ray of the pelvis suggested a large radio-opaque shadow in the bladder. However, CT revealed an encrusted intravesical extension of the migrated mesh along the right anterolateral wall. The entire intravesical part of the migrated mesh with encrustations was successfully retrieved by endourological approach using holmium laser. The patient symptomatically improved and at follow-up, cystoscopy showed a complete re-epithelisation of the bladder mucosa. The intravesical extension of migrated mesh is a rare but challenging complication following mesh hernioplasty and can be successfully managed with a complete endoscopic approach.
Osteochondroma of the talus: three varying cases
Authors: Kumar Saurabh , Dhammi Ish Kumar , Jain Anil Kumar , Shahi Pratyush
Published: December 2020

Osteochondroma of the talus is a rare entity that can cause pain, swelling, restriction of movements, synovitis and tarsal tunnel syndrome (TTS). We present three such cases with varying presentation. Case 1 presented with synovitis of the ankle along with a bifocal origin of the talar osteochondroma. Case 2 presented with TTS as a result of compression of the posterior tibial nerve. Case 3 presented with deformity of the foot. In all the three cases, the mass was excised en bloc and histologically proven to be osteochondroma. In case 3, the ankle joint was reconstructed with plate, bone graft and arthrodesis of the inferior tibiofibular joint. All the three cases had good clinical outcomes.
Burkholderia pseudomalleisepsis with osteoarticular melioidosis of the hip in a patient with diabetes mellitus
Authors: Boyer Pierre-Nicolas , Woods Marion L
Published: December 2020

Melioidosis is caused by the tropical soil pathogenBurkholderia pseudomallei. Infection, usually in the form of pneumonia, disproportionately affects people with a risk factor for immune dysregulation and mortality remains high even with treatment. Climate change and increasing rates of diabetes render the populations of endemic areas increasingly vulnerable to the disease, which is emerging as a serious global health threat. We present here a case of a 68-year-old man from northern Australia with sepsis and osteoarticular melioidosis of the hip, and explore the links between diabetes mellitus and melioidosis, particularly with respect to musculoskeletal infection.
Hypoxaemia and interstitial lung disease in an infant with hypothyroidism and hypotonia
Authors: Lynn Melodie M , Simon Dawn , Kasi Ajay S
Published: December 2020

A 7-month-old-term male infant presented with cough, tachypnoea, hypoxaemia and post-tussive emesis. Clinical history was significant for respiratory failure and pulmonary hypertension in the neonatal period requiring assisted ventilation, congenital hypothyroidism, mild hypotonia, recurrent respiratory infections, hypoxaemia requiring supplemental oxygen and nasogastric tube feeds. Physical examination showed tachypnoea, coarse bilateral breath sounds and mild hypotonia. Chest radiograph revealed multifocal pulmonary opacities with coarse interstitial markings and right upper lobe atelectasis. Following antibiotic therapy for suspected aspiration pneumonia, chest CT scan was performed and showed multiple areas of pulmonary consolidation and scattered areas of bilateral ground-glass opacities. Genetic studies showed a large deletion of chromosome 14q13.1–14q21.1, encompassing the NK2 homeobox 1 (NKX2-1) gene consistent with a diagnosis of brain–thyroid–lung (BTL) syndrome. Our case highlights the importance of genetic studies to diagnose BTL syndrome in infants with hypothyroidism, hypotonia and lung disease.
Advanced atrioventricular block and left bundle branch block in a patient with coronary artery fistula
Authors: Ono Ryohei , Okada Sho , Kitagawa Mari , Takaoka Hiroyuki , Miyauchi Hideyuki , Kobayashi Yoshio
Published: December 2020

Coronary artery fistulas are abnormal vascular conduits, rarely related to atrioventricular conduction abnormalities. We report the case of a 52-year-old woman who presented with dyspnoea on exertion. Her ECG revealed advanced atrioventricular block and left bundle branch block. CT scans confirmed two fistulas, from the conus branch of right coronary artery and from the left anterior descending coronary artery, into the pulmonary artery. The patient underwent pacemaker implantation. To date, only nine patients with different degrees of heart blocks associated with coronary artery fistulas have been reported. Herein, we review and summarise previously reported cases of different degrees of heart blocks associated with coronary artery fistulas.
Role of thuja in the management of laryngeal papilloma
Authors: Murali Shivagamasundari , Saravanam Prasanna Kumar , Dinakaran Nethra
Published: December 2020

Juvenile respiratory laryngeal papillomatosis is a subset of a larger clinical entity of recurrent respiratory papillomatosis. It is characterised by the development of recurrent papillomata in the vocal folds. Human papillomavirus types 6 and 11 has been implicated to be the most common strain of virus associated with the formation of laryngeal papilloma. Clinical diagnosis is based on typical appearance of warty lesion on endoscopy. Surgery is the primary line of management along with adjuvant therapy like antiviral drugs and immunomodulators. Thuja occidentalis is a tree native to North America whose leaves and leaf oil have antiviral, antibacterial and antifungal properties. It has been widely used for the treatment of condylomatous skin lesions and warts. Here we discuss the outcome of thuja as an adjuvant therapy in the treatment of laryngeal papillomatosis in an 8-year-old child.
Horizontal fracture of anterior mandible
Authors: Jain Anuj , Rai Anshul , Yadav Surendra
Published: December 2020

A 33-year-old male patient reported to us with the history of assault. The patient was cooperative and oriented, with no sign of head injury. He was assaulted with an axe over the mandible. The patient is having posteroanterior view radiographs of the mandible suggesting isolated horizontal fracture of the anterior mandible. Under general anaesthesia, this unusual fracture was treated by open reduction and internal fixation with a three-dimensional plate and miniplates. The case was managed successfully without any postoperative complications.
Association between tendon ruptures and use of fluoroquinolone, and other oral antibiotics: a 10-year retrospective study of 1 million US senior Medicare beneficiaries
Authors: Baik Seo , Lau Jason , Huser Vojtech , McDonald Clement J
Published: December 2020

Objectives

To assess the association of fluoroquinolone use with tendon ruptures compared with no fluoroquinolone and that of the four most commonly prescribed non-fluoroquinolone antibiotics in the USA.

Design

Retrospective observational study.

Setting

US seniors enrolled in the federal old-age, survivor’s insurance programme.

Participants

1 009 925 Medicare fee-for-service beneficiaries and their inpatient, outpatient, prescription drug records were used.

Interventions

Seven oral antibiotics, fluoroquinolones (ciprofloxacin, levofloxacin, moxifloxacin) and amoxicillin, amoxicillin-clavulanate, azithromycin and cephalexin.

Primary and secondary outcome measures

All tendon ruptures combined, and three types of tendon ruptures by anatomic site, Achilles tendon rupture, rupture of rotator cuff and other tendon ruptures occurred in 2007–2016.

Results

Of three fluoroquinolones, only levofloxacin exhibited a significant increased risk of tendon ruptures—16% (HR=1.16; 95% CI 1.06 to 1.28), and 120% (HR=2.20; 95% CI 1.50 to 3.24) for rotator cuff and Achilles tendon rupture, respectively, in the ≤30 days window. Ciprofloxacin (HR=0.96; 95% CI 0.89 to 1.03) and moxifloxacin (HR=0.59; 95% CI 0.37 to 0.93) exhibited no increased risk of tendon ruptures combined.

Among the non-fluoroquinolone antibiotics, cephalexin exhibited increased risk of combined tendon ruptures (HR=1.31; 95% CI 1.22 to 1.41) and modest to large risks across all anatomic rupture sites (HRs 1.19–1.93) at ≤30 days window. Notably, the risk of levofloxacin never exceeded the risk of the non-fluoroquinolone, cephalexin in any comparison.

Conclusions

In our study, fluoroquinolones as a class were not associated with the increased risk of tendon ruptures. Neither ciprofloxacin nor moxifloxacin exhibited any risk for tendon ruptures. Levofloxacin did exhibit significant increased risk. Cephalexin with no reported effect on metalloprotease activity had an equal or greater risk than levofloxacin; so we question whether metalloprotease activity has any relevance to observed associations with tendon rupture. Confounding by indication bias may be more relevant and should be given more consideration as explanation for significant associations in observational studies of tendon rupture.
Gender and ethnic differences in publication of BMJ letters to the editor: an observational study using machine learning
Authors: Zeina Mohamad , Balston Alfred , Banerjee Amitava , Woolf Katherine
Published: December 2020

Objectives

To analyse the relationship between first author’s gender and ethnicity (estimated from first name and surname), and chance of publication of rapid responses in the British Medical Journal (BMJ). To analyse whether other features of the rapid response account for any gender or ethnic differences, including the presence of multiple authors, declaration of conflicts of interests, the presence of Twitter handle, word count, reading ease, spelling and grammatical mistakes, and the presence of references.

Design

A retrospective observational study.

Setting

Website of the BMJ (BMJ.com).

Participants

Publicly available rapid responses submitted to BMJ.com between 1998 and 2018.

Main outcome measures

Publication of a rapid response as a letter to the editor in the BMJ.

Results

We analysed 113 265 rapid responses, of which 8415 were published as letters to the editor (7.4%). Statistically significant univariate correlations were found between odds of publication and first author estimated gender and ethnicity, multiple authors, declaration of conflicts of interest, the presence of Twitter handle, word count, reading ease, spelling and grammatical mistakes, and the presence of references. Multivariate analysis showed that first author estimated gender and ethnicity predicted publication after taking into account the other factors. Compared to white authors, black authors were 26% less likely to be published (OR: 0.74, CI: 0.57–0.96), Asian and Pacific Islander authors were 46% less likely to be published (OR: 0.54, CI: 0.49–0.59) and Hispanic authors were 49% less likely to be published (OR: 0.51, CI: 0.41–0.64). Female authors were 10% less likely to be published (OR: 0.90, CI: 0.85–0.96) than male authors.

Conclusion

Ethnic and gender differences in rapid response publication remained after accounting for a broad range of features, themselves all predictive of publication. This suggests that the reasons for the differences of these groups lies elsewhere.
Depressive symptoms and cardiovascular disease: a population-based study of older adults in rural Burkina Faso
Authors: Brinkmann Ben , Payne Collin F , Kohler Iliana , Harling Guy , Davies Justine , Witham Miles , Siedner Mark J , Sie Ali , Bountogo Mamadou , Ouermi Lucienne , Coulibaly Boubacar , Bärnighausen Till
Published: December 2020

Objectives

To contribute to the current understanding of depressive disorders in sub-Saharan African (SSA) countries by examining the association of depressive symptoms with cardiovascular and cardiometabolic conditions in a population-based study of middle-aged and older adults in rural Burkina Faso.

Setting

This study was conducted in the Nouna Health and Demographic Surveillance System in north-western Burkina Faso, in a mixed rural and small-town environment. The data were obtained between May and July 2018.

Participants

Consenting adults over 40 years of age (n=3026).

Primary and secondary outcome measures

Depressive symptoms were assessed using the Patient Health Questionnaire depression module (PHQ-9). Chronic cardiometabolic conditions were assessed via a lipid panel and glycated haemoglobin measures from serum, alongside anthropometry and blood pressure measurements and a self-reported questionnaire. Multivariable linear regression was used to test the relationship between depressive symptoms and cardiovascular/cardiometabolic conditions after controlling for sociodemographic factors.

Results

Depressive symptoms were not associated with the metabolic syndrome (standardised beta coefficient=0.00 (95% CI −0.04 to 0.03)), hypertension (beta=0.01 (95% CI −0.02 to 0.05)), diabetes mellitus (beta=0.00 (95% CI −0.04 to 0.04)) and past diagnosis of elevated blood pressure or blood sugar. Prior stroke diagnosis (beta=0.04 (95% CI 0.01 to 0.07)) or heart disease (beta=0.08 (95% CI 0.05 to 0.11)) was positively associated with the standardised PHQ-9 score as were self-reported stroke symptoms.

Conclusion

Objectively measured cardiometabolic conditions had no significant association with depressive symptoms in an older, poor, rural SSA population, in contrast to observations in high income countries. However, consequences of cardiovascular disease such as stroke and heart attack were associated with depressive symptoms in older adults in Burkina Faso.
Acupuncture for neck pain caused by cervical spondylosis: a systematic review and meta-analysis protocol
Authors: Gao Zhen , Liu Gao-Feng , Zhang Jing , Ji Lai-Xi
Published: December 2020

Introduction

Neck pain causes serious social and economic burden. Research on the use of acupuncture for managing cervical spondylosis has increased over time, with the quality of studies showing an improved trend. The present study seeks to use a systematic review approach to understand efficacy and safety of acupuncture for treatment of neck pain caused by cervical spondylosis.

Methods and analysis

We will search PubMed, Web of Science, Cochrane Library, Embase, China National Knowledge Infrastructure, Chinese BioMedical Literature, Wanfang database and VIP databases, from their inception to July 2020, to identify and retrieve all randomised controlled trials, describing the use of acupuncture for treatment of cervical spondylosis. Thereafter, two reviewers will independently select the studies, extract data and assess the risk of bias. Any disagreements, between them, will be resolved through a discussion with a third reviewer. Data synthesis and statistical analyses will be performed using the Revman V.5.3 software. Specifically, data will be synthesised by either fixed-effects (heterogeneity less than 50%) or random-effects models, following a heterogeneity test, with outcome measures focusing on pain intensity, functional disability, psychological improvements and adverse events. In cases where no considerable heterogeneity is detected, a meta-analysis will be conducted.

Ethics and dissemination

No ethical approval will be required for this study, since it does not infringe on anyone’s interests. The findings will be published in a peer-reviewed journal or disseminated through conferences.

PROSPERO registration number

CRD42020152379.
Future Health Today: codesign of an electronic chronic disease quality improvement tool for use in general practice using a service design approach
Authors: Hunter Barbara , Biezen Ruby , Alexander Karyn , Lumsden Natalie , Hallinan Christine , Wood Anna , McMorrow Rita , Jones Julia , Nelson Craig , Manski-Nankervis Jo-Anne
Published: December 2020

Objective

To codesign an electronic chronic disease quality improvement tool for use in general practice.

Design

Service design employing codesign strategies.

Setting

General practice.

Participants

Seventeen staff (general practitioners, nurses and practice managers) from general practice in metropolitan Melbourne and regional Victoria and five patients from metropolitan Melbourne.

Interventions

Codesign sessions with general practice staff, using a service design approach, were conducted to explore key design criteria and functionality of the audit and feedback and clinical decision support tools. Think aloud interviews were conducted in which participants articulated their thoughts of the resulting Future Health Today (FHT) prototype as they used it. One codesign session was held with patients. Using inductive and deductive coding, content and thematic analyses explored the development of a new technological platform and factors influencing implementation of the platform.

Results

Participants identified that the prototype needed to work within their existing workflow to facilitate automated patient recall and track patients with or at-risk of specific conditions. It needed to be simple, provide visual snapshots of information and easy access to relevant guidelines and facilitate quality improvement activities. Successful implementation may be supported by: accuracy of the algorithms in FHT and data held in the practice; the platform supporting planned and spontaneous interactions with patients; the ability to hide tools; links to Medicare Benefits Schedule; and prefilled management plans. Participating patients supported the use of the platform in general practice. They suggested that use of the platform demonstrates a high level of patient care and could increase patient confidence in health practitioners.

Conclusion

Study participants worked together to design a platform that is clear, simple, accurate and useful and that sits within any given general practice setting. The resulting FHT platform is currently being piloted in general practices and will continue to be refined based on user feedback.
Efficacy and safety of mesenchymal stem cells for the treatment of patients infected with COVID-19: a systematic review and meta-analysis protocol
Authors: Chen Yunhui , Zhang Qing , Peng Wei , Liu Dan , You Yanyan , Liu Xinglong , Tang Songqi , Zhang Tiane
Published: December 2020

Introduction

To date, no specific antivirus drugs or vaccines have been available to prevent or treat the COVID-19 pandemic. Mesenchymal stem cell (MSC) therapy may be a promising therapeutic approach that reduces the high mortality in critical cases. This protocol is proposed for a systematic review and meta-analysis that aims to evaluate the efficacy and safety of MSC therapy on patients with COVID-19.

Methods and analysis

Ten databases including PubMed, EMBASE, Cochrane Library, CINAHL, Web of Science, Chinese National Knowledge Infrastructure (CNKI), Chinese Scientific Journals Database (VIP), Wanfang database, China Biomedical Literature Database (CBM) and Chinese Biomedical Literature Service System (SinoMed) will be searched from inception to 1 December 2020. All published randomised controlled trials, clinical controlled trials and case series that meet the prespecified eligibility criteria will be included. The primary outcomes include mortality, incidence and severity of adverse events, respiratory improvement, days from ventilator, duration of fever, progression rate from mild or moderate to severe, improvement of such serious symptoms as difficulty breathing or shortness of breath, chest pain or pressure, and loss of speech or movement, biomarkers of laboratory examination and changes in CT. The secondary outcomes include dexamethasone doses and quality of life. Two reviewers will independently perform study selection, data extraction and assessment of bias risk. Data synthesis will be conducted using RevMan software (V.5.3.5). If necessary, subgroup and sensitivity analysis will be performed. Grading of Recommendations Assessment, Development and Evaluation system will be used to assess the strength of evidence.

Ethics and dissemination

Ethical approval is not necessary since no individual patient or privacy data have been collected. The results of this review will be disseminated in a peer-reviewed journal or an academic conference presentation.

PROSPERO registration number

CRD42020190079.
Risk assessment of workplace violence towards health workers in a Chinese hospital: a cross-sectional study
Authors: Liu Yujie , Zhang Min , Li Rui , Chen Na , Huang Yiming , Lv Yalan , Wang Yuping
Published: December 2020

Objective

This study aimed to assess the risk factors associated with workplace violence towards health workers (HWs) in a Chinese hospital.

Methods

We conducted a cross-sectional survey in a Chinese secondary hospital in 2019 using an international survey questionnaire, and collected valid data from 1028 HW respondents via mobile phone. Alongside analysing the potential association between exposure to violence and respondents’ characteristics, we compared the workplace violence between this survey and a baseline survey in the same hospital using the same questionnaire in 2018, and investigated the existing measures.

Results

A total of 5.45% of respondents had encountered physical violence while 41.63% had experienced psychological violence. Women (OR=3.45, 95% CI 1.87 to 6.38), those working in outpatient and emergency departments (OR=7.96, 95% CI 2.27 to 27.95), and those with extremely high concern about workplace violence (OR=7.94, 95% CI 1.04 to 60.85) were significantly more likely to suffer physical violence. Working in the outpatient and emergency department (OR=2.03, 95% CI 1.23 to 3.34), having direct physical contact/interaction with patients (OR=2.98, 95% CI 1.62 to 5.49), and extremely high worry about workplace violence (OR=6.47 95% CI 3.38 to 12.40) significantly increased the risk of psychological violence. When the results of the baseline survey were compared with those in this survey, it was shown that physical violence declined significantly from 8.79% in 2018 to 5.45% in 2019, while psychological violence declined significantly from 47.14% in 2018 to 41.63% in 2019. The most recognised measures were security measures (81.03%) while the least recognised measures were check-in procedures for staff (11.19%).

Conclusion

Workplace violence towards HWs is a global problem with country-specific features. In our study, workplace violence in the hospital is of great concern. While demonstrating the effectiveness of measures in some degree, there is significant room for improvement. To achieve the vision of ‘zero violence’ in the health sector, aligned comprehensive measures should be systematically adopted.
Psychological impact of the COVID-19 pandemic on healthcare workers at acute hospital settings in the South-East of Ireland: an observational cohort multicentre study
Authors: Ali Saied , Maguire Sinead , Marks Eleanor , Doyle Maeve , Sheehy Claire
Published: December 2020

Objective

Our study aims to understand the psychological impact of the COVID-19 pandemic among healthcare workers (HCWs) at acute hospital settings in the South-East of Ireland, as a crucial step in guiding policies and interventions to maintain their psychological well-being.

Design

Observational cohort study.

Participants and setting

472 HCWs participated from two distinct acute hospital settings, A and B, in the South-East of Ireland.

Primary and secondary outcome measures

Measures of psychological distress—depression, anxiety, acute and post-traumatic stress disorder (PTSD)—as dictated by the Depression, Anxiety and Stress Scale (DASS-21) and Impact of Event Scale-Revised (IES-R). An independent sample t-test and a Mann-Whitney U test was used to determine significance of difference in continuous variables between groups. Categorical variables were assessed for significance with a χ2 test for independence.

Results

The DASS-21 provided independent measures of depression (mean 4.57, IQR 2–7), anxiety (mean 3.87, IQR 1–6) and stress (mean 7.41, IQR 4–10). Positive scores were reflected in 201 workers (42.6%) for depression and 213 (45.1%) for both anxiety and stress. The IES-R measured subjective distress on three subscales: intrusion (mean 1.085, IQR 0.375–1.72), avoidance (mean 1.008, IQR 0.375–1.5) and hyperarousal (mean 1.084, IQR 0.5–1.667). Overall, 195 cases (41.3%) were concerning for PTSD. Site B scored significantly higher across all parameters of depression (5.24 vs 4.08, p<0.01), anxiety (4.66 vs 3.3, p<0.01), stress (8.91 vs 6.33, p<0.01) and PTSD (0.058 vs 0.043, p<0.01). Worse outcomes were also noted in HCWs with underlying medical ailments.

Conclusion

Psychological distress is prevalent among HCWs during the COVID-19 pandemic; screening for adverse mental and emotional outcomes and developing timely tailored preventative measures with effective feedback are vital to protect their psychological well-being, both in the immediate and long-term.
Evaluation of the effectiveness of behavioural economic incentive programmes for the promotion of a healthy diet and physical activity: a protocol for a systematic review and network meta-analysis
Authors: Boonmanunt Suparee , Pattanaprateep Oraluck , Ongphiphadhanakul Boonsong , McKay Gareth , Attia John , Thakkinstian Ammarin
Published: December 2020

Introduction

Obesity and being overweight are major risk factors for metabolic syndrome and non-communicable diseases. Despite the recommendation that a healthy diet and physical activity can reduce the severity of these diseases, many fail to adhere to these measures. From a behavioural economic perspective, adherence to such measures can be encouraged through financial incentives. However, additional related behavioural economic approaches may improve the effectiveness of an incentive programme. As such, we have developed a protocol for a systematic review and network meta-analysis to summarise the current evidence from financial incentive programmes with and without behavioural economic insights for promoting healthy diet and physical activity.

Methods and analysis

Previous systematic reviews, meta-analyses and individual studies were identified from Medline and Scopus in June 2020 and will be updated until December 2020. Individual studies will be selected and data extracted by two reviewers. Disagreement will be resolved by consensus or adjudicated by a third reviewer. A descriptive analysis will summarise the effectiveness of behavioural economic incentive programmes for promoting healthy diet and physical activity. Moreover, individual studies will be pooled using network meta-analyses where possible. I2 statistics and Cochran’s Q test will be used to assess heterogeneity. Risk of bias and publication bias, if appropriate, will be evaluated, as well as the overall strength of the evidence.

Ethics and dissemination

Ethics approval for a systematic review and meta-analysis is not required. The findings will be published in a peer-reviewed journal.

PROSPERO registration number

CRD42020198024.
Physiological tests of small airways function in diagnosing asthma: a systematic review
Authors: Almeshari Mohammed A , Alobaidi Nowaf Y , Edgar Ross G , Stockley James , Sapey Elizabeth
Published: December 2020

Background

Asthma is a common, heterogeneous disease that is characterised by chronic airway inflammation and variable expiratory airflow limitation. Current guidelines use spirometric measures for asthma assessment. This systematic review aimed to assess whether the most commonly reported tests of small airways function could contribute to the diagnosis of asthma.

Methods

Standard systematic review methodology was used, and a range of electronic databases was searched (Embase, MEDLINE, CINAHL, CENTRAL, Web of Science, DARE). Studies that included physiological tests of small airways function to diagnose asthma in adults were included, with no restrictions on language or date. The risk of bias and quality assessment tools used were Agency for Healthcare Research and Quality tool for cross-sectional studies and Quality Assessment of Diagnostic Accuracy Studies 2 for diagnostic test accuracy (DTA) studies.

Results

7072 studies were identified and 10 studies met review criteria. 7 included oscillation techniques and 5 included maximal mid-expiratory flow (MMEF). Studies were small and of variable quality. In oscillometry, total resistance (R5) and reactance at 5 Hz (X5) was altered in asthma compared with healthy controls. The percentage predicted of MMEF was lower in patients with asthma compared with controls in all studies and lower than the % predicted forced expiratory volume in 1 s. In DTA of oscillometry, R5 showed a sensitivity between 69% and 72% and specificity between 61% and 86%.

Conclusion

There were differences in the results of physiological tests of small airway function in patients with asthma compared with controls. However, studies are small and heterogeneous. Further studies are needed to assess the effectiveness of these tests on a larger scale, including studies to determine which test methodology is the most useful in asthma.
Aberrant opioid use behaviour in advanced cancer
Authors: Mercadante Sebastiano , Adile Claudio , Tirelli Walter , Ferrera Patrizia , Penco Italo , Casuccio Alessandra
Published: December 2020

Objectives

To evaluate the presence of aberrant behaviour in a consecutive sample of patients with advanced cancer treated with opioids in a country like Italy, with its peculiar attitudes towards the use opioids. The second objective was to detect the real misuse of opioids in clinical practice.

Methods

Prospective observational study in two palliative care units in Italy in a period of 6 months. At admission the Edmonton Symptom Assessment Scale, the Memorial Delirium Assessment Scale, Brief Pain Inventory (BPI) and the Hospital Anxiety Depression Scale were measured. For detecting the risk of aberrant opioid use, the Screener and Opioid Assessment for Patients With Pain (SOAAP), the Opioid Risk Tool (ORT), the Cut Down-Annoyed-Guilty-Eye Opener (CAGE) questionnaire adapted to include drug use (CAGE-AID) were used. Aberrant behaviours displayed at follow-up within 1 month were recorded.

Results

One-hundred and thirteen patients with advanced cancer were examined. About 35% of patients were SOAPP positive. There was correlation between SOAPP, CAGE-AID and ORT. SOAPP was independently associated with a lower Karnofsky level, pain intensity, poor well-being, BPI pain at the moment. No patient displayed aberrant behaviours, despite having a moderate-high risk.

Conclusions

Despite a high percentage of patients showed a high risk of aberrant behaviours, no patient displayed clinical aberrant behaviours after 1 month-follow-up. This does not exempt from continuous monitoring for patients who are at risk.
Foaming Behavior and Pore Structure Evolution of Foamed Aluminum under the Extrusion Constraint
Authors: Wang Lucai , Wang Yanli , You Xiaohong , Wang Fang
Published: December 2020

This study evaluates foaming behavior and pore structure evolution of aluminum foam by cross‐sectional image processing, which was prepared by the powder compact melting (PCM) method under the constraint. The results revealed that the heating time and the heating rate are the key factors affecting the foaming behavior and pore structure of aluminum foam. The thermal decomposition of the foaming agent and aluminum melting behavior affect the foam expansion under different heating times and heating rates. The evolution of the pore structure during the foaming process includes pore formation, small‐sized spherical pores, large‐sized spherical pores, polygonal pores, merging, and collapse. Due to the limitation of the pipe wall, the maximum expansion height and porosity are constrained, and the macrostructure of aluminum foam is improved.
Relative Performance Concern on DC Pension Plan under Heston Model with Inflation Risk
Authors: Song Aimin , Chen Peimin
Published: December 2020

With the global outbreak of new coronavirus pneumonia, more and more countries have entered the state of sealing off cities. After the epidemic, with the shortage of some materials, the economy is very likely to enter the state of inflation. Thereby, it is necessary and urgent for us to reconsider investment problems involving inflation risk. In this paper, we mainly study the optimal investment strategy of two defined contribution (DC) pension managers with strategy interaction under inflation risk. The traditional portfolio literatures mainly focus on DC pension plan and try to maximize the expected utility of terminal nominal wealth. In this paper, we consider the more complicated situation that pension managers have, both concerns on relative wealth and relative risk aversion. Then, the objective function is constructed to satisfy these two concerns. The dynamic programming principle method is employed to solve the above problems, and a series of analytical solutions to this problem are obtained. Finally, some numerical examples are discussed for the economic implications to support our theoretical results.
Mechanistic Investigation of the Pyrolysis of Brown Grease
Authors: Almatarneh Mansour H. , Alnemrat Imarat Y. , Omeir Reema A. , Pratt Lawrence M. , Luu Thi Xuan Thi , Bui Minh , Hilaire Dickens Saint
Published: December 2020

The conversion of brown grease using pyrolysis reactions represents a very promising option for the production of renewable fuels and chemicals. Brown grease forms a mixture of alkanes, alkenes, and ketones at a temperature above 300°C at atmospheric pressure. This work is a computational study of the detailed reaction mechanisms of brown grease pyrolysis using DFT methodology. Prior experimental investigations confirmed product formation consistent with a set of radical reactions with CO2 elimination, as well as ketone by product formation, CO forming reactions, and formation of alcohols and aldehydes as minor byproducts. In this work, computational quantum chemistry was used to explore these reactions in greater detail. Particularly, a nonradical pathway formed ketone byproducts via the ketene, which we refer to as Pathways A1 and A2. Radical formation by thermal decomposition of unsaturated fatty acids initiates a set of reactions which eliminate CO2, regenerating alkyl radicals leading to hydrocarbon products (Pathway B). A third pathway (Pathway C) is an alternative set of radical reactions, resulting in decarbonylation and formation of minor byproducts. The results of the calculations are in good agreement with recent experimental studies.
Long-Term Follow-Up of Contrast-Induced Acute Kidney Injury: A Study from a Developing Country
Authors: Oweis Ashraf O. , Alshelleh Sameeha A. , Saadeh Nesreen , Jarrah Mohamad I. , Ibdah Rasheed , Alzoubi Karem H.
Published: December 2020

Introduction. Contrast-induced acute kidney injury (CI-AKI) is a worldwide known complication related to the use of contrast media with either imaging or angiography; it carries its own complications and effect on both morbidity and mortality; early identification of patients at risk and addressing modifiable risk factors may help reducing risk for this disease and its complications. Methods. This was a prospective observational study, where all patients admitted for cardiac catheterization between June 2015 and January 2016 were evaluated for CI-AKI. There were two study groups: contrast-induced acute kidney injury (CI-AKI) group, and noncontrast-induced acute kidney injury (non-CI-AKI) group. Results. Patients (

n
=
202

) were included and followed up for 4 years. Death and development of chronic kidney disease (CKD) need for another revascularization were the end points. The incidence of CI-AKI was 14.8%.In univariate analysis, age (

P
=
0.016

) and serum albumin at admission (

P
=
0.001

) were statistically significant predictors of overall death. Age (

P
=
0.002

), HTN (

P
=
0.002

), DM (

P
=
0.02

), and the use of diuretics (

P
=
0.001

) had a statistically significant impact on eGFR. The rate of recatheterization was not statistically significant between the two groups (61 (35.5%) for the non-CI-AKI vs. 12 (40%) for the other group;

P
=
0.63

). Some inflammatory markers (NGAL

P
=
0.06

, IL-19

P
=
0.08

) and serum albumin at admission

P
=
0.07

had a trend toward a statistically significant impact on recatheterization. Death (

P
=
0.66

) and need for recatheterization (

P
=
0.63

) were not statistically different between the 2 groups, while the rate of eGFR decline in for the CI-AKI was significant (

P
=
0.004

). Conclusion. CI-AKI is a common complication post percutaneous catheterization (PCI), which may increase the risk for CKD, but not death or the need for recatheterization. Preventive measures must be taken early to decrease the morbidity.
Co-Designing for Rightful Presence in Informal Science Learning Environments
Authors: Calabrese Barton Angela , Kim Won Jung , Tan Edna
Published: December 2020

Addressing ways in which systemic injustices manifest in learning environments has been a significant challenge to the field of informal science learning (ISL). The dominant discourses of equity are framed around calls for inclusion and the extension of rights for quality learning opportunities for all youth. In this paper, we move beyond inclusionary approaches to use the justice-oriented framework of rightful presence. Grounded in participatory design research, the findings show how possibilities for rightful presence arise when educators and youths collaboratively engage in exposing, disrupting, and transforming unjust narratives and practices that position youths as knowledge recipients and temporary guests in the host ISL institutions. These possibilities are characterized by opportunities to foreground youths’ lived lives and community wisdom in ways that shift the boundaries of who and what science is for. We discuss insights, dilemmas, and implications regarding justice-oriented pedagogies and their possibilities for rightful presence in science education.
Neuman Systems Model With Nurse-Led Interprofessional Collaborative Practice
Authors: Montano Anna-Rae
Published: December 2020

The Neuman Systems Model was developed to create a structure to depict nursing clients as complex systems, in constant energy exchange with their environments, comprised of multiple interrelated parts. It has been widely used in practice, education, research, and administration. An analysis of the theory, based upon Meleis’ methods, was conducted. The theory has high utility and a large circle of contagiousness despite its complexity, lack of teleology, and level of abstractness. Based upon this analysis, a new model entitled the Neuman Systems Model Perspective of Nurse-Led Interprofessional Collaborative Practice has been created to provide a framework for the care of community-dwelling older adults. As a first step in its development, this new model will be used to guide a mixed-methods study evaluating an interprofessional collaborative practice intervention for community-dwelling older adults.
Sarcoidosis: rarely a single system disorder
Authors: Mannes Katrin , Thomas Paul S.
Published: December 2020

Sarcoidosis is a systemic disease with a number of extrapulmonary manifestations, rarely limited to a single system. The objective of this review is to provide a overview of the systemic features of sarcoidosis and their surveillance.

Sarcoidosis is disease that can affect any organ system, resulting in a number of complications that can cause significant morbidity and mortality, including ophthalmological and cardiac complications. A number of investigations play a role in identifying manifestations of sarcoidosis. Respiratory physicians have an important role to play in identifying complications and monitoring patients with sarcoidosis, as they may be the first to encounter them.
Pulmonary manifestations of systemic vasculitis in childhood
Authors: Lawton Adam , Machta Joseph , Semple Thomas , Gupta Atul
Published: December 2020

The systemic vasculitides are a heterogenous group of rare conditions with an incompletely understood aetiology. Any of the systemic vasculitides may cause respiratory disease, but some conditions are more likely to affect the pulmonary system, often through pulmonary infarction and diffuse alveolar haemorrhage. These conditions are often difficult to diagnose due to their rarity and significant clinical overlap with common respiratory conditions. Prompt diagnosis and management can significantly reduce morbidity and mortality.