bluuebunny/crossref_metadata_2025 huggingface dataset:
Electronic records management systems and the competency of educational institutions: Evidence from Yemen
Authors: Mukred Muaadh , Yusof Zawiyah M. , Al-Moallemi Waleed Abdulkafi , Mokhtar Umi Asma’a , Hawash Burkan
Published: February 2021

In the modern world, the amount of information stored in modern technology has been exponentially increasing. Access to vast amounts of information has changed how governments, institutions, organizations, and individuals conduct their business and record keeping. The increased use of cloud computing in conjunction with information and communication technologies (ICT), office automation, and digitalization has altered how electronic records are generated. Organizations should embrace this emerging environment to ensure competent operations and regulatory compliance well into the future. The absence of framework makes it difficult to implement the Electronic Records Management System (ERMS). Thus, this study proposed a framework for ERMS implementation and identified the most critical factors that are related to the ERMS characteristics and cloud characteristics. The ERMS implementation will improve Yemeni public sector educational institution competency and such implementation will be facilitated by the proposed framework. The study uses the Technology Acceptance Model 3 (TAM3) to implement a cloud Electronic Records Management System (ERMS). In addition to that, the study used a quantitative approach method and distributed questionnaires to 350 academicians and managers in the Yemeni public education sector. Variable relationships were identified using Partial Least Square-Structural Equation Modelling (PLS-SEM) through a second-order analysis method. All the identified factors were found to be essential and have a significant relationship with the behavioral intention to implement ERMS. The findings also revealed that ERMS plays a substantial and vital role in the competency of educational organizations. In other words, the study results demonstrated the importance of ERMS and Cloud dimension to ERMS implementation as well as the significant effect of ERMS implementation on public sector educational competency. These findings of the study have the potential to assist in shaping the direction of theory and empirical studies concerning the ERMS, particularly in its implementation to support the competency of educational institutions.
Effects of electromyographic biofeedback interventions for shoulder pain and function: Systematic review and meta-analysis
Authors: Kamonseki Danilo Harudy , Calixtre Letícia Bojikian , Barreto Rodrigo Py Gonçalves , Camargo Paula Rezende
Published: February 2021

Objective:

To systematically review the effectiveness of electromyographic biofeedback interventions to improve pain and function of patients with shoulder pain.

Design:

Systematic review of controlled clinical trials.

Literature search:

Databases (Medline, EMBASE, CINAHL, PEDro, CENTRAL, Web of Science, and SCOPUS) were searched in December 2020.

Study selection criteria:

Randomized clinical trials that investigated the effects of electromyographic biofeedback for individuals with shoulder pain. Patient-reported pain and functional outcomes were collected and synthesized.

Data synthesis:

The level of evidence was synthesized using GRADE and Standardized Mean Differences and 95% confidence interval were calculated using a random-effects inverse variance model for meta-analysis.

Results:

Five studies were included with a total sample of 272 individuals with shoulder pain. Very-low quality of evidence indicated that electromyographic biofeedback was not superior to control for reducing shoulder pain (standardized mean differences = −0.21, 95% confidence interval: −0.67 to 0.24, P = 0.36). Very-low quality of evidence indicated that electromyographic biofeedback interventions were not superior to control for improving shoulder function (standardized mean differences = −0.11, 95% confidence interval: −0.41 to 0.19, P = 0.48).

Conclusion:

Electromyographic biofeedback may be not effective for improving shoulder pain and function. However, the limited number of included studies and very low quality of evidence does not support a definitive recommendation about the effectiveness of electromyographic biofeedback to treat individuals with shoulder pain.
Role of nitric oxide signaling in the antidepressant mechanism of action of ketamine: A randomized controlled trial
Authors: Bevilacqua Laura , Charney Alex , Pierce Charlotte R , Richards Samantha M , Jha Manish K , Glasgow Andrew , Brallier Jess , Kirkwood Katherine , Bagiella Emilia , Charney Dennis S , Murrough James W
Published: February 2021

Ketamine is an N-methyl-D-aspartate receptor antagonist with rapid antidepressant effects. Studies suggest that inhibition of nitric oxide synthesis plays a role in the mechanism of action of ketamine. This randomized, placebo-controlled study investigated whether co-administration of sodium nitroprusside, a nitric oxide donor, compared to placebo, would attenuate the antidepressant and dissociative effects of ketamine. Sixteen ketamine responders were randomized to a double-blind infusion of ketamine co-administered with placebo or sodium nitroprusside. Our findings show no difference between the two conditions suggesting that the nitric oxide pathway may not play a primary role in ketamine’s antidepressant or dissociative effects. The study is registered at clinicaltrials.gov (NCT03102736).
Structural Consequences of a Partial Anterior Cruciate Ligament Injury on Remaining Joint Integrity: Evidence for Ligament and Bone Changes Over Time in an Ovine Model
Authors: Barton Kristen I. , Heard Bryan J. , Kroker Andres , Sevick Johnathan L. , Raymond Duncan A. , Chung May , Achari Yamini , Martin C. Ryan , Frank Cyril B. , Boyd Steven K. , Shrive Nigel G. , Hart David A.
Published: February 2021

Background:

Severe injury to the knee joint often results in accelerated posttraumatic osteoarthritis (PTOA). In an ovine knee injury model, altered kinematics and degradation of the cartilage have been observed at 20 and 40 weeks after partial anterior cruciate ligament (ACL) transection (p-ACL Tx) surgery. However, changes to the integrity of the remaining intact intra-articular ligaments (posterolateral [PL] band and posterior cruciate ligament [PCL]) as well as the subchondral bone after anteromedial (AM) band Tx remain to be characterized.

Purpose:

(1) To investigate histological alterations to the remaining intact intra-articular ligaments, the synovium, and the infrapatellar fat pad (IPFP) and (2) to quantify subchondral bone changes at the contact surfaces of the proximal tibia at 20 and 40 weeks after AM band Tx.

Study Design:

Descriptive laboratory study.

Methods:

Mature female Suffolk cross sheep were allocated into 3 groups: nonoperative controls (n = 6), 20 weeks after partial ACL transection (p-ACL Tx; n = 5), and 40 weeks after p-ACL Tx (n = 6). Ligament, synovium, and IPFP sections were stained and graded. Tibial subchondral bone microarchitecture was assessed using high-resolution peripheral quantitative computed tomography.

Results:

p-ACL Tx of the AM band led to significant change in histological scores of the PL band and the PCL at 20 weeks after p-ACL Tx ( P = .031 and P = .033, respectively) and 40 weeks after p-ACL Tx ( P = .011 and P = .029) as compared with nonoperative controls. Alterations in inflammatory cells and collagen fiber orientation contributed to the greatest extent of the combined histological score in the PL band and PCL. p-ACL Tx did not lead to chronic activation of the synovium or IPFP. Trabecular bone mineral density was strongly inversely correlated with combined gross morphological damage in the top and middle layers of the subchondral bone in the lateral tibial plateau for animals at 40 weeks after p-ACL Tx.

Conclusion:

p-ACL Tx influences the integrity (biology and structure) of remaining intact intra-articular ligaments and bone microarchitecture in a partial knee injury ovine model.

Clinical Relevance:

p-ACL Tx leads to alterations in structural integrity of the remaining intact ligaments and degenerative changes in the trabecular bone mineral density, which may be detrimental to the injured athlete’s knee joint in the long term.
(Lack of) government policy for indigenous (Sámi) sport: A chain of legitimating and de-legitimating acts
Authors: Skille Eivind Å , Fahlén Josef , Stenling Cecilia , Strittmatter Anna-Maria
Published: February 2021

While colonization as policy is formally a historic phenomenon in Norway and elsewhere, many former structures of state organization – including their relationship to sport – remain under post-colonial conditions. This paper is concerned with how the Norwegian government contributes to creating a situation, which includes the Norwegian sports confederation (NIF) but excludes the indigenous people Sámi’s sports organisation. Based on existing data and literature, we analyse how the state favours NIF through a chain of legitimating acts. Thus, sport is a preserve of colonization, where a one-sided legitimation parallels a de-legitimation of the overarching sport policy goal of sport-for-all. However, there are signs of change whereby actors are challenging NIF’s monopoly and ‘older’ state-sport regimes.
Markets are constantly collapsing: Reconceptualizing ‘the market’ as a quantum social wavefunction
Authors: Murphy Michael
Published: February 2021

The quantum moment in International Relations theory challenges the taken for granted Newtonian assumptions of conventional theories, while offering a novel physical imaginary grounded in quantum mechanics. As part of the special issue on reconceptualizing markets, this article questions if prior efforts to conceptualize ‘the market’ have been unsuccessful at capturing the paradoxical microfoundational/macrostructural because of the Newtonian worldview within which much social science operates. By developing a new, quantum perspective on the market, taking the physical paradigm of the wavefunction, I seek to explore the connections between entanglement, nonlocality, interference and invisible social structures. To demonstrate the applicability of quantum thinking, I explore how global value chains and open economy politics might be ‘quantized’, through the mobilization of core concepts of quantum social theory, within the broad framework of the market as a quantum social wavefunction.
Bonded from Brokenness: A Collaborative Autoethnography on Maternal Bereavement
Authors: Whalen Gina C. , Simmons Tara E.
Published: February 2021

The purpose of this study is to explore the experience of maternal bereavement. As scholar practitioners the authors offer their personal narratives to bring awareness to the multifaceted aspects of grieving the death of a child. Using collaborative autoethnography as the study’s methodology enabled the authors to explore their connection to the sociocultural context of maternal grief. Data collection consisted of a dialogue process that took place electronically through the course of asynchronous messages. Data analysis revealed three interrelated themes: transformation, constructing meaning, and creative ways of knowing. The findings are examined in light of literature regarding maternal bereavement and the expressing of grief through writing. The study concludes with a discussion on implications and recommendations for bereaved mothers and those who serve this population.
Total Ankle Arthroplasty With Valgus Deformity
Authors: Piga Camilo , Maccario Camilla , D’Ambrosi Riccardo , Romano Fausto , Usuelli Federico Giuseppe
Published: February 2021

Background:

A substantial coronal plane deformity is common in the context of end-stage ankle osteoarthritis. Recent literature shows a trend toward extending the indication of total ankle arthroplasty in increasingly severe coronal deformities, showing promising results when correct alignment is achieved. Nevertheless, the results of lateral transfibular total ankle replacement (LTTAR) in valgus has not been extensively studied. We aimed to evaluate if the outcomes of LTTAR in ankles with valgus deformity were similar to those with no major deformity at short-term follow-up.

Methods:

This retrospective cohort study included 228 LTTARs. Patients were classified into 2 groups according to the preoperative coronal plane tibiotalar angle (TTS): neutral (less than 10 degrees of coronal deformity, 209 patients) and valgus (above 10 degrees of valgus, 19 patients). Clinical evaluation was performed using the American Orthopaedic Foot & Ankle Society (AOFAS) score, visual analog scale (VAS), 12-Item Short Form Health Survey 12 (SF-12) regarding its Physical and Mental Component Summary items. The radiographic evaluation considered anteroposterior and lateral ankle radiographs. Complications were also registered and classified as major or minor. The minimum follow-up was 2 years.

Results:

The average AOFAS, VAS, and SF-12 scores improved significantly postoperatively ( P < .001), without differences between groups. At final radiographic follow-up, the valgus alignment group did not show significant differences with the neutral alignment group regarding TTS, lateral distal tibial angle, or anterior distal tibial angle ( P > .05).

Conclusion:

LTTAR in cases with valgus deformity achieved and maintained correction at short-term follow-up, as obtained in neutral alignment ankles. Clinical outcomes improved significantly regardless of preoperative valgus deformity.

Level of Evidence:

Prognostic Level III, retrospective cohort study.
Planning the Episode: Home Care Admission Nurse Decision-Making Regarding the Patient Visit Pattern
Authors: Sockolow Paulina S. , Bowles Kathryn H. , Pankok Carl , Zhou Yingjie , Potashnik Sheryl , Bass Ellen J.
Published: February 2021

During home health care (HHC) admissions, nurses provide input into decisions regarding the skilled nursing visit frequency and episode duration. This important clinical decision can impact patient outcomes including hospitalization. Episode duration has recently gained greater importance due to the Centers for Medicare and Medicaid Services (CMS) decrease in reimbursable episode length from 60 to 30 days. We examined admissions nurses’ visit pattern decision-making and whether it is influenced by documentation available before and during the first home visit, agency standards, other disciplines being scheduled, and electronic health record (EHR) use. This observational mixed-methods study included admission document analysis, structured interviews, and a think-aloud protocol with 18 nurses from 3 diverse HHC agencies (6 at each) admitting 2 patients each (36 patients). Findings show that prior to entering the home, nurses had an information deficit; they either did not predict the patient’s visit frequency and episode duration or stated them based on experience with similar patients. Following patient interaction in the home, nurses were able to make this decision. Completion of documentation using the EHR did not appear to influence visit pattern decisions. Patient condition and insurance restrictions were influential on both frequency and duration. Given the information deficit at admission, and the delay in visit pattern decision making, we offer health information technology recommendations on electronic communication of structured information, and EHR documentation and decision support.
Escaping the inescapable: Risk of mental health disorder, somatic symptoms and resilience in Palestinian refugee children
Authors: Wilson Naomi , Turner-Halliday Fiona , Minnis Helen
Published: February 2021

Exposure to war, conflict and forced migration puts children at risk of mental health problems. The present study examined the levels of psychological distress and resilience factors among 106 Palestinian refugee children aged 11 to 17 in the West Bank. In a cross-sectional, mixed method design along with qualitative interviews, three questionnaires were administered: the Strength and Difficulties Questionnaire and Patient Health Questionnaire-15, assessed the risk of mental health disorders and psychosomatic complaints, and the Child and Youth Resilience Measure assessed the availability of resilience-enhancing factors. Palestinian refugee children were found to be at greater risk for mental disorders and psychosomatic complaints than were children living in non-conflict affected settings. In addition, resilience-enhancing resources were significantly reduced and were negatively correlated with both symptom outcomes. Risk factors identified included poverty, violence and marginalisation. Key protective factors were youth education, supportive relationships and social participation. Our findings support interventions that address the identified protective factors, which may promote the mental health of this vulnerable population.
Dosimetric Comparison of Helical Tomotherapy, Volumetric-Modulated Arc Therapy, and Intensity-Modulated Proton Therapy for Angiosarcoma of the Scalp
Authors: Mizuno Tomoki , Tomita Natsuo , Takaoka Taiki , Tomida Masashi , Fukuma Hiroshi , Tsuchiya Takahiro , Shibamoto Yuta
Published: February 2021

Objective:

We compared radiotherapy plans among helical tomotherapy (HT), volumetric-modulated arc therapy (VMAT), and intensity-modulated proton therapy (IMPT) for angiosarcoma of the scalp (AS).

Methods:

We conducted a planning study for 19 patients with AS. The clinical target volume (CTV) 1 and CTV2 were defined as the gross tumor volume with a specific margin and total scalp, respectively. For HT and VMAT, the planning target volume (PTV) 1 and PTV2 were defined as CTV1 and CTV2 with 0.5-cm margins, respectively. For IMPT, robust optimization was used instead of a CTV-PTV margin (i.e. CTV robust). The targets of the HT and VMAT plans were the PTV, whereas the IMPT plans targeted the CTV robust. In total, 70 Gy and 56 Gy were prescribed as the D95% (i.e. dose to 95% volume) of PTV1 (or CTV1 robust) and PTV2 (or CTV2 robust), respectively, using the simultaneous integrated boost (SIB) technique. Other constraint goals were also defined for the target and organs at risk (OAR).

Results:

All dose constraint parameters for the target and OAR met the goals within the acceptable ranges for the 3 techniques. The coverage of the targets replaced by D95% and D98% were almost equivalent among the 3 techniques. The homogeneity index of PTV1 or CTV1 robust was equivalent among the 3 techniques, whereas that of PTV2 or CTV2 robust was significantly higher in the IMPT plans than in the other plans. IMPT reduced the Dmean of the brain and hippocampus by 49% to 95%, and the Dmax of the spinal cord, brainstem, and optic pathway by 70% to 92% compared with the other techniques.

Conclusion:

The 3 techniques with SIB methods provided sufficient coverage and satisfactory homogeneity for the targets, but IMPT achieved the best OAR sparing.
Effects of Robotic Therapy Associated With Noninvasive Brain Stimulation on Upper-Limb Rehabilitation After Stroke: Systematic Review and Meta-analysis of Randomized Clinical Trials
Authors: Reis Suzana Bleckmann , Bernardo Wanderley Marques , Oshiro Carlos Andre , Krebs Hermano Igo , Conforto Adriana Bastos
Published: February 2021

Background

Robot-assisted therapy and noninvasive brain stimulation (NIBS) are promising strategies for stroke rehabilitation.

Objective

This systematic review and meta-analysis aims to evaluate the evidence of NIBS as an add-on intervention to robotic therapy in order to improve outcomes of upper-limb motor impairment or activity in individuals with stroke.

Methods

This study was performed according to the PRISMA Protocol and was previously registered on the PROSPERO Platform (CRD42017054563). Seven databases and gray literature were systematically searched by 2 reviewers, and 1176 registers were accessed. Eight randomized clinical trials with upper-limb body structure/function or activity limitation outcome measures were included. Subgroup analyses were performed according to phase poststroke, device characteristics (ie, arm support, joints involved, unimanual or bimanual training), NIBS paradigm, timing of stimulation, and number of sessions. The Grade-Pro Software was used to assess quality of the evidence.

Results

A nonsignificant homogeneous summary effect size was found both for body structure function domain (mean difference [MD] = 0.15; 95% CI = −3.10 to 3.40; P = 0.93; I2 = 0%) and activity limitation domain (standard MD = 0.03; 95% CI = −0.28 to 0.33; P = 0.87; I2 = 0%).

Conclusions

According to this systematic review and meta-analysis, at the moment, there are not enough data about the benefits of NIBS as an add-on intervention to robot-assisted therapy on upper-limb motor function or activity in individuals with stroke.
The Post-ICU presentation screen (PICUPS) and rehabilitation prescription (RP) for intensive care survivors part II: Clinical engagement and future directions for the national Post-Intensive care Rehabilitation Collaborative
Authors: Puthucheary Zudin , Brown Craig , Corner Evelyn , Wallace Sarah , Highfield Julie , Bear Danielle , Rehill Nirandeep , Montgomery Hugh , Aitken Leanne , Turner-Stokes Lynne
Published: February 2021

Background

Many Intensive Care Unit (ICU) survivors suffer from a multi- system disability, termed the post-intensive care syndrome. There is no current national coordination of either rehabilitation pathways or related data collection for them. In the last year, the need for tools to systematically identify the multidisciplinary rehabilitation needs of severely affected COVID-19 survivors has become clear. Such tools offer the opportunity to improve rehabilitation for all critical illness survivors through provision of a personalised Rehabilitation Prescription (RP). The initial development and secondary refinement of such an assessment and data tools is described in the linked paper. We report here the clinical and workforce data that was generated as a result.

Methods

Prospective service evaluation of 26 acute hospitals in England using the Post-ICU Presentation Screen (PICUPS) tool and the RP. The PICUPS tool comprised items in domains of a) Medical and essential care, b) Breathing and nutrition; c) Physical movement and d) Communication, cognition and behaviour.

Results

No difference was seen in total PICUPS scores between patients with or without COVID-19 (77 (IQR 60-92) vs. 84 (IQR 68-97); Mann-Whitney z = −1.46, p = 0.144. A network analysis demonstrated that requirements for physiotherapy, occupational therapy, speech and language therapy, dietetics and clinical psychology were closely related and unaffected by COVID-19 infection status. A greater proportion of COVID-19 patients were referred for inpatient rehabilitation (13% vs. 7%) and community-based rehabilitation (36% vs.15%). The RP informed by the PICUPS tool generally specified a greater need for multi-professional input when compared to rehabilitation plans instituted.

Conclusions

The PICUPS tool is feasible to implement as a screening mechanism for post-intensive care syndrome. No differences are seen in the rehabilitation needs of patients with and without COVID-19 infection. The RP could be the vehicle that drives the professional interventions across the transitions from acute to community care. No single discipline dominates the rehabilitation requirements of these patients, reinforcing the need for a personalised RP for critical illness survivors.
Penetration of an optimal depleted uranium liner of a shaped charge: A numerical simulation method
Authors: Xu Rongzheng , Chen Li , Zhang Jinhua , Xiang Hengbo , Fang Qin
Published: February 2021

Depleted uranium (DU) has surprising physical properties such as a high density, high hardness, and high toughness. A numerical method was developed in AUTODYN to study the penetration performance of a shaped charge with a liner made of DU with 0.75% titanium. By comparing different parameters and results from different models, the strength model suitable for DU was determined. According to available experimental data, the geometric strains in the strength models for DU and the steel target were calibrated. The characteristics of the DU liner, employed in a finished shaped charge instead of a copper liner, were optimized by tuning different parameters, and the performance of this optimal liner was verified through relevant tests. Moreover, in agreement with the optimized computational model and structural studies, a novel structure for the shaped charge was proposed that aimed to achieve a penetration depth of eight charge diameters. Different penetration depths were obtained by changing specific parameters, and the influence of standoff on the penetration depth was also studied. By evaluating the best penetration performance, the optimal structure for the shaped charge was finally determined. These results can have a great impact on future experimental tests and engineering applications of DU.
Impact of California Safe Patient Handling Legislation: Health Care Workers’ Perspectives
Authors: Lee Soo-Jeong , Stock Laura , Michalchuk Victoria , Adesoye Kelsie , Mullen Kathleen
Published: February 2021

Background:

Musculoskeletal injuries from patient handling are significant problems among health care workers. In California, legislation requiring hospitals to implement safe patient handling (SPH) programs was enacted in 2011. This qualitative study explored workers’ experiences and perceptions about the law, their hospital’s SPH policies and programs, patient handling practices, and work environment.

Methods:

Three focus groups were conducted with 21 participants (19 nurses and 2 patient handling specialists) recruited from 12 hospitals located in the San Francisco Bay Area and San Joaquin Valley. Qualitative content analysis was used for data analysis.

Results:

Multiple themes emerged from diverse experiences and perceptions. Positive perceptions included empowerment to advocate for safety, increased awareness of SPH policies and programs, increased provision of patient handling equipment and training, increased lift use, and improvement in safety culture. Perceived concerns included continuing barriers to safe practices and lift use such as difficulty securing assistance, limited availability of lift teams, understaffing, limited nursing employee input in the safety committee, blaming of individuals for injury, increased workload, and continuing injury concerns. Participants indicated the need for effective training, sufficient staffing, and management support for injured workers.

Conclusions/Application to Practice:

This study identified improvements in hospitals’ SPH programs and practices since the passage of California’s SPH law, as well as continuing challenges and barriers to safe practices and injury prevention. The findings provide useful information to understanding the positive impacts of the SPH law but also notes the potential limitations of this legislation in the view of health care workers.
Followers’ Perceptions of Positive Communication Practices in Leadership: What Matters and Surprisingly What Does Not
Authors: Biganeh Maryam , Young Stacy L.
Published: February 2021

Using the model of positive communication as a guiding framework, this study explored which specific prosocial behaviors best explained a relationship- or task-oriented leadership style. Examining data gathered from 359 participants working in various industries, regression analyses revealed that listening behaviors and inspirational actions were meaningful for both relationship- and task-oriented leaders; however, complimenting emerged as particularly salient for relationship-oriented leadership styles whereas asking was significant for task-oriented leadership styles. Interestingly, followers’ age, race-ethnicity, and gender did not impact their perceptions of leader’s positive communication practices. The implications of these findings for leadership training, particularly in an increasingly diverse workforce, are discussed.
Increasing hepatitis virus screening uptake at worksites in Japan using nudge theory and full subsidies
Authors: Fukuyoshi Jun , Korenaga Masaaki , Yoshii Yui , Hong Lek , Kashihara Soichiro , Sigel Byron , Takebayashi Toru
Published: February 2021

Background

Despite the importance of hepatitis screening for decreasing liver cancer mortality, screening rates remain low in Japan. Previous studies show that full subsidies increase screening uptake, but full subsidies are costly and difficult to implement in low-resource settings. Alternatively, applying nudge theory to the message design could increase screening at lower costs. This study examined the effects of both methods in increasing hepatitis virus screening rates at worksites.

Methods

1496 employees from a Japanese transportation company received client reminders for an optional hepatitis virus screening before their general health checkups. Groups A and B received a client reminder designed based on the principles of “Easy” and “Attractive,” while the control group received a client reminder not developed using nudge theory. Additionally, hepatitis virus screening was offered to the control group and group A for a co-payment of JPY 612, but was fully subsidized for group B. The hepatitis virus screening rates among the groups were compared using a Chi-square test with Bonferroni correction, and the risk ratios of group A and group B to the control group were also calculated. To adjust for unobservable heterogeneity per cluster, the regression analysis was performed using generalized linear mixed models.

Results

The screening rate was 21.2%, 37.1%, and 86.3% for the control group, group A, and group B, respectively. And the risk ratio for group A was 1.75 (95% confidence interval [CI] 1.45–2.12) and that of group B was 4.08 (95% CI 3.44–4.83). The parameters of group A and group B also were significant when estimated using generalized linear mixed models. However, the cost-effectiveness (incremental cost-effectiveness ratio (ICER)) of the nudge-based reminder with the full subsidies was lower than that of only the nudge-based reminder.

Conclusions

While fully subsidized screening led to the highest hepatitis screening rates, modifying client reminders using nudge theory significantly increased hepatitis screening uptake at lower costs per person.
Subacute Sclerosing Panencephalitis manifesting as Bell’s palsy and bilateral macular necrotizing retinitis: an atypical presenting feature
Authors: Paul Lagan , Jain Tanya , Agarwal Manisha , Singh Shalini
Published: February 2021

Background

Subacute sclerosing panencephalitis (SSPE) is a potentially lethal complication of measles infection. Neurological complications take years to manifest after primary viral infection of brain and can lead to blindness in some individuals.

Findings

A 13-year-old female patient with history of Bell’s palsy 2 months prior, presented with rapidly progressing necrotizing retinitis in both eyes. Soon after, she was unable to walk, developed myoclonic jerks, altered sensorium and loss of bowel and bladder control. Her clinical history, CSF IgG measles antibody analysis, MRI brain and EEG findings confirmed the diagnosis of SSPE.

Conclusion

SSPE in our case presented as Bell’s palsy and sudden painless diminution of vision due to ocular involvement, and developed full blown disease within 2 months. SSPE can present as a diagnostic challenge and warrants early identification and referral for timely diagnosis and management.
Insights of Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2) pandemic: a current review
Authors: Choudhary Jyoti , Dheeman Shrivardhan , Sharma Vipin , Katiyar Prashant , Karn Santosh Kumar , Sarangi Manoj Kumar , Chauhan Ankit Kumar , Verma Gaurav , Baliyan Nitin
Published: February 2021

COVID-19, a pandemic of the 21st century caused by novel coronavirus SARS-CoV-2 was originated from China and shallowed world economy and human resource. The medical cures via herbal treatments, antiviral drugs, and vaccines still in progress, and studying rigorously. SARS-CoV-2 is more virulent than its ancestors due to evolution in the spike protein(s), mediates viral attachment to the host’s membranes. The SARS-CoV-2 receptor-binding spike domain associates itself with human angiotensin-converting enzyme 2 (ACE-2) receptors. It causes respiratory ailments with irregularities in the hepatic, nervous, and gastrointestinal systems, as reported in humans suffering from COVID-19 and reviewed in the present article. There are several approaches, have been put forward by many countries under the world health organization (WHO) recommendations and some trial drugs were introduced for possible treatment of COVID-19, such as Lopinavir or Ritonavir, Arbidol, Chloroquine (CQ), Hydroxychloroquine (HCQ) and most important Remdesivir including other like Tocilizumab, Oritavancin, Chlorpromazine, Azithromycin, Baricitinib, etc. RT-PCR is the only and early detection test available besides the rapid test kit (serodiagnosis) used by a few countries due to unreasonable causes. Development of vaccine by several leader of pharmaceutical groups still under trial or waiting for approval for mass inoculation. Management strategies have been evolved by the recommendations of WHO, specifically important to control COVID-19 situations, in the pandemic era. This review will provide a comprehensive collection of studies to support future research and enhancement in our wisdom to combat COVID-19 pandemic and to serve humanity.
Eye-tracking-aided characterization of saccades and antisaccades in SYNE1 ataxia patients: a pilot study
Authors: Szpisjak Laszlo , Szaraz Gabor , Salamon Andras , Nemeth Viola L. , Szepfalusi Noemi , Veres Gabor , Kincses Balint , Maroti Zoltan , Kalmar Tibor , Rydzanicz Malgorzata , Ploski Rafal , Klivenyi Peter , Zadori Denes
Published: February 2021

Background

SYNE1 ataxia is an autosomal recessive hereditary condition, the main characteristic features of which are gait and limb ataxia and cerebellar dysarthria. Reports have revealed that the clinical phenotype of SYNE1 ataxia is more complex than the first published cases with pure cerebellar signs indicated. The aim of this study was to characterize eye movement alterations in the first diagnosed Hungarian SYNE1 ataxia patients.

Results

Saccades and antisaccades were examined with an eye tracker device in 3 SYNE1 (one patient has two frameshift mutations [c.8515_8516insA, p.Met2839Asnfs*53 and c.11594_11595insG, p.Glu3866*] in a compound heterozygous state, whereas two subjects have a splicing variant [c.23146-2A > G] in a homozygous state), 6 Friedreich ataxia (FA) patients and 12 healthy controls. Besides that, detailed clinical phenotyping and comprehensive neuropsychological assessment were carried out in all patients with ataxia.

In addition to the characteristic cerebellar alterations, pyramidal signs and polyneuropathy were observed at least in 2 SYNE1 ataxia patients, for which no other underlying reason was found. The eye tracking assessment revealed hypometric saccades in the longer amplitude (18.4°) saccadic paradigm in all SYNE1 patients, whereas 2 out of 3 SYNE1 subjects performed slow saccades as well. In the antisaccade task, higher incorrect ratios of antisaccades were demonstrated in SYNE1 patients compared to healthy controls, showing inverse correlation with working memory test results. The corresponding data of FA patients was dispersed over a wide range, partially overlapping with control data.

Conclusions

The current study draws attention to the presence of eye movement disorders in patients with SYNE1 ataxia and demonstrates that alterations in the antisaccade paradigm may be related to working memory deficits.
Physical frailty and long-term mortality in older people with chronic heart failure with preserved and reduced ejection fraction: a retrospective longitudinal study
Authors: Weng Shuo-Chun , Lin Chu-Sheng , Tarng Der-Cherng , Lin Shih-Yi
Published: February 2021

Background

Frailty, a syndrome characterized by a decline in function reserve, is common in older patients with heart failure (HF) and is associated with prognosis. This study aimed to evaluate the impact of frailty on outcomes in older patients with preserved and reduced cardiac function.

Methods

In total, 811 adults aged ≥65 years were consecutively enrolled from 2009 to 2018. HF was diagnosed according to the ICD9 code and a 2D echocardiogram was categorized by reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF). The index date was registered at the time of HF. All patients received a comprehensive geriatric assessment, and clinical outcomes were examined with adjustment of the other prognostic variables.

Results

Mean age was 80.5 ± 7.1 years. The prevalence of HF, HFpEF, HFrEF, Fried, and Rockwood frailty indicators was 28.5, 10.4, 9.7, 52.5, and 74.9%, respectively. At baseline, scores in the Timed Up and Go test was closely associated with the severity of HF, either with HFpEF or HFrEF. After a mean follow-up of 3.2 ± 2.0 years, we found that HF patients with low handgrip strength (HGS) had the poorest survival, followed by non-HF patients with decreased HGS, and HF with fair HGS in comparison with non-HF with fair HGS (p = 0.008) if participants were arbitrarily divided into two HGS groups. In all patients, a high Rockwood frailty index was independently associated with increased mortality (adjusted hazard ratio [aHR] = 1.05; 95% confidence interval [CI]: 1.0004 to 1.10). In addition, the adjusted mortality HR was 3.42 with decreased HGS (95% CI: 1.03 to 11.40), 7.65 with use of mineralocorticoid receptor antagonist (95% CI: 2.22 to 26.32), and 1.26 with associated multi-comorbidities assessed by Charlson comorbidity index (95% CI: 1.05 to 1.51).

Conclusions

Our study results indicate that frailty and decreased physical functions were associated with HF. Besides, frailty and HGS predicted prognosis in the patients, and there was a combined effect of HF and low HGS on survival.
Group or individual lifestyle-integrated functional exercise (LiFE)? A qualitative analysis of acceptability
Authors: Reicherzer Leah , Kramer-Gmeiner Franziska , Labudek Sarah , Jansen Carl-Philipp , Nerz Corinna , Nystrand Malin J. , Becker Clemens , Clemson Lindy , Schwenk Michael
Published: February 2021

Background

The Lifestyle-integrated Functional Exercise (LiFE) program is an effective but resource-intensive fall prevention program delivered one-to-one in participants’ homes. A recently developed group-based LiFE (gLiFE) could enhance large-scale implementability and decrease resource intensity. The aim of this qualitative focus group study is to compare participants’ experiences regarding acceptability of gLiFE vs LiFE.

Methods

Programs were delivered in seven group sessions (gLiFE) or seven individual home visits (LiFE) within a multi-center, randomized non-inferiority trial. Four structured focus group discussions (90–100 min duration; one per format and study site) on content, structure, and subjective effects of gLiFE and LiFE were conducted. Qualitative content analysis using the method of inductive category formation by Mayring was applied for data analysis. Coding was managed using NVivo.

Results

In both formats, participants (N = 30, 22 women, ngLiFE = 15, nLiFE = 15, mean age 78.8 ± 6.6 years) were positive about content, structure, and support received by trainers. Participants reflected on advantages of both formats: the social aspects of learning the program in a peer group (gLiFE), and benefits of learning the program at home (LiFE). In gLiFE, some difficulties with the implementation of activities were reported. In both formats, the majority of participants reported positive outcomes and successful implementation of new movement habits.

Conclusion

This is the first study to examine participants’ views on and experiences with gLiFE and LiFE, revealing strengths and limitations of both formats that can be used for program refinement. Both formats were highly acceptable to participants, suggesting that gLiFE may have similar potential to be adopted by adults aged 70 years and older compared to LiFE.

Trial registration

ClinicalTrials.gov, NCT03462654. Registered on March 12, 2018.
Structure and processes of emergency observation units with a geriatric focus: a scoping review
Authors: Heeren Pieter , Hendrikx Annabelle , Ceyssens Janne , Devriendt Els , Deschodt Mieke , Desruelles Didier , Flamaing Johan , Sabbe Marc , Milisen Koen
Published: February 2021

Background

Combining observation principles and geriatric care concepts is considered a promising strategy for risk-stratification of older patients with emergency care needs. We aimed to map the structure and processes of emergency observation units (EOUs) with a geriatric focus and explore to what extent the comprehensive geriatric assessment (CGA) approach was implemented in EOUs.

Methods

The revised scoping methodology framework of Arksey and O’Malley was applied. Manuscripts reporting on dedicated areas within hospitals for observation of older patients with emergency care needs were eligible for inclusion. Electronic database searches were performed in MEDLINE, EMBASE and CINAHL in combination with backward snowballing. Two researchers conducted data charting independently. Data-charting forms were developed and iteratively refined. Data inconsistencies were judged by a third researcher or discussed in the research team. Quality assessment was conducted with the Methodological Index for Non-Randomized Studies.

Results

Sixteen quantitative studies were included reporting on fifteen EOUs in seven countries across three continents. These units were located in the ED, immediately next to the ED or remote from the ED (i.e. hospital-based). All studies reported that staffing consisted of at least three healthcare professions. Observation duration varied between 4 and 72 h. Most studies focused on medical and functional assessment. Four studies reported to assess a patients’ medical, functional, cognitive and social capabilities. If deemed necessary, post-discharge follow-up (e.g. community/primary care services and/or outpatient clinics) was provided in eleven studies.

Conclusion

This scoping review documented that the structure and processes of EOUs with a geriatric focus are very heterogeneous and rarely cover all elements of CGA. Further research is necessary to determine how complex care principles of ‘observation medicine’ and ‘CGA’ can ideally be merged and successfully implemented in clinical care.
Implementation of highly challenging balance training for Parkinson’s disease in clinical practice: a process evaluation
Authors: Leavy Breiffni , Joseph Conran , Kwak Lydia , Franzén Erika
Published: February 2021

Background

Process evaluations provide contextual insight into the way in which interventions are delivered. This information is essential when designing strategies to implement programs into wider clinical practice. We performed a process evaluation of the HiBalance effectiveness trial investigating the effects of a 10-week of highly challenging and progressive balance training for mild-moderate Parkinson’s disease (PD). Study aims were to investigate i) the quality and quantity of intervention delivery and ii) barriers and facilitators for implementation.

Methods

Process outcomes included; Fidelity; Dose (delivered and received) Recruitment and Reach. Investigation of barriers and facilitators was guided by the Consolidated Framework for Implementation Research. Program delivery was assessed across four neurological rehabilitation sites during a two-year period. Data collection was mixed-methods in nature and quantitative and qualitative data were merged during the analysis phase.

Results

Thirteen program trainers delivered the intervention to 12 separate groups during 119 training sessions. Trainer fidelity to program core components was very high in 104 (87%) of the sessions. Participant responsiveness to the core components was generally high, although adherence to the home exercise program was low (50%). No significant context-specific differences were observed across sites in terms of fidelity, dose delivered/ received or participant characteristics, despite varying recruitment methods. Facilitators to program delivery were; PD-specificity, high training frequency and professional autonomy. Perceived barriers included; cognitive impairment, absent reactional balance among participants, as well a heterogeneous group in relation to balance capacity.

Conclusion

These findings provide corroborating evidence for outcome evaluation results and valuable information for the further adaptation and implementation of this program. Important lessons can also be learned for researchers and clinicians planning to implement challenging exercise training programs for people with mild-moderate PD.

Trial registration

ClinicalTrials.gov,NCT02727478, registered 30 march, 2016 − Retrospectively registered.
Rapid review of COVID-19 epidemic estimation studies for Iran
Authors: Pourmalek Farshad , Rezaei Hemami Mohsen , Janani Leila , Moradi-Lakeh Maziar
Published: February 2021

Background

To inform researchers about the methodology and results of epidemic estimation studies performed for COVID-19 epidemic in Iran, we aimed to perform a rapid review.

Methods

We searched for and included published articles, preprint manuscripts and reports that estimated numbers of cumulative or daily deaths or cases of COVID-19 in Iran. We found 131 studies and included 29 of them.

Results

The included studies provided outputs for a total of 84 study-model/scenario combinations. Sixteen studies used 3–4 compartmental disease models. At the end of month two of the epidemic (2020-04-19), the lowest (and highest) values of predictions were 1,777 (388,951) for cumulative deaths, 20,588 (2,310,161) for cumulative cases, and at the end of month four (2020-06-20), were 3,590 (1,819,392) for cumulative deaths, and 144,305 (4,266,964) for cumulative cases. Highest estimates of cumulative deaths (and cases) for latest date available in 2020 were 418,834 on 2020-12-19 (and 41,475,792 on 2020-12-31). Model estimates predict an ominous course of epidemic progress in Iran. Increase in percent population using masks from the current situation to 95% might prevent 26,790 additional deaths (95% confidence interval 19,925–35,208) by the end of year 2020.

Conclusions

Meticulousness and degree of details reported for disease modeling and statistical methods used in the included studies varied widely. Greater heterogeneity was observed regarding the results of predicted outcomes. Consideration of minimum and preferred reporting items in epidemic estimation studies might better inform future revisions of the available models and new models to be developed. Not accounting for under-reporting drives the models’ results misleading.