bluuebunny/crossref_metadata_2025 huggingface dataset:
Three-Dimensional Multi-Morphology TPMS-Based Microchannel Design Method for Conformal Cooling in Injection Molding
Authors: Yang Guan-Hua , Chi Zi-Peng , Wang Qing-Hui
Published: November 2024

Triply periodic minimal surface (TPMS) possesses diverse morphological characteristics, such as pore sizes, porosity, and structural types. Integrating TPMS-based microchannels into micro-cellular cooling structures is advantageous for designing and controlling fluid characteristics within mold cooling channels. However, it is still difficult to design multi-morphology TPMS-based cooling microchannels that conform to the external shapes of injection molds. This work proposes a 3D multi-morphology TPMS-based design method that transforms 3D constraints into a combination of 2D constraints. First, a beta growth algorithm based on closed-loop constraints is proposed to transition different morphologies smoothly on the plane. Subsequently, a transition optimization algorithm along the normal direction of the plane is introduced to smoothly transition multi-morphology TPMS-based microchannels in all directions. With this layered approach, multi-morphology microchannels can be obtained with first-order geometric continuity under complex shape constraints. Finally, several TPMS-based conformal cooling structures are designed for an automotive hood cover. The results of finite element simulations show that the cooling structures generated by the proposed method have a better cooling effect than the conformal channels. It can be concluded that multi-morphology TPMS-based structures perform better by contrast with conformal channels as the average temperature of the cooling surface decreases by 8.48 K, and the standard deviation of temperature distribution decreases by 24.65%.
Investigation on the Influence of Rural Residents' Behavior Regulation on Gas-Fired Combi-Boiler Heating in Northern China
Authors: Zhou Weiye , Gao Wenxue , Yang Lijie , Lu Xinyu , Yang Lin , Ding Zequn , Zhou Chengye
Published: November 2024

There is basically no research on the impact of rural residents' behavior on heating when using gas-fired heating and hot water combi-boilers as a heat source. Two residential buildings in rural areas of Handan were selected for the study, indoor and outdoor temperatures and gas consumption were tested, and a survey of residents' behavior was conducted. The results show that the ratio of actual heat inputs to rated heat input in two buildings is 47–76% and 25–91%, indicating that the reason for the indoor temperature being lower than design temperature is not the insufficient heating capacity of the heating system, but rather the result of residents actively adjusting the combi-boilers. Resident behavior adjustment has a significant impact on the temperature difference between indoor and outdoor and gas consumption for heating. Compared to the automatic adjustment behavior mode, the maximum deviation of the temperature difference between indoor and outdoor under artificial adjustment behavior during period 1 is 59%, with an average deviation of 44%. However, the average gas consumption is reduced by 9.2%. The study reflects that rural residents actively adjust the gas-fired combi-boilers to significantly reduce the gas cost of building heating while meeting their own thermal comfort requirements.
Fabrication of double-grooved gratings using coplanar multibeam holographic lithography with a phase mask
Authors: Li Shiyang , Huan Shuhu , Ren Tao , Liu Ying , Hong Yilin , Fu Shaojun
Published: November 2024

Submicrometer double-grooved gratings feature unique optical properties and diverse potential applications, most of which have been fabricated by electron beam lithography up till now. On the other hand, holographic lithography based on a phase mask [near-field holography (NFH)] has the advantages of high throughput, low cost, and a compact setup in terms of a short optical path. Distinguished from conventional NFH based on double-beam interference, multibeam NFH based on multibeam interference is studied to form groove profiles of double-grooved gratings in this study. The formation principle of double-grooved gratings is attributed to the multibeam interference of the transmitted beams behind the phase mask. Within such multibeam interference, every two of diffracted beams interfere and form several sets of latent subgrating patterns. The formation of double-grooved gratings can be understood as the superimposition of different portions of subgrating patterns. We also demonstrated the potential and challenges of several key factors in tailoring the symmetric and asymmetric double-grooved structures, including the incidence angles, the efficiency distribution of phase masks, exposure-development conditions, and the spacing between the mask and substrate. Symmetric and asymmetric double-grooved gratings with periods of 666.7, 950, and 1000 nm were fabricated by coplanar three-beam NFH at normal incidence, and coplanar four-beam NFH at oblique incidence and near normal incidence. The experimental results of the evolution of the grating profiles of double-grooved gratings are in relatively good agreement with the simulation. This study provides an alternative cost-effective fabrication method for the mass production of double-grooved gratings. Moreover, this study also enriches the diversity of groove profiles of diffraction grating by NFH.
Genetic linkage between parent granite and zoned rare metal pegmatite in the Renli-Chuanziyuan granite-pegmatite system, South China
Authors: Xiong Yi-Qu , Fan Zhi-Wei , Yu Hao-Yu , Di Hongfei , Cao Yong-Hua , Wen Chun-Hua , Jiang Shao-Yong
Published: November 2024

Elucidating the causal relationship between parent granite and pegmatite and tracing the magmatic-hydrothermal evolution and rare metal mineralization are intriguing scientific issues that remain unsolved. The Renli-Chuanziyuan granite-pegmatite field, hosted in and adjacent to the Mufushan batholith, represents a significant rare metal ore district in southern China. The field reveals well-defined regional zonation, encompassing biotite, two-mica, and muscovite monzogranites at the core, which transition outward to microcline (K-pegmatite), microcline-albite (K-Na-pegmatite), albite (Na-pegmatite), and albite-spodumene pegmatites (Na-Li-pegmatite) at the southwestern margin of the Mufushan batholith. The U-Pb ages of the columbite-tantalite (coltan) grains from the Na-Li-pegmatite samples from the Chuanziyuan deposits are 139.1 ± 1.2 Ma and 138.6 ± 1.1 Ma, which are consistent with the ages of the coltan grains from the Renli deposit, indicating contemporaneous mineralization. Chemical analyses of muscovite, garnet, and coltan from various pegmatite zones reveal a gradual increase in the degree of differentiation and volatile components of the Early Cretaceous magmatic system from north to south. Particularly noteworthy is the significant increase in the abundance of Na-Li-pegmatites to the south, signifying the transition from an early melt stage with a minor fluid component to a melt-fluid stage with a substantial volume of unmixed fluid. This evolution led to the enrichment and precipitation of Nb and Ta in the Renli deposit and of Li in the Chuanziyuan deposit, which were facilitated by the separation and exsolution of flux-rich (e.g., F, H2O) fluid. The highly evolved ca. 140 Ma muscovite monzogranite exhibits a well-defined spatial and temporal relationship with rare metal pegmatites, providing strong evidence of genetic associations. Furthermore, the geochemical characteristics of muscovite and garnet from the muscovite monzogranite overlap with those of mineralized pegmatites, further suggesting (together with the simulation study) that the muscovite monzogranite served as the parental granite of the mineralized pegmatites. These findings underscore the importance of understanding the evolution of the granite-pegmatite system, particularly in the context of rare metal exploration, and contribute to a deeper understanding of the ore-forming mechanisms of zoned rare metal pegmatites.
Early endomyocardial fibrosis mimicking dilated cardiomyopathy
Authors: Ferreira Joana , Duarte Tatiana , Soares Andreia , Gonçalves Sara
Published: November 2024

Endomyocardial fibrosis (EMF) is a poorly understood but common cause of heart failure in sub-Saharan Africa, which typically presents with a restrictive phenotype. We describe a previously unreported presentation of EMF with severe left ventricular dilatation and systolic dysfunction, mimicking dilated cardiomyopathy, in which longitudinal and multimodality imaging was crucial for the diagnosis.
Emergency autologous vein graft reconstruction after vascular closure device usage and subsequent infection
Authors: Chio Jonathon Chon Teng , Gordon Lauren , Roche-Nagle Graham
Published: November 2024

Different techniques and devices can achieve haemostasis after endovascular procedures to reduce time to haemostasis and facilitate percutaneous large-bore access. One such device is the Angio-Seal, which accomplishes haemostasis by compressing a collagen plug against the arteriotomy. Multiple complications related to Angio-Seal exist, most commonly acute artery occlusions and rarely infections and endarteritis. We present a case of an adult male (aged 80–85) who developed a groin haematoma associated with Angio-Seal use. Arterial bypass for arterial reconstruction and intravenous antibiotics were required. This case addresses the associated pathologies of Angio-Seal failure and Angio-Seal infection, patient- and device-specific risk factors and measures to treat and prevent these complications (ANGIO-SEAL VIP Vascular Closure Device—6 Fr Terumo Medical, NJ, USA).
20p chromosome inverted duplication syndrome with phenotypes of congenital heart disease, anorectal malformation and megacolon
Authors: Yang Guangxian , Fan Wenwen , Yin Ni , Tan Zhiping
Published: November 2024

20p chromosome inverted duplication deletion syndrome is a rare chromosomal disorder in which the short arm segment 20p11.2–p13 and the deleted subtopic region 20p13–20 replicate simultaneously. Patients with this syndrome are mainly presented with intellectual disability and motor development delay. We report here a middle childhood case of this syndrome characterised by intellectual disability, backward movement, unique facial features, congenital heart disease: ventricular septal defect, patent foramen ovale, pulmonary hypertension and congenital anorectal malformation. The patient’s chromosome karyotyping analysis showed a short arm duplication on chromosome 20, described as 46, XY, 20p+?; his parents’ karyotyping analysis is normal. Later genotype analysis by array-single nucleotide polymorphisms identified a total of 107 genome-wide copy number variations and we detected a new 1.3 Mb deletion (chr20:63 244–1 349 002) and 20.2 Mb duplication (chr20:1 608 108–24 174 965) from 20p13 to 20p11.2 using infinium asian screening array-24 V1.0 BeadChip (Illumina Inc., San Diego, USA).
Von Hippel-Lindau disease with ocular and multiple systemic findings
Authors: Singh Bhupinderjeet , Kumari Reena , Bhagat Dinesh Kumar , Bhatia Deeksha
Published: November 2024

Von Hippel-Lindau is a rare genetic disease that is inherited as an autosomal dominant pattern. Characteristics of this disease include multiple vascularised tumours, particularly cerebellar, retinal and/or visceral. The disease can occur at any age with retinal haemangioblastomas as one of the earliest manifestations. The gold-standard investigation for cerebral haemangioblastomas is MRI or cerebral CT and for retinal haemangioblastomas is fluorescein angiography. We present the case of a woman in her late 30s who reported a primary concern of diminished vision in both eyes for the past 6 months. Fundus examination revealed blurred disc margins, optic nerve head haemangioblastomas and peripheral retinal haemangioblastomas in both eyes. Blood investigations showed polycythaemia. A 24-hour urine protein report showed increased levels. MRI showed multiple cystic lesions in the posterior fossa, on the right optic nerve in the optic canal, multiple cortical cysts in both kidneys and a soft tissue space-occupying lesion.
Refractory status epilepticus seen in the early phase of sporadic Creutzfeldt-Jakob disease
Authors: Ahmed Faraaz , Herath Tharuka Milinda , Samarasinghe Harini , Nithi Kannan
Published: November 2024

A male patient in his 60s presented with subacute-onset progressively worsening encephalopathy, myoclonus, paranoia, behavioural changes, confusion and cognitive decline, all on a background of paranoid schizophrenia. Extensive investigations, including blood tests and cerebrospinal fluid analysis, were inconclusive. MRI of the brain demonstrated cortical ribboning, with high signals noted in the caudate nucleus and internal capsule bilaterally on T2/fluid-attenuated inversion recovery and diffusion-weighted imaging. Electroencephalogram identified widespread sharp wave discharges consistent with status epilepticus.
Carcinoid heart findings in vasoactive intestinal peptide-secreting tumour
Authors: Joshi Mugdha , Aldea Daniel , Ngo Peter , Shah Sonia
Published: November 2024

Tricuspid valve disease in carcinoid heart syndrome is usually diagnosed via screening echocardiography in patients with known carcinoid syndrome. Vasoactive intestinal peptide tumour (VIPoma) is a rare tumour with an incidence of 0.05%–2% that typically presents with symptoms related to the release of vasoactive intestinal peptide: flushing, diarrhoea and electrolyte abnormalities like hypokalaemia and hypochlorhydria. Historically, the cardiac valves are unaffected. We present a case where a finding of tricuspid regurgitation and stenosis on echocardiography prompted an expedited workup for malignancy ultimately leading to a diagnosis of VIPoma.
Building resilient surgical systems that can withstand external shocks
Authors: Glasbey James C , Ademuyiwa Adesoji O , Chu Kathryn , Dare Anna , Harrison Ewen , Hutchinson Peter , Hyman Gabriella , Lawani Ismail , Martin Janet , Martinez Laura , Meara John , Reddy K Srinath , Sullivan Richard
Published: November 2024

When surgical systems fail, there is the major collateral impact on patients, society and economies. While short-term impact on patient outcomes during periods of high system stress is easy to measure, the long-term repercussions of global crises are harder to quantify and require modelling studies with inherent uncertainty. When external stressors such as high-threat infectious disease, forced migration or climate-change-related events occur, there is a resulting surge in healthcare demand. This, directly and indirectly, affects perioperative pathways, increasing pressure on emergency, critical and operative care areas. While different stressors have different effects on healthcare systems, they share the common feature of exposing the weakest areas, at which point care pathways breakdown. Surgery has been identified as a highly vulnerable area for early failure. Despite efforts by the WHO to improve preparedness in the wake of the SARS-CoV-2 pandemic, measurement of healthcare investment and surgical preparedness metrics suggests that surgical care is not yet being prioritised by policy-makers. Investment in the ‘response’ phase of health system recovery without investment in the ‘readiness’ phase will not mitigate long-term health effects for patients as new stressors arise. This analysis aims to explore how surgical preparedness can be measured, identify emerging threats and explore their potential impact on surgical services. Finally, it aims to highlight the role of high-quality research in developing resilient surgical systems.
Research agenda for ending preventable maternal deaths from postpartum haemorrhage: a WHO research prioritisation exercise
Authors: Williams Caitlin R , Adnet Guervan , Gallos Ioannis D , Coomarasamy Arri , Gülmezoglu A Metin , Islam Md Asiful , Rushwan Sara , Widmer Mariana , Althabe Fernando , Oladapo Olufemi T
Published: November 2024

Introduction

Postpartum haemorrhage (PPH) remains the leading cause of maternal death. Yet there is a lack of clarity around what research is needed to determine what works and how best to deliver proven PPH interventions. This article describes a WHO-led effort to develop a global PPH research agenda for 2023–2030, to reinvigorate research and innovation while avoiding duplication and waste.

Methods

Potential questions were culled from evidence gaps in a forthcoming Lancet PPH series, a pipeline analysis on PPH medicines and devices, international PPH guidelines, previous research prioritisation efforts and submissions from a reference group of PPH experts and stakeholders. Questions were deduplicated and consolidated, categorised into three tracks (innovation, implementation and cross-cutting) and subjected to an online prioritisation survey. Survey participants (n=120) assessed these questions using five criteria (answerability, effectiveness, deliverability, maximum potential for disease burden reduction and equity) following the Child Health and Nutrition Research Initiative methodology. The outcome of this exercise was complemented by an in-person consensus meeting (Global PPH Summit from 7 March 2023 to 10 March 2023 in Dubai, United Arab Emirates) to finalise the research agenda.

Results

Fifteen research questions (five per track) were identified as top priority. The top question per track called for research on the comparative effectiveness and safety of alternative routes of administration (other than the intravenous route) of tranexamic acid in the treatment of PPH (innovation); identifying barriers and facilitators affecting the adoption and use of evidence-based recommendations for PPH management (implementation) and the effectiveness of a strategy of early detection and first response treatment using a bundle of recommended interventions for improving PPH-related outcomes (cross-cutting).

Conclusion

This shared research agenda should guide future investments into PPH studies with high potential to transform policy and clinical practice in the near term to medium term. Funding for the new research priorities is urgently needed.
Understanding prescribing errors for system optimisation: the technology-related error mechanism classification
Authors: Raban Magdalena Z , Merchant Alison , Fitzpatrick Erin , Baysari Melissa T , Li Ling , Gates Peter , Westbrook Johanna I
Published: November 2024

Objectives

Technology-related prescribing errors curtail the positive impacts of computerised provider order entry (CPOE) on medication safety. Understanding how technology-related errors (TREs) occur can inform CPOE optimisation. Previously, we developed a classification of the underlying mechanisms of TREs using prescribing error data from two adult hospitals. Our objective was to update the classification using paediatric prescribing error data and to assess the reliability with which reviewers could independently apply the classification.

Materials and methods

Using data on 1696 prescribing errors identified by chart review in 2016 and 2017 at a tertiary paediatric hospital, we identified errors that were technology-related. These errors were investigated to classify their underlying mechanisms using our previously developed classification, and new categories were added based on the data. A two-step process was used to identify and classify TREs involving a review of the error in the CPOE and simulating the error in the CPOE testing environment.

Results

The technology-related error mechanism (TREM) classification comprises six mechanism categories, one contributing factor and 19 subcategories. The categories are as follows: (1) incorrect system configuration or system malfunction, (2) opening or using the wrong patient record, (3) selection errors, (4) construction errors, (5) editing errors, (6) errors that occur when using workflows that differ from a paper-based system (7) contributing factor: use of hybrid systems.

Conclusion

TREs remain a critical issue for CPOE. The updated TREM classification provides a systematic means of assessing and monitoring TREs to inform and prioritise system improvements and has now been updated for the paediatric setting.
Esketamine administered epidurally as an adjuvant to epidural ropivacaine for labour analgesia: a prospective, double-blind dose-response study
Authors: Xu Lili , Li Shuxi , Zhang Chenghong , Zhou Yanhong , Chen Xinzhong
Published: November 2024

Objective

To investigate the efficacy of esketamine as an adjuvant to epidural ropivacaine for labour analgesia by determining its effect on the median effective concentration (EC50) in a 20 ml volume of ropivacaine.

Design

A prospective, double-blind dose-response study.

Setting

This study was conducted in Women’s Hospital, School of Medicine, Zhejiang University, China.

Participants

One hundred and fifty parturients who requested epidural analgesia were recruited in this study to randomly receive epidural ropivacaine alone or with esketamine of 0.2 mg ml−1, 0.3 mg ml−1, 0.4 mg ml−1or 0.5 mg ml−1, respectively.

Primary and secondary outcome measures

The primary outcome, EC50of ropivacaine, was determined using an up-down sequential allocation technique. The secondary outcomes were analgesia characteristics, Ramsay Sedation Scale score, labour duration, caesarean section rate and adverse effects.

Results

The EC50of ropivacaine with the addition of esketamine at concentrations of 0.3 mg ml−1, 0.4 mg ml−1and 0.5 mg ml−1resulted in significant reductions in the EC50of ropivacaine to 0.050%, 0.044% and 0.043%, respectively, from baseline (esketamine 0 mg ml−1) (p<0.0001). However, reductions of the EC50of ropivacaine were similar among the groups with esketamine of 0.3 mg ml−1, 0.4 mg ml−1and 0.5 mg ml−1(p>0.05). The Ramsay Sedation Scale score was higher and more dizziness was observed in the Group of esketamine 0.5 mg ml−1compared with all other groups (p<0.0001). During the peripartum period, no differences in sensory blockade level, Bromage score, labour duration and percentage of caesarean delivery were found among the groups.

Conclusions

Under the conditions of this study, the addition of epidural esketamine of 0.3 mg⋅mL−1, 0.4 mg⋅mL−1and 0.5 mg⋅mL−1offered a similar ropivacaine dose-sparing effect; 0.5 mg⋅mL−1of esketamine produced more adverse effects.

Trial registration number

ChiCTR2100054348.
Association ofHelicobacter pyloriinfection and white blood cell count: a cross-sectional study
Authors: Jiao Rui , Ma Xiaojuan , Guo Xiaoqing , Zhu Yanli , Wu Xue , Wang Haiying , Zhang Shaofei , Wang Yahong , Yang Yang , Wang Qiang
Published: November 2024

Introduction

Helicobacter pyloriis a type of Gram-negative microaerobic bacteria that inhabits the gastric mucosal epithelium. It can cause various gastrointestinal diseases including gastritis, peptic ulcer and gastric cancer. White blood cells (WBC) are common immune cells, the increase in whose countoften indicates the presence of an infection. Currently, the relationship betweenH. pyloriand WBC count remains full of controversy. This study aims to further elucidate the effects ofH. pylorion WBC count in a population undergoing physical examination.

Methods and analysis

A total of 864 participants who underwent physical examination and14C urea breath test (UBT) were retrospectively enrolled in this study from January to June 2021. The overall population was divided intoH. pylori-negative (Hp−) andH. pylori-positive (Hp+) groups based on the disintegration per minute (DPM) value detected by UBT. Spearman’s correlation analysis was used to assess the correlation between DPM and WBC count. General linear regression models were applied to assess the potential factors contributing to the increase in WBC count. Generalised additive model (GAM) was performed to identify the non-linear relationship between DPM and WBC count. Additionally, a piecewise linear regression was used to examine the threshold effect of the DPM on WBC count.

Results

403 subjects were diagnosed withH. pyloriinfection. The WBC and platelet (PLT) counts in the Hp+ group were significantly higher than those in the Hp− group. Additionally, the prevalence ofH. pyloriinfection gradually increased with the WBC count quartiles (38.89% and 54.67% in quartile 1 and quartile 4, respectively). Spearman’s correlation analysis showed that the DPM value significantly correlated with WBC count (r=0.089, p=0.009) and PLT count (r=0.082, p=0.017). The linear model revealed a positive independent association ofH. pyloriinfection and DPM with WBC count (βHp+=0.398 (95% CI 0.170, 0.625), p<0.001; βDPM=0.002 (95% CI 0.000, 0.0030), p=0.018). The results of the GAM and the piecewise linear regression suggested that the cut-off points of the association between DPM and WBC count were 40 and 155 of DPM, that is, the effect of DPM on WBC count varied with the difference of DPM <40, 40–155, and >155 (βDPM=−0.005 (95% CI −0.017, 0.007), p=0.423; βDPM=0.006 (95% CI 0.002, 0.013), p=0.047; and βDPM=−0.007 (95% CI −0.012, –0.002), p=0.004, respectively).

Conclusions

H. pyloriinfection was independently and positively correlated with WBC count; however, the effect of DPM on WBC count varied across different WBC count intervals, suggesting distinct immunological responses at different stages of infection.
Importance of medical home domains on emergency visits using a cross-sectional national survey of US children
Authors: Rajan Mangala , Baer Benjamin R , Scheinfeld Adina , Abramson Erika L , Kern Lisa , Pinheiro Laura
Published: November 2024

Background and objectives

Receiving care at patient-centred medical homes (PCMH) is associated with reduced emergency department (ED) visits among children. Adverse social determinants of health (SDoH), such as lower socioeconomic status and household poverty, are associated with increased ED visits in children. The objective of this study is to use machine learning techniques to understand the relative importance of each PCMH component among different populations with adverse SDoH on the outcome of ED visits.

Methods: design, setting and participants

This study used the 2018–2019 pooled data from the National Survey of Children’s Health (NSCH), an annual survey of parents and caregivers of US children from birth to 17 years. PCMH components were operationalised by classifying parent/caregiver responses into five domains: care coordination (CC), having a personal doctor or nurse, having a usual source of care, family-centred care and ease of getting referrals. SDoH included five categories: (1) social and community context, (2) economic stability, (3) education access and quality, (4) healthcare access and quality and (5) neighbourhood and built environment.

Primary outcome measure

We used a split-improvement variable importance measure based on random forests to determine the importance of PCMH domains on ED visits overall and stratified by SDoH.

Results

Overall, between 3% and 28% experienced one or more gaps in PCMH domains. Models show that problems with referrals (rank, 2; Gini, 83.5) and gaps in CC (rank, 3; Gini, 81.0) were the two most important domains of PCMH associated with ED visits in children. This result was consistent among black and Hispanic children and among children with lower socioeconomic status.

Conclusions

Our study findings underscore the importance of poor CC and referrals on ED visits for all children and those from disadvantaged populations. Initiatives for expanding the reach of PCMH should consider prioritising these two domains, especially in areas with significant minority populations.
Impact of virtual consultations on quality of care in type 2 diabetes: a systematic review and narrative synthesis protocol
Authors: Aldakhil Reham , Lammila-Escalera Elena , Hayhoe Benedict , Majeed Azeem , Greenfield Geva , Neves Ana Luisa
Published: November 2024

Background

Around 463 million people globally have diabetes, of which over 90% have type 2 diabetes (T2D). Projections indicate an expected increase to 700 million by 2045. The COVID-19 pandemic accelerated digital health uptake, establishing virtual consultations as a feasible alternative to traditional in-person care. Despite promising preliminary evidence, a comprehensive review is needed to fully assess the impact of virtual consultations on diabetes care. This review aims to systematically evaluate the impact of remote consultations on the quality of care provided to persons with T2D, by mapping impacts against the six quality domains outlined by the National Academy of Medicine (NAM) (ie, patient-centeredness, effectiveness, efficiency, timeliness, equity and safety).

Methods and analysis

PubMed/MEDLINE (Medical Literature Analysis and Retrieval System Online), COCHRANE Library, EMBASE (Excerpta Medica Database), CINAHL (Cumulative Index to Nursing and Allied Health Literature) and Web of Science will be searched for studies published between 2010 and 2024. Primary outcomes will include any quality measures pertaining to the NAM domains for adult patients accessing virtual consultations. The Cochrane Collaboration’s tool will be used to assess the quality of the randomised studies, and the Risk of Bias in Non-Randomised Studies of Interventions will be used for non-randomised studies. The findings will be summarised as a narrative synthesis. This systematic review protocol was registered with the International Prospective Register of Systematic Reviews on 15 November 2023 (registration number: CRD42023474219).

Ethics and dissemination

This review will not include primary data and therefore does not require ethical approval. This protocol complies with the Preferred Reporting Items for Systematic Review and Meta-Analyses Protocols guidelines. Findings will be disseminated as academic publications and conference presentations and summarised into patient-led lay summaries.
A person-centred primary care pharmacist-led osteoporosis review for optimising medicines (PHORM): a protocol for the development and co-design of a model consultation intervention
Authors: Sturrock Andrew , Grabrovaz Meaghan , Bullock Laurna , Clark Emma , Finch Tracy , Haining Shona , Helliwell Toby , Horne Robert , Hyde Robin , Maidment Ian , Pryor Claire , Statham Louise , Paskins Zoe
Published: November 2024

Introduction

Adherence to medicines in osteoporosis is poor, with estimated 1 year persistence rates between 16% and 60%. Poor adherence is complex, relating to combinations of fear of side effects, beliefs about medication being unnecessary, doubts about effectiveness and the burden of medication management. This is compounded by an absence of monitoring, as many patients are effectively discharged from ongoing care following the initial prescription. Clinical pharmacists in general practice are a relatively new workforce in the UK NHS; this is an unexplored professional group that could provide person-centred, adherence-focused interventions in an osteoporosis context.

A model consultation intervention to be delivered by clinical pharmacists in general practice for patients already prescribed fracture prevention medications will be developed using existing evidence and theory and empirical qualitative work outlined in this protocol.

Methods and analysis

We will investigate the current practice and barriers and facilitators to a clinical pharmacist-led osteoporosis intervention, including exploring training needs, through focus groups with people living with osteoporosis, pharmacists, general practitioners, osteoporosis specialists and service designers/commissioners. Framework analysis will identify and prioritise salient themes, followed by mapping codes to the theoretical domains framework and normalisation process theory to understand integration and implementation issues.

We will further develop the content and model of care for the new consultation intervention through co-design workshops with stakeholder and patient and public involvement and engagement group members. The intervention in practice will be refined in a sequential process with workshops and in-practice testing with people prescribed fracture prevention medication, pharmacists and the multidisciplinary team.

Ethics and dissemination

Ethical approval was obtained from NHS North West—Greater Manchester South Research Ethics Committee (Ref 23/NW/0199). Dissemination and knowledge mobilisation will be facilitated through a range of national bodies/stakeholders. Impact and implementation plans will accelerate this research towards a future clinical trial to determine cost and clinical effectiveness.
Development of the continuous ambulatory vestibular assessment (CAVA) system to provide an automatic diagnosis for vestibular conditions: protocol for a multicentre, single-arm, non-randomised clinical trial
Authors: Phillips John S , Cox Stephen J , Howard Gregory , High Juliet , Murdin Louisa , Nunney Ian , Rea Peter , Shepstone Lee
Published: November 2024

Introduction

Dizziness is a common symptom that can occur in an unpredictable and episodic manner leading to the imprecise reporting of symptoms. Patients will often see many specialists before receiving a diagnosis and treatments can vary in terms of risk and invasiveness which places a significant burden on health services. Achieving an early precise diagnosis could be key in reducing the impact of symptoms on patients and health services.

Methods and analysis

The continuous ambulatory vestibular assessment (CAVA) trial is a single-arm, non-randomised, multicentre diagnostic accuracy device trial that aims to quantify the extent to which the CAVA system can differentiate three common inner-ear causes of dizziness: Ménière’s disease, vestibular migraine and benign paroxysmal positional vertigo. 85 participants with an established diagnosis from each of the three dizziness conditions, a total of 255 participants, will be recruited from ear, nose and throat, audiology and audiovestibular medicine departments in National Health Service (NHS) sites across the UK. The CAVA device is composed of two components: A set of bespoke single-use sensor arrays that adhere to the left and right side of the participant’s face; and a small reusable module fitting over the ear that contains a battery, a data storage facility and connection ports for the arrays. The CAVA device will be worn by all participants for up to 30 days with the aim of capturing eye movement data during a dizzy attack. The first objective is to develop an algorithm that can discriminate between the three dizziness conditions listed above. The second is to quantify the financial and patient benefits of deployment in the NHS. The final objective is to expedite a plan to deploy the system in the NHS.

Ethics and dissemination

The trial was approved by the West Midlands—South Birmingham Research Ethics Committee and the Medicines and Healthcare products Regulatory Agency (MHRA). REC reference: 22/WM/0229, IRAS Project ID: 317899, and MHRA: CI/2022/0062 /GB. Participants will provide full informed consent and can withdraw for any reason without it affecting their standard care. Dissemination will include publication in peer-reviewed journals, presentations at academic and public conferences including patients and the public and to policymakers and practitioners.

Trial registration number

ISRCTN81218533, trial protocol V.3.1 (25 January 2024).
Development of gout in people with asymptomatic hyperuricemia: study protocol for a 5-year prospective cohort
Authors: Stewart Sarah , Gamble Greg , Taylor William , Su Isabel , Merriman Tony , Mihov Borislav , Horne Anne , Stamp Lisa , Pascart Tristan , Andrés Mariano , Peral-Garrido Maria-Luisa , Neogi Tuhina , Norkuviene Eleonora , Vazquez-Mellado Janitzia , FitzGerald John D , Terslev Lene , Hammer Hilde Berner , Uhlig Tillman , D’Agostino Maria-Antonietta , Martin Julia , Sun Mingshu , Li Changgui , Dalbeth Nicola
Published: November 2024

Introduction

The central biochemical cause of gout is hyperuricemia (elevated serum urate levels). Ultrasound features of monosodium urate (MSU) crystal deposition are common in people with asymptomatic hyperuricemia. However, it is unclear whether this is a precondition for the development of gout. This study aims to determine whether ultrasound imaging evidence of MSU crystal deposition predicts development of symptomatic gout over 5 years, in people who already have an increased risk of gout due to elevated serum urate concentrations (≥8 mg/dL).

Methods and analysis

This is a prospective, international, multicentre study. The study population comprises over 250 participants with asymptomatic hyperuricemia (serum urate ≥8.0 mg/dL). After the baseline assessments, participants are followed for 5 years or until the development of gout, defined by the 2015 American College of Rheumatology/European Alliance of Associations for Rheumatology gout classification criteria. Baseline assessments include anthropomorphic measures, laboratory tests, questionnaires, blood and urine specimen collection, plain radiographs of the feet and standardised ultrasound scans of the lower limbs, scored according to the Outcomes in Rheumatology (OMERACT) gout ultrasound scoring system. The primary outcomes are the development of gout and time course for development of gout in people with and without ultrasound evidence of MSU crystal deposition. Exploratory analyses will examine clinical, genetic and biological factors associated with development of MSU crystal deposition and gout.

Ethics and dissemination

This study protocol was approved by the New Zealand Ministry of Health Southern Health and Disability Ethics Committee (MEC/05/10/130/AM16) on 18 December 2018. The findings from this study will be published in peer-reviewed journals and will be presented at national and international conferences.

Trial registration number

ACTRN12619000915156.
Investigating the effects of simulated high altitude on colour discrimination
Authors: Liu Siru , Wang Yuchen , Yu Xinli , Li Jiaxi , Zhou Jun , Li Yuanhong , Wang Zesong , Zhou Chengkai , Xie Jiaxing , Guo Anqi , Zhou Xinzuo , Ding Yi , Li Xuemin , Ding Li
Published: November 2024

Purpose

To quantify changes in colour vision immediately after exposure to different altitudes of low-pressure hypoxia.

Methods

The study involved 35 healthy participants (ages 20–26). Colour vision was assessed using the Farnsworth-Munsell 100-Hue test at eight different altitudes (condition 1: ground, condition 2: 3500 m, condition 3: 3500 m after 40 min, condition 4: 4000 m, condition 5: 4000 m after 40 min, condition 6: 4500 m, condition 7: 4500 m after 40 min, condition 8: back to the ground). Data were analysed using Analysis of Variance (ANOVA), paired t-test, and χ2test .

Results

Total Error Score (TES) increased with altitude and hypoxia duration, with higher TES in condition 8 than in condition 1. There were significant TES differences between conditions 3 and 7, as well as 4 and 7. Friedman and repeated ANOVA tests revealed significant sector differences, with Blue-Yellow Partial Error Score (PES) greater than Red-Green PES, particularly on conditions 4, 5 and 8. Significant Red-Green PES differences were found between conditions 4 and 7, and Blue-Yellow PES between conditions 3 and 5, 7, 8. Tritan (Blue-Yellow) shift was most pronounced at high altitudes.

Conclusions

This experiment investigated acute low-pressure hypoxia’s effects on colour vision, supplementing chronic hypoxia research. Increased altitudes and exposure duration worsen colour vision, with effects persisting post-recovery. Tritan axis loss is most significant under hypoxia.
Increasing the uptake of advance care directives through staff education and one-on-one support for people facing end-of-life
Authors: Kinsman Leigh David , Mooney Graeme , Whiteford Gail , Lower Tony , Hobbs Megan , Morris Bev , Bartlett Kerry , Jacob Alycia , Curley Dan
Published: November 2024

Background

An advance care plan outlines a patient’s wishes regarding medical treatment or goals of care in the case that they become unable to communicate or to make decisions. An advance care directive (ACD) is an advance care plan that has been formally recorded and has legal status. Despite ACDs playing an important role in person-centred end-of-life care, an earlier retrospective medical records audit demonstrated that only 11% (58/531) of people who died due to a terminal illness had an ACD.

The aim of this project was to increase the proportion of patients with a terminal illness completing an ACD. A secondary outcome was to measure the impact of ACDs on hospital and intensive care unit (ICU) admissions in the last 6 months of life.

This multifaceted project comprised (1) education for health professionals and the public; (2) individual support for patients on request; (3) development of online resources for health professionals and the general public; and (4) monthly team meetings.

Method

The proportion of ACDs completed and hospital and ICU admissions during the last 6 months of life, were extracted via medical record audits.

Written consent was required for patients to participate, including being contacted by the project team and accessing their medical records.

Results

112 patients consented to participate in the project and 109 (97%) completed an ACD. There was no reduction in the average number of hospital admissions, while ICU admissions reduced from 14% (n=74) to 0%.

Conclusion

The targeted, multifaceted approach to education and support for completion of ACDs, resulted in a significant increase in ACD completion and a major reduction in ICU admissions.
Getting it Right from the Start (GIRFTS): protocol for a stepped-wedge cluster randomised controlled trial of a school-based framework to improve children’s oral language and reading outcomes
Authors: Quach Jon , Siew Melissa L , Sinclair Cecilia , Snow Pamela , Eadie Patricia , Poed Shiralee , Shingles Beth , Gold Lisa , Orsini Francesca , Connell Judy , Edwards Stuart , Goldfeld Sharon
Published: November 2024

Introduction

Strong oral language and reading skills are important for child development. The response to intervention (RTI) framework supports schools to apply evidence-based practices and interventions to proactively meet the learning needs of all students and identify and support students at risk of learning difficulties. Getting it Right from the Start (GIRFTS) aims to implement a codesigned RTI framework in the first 2 years of formal schooling (foundation and grade 1) to improve oral language and reading skills. GIRFTS includes an implementation evaluation.

Methods and analysis

GIRFTS is a stepped-wedge cluster randomised trial conducted in Victoria, Australia, over 3 years. Clusters are primary schools. The intervention is to implement tiers 1 and 2 of the RTI framework into foundation and grade 1 according to RTI principles. The primary outcome is reading comprehension by the start of grade 2. Secondary outcomes include listening comprehension, word and non-word reading and phonological awareness. An implementation evaluation will also be conducted with the study to understand schools’ RTI implementation process and enablers and barriers to implementation. Strategies used by schools to overcome implementation challenges will also be investigated.

Ethics and dissemination

This trial was approved by the Royal Children’s Hospital Human Research Ethics Committee (HREC/58832/RCHM-2019). Investigators will communicate the results to stakeholders, collaborators and participating schools and teachers through presentations and publications.

Trial registration numbers

ISRCTN91164066, ACTRN12622000146796.
Comparative analysis of INTERGROWTH-21st and Fenton growth charts for birthweight classification in a multiethnic Asian cohort: a cross-sectional study
Authors: Chan Daniel , Zheng Ruther Teo , Beh Eirena , Heng Thurston Yan Jia , Chandran Suresh , Yap Fabian
Published: November 2024

Objective

The objective of this study is to evaluate the impact of using International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st) (IG-21) growth standards compared with Fenton growth charts on birthweight classification in a multiethnic newborn cohort in Singapore.

Design

Cross-sectional study.

Setting

KK Women’s and Children’s Hospital, Singapore.

Patients

Study population included 2541 babies born between 16 December 2019 and 16 March 2020.

Interventions

None.

Main outcome measures

Birthweight classifications of small for gestational age (SGA), appropriate for gestational age (AGA) and large for gestational age (LGA) were assessed using IG-21 and Fenton growth charts. The level of agreement between the two charts was measured using Cohen’s kappa coefficient (K).

Results

Of 2541 neonates, 171 (6.7%) had discordant birthweight classifications. The kappa coefficient indicated moderate overall agreement (K=0.79) between the charts, with decreasing agreement from preterm (K=0.88) to full-term categories (K=0.71). The largest discordance was observed in 98 (60.5%) neonates classified as LGA by IG-21 but AGA by Fenton. In comparison, 60 (2.9%) neonates classified as AGA by IG-21 were SGA by Fenton, while 13 (4.6%) were SGA by IG-21 but AGA by Fenton.

Conclusions

The study found discrepancies in birthweight classification between IG-21 and Fenton growth charts, with Fenton charts overclassifying SGA and underclassifying LGA in our study population. These findings suggest the potential need to integrate IG-21 growth standards into local practice to improve accuracy in neonatal growth assessment. Further research is necessary to evaluate the clinical implications of these discordant classifications on neonatal outcomes.
Agreement and comparative accuracy of instability criteria at discharge for predicting adverse events in patients with community-acquired pneumonia
Authors: Danjou Anne , Bouisse Magali , Boussat Bastien , Blaise Sophie , Gaillat Jacques , Francois Patrice , Courtois Xavier , Sellier Elodie , Toffart Anne-Claire , Schwebel Carole , Halm Ethan A , Labarere José
Published: November 2024

Objective

Five definitions of clinical instability have been published to assess the appropriateness and safety of discharging patients hospitalised for pneumonia. This study aimed to quantify the level of agreement between these definitions and estimate their discriminatory accuracy in predicting post-discharge adverse events.

Study design and setting

We conducted a retrospective cohort study involving 1038 adult patients discharged alive following hospitalisation for pneumonia.

Results

The prevalence of unstable criteria within 24 hours before discharge was 4.5% for temperature >37.8°C, 13.8% for heart rate >100/min, 1.0% for respiratory rate >24/min, 2.6% for systolic blood pressure <90 mm Hg, 3.3% for oxygen saturation <90%, 5.4% for inability to maintain oral intake and 6.4% for altered mental status. The percentage of patients classified as unstable at discharge ranged 12.8%–41.0% across different definitions (Fleiss Kappa coefficient, 0.47; 95% CI 0.44 to 0.50). Overall, 140 (13.5 %) patients experienced adverse events within 30 days of discharge, including 108 unplanned readmissions (10.4%) and 32 deaths (3.1%). Clinical instability was associated with a 1.3-fold to 2.0-fold increase in the odds of postdischarge adverse events, depending on the definition, withc-statistics ranging 0.54–0.59 (p=0.31).

Conclusion

Clinical instability was associated with higher odds of 30-day postdischarge adverse events according to all but one of the published definitions. This study supports the validity of definitions that combine vital signs, mental status and the ability to maintain oral intake within 24 hours prior to discharge to identify patients at a higher risk of postdischarge adverse events.