bluuebunny/crossref_metadata_2025 huggingface dataset:
Numerical and Experimental Investigation of Melting of Paraffin in a Hemicylindrical Capsule
Authors: Dhaidan Nabeel S. , Khalaf Abbas F. , Khodadadi J. M.
Published: January 2021

Phase change of paraffin in a hemicylindrical storage unit is investigated numerically and experimentally. The predicted findings are confirmed by comparison with the experimental results of the present work. Good agreements are achieved between the two approaches. The influence of the hot wall temperatures of 80, 85, and 90 °C is examined. The conduction mechanism is dominant only during the initial periods of the charging process, while buoyancy-driven convection is prevalent at later stages. The charging rate and stored energy both increased, whereas the melting time is reduced as the wall temperature increases. The Nusselt number increases sharply at the initial period of the fusion process, followed by a decaying trend with time until it stabilizes when the charging process is terminated. Increasing the cell diameter from 20 to 40 cm will raise the melting time by 300% for the wall temperature of 90 °C. In addition, under the same operating conditions, the melting of the phase change material (PCM) inside the hemicylindrical cell is faster than that observed in a rectangular one with equivalent volume. Savings in melting time due to using hemicylindrical container instead of a rectangular one of equivalent PCM volume are about 7.1%, 8.3%, and 11.7% for hot wall temperatures of 65, 75, and 85 °C, respectively.
Effect of wavy trachea walls on the oscillation onset pressure of silicone vocal folds
Authors: Häsner Patrick , Prescher Andreas , Birkholz Peter
Published: January 2021

The influence of non-smooth trachea walls on phonation onset and offset pressures and the fundamental frequency of oscillation were experimentally investigated for three different synthetic vocal fold models. Three models of the trachea were compared: a cylindrical tube (smooth walls) and wavy-walled tubes with ripple depths of 1 and 2 mm. Threshold pressures for the onset and offset of phonation were measured at the lower and upper ends of each trachea tube. All measurements were performed both with and without a supraglottal resonator. While the fundamental frequency was not affected by non-smooth trachea walls, the phonation onset and offset pressures measured right below the glottis decreased with an increasing ripple depth of the trachea walls (up to 20% for 2 mm ripples). This effect was independent from the type of glottis model and the presence of a supraglottal resonator. The pressures at the lower end of the trachea and the average volume velocities showed a tendency to decrease with an increasing ripple depth of the trachea walls but to a much smaller extent. These results indicate that the subglottal geometry and the flow conditions in the trachea can substantially affect the oscillation of synthetic vocal folds.
An Assessment of the Validity of the Remote Food Photography Method (Termed Snap-N-Send) in Experienced and Inexperienced Sport Nutritionists
Authors: Stables Reuben G. , Kasper Andreas M. , Sparks S. Andy , Morton James P. , Close Graeme L.
Published: January 2021

The remote food photography method, often referred to as “Snap-N-Send” by sport nutritionists, has been reported as a valid method to assess energy intake in athletic populations. However, preliminary studies were not conducted in true free-living conditions, and dietary assessment was performed by one researcher only. The authors, therefore, assessed the validity of Snap-N-Send to assess the energy and macronutrient composition in experienced (EXP, n = 23) and inexperienced (INEXP, n = 25) sport nutritionists. The participants analyzed 2 days of dietary photographs, comprising eight meals. Day 1 consisted of “simple” meals based around easily distinguishable foods (i.e., chicken breast and rice), and Day 2 consisted of “complex” meals, containing “hidden” ingredients (i.e., chicken curry). The estimates of dietary intake were analyzed for validity using one-sample t tests and typical error of estimates (TEE). The INEXP and EXP nutritionists underestimated energy intake for the simple day (mean difference [MD] = −1.5 MJ, TEE = 10.1%; −1.2 MJ, TEE = 9.3%, respectively) and the complex day (MD = −1.2 MJ, TEE = 17.8%; MD = −0.6 MJ, 14.3%, respectively). Carbohydrate intake was underestimated by INEXP (MD = −65.5 g/day, TEE = 10.8% and MD = −28.7 g/day, TEE = 24.4%) and EXP (MD = −53.4 g/day, TEE = 10.1% and −19.9 g/day, TEE = 17.5%) for both the simple and complex days, respectively. Interpractitioner reliability was generally “poor” for energy and macronutrients. The data demonstrate that the remote food photography method/Snap-N-Send underestimates energy intake in simple and complex meals, and these errors are evident in the EXP and INEXP sport nutritionists.
The Influence of Long-Chain Omega-3 Fatty Acids on Eccentric Exercise-Induced Delayed Muscle Soreness: Reported Outcomes Are Compromised by Study Design Issues
Authors: Anthony Ryan , Macartney Michael J. , Peoples Gregory E.
Published: January 2021

Delayed onset muscle soreness (DOMS) following eccentric exercise is associated with increased inflammation which can be debilitating. Incorporation of long-chain omega-3 polyunsaturated fatty acids (LC n-3 PUFA), eicosapentaenoic acid, and docosahexaenoic acid into membrane phospholipids provides anti-inflammatory, proresolving, and analgesic effects. This systematic review aims to examine both the quality of studies and the evidence for LC n-3 PUFA in the attenuation of DOMS and inflammation following eccentric exercise, both which of course are empirically linked. The Scopus, Embase, and Web of Science electronic databases were searched to identify studies that supplemented fish oil for a duration of ≥7 days, which included DOMS outcomes following an eccentric exercise protocol. Fifteen (n = 15) studies met inclusion criteria. Eccentric exercise protocols varied from single to multijoint activities. Risk of bias, assessed using either the Cochrane Collaboration tool or the Risk of Bias in Nonrandomized Studies of Interventions tool, was judged as “unclear” or “medium,” respectively, for the majority of outcomes. Furthermore, a custom 5-point quality assessment scale demonstrated that only one (n = 1) study satisfied current recommendations for investigating LC n-3 PUFA. In combination, this highlights widespread inappropriate design protocols among studies investigating the role of LC n-3 PUFA in eccentric exercise. Notwithstanding these issues, LC n-3 PUFA supplementation appears to have favorable effects on eccentric exercise-induced DOMS and inflammatory markers. However, the optimal LC n-3 PUFA supplemental dose, duration, and fatty acid composition will only become clear when study design issues are rectified and underpinned by appropriate hypotheses.
Is Altitude Training Bad for the Running Mechanics of Middle-Distance Runners?
Authors: Millet Grégoire P. , Trigueira Rosalie , Meyer Frédéric , Lemire Marcel
Published: January 2021

Aims: It has been hypothesized that altitude training may alter running mechanics due to several factors such as the slower training velocity with associated alteration in muscle activation and coordination. This would lead to an altered running mechanics attested by an increase in mechanical work for a given intensity and to the need to “re-establish” the neuromuscular coordination and running biomechanics postaltitude. Therefore, the present study aimed to test the hypothesis that “live high—train high” would induce alteration in the running biomechanics (ie, longer contact time, higher vertical oscillations, decreased stiffness, higher external work). Methods: Before and 2 to 3 days after 3 weeks of altitude training (1850–2200 m), 9 national-level middle-distance (800–5000 m) male runners performed 2 successive 5-minute bouts of running at moderate intensity on an instrumented treadmill with measured ground reaction forces and gas exchanges. Immediately after the running trials, peak knee extensor torque was assessed during isometric maximal voluntary contraction. Results: Except for a slight (−3.0%; P = .04) decrease in vertical stiffness, no mechanical parameters (stride frequency and length, contact and flight times, ground reaction forces, and kinetic and potential work) were modified from prealtitude to postaltitude camp. Running oxygen cost was also unchanged. Discussion: The present study is the first one to report that “live high—train high” did not change the main running mechanical parameters, even when measured immediately after the altitude camp. This result has an important practical implication: there is no need for a corrective period at sea level for “normalizing” the running mechanics after an altitude camp.
Women Caring for Retired Men: A Continuation of Inequality in the Sport Marriage
Authors: Ortiz Steven M.
Published: January 2021

Drawing from longitudinal qualitative research on the heteronormative sport marriage that primarily featured interviews with women married to male professional athletes, this article focuses on how women were affected by and managed their retired husbands’ physical and mental–emotional health issues. It explores the women’s continued use of self-management strategies they developed during their husband’s career as they offered increasingly challenging care work to their husbands and examines how long-held expectations about their caregiver role continued to contribute to post-career gender inequality in their marriages. It captures the women’s voices as they discovered that they were not sufﬁciently prepared for the emerging personal and relational complexities that emerged in retirement.
New mutations raise specter of ‘immune escape’
Authors: Kupferschmidt Kai
Published: January 2021

SARS-CoV-2 variants found in Brazil and South Africa may evade human antibodies.
Global temperatures in 2020 tied record highs
Authors: Voosen Paul
Published: January 2021

Defying cooling from La Niña, warming planet speeds toward breach of climate targets.
Mapping the molecular and cellular complexity of cortical malformations
Authors: Klingler Esther , Francis Fiona , Jabaudon Denis , Cappello Silvia
Published: January 2021

From development to disease

When brain development goes awry, whether in genes or cells or circuits, neurodevelopmental disorders ensue. Klingler
et al.
review how disrupted development leads to clinical symptoms, with a particular focus on the linkage between cortical malformations and neuropsychiatric disorders. The complexity of the developmental process may underlie the variability in symptoms.

Science
, this issue p.
eaba4517
Two-dimensional superconductivity and anisotropic transport at KTaO
3
(111) interfaces
Authors: Liu Changjiang , Yan Xi , Jin Dafei , Ma Yang , Hsiao Haw-Wen , Lin Yulin , Bretz-Sullivan Terence M. , Zhou Xianjing , Pearson John , Fisher Brandon , Jiang J. Samuel , Han Wei , Zuo Jian-Min , Wen Jianguo , Fong Dillon D. , Sun Jirong , Zhou Hua , Bhattacharya Anand
Published: January 2021

A superconducting interface

Interfaces between materials can harbor quantum states that belong to neither of the materials. A classic example is the superconducting interface between two insulating oxides, LaAlO
3
and SrTiO
3
, with a critical temperature of around 200 millikelvin. Liu
et al.
observed superconductivity at a different interface—formed between KTaO
3
as a substrate and an overlayer of either EuO or LaAlO
3
—at a considerably higher temperature of about 2 kelvin. Transport measurements displayed anisotropy, which may indicate an unusual superconducting state.

Science
, this issue p.
716
Developmental cell programs are co-opted in inflammatory skin disease
Authors: Reynolds Gary , Vegh Peter , Fletcher James , Poyner Elizabeth F. M. , Stephenson Emily , Goh Issac , Botting Rachel A. , Huang Ni , Olabi Bayanne , Dubois Anna , Dixon David , Green Kile , Maunder Daniel , Engelbert Justin , Efremova Mirjana , Polański Krzysztof , Jardine Laura , Jones Claire , Ness Thomas , Horsfall Dave , McGrath Jim , Carey Christopher , Popescu Dorin-Mirel , Webb Simone , Wang Xiao-nong , Sayer Ben , Park Jong-Eun , Negri Victor A. , Belokhvostova Daria , Lynch Magnus D. , McDonald David , Filby Andrew , Hagai Tzachi , Meyer Kerstin B. , Husain Akhtar , Coxhead Jonathan , Vento-Tormo Roser , Behjati Sam , Lisgo Steven , Villani Alexandra-Chloé , Bacardit Jaume , Jones Philip H. , O’Toole Edel A. , Ogg Graham S. , Rajan Neil , Reynolds Nick J. , Teichmann Sarah A. , Watt Fiona M. , Haniffa Muzlifah
Published: January 2021

Cellular beauty is skin deep

Human skin works as barrier, preventing the entry of pathogens, among other functions. Reynolds
et al.
used single-cell sequencing to generate an atlas of the human skin from both developing and adult sources, identifying differences and similarities across heterogeneous populations of skin cells. In this atlas, gene expression in the two disease states studied—atopic dermatitis and psoriasis—varied from that in a healthy adult, suggesting that a fetal skin signature is expressed in adult inflamed skin. Furthermore, differences in immune cell composition between healthy fetal and adult skin and that of individuals suffering from disease were observed.

Science
, this issue p.
eaba6500
Nanoscale localized contacts for high fill factors in polymer-passivated perovskite solar cells
Authors: Peng Jun , Walter Daniel , Ren Yuhao , Tebyetekerwa Mike , Wu Yiliang , Duong The , Lin Qiaoling , Li Juntao , Lu Teng , Mahmud Md Arafat , Lem Olivier Lee Cheong , Zhao Shenyou , Liu Wenzhu , Liu Yun , Shen Heping , Li Li , Kremer Felipe , Nguyen Hieu T. , Choi Duk-Yong , Weber Klaus J. , Catchpole Kylie R. , White Thomas P.
Published: January 2021

Opening charge transport pathways

In perovskite solar cells, the insulating nature of passivation layers needed to boost open-circuit voltage also increases the series resistance of the cell and limits the fill factor. Most improvements in power conversion efficiency have come from higher open-circuit voltage, with most fill factor improvements reported for very small-area cells. Peng
et al.
used a nanostructured titanium oxide electron transport layer to boost the fill factor of larger-area cells (1 square centimeter) to 0.84 by creating local regions with high conductivity.

Science
, this issue p.
390
Transvection regulates the sex-biased expression of a fly X-linked gene
Authors: Galouzis Charalampos Chrysovalantis , Prud’homme Benjamin
Published: January 2021

Enhancer-gene interactions drive split

In many species across the animal kingdom, male and female phenotypes differ. One such example is the wing spot seen in male
Drosophila biarmipes
flies but not the female flies. Galouzis and Prud'homme investigate the X-linked
yellow
gene and its enhancer. Investigating the genetics of the trait, they found evidence that the male-specific phenotype is caused by a trans interaction between the enhancer and gene that silences the gene when it is present in only one copy in the male (which only has a single X chromosome) versus the two copies found in the female. This gene thus appears to be regulated by differing genomic interactions in male and female flies and is an example of the phenomenon known as transvection.

Science
, this issue p.
396
Sex differences in immune responses
Authors: Takahashi Takehiro , Iwasaki Akiko
Published: January 2021

Biological sex differences in immunity potentially underlie male bias for severe COVID-19
Darwin and human evolution
A Most Interesting Problem
Jeremy M. DeSilva, editor
Princeton University Press, 2021. 288 pp.
Authors: Milam Erika Lorraine
Published: January 2021

An anniversary appraisal of
The Descent of Man
probes the naturalist's prescience and prejudices
A host metabolite promotes
Salmonella
survival
Authors: Lynch Jason P. , Lesser Cammie F.
Published: January 2021

Succinate is used by
Salmonella
in different ways when it is in macrophages or the gut
Identification of the Interferon-Inducible GTPase GBP1 as a Major Restriction Factor for Hepatitis E Virus
Authors: Glitscher Mirco , Himmelsbach Kiyoshi , Woytinek Kathrin , Schollmeier Anja , Johne Reimar , Praefcke Gerrit J. K. , Hildt Eberhard
Published: January 2021

Although HEV represents a worldwide public health problem with 20 million infections and 44,000 deaths per year, there are still no specific antivirals available and many aspects of the viral life cycle are not well understood. Here, we identify guanylate binding protein 1 (GBP1) as a restriction factor affecting the life cycle of HEV.
Management of systemic hypotension in term infants with persistent pulmonary hypertension of the newborn: an illustrated review
Authors: Siefkes Heather M , Lakshminrusimha Satyan
Published: January 2021

In persistent pulmonary hypertension of the newborn (PPHN), the ratio of pulmonary vascular resistance to systemic vascular resistance is increased. Extrapulmonary shunts (patent ductus arteriosus and patent foramen value) allow for right-to-left shunting and hypoxaemia. Systemic hypotension can occur in newborns with PPHN due to variety of reasons, such as enhanced peripheral vasodilation, impaired left ventricular function and decreased preload. Systemic hypotension can lead to end organ injury from poor perfusion and hypoxaemia in the newborn with PPHN. Thus, it must be managed swiftly. However, not all newborns with PPHN and systemic hypotension can be managed the same way. Individualised approach based on physiology and echocardiographic findings are necessary to improve perfusion to essential organs. Here we present a review of the physiology and mechanisms of systemic hypotension in PPHN, which can then guide treatment.
Gender-specific prevalence and associated factors of hypertension among elderly Bangladeshi people: findings from a nationally representative cross-sectional survey
Authors: Hanif Abu Abdullah Mohammad , Shamim Abu Ahmed , Hossain Md Mokbul , Hasan Mehedi , Khan Md Showkat Ali , Hossaine Moyazzam , Ullah Mohammad Aman , Sarker Samir Kanti , Rahman S M Mustafizur , Mitra Dipak K , Mridha Malay Kanti
Published: January 2021

Objective

We aimed to estimate the gender-specific prevalence and associated factors of hypertension among elderly people in Bangladesh.

Design and method

We analysed data from the food security and nutrition surveillance round 2018–2019. The multistage cluster sampling method was used to select the study population. Hypertension was defined as systolic blood pressure ≥140 mm Hg and/or diastolic blood pressure ≥90 mm Hg and/or having a history of hypertension. We carried out the descriptive analysis, bivariate and multivariable logistic regression to report the weighted prevalence of hypertension as well as crude and adjusted ORs with 95% CI. A p value<0.05 was considered statistically significant.

Setting

The study was conducted in 82 clusters (57 rural, 15 non-slum urban and 10 slums) in all eight administrative divisions of Bangladesh.

Participants

A total of 2482 males and 2335 females aged ≥60 years were included in this analysis.

Results

The weighted prevalence of hypertension was 42% and 56% among males and females, respectively. The prevalence was higher among females across all sociodemographic, behavioural and clinical strata. Factors associated with higher odds of hypertension (adjusted OR (AOR) (95% CI) for males and females, respectively) were age ≥70 years (1.32 (1.09, 1.60) and 1.40 (1.15, 1.71)); insufficient physical activity (1.50 (1.25, 1.81) and 1.38 (1.15, 1.67)); higher waist circumference (2.76 (2.22, 3.43) and 2.20 (1.82, 2.67)); and self-reported diabetes (1.36 (1.02, 1.82) and 1.82 (1.35, 2.45)). Additionally, living in slums decreased (0.71 (0.52, 0.96)) and education >10 years increased odds of hypertension (1.83 (1.38, 2.44)) among males.

Conclusion

In Bangladesh, half of the elderly persons were hypertensive, with a higher prevalence in females. In both sexes, odds of hypertension was higher among persons with older age (≥70 years), insufficient physical activity, higher waist circumference and self-reported diabetes. The Ministry of Health of Bangladesh should consider these findings while designing and implementing health programmes for elderly population.
Network meta-analysis on the comparative efficacy of family interventions for psychotic disorders: a protocol
Authors: Laskowski Alina , Lincoln Tania M
Published: January 2021

Introduction

Family interventions are effective and are strongly recommended for psychotic disorders. However, there is a variety of intervention types, and their differential efficacy is widely unclear. The aim of the planned network meta-analysis (NMA) is to compare the efficacy of family interventions that differ in content (eg, psychoeducation, mutual support, skills training) and format (eg, number of sessions, inclusion of patients, form of delivery).

Methods and analysis

We will include randomised controlled trials comparing psychosocial interventions directed at the adult relatives, friends or non-professional carers of people with a diagnosis of a psychotic disorder (schizophrenia spectrum) to any kind of control condition. The main outcomes will be global clinical state for the patients and coping with psychosis as well as attitudes towards psychosis for the relatives. Additional outcomes will be severity of symptoms, functioning, burden and compliance/drop-out. We conducted a comprehensive search of Cochrane Central Register of Controlled Trials, MEDLINE(R), PsycINFO, Cumulative Index to Nursing & Allied Health Literature (8 August 2019) and reference lists of review articles. Full-text assessment of eligibility, data extraction and risk-of-bias assessment will be done by two independent reviewers. An NMA will be conducted for any of the planned outcomes and intervention characteristics for which sufficient and appropriate data are available. The analyses will make use of a random effects model within a frequentist framework. Estimates for all pairwise treatment effects will be obtained using standardised mean differences for continuous outcomes and risk ratios for dichotomous outcomes. Interventions will be ranked according to their relative efficacy. We will address the assumption of transitivity, heterogeneity and inconsistency using theoretical and statistical approaches. The possibility of publication bias and the strength of evidence will also be examined.

Ethics and dissemination

There are no ethical concerns. Results will be published in peer-reviewed journals and presented at practitioners’ conferences.

PROSPERO registration number

CRD42020148728.
Observational study investigating the prevalence of asymptomatic stage B heart failure in patients with type 2 diabetes who are not known to have coronary artery disease
Authors: Oo Mon Myat , Tan Chung Zhen Isaiah , Ng Kee Seong , Tan Kok Leng , Tan Alexander T B , Vethakkan Shireene Ratna , A/L Ratnasingam R Jeyakantha , Chee Kok Han
Published: January 2021

Objective

To identify the prevalence of stage B heart failure (SBHF) in patients with type 2 diabetes mellitus (T2DM) with no history of cardiovascular disease (CVD).

Design

Observational study.

Setting

A single-centre study in which eligible patients were recruited from T2DM clinic. Following consent, patients completed a questionnaire and underwent physical examinations. Patients had blood drawn for laboratory investigations and had a transthoracic echocardiography.

Participants

A total of 305 patients who were not known to have CVD were recruited. Patients with deranged liver function tests and end stage renal failure were excluded.

Main outcome measures

Echocardiographic parameters such as left ventricular ejection fraction, left ventricular mass index (LVMI), left ventricular hypertrophy, left atrial enlargement and diastolic function were examined.

Results

A total of 305 patients predominantly females (65%), with mean body mass index of 27.5 kg/m2 participated in this study. None of them had either a history or signs and symptoms of CVD. Seventy-seven percent of patients had a history of hypertension and 83% of this study population had T2DM for more than 10 years. Mean HbA1c of 8.3% was recorded. Almost all patients were taking metformin. Approximately, 40% of patients were on newer anti-T2DM agents such as sodium-glucose cotransporter-2 and dipeptidyl peptidase 4 inhibitors. Fifty-seven percent (n=174) of the study population had SBHF at the time of study: diastolic dysfunction, increased LVMI and increased left atrial volume index (LAVI) were noted in 51 patients (17%), 128 patients (42%) and 98 patients (32%), respectively. Thirty-seven patients (12%) had both increase LVMI and LAVI.

Conclusion

Our study has revealed a high prevalence of SBHF in T2DM patients without overt cardiac disease in Malaysia that has one of the highest prevalence of TDM in the world.
COVID-19 and healthcare workers: a rapid systematic review into risks and preventive measures
Authors: Gross J Valérie , Mohren Judith , Erren Thomas C
Published: January 2021

Objective

The COVID-19 pandemic is demanding for occupational medicine and for public health. As healthcare workers (HCWs) fight impacts of SARS-CoV-2 on front lines, we must create safe work environments through comprehensive risk assessments, evaluation and effective implementation of counter-measures. We ask: ‘What does current literature report on health risks at workplaces regarding COVID-19?’ and ‘What do current studies report on the effectiveness of enacted preventative recommendations?’

Methods

As a snapshot of early HCW research, on 26 April 2020, we conducted a rapid systematic literature search in three databases (PubMed, Web of Science and PsycInfo) for COVID-19-related health outcomes and preventive measures in healthcare-associated workplaces.

Results

27 studies were identified as relevant for exploring the risk of infection, 11 studies evaluated preventive measures. The studies described that SARS-CoV-2 impacts significantly on HCW’s health and well-being, not only through infections (n=6), but also from a mental health perspective (n=16). 4 studies reported indirect risks such as skin injuries, one study described headaches to result from the use of personal protective equipment. Few studies provided information on the effectiveness of prevention strategies. Overall, most studies on health risks as well as on the effectiveness of preventive measures were of a moderate-to-low quality; this was mainly due to limitations in study design, imprecise exposure and outcome assessments.

Conclusions

Due to widespread exposure of HCW to SARS-CoV-2, workplaces in healthcare must be as safe as possible. Information from HCW can provide valuable insights into how infections spread, into direct and indirect health effects and into how effectively counter-measures mitigate adverse health outcomes. However, available research disallows to judge which counter-measure(s) of a current ‘mix’ should be prioritised for HCW. To arrive at evidence-based cost-effective prevention strategies, more well-conceived studies on the effectiveness of counter-measures are needed.
Estimating under-reporting of COVID-19 cases in Indian states: an approach using a delay-adjusted case fatality ratio
Authors: Unnikrishnan Jayakrishnan , Mangalathu Sujith , Kutty Raman V
Published: January 2021

Objectives

The COVID-19 pandemic has spread to all states in India. Due to limitations in testing coverage, the true extent of the spread may not be fully reflected in the reported cases. In this study, we obtain time-varying estimates of the fraction of COVID-19 infections reported in the different states.

Methods

Following a methodology developed in prior work, we use a delay-adjusted case fatality ratio to estimate the true fraction of cases reported in different states. We also develop a delay adjusted test positivity estimation method and study the relationship between the estimated test positivity rate for each state and the estimated fraction of cases reported.

Setting

We apply this method of analysis to all Indian states reporting at least 100 deaths as of 10 October 2020.

Results

Our analysis suggests that delay-adjusted case fatality ratios observed in different states range from 0.47% to 3.55%. The estimated fraction of cases reported in different states ranges from 39% to 100% for an assumed baseline case fatality ratio of 1.38%, from 18.6% to 100% for an assumed baseline case fatality ratio of 0.66%, and from 2.8% to 19.7% for an assumed baseline case fatality ratio of 0.1%. We also demonstrate a statistically significant negative relationship between the fraction of cases reported in each state and the testing positivity rate.

Conclusions

The estimates provide a means to quantify and compare the trends of reporting and the true level of current infections in different states. This information may be used to guide policies for prioritising testing in different states, and also to analyse the time-varying effects of different quarantine measures adopted in different states.
Predictive utility of the Activity Measure for Post-Acute Care ‘6-Clicks’ short forms on discharge disposition and effect on readmissions: a retrospective observational cohort study
Authors: Harry Melissa , Woehrle Theo , Renier Colleen , Furcht Margaret , Enockson Michelle
Published: January 2021

Objectives

To evaluate the predictive utility of the Activity Measure for Post-Acute Care ‘6-Clicks’ daily activity and basic mobility functional assessment short forms on inpatient discharge to home compared with skilled nursing facilities, including by diagnostic group (trauma injury, major lower joint replacement/reattachment, spinal fusion excluding cervical), as well as assess the effect of the short forms on 30-day inpatient readmissions.

Design

Retrospective, observational cohort study of electronic health record data.

Setting

Five hospitals in a multistate, integrated healthcare system serving a large, rural US population.

Participants

The population-based adult (age ≥18) sample of acute care hospitalised patients receiving rehabilitation services included 10 316 patients with 12 314 hospital admissions from the year prior to 6-Clicks implementation (1 June 2015–31 May 2016) (pre-6-Clicks cohort) and 10 931 patients with 13 241 admissions from the year after 6-Clicks implementation (1 January 2017–31 December 2017) (post-6-Clicks cohort). Patients were admitted for major lower joint replacement/reattachment, spinal fusion excluding cervical, trauma injury or another reason.

Intervention

Occupational and physical therapist use of 6-Clicks daily activity and basic mobility short forms in the post-6-Clicks cohort.

Primary and secondary outcomes

Discharge disposition (home, including to assisted living, or skilled nursing facility, including swing beds) and 30-day inpatient readmissions.

Results

Areas under the receiver operating characteristic curve were 0.82–0.92 (daily activity) and 0.87–0.94 (basic mobility) for discharge to home or skilled nursing facilities, with trauma and spinal fusion patients having the highest values. Daily activity and basic mobility standardised positive and negative predictive values were highest for the three diagnostic groups compared with the full study sample. Few significant differences in 30-day readmissions were seen between pre- and post-6-Clicks cohorts.

Conclusions

6-Clicks performed well when distinguishing between discharge home or skilled nursing facilities, especially by diagnostic group, supporting use by occupational and physical therapists in discharge planning. Future research could assess where additional intervention or training may reduce 30-day readmissions.
Violence-related deaths among people released from incarceration: protocol for a systematic review
Authors: Willoughby Melissa , Young Jesse T , Spittal Matthew J , Borschmann Rohan , Janca Emilia K , Kinner Stuart A
Published: January 2021

Introduction

Young people and adults released from incarceration have a risk of dying from violence that far exceeds that in the general population. Despite this, evidence regarding the incidence, elevated risk and predictive factors for violence-related deaths after release have not yet been synthesised. This information is important to inform the development of evidence-based approaches to effectively prevent deaths from violence in this population. This systematic review will synthesise the literature examining the crude mortality rates (CMRs), standardised mortality ratios (SMRs) and predictive factors for violence-related deaths among people released from incarceration.

Methods and analysis

We searched key electronic health, social science and criminology databases (MEDLINE, PubMed, PsycINFO, Scopus, Web of Science, CINCH, Criminal Justice Abstracts) for peer-reviewed cohort studies published in English on 14thSeptember 2020. Our primary outcome of interest is violence-related deaths occurring in the community following release from incarceration. We will not restrict study eligibility by year of publication or age of participants. The Methodological Standard for Epidemiological Research (MASTER) scale will be used to assess the quality of included studies. If there are sufficient studies and homogeneity between studies, we will conduct meta-analyses to calculate pooled estimates of CMRs, SMRs or predictive factors for violence-related deaths. If there is a sufficient number of included studies, meta-regression will be conducted to examine the influence of subgroups and methodological factors on the CMRs, SMRs or predictive factors. If the studies do not report sufficient data, or if there is substantial heterogeneity, findings will be presented in a narrative form.

Ethics and dissemination

This review is exempt from ethics approval as it will synthesise findings from published studies that have already obtained ethics approval. Our findings will be disseminated through a peer-reviewed journal article, and national and international conference and seminar presentations.

Trial registration details

This study is registered with PROSPERO (CRD42020209422).
171 Early senior assessment and access to CT in an emergency department
Authors: Crespo Marta de Andres , Zogg Cheryl , Novak Alex , Metcalfe David
Published: January 2021

Aims/Objectives/Background

The Rapid Assessment and Treatment (RAT) model provides early senior assessment of undifferentiated ‘majors’ patients and has been proposed as a strategy for improving Emergency Department (ED) efficiency. One goal of RAT is to organise essential imaging at an earlier stage within the patient’s ED journey. This study aimed to identify any potential early impact of a RAT initiative on time to imaging for patients requiring CT head.

Methods/Design

Electronic health record data were extracted for all patients that underwent head CT while in the ED over a 54-month period (48 months pre-intervention and 6 post-intervention) at a single Major Trauma Centre in England. Interrupted time series analysis was used to estimate any effect of RAT on time from ED arrival to imaging.

Results/Conclusions

There was a pre-existing gradual trend over the entire time series towards patients waiting less time for CT. Although time to CT appeared to increase when the RAT model was implemented, this change was small and not statistically significant (9.8 [95% CI -1.6 to 21.3] minutes). Following RAT implementation, the pre-existing trend towards quicker access to CT resumed but without any change in the slope of the line.

This early evaluation did not identify an association between RAT implementation and speed of access to CT head. The system may mature over time and further evaluations will be necessary to identify delayed effects on access to imaging as well as other process measures intended to improve ED safety and efficiency.
130 Quality improvement project – improving the quality of care for homeless patients presenting to the homerton university hospital emergency department 2019-20
Authors: Leung Phoebe , Chambers Jane , Morris Amber , Arthur Kobbina , Prowse Fenella , Crowson Richard , Niven William
Published: January 2021

Aims/Objectives/Background

Homelessness is on the rise in the UK. The problem identified specific to homeless patient care was clinician understanding of the homeless person’s social needs to form an adequate discharge plan as well as completing their legal duty to refer such patients to the local housing authority.

Methods/Design

This quality improvement project (QIP) aimed to reduce the reattendance rate of homeless patients presenting to the Homerton University Hospital (HUH) Emergency Department (ED) by 20% from November 2019 to April 2020. This would be done by improving social history taking, signposting of patients to appropriate resources, and performing the legal duty to refer. Using the PDSA cycle method, interventions included a week of presentations to inform clinicians of the process measures; an advertising campaign; and a defined flowchart process for the duty to refer.

Results/Conclusions

The QIP yielded the following results in terms of median baselines: social history taking 60% to 88%, signposting to resources 30% to 67%, and duty to refer 0 to 41%. There was no change to the outcome measure of reattendance rate, maintained at 40% throughout the project and hence the QIP did not meet its SMART aim.

However this may have been the result of the decision to cut short data collection time due to the unprecedented COVID-19 pandemic which saw overall reduction in ED patient attendance. Most street homeless persons were put up in temporary hotels in the government funded scheme ‘Everybody In’, lockdown meant the hidden homeless should stay indoors, and a ban on court evictions has been extended until 23 August 2020.

Nonetheless, work to improve quality of care continued with a new pathway for safe discharge of homeless patients with suspected COVID-19. Planning ahead for post pandemic times has brought about a new standard operating procedure, which will ensure sustainability of the QIP.
419 What are the priorities for older adults attending the ED? Findings from a multiple stakeholder group consensus meeting
Authors: Graham Blair , Endacott Ruth , Smith Jason E , Barham Ffion , Latour Jos M
Published: January 2021

Aims/Objectives/Background

Patient Reported Experience & Outcome Measures (PREMs/PROMs) are not yet well established in emergency care. This study aimed to determine priorities for older adults attending the ED, to inform item inclusion for a new PREM/PROM.

Methods/Design

One hundred thirty-five priority statements, linked to suggested PREM/PROM items, were derived from the literature, patient interviews (n=24) and staff focus groups (n=7)(October 2018- April 2019). All statements had a Flesch-Kincaid Reading Ease score >70. A one-day consensus meeting was held, December 2019.

Invitations were issued via social media, patient/public involvement groups and charities. Following focus groups to assess interpretability, nominal group technique was used to prioritise statements. Individuals scored statements from 1(least important) to 9(most important). Statements with a median score of >6.5 were ‘critically important’, 3.5 to 6 ‘important, not critical’, and <3 ‘less important’. Inter-rater agreement was assessed using mean absolute deviation from the median (MADM). ‘Critically important’ or ‘less important’ statements with MADM <50% were automatically included or excluded, respectively. Statements deemed ‘important, not critical’, or with MADM >50% underwent further voting.

Remaining statements underwent dichotomous voting. A >70% favourable majority was required for inclusion.

Results/Conclusions

Twenty-nine participants attended. Average age was 65.6 years (R32—78). Experiences of emergency care were as a patient (n=16(55.2%)), accompanying person (n=11(37.9%)), third-sector representative (n=14(48.2%)) and/or clinician (n=7(27.6%)).

Initial prioritisation yielded 71 statements for inclusion. Further voting led to the inclusion of another 31 statements (102 total).

Statements relating to care delivery, communication and emotional needs ranked as more important overall. Statements related to waiting were considered less important (seesupplementary file).

Participants reported having ‘adequate say’ during the meeting (76.9% Strongly Agree).

Conclusion

This meeting established priorities for older adults attending the ED. The low priority assigned to waiting confounds some previous findings. Further item reduction is planned to create a final PREM/PROM for older adults.
216 Evaluation of the use of tele-sim in the examination setting for final year emergency medicine residents in India
Authors: Gidwani Shweta , Ahluwalia Tania , Douglass Katherine
Published: January 2021

Aims/Objectives/Background

Travel restrictions during this Covid-19 pandemic created a barrier to bringing external examiners to conduct simulation assessments, a crucial component of emergency medicine examinations in India. Indefinite postponement would prevent several final year trainees from progressing and would have added to their stress and frustration during an already challenging time.

We conducted these evaluation via tele-simulation and sought to evaluate the feasibility and effectiveness of tele-simulation as tool for assessing the management of critically ill or injured patients by emergency medicine (EM) trainees. Our secondary outcome was a survey evaluating the attitudes and perceptions of fairness of this remote simulation modality for both faculty and trainees.

Methods/Design

104 residents from 14 separate hospitals across India were evaluated in pairs by a local facilitator and a remote examiner via Zoom. There were 14 local facilitators and 10 remote examiners based in the US, UK and India. All residents examined were given the same simulation case he examination over the course of 7 hours. Real time online structured evaluation forms were completed by both evaluators and each candidate was discussed after every pair to agree a pass/fail grade. The external examiners were blinded to the students overall 3 year performance, theory and thesis results. The tele-simulation evaluation was triangulated with the final examination theory and thesis exam grades and overall clinical performance and feedback over 3 yrs from their local supervisor. We surveyed local faculty, remote examiners and trainees.

Results/Conclusions

52 paired tele-simulation examinations were conducted by 24 local and remote examiners from India, United Kingdom and USA over 7 hours. Of the 14 candidates who failed, their tele-simulation grades correlated with overall performance. The interim data analysis of the survey results show that 96.7% thought the exam was fair Tele-simulation is a feasible and effective way to evaluate EM trainees.
356 Comparison of qSOFA, and hospital early warning scores for prognosis in suspected sepsis in emergency department patients: a systematic review
Authors: Sabir Lisa , Ramlakhan Shammi , Goodacre Steve
Published: January 2021

Aims/Objectives/Background

Sepsis is a major cause of morbidity and mortality and many tools exist to facilitate early recognition. The current international consensus definition of sepsis recommends the use of the quick Sequential Organ Failure Assessment (qSOFA) score in the emergency department (ED) to rapidly identify those who are likely to have poor outcomes. Early Warning Scores (EWS) are used more routinely; if these could provide the same information, they could allow standardisation and streamlining of effort.

This review compares two tools

qSOFA and EWS (National/Modified Early Warning Scores (NEWS/MEWS)) for predicting intensive care (ICU) admission and mortality when applied to suspected sepsis patients in the ED.

Methods/Design

A literature search was conducted using Medline, CINAHL, Embase, and Cochrane Library, hand searching of references and a grey literature search with no language or date restrictions. Two authors selected studies and quality assessment completed using QUADAS-2. Area under the Receiver Operating Characteristic Curve (AUROC), sensitivities, and specificities were compared.

Results/Conclusions

Results

12 studies were included, totalling 395,661 patients. All reported mortality and six reported ICU admission.

AUROC estimates were variable ranging from little better than chance to good prediction. The ranges demonstrated overlap between scores suggesting little difference for predicting mortality (NEWS: 0.59–0.88; qSOFA: 0.57–0.79; MEWS 0.56–0.75). However, individual papers mostly reported higher AUROC values for NEWS than qSOFA. NEWS demonstrated a trend to better sensitivity for ICU admission (NEWS≥5 0.46–0.91; qSOFA≥2 0.12–0.53) and mortality (NEWS≥5 0.51–0.97; qSOFA≥2 0.14–0.7) but lower specificity (ICU: NEWS≥5 0.25–0.91; qSOFA≥2 0.67–0.99. Mortality: NEWS≥5 0.22–0.91; qSOFA≥2 0.58–0.99).

Conclusion

The wide range of AUROC estimates and high heterogeneity limit our conclusions. Allowing for this, the NEWS AUROC was consistently higher than qSOFA within individual papers. Both scores allow threshold setting, determined by the preferred compromise between sensitivity and specificity. At established thresholds NEWS trended to higher sensitivity whilst qSOFA favoured specificity.
215 Current management of moderate/severe traumatic pneumothoraces: a survey of emergency clinicians
Authors: Carlton Edward , Watkins Millie , Avery Pascale
Published: January 2021

Aims/Objectives/Background

Traumatic pneumothoraces are present in one-fifth of multiple trauma victims. Traditional teaching mandates the insertion of a chest drain in the majority of cases. However, recent retrospective observational evidence suggests a trend towards conservative management. The aim of this survey was to understand the current emergency medicine (EM) practice in placing chest drains for the management of moderate/severe traumatic pneumothoraces.

Methods/Design

This scoping survey was developed through expert consensus. To achieve face validity, clinical sensibility testing was performed using a pilot survey (with user feedback). There were 14 pilot-phase respondents. The survey was then modified to achieve content validity. The survey was sent electronically to senior EM doctors in 15 sites internationally, and involved six clinical/imaging vignettes asking ‘how likely are you to insert an intercostal chest drain to manage the pneumothorax in ED?’. A five-point response was available from very unlikely to very likely. All pneumothroraces were >1 cm on imaging, but mechanism, physiology and need for ventilation varied.

Results/Conclusions

Of a potential 409 respondents, 141 responses were received (34% response rate). Respondents had a range of clinical experience, with the majority qualified more than 10 years (median; 19 years).

For 5/6 cases chest drain insertion was likely or very likely in >50% of responses, ranging from 52% for a non-compromised 1 cm pneumothorax in a ventilated patient to 98% for a tension pneumothorax on chest x-ray. Chest drain insertion was unlikely or very unlikely (62% of responses) in one case; an 86-year-old female on rivaroxaban with moderate respiratory compromise (respiratory rate 30 min-1) and a 2 cm pneumothorax.

There is a broad range of clinical practice involving both conservative and invasive strategies in the treatment of moderate/severe traumatic pneumothoraces. There is clinical equipoise for interventional trials to determine the optimal management strategy for this patient group.