bluuebunny/crossref_metadata_2025 huggingface dataset:
286 Are Telephone Reviews the Future in Outpatient Clinic Consultations?
Authors: Karagiannidis G. , Mallidis E.
Published: February 2022

Aim

The COVID-19 pandemic posed many challenges to healthcare system in the UK. Attempts were made to ensure the provision of treatment, continuity of care and follow-up of the patients. As a result, implementation of telephone consultations was started for most of the outpatient appointments. The aim of this study was to evaluate patient satisfaction and views on this alteration in service.

Method

The first 150 patients who had breast clinic appointments delivered by telephone consultation at Ipswich hospital during the pandemic in early 2020 were retrospectively identified and sent a postal survey. The satisfaction levels were assessed through a degree of agreement with statements (four items), yes/no answers (two questions), and space for comments.

Results

142 survey responses were included (94.7% response rate). The majority of patients (n = 130) were satisfied with the care they received. Even though almost half of the patients stated that they would like to be seen face-to-face in the hospital, only 10% (n = 4) of them stated that they would not like a second phone consultation. Surprisingly,78% (n = 117) of patients stated they would be happy for further breast clinic appointments to be carried out in the same way.

Conclusions

Our study has shown that telephone consultations are a safe and rapid method of adaptation to the COVID-19 pandemic, achieving high satisfactory rate amongst patients. Our findings suggest that this tool has benefits in post pandemic healthcare delivery. Can telephone reviews be the future in outpatient clinic consultations?
326 The Incidence and Prevalece of Unruptured Intracranial Aneurysms in Sickle Cell Disease Patients: A Systematic Review
Authors: Essiet E.
Published: February 2022

Aim

To estimate the prevalence, incidence, and characteristics of Unruptured Intracranial Aneurysms (UIAs) in (sickle cell disease) SCD patients and compare same with the metrics and features in the general population.

Method

The Data repositories, Medline (PubMed), Embase and Web of science were systematically searched from January 1st, 1990, to July 31st, 2021. Publications that passed an inclusion test were reviewed for data on the incidence and prevalence of UIAs, aneurysm characteristics and outcomes in SCD patients extracted. Findings from the included studies were appraised, using the Methodological Index for Non-randomized studies score (MINORS). The results were descriptively analysed. Given the marked heterogeneity of retrieved data, results were reported as standardized values, including the mean weighted annual incidence rate.

Results

105 SCD patients with 186 UIAs were identified in 10 retrospective studies. Mean age ranged from 10.5 to 40.18 across studies with adult (>18 years) predominance. Prevalence of UIAs in SCD was 4.1% (95%CI 3.6 and 4.6) incidence rate was 1290.3/100,000 patient-years (95% CI 1018.0 to 1562.6). Aneurysms tended to be small (60%), anterior (76.1%), multiple (45.7%), managed conservatively (62%) with mostly good outcomes (95%). Average MINORS score was 9.4 ±3.1 for non-comparative studies (n = 8) and 19.5 ±0.7 for comparative studies (n = 2).

Conclusions

UIAs have a definite relationship with SCD, with higher incidence figures relative to the general population. Aneurysmal characteristics although largely similar, tend to be smaller in SCD patients. The low methodological quality of reviewed studies informs the need for well-designed prospective randomized controlled studies to better understand the mechanics of this relationship.
341 Consenting Practices in Plastic Surgery
Authors: Noton T. , Benshetrit G. , Bradley A. , Mitchell C.
Published: February 2022

Introduction

Informed consent is a vital aspect of safe patient care within any surgical specialty, and if not completed thoroughly, may result in misinformation and patient dissatisfaction.

Traditional paper consent forms are notoriously poorly completed by medical professionals, with common issues ranging from ineligible handwriting, to missing key components of the form.

The aim of this audit was to assess our departments’ compliance with standard trust consent forms and compare adherence to local and national consenting policies.

Method

All elective and emergency plastic surgical procedures carried out over a one-week period from 17/05/2021 to 23/05/2021 were identified using eTrauma and Cerner operative records. In total, 40 procedures were identified. Consent forms were then reviewed and assessed for completion in key areas. 4 procedures were excluded due to the consent form not being available for review, and 1 procedure was excluded due to a cancellation.

Results

The risks and benefits of procedures were generally documented to a high standard. Providing written information to patients, confirmation of consent if the procedure was being performed on a different day, and possible additional procedures were poorly completed throughout. 90% of consent forms screened, failed to include confirmation of the surgical site within the specific section of the form.

Conclusions

Overall, the department demonstrated good compliance with completing trust consent forms. Electronic consent forms would likely address the shortcomings identified in this audit and should be adopted. Continued responsibility from the whole team should be highlighted and maintained to ensure a high standard of consenting.
371 Use of Trello as a Project Management Tool for Collaborative Surgical Research and Audit
Authors: Khoury A. , Bucknor A. , King I. , Kerstein R. , Nduka C.
Published: February 2022

Introduction

Managing surgical research projects alongside clinical commitments requires organisation, prioritisation, and communication. Our unit is a tertiary plastic surgery centre with a large workforce, high volume case load and abundant research opportunity. In a busy department, co-ordination and communication is imperative for timely high-quality research and audit output and maximum productivity. Tools can be used to support this output; we trialled use of Trello project management software to increase productivity in this context.

Method

We set up a Trello account for our unit’s plastic surgery department. All consultants and trainees have access, and each project has a timeline and standardised progress checklist to support completion of projects to a uniform high standard.

Results

Our Trello for Surgical Research pilot has promoted organised collaborative working and reduced duplication and partial completion of audit and research projects within our department. It has encouraged engagement between smaller subgroups within the unit, and a platform to monitor progression through key stages of project development with oversight of an appointed Research Lead, resulting in an increase in completion of closed loop audits and research projects.

Conclusions

Similar experiences have been described in mathematics and engineering research groups, and delivery of educational material for English Literature study, but we have not identified description of Trello as a tool for medical research. Use of such platforms increases productivity and likelihood of completion of projects, as well as providing a clear outline of a departments’ research priorities and accessible opportunities for rotating juniors.
384 Local Closed Loop Audit: COVID-19 Screening Before Endoscopic Ultrasound
Authors: Thu K.T. , Wilson S.
Published: February 2022

Aim

Endoscopic Ultrasound (EUS) is one of the important diagnostic tests in patients with probable hepatobiliary or lung diseases. As it is an airborne procedure and due to the current COVID-19 pandemic, British Society of Gastroenterology and NICE guidelines have stated that patients who are undergoing EUS must be tested for COVID-19 within 3 days before the procedure. EUS must be considered deferring if the patient tests positive. The aim of this audit is to increase the proportion of patients being swabbed within 3 days/72 hours of the procedure to > 90% by the end of 2021.

Method

A list of patients who underwent elective EUS in January (initial audit) and mid-May to mid-June (re-audit) were collected using Endosoft software. Afterwards, electronic patient record system was checked for the date of the COVID-19 swab and its results. This data was then recorded in a password-protected Excel spreadsheet and the proportion of the patients meeting the standard was calculated.

Results

The results of the initial audit indicated that although 95.7% of swabs were done within 3 days of the procedure, only 40.9% were done within 72 hours. These results were discussed at a mortality and morbidity meeting, and recommendations were. Hence, in the re-audit, 98.4% of the swabs were done within 3 days of the procedure and the percentage of swabs being done within 72 hours increased to 95.2%.

Conclusions

The target of increasing the proportion of patients being swabbed within 3 days/72 hours of the EUS procedure to > 90% was met in mid-2021.
391 An Audit of Nurse-Led Follow-Up of Patients with Colorectal Cancer in a District General Hospital
Authors: Boodhoo V. , Payne A.
Published: February 2022

Introduction

Rates of recurrence of colorectal cancer after potentially curative surgery vary between 30–65%. Regular post-operative surveillance of these patients is essential in detecting recurrence and improves overall survival. NICE guidelines recommend follow-up with measurement of serum carcinoembryogenic antigen (CEA) and with CT scans of the chest abdomen and pelvis. In our unit, patients have been followed up by Cancer Nurse Specialists (CSNs) since 2016. The aim of this audit is to determine the compliance with surveillance guidelines in our nurse-led follow-up programme.

Method

This is a retrospective audit of randomly selected post-operative patients with colorectal cancer who were followed up by CSNs. All patients with appointments with CSNs in 2 randomly selected months (1st January- 28th February 2020) were included. Data was collected using electronic patient records.

Results

54 patients were identified. For low-risk patients, 100% (34/34) had their CT surveillance at 1 year, and, for those 30 months post- surgery, 100% (30/30) had their 30 months CT scan. 94% (32/34) had recommended CEA measurements.

In high-risk patients, 85% (17/20) had their 1-year CT scan, 100% of eligible patients (19/19) had their 2-year CT, or a plan in place for one. Of patients eligible for a 3-year CT scan, 46% (6/13) had one. 95% (19/20) had recommended CEA measurements.

Conclusions

Nurse-led follow-up overall leads to adequate follow-up, better compliance with guidelines and improved continuity of care.
393 Cholecystostomy Drains Patients Selections, Management and Outcomes
Authors: Mohamed B. , Nurmeen Nahaboo Solim Z. , Canelo R.
Published: February 2022

Background

Laparoscopic cholecystectomy (LC) is the gold standard treatment for acute cholecystitis (AC). Percutaneous cholecystostomy (PC) has been developed to reduce the morbidity and mortality associated with high-risk patients. PC offers advantages such as general anaesthesia is not required, can be performed at the bedside, success rate is above 95%, low complication rate and can be used as bridging therapy before elective surgery.

Aim

To investigate the demographics, clinical factors, and the outcomes of cholecystostomy in management of cholecystitis.

Method

The sample includes 24 inpatients at North Cumbria trust who had cholecystostomy drain insertion in 2019 and 2020 (retrospective audit)

Results

One patient was less than 40 years old. 6 were between 40 and 60 years old while 17 were above 60 years old. 21 patients had 1 drain, 2 patients had 2 drains and 1 patient had 3 drains in total. Duration of the drain insertion 0–7 days 5 patients, 8–21 days 7 patients, more than 3 weeks 12 patients. Numbers of patients attended SDEC 1 times 4 patients 2–5 times 15 patients more than 5 times 5 patients. 5 patients had no investigations, while12 (50%) patients had more than one investigation post procedure.

Complications

Conclusions
17 Establishment of Virtual Fracture Clinic in Princess Royal Hospital Telford: Experience and Recommendations During the First 9 Months
Authors: Khaleeq T. , Lancaster P. , Fakoya K. , Ferreira P. , Ahmed U.
Published: February 2022

Introduction

Virtual fracture clinics (VFC) have been shown to be a safe and cost-effective way of managing outpatient referrals to the orthopaedic department. During the coronavirus pandemic there has been a push to reduce unnecessary patient contact whilst maintaining patient safety.

Method

A protocol was developed by the clinical team on how to manage common musculoskeletal presentations to A&E prior to COVID as part of routine service development. Patients broadly triaged into 4 categories; discharge with advice, referral to VFC, referral to face to face clinic or discussion with on call team. The first 9 months of data were analysed to assess types of injury seen and outcomes.

Results

In total 2489 patients were referred to VFC from internal and external sources. 734 patients were discharged without follow-up and 182 patients were discharged for physiotherapy review. Only 3 patients required admission. Regarding follow-ups, 431 patients had a virtual follow-up while 1036 of patients required further face to face follow up. 87 patients were triaged into subspecialty clinics. 37 patients were felt to have been referred inappropriately.

Conclusions

BOA guidelines state all patients must be reviewed within 72 hours of their orthopaedic injury. Implementation of a VFC allows this target to be achieved and at the same time reduce patient contact. Almost half the patients were discharged following VFC review, the remaining patients were followed up. This is especially relevant in the current pandemic where reducing unnecessary trips to hospital will benefit the patient and make the most of the resources available.
120 Artificial Intelligence (AI) Risk-Based Stratification for Surgical Waiting List Prioritisation: A Pilot Study Addressing the NHS Growing Waiting Times
Authors: Jegatheeswaran L. , Tolley N.
Published: February 2022

Aim

336,733 patients in England awaited NHS hospital treatment in May 2021. The Royal College of Surgeons of England’s New Deal for Surgery report encouraged utilising new technology in healthcare to address this.

During the pandemic’s second wave, this pilot study investigated utilising COMPASS Surgical List Triage (COMPASS SLT), an artificial intelligence-based system, in assisting surgical decision-making on patient prioritisation. Data generated from COMPASS SLT was compared to data from the British Association of Endocrine and Thyroid Surgeons’ prioritisation guidance.

Method

A cohort of Thyroidectomy and Parathyroidectomy patients on the surgical waiting list at Imperial College Healthcare NHS Trust was used. COMPASS SLT calculated individuals’ mortality and significant morbidity risk (risk >2.5%). Additional increase in mortality and morbidity due to treatment delay were calculated. Actual treatment time was aligned to the treatment delay (in weeks) experienced by each patient.

Results

29 patients, with a median age and waiting time at the onset of the second wave of 43 years and 18 weeks respectively, were enrolled. Non-statistically significant differences (p=0.937) between the FSSA and BAETS classification existed. However, cohort size could promote a type II error. There was an increase in mean mortality and morbidity risk (p<0.001) arising from treatment delay, and decisions based on the FSSA and BAETS classifications.

Conclusions

COMPASS SLT can supplement clinical decision making. The FSSA and BAETS guidance lacks precision and responsiveness to solely inform patient prioritisation. An AI tool provides clinicians objectivity and flexibility in prioritising patients, with information on individual morbidity, mortality, and treatment delay costs.
Increased acrolein–DNA adducts in buccal brushings of e-cigarette users
Authors: Cheng Guang , Guo Jiehong , Carmella Steven G , Lindgren Bruce , Ikuemonisan Joshua , Niesen Brittany , Jensen Joni , Hatsukami Dorothy K , Balbo Silvia , Hecht Stephen S
Published: February 2022

DNA adducts are central in the mechanism of carcinogenesis by genotoxic agents. We compared levels of a DNA adduct of acrolein, a genotoxic carcinogen found in e-cigarette vapor, in oral cell DNA of e-cigarette users and non-users of any tobacco or nicotine product. e-Cigarette users and non-users visited our clinic once monthly for 6 months, and oral brushings and urine samples were collected. For this study, we analyzed oral cell DNA adducts from three monthly visits in e-cigarette users and non-users as confirmed by urinary cyanoethyl mercapturic acid and total nicotine equivalents. DNA was isolated from the oral brushings and analyzed by a validated liquid chromatography-nanoelectrospray ionization-high resolution tandem mass spectrometry method for the acrolein DNA adduct 8R/S-3-(2’-deoxyribos-1’-yl)-5,6,7,8-tetrahydro-8-hydroxypyrimido[1,2-a]purine-10-(3H)-one (γ-OH-Acr-dGuo). The median value of this DNA adduct in the e-cigarette users was 179 fmol/µmol dGuo (range 5.0 - 793 fmol/µmol dGuo) while that for non-users was 21.0 fmol/µmol dGuo (range 5.0 - 539 fmol/µmol dGuo), P = 0.001. These results demonstrate for the first time that e-cigarette users have elevated levels of a carcinogen–DNA adduct in their oral cells.
Effect of various ratios of poly(3-hexylthiophene) with polyvinyl alcohol gel-polymer electrolytes in flexible sodium-ion batteries using Samanea saman tree-leaf-derived carbon quantum dots decorated with SnO2 and NaVO3
Authors: Thangaraj Baskar , Wongyao Nutthapon , Solomon Pravin Raj , Chaiworn Wachira , Chuangchote Surawut , Surareungchai Werasak
Published: February 2022

Gel-polymer electrolytes with high thermal stability and mechanical properties were considered suitable in rechargeable batteries so as to overcome the problems encountered in liquid electrolytes. In a previous study, flexible sodium-ion batteries (FSIBs) were fabricated using electrodes made of carbon quantum dots (CQDs) decorated with SnO2 and NaVO3 utilizing a polyvinyl alcohol (PVA)/P3HT gel-polymer electrolyte at a ratio of 1:0.05. In addition, various separators such as indium-doped tin oxide/polyoxyethylene tridecyl ether (ITO/PTE), rice paper (RP), silicone with three big holes (SIL BH), silicone with many small holes (SIL SH) and cellulose paper (CP) were tested in flexible Na-ion batteries. The SIL SH delivered a high specific discharge capacity of 4246 mAh g–1 in the initial cycle at 2 V and maintained a value of 71 mAh g–1 in the 50th cycle. With the aim of improving the cyclic ability of FSIBs, different weight ratios of PVA/P3HT (1:0.025, 1:0.05, 1:0.1, 1:0.15, 1:0.2) were tried in this work using the electrodes CQDs@SnO2 and CQDs@NaVO3. The above ratios were referred to as B25, B50, B100, B150 and B200, respectively. SIL SH was used as a separator. Cyclic voltammetry studies indicated that B150 had a high specific capacitance of 13 062 F g–1. B25 and B100 exhibited high discharge capacities (171 mAh g–1) and (151 mAh g–1) compared to that of other ratios B50 (75 mAh g–1), B150 (88 mAh g–1) and B200 (54 mAh g–1) in the 50th cycle at 2.0 V. This study reveals the scope of developing FSIBs of high capacity and cyclability at different voltages using carbonaceous electrodes and gel-polymer electrolytes with different ratios of PVA/P3HT. The focus of the present study is to bring out the optimum ratio of PVA/P3HT for maximizing the cyclic ability of FSIBs.
Dynamics of cortical and corticomuscular connectivity during planning and execution of visually guided steps in humans
Authors: Spedden Meaghan E , Beck Mikkel M , West Timothy O , Farmer Simon F , Nielsen Jens B , Lundbye-Jensen Jesper
Published: February 2022

The cortical mechanisms underlying the act of taking a step—including planning, execution, and modification—are not well understood. We hypothesized that oscillatory communication in a parieto-frontal and corticomuscular network is involved in the neural control of visually guided steps. We addressed this hypothesis using source reconstruction and lagged coherence analysis of electroencephalographic and electromyographic recordings during visually guided stepping and 2 control tasks that aimed to investigate processes involved in (i) preparing and taking a step and (ii) adjusting a step based on visual information. Steps were divided into planning, initiation, and execution phases. Taking a step was characterized by an upregulation of beta/gamma coherence within the parieto-frontal network during planning followed by a downregulation of alpha and beta/gamma coherence during initiation and execution. Step modification was characterized by bidirectional modulations of alpha and beta/gamma coherence in the parieto-frontal network during the phases leading up to step execution. Corticomuscular coherence did not exhibit task-related effects. We suggest that these task-related modulations indicate that the brain makes use of communication through coherence in the context of large-scale, whole-body movements, reflecting a process of flexibly fine-tuning inter-regional communication to achieve precision control during human stepping.
Cyto/myeloarchitecture of cortical gray matter and superficial white matter in early neurodevelopment: multimodal MRI study in preterm neonates
Authors: Yuan Shiyu , Liu Mengting , Kim Sharon , Yang Jingda , Barkovich Anthony James , Xu Duan , Kim Hosung
Published: February 2022

The cerebral cortex undergoes rapid microstructural changes throughout the third trimester. Recently, there has been growing interest on imaging features that represent cyto/myeloarchitecture underlying intracortical myelination, cortical gray matter (GM), and its adjacent superficial whitematter (sWM). Using 92 magnetic resonance imaging scans from 78 preterm neonates, the current study used combined T1-weighted/T2-weighted (T1w/T2w) intensity ratio and diffusion tensor imaging (DTI) measurements, including fractional anisotropy (FA) and mean diffusivity (MD), to characterize the developing cyto/myeloarchitectural architecture. DTI metrics showed a linear trajectory: FA decreased in GM but increased in sWM with time; and MD decreased in both GM and sWM. Conversely, T1w/T2w measurements showed a distinctive parabolic trajectory, revealing additional cyto/myeloarchitectural signature inferred. Furthermore, the spatiotemporal courses were regionally heterogeneous: central, ventral, and temporal regions of GM and sWM exhibited faster T1w/T2w changes; anterior sWM areas exhibited faster FA increases; and central and cingulate areas in GM and sWM exhibited faster MD decreases. These results may explain cyto/myeloarchitectural processes, including dendritic arborization, synaptogenesis, glial proliferation, and radial glial cell organization and apoptosis. Finally, T1w/T2w values were significantly associated with 1-year language and cognitive outcome scores, while MD significantly decreased with intraventricular hemorrhage.
Noise-rearing precludes the behavioral benefits of multisensory integration
Authors: Bean Naomi L , Smyre Scott A , Stein Barry E , Rowland Benjamin A
Published: February 2022

Concordant visual–auditory stimuli enhance the responses of individual superior colliculus (SC) neurons. This neuronal capacity for “multisensory integration” is not innate: it is acquired only after substantial cross-modal (e.g. auditory–visual) experience. Masking transient auditory cues by raising animals in omnidirectional sound (“noise-rearing”) precludes their ability to obtain this experience and the ability of the SC to construct a normal multisensory (auditory–visual) transform. SC responses to combinations of concordant visual–auditory stimuli are depressed, rather than enhanced. The present experiments examined the behavioral consequence of this rearing condition in a simple detection/localization task. In the first experiment, the auditory component of the concordant cross-modal pair was novel, and only the visual stimulus was a target. In the second experiment, both component stimuli were targets. Noise-reared animals failed to show multisensory performance benefits in either experiment. These results reveal a close parallel between behavior and single neuron physiology in the multisensory deficits that are induced when noise disrupts early visual–auditory experience.
Airborne Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in Hospitals: Effects of Aerosol-Generating Procedures, HEPA-Filtration Units, Patient Viral Load, and Physical Distance
Authors: Thuresson Sara , Fraenkel Carl Johan , Sasinovich Sviataslau , Soldemyr Jonathan , Widell Anders , Medstrand Patrik , Alsved Malin , Löndahl Jakob
Published: February 2022

Background

Transmission of coronavirus disease 2019 (COVID-19) can occur through inhalation of fine droplets or aerosols containing infectious virus. The objective of this study was to identify situations, patient characteristics, environmental parameters, and aerosol-generating procedures (AGPs) associated with airborne severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus.

Methods

Air samples were collected near hospitalized COVID-19 patients and analyzed by RT-qPCR. Results were related to distance to the patient, most recent patient diagnostic PCR cycle threshold (Ct) value, room ventilation, and ongoing potential AGPs.

Results

In total, 310 air samples were collected; of these, 26 (8%) were positive for SARS-CoV-2. Of the 231 samples from patient rooms, 22 (10%) were positive for SARS-CoV-2. Positive air samples were associated with a low patient Ct value (OR, 5.0 for Ct <25 vs >25; P = .01; 95% CI: 1.18–29.5) and a shorter physical distance to the patient (OR, 2.0 for every meter closer to the patient; P = .05; 95% CI: 1.0–3.8). A mobile HEPA-filtration unit in the room decreased the proportion of positive samples (OR, .3; P = .02; 95% CI: .12–.98). No association was observed between SARS-CoV-2–positive air samples and mechanical ventilation, high-flow nasal cannula, nebulizer treatment, or noninvasive ventilation. An association was found with positive expiratory pressure training (P < .01) and a trend towards an association for airway manipulation, including bronchoscopies and in- and extubations.

Conclusions

Our results show that major risk factors for airborne SARS-CoV-2 include short physical distance, high patient viral load, and poor room ventilation. AGPs, as traditionally defined, seem to be of secondary importance.
Mechanically Ventilated Patients Shed High-Titer Live Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) for Extended Periods From Both the Upper and Lower Respiratory Tract
Authors: Saud Zack , Ponsford Mark , Bentley Kirsten , Cole Jade M , Pandey Manish , Jolles Stephen , Fegan Chris , Humphreys Ian , Wise Matt P , Stanton Richard
Published: February 2022

Background

SARS-CoV-2 infection can lead to severe acute respiratory distress syndrome needing intensive care admission and may lead to death. As a virus that transmits by respiratory droplets and aerosols, determining the duration of viable virus shedding from the respiratory tract is critical for patient prognosis, and informs infection-control measures both within healthcare settings and the public domain.

Methods

We prospectively examined upper and lower airway respiratory secretions for both viral RNA and infectious virions in mechanically ventilated patients admitted to the intensive care unit (ICU) of the University Hospital of Wales. Samples were taken from the oral cavity (saliva), oropharynx (subglottic aspirate), or lower respiratory tract (nondirected bronchoalveolar lavage [NBAL] or bronchoalveolar lavage [BAL]) and analyzed by both quantitative PCR (qPCR) and plaque assay.

Results

117 samples were obtained from 25 patients. qPCR showed extremely high rates of positivity across all sample types; however, live virus was far more common in saliva (68%) than in BAL/NBAL (32%). Average titers of live virus were higher in subglottic aspirates (4.5 × 107) than in saliva (2.2 × 106) or BAL/NBAL (8.5 × 106) and reached >108 PFU/mL in some samples. The longest duration of shedding was 98 days, while most patients (14/25) shed live virus for ≥20 days.

Conclusions

ICU patients infected with SARS-CoV-2 can shed high titers of virus both in the upper and lower respiratory tract and tend to be prolonged shedders. This information is important for decision making around cohorting patients, de-escalation of personal protective equipment, and undertaking potential aerosol-generating procedures.
Revisiting “Leadership” in Global Climate Governance: China’s Normative Engagement with the CBDRs Principle
Authors: Jiang Chaoyi
Published: February 2022

This paper studies how China has established and exercised leadership by creating and operationalising the principle of “common but differentiated responsibilities” (CBDRs) in United Nations climate negotiations—from the embryo of this principle in the Stockholm Declaration to its operationalisation in the Paris Agreement. Building on the updated scholarship on climate leadership, this paper proposes a four criteria test to ascertain the existence of a leadership relationship. It comprises (1) a wilful leader; (2) consensual followers; (3) a commonly shared goal shaped mainly by the leader and accepted by the followers; and (4) a process of leadership-building triggered through use of any one of the following four modes of leadership: ideational, directional, instrumental, or structural. In light of the leadership criteria, this paper focuses on how China has operationalised these various leadership modes towards realising the evolving collective goals of its developing followers. In doing so, the paper provides empirical evidence of the significance of each of the four leadership modes in underpinning China’s leadership in the climate regime. This paper finds that while ideational leadership was prominent in creating the CBDRs principle, instrumental leadership, with the support of occasional usages of directional and structural leadership, has also been vital to China in tackling the internal divisions of developing countries and in overcoming the limitations of such countries’ normative power in the post-Kyoto era.
On the inversion and admissibility for a class of Volterra integro-differential problems
Authors: Tismane M , Bounit H , Fadili A
Published: February 2022

We study the Volterra integro-differential problems of convolution kernel type from two perspectives: complex inversion formula and the admissibility in the Salamon–Weiss sense (which leads us to consider unbounded control operators). Due to the hybrid Cauchy–Volterra context of these problems, the control operators need to have the admissibility property. First, we show the validity of the inverse formula of the Laplace transform for the resolvent operators associated with some class of Volterra integro-differential problems of convolution type in Banach spaces with the leading operator generating a $C_{0}$-semigroup. This extends and improves the results in Hille & Phillips (1957, 347–348, Theorem 11.6.1), Driouich & El-Mennaoui (1999, 72, Theorem 1), Cioranescu & Lizama (2003, 188–189, Proposition 2), Haase (2008, 84, 81–82, Theorems 4.2 and 4.1) and Fadili & Bounit (2014, 7–8, Proposition 8), including the strong version for this class on UMD spaces. Second, the sufficient or/and necessary conditions for $L^{p}$-admissibility with $p\in (1,+\infty )$ of the control operators are given in terms of the UMD geometric property of its underlying control spaces for a wide class of Volterra integro-differential problems, which provides a generalization of a result known to hold for the standard Cauchy problems shown in Bounit et al. (2010, Proposition 3.2) and the standard Volterra integro-differential problems shown in Fadili & Bounit (2014, 9–10, Theorem 12).
Severe Acute Respiratory Syndrome Coronavirus 2 Nucleocapsid Antigen in Urine of Hospitalized Patients With Coronavirus Disease 2019
Authors: Veyrenche Nicolas , Pisoni Amandine , Debiesse Ségolène , Bollore Karine , Bedin Anne Sophie , Makinson Alain , Niel Clémence , Alcocer-Cordellat Carmen , Mondain Anne Marie , Le Moing Vincent , Van de Perre Philippe , Tuaillon Edouard
Published: February 2022

Background

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleocapsid antigen (N-Ag) can be detected in the blood of patients with coronavirus disease 2019 (COVID-19). We used a highly sensitive and specific assay to explore the presence of N-Ag in urine during the course of COVID-19 and its relationship with the severity of disease.

Methods

We studied urinary and plasma N-Ag using a highly sensitive immunoassay in 82 patients with SARS-CoV-2 infection proved by polymerase chain reaction.

Results

In the first and second weeks of COVID-19, hospitalized patients tested positive for urinary N-Ag (81.25% and 71.79%, respectively) and plasma N-Ag (93.75% and 94.87%, respectively). High urinary N-Ag levels were associated with the absence of SARS-CoV-2 nucleocapsid antibodies, admission in intensive care units, high C-reactive protein levels, lymphopenia, eosinopenia, and high lactate dehydrogenase levels. Higher accuracy was observed for urinary N-Ag as a predictor of severe COVID-19 than for plasma N-Ag.

Conclusions

Our study demonstrates that N-Ag is present in the urine of patients hospitalized in the early phase of COVID-19. As a direct marker of SARS-CoV-2, urinary N-Ag reflects the dissemination of viral compounds in the body. Urinary N-Ag may be a useful marker for disease severity in SARS-CoV-2 infections.
The response of ecosystem carbon and nitrogen pools to experimental warming in grasslands: a meta-analysis
Authors: Zou Junliang , Wu Juying , Osborne Bruce , Luo Yiqi
Published: February 2022

Carbon (C) and nitrogen (N) coupling processes in terrestrial ecosystems have the potential to modify the sensitivity of the global C cycle to climate change. But the degree to which C–N interactions contribute to the sequestration of terrestrial ecosystem C (Cseq), both now and in the future, remains uncertain. In this study, we used a meta-analysis to quantitatively synthesize C and N responses from field experiments on grasslands subjected to simulated warming and assessed the relative importance of three properties (changes in ecosystem N amount, redistribution of N among soil, litter and vegetation, and modifications in the C:N ratio) associated with grassland Cseq in response to warming. Warming increased soil, litter and vegetation C:N ratios and approximately 2% of N shifted from the soil to vegetation and litter. Warming-induced grassland Cseq was the result of the net balance between increases in vegetation and litter C (111.2 g m−2) and decreases in soil C (30.0 g m−2). Warming-induced accumulation of C stocks in grassland ecosystems indicated that the three processes examined were the main contributors to Cseq, with the changes in C:N ratios in soil, litter and vegetation as the major contributors, followed by N redistribution, whilst a decrease in total N had a negative effect on Cseq. These results indicate that elevated temperatures have a significant influence on grassland C and N stocks and their coupling processes, suggesting that ecological models need to include C–N interactions for more accurate predictions of future terrestrial C storage.
Interlogue
Authors: Gussak David E.
Published: February 2022

To best understand the following two chapters addressing the work of multiple murderers, an interlogue is included here to provide a working understanding of psychopathy and sociopathy. While at times the terms have been used interchangeably, various psychological, sociological, and criminology theoretical perspectives provide some illumination on their differences and their characterological classifications. In examining these terms, this Interlogue provides various descriptors of those deemed to have psychopathic and sociopathic personalities.
Charles Bronson Becomes Charlie Salvador
Authors: Gussak David E.
Published: February 2022

Charles Bronson was considered England’s most notoriously violent inmate. This chapter relies on published accounts of Bronson’s crimes and subsequent imprisonment, his autobiographical memoirs, direct communications, and reproductions of his drawings to reveal the power art had in redirecting his aggression and relabelling a violent identity. Originally, his art began as a way to confront and express his anger, frustration, and hostility. His drawings became an expressive outlet as he developed a new identity, no longer as Great Britain’s most violent inmate but now as a “con” artist. His art was transformed from a weapon of attack to an instrument of containment, mitigation, and sublimation. As his new art was accepted, so was he, thus facilitating his change in identity from one of violence to one of acceptance and peace.
Guernica
Authors: Gussak David E.
Published: February 2022

Picasso’s Guernica captured his fury in response to the innocent Basque village of Guernica being destroyed by the German Luftwaffe during the Spanish Civil War. This painting became the template for the Guernica Children’s Peace Mural Project, developed by art educators to facilitate change by guiding children who are experiencing strife to redirect their frustrations into a transformative message of peace. This chapter provides a succinct examination of Picasso and the painting that captured the destruction of a peaceful village. Following this, an in-depth conversation with one of the founders of the Children’s Peace Mural Project, Dr. Tom Anderson, is presented along with a comprehensive review gleaned from the literature. This chapter ultimately explores how one painting provided the blueprint for how art can help children develop connections and help allay the powerlessness, fear, frustration, and anxiety derived from overwhelming circumstances.
Continuing the Dance
Authors: Gussak David E.
Published: February 2022

Drawing from the author’s professional experiences as an art therapist working with aggressive people, this chapter provides a brief introduction to art therapy, case examples with violent clients, and a summation of why and how art therapy is effective in slowing and at times halting the cycle of violence. In particular, the author stresses how art can act as containment, expression, sublimation, humanization, and resistance or as a weapon against violence, which in turn can aid the therapist in knowing when and how to facilitate the art process to either amplify or diminish these dynamic interchanges. In addition, this chapter summarizes how art therapists, as peace-makers, may also provide a sense of safety and well-being within extremely volatile environments.
Epilogue
Authors: Gussak David E.
Published: February 2022

In bringing this book to a close, this Epilogue revisits each chapter in the book and relies on them to explore several dawning realizations. The original visual of the two-partner dance presented in the Prologue and Introduction did not persist during the 7 years it took to research and write this book; what emerged was something much more complicated. While art sometimes contains and sublimates violent and aggressive tendencies, and art making can provide respite and can wrest control from violent surroundings, art can and has been used as a dangerous weapon. Thus, two seemingly counterintuitive notions emerged: aggressive and violent impulses are not always bad, and art making is not always good. Yet one thing remained clear: there seems to exist a distinct interdependence and co-reliance between art and violence.
Clinical trajectories and impact of acute kidney disease after acute kidney injury in the intensive care unit: a 5-year single-centre cohort study
Authors: Orieux Arthur , Prezelin-Reydit Mathilde , Prevel Renaud , Combe Christian , Gruson Didier , Boyer Alexandre , Rubin Sébastien
Published: February 2022

Background

Patients suffering from acute kidney injury(AKI) in the intensive care unit (ICU) can have various renal trajectories and outcomes. Aims were to assess the various clinical trajectories after AKI in the ICU and to determine risk factors for developing chronic kidney disease (CKD).

Methods

We conducted a prospective 5-year follow-up study in a medical ICU at Bordeaux University Hospital (France). The patients who received invasive mechanical ventilation, catecholamine infusion or both and developed an AKI from September 2013 to May 2015 were included. In the Cox analysis, the violation of the proportional hazard assumption for AKD was handled using appropriate interaction terms with time, resulting in a time-dependent hazard ratio (HR).

Results

A total of 232 patients were enrolled, with an age of 62 ± 16 years and a median follow-up of 52 days (interquartile range 6–1553). On day 7, 109/232 (47%) patients progressed to acute kidney disease (AKD) and 66/232 (28%) recovered. A linear trajectory (AKI, AKD to CKD) was followed by 44/63 (70%) of the CKD patients. The cumulative incidence of CKD was 30% [95% confidence interval (CI) 24–36] at the 5-year follow-up. In a multivariable Cox model, in the 6 months following AKI, the HR for CKD was higher in AKD patients [HR 29.2 (95% CI 8.5–100.7); P < 0.0001). After 6 months, the HR for CKD was 2.2 (95% CI 0.6–7.9; P = 0.21; n = 172 patients).

Conclusion

There were several clinical trajectories of kidney disease after ICU-acquired AKI. CKD risk was higher in AKD patients only in the first 6 months. Lack of renal recovery rather than AKD per se was associated with the risk of CKD.
Myocarditis post-SARS-CoV-2 vaccination: a systematic review
Authors: Goyal M , Ray I , Mascarenhas D , Kunal S , Sachdeva R A , Ish P
Published: February 2022

Variable clinical criteria taken by medical professionals across the world for myocarditis following coronavirus disease 2019 (COVID-19) vaccination along with wide variation in treatment necessitates understanding and reviewing the same. A systematic review was conducted to elucidate the clinical findings, laboratory parameters, treatment and outcomes of individuals with myocarditis after COVID-19 vaccination after registering with PROSPERO. Electronic databases including MEDLINE, EMBASE, PubMed, LitCovid, Scopus, ScienceDirect, Cochrane Library, Google Scholar and Web of Science were searched. A total of 85 articles encompassing 2184 patients were analysed. It was a predominantly male (73.4%) and young population (mean age: 25.5 ± 14.2 years) with most having taken an mRNA-based vaccine (99.4%). The mean duration from vaccination to symptom onset was 4.01 ± 6.99 days. Chest pain (90.1%), dyspnoea (25.7%) and fever (11.9%) were the most common symptoms. Only 2.3% had comorbidities. CRP was elevated in 83.3% and cardiac troponin in 97.6% patients. An abnormal ECG was reported in 979/1313 (74.6%) patients with ST-segment elevation being most common (34.9%). Echocardiographic data were available for 1243 patients (56.9%), of whom 288 (23.2%) had reduced left ventricular ejection fraction. Non-steroidal antiinflammatory drugs (76.5%), steroids (14.1%) followed by colchicine (7.3%) were used for treatment. Only 6 patients died among 1317 of whom data were available. Myocarditis following COVID-19 vaccination is often mild, seen more commonly in young healthy males and is followed by rapid recovery with conservative treatment. The emergence of this adverse event calls for harmonizing case definitions and definite treatment guidelines, which require wider research.
Using Bid Rotation and Incumbency to Detect Collusion: A Regression Discontinuity Approach
Authors: Kawai Kei , Nakabayashi Jun , Ortner Juan , Chassang Sylvain
Published: February 2022

Cartels participating in procurement auctions frequently use bid rotation or prioritize incumbents to allocate contracts. However, establishing a link between observed allocation patterns and firm conduct has been difficult: there are cost-based competitive explanations for such patterns. We show that by focusing on auctions in which the winning and losing bids are very close, it is possible to distinguish allocation patterns reflecting cost differences across firms from patterns reflecting non-competitive environments. We apply our tests to two datasets: the sample of Ohio milk auctions studied in Porter and Zona (1999, “Ohio School Milk Markets: An Analysis of Bidding”, RAND Journal of Economics, 30, 263–288), and a sample of municipal procurement auctions from Japan.
Analyzing the Military’s Role in Producing Air Toxics Disparities in the United States: A Critical Environmental Justice Approach
Authors: Alvarez Camila H , Shtob Daniel A , Theis Nicholas G
Published: February 2022

The negative environmental, health, and social effects arising from U.S. military action in communities both domestically and abroad suggest that the military represents an understudied institutional source of environmental injustice. Moreover, scholars and activists have long argued that the state is an active or a tacit contributor to environmental inequality, thus providing an opportunity to link U.S. military activity with approaches to the state developed under critical environmental justice. We build on these literatures to ask: Does the presence of domestic military facilities significantly increase carcinogenic risks from air toxics? And do communities of color face additional military-associated carcinogenic risks? Multilevel analyses reveal that locales in closer proximity to a military facility and those exposed to greater military technological intensity, independent of each other, experience significantly higher carcinogenic risk from air toxics. We find that proximity to military facilities tends to intensify racial and ethnic environmental inequalities in exposure to airborne toxics, but in different ways for Latinx and Black populations. These results highlight the role of the state in perpetuating racial and environmental expendability as reflected in critical environmental justice and represent an important expansion of nationwide environmental justice studies on contributors to environmental inequality.