bluuebunny/crossref_metadata_2025 huggingface dataset:
Zircon petrochronology of Cretaceous Cordilleran interior granites of the Snake Range and Kern Mountains, Nevada, USA
Authors: Gottlieb Eric S. , Miller Elizabeth L. , Valley John W. , Fisher Christopher M. , Vervoort Jeffrey D. , Kitajima Kouki
Published: February 2022

We addressed fundamental questions about the lithology, age, structure, and thermal evolution of the deep crust of the retroarc hinterland of the North American Cordilleran orogen through systematic investigation of zircons from Cretaceous plutons in the Snake Range and Kern Mountains of east-central Nevada. Geochronological (U-Pb) and geochemical (trace element, O and Hf isotopes) characterization of pre- and synmagmatic growth domains of zircons, coupled with traditional petrologic methods (petrography, field relationships, and whole-rock major-element, trace-element, and Sr-Nd and Pb isotope geochemistry), fingerprinted temporal variations in crustal contributions to magmatism. The samples are typical felsic, peraluminous Cordilleran interior granitoids that formed between 102 ± 2 Ma and 71 ± 1 Ma (95% confidence). Over the entire time span of magmatism, 87Sr/86Srinitial, εNd(t), 208Pb/204Pb, and εHf(t) exhibit incrementally more “crustal” ratios. The oldest and youngest samples, respectively, predate and postdate all published timing constraints of Cretaceous peak metamorphism in the region and exhibit the least and most radiogenic whole-rock isotopic results in the study (87Sr/86Srinitial = 0.7071 vs. 0.7222; εNd(t) = −3.4 vs. −18.8; 208Pb/204Pb = 38.8 vs. 40.1). Accordingly, the least intrasample variability of εHf(t), δ18OZrc, and trace-element ratios in magmatic zircon domains is also observed in these oldest and youngest samples, whereas greater intrasample variability is observed in intermediate-age samples that intruded during peak metamorphism. The geochemistry of zircon growth in the intermediate-age samples suggests assimilation of partially molten metasedimentary crust led to increased heterogeneity in their magma chemistry. Interaction of magmas with distinctive crust types is indicated by contrasts between four categories of inherited zircon observed in the studied intrusions: (1) detrital zircon with typical magmatic trace-element ratios; (2) zircon derived from high-grade 1.8–1.6 Ga basement; (3) zircon with anomalously low δ18O of uncertain origin, derived from 1.7/2.45 Ga basement (or detritus derived thereof); and (4) zircon from variably evolved Jurassic–Early Cretaceous deep-seated intrusions. The progression of zircon inheritance patterns, correlated with evolving geochemical signatures, in Late Cretaceous granitic plutons is best explained by early, relatively primitive intrusions and their penecontemporaneously metamorphosed country rock having been tectonically transported cratonward and superposed on older basement, from which the later, more-evolved Tungstonia pluton was generated. This juxtaposition consequentially implies tectonic transport of synorogenic plutonic rocks occurred in the Cordilleran hinterland during the Sevier orogeny as a result of the interplay of retroarc magmatism and convergent margin tectonism.
Rare association of haemophagocytic lymphohistiocytosis (HLH) and antiphospholipid syndrome (APS) in postpartum period: a considerable overlap?
Authors: B Rathna Roger , Dhali Arkadeep , Varghese Athul Kurien , H Balakrishnan Chaitanya
Published: February 2022

Haemophagocytic lymphohistiocytosis (HLH) is an aggressive and life-threatening disease of disproportionate immune activation. We present a case of a 25-year-old woman who is postnatal day 26 status post lower segment caesarean section who came with fever, breathlessness and abdominal pain in shock in the background of a malarial infection 3 days ago, which was initially evaluated on the lines of fever with multiple organ dysfunction syndrome. On further evaluation turned out to fulfil the criteria for secondary HLH seemingly triggered by an infectious cause or an autoimmune phenomenon. On further assessment, she was found to be positive for antiphospholipid antibodies which forced other possible diagnoses such as catastrophic antiphospholipid antibody syndrome into contention.
Hyperkalaemia mimics pseudostemi infarct pattern
Authors: Idilbi Nasra , Zbidat Mohamad
Published: February 2022

Hyperkalaemia is an electrolyte abnormality that warrants urgent intervention and has well-recognised electrocardiographic changes. Peaking T wave is the most appreciated ECG sign, but hyperkalaemia manifesting electrocardiographically as acute ischemia with ST segment elevation is a very rare condition. We present a case of acute kidney injury, complicated by severe hyperkalaemia causing ST segment elevation changes in ECG simulating acute myocardial infarction. Rapid serum potassium level in arterial blood gases blood test guide treatment in this case saved the need for unnecessary activation of the catheterisation lab and more importantly, saved the patient from malignant dysthymia in case of treatment delay. Aggressive treatment of hyperkalaemia resulted in successful reduction of serum potassium level; ECG changes returned to baseline without any evidence of pseudoinfarction pattern. The medical staff should be aware of this condition in order to administer correct therapy and prevent unnecessary interventions and the associated risk of complications.
Caecum volvulus as a late presentation of intestinal malrotation in an adult: a challenging diagnosis
Authors: Torre Ana , Amado Andreia , Graça Susana , Póvoa Antónia
Published: February 2022

Intestinal malrotation is usually diagnosed in early childhood. It results from failure of the normal gut rotation during embryological development. We present a case of a 62-year-old woman with a delayed presentation of an intestinal malrotation. She was admitted in the emergency department with an acute intestinal obstruction. Exploratory laparotomy revealed Ladd’s band with caecum volvulus and intestinal malrotation. Ladd’s procedure and right hemicolectomy were performed with uneventful recovery. Since both caecum volvulus and intestinal malrotation are rare events, particularly in adulthood, clinical diagnosis is challenging. Our aim is to increase the awareness of surgeons about this rare association as a cause of acute intestinal obstruction.
Relationship between macular intercapillary area measured by optical coherence tomography angiography and central visual field sensitivity in normal tension glaucoma
Authors: Shen Ruyue , Wang Yu Meng , Cheung Carol Y , Tang Fang Yao , Lam Alexander , Tham Clement C , Chan Poemen PuiMan
Published: February 2022

Purpose

To investigate the relationship of macular intercapillary area (ICA) with macular ganglion cell-inner plexiform layer (GCIPL) thickness and central visual field sensitivity (CVFS) in normal tension glaucoma (NTG).

Methods

Seventy-eight early NTG eyes, 33 moderate-to-severe NTG eyes and 75 normal control eyes were cross-sectional evaluated. All participants underwent swept-source optical coherence tomography angiography (OCT-A; DRI-OCT, Topcon, Tokyo, Japan). A customised MATLAB program was used to quantify macular OCT-A metrics at central 3×3 mm macular region including vascular density (VD), foveal avascular zone (FAZ) area, 10 largest ICA including FAZ area (ICA10_IncFAZ) and excluding FAZ area (ICA10_ExcFAZ). Generalised estimating equation regression models were performed to determine the relationships of OCT-A vascular metrics with GCIPL thickness in the macular region and CVFS.

Results

NTG eyes had lower global VD, larger ICA10_IncFAZ, and larger ICA10_ExcFAZ than normal controls (all p≤0.016). In the multivariable analyses, decreased VD (β=−0.304, p=0.006) and increased ICA (β=−0.231 for ICA10_IncFAZ and β=−0.259 for ICA10_ExcFAZ, all p≤0.042) were significantly associated with decreased GCIPL thickness in early NTG eyes but not in moderate-to-severe NTG eyes. ICA enlargement was associated with CVFS in early NTG eyes (β=−0.310, p=0.009), while VD was associated with CVFS in moderate-to-severe NTG eyes (β=−0.272, p=0.038).

Conclusion

ICA enlargement could be a potentially important disease marker of early NTG as reflected by its association with GCIPL thinning and decrease CVFS specifically for early NTG eyes.
Shifting the dynamics: implementation of locally driven, mixed-methods modelling to inform schistosomiasis control and elimination activities
Authors: Fergus Cristin Alexis , Ozunga Bono , Okumu Noah , Parker Melissa , Kamurari Solomon , Allen Tim
Published: February 2022

Introduction

The integration of more diverse perspectives into the development of evidence for decision-making has been elusive, despite years of rhetoric to the contrary. This has led to cycles of population-based health interventions which have not delivered the promised results. The WHO most recently set a target for schistosomiasis elimination by 2030 and called for cross-cutting approaches to be driven by endemic countries themselves. The extent to which elimination is feasible within the time frame has been a subject of debate.

Methods

Systems maps were developed through participatory modelling activities with individuals working on schistosomiasis control and elimination activities from the village through national levels in Uganda. These maps were first synthesised, then used to frame the form and content of subsequent mathematical modelling activities, and finally explicitly informed model parameter specifications for simulations, using the open-source SCHISTOX model, driven by the participants.

Results

Based on the outputs of the participatory modelling, the simulation activities centred around reductions in water contact. The results of the simulations showed that mass drug administration, at either the current or target levels of coverage, combined with water contact reduction activities, achieved morbidity control in high prevalenceSchistosoma mansonisettings, while both morbidity control and elimination were achieved in high prevalenceS. haematobiumsettings within the 10-year time period.

Conclusion

The combination of participatory systems mapping and individual-based modelling was a rich strategy which explicitly integrated the perspectives of national and subnational policymakers and practitioners into the development of evidence. This strategy can serve as a method by which individuals who have not been traditionally included in modelling activities, and do not hold positions or work in traditional centres of power, may be heard and truly integrated into the development of evidence for decision-making in global health.
Burden of gastric and digestive cancers in the French Caribbean: perspectives from population-based cancer registries of Martinique, Guadeloupe and French Guiana (2007–2014)
Authors: Imounga Desroziers Laure , Belliardo Sophie , Deloumeaux Jacqueline , Plenet Juliette , Bhakkan-Mambir Bernard , Péruvien Jessica , Chatignoux Edouard , Macni Jonathan , Boullard Manon , Beaubrun-Renard Murielle , Véronique-Baudin Jacqueline , Joachim Clarisse
Published: February 2022

Objectives

Data from population-based cancer registries contribute to improving our knowledge of digestive cancer trends worldwide. In this study, we present cancer incidence and mortality in Guadeloupe, French Guiana and Martinique for the periods 2008–2014, 2010–2014 and 2007–2014, respectively.

Design

Data were extracted from population-based cancer registries. World-standardised incidence (WSI) and mortality (WSM) rates were calculated. Main digestive cancers were analysed, including oesophagus, stomach, colorectum, liver and pancreas cancers.

Setting

This study was performed based on data from French Territories in the Caribbean.

Results

We observed a lower-incidence compared with mainland France, except for stomach cancer for which the incidence is high, with significant standardised incidence ratios in men and women at 1.90 vs 2.29 for Guadeloupe and French Guiana and 1.58 vs 2.31 for Martinique. We found a lower-mortality, except for stomach cancer for which the mortality remains high, with significant mortality ratios in men and women at 2.10 vs 2.74 for Guadeloupe, 1.64 vs 1.79 for French Guiana and 2.05 vs 2.53 for Martinique. Overall, these three regions have similar WSI and WSM rates which remain lower than those in mainland France. We noticed an overall high incidence and high mortality in men compared with women as in France.

Conclusions

There is a high incidence of stomach cancer in French overseas territories. Publication of these data contributed to expanding knowledge on the epidemiology of world cancers with data from the Caribbean zone.
Advancing a programme theory for community-level oral health promotion programmes for humanitarian migrants: a realist review protocol
Authors: Eslamiamirabadi Negin , Mostafa Nurelhuda Nazik , Nicolau Belinda , Macdonald Mary Ellen
Published: February 2022

Introduction

Humanitarian migrants often suffer from poor health, including oral health. Reasons for their oral health conditions include difficult migration trajectories, poor nutrition and limited financial resources. Oral health promotion is crucial for improving oral health-related quality of life of humanitarian migrants. While community-level oral health promotion programmes for humanitarian migrants have been implemented (eg, in host countries and refugee camps), there is scant literature evaluating their transferability or effectiveness. Given that these programmes yield unique context-specific outcomes, the purpose of this study is to understand how community-level oral health promotion programmes for humanitarian migrants work, in which contexts and why.

Methods and analysis

Realist review, a theory-driven literature review methodology, incorporates a causal heuristic called context–mechanism–outcome configurations to explain how programmes work, for whom, and under which conditions. Using Pawson’s five steps of realist review (clarifying scope and drafting an initial programme theory; identifying relevant studies; quality appraisal and data extraction; data synthesis; and dissemination of findings), we begin by developing an initial programme theory using the references of a scoping review on the oral health of refugees and asylum seekers and through hand searching in Google Scholar. Following stakeholder validation of our initial programme theory, we will locate additional evidence by searching in four databases (Ovid Medline, Ovid Embase, Cochrane Library and Cumulative Index to Nursing and Allied Health Literature (CINAHL)) to test and refine our initial programme theory into a middle-range realist programme theory. The resultant theory will explain how community-level oral health promotion programmes for humanitarian migrants work, for whom, in which contexts and why.

Ethics and dissemination

Since this study is a review and no primary data collection will be involved, institutional ethics approval is not required. The findings of this study will be disseminated in peer-reviewed journals, local and international conferences, and via social media.

Trial registration number

CRD42021226085.
Duration of untreated psychosis and pathways to care in Suriname: a qualitative study among patients, relatives and general practitioners
Authors: van Beek Atousa , de Zeeuw Janine , de Leeuw Menno , Poplawska Mia , Kerkvliet Lise , Dwarkasing Rudi , Nanda Randhir , Veling Wim
Published: February 2022

Purpose

Psychosis is a severe mental health problem and is responsible for poor health outcomes, premature mortality and morbidity, especially in low- and middle-income countries. The duration of untreated psychosis (DUP), that is the time period between onset of symptoms until initiation of appropriate treatment by a healthcare professional, is one of the main determinants for successful treatment in western settings. This study aims to explore the factors related to the DUP among Surinamese patients using the perspectives from patients, their families and first-line healthcare professionals in Suriname.

Methods

Semi-structured interviews were conducted with patients having a history of psychosis, family members and general practitioners between February 2019 and April 2019 in Suriname. Interviews were tape-recorded and transcribed verbatim. Data were analysed using a thematic analysis for which an inductive and deductive approach was applied.

Results

In total, 28 patients, 13 family members and 8 general practitioners were interviewed. Five patients were excluded from the study. A median DUP of 4 months was found (IQR 1–36). Identified themes related to DUP included presentation of symptoms and illness awareness, help-seeking behaviour and alternative medicine, social support and stigma, financial and practical factors.

Conclusion

Multiple factors were related to DUP, of which poor illness awareness, traditional medicine, stigma and social support were predominant. Poor illness awareness and use of alternative medicine were related to a longer DUP. Stigma was often an obstacle for patients and their families. Social and family support was important in helping patients to get medical help sooner. Other explored factors including financial and practical factors did not contribute to DUP.
Application of primary healthcare principles in national community health worker programmes in low-income and middle-income countries: a scoping review
Authors: Perveen Shagufta , Lassi Zohra S , Mahmood Mohammad Afzal , Perry Henry B , Laurence Caroline
Published: February 2022

Objective

To identify which primary healthcare (PHC) principles are reflected in the implementation of national community health worker (CHW) programmes and how they may contribute to the outcomes of these programmes in the context of low-income and middle-income countries (LMICs).

Design

Scoping review.

Data sources

A systematic search was conducted through PubMed, CINAHL, EMBASE and Scopus databases.

Eligibility criteria

The review considered published primary studies on national programmes, projects or initiatives using the services of CHWs in LMICs focused on maternal and child health. We included only English language studies. Excluded were programmes operated by non-government organisations, study protocols, reviews, commentaries, opinion papers, editorials and conference proceedings.

Data extraction and synthesis

We reviewed the application of four PHC principles (universal health coverage, community participation, intersectoral coordination and appropriateness) in the CHW programme’s objectives, implementation and stated outcomes. Data extraction was undertaken systematically in an excel spreadsheet while the findings were synthesised in a narrative manner. The quality appraisal of the selected studies was not performed in this scoping review.

Results

From 1280 papers published between 1983 and 2019, 26 met the inclusion criteria. These 26 papers included 14 CHW programmes from 13 LMICs. Universal health coverage and community participation were the two commonly reported PHC principles, while intersectoral coordination was generally missing. Similarly, the cultural acceptability aspect of the principle of appropriateness was present in all programmes as these programmes select CHWs from within the communities. Other aspects, particularly effectiveness, were not evident.

Conclusion

The implementation of PHC principles across national CHW programmes in LMICs is patchy. For comprehensiveness and improved health outcomes, programmes need to incorporate all attributes of PHC principles. Future research may focus on how to incorporate more attributes of PHC principles while implementing national CHW programmes in LMICs. Better documentation and publications of CHW programme implementation are also needed.
Safety of intravenous tranexamic acid in patients undergoing supratentorial meningiomas resection: protocol for a randomised, parallel-group, placebo control, non-inferiority trial
Authors: Li Shu , Yan Xiang , Li Ruowen , Zhang Xingyue , Ma Tingting , Zeng Min , Dong Jia , Wang Juan , Liu Xiaoyuan , Peng Yuming
Published: February 2022

Introduction

Growing evidence recommends antifibrinolytic agent tranexamic acid (TXA) to reduce blood loss and transfusions rate in various surgical settings. However, postoperative seizure, as one of the major adverse effects of TXA infusion, has been a concern that restricts its utility in neurosurgery.

Methods and analysis

This is a randomised, placebo-controlled, non-inferiority trial. Patients with supratentorial meningiomas and deemed suitable for surgical resection will be recruited in the trial. Patients will be randomised to receive either a single administration of 20 mg/kg TXA or a placebo of the same volume with a 1:1 allocation ratio after anaesthesia induction. The primary endpoint is the cumulative incidence of early postoperative seizures within 7 days after craniotomy. Secondary outcomes include the incidence of non-seizure complications, changes of haemoglobin level from baseline, intraoperative blood loss, erythrocyte transfusion volume, Karnofsky Performance Status, all-cause mortality, and length of stay, and total hospitalisation cost.

Ethics and dissemination

This trial is registered at ClinicalTrial.gov and approved by the Chinese Ethics Committee of Registering Clinical Trials (ChiECRCT20200224). The findings will be disseminated in peer-reviewed journals and presented at national or international conferences relevant to subject fields.

Trial registration number

NCT04595786.
Cross-sectional study of mental health and sexual behaviours for Ebola Survivors in Beni, Butembo and Katwa health zones of the Democratic Republic of Congo
Authors: Lieberman Lawry Lynn , Stroupe Kannappan Nancy , Canteli Covadonga , Clemmer William
Published: February 2022

Objectives

To understand the prevalence of mental health disorders in Ebola-affected communities and their association with condom use.

Design

Cross-sectional study.

Setting

Beni, Butembo and Katwa health zones, Democratic Republic of Congo (DRC).

Participants

223 adult Ebola survivors, 102 sexual partners and 74 comparison respondents.

Primary and secondary outcome measures

Post-traumatic stress disorder (PTSD), depression, anxiety, substance use, suicidal ideation and attempts, stigma, condom use and sexual behaviour.

Results

Most respondents reported to be married, Christian, from the Nande ethnic group, and farmers/herders. Survivors met symptom criteria for depression at higher rates than partners (23.5% (95% CI 18.0 to 29.1) vs 5.7 (1.2 to 10.1); p<0.001). PTSD symptom criteria for survivors (24.1%, 95% CI 18.5% to 29.7%) and partners (16.7%, 95% CI 9.4% to 23.9%) were four times greater than the comparison participants (6.0%, 95% CI 0.6% to 11.4%). Two times as many survivors as partners reported that sexual activity precautions were discussed at discharge (71.5% (95% CI 65.6 to 77.5) vs 36.2% (95% CI 26.9 to 45.5); p<0.001). The majority of survivors (95.0 (95% CI 85.1% to 98.5%) and partners 98.5% (95% CI 89.6% to 99.8%; p=0.26) participated in risky sexual behaviour after the survivor left the Ebola treatment centre. The ability to refuse sex or insist on condom use before Ebola had a threefold increase in the odds of condom use (adjusted OR 3.3, 95% CI 1.7 to 6.1, p<0.001). Up to 36% of the comparison group held discriminatory views of survivors.

Conclusions

The new outbreaks in both Guinea and DRC show Ebola remains in semen longer than previously known. Understanding and addressing condom non-use and updating condom use guidelines are necessary to protect against future Ebola outbreaks, especially among sexual partners who did not have similar access to health information regarding sexual transmission of Ebola. Mental health treatment and decreasing stigma in Ebola areas is a priority.
Quantitative assessment of pregnancy outcome following recurrent miscarriage clinic care: a prospective cohort study
Authors: Shields Rebecca , Khan Omar , Lim Choi Keung Sarah , Hawkes Amelia Jane , Barry Aisling , Devall Adam J , Quinn Stephen D , Keay Stephen D , Arvanitis Theodoros N , Bick Debra , Quenby Siobhan
Published: February 2022

Objectives

To measure pregnancy outcome following attendance at a recurrent miscarriage service and identify factors that influence outcome.

Design

Prospective, observational electronic cohort study.

Setting

Participants attending a specialist recurrent miscarriage clinic, with a history of two or more pregnancy losses. 857 new patients attended over a 30-month period and were invited to participate. Participant data were recorded on a bespoke study database, ‘Tommy’s Net’.

Participants

777 women consented to participate (90.7% of new patients). 639 (82%) women continued within the cohort, and 138 were lost to follow-up. Mean age of active participants was 34 years for women and 37 years for partners, with a mean of 3.5 (1–19) previous pregnancy losses. Rates of obesity (maternal: 23.8%, paternal: 22.4%), smoking (maternal:7.4%, paternal: 19.4%) and alcohol consumption (maternal: 50%, paternal: 79.2%) were high and 55% of participants were not taking folic acid.

Outcome measures

Biannual collection of pregnancy outcomes, either through prompted self-reporting, or existing hospital systems.

Results

639 (82%) women were followed up. 404 (83.4%) reported conception and 106 (16.6%) reported no pregnancy, at least 6 months following registration. Of those that conceived, 72.8% (294/404) had a viable pregnancy. Maternal smoking and body mass index (BMI) over 30 were significantly higher in those who did not conceive (p=0.001)

Conclusions

Tommy’s Net provides a secure electronic repository on data for couples with recurrent pregnancy loss and associated outcomes. The study identified that subfertility, as well as repeated miscarriage, maternal BMI and smoking status, contributed to failure to achieve live birth. Study findings may enable comparison of clinic outcomes and inform the development of a personalised holistic care package.
Analytical observational study evaluating global pandemic preparedness and the effectiveness of early COVID-19 responses in Ethiopia, Nigeria, Singapore, South Korea, Sweden, Taiwan, UK and USA
Authors: Nikolaeva Alexandra , Versnel Jenny
Published: February 2022

Objectives

An analysis of early country-specific COVID-19 strategies and the impact of policies, healthcare resources and cultural influences on their effectiveness.

Design

Analytical observational study.

Setting

USA, UK, Sweden, South Korea, Singapore, Taiwan, Ethiopia and Nigeria.

Main outcome measures

OxCGRT indices were used to quantify variations in governments’ responses, and effectiveness was measured by the number of deaths as a proportion of the population. Hofstede’s cultural dimensions, and the availability of healthcare resources, were analysed for their potential impact on effectiveness.

Results

Effective strategies reflect factors such as speed of governmental intervention, cultural norms, population demographics and available resources. While biases, confounders and lack of data at the beginning of the pandemic make inferences challenging, publicly available data suggest that South Korea, Singapore and Taiwan were most successful through rapid identification and isolation of cases, and effective contact tracing systems.

Conclusion

The rapid spread of the highly transmissible SARS-CoV-2 virus took many countries by surprise and the delayed global response contributed to the severity of the COVID-19 pandemic. The speed at which strategies were implemented is highly correlated to the number of deaths. Factors such as cultural norms and healthcare resources impact effectiveness significantly, implying that implementation of a global ‘one size fits all’ approach is challenging. Global preparedness should focus on effective surveillance and preparedness strategies to enable timely identification and containment of future threats.
Adolescent mental health research in Tanzania: a study protocol for a priority setting exercise and the development of an interinstitutional capacity strengthening programme
Authors: Obasi Angela , Seekles Maaike , Boshe Judith , Dow Dorothy , Mmbaga Blandina , Ngakongwa Fileuka , Okello Elialilia , Renju Jenny , Shayo Elizabeth , Simbee Gema , Todd Jim , Oriyo Ndekya
Published: February 2022

Introduction

Poor adolescent mental health is a barrier to achieving several sustainable development goals in Tanzania, where adolescent mental health infrastructure is weak. This is compounded by a lack of community and policy maker awareness or understanding of its burden, causes and solutions. Research addressing these knowledge gaps is urgently needed. However, capacity for adolescent mental health research in Tanzania remains limited. The existence of a National Institute for Medical Research (NIMR), with a nationwide mandate for research conduct and oversight, presents an opportunity to catalyse activity in this neglected area. Rigorous research priority setting, which includes key stakeholders, can promote efficient use of limited resources and improve both quality and uptake of research by ensuring that it meets the needs of target populations and policy makers. We present a protocol for such a research priority setting study and how it informs the design of an interinstitutional adolescent mental health research capacity strengthening strategy in Tanzania.

Methods and analysis

From May 2021, this 6 month mixed-methods study will adapt and merge the James Lind Alliance approach and validated capacity strengthening methodologies to identify priorities for research and research capacity strengthening in adolescent mental health in Tanzania. Specifically, it will use online questionnaires, face-to-face interviews, focus groups, scoping reviews and a consensus meeting to consult expert and adolescent stakeholders. Key evidence-informed priorities will be collaboratively ranked and documented and an integrated strategy to address capacity gaps will be designed to align with the nationwide infrastructure and overall strategy of NIMR.

Ethics and dissemination

National and institutional review board approvals were sought and granted from the National Health Research Ethics Committee of the NIMR Medical Research Coordinating Committee (Tanzania) and the Liverpool School of Tropical Medicine (United Kingdom). Results will be disseminated through a national workshop involving all stakeholders, through ongoing collaborations and published commentaries, reviews, policy briefs, webinars and social media.
Demographic, clinical guideline criteria, Medicaid expansion and state of residency: a multilevel analysis of PrEP use on a large US sample
Authors: Carneiro Pedro Botti , Mirzayi Chloe , Jones Scott , Rendina Jonathon , Grov Christian
Published: February 2022

Objective

To explore the association of clinical guideline-related variables, demographics and Medicaid expansion on pre-exposure prophylaxis (PrEP) uptake in one of the largest US sample of men who have sex with men(MSM) and transgender and gender non-binary (TGNB) people ever analysed.

Methods

We cross-sectionally analysed predictors of current PrEP use using demographic and HIV risk-related variables (level-1), as well as state-level variables (level-2) (ie, Medicaid expansion status). We further explored the role state of residence plays in PrEP uptake disparities across the USA.

Results

We found that the odds of PrEP use were significantly greater in older age, white, cisgender men. Moreover, individuals who reported recent post-exposure prophylaxis use, a recent sexually transmitted infection diagnosis and recent drug use were significantly more likely to report PrEP use. Finally, we found that the median odds of PrEP use between similar individuals from different states were 1.40 for the ones living in the Medicaid expansion states, compared with those not living in Medicaid expansion states. State of residence did not play a significant role in explaining PrEP disparities overall.

Conclusion

Our analysis showed that PrEP use is less common in communities standing to benefit the most from it—young MSM and TGNB of colour. However, individuals meeting federal guidelines for PrEP were significantly more likely to use PrEP. Though we found a positive association between living in Medicaid expansion states and PrEP use; that variable, as well as one’s state of residency, were not suitable to explain variations in PrEP use in the US.
Development of a nomogram for the prediction of in-hospital mortality in patients with acute ST-elevation myocardial infarction after primary percutaneous coronary intervention: a multicentre, retrospective, observational study in Hebei province, China
Authors: Wang Yudan , Wang Wenjing , Jia Shengqi , Gao Man , Zheng Shihang , Wang Jiaqi , Dang Yi , Li Yingxiao , Qi Xiaoyong
Published: February 2022

Objectives

To establish a clinical prognostic nomogram for predicting in-hospital mortality after primary percutaneous coronary intervention (PCI) among patients with ST-elevation myocardial infarction (STEMI).

Design

Retrospective, multicentre, observational study.

Setting

Thirty-nine hospitals in Hebei province.

Participants

Patients with STEMI who underwent PCI from January 2018 to December 2019.

Interventions

A multivariable logistic regression model was used to identify the factors associated with in-hospital mortality, and a nomogram was established using these factors. The performance of the nomogram was evaluated by the discrimination, calibration and clinical usefulness.

Primary and secondary outcome measures

The outcome was the factors associated with in-hospital mortality.

Results

This study included 855 patients, among whom 223 died in hospital. Age, body mass index, systolic pressure on admission, haemoglobin, random blood glucose on admission, ejection fraction after PCI, use aspirin before admission, long lesions, thrombolysis in myocardial infarction flow grade and neutrophils/lymphocytes ratio were independently associated with in-hospital mortality (all p<0.05). In the training set, the nomogram showed a C-index of 0.947, goodness-of-fit of 0.683 and area under the receiver operating characteristic curve (AUC) of 0.947 (95% CI 0.927 to 0.967). In the testing set, the C-index was 0.891, goodness-of-fit was 0.462 and AUC was 0.891 (95% CI 0.844 to 0.939). The results indicate that the nomogram had good discrimination and good prediction accuracy and could achieve a good net benefit.

Conclusions

A nomogram to predict in-hospital mortality in patients with STEMI after PCI was developed and validated in Hebei, China and showed a satisfactory performance. Prospective studies will be necessary to confirm the performance and clinical applicability and practicality of the nomogram.
Changes to postdiagnostic dementia support in England and Wales during the COVID-19 pandemic: a qualitative study
Authors: Wheatley Alison , Poole Marie , Robinson Louise
Published: February 2022

Objectives

To explore the impact of COVID-19 on postdiagnostic dementia care and support provision in England and Wales.

Design

Qualitative research using semistructured interviews, via video or telephone conferencing.

Setting

Services providing postdiagnostic support across health, social care and the third sector.

Participants

21 professionals previously recruited to an ongoing research programme on postdiagnostic dementia care (or colleagues, if unavailable).

Results

Key themes identified from the data were: challenges caused by COVID-19; responses to those challenges, including a widespread shift to remote working; and effects of COVID-19 on future postdiagnostic support. Challenges included changing and sometimes conflicting guidelines; a lack of access to support; identifying and responding to emerging needs; emotional and physical impact of COVID-19; and balancing COVID-19 risk with other risks such as deterioration. Some dementia services closed, while others adapted and continued to provide support thus potentially widening existing inequalities. There were also some unintended positive outcomes, including improved cross-sector and multidisciplinary working between professionals.

Conclusion

Delivering postdiagnostic dementia support during COVID-19 required essential adaptations. While some changes were detrimental to service users, others were identified as potentially beneficial and highly likely to become the new ‘norm’, for example, use of blended approaches, combining virtual and face-to-face work, thus allowing more flexible, integrated care. Our data have implications for policy and practice to improve the response to the lingering effects of COVID-19 as well as creating service provision that is more resilient to future pandemics or other periods of disruption.
Better general paediatric and neonatal palliative care skills: simulation teaching
Authors: Taylor Naomi , Nair Vrinda , Grimbley Jonathan
Published: February 2022

Objectives

To assess the role of simulation to teach ‘palliative care’ skills to the multidisciplinary team (MDT) within general paediatric and neonatal settings.

Methods

Five simulation sessions were undertaken. The themes were acute presentation of a patient with a deteriorating life-limiting condition with no advance care plan (ACP) in place and parents not wishing for escalation of treatment; putting wishes expressed in an ACP in place for a dying child; managing an expected death; putting an antenatal ACP into place at delivery; and withdrawal of life-sustaining respiratory support in an extremely preterm neonate. Simulations were attended by the MDT. Participants completed feedback rating enjoyment, organisation, quality and relevance of sessions, and likelihood of attending further paediatric palliative medicine (PPM) simulation sessions, alongside a 10-point confidence scale rating confidence in dealing with ‘palliative care’ scenarios and talking to families about death.

Results

Participants reported they enjoyed the sessions (mean score 4.5, range 1–5) and felt they were well organised (4.7/5, range 1–5) and of high quality (4.7/5, range 1–5). They felt sessions were relevant to their training (4.6/5, range 1–5) and that they would attend further simulation training in the area of PPM (mean 4.8/5, range 1–5). Confidence in managing PPM scenarios increased by a mean of 2.3 confidence points (range −1 to 5) and confidence in talking about death increased by a mean of 1.7 confidence points (range 0–5).

Conclusions

PPM simulation training was acceptable to participants and effective in increasing confidence with PPM skills. Training in PPM simulation should be a routine part of paediatric and neonatal training across the MDT.
Physician judgement in predicting obstructive coronary artery disease and adverse events in chest pain patients
Authors: Fordyce Christopher B , Hill C Larry , Mark Daniel B , Alhanti Brooke , Pellikka Patricia A , Hoffmann Udo , Patel Manesh R , Douglas Pamela S
Published: February 2022

Objective

To evaluate informal physician judgement versus pretest probability scores in estimating risk in patients with suspected coronary artery disease (CAD).

Methods

We included 4533 patients from the PROMISE (Prospective Multicenter Imaging Study for Evaluation of Chest Pain) trial. Physicians categorised a priori the pretest probability of obstructive CAD (≥70% or ≥50% left main); Diamond-Forrester (D-F) and European Society of Cardiology (ESC) pretest probability estimates were calculated. Agreement was calculated using the κ statistic; logistic regression evaluated estimates of pretest CAD probability and actual CAD (as determined by CT coronary angiography), and clinical outcomes were modelled using Cox proportional hazard models.

Results

Physician estimates agreed poorly with D-F (κ 0.16; 95% CI 0.14 to 0.18) and ESC (κ 0.04; 95% CI 0.02 to 0.05). Actual obstructive CAD was significantly more prevalent in both the high-likelihood (OR 3.30; 95% CI 2.30 to 4.74) and the intermediate-likelihood (OR 1.43; 95% CI 1.16 to 1.76) physician-estimated groups versus the low-likelihood group; ESC similarly differentiated between the three groups (OR 9.07; 95% CI 2.87 to 28.70; and OR 3.87; 95% CI 1.22 to 12.28). However, using D-F, only the high-probability group differed (OR 2.49; 95% CI 1.74 to 3.54). Only physician estimates were associated with a higher incidence of adjusted death/myocardial infarction/unstable angina hospitalisation in the high-probability versus low-probability group (HR 2.68; 95% CI 1.52 to 4.74); neither pretest probability score provided prognostic information.

Conclusions

Compared with D-F and ESC estimates, physician judgement more accurately identified obstructive CAD and worse patient outcomes. Integrating physician judgement may improve risk prediction for patients with stable chest pain.

Trial registration number

NCT01174550.
Inter-racial differences in patients undergoing transcatheter aortic valve implantation
Authors: Kang Do-Yoon , Ahn Jung-Min , Kim Juyong Brian , Yeung Alan , Nishi Takeshi , Fearon William , Cantey Eric Page , Flaherty James D , Davidson Charles J , Malaisrie S Christopher , Park Seo Young , Yun Sung-Cheol , Ko Euihong , Park Hanbit , Lee Seung-Ah , Kim Dae-Hee , Kim Ho Jin , Kim Joon Bum , Choo Suk Jung , Park Duk-Woo , Park Seung-Jung
Published: February 2022

Objective

Little information exists about inter-racial differences in patients with aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI). We investigated whether differences in baseline characteristics between Asian and non-Asian population may contribute to disparities in clinical outcomes after TAVI.

Methods

We performed a registry-based, multinational cohort study of patients with severe AS who underwent TAVI at two centres in the USA and one centre in South Korea. The primary outcome was a composite of death, stroke or rehospitalisation at 1 year.

Results

Of 1412 patients, 581 patients were Asian and 831 were non-Asian (87.5% white, 1.7% black, 6.1% Hispanic or 4.7% others). There were substantial differences in baseline characteristics between two racial groups. The primary composite outcome was significantly lower in the Asian group than in the non-Asian group (26.0% vs 35.0%; HR 0.73; 95% CI 0.59 to 0.89; p=0.003). However, after adjustment of baseline covariates, the risk of primary composite outcome was not significantly different (HR 0.79; 95% CI 0.60 to 1.03; p=0.08). The all-cause mortality at 1 year was significantly lower in the Asian group than the non-Asian group (7.4% vs 12.5%; HR 0.60; 95% CI 0.41 to 0.88; p=0.009). After multivariable adjustment, the risk of all-cause mortality was also similar (HR 1.17; 95% CI 0.73 to 1.88; p=0.52).

Conclusions

There were significant differences in baseline and procedural factors among Asian and non-Asian patients who underwent TAVI. Observed inter-racial differences in clinical outcomes were largely explained by baseline differences in clinical, anatomical and procedural factors.

Trial registration number

NCT03826264(https://wwwclinicaltrialsgov).
Ascites and resistance to immune checkpoint inhibition in dMMR/MSI-H metastatic colorectal and gastric cancers
Authors: Fucà Giovanni , Cohen Romain , Lonardi Sara , Shitara Kohei , Elez Maria Elena , Fakih Marwan , Chao Joseph , Klempner Samuel J , Emmett Matthew , Jayachandran Priya , Bergamo Francesca , García Marc Díez , Mazzoli Giacomo , Provenzano Leonardo , Colle Raphael , Svrcek Magali , Ambrosini Margherita , Randon Giovanni , Shah Aakash Tushar , Salati Massimiliano , Fenocchio Elisabetta , Salvatore Lisa , Chida Keigo , Kawazoe Akihito , Conca Veronica , Curigliano Giuseppe , Corti Francesca , Cremolini Chiara , Overman Michael , Andre Thierry , Pietrantonio Filippo
Published: February 2022

Background

Despite unprecedented benefit from immune checkpoint inhibitors (ICIs) in patients with mismatch repair deficient (dMMR)/microsatellite instability high (MSI-H) advanced gastrointestinal cancers, a relevant proportion of patients shows primary resistance or short-term disease control. Since malignant effusions represent an immune-suppressed niche, we investigated whether peritoneal involvement with or without ascites is a poor prognostic factor in patients with dMMR/MSI-H metastatic colorectal cancer (mCRC) and gastric cancer (mGC) receiving ICIs.

Methods

We conducted a global multicohort study at Tertiary Cancer Centers and collected clinic-pathological data from a cohort of patients with dMMR/MSI-H mCRC treated with anti-PD-(L)1 ±anti-CTLA-4 agents at 12 institutions (developing set). A cohort of patients with dMMR/MSI-high mGC treated with anti-PD-1 agents±chemotherapy at five institutions was used as validating dataset.

Results

The mCRC cohort included 502 patients. After a median follow-up of 31.2 months, patients without peritoneal metastases and those with peritoneal metastases and no ascites had similar outcomes (adjusted HR (aHR) 1.15, 95% CI 0.85 to 1.56 for progression-free survival (PFS); aHR 0.96, 95% CI 0.65 to 1.42 for overall survival (OS)), whereas inferior outcomes were observed in patients with peritoneal metastases and ascites (aHR 2.90, 95% CI 1.70 to 4.94; aHR 3.33, 95% CI 1.88 to 5.91) compared with patients without peritoneal involvement. The mGC cohort included 59 patients. After a median follow-up of 17.4 months, inferior PFS and OS were reported in patients with peritoneal metastases and ascites (aHR 3.83, 95% CI 1.68 to 8.72; aHR 3.44, 95% CI 1.39 to 8.53, respectively), but not in patients with only peritoneal metastases (aHR 1.87, 95% CI 0.64 to 5.46; aHR 2.15, 95% CI 0.64 to 7.27) when compared with patients without peritoneal involvement.

Conclusions

Patients with dMMR/MSI-H gastrointestinal cancers with peritoneal metastases and ascites should be considered as a peculiar subgroup with highly unfavorable outcomes to current ICI-based therapies. Novel strategies to target the immune-suppressive niche in malignant effusions should be investigated, as well as next-generation ICIs or intraperitoneal approaches.
Thrombus enhancement sign on CT angiography is associated with the first pass effect of stent retrievers
Authors: He Guangchen , Deng Jiangshan , Lu Haitao , Wei Liming , Zhao Yuwu , Zhu Yueqi , Li Yuehua
Published: February 2022

Background

The thrombus enhancement sign (TES) is thought to be associated with the source of the stroke and thrombus composition. We investigated whether this imaging sign along with other thrombus characteristics could be used to predict the successful first pass effect (FPE) of mechanical thrombectomy.

Methods

246 consecutive patients with acute ischemic stroke in the anterior circulation with large vessel occlusion who underwent thrombectomy with a stent retriever and clot collection were included. Patients were divided into FPE (modified Thrombolysis in Cerebral Infarction (mTICI) grade 2c or 3)/non-FPE (mTICI 0–2b) and modified FPE (mFPE) (mTICI 2b–3)/non-mFPE (mTICI 0–2a) groups based on flow restoration after the first pass. TES presence, thrombus density, thrombus length, clot burden score, and thrombus composition were compared. The association between FPE and imaging biomarkers, along with clinical and interventional parameters, was investigated by univariate and multivariate analysis.

Results

FPE was achieved in 85 (34.6%) patients. TES presence was significantly lower in the FPE group (64.7% vs 80.7% in the non-FPE group, p=0.008) and mFPE group (69.1% vs 81.0% in the non-mFPE group, p=0.039). Histopathological examination revealed that TES (+) thrombi contained a higher fibrin/platelet proportion (50.9% vs 46.9% in TES (−) thrombi, p=0.029) and fewer erythrocytes (43.3% vs 47.3% in TES (−) thrombi, p=0.030). Thrombus characteristics, namely shorter thrombus length (p=0.032), higher erythrocyte proportions (p=0.026), and less fibrin/platelets (p=0.014), were confirmed in patients with FPE. In multivariable analysis, TES was the only independent predictor of FPE failure (OR 0.51, 95% CI 0.28 to 0.94; p=0.031).

Conclusions

TES was independently associated with first pass angiographic failure in patients treated with a stent retriever.