bluuebunny/crossref_metadata_2025 huggingface dataset:
Permeability heterogeneity of sandstone intrusion fluid‐escape systems, Panoche Hills, California: Implications for sedimentary basins globally
Authors: Callow Ben , Falcon‐Suarez Ismael Himar , Bull Jonathan M. , Gernon Thomas M. , Ruffell Sean , Grippa Antonio , Hurst Andrew
Published: April 2022

Natural surface gas seeps provide a significant input of greenhouse gas emissions into the Earth’s atmosphere and hydrosphere. The gas flux is controlled by the properties of underlying fluid‐escape conduits, which are present within sedimentary basins globally. These conduits permit pressure‐driven fluid flow, hydraulically connecting deeper strata with the Earth’s surface; however they can only be fully resolved at sub‐seismic scale. Here, a novel ‘minus cement and matrix permeability’ method using three‐dimensional X‐ray micro‐computed tomography imaging enables the improved petrophysical linkage of outcrop and sub‐surface data. The methodology is applied to the largest known outcrop of an inactive fluid‐escape system, the Panoche Giant Intrusion Complex in Central California, where samples were collected along transects of the 600 to 800 m stratigraphic depth range to constrain porosity and permeability spatial heterogeneity. The presence of silica cement and clay matrix within the intergranular pores of sand intrusions are the primary control of porosity (17 to 27%) and permeability (≤1 to ca 500 mD) spatial heterogeneity within the outcrop analogue system. Following the digital removal of clay matrix and silica (opal‐CT and quartz) cement derived from the mudstone host strata, the sand intrusions have porosity−permeability ranges of ca 30 to 40% and 103 to 104 mD. These calculations are closely comparable to active sub‐surface systems in sedimentary basins. Field observations revealed that, at decreasing depth, the connected sand intrusion network reduces in thickness and becomes carbonate cemented, terminating at carbonate mounds formed from methane escape at the seafloor. A new conceptual model integrates the pore‐scale calculations and field‐scale observations to highlight the key processes that control sand intrusion permeability, spatially and temporally. The study demonstrates the control of matrix and cement addition on the physical properties of fluid‐escape conduits, which has significance for hydrocarbon reservoir characterization and modelling, as well as subsurface CO2 and energy storage containment assessment.
Brief modular approach to target perceived burdensomeness in clinic‐referred youth
Authors: Buitron Victor , Hill Ryan M. , Bose Deepika , Vaclavik Daniella , Rey Yasmin , Pettit Jeremy W.
Published: April 2022

Introduction

Existing CBT protocols for internalizing disorders target thoughts and behaviors related to anxiety and/or depression, but do not explicitly target other identified risk factors for suicide ideation, including perceived burdensomeness toward others. The aims of the current study were to (1) develop a novel, brief module (the “Give program”) targeting perceived burdensomeness toward others that can be embedded within existing CBT protocols for youth internalizing disorders, (2) evaluate the acceptability and feasibility of the module with an eye toward intervention refinement, and (3) examine reductions in perceived burdensomeness.

Methods

Participants were 18 clinic‐referred youths with anxiety or depressive disorders who endorsed burdensomeness. We used a quasi‐experimental interrupted time‐series design to evaluate changes in burdensomeness scores following the administration of the module.

Results

The module was clinically feasible and well‐accepted. Youth burdensomeness scores increased in the first half of the CBT protocol and decreased immediately following the administration of the Give program module. Burdensomeness scores were significantly associated with suicide ideation.

Conclusion

The current study is the first to develop and evaluate a module targeting burdensomeness in at‐risk youth in an outpatient setting, demonstrating that burdensomeness can be efficiently and effectively targeted within existing evidence‐based treatment protocols for internalizing disorders in youth.
Sports ball projectile ocular trauma in dogs
Authors: Chan Remington X. , Ledbetter Eric C.
Published: April 2022

Objective

To describe the clinical features, management, and outcome of dogs presenting with sports ball projectile ocular injuries.

Animals Studied

Eighteen dogs.

Procedures

A retrospective study reviewing cases of ocular injury due to a sports ball projectile that presented to the Cornell University ophthalmology service between 2004 and 2021. Dog age, type of sports ball, initial ocular lesions, eye affected, clinical management, and visual outcome were recorded.

Results

Sports ball projectile ocular injuries were identified in 18 eyes of 18 dogs. The median age of the dogs was 1.0 years old, ranging from 0.3‐ to 9‐years‐ old. Nine dogs were male, and 9 were female. Ocular injuries were caused by small, dense balls (e.g., golf balls, baseballs) in 11 dogs; small, light balls (e.g., tennis balls, toy balls) in 5 dogs; and large, soft balls (e.g., soccer ball, football) in 2 dogs. Closed‐globe injuries (12 of 18 eyes) presented with traumatic uveitis (91%), hyphema (45%), and subconjunctival hemorrhage (18%). All 12 closed‐globe injury cases were medically managed, eight dogs remained visual. Open‐globe injuries (6 of 18 dogs) presented with three corneal lacerations and three scleral ruptures. Five open‐globe injuries required enucleation, and one was medically managed and maintained vision.

Conclusion

Sports ball projectile ocular injuries in dogs can result in substantial ocular morbidity and in loss of vision. Small, dense balls were associated with injuries that carried the most guarded prognosis and required more aggressive management. Small and large lighter projectiles were associated with less serious ocular injuries and visual outcomes.
Wound fluid sampling methods for proteomic studies: A scoping review
Authors: Harvey Joe , Mellody Kieran T. , Cullum Nicky , Watson Rachel E. B. , Dumville Jo
Published: April 2022

Understanding why some wounds are hard to heal is important for improving care and developing more effective treatments. The method of sample collection used is an integral step in the research process and thus may affect the results obtained. The primary objective of this study was to summarise and map the methods currently used to sample wound fluid for protein profiling and analysis. Eligible studies were those that used a sampling method to collect wound fluid from any human wound for analysis of proteins. A search for eligible studies was performed using MEDLINE, Embase and CINAHL Plus in May 2020. All references were screened for eligibility by one reviewer, followed by discussion and consensus with a second reviewer. Quantitative data were mapped and visualised using appropriate software and summarised via a narrative summary. After screening, 280 studies were included in this review. The most commonly used group of wound fluid collection methods were vacuum, drainage or use of other external devices, with surgical wounds being the most common sample source. Other frequently used collection methods were extraction from absorbent materials, collection beneath an occlusive dressing and direct collection of wound fluid. This scoping review highlights the variety of methods used for wound fluid collection. Many studies had small sample sizes and short sample collection periods; these weaknesses have hampered the discovery and validation of novel biomarkers. Future research should aim to assess the reproducibility and feasibility of sampling and analytical methods for use in larger longitudinal studies.
Effect of interface roughness on the tribo-corrosion behavior of diamond like carbon coatings on titanium alloy
Authors: Pougoum Fabrice , Jedrzejczak Anna , Azzi Marwan , Martinu Ludvik , Klemberg-Sapieha Jolanta E.
Published: April 2022

Substrate surface morphology can significantly affect the functional performance and durability of the subsequently deposited coatings. In the present work, diamondlike carbon films were prepared by radio frequency plasma enhanced chemical vapor deposition on Ti-6Al-4V alloy substrates with different premediated surface roughness parameters (average roughness Ra, Skewness Rsk and Kurtosis Rku), and their mechanical, electrochemical, and tribo-corrosion properties were studied. The surface parameters, the microstructure, and the chemical composition were assessed by optical profilometry, scanning electron microscopy, Raman spectroscopy, and energy dispersive spectroscopy. The mechanical properties were evaluated using depth-sensing indentation and scratch testing, and the films' tribo-corrosion behavior was determined using a reciprocating tribometer in a ball-on-flat configuration with the tribological contact (Al2O3 counterpart) immersed in a 3.5% NaCl sea waterlike solution. The evolution of the corrosion potential as a function of time before, during, and after the wear tests indicated that the tribo-corrosion behavior is strongly affected by the surface roughness parameters. The potential of samples with Ra = 20 nm was unaffected by the rubbing process under the chosen tribological conditions compared to samples with higher Ra values. A similar trend was observed for samples with negative Rsk as opposed to those with Rku values greater than 3. The poor tribo-corrosion behavior of samples with Ra > 20 nm and high Rku (greater than 3) is mainly due to the significant height of asperities that constitute initiation sites for stress and strain failure on the surface. The predominant degradation mechanism was abrasive wear for samples with high surface roughness, tested under dry wear conditions. In the tribo-corrosion process, a synergy between the abrasive wear and corrosion was found to contribute to the overall material loss.
Atomic layer etching of titanium nitride with surface modification by Cl radicals and rapid thermal annealing
Authors: Miyoshi Nobuya , McDowell Nicholas , Kobayashi Hiroyuki
Published: April 2022

Thermal atomic layer etching (ALE) is a promising method for isotropic etching with atomic level precision and high conformality over three-dimensional structures. In this study, a thermal ALE process for titanium nitride (TiN) films was developed using surface modification with a Cl2/Ar downstream plasma followed by infrared (IR) annealing of the films. The oxygen-free Cl2-based plasma was adopted to enable highly selective etching of TiN with regard to various materials. It was confirmed that spontaneous etching of TiN during radical exposure can be suppressed at a surface temperature of −10 °C. Measurements of etch per cycle (EPC) of TiN demonstrated that the EPC is self-limiting with respect to both the radical exposure and IR annealing times. With repeated steps of self-limiting radical exposure and IR annealing, TiN was etched at 2.0 nm/cycle, while no thickness change was observed for poly-Si, SiO2, Si3N4, W, and HfO2. The selectivity to amorphous carbon was higher than 4. X-ray photoelectron spectroscopy analysis revealed that during surface modification, NClx species sublimate spontaneously, while TiClx species remain in the surface-modified layer on TiN. This TiClx-based modified layer desorbs in the IR annealing step, and the TiN surface then returns to its original condition (pristine TiN) before surface modification.
Acoustics for architects: A potpourri of undergraduate and graduate level teaching styles, tools and in-course projects
Authors: Sü Gül Zühre , Çalışkan Mehmet
Published: April 2022

Acoustics is one of the basic environmental comfort factors both in indoor and outdoor spaces. Students of architecture need to confront this theoretical field at some phase of their education. The main focus of this study is to provide a discussion platform of tools and teaching styles in architectural acoustics education of future architects, by depicting approaches that can motivate students and provide them a long-lasting understanding of the phenomena. Accordingly, a long-term experience in acoustics classes with undergraduate and graduate level students, mainly from departments of architecture of two prominent Turkish universities, is exemplified. Course contents of architectural acoustics programs are described, different models and methods of teaching are discussed, and last, selected projects, specifically those having an academic output, are presented. The study also aims to highlight some techniques and approaches that can be employed in acoustics education with limited technological tools, simply by active inclusion of the design background and creative thinking of the architecture students in this applied research area.
Brain aging by gut AGE
Authors: Ferrarelli Leslie K.
Published: April 2022

An advanced glycation end product (AGE) links the gut microbiome, a “leaky gut,” and microglial aging.
bla
KPC-2
-Encoding IncP-6 Plasmids in Citrobacter freundii and Klebsiella variicola Strains from Hospital Sewage in Japan
Authors: Ota Yusuke , Prah Isaac , Nukui Yoko , Koike Ryuji , Saito Ryoichi
Published: April 2022

Antimicrobial resistance is a significant problem for global health, and the hospital environment has been recognized as a reservoir of antimicrobial resistance. Here, we provide insight into the genomic features of
bla
KPC-2
-harboring isolates of
Citrobacter freundii
and
Klebsiella variicola
obtained from hospital sewage in Japan.
Detection of SARS-CoV-2 Variants Mu, Beta, Gamma, Lambda, Delta, Alpha, and Omicron in Wastewater Settled Solids Using Mutation-Specific Assays Is Associated with Regional Detection of Variants in Clinical Samples
Authors: Wolfe Marlene , Hughes Bridgette , Duong Dorothea , Chan-Herur Vikram , Wigginton Krista R. , White Bradley J. , Boehm Alexandria B.
Published: April 2022

Wastewater represents a pooled biological sample of the contributing community and thus a resource for assessing community health. Here, we show that emergence, spread, and disappearance of SARS-CoV-2 infections caused by variants of concern are reflected in the presence of variant genomic RNA in wastewater settled solids. This work highlights an important public health use case for wastewater.
Role of Lipoteichoic Acid from the Genus
Apilactobacillus
in Inducing a Strong IgA Response
Authors: Matsuzaki Chiaki , Shiraishi Tsukasa , Chiou Tai-Ying , Nakashima Yukari , Higashimura Yasuki , Yokota Shin-ichi , Yamamoto Kenji , Takahashi Tomoya
Published: April 2022

The components of lactic acid bacteria that exert immunostimulatory effects are of increasing interest for therapeutic and prophylactic options, such as alternatives to antibiotics, cognitive enhancements, and vaccine adjuvants. LTAs act as immunostimulatory molecules in the host innate immune system by interacting with pattern recognition receptors.
ADAR-Editing during Ostreid Herpesvirus 1 Infection in
Crassostrea gigas
: Facts and Limitations
Authors: Rosani Umberto , Bortoletto Enrico , Montagnani Caroline , Venier Paola
Published: April 2022

Ostreid herpesvirus-1 (OsHV-1) is a harmful pathogen of bivalve species, such as oysters. However, knowledge is lacking about host–virus interactions at the molecular level, hampering the possibility of a correct management of viral outbreaks and related massive mortalities.
Effects of resistance exercise on blood glucose level and pregnancy outcome in patients with gestational diabetes mellitus: a randomized controlled trial
Authors: Xie Yaping , Zhao Huifen , Zhao Meijing , Huang Huibin , Liu Chunhong , Huang Fengfeng , Wu Jingjing
Published: April 2022

Introduction

To date, the effects of resistance exercise on diabetes-related parameters (blood glucose level and insulin use) and pregnancy outcome in participants with gestational diabetes mellitus (GDM) have not been compared with those of aerobic exercise. To investigate the effect of resistance exercise versus aerobic exercise on blood glucose level, insulin utilization rate, and pregnancy outcome in patients with GDM.

Research design and methods

From December 2019 to December 2020, 100 pregnant women with GDM were selected and divided into a resistance exercise group (49 patients) and an aerobic exercise group (51 patients) randomly. The aerobic exercise group received an aerobic exercise intervention, while the resistance exercise group received a resistance exercise intervention. Both groups received exercise intervention for 50–60 min, 3 times per week, lasting for 6 weeks. In addition, patients in both groups received the same routine care, including personalized dietary intervention, online education, and school courses for pregnant women.

Results

The blood glucose level in the resistance exercise group and the aerobic exercise group was lower after the intervention than before the intervention (p<0.05). After the intervention, no significant differences were observed in the fasting blood glucose level, insulin utilization rate, and incidence of adverse pregnancy outcomes between the two groups (p>0.05); however, significant differences were noted in 2-hour postprandial blood glucose level and exercise compliance between the two groups (p<0.05), with the resistance exercise group showing better outcomes than the aerobic exercise group.

Conclusions

Resistance exercise is more compliant for pregnant women with GDM than aerobic exercise; hence, it is necessary to popularize resistance exercise in this specific population group. Long-term effects of resistance exercise should be evaluated in future studies.

Trial registration number

ChiCTR 1900027929.
Exploring vibroacoustic therapy in adults experiencing pain: a scoping review
Authors: Kantor Jiří , Campbell Elsa A , Kantorová Lucia , Marečková Jana , Regec Vojtěch , Karasová Kristýna , Sedláčková Dagmar , Klugar Miloslav
Published: April 2022

Objective

To explore the characteristics and outcomes of vibroacoustic therapy (VAT) in adults experiencing pain. To give directions for future research and clinical applications of VAT in pain management for adults.

Design

Scoping review.

Data sources

BMČ, CINAHL Plus, Cochrane Library, EBSCOhost, EBM Reviews, EMBASE, Epistemonikos, ERIC, MEDLINE complete, Scopus, Web of Science, Google Scholar, ProQuest, hand search in unpublished sources.

Study selection

All quantitative and qualitative research studies and systematic reviews, without any date or language limit.

Data extraction

Two independent reviewers extracted data on the study design, location and setting, the causes of pain, participants, vibroacoustic intervention, measurement tools, and key findings related to pain.

Results

From 430 records, 20 were included for narrative synthesis. Fifteen studies researched chronic pain, two studies acute pain, two studies both types of pain and one study experimentally induced pain. The description of VAT applied in studies usually included the description of research experiments, vibroacoustic devices and frequencies of sinusoidal sound. There was high heterogeneity in study protocols, however, 40 Hz was predominantly used, most sessions ranged between 20 and 45 min, and the frequency of treatment was higher for acute pain (daily) compared with chronic pain (daily to once a week). Outcomes related to pain focused mainly on perceived pain; however, other surrogate measures were also considered, for example, an increased number of treatment days or pain medication usage.

Conclusions

Research in this area is too sparse to identify properties of VAT that are beneficial for pain management. We suggest VAT researchers describe a minimum of four measurements—frequency, amplitude, pulsation and loudness. Randomised controlled trials are needed to establish reliable scientific proof of VAT effectiveness for both acute and chronic pain. Furthermore, clinical practice would benefit from researching patients’ experiences and preferences of vibroacoustic treatment and its psychosocial components.
Maximising access to timely trauma care across population of Karachi and its districts: a geospatial approach to develop a trauma care network
Authors: Ashraf Muhammad Nabeel , Khalil Mohammad Salman , Akhtar Ahwaz , Samad Lubna , Latif Asad
Published: April 2022

Objectives

To develop and propose a cost-effective trauma care network for Karachi, Pakistan, by calculating maximum timely trauma care (TTC) coverage achieved with the addition of potential designated private and public level 1 and level 2 trauma centres (TCs).

Setting

A lower middle-income country metropolis, Karachi is Pakistan’s largest city with a population of 16 million and a total of 56 hospitals as per government registry data.

Participants

41 potential TCs selected using a two-level, contextually-relevant TC designation criteria adapted from various international guidelines.

Primary and secondary outcome measures

Maximum TTC coverage achievable with the addition of potential TCs. Proposed trauma care network composition to achieve maximum TTC coverage.

Results

Coverage with five public level 1 hospitals alone is 74.4%. Marginal benefit with stepwise addition of five potential private level 1 TCs, four public level 2 TCs and two private level 2 TCs is 12.2%, 7.1% and 3.1%, respectively. Maximum possible TTC coverage is 96.7%. Poorest coverage with the proposed 16 hospital network is noted in Malir district while 100% coverage is achieved in the centrally located South, Central and East districts.

Conclusion

Addition of private level 1 and private and public level 2 hospitals to the trauma care network is necessary. Implementation of the proposed trauma care network requires strong stewardship from the government and coordinated effort of multiple stakeholders is needed to ensure standard TC designation. The study exhibits an effective method to scientifically plan and develop a cost-effective trauma system which can be applied in other resource-limited geographical areas.
Potentially avoidable causes of hospitalisation in people with dementia: contemporaneous associations by stage of dementia in a South London clinical cohort
Authors: Gungabissoon Usha , Perera Gayan , Galwey Nicholas W , Stewart Robert
Published: April 2022

Objectives

To estimate the frequency of all-cause and ambulatory care sensitive condition (ACSCs)-related hospitalisations among individuals with dementia. In addition, to investigate differences by stage of dementia based on recorded cognitive function.

Setting

Data from a large London dementia care clinical case register, linked to a national hospitalisation database.

Participants

Individuals aged ≥65 years with a confirmed dementia diagnosis with recorded cognitive function.

Outcome measures

Acute general hospital admissions were evaluated within 6 months of a randomly selected cognitive function score in patients with a clinical diagnosis of dementia. To evaluate associations between ACSC-related hospital admissions (overall and individual ACSCs) and stage of dementia, an ordinal regression was performed, modelling stage of dementia as the dependant variable (to facilitate efficient model selection, with no implication concerning the direction of causality).

Results

Of the 5294 people with dementia, 2993 (56.5%) had at least one hospitalisation during a 12-month period of evaluation, and 1192 (22.5%) had an ACSC-related admission. Proportions with an all-cause or ACSC-related hospitalisation were greater in the groups with more advanced dementia (all-cause 53.9%, 57.1% and 60.9%, p 0.002; ACSC-related 19.5%, 24.0% and 25.3%, p<0.0001 in the mild, moderate and severe groups, respectively). An ACSC-related admission was associated with 1.3-fold (95% CI 1.1 to 1.5) increased odds of more severe dementia after adjusting for demographic factors. Concerning admissions for individual ACSCs, the most common ACSC was urinary tract infection /pyelonephritis (9.8% of hospitalised patients) followed by pneumonia (7.1%); in an adjusted model, these were each associated with 1.4-fold increased odds of more severe dementia (95% CI 1.2 to 1.7 and 1.1 to 1.7, respectively).

Conclusions

Potentially avoidable hospitalisations were common in people with dementia, particularly in those with greater cognitive impairment. Our results call for greater attention to the extent of cognitive status impairment, and not just dementia diagnosis, when evaluating measures to reduce the risk of potentially avoidable hospitalisations.
Mobile telephone follow-up assessment of postdischarge death and disability due to trauma in Cameroon: a prospective cohort study
Authors: Ding Kevin , Sur Patrick J , Mbianyor Mbiarikai Agbor , Carvalho Melissa , Oke Rasheedat , Dissak-Delon Fanny Nadia , Signe-Tanjong Magdalene , Mfopait Florentine Y , Essomba Frank , Mbuh Golda E , Etoundi Mballa Georges Alain , Christie S Ariane , Juillard Catherine , Chichom Mefire Alain
Published: April 2022

Objectives

In Cameroon, long-term outcomes after discharge from trauma are largely unknown, limiting our ability to identify opportunities to reduce the burden of injury. In this study, we evaluated injury-related death and disability in Cameroonian trauma patients over a 6-month period after hospital discharge.

Design

Prospective cohort study.

Setting

Four hospitals in the Littoral and Southwest regions of Cameroon.

Participants

A total of 1914 patients entered the study, 1304 were successfully contacted. Inclusion criteria were patients discharged after being treated for traumatic injury at each of four participating hospitals during a 20-month period. Those who did not possess a cellular phone or were unable to provide a phone number were excluded.

Primary and secondary outcome measures

The Glasgow Outcome Scale—Extended (GOSE) was administered to trauma patients at 2 weeks, 1 month, 3 months and 6 months post discharge. Median GOSE scores for each timepoint were compared and regression analyses were performed to determine associations with death and disability.

Results

Of 71 deaths recorded, 90% occurred by 2 weeks post discharge. At 6 months, 22% of patients still experienced severe disability. Median (IQR) GOSE scores at the four timepoints were 4 (3–7), 5 (4–8), 7 (4–8) and 7 (5–8), respectively, (p<0.01). Older age was associated with greater odds of postdischarge disability (OR: 1.23, 95% CI: 1.07 to 1.41) and mortality (OR: 2.15, 95% CI: 1.52 to 3.04), while higher education was associated with decreased odds of disability (OR: 0.65, 95% CI: 0.58 to 0.73) and mortality (OR: 0.38, 95% CI: 0.31 to 0.47). Open fractures (OR: 1.73, 95% CI: 1.38 to 2.18) and closed fractures (OR: 1.83, 95% CI: 1.42 to 2.36) were associated with greater postdischarge disability, while higher Injury Severity Score (OR: 2.44, 95% CI: 2.13 to 2.79) and neurological injuries (OR: 4.40, 95% CI: 3.25 to 5.96) were associated with greater odds of postdischarge mortality.

Conclusion

Mobile follow-up data show significant morbidity and mortality, particularly for orthopaedic and neurologic injuries, up to 6 months following trauma discharge. These results highlight the need for reliable follow-up systems in Cameroon.
What medical students think about measurement of their well-being: cross-sectional survey and qualitative interviews
Authors: Simons Gemma , Effah Raymond , Baldwin David S
Published: April 2022

Objectives

To find out how medical students think well-being should be measured.

Design

A mixed-methods study comprising a cross-sectional online survey (November 2020–March 2021) and semi-structured online interviews. Views on the frequency of availability for measurement, the format, type and purpose of measurement, and with whom well-being should be discussed were measured. When an outcome was scored 7–9 on a 9-point Likert scale of agreement by ≥75% of participants it was considered critical. Inductive thematic analysis was undertaken on the interview transcripts.

Setting

All medicine programmes at University of Southampton.

Participants

Medical students from all years took part in the survey (n=118) and interviews (n=16).

Results

Most participants (94%) felt able to give 5 min to measure their well-being at least once per month. Research, governance and individual feedback were all considered critically important. Only subjective assessments undertaken by the individual in real-time were rated critically important (78.1%) measurement tools. Students selected that they would discuss their well-being with other medical students (n=87) nearly as often as they selected a member of the faculty (n=104). Five interview themes further explained these findings: (1) well-being is mental well-being; (2) exercise and support from friends and family are most important; (3) isolation and the design of the medicine programme are detrimental to well-being; (4) there are advantages to surveys, and conversations; (5) personal academic tutors and medical students in later years are the best to discuss well-being with.

Conclusions

Medical students thought that measurement of their well-being was critically important for governance showing their support for quality assurance of well-being and peer support. They wanted to be able to choose surveys, or conversations, to measure their well-being, as well as the person they discussed well-being with. Four recommendations are discussed in light of these findings.
Prognostic decision-making about imminent death within multidisciplinary teams: a scoping review
Authors: Bruun Andrea , Oostendorp Linda , Bloch Steven , White Nicola , Mitchinson Lucy , Sisk Ali-Rose , Stone Patrick
Published: April 2022

Objective

To summarise evidence on how multidisciplinary team (MDTs) make decisions about identification of imminently dying patients.

Design

Scoping review.

Setting

Any clinical setting providing care for imminently dying patients, excluding studies conducted solely in acute care settings.

Data sources

The databases AMED, CINAHL, Embase, MEDLINE, PsychINFO and Web of Science were searched from inception to May 2021.

Included studies presented original study data written in English and reported on the process or content of MDT discussions about identifying imminently dying adult patients.

Results

40 studies were included in the review. Studies were primarily conducted using interviews and qualitative analysis of themes.

MDT members involved in decision-making were usually doctors and nurses. Some decisions focused on professionals recognising that patients were dying, other decisions focused on initiating specific end-of-life care pathways or clarifying care goals. Most decisions provided evidence for a partial collaborative approach, with information-sharing being more common than joint decision-making. Issues with decision-making included disagreement between staff members and the fact that doctors were often regarded as final or sole decision-makers.

Conclusions

Prognostic decision-making was often not the main focus of included studies. Based on review findings, research explicitly focusing on MDT prognostication by analysing team discussions is needed. The role of allied and other types of healthcare professionals in prognostication needs further investigation as well. A focus on specialist palliative care settings is also necessary.
Active surveillance of chemotherapy-related symptom burden in ambulatory cancer patients via the implementation of electronic patient-reported outcomes and sensor-enabled vital signs capture: protocol for a decentralised feasibility pilot study
Authors: Offodile Anaeze C , DiBrito Sandra R , Finder Janice P , Shete Sanjay , Jain Sanchita , Delgado Domenica A , Miller Christopher J , Davidson Elenita , Overman Michael J , Peterson Susan K
Published: April 2022

Introduction

Remote patient monitoring (RPM) has emerged as a potential avenue for optimising the management of symptoms in patients undergoing chemotherapy. However, RPM is a complex, multilevel intervention with technology, workflow, contextual and patient experience components. The purpose of this pilot study is to determine the feasibility of RPM protocol implementation with respect to decentralised recruitment, patient retention, adherence to reporting recommendations, RPM platform usability and patient experience in ambulatory cancer patients at high risk for chemotherapy-related symptoms.

Methods and analysis

This protocol describes a single-arm decentralised feasibility pilot study of technology-enhanced outpatient symptom management system in patients with gastrointestinal and thoracic cancer receiving chemotherapy and cancer care at a single site (MD Anderson Cancer Center, Houston Texas). An anticipated total of 25 patients will be recruited prior to the initiation of chemotherapy and provided with a set of validated questionnaires at enrollment and after our 1-month feasibility pilot trial period. Our intervention entails the self-reporting of symptoms and vital signs via a HIPAA-compliant, secure tablet interface that also enables (1) the provision of self-care materials to patients, (2) generation of threshold alerts to a dedicated call-centre and (3) videoconferencing. Vital sign information (heart rate, blood pressure, pulse, oxygen saturation, weight and temperature) will be captured via Bluetooth-enabled biometric monitoring devices which are integrated with the tablet interface. Protocolised triage and management of symptoms will occur in response to the alerts. Feasibility and acceptability metrics will characterise our recruitment process, protocol adherence, patient retention and usability of the RPM platform. We will also document the perceived effectiveness of our intervention by patients.

Ethics and dissemination

This study has been granted approval by the institutional review board of MD Anderson Cancer Center. We anticipate dissemination of our pilot and subsequent effectiveness trial results via presentations at national conferences and peer-reviewed publications in the relevant medical journals. Our results will also be made available to cancer survivors, their caregivers and hospital administration.

Trial registration number

NCI202107464.
SARS-CoV-2 seroprevalence among Vancouver public school staff in British Columbia, Canada: a cross-sectional study
Authors: Goldfarb David M , Mâsse Louise C , Watts Allison W , Hutchison Sarah M , Muttucomaroe Lauren , Bosman Else S , Barakauskas Vilte E , Choi Alexandra , Dhillon Nalin , Irvine Michael A , Reicherz Frederic , O’Reilly Collette , Sediqi Sadaf , Xu Rui Yang , Razzaghian Hamid R , Sadarangani Manish , Coombs Daniel , O’Brien Sheila F , Lavoie Pascal M
Published: April 2022

Objectives

Few studies reported COVID-19 cases in schools during the 2020/21 academic year in a setting of uninterrupted in-person schooling. The main objective was to determine the SARS-CoV-2 seroprevalence among school staff in Vancouver public schools.

Design

Cumulative incident COVID-19 cases among all students and school staff based on public health data, with an embedded cross-sectional serosurvey among a school staff sample that was compared to period, age, sex and geographical location-weighted data from blood donors.

Setting

Vancouver School District (British Columbia, Canada) from kindergarten to grade 12.

Participants

Active school staff enrolled from 3 February to 23 April 2021 with serology testing from 10 February to 15 May 2021.

Main outcome measures

SARS-CoV-2 seroprevalence among school staff, based on spike (S)-based (unvaccinated staff) or N-based serology testing (vaccinated staff).

Results

Public health data showed the cumulative incidence of COVID-19 among students attending in-person was 9.8 per 1000 students (n=47 280), and 13 per 1000 among school staff (n=7071). In a representative sample of 1689 school staff, 78.2% had classroom responsibilities, and spent a median of 17.6 hours in class per week (IQR: 5.0–25 hours). Although 21.5% (363/1686) of surveyed staff self-reported close contact with a COVID-19 case outside of their household (16.5% contacts were school-based), 5 cases likely acquired the infection at school based on viral testing. Sensitivity/Specificity-adjusted seroprevalence in 1556/1689 staff (92.1%) was 2.3% (95% CI: 1.6% to 3.2%), comparable to a sex, age, date and residency area-weighted seroprevalence of 2.6% (95% CI: 2.2% to 3.1%) among 5417 blood donors.

Conclusion

Seroprevalence among staff was comparable to a reference group of blood donors from the same community. These data show that in-person schooling could be safely maintained during the 2020/21 school year with mitigation measures, in a large school district in Vancouver, Canada.
Transmission of SARS-CoV-2 in educational settings in 2020: a review
Authors: Vardavas Constantine , Nikitara Katerina , Mathioudakis Alexander G , Hilton Boon Michele , Phalkey Revati , Leonardi-Bee Jo , Pharris Anastasia , Deogan Charlotte , Suk Jonathan E
Published: April 2022

Objectives

School closures have been used as a core non-pharmaceutical intervention (NPI) during the COVID-19 pandemic. This review aims at identifying SARS-CoV-2 transmission in educational settings during the first waves of the pandemic.

Methods

This literature review assessed studies published between December 2019 and 1 April 2021 in Medline and Embase, which included studies that assessed educational settings from approximately January 2020 to January 2021. The inclusion criteria were based on the PCC framework (P-Population, C-Concept, C-Context). The studyPopulationwas restricted to people 1–17 years old (excluding neonatal transmission), theConceptwas to assess child-to-child and child-to-adult transmission, while theContextwas to assess specifically educational setting transmission.

Results

Fifteen studies met inclusion criteria, ranging from daycare centres to high schools and summer camps, while eight studies assessed the re-opening of schools in the 2020–2021 school year. In principle, although there is sufficient evidence that children can both be infected by and transmit SARS-CoV-2 in school settings, the SAR remain relatively low—when NPI measures are implemented in parallel. Moreover, although the evidence was limited, there was an indication that younger children may have a lower SAR than adolescents.

Conclusions

Transmission in educational settings in 2020 was minimal—when NPI measures were implemented in parallel. However, with an upsurge of cases related to variants of concern, continuous surveillance and assessment of the evidence is warranted to ensure the maximum protection of the health of students and the educational workforce, while also minimising the numerous negative impacts that school closures may have on children.
Experiences of children with disabilities during the COVID-19 pandemic in Sweden: a qualitative interview study
Authors: Fäldt Anna Erica , Klint Filippa , Warner Georgina , Sarkadi Anna
Published: April 2022

Background

The impact of the COVID-19 pandemic on people with disabilities has been described as a ‘triple jeopardy’. Not only have they experienced the negative social impacts of disease control measures, but access to required health services has been affected, and, not least, they are at increased risk of severe outcomes from COVID-19. This study aimed to determine how children with disabilities have experienced the pandemic in Sweden and its impact on their lives.

Methods

Six children (5–13 years) were interviewed via video conferencing. An interview guide was adapted based on the children’s communicative abilities and included augmentative and alternative communication support. Reflective field notes were included in the analysis. The data were analysed using qualitative content analysis.

Results

Two themes were identified: The child’s knowledge of Corona raises anxiety and fear; and Boring Corona makes the child even lonelier. The children had knowledge about and were worried about COVID-19, primarily about illness and death of their grandparents. The children longed for their grandparents and other social contacts at school, and life was described as boring and lonely. Many families lacked adequate tools to communicate with their children about the pandemic.

Conclusion

Given adequate support, children with disabilities and communication difficulties can give insights to their unique life situations. The interviewed children reported significant impact on their life and school life. Children were worried about their grandparents based on their knowledge about the virus. The enthusiasm with which the children engaged in the interviews is testament to the need and right of all children, regardless of communicative competence, to voice their experiences
Cocreating injury prevention training for youth team handball: bridging theory and practice
Authors: Ageberg Eva , Brodin Eva M , Linnéll Jennie , Moesch Karin , Donaldson Alex , Adébo Emme , Benjaminse Anne , Ekengren Johan , Granér Simon , Johnson Urban , Lucander Karolina , Myklebust Grethe , Møller Merete , Tranaeus Ulrika , Bunke Sofia
Published: April 2022

Although it is advocated that end-users are engaged in developing evidence-based injury prevention training to enhance the implementation, this rarely happens. The ‘Implementing injury Prevention training ROutines in TEams and Clubs in youth Team handball (I-PROTECT)’ uses an ecological participatory design incorporating the perspectives of multiple stakeholders throughout the project. Within the I-PROTECT project, the current study aimed to describe the development of holistic injury prevention training specifically for youth handball players through using knowledge from both end-users (coaches and players) and researchers/handball experts. Employing action evaluation within participatory action research, the cyclical development process included three phases: research team preparation, handball expert-based preparation and end-user evaluation to develop injury prevention training incorporating both physical and psychological perspectives. To grow the knowledge of the interdisciplinary research team, rethinking was conducted within and between phases based on participants’ contributions. Researchers and end-users cocreated examples of handball-specific exercises, including injury prevention physical principles (movement technique for upper and lower extremities, respectively, and muscle strength) combined with psychological aspects (increase end-user motivation, task focus and body awareness) to integrate into warm-up and skills training within handball practice. A cyclical development process that engaged researchers/handball experts and end-users to cocreate evidence-based, theory-informed and context-specific injury prevention training specifically for youth handball players generated a first pilot version of exercises including physical principles combined with psychological aspects to be integrated within handball practice.
Characterization of the treatment-naive immune microenvironment in melanoma with BRAF mutation
Authors: Wang Minyu , Zadeh Soroor , Pizzolla Angela , Thia Kevin , Gyorki David E , McArthur Grant A , Scolyer Richard A , Long Georgina , Wilmott James S , Andrews Miles C , Au-Yeung George , Weppler Ali , Sandhu Shahneen , Trapani Joseph A , Davis Melissa J , Neeson Paul Joseph
Published: April 2022

Background

Patients with BRAF-mutant and wild-type melanoma have different response rates to immune checkpoint blockade therapy. However, the reasons for this remain unknown. To address this issue, we investigated the precise immune composition resulting from BRAF mutation in treatment-naive melanoma to determine whether this may be a driver for different response to immunotherapy.

Methods

In this study, we characterized the treatment-naive immune context in patients with BRAF-mutant and BRAF wild-type (BRAF-wt) melanoma using data from single-cell RNA sequencing, bulk RNA sequencing, flow cytometry and immunohistochemistry (IHC).

Results

In single-cell data, BRAF-mutant melanoma displayed a significantly reduced infiltration of CD8+ T cells and macrophages but also increased B cells, natural killer (NK) cells and NKT cells. We then validated this finding using bulk RNA-seq data from the skin cutaneous melanoma cohort in The Cancer Genome Atlas and deconvoluted the data using seven different algorithms. Interestingly, BRAF-mutant tumors had more CD4+ T cells than BRAF-wt samples in both primary and metastatic cohorts. In the metastatic cohort, BRAF-mutant melanoma demonstrated more B cells but less CD8+ T cell infiltration when compared with BRAF-wt samples. In addition, we further investigated the immune cell infiltrate using flow cytometry and multiplex IHC techniques. We confirmed that BRAF-mutant melanoma metastases were enriched for CD4+ T cells and B cells and had a co-existing decrease in CD8+ T cells. Furthermore, we then identified B cells were associated with a trend for improved survival (p=0.078) in the BRAF-mutant samples and Th2 cells were associated with prolonged survival in the BRAF-wt samples.

Conclusions

In conclusion, treatment-naive BRAF-mutant melanoma has a distinct immune context compared with BRAF-wt melanoma, with significantly decreased CD8+ T cells and increased B cells and CD4+ T cells in the tumor microenvironment. These findings indicate that further mechanistic studies are warranted to reveal how this difference in immune context leads to improved outcome to combination immune checkpoint blockade in BRAF-mutant melanoma.
Assessment of hyperprogression versus the natural course of disease development with nivolumab with or without ipilimumab versus placebo in phase III, randomized, controlled trials
Authors: Kang Yoon-Koo , Reck Martin , Nghiem Paul , Feng Yan , Plautz Gregory , Kim Hye Ryun , Owonikoko Taofeek K , Boku Narikazu , Chen Li-Tzong , Lei Ming , Chang Han , Lin Wen Hong , Roy Amit , Bello Akintunde , Sheng Jennifer
Published: April 2022

Background

Retrospective studies have suggested a potential risk of hyperprogressive disease (HPD) in patients receiving immune checkpoint inhibitors (ICIs). We compared the incidence of HPD during treatment with nivolumab±ipilimumab versus natural tumor progression with placebo in post hoc analyses of two randomized, double-blind clinical trials.

Methods

ATTRACTION-2 randomized patients with advanced gastric or gastroesophageal junction cancer (GC/GEJC) and progression on ≥2 prior regimens to nivolumab 3 mg/kg Q2W or placebo. CheckMate 451 randomized patients with extensive-disease small cell lung cancer (ED SCLC) and ongoing complete/partial response or stable disease after first-line chemotherapy to nivolumab 240 mg Q2W, nivolumab 1 mg/kg+ipilimumab 3 mg/kg Q3W for four doses then nivolumab 240 mg Q2W, or placebo. Patients receiving ≥1 dose of study drug and with tumor scans at baseline and the first on-treatment evaluation were included in the HPD analyses. HPD definitions were ≥20%, ≥50%, and ≥100% increase in target lesion sum of the longest diameters (SLD) at the first on-treatment assessment.

Results

In the ATTRACTION-2 HPD-evaluable population, 243 patients received nivolumab and 115 placebo. Fewer patients receiving nivolumab versus placebo had increases in SLD ≥20% (33.7% vs 46.1%) and ≥50% (6.2% vs 11.3%); similar proportions had increases in SLD ≥100% (1.6% vs 1.7%). In the CheckMate 451 HPD-evaluable population, 177 patients received nivolumab, 179 nivolumab+ipilimumab, and 175 placebo. Fewer patients receiving nivolumab or nivolumab+ipilimumab versus placebo had increases in SLD ≥20% (27.1%, 27.4% vs 45.7%), ≥50% (10.2%, 11.2% vs 22.3%), and ≥100% (2.8%, 2.8% vs 6.3%).

Conclusions

Nivolumab±ipilimumab was not associated with an increased rate of progression versus placebo in patients with GC, GEJC, or ED SCLC, suggesting that previous reports of HPD may reflect the natural disease course in some patients rather than ICI-mediated progression.

Trial registration number

NCT02538666;NCT02267343.