bluuebunny/crossref_metadata_2025 huggingface dataset:
The Dutch Individualised Care Scale for patients and nurses – a psychometric validation study
Authors: Theys Sofie , Van Hecke Ann , Akkermans Reinier , Heinen Maud
Published: April 2020

Aims and objectives

Translating and psychometrically assessing the Individualised Care Scale (ICS) for patients and nurses for the Flemish and Dutch healthcare context.

Background

Individualised care interventions have positive effects on health outcomes. However, there are no valid and reliable instruments for evaluating individualised care for the Flemish and Dutch healthcare context.

Design

Psychometric validation study.

Setting and participants

In Flemish hospitals, data were collected between February and June 2016, and in Dutch hospitals, data were collected between December 2014 and May 2015. Nurses with direct patient contact and a working experience of minimum 6 months on the wards could participate. Patient inclusion criteria were being an adult, being mentally competent, having an expected hospital stay of minimum 1 day, and being able to speak and read the Dutch language. In total, 845 patients and 569 nurses were included.

Methods

The ICS was translated into Dutch using a forward–backward translation process. Minimal linguistic adaptations to the Dutch ICS were made to use the scale as a Flemish equivalent. Omega, Cronbach’s Alpha, mean inter‐item correlations and standardised subscale correlations established the reliability and confirmatory factor analysis the construct validity of the ICS.

Results

Internal consistency using Omega (Cronbach’s Alpha) ranged from 0.83 to 0.96 (0.82–0.95) for the ICS‐Nurse and from 0.88 to 0.96 (0.87–0.96) for the ICS‐Patient. Fit indices of the confirmatory factor analysis indicated a good model fit, except for the root mean square error of approximation, which indicated only moderate model fit.

Conclusion

The Dutch version of the ICS showed acceptable psychometric performance, supporting its use for the Dutch and Flemish healthcare context.

Relevance to clinical practice

Knowledge of nurses’ and patients’ perceptions on individualised care will aid to target areas in the Dutch and Flemish healthcare context in which work needs to be undertaken to provide individualised nursing care.
Injuries and illnesses in Swedish Paralympic athletes—A 52‐week prospective study of incidence and risk factors
Authors: Fagher Kristina , Dahlström Örjan , Jacobsson Jenny , Timpka Toomas , Lexell Jan
Published: April 2020

Introduction

Sports‐related injuries and illnesses in Paralympic sport (SRIIPS) are a concern, but knowledge about the etiology and risk factors is limited. The aim of this study was to describe the annual incidence, type, and severity of injuries and illnesses among Swedish Paralympic athletes and to assess risk factors.

Methods

Swedish Paralympic athletes (n = 107) self‐reported SRIIPS every week during 52 weeks using an eHealth application. Incidence proportions (IP) and incidence rates (IR) were used as measures of disease burden. Time‐to‐event methods (Kaplan‐Meier and Cox regression) were used to identify risk factors.

Results

The annual IP for injury was 68% and for illness 77%. The injury IR was 6.9/1000 hours and the illness IR 9.3/1000 hours. The median time to injury was 19 weeks (95% CI: 10.5‐27.4) and to illness 9 weeks (95% CI: 1.4‐16.6). Most injuries occurred during training, and 34% were classified as severe (≥21 days of time loss). An increased injury risk was observed among athletes in team sports (HR 1.88; 95% CI: 1.19‐2.99), athletes with a previous severe injury (HR 2.37; 95% CI: 1.47‐3.83), and male athletes (HR 1.76; 95% CI: 1.06‐2.93). The most common illness type was infection (84%). Athletes in team sports (HR 1.64; 95% CI: 1.05‐2.54) and males with a previous illness (HR = 2.13; 95% CI: 1.04‐4.36) had a higher illness risk.

Conclusion

Paralympic athletes report a high incidence of injuries and illnesses over time. This emphasizes the need to develop preventive strategies of SRIIPS and optimize medical services for this heterogeneous athlete population.
Optimizing bidirectional impulse turbines for thermoacoustic engines
Authors: Timmer Michael A. G. , van der Meer Theo H.
Published: April 2020

The design of a bidirectional impulse turbine to convert thermoacoustic power into electricity is experimentally optimized. The turbine efficiency is measured for rotors with and without a shroud ring and for a varying tip clearance. Furthermore, the axial spacing between the guide vanes and rotor is varied with respect to the displacement amplitude of the acoustic wave. All measurements are carried out for several turbine loads and acoustic frequencies. For a chosen implementation, a design study on the guide vane and rotor blade geometry is presented to further optimize the bidirectional impulse turbine for thermoacoustic engines.
Effect of lowest harmonic rank on fundamental-frequency difference limens varies with fundamental frequency
Authors: Mehta Anahita H. , Oxenham Andrew J.
Published: April 2020

This study investigated the relationship between fundamental frequency difference limens (F0DLs) and the lowest harmonic number present over a wide range of F0s (30–2000 Hz) for 12-component harmonic complex tones that were presented in either sine or random phase. For fundamental frequencies (F0s) between 100 and 400 Hz, a transition from low (∼1%) to high (∼5%) F0DLs occurred as the lowest harmonic number increased from about seven to ten, in line with earlier studies. At lower and higher F0s, the transition between low and high F0DLs occurred at lower harmonic numbers. The worsening performance at low F0s was reasonably well predicted by the expected decrease in spectral resolution below about 500 Hz. At higher F0s, the degradation in performance at lower harmonic numbers could not be predicted by changes in spectral resolution but remained relatively good (<2%–3%) in some conditions, even when all harmonics were above 8 kHz, confirming that F0 can be extracted from harmonics even when temporal envelope or fine-structure cues are weak or absent.
Accelerometer-Measured Physical Activity Levels and Fatigue in Older Women
Authors: Zaslavsky Oleg , Su Yan , Rillamas-Sun Eileen , Roopsawang Inthira , LaCroix Andrea Z.
Published: April 2020

The authors examined whether the associations between physical activity (PA) levels and fatigue vary by body mass index and physical performance, and whether substituting sedentary time (ST) with low light PA, high light PA, and moderate to vigorous PA (MVPA) was associated with better mean fatigue scores. In total, 6,111 participants (aged 65 years and older) were from the Women’s Health Initiative Objective Physical Activity and Cardiovascular Health Study. PA levels were from a hip-worn GT3X accelerometer. Overall fatigue, energy, and weariness subdomains were from the RAND-36 Vitality subscale. Isotemporal substitution models examined the time-substitution effects. Interactions were observed between MVPA and short physical performance battery performance measure (p < .05). Substituting ST with 34.3 min of MVPA was associated on average with a 1.63-point improvement in fatigue score. Substituting ST with 50.2 min of low light PA and 34.3 min of MVPA was associated on average with an energy score improvement of 1.18 and 2.06 points respectively. Substituting ST with 34.3 min of MVPA was associated on average with a 1.08-point improvement in weariness score (p < .05 for all).
Promoting Para Athlete Activism: Critical Insights From Key Stakeholders in Ireland
Authors: Haslett Damian , Monforte Javier , Choi Inhyang , Smith Brett
Published: April 2020

In 2019, the International Paralympic Committee produced a new strategy that highlighted the need to promote disability activism through Para sport. The purpose of this study is to understand what promoting disability activism through Para sport means to key stakeholders within an Irish national-level sociopolitical and Para sport context. Three groups of Irish stakeholders participated in interviews. Data were analyzed using a reflexive thematic analysis. Three themes were generated: social responsibility, identity performance, and Paralympic discourse. Within each theme, different stakeholders drew on different activist discourses to argue for and against promoting activism. This article poses significant challenges to the International Paralympic Committee’s strategy. Challenges are addressed by highlighting nine activist discourses that could have practical implications when promoting activism in different sociopolitical and Para sport contexts.
Super-resolution nanoscopy by coherent control on nanoparticle emission
Authors: Liu Congyue , Liu Wei , Wang Shufeng , Li Hongjia , Lv Zhilong , Zhang Fa , Zhang Donghui , Teng Junlin , Zheng Tao , Li Donghai , Zhang Mingshu , Xu Pingyong , Gong Qihuang
Published: April 2020

A coherent control strategy for super-resolution nanoscopy achieves resolution <50 nm in wide-field imaging.
Self-testing nonprojective quantum measurements in prepare-and-measure experiments
Authors: Tavakoli Armin , Smania Massimiliano , Vértesi Tamás , Brunner Nicolas , Bourennane Mohamed
Published: April 2020

Generalized measurements on quantum systems can be characterized with only small control of laboratory devices.
The deubiquitinase UCHL1 regulates cardiac hypertrophy by stabilizing epidermal growth factor receptor
Authors: Bi Hai-Lian , Zhang Xiao-Li , Zhang Yun-Long , Xie Xin , Xia Yun-Long , Du Jie , Li Hui-Hua
Published: April 2020

UCHL1 positively regulates cardiac hypertrophy via stabilizing EGFR and highlighting it as a yet unknown therapeutic target.
Under oil open-channel microfluidics empowered by exclusive liquid repellency
Authors: Li Chao , Hite Zachary , Warrick Jay W. , Li Jiayi , Geller Stephanie H. , Trantow Victoria G. , McClean Megan N. , Beebe David J.
Published: April 2020

Extreme wettability empowered under oil open-channel microfluidics bridges the gap between open- and closed-channel microfluidics.
Maternal exercise via exerkine apelin enhances brown adipogenesis and prevents metabolic dysfunction in offspring mice
Authors: Son Jun Seok , Zhao Liang , Chen Yanting , Chen Ke , Chae Song Ah , de Avila Jeanene M. , Wang Hongyang , Zhu Mei-Jun , Jiang Zhihua , Du Min
Published: April 2020

Maternal exercise epigenetically programs brown/beige adipose tissue development and thermogenesis in offspring mice.
Hawkmoth lamina monopolar cells act as dynamic spatial filters to optimize vision at different light levels
Authors: Stöckl Anna Lisa , O’Carroll David Charles , Warrant Eric James
Published: April 2020

Hawkmoth lamina monopolar cells act as dynamic spatial filters to optimize vision at different light levels.
Molecular engineering of metal coordination interactions for strong, tough, and fast-recovery hydrogels
Authors: Sun Wenxu , Xue Bin , Fan Qiyang , Tao Runhan , Wang Chunxi , Wang Xin , Li Yiran , Qin Meng , Wang Wei , Chen Bin , Cao Yi
Published: April 2020

A strong, tough, and fast-recovery hydrogel is engineered by cooperative interactions between histidine-rich peptides and Zn
2+
.
Rapid Reconstitution of the Fecal Microbiome after Extended Diet-Induced Changes Indicates a Stable Gut Microbiome in Healthy Adult Dogs
Authors: Allaway David , Haydock Richard , Lonsdale Zoe N. , Deusch Oliver D. , O’Flynn Ciaran , Hughes Kevin R.
Published: April 2020

Diet can influence the adult gut microbiome (the community of bacteria) and health outcomes, but the ability to make changes persisting beyond feeding of a particular diet is poorly understood. We investigated whether feeding highly purified diets to adult dogs for 36 weeks would alter bacterial populations sufficiently to result in a persistent change following the dogs’ return to a commercial diet. As expected, the microbiome changed when the purified diet was fed, but the original microbiome was reconstituted within weeks of the dogs returning to the commercial diet. The significance of these findings is in identifying an intrinsic stability of the host microbiome in healthy dogs, suggesting that dietary changes to support adult dog health through modifying the gut microbiome may be achieved only through maintenance on a specified diet, rather than through feeding transitionary diets.
The Homogalacturonan Deconstruction System of Paenibacillus amylolyticus 27C64 Requires No Extracellular Pectin Methylesterase and Has Significant Industrial Potential
Authors: Keggi Christian , Doran-Peterson Joy
Published: April 2020

Pectin is an important structural polysaccharide found in most plant cell walls. In the environment, pectin degradation is part of the decomposition process that turns over dead plant material and is important to organisms that feed on plants. Industrially, pectinases are used to improve the quality of fruit juices and can also be used to process coffee cherries or tea leaves. These enzymes may also prove useful in reducing the environmental impact of paper and cotton manufacturing. This work is significant because it focuses on a Gram-positive bacterium that is evolutionarily distinct from other well-studied pectin-degrading organisms and differs from known systems in key ways. Most importantly, a simplified extracellular deconstruction process in this organism is able to break down pectins without first removing the methyl groups that inhibit other systems. Moreover, some of the enzymes described here have the potential to improve industrial processes that rely on pectin deconstruction.
PCV2 Induces Reactive Oxygen Species To Promote Nucleocytoplasmic Translocation of the Viral DNA Binding Protein HMGB1 To Enhance Its Replication
Authors: Sun Renjie , Sun Siqi , Zhang Yikai , Zhou Yingshan , Shan Ying , Li Xiaoliang , Fang Weihuan
Published: April 2020

Porcine circovirus type 2 (PCV2) is a small DNA virus that depends heavily on host cells for its infection. This study reports the close relationship between subcellular localization of host high-mobility-group box 1 (HMGB1) protein and viral replication during PCV2 infection. Restriction of PCV2 replication by nuclear HMGB1 is the early step of host defense at the host-pathogen interface. PCV2 then upregulates host reactive oxygen species (ROS) to prevent sequestration of its genome by expelling nuclear HMGB1 into the cytosol. It will be interesting to study if a similar evasion strategy is employed by other circoviruses such as beak and feather disease virus, recently discovered PCV3, and geminiviruses in plants. This study also provides insight into the justification and pharmacological basis of antioxidants as an adjunct therapy in PCV2 infection or possibly other diseases caused by the viruses that deploy the ROS-HMGB1 interaction favoring their replication.
Coccidioidesin lung transplant: case report
Authors: Diaz Mark Anthony , Bayo Maria Luisa , Alvarez Francisco , Alvarez Salvador
Published: April 2020

A middle-aged woman was hospitalised for generalised, painful skin lesions 6 weeks after a successful double-lung transplant. She had end-stage lung disease associated with chronic obstructive pulmonary disease due to alpha-1 antitrypsin deficiency, and she had been treated with itraconazole for 16 months because of lung infection associated withMalbrancheaspp. Results of a skin biopsy of the initial lesion on her arm showed non-specific dermal inflammation, presumably due to reactivation of theMalbrancheaspp infection. Follow-up cervical lymph node biopsy and culture showedCoccidioides posadasii/C. immitis. A detailed review of her travel history showed a 4-month stay in Arizona as a teenager that she barely remembered.Coccidioidesspp were likely misidentified asMalbrancheaspp owing to similar morphological characteristics. Dosages of immunosuppressive medications were reduced, and antifungal therapy was changed to posaconazole. Her skin lesions resolved.
Using implementation science theories and frameworks in global health
Authors: Ridde Valéry , Pérez Dennis , Robert Emilie
Published: April 2020

In global health, researchers and decision makers, many of whom have medical, epidemiology or biostatistics background, are increasingly interested in evaluating the implementation of health interventions. Implementation science, particularly for the study of public policies, has existed since at least the 1930s. This science makes compelling use of explicit theories and analytic frameworks that ensure research quality and rigour. Our objective is to inform researchers and decision makers who are not familiar with this research branch about these theories and analytic frameworks. We define four models of causation used in implementation science: intervention theory, frameworks, middle-range theory and grand theory. We then explain how scientists apply these models for three main implementation studies: fidelity assessment, process evaluation and complex evaluation. For each study, we provide concrete examples from research in Cuba and Africa to better understand the implementation of health interventions in global health context. Global health researchers and decision makers with a quantitative background will not become implementation scientists after reading this article. However, we believe they will be more aware of the need for rigorous implementation evaluations of global health interventions, alongside impact evaluations, and in collaboration with social scientists.
Time-critical conditions: assessment of burden and access to care using verbal autopsy in Agincourt, South Africa
Authors: Fraser Andrew , Newberry Le Vay Jessica , Byass Peter , Tollman Stephen , Kahn Kathleen , D'Ambruoso Lucia , Davies Justine I
Published: April 2020

Background

Time-critical conditions (TCC) are estimated to cause substantial mortality in low and middle-income countries. However, quantification of deaths and identification of contributing factors to those deaths are challenging in settings with poor health records.

Aim

To use verbal autopsy (VA) data from the Agincourt health and sociodemographic surveillance system in rural South Africa to quantify the burden of deaths from TCC and to evaluate the barriers in seeking, reaching and receiving quality care for TCC leading to death.

Methodology

Deaths from 1993 to 2015 were analysed to identify causality from TCC. Deaths due to TCC were categorised as communicable, non-communicable, maternal, neonatal or injury-related. Proportion of deaths from TCC by age, sex, condition type and temporal trends was described. Deaths due to TCC from 2012 to 2015 were further examined by circumstances of mortality (CoM) indicators embedded in VA. Healthcare access, at illness onset and during the final day of life, as well as place of death, was extracted from free text summaries. Summaries were also analysed qualitatively using a Three Delays framework to identify barriers to healthcare.

Results

Of 15 305 deaths, 5885 (38.45%) were due to TCC. Non-communicable diseases were the most prevalent cause of death from TCC (2961/5885 cases, 50.31%). CoM indicators highlighted delays in a quarter of deaths due to TCC, most frequently in seeking care. The most common pattern of healthcare access was to die outwith a facility, having sought no healthcare (409/1324 cases, 30.89%). Issues in receipt of quality care were identified by qualitative analysis.

Conclusion

TCCs are responsible for a substantial burden of deaths in this rural South African population. Delays in seeking and receiving quality care were more prominent than those in reaching care, and thus further research and solution development should focus on healthcare-seeking behaviour and quality care provision.
Validity and feasibility of a self-administered home vision examination in Yueqing, China: a cross-sectional study
Authors: Ge Zhengyan , Li Linshan , Lohfeld Lynne , Lu Chunjie , Congdon Nathan , Lin Sigeng , Deng Yuxuan , Lan Yuan , Zhang Shaodan , Hou Laurence , Zhou Weihe , Cui Lele , Qu Jia , Liang Yuanbo
Published: April 2020

Objective

To investigate the validity and feasibility of a self-administered home vision examination programme in China.

Design

Cross-sectional study.

Setting

Yueqing, China.

Participants

A two-stage convenience sampling procedure was used to randomly select 600 households from 30 communities participating in the Yueqing Eye Study (YES). The aim of YES is to encourage home-based vision screening, reporting of visual acuity (VA) annually through social media and encouraging people to attend follow-up clinic appointments as a way to improve eye care access for adults with VA ≤+0.5 log of the minimum angle of resolution (logMAR).

Interventions

Household screeners (one per household) who tested other family members’ VA completed a questionnaire on family structure, demographic information and knowledge about screening procedures. Other family members then underwent confirmatory VA testing by researchers.

Outcome measures

The completion rate of home-based VA screening, its sensitivity and specificity were used to evaluate validity. Factors that determined whether families participated in the self-VA screening were used to evaluate feasibility.

Results

345 (66%) of the 523 (87.2%) households with valid data form their home-based vision examinations also were retested by researchers. There was no statistically significant difference in scores on the family-administerd or researcher-administerd VA test (VA≤+0.5 logMAR, p=0.607; VA >+0.5 logMAR, p=0.612). The sensitivity and specificity of home-based vision screening were 80.5% (95% CI 70.2% to 86.9%) and 95.1% (95% CI 92.6% to 96.8%), respectively. 14.7% (77/523) of tested respondents had VA ≤+0.5 logMAR. Predictors of performing home screening for VA remaining in regression models included higher economic status (‘fair and above’ vs ‘poor’: OR 1.74; 95% CI 1.08 to 2.76; p=0.022), age (<45 years vs ≥45 years: OR 0.46; 95% CI 0.25 to 0.85; p=0.014) and living in a nuclear (OR 5.17; 95% CI 2.86 to 9.36; p<0.001) or extended family (OR 8.37; 95% CI 4.93 to 14.20; p<0.001).

Conclusion

Self-administered home vision screening is reliable and highly accepted by Chinese adults.
Prevalence of occupational exposure and its influence on job satisfaction among Chinese healthcare workers: a large-sample, cross-sectional study
Authors: Shi Yu , Xue Haifeng , Ma Yuanshuo , Wang Licheng , Gao Tian , Shi Lei , Wang Yang , Cui Mei , Wang Chao , Yang Xi , Liu Ming , Fan Lihua , Yan Guanyun
Published: April 2020

Objectives

This study had three objectives: (1) describe the prevalence of occupational exposure among Chinese medical personnel in detail, (2) verify the partial mediating role of work environment satisfaction in the relationship between occupational exposure and job satisfaction, and (3) examine if stress symptoms moderate the relationship between occupational exposure and job satisfaction.

Design

A large cross-sectional online survey was conducted in July 2018 in China.

Setting

A survey was conducted in 54 cities across 14 provinces of China.

Participants

A total of 12 784 questionnaires were distributed, and 9924 healthcare workers (HCWs) completed valid questionnaires. The response rate was 77.63%.

Outcome measures

A confidential questionnaire was distributed to HCWs. The relationships among and the mechanisms of the variables were explored using descriptive statistical analyses, Pearson’s correlation coefficient and multiple linear regression analysis.

Results

The most common occupational exposures among HCWs in the past 12 months were psychosocial and organisational hazards (85.93%). Overall, physicians (93.7%) and nurses (89.2%) were the main victims of occupational exposure. Occupational exposure correlated negatively with work environment satisfaction and job satisfaction, and positively with stress symptoms. Moreover, work environment satisfaction fully mediated the relationship between occupational exposure and job satisfaction, and stress symptoms moderated the relationship between occupational exposure and job satisfaction.

Conclusion

The incidence of occupational exposure among HCWs is generally high. The high frequency of psychosocial and organisational hazards among physicians and nurses should be taken seriously and dealt with in a timely manner by hospital managers. The negative impact of occupational exposure on job satisfaction must be buffered by measures to reduce stress symptoms and enhance working environment satisfaction, ultimately improving the overall quality of life of HCWs and promoting comprehensive development of the medical team.
Canada-wide mixed methods analysis evaluating the reasons for inappropriate emergency department presentation in patients with a history of atrial fibrillation: the multicentre AF-ED trial
Authors: Hong Kathryn Lauren , Babiolakis Corinne , Zile Brigita , Bullen Milena , Haseeb Sohaib , Halperin Frank , Hohl Corinne M , Magee Kirk , Sandhu Roopinder K , Tian Simon Yu , Kennedy Ashley , Lobban Trudie , Mariano Zana , Dorian Paul , Angaran Paul , Evans Marilyn , Leong-Sit Peter , Glover Benedict M
Published: April 2020

Objectives

The primary objective of this study was to ascertain the reasons for emergency department (ED) attendance among patients with a history of atrial fibrillation (AF).

Design

Appropriate ED attendance was defined by the requirement for an electrical or chemical cardioversion and/or an attendance resulting in hospitalisation or administration of intravenous medications for ventricular rate control. Quantitative and qualitative responses were recorded and analysed using descriptive statistics and content analysis, respectively. Random effects logistic regression was performed to estimate the OR of inappropriate ED attendance based on clinically relevant patient characteristics.

Participants

Participants ≥18 years with a documented history of AF were approached in one of eight centres partaking in the study across Canada (Ontario, Nova Scotia, Alberta and British Columbia).

Results

Of the 356 patients enrolled (67±13, 45% female), the majority (271/356, 76%) had inappropriate reasons for presentation and did not require urgent ED treatment. Approximately 50% of patients(172/356, 48%) were driven to the ED due to symptoms, while the remainder presented on the basis of general fear or anxiety (67/356, 19%) or prior medical advice (117/356, 33%). Random effects logistic regression analysis showed that patients with a history of congestive heart failure were significantly more likely to seek urgent care for appropriate reasons (p=0.03). Likewise, symptom-related concerns for ED presentation were significantly less likely to result in inappropriate visitation (p=0.02). When patients were surveyed on alternatives to ED care, the highest proportion of responses among both groups was in favour of specialised rapid assessment outpatient clinics (186/356, 52%). Qualitative content analysis confirmed these results.

Conclusions

Improved education focused on symptom management and alleviating disease-related anxiety as well as the institution of rapid access arrhythmias clinics may reduce the need for unnecessary healthcare utilisation in the ED and subsequent hospitalisation.

Trial registration number

NCT03127085
Clozapine is strongly associated with the risk of pneumonia and inflammation
Authors: de Leon Jose , Ruan Can-Jun , Verdoux Hélène , Wang Chuanyue
Published: April 2020

Clinicians need to remember that (1) systemic inflammations can increase clozapine level; (2) clozapine, by itself, can cause inflammation, particularly during titration that is too rapid for that patient; (3) clozapine may increase the risk of infection; and (4) more specifically, clozapine may be particularly strongly associated with the risk of pneumonia. Pneumonia appears to be associated with high mortality in clozapine patients around the world. Clinicians who are alert to the risk of pneumonia in clozapine patients may significantly decrease mortality in clozapine patients. There is no data on COVID-19 infections in clozapine patients, but based on what we know about clozapine pharmacology, we can hypothesise that clozapine, possibly by impairing immunological mechanisms, may increase the risk of pneumonia in infected patients. More importantly, once fever and/or pneumonia develops, the clozapine dose should be cut in half to decrease the risk of clozapine intoxication. If there is any doubt that in spite of halving the dose there are still signs of clozapine intoxication, completely stopping clozapine may be indicated. Once the signs of inflammation and fever have disappeared, the clozapine dose can be increased to the prior dosage level.
Association of big-5 personality traits with cognitive impairment and dementia: a longitudinal study
Authors: Singh-Manoux A , Yerramalla M S , Sabia S , Kivimäki Mika , Fayosse A , Dugravot A , Dumurgier J
Published: April 2020

Background

Personality traits have been liked to cognitive outcomes such as dementia, but whether these associations are robust to the effects of third variables remains the subject of debate. We examined the role of socioeconomic status, depression (history and depressive symptoms), health behaviours and chronic conditions in the association of the big-5 personality traits with cognitive performance, cognitive impairment and incidence of dementia.

Methods

Data on 6135 persons (30% women), aged 60–83 years in 2012/13, are drawn from the Whitehall II Study. Participants responded to the 26-item Midlife Development Inventory to assess personality traits (openness, conscientiousness, extraversion, agreeableness and neuroticism), underwent cognitive testing in 2012/13 and 2015/16 and were followed for incidence of dementia (N=231) until 2019.

Results

Logistic regression, adjusted for sociodemographic factors, suggested a cross-sectional association with cognitive impairment for four of the five traits but only neuroticism was associated with incident cognitive impairment. All associations were completely attenuated when the analyses were adjusted for depression. Cox regression (mean follow-up: 6.18 years) adjusted for sociodemographic variables showed higher conscientiousness (HR per SD increment=0.72; 95% CI 0.65 to 0.81) and extraversion (HR=0.85; 95% CI 0.75 to 0.97) to be associated with lower dementia risk; higher neuroticism (HR=1.32; 95% CI 1.17 to 1.49) was associated with increased risk. Further adjustment for depression led to only conscientiousness retaining an association with dementia (HR=0.81; 95% CI 0.69 to 0.96), which was robust to adjustment for all covariates (HR=0.84; 95% CI 0.71 to 0.91; P=0.001).

Conclusion

Our results show that only conscientiousness has an association with incidence of dementia that is not attributable to socioeconomic status or depression. The association of neuroticism with dementia was explained by depression.
Cultural participation and all-cause mortality, with possible gender differences: an 8-year follow-up in the HUNT Study, Norway
Authors: Løkken B I , Merom D , Sund E R , Krokstad S , Rangul V
Published: April 2020

Background

Cultural activities can promote health and longevity, but longitudinal studies examining a broad spectrum of participation are scarce. This study investigated the gender-specific association between all-causes of mortality and participation in single types of cultural activities, amount and participation frequency.

Methods

We used cohort data from the Nord-Trøndelag Health Study (HUNT Study), Norway (2006–2008), resulting in 35 902 participants, aged 20 and above. Cultural participation in receptive and creative activities was measured. HRs were reported for partially and fully adjusted models.

Results

A total of 1905 participants died during the median 8-year follow-up. Mortality risk was higher for non-participants in any receptive or creative activities, except sport event attendees. Gender association was also evaluated: among men, we found similar results as above except for parish work, while women increased their longevity only through creative activity participation. When a number of receptive activities was associated with all-cause mortality, reduced risk occurred with attendance in 2 or 3–4 activities (21% and 31%, respectively). Risk was reduced through creative activities, with participation in 3–5 activities (43%). Gender-specific analyses showed a clear gradient of protective effect in creative activity participation: for men, 28%, 44% and 44% reduction with 1, 2 or 3–5 activities, respectively, and a 28%, 35% and 44% reduction for women.

Conclusion

Frequently attending at least one cultural activity influenced longevity. Creative activities lowered mortality in both genders, while receptive activity benefits were mostly found for men. Thus, promoting and facilitating engaged cultural lifestyles are vital for longevity.
Do men avoid seeking medical advice? A register-based analysis of gender-specific changes in primary healthcare use after first hospitalisation at ages 60+ in Denmark
Authors: Höhn Andreas , Gampe Jutta , Lindahl-Jacobsen Rune , Christensen Kaare , Oksuyzan Anna
Published: April 2020

Background

It remains unclear whether women’s greater primary healthcare use reflects a lower treatment-seeking threshold or a health disadvantage. We address this question by studying primary healthcare use surrounding a major health shock.

Methods

This cohort study utilises routinely-collected healthcare data covering the Danish population aged 60+ years between 1996 and 2011. Using a hurdle model, we investigate levels of non-use and levels of primary healthcare use before and after first inpatient hospitalisation for stroke, myocardial infarction (MI), chronic obstructive pulmonary disease (COPD) and gastrointestinal cancers (GIC).

Results

Before hospitalisation, irrespective of cause, men were more likely than women to be non-users of primary healthcare (OR (95% CI): stroke 1.802 (1.731 to 1.872); MI 1.841 (1.760 to 1.922); COPD 2.160 (2.028 to 2.292); GIC 1.609 (1.525 to 1.693)). Men who were users had fewer primary healthcare contacts than women (proportional change (eβ) (95% CI): stroke 0.821 (0.806 to 0.836); MI 0.796 (0.778 to 0.814); COPD 0.855 (0.832 to 0.878); GIC 0.859 (0.838 to 0.881)). Following hospitalisation, changes in the probability of being a non-user (OR (95% CI): stroke 0.965 (0.879 to 1.052); MI 0.894 (0.789 to 0.999); COPD 0.755 (0.609 to 0.900); GIC 0.895 (0.801 to 0.988)) and levels of primary healthcare use (eβ(95% CI): stroke 1.113 (1.102 to 1.124); MI 1.112 (1.099 to 1.124); COPD 1.078 (1.063 to 1.093); GIC 1.097 (1.079 to 1.114)) were more pronounced among men. Gender differences widened after accounting for survival following hospitalisation.

Conclusion

Women’s consistently higher levels of primary healthcare use are likely to be explained by a combination of a lower treatment-seeking threshold and a health disadvantage resulting from better survival in bad health.
C reactive protein impairs adaptive immunity in immune cells of patients with melanoma
Authors: Yoshida Tatsuya , Ichikawa Junya , Giuroiu Iulia , Laino Andressa S , Hao Yuhan , Krogsgaard Michelle , Vassallo Melinda , Woods David M , Stephen Hodi F , Weber Jeffrey
Published: April 2020

Background

High C reactive protein (CRP) levels have been reported to be associated with a poor clinical outcome in a number of malignancies and with programmed cell death protein 1 immune checkpoint blockade in patients with advanced cancer. Little is known about the direct effects of CRP on adaptive immunity in cancer. Therefore, we investigated how CRP impacted the function of T cells and dendritic cells (DCs) from patients with melanoma.

Methods

The effects of CRP on proliferation, function, gene expression and phenotype of patient T cells and DCs, and expansion of MART-1 antigen-specific T cells were analyzed by multicolor flow cytometry and RNA-seq. Additionally, serum CRP levels at baseline from patients with metastatic melanoma treated on the Checkmate-064 clinical trial were assessed by a Luminex assay.

Results

In vitro, CRP inhibited proliferation, activation-associated phenotypes and the effector function of activated CD4+ and CD8+ T cells from patients with melanoma. CRP-treated T cells expressed high levels of interleukin-1β, which is known to enhance CRP production from the liver. CRP also suppressed formation of the immune synapse and inhibited early events in T-cell receptor engagement. In addition, CRP downregulated the expression of costimulatory molecules on mature DCs and suppressed expansion of MART-1-specific CD8+ T cells in a dose-dependent manner by impacting on both T cells and antigen-presenting cells. High-serum CRP levels at baseline were significantly associated with a shorter survival in both nivolumab-treated and ipilimumab-treated patients.

Conclusions

These findings suggest that high levels of CRP induce an immunosuppressivemilieuin melanoma and support the blockade of CRP as a therapeutic strategy to enhance immune checkpoint therapies in cancer.

Trial registration number

NCT01783938andNCT02983006.
Viral status, immune microenvironment and immunological response to checkpoint inhibitors in hepatocellular carcinoma
Authors: Ho Won Jin , Danilova Ludmila , Lim Su Jin , Verma Rohan , Xavier Stephanie , Leatherman James M , Sztein Marcelo B , Fertig Elana J , Wang Hao , Jaffee Elizabeth , Yarchoan Mark
Published: April 2020

Background and aims

Immune checkpoint inhibitors (ICIs) targeting the programmed cell death protein 1 (PD-1)/programmed death-ligand 1 (PD-L1) pathway have clinical activity in hepatocellular carcinoma (HCC), but only a subset of patients respond to these therapies, highlighting a need for novel biomarkers to improve clinical benefit. HCC usually occurs in the setting of liver cirrhosis from chronic hepatitis B or C viral infection, but the effects of viral status on the tumor immune microenvironment and clinical responses to ICIs in HCC remains unclear.

Methods

We conducted a meta-analysis to estimate the objective response rates for PD-1/PD-L1 inhibitors in virally-infected and uninfected patients, and examined the effects of viral etiology on the tumor microenvironment using data from The Cancer Genome Atlas, as well as peripheral blood responses using an independent cohort of patients studied by mass cytometry (cytometry by time-of-flight (CyTOF)).

Results

Meta-analysis comparing objective response rates (ORR) between virally-infected and uninfected patients showed no clinically meaningful difference (absolute difference of ORR in virally-infected vs uninfected=−1.4%, 95% CI: −13.5% to 10.6%). There was no relationship between viral etiology on features of the tumor immune microenvironment that are known to modulate responses to PD-1/PD-L1 inhibitors, and the tumor mutational burden was similar between virally-infected and uninfected HCC. RNA sequencing of tissue-resident T cell and B cell repertoires similarly showed no effect of viral status on their diversity. CyTOF analysis of peripheral blood specimens further demonstrated similar expression of immune-related markers in response to PD-1 inhibitor therapy in virally-infected and uninfected HCC.

Conclusion

There is no significant effect of viral etiology on the tumor immune microenvironment in HCC, and viral status should not be used as a criterion to select patients for PD-1/PD-L1 therapy.
Autoimmune encephalitis associated with Ma2 antibodies and immune checkpoint inhibitor therapy
Authors: Lyons Shane , Joyce Ronan , Moynagh Patrick , O"Donnell Luke , Blazkova Silive , Counihan Timothy J
Published: April 2020

Immune checkpoint inhibitors have transformed the treatment of advanced malignancy, while increasing the risk of immune-related adverse events. A 56-year-old woman who had received nivolumab for stage 4 renal cell carcinoma subsequently developed altered behaviour, memory deficits and worsening of previously stable epilepsy. MR scan of the brain showed bilateral FLAIR (fluid-attenuated inversion recovery) hyperintensity of the mesial temporal lobes, and there were anti-Ma2 antibodies in both serum and cerebrospinal fluid. She was treated with corticosteroids but developed further clinical relapses requiring immunoglobulin and rituximab. The immune-related adverse events relating to immune checkpoint inhibitors are an emerging challenge for the neurologist. Some cases are refractory and require serial immunosuppression.
Utility of routine screening for alpha-1 antitrypsin deficiency in patients with bronchiectasis
Authors: Carreto Luis , Morrison Meghan , Donovan Jackie , Finch Simon , Tan Gan Liang , Fardon Tom , Wilson Robert , Furrie Elisabeth , Loebinger Michael , Chalmers James D
Published: April 2020

Alpha-1 antitrypsin deficiency (AATD) is a cause of bronchiectasis. Guidelines for bronchiectasis from the British Thoracic Society do not recommend to routinely test patients for AATD. In contrast, guidelines for AATD recommend routine screening. This contradiction, in part, results from the lack of data from large studies performing comprehensive screening. We screened 1600 patients with bronchiectasis at two centres in the UK from 2012 to 2016. In total, only eight individuals with AATD were identified representing 0.5% of the overall population. We conclude that routine screening for AATD in bronchiectasis in the UK has a low rate of detection. Further studies are required in different geographical regions, which may have a higher prevalence of AATD.
Evaluation of non-market environmental services in smallholder forest plantations with choice experiments in Dormaa forest district, Ghana
Authors: Bampoh Alex Aboagye , Damnyag Lawrence
Published: April 2020

Timber production is the focus of forest management in Ghana. Environmental services are scarcely factored into forest management plans. This may be due to a lack of understanding and estimation of the value of environmental services. Using choice modelling, this study attempts to fill the information gap. Non-market attributes of forest plantations were identified from literature and reconnaissance surveys. Conjoint analysis was employed to estimate the value of these attributes. Orthogonal design was used to generate different combinations of attribute levels into profiles. Respondents ranked the profiles from most to least preferred. The results show that water regulation was the most influential attribute in the ranking of choice profiles. Farmers were willing to accept US$114.30·ha−1·year−1 as compensation for improving environmental services. Findings on the non-market environmental services and socioeconomic characteristics of farmers can help forest managers better evaluate actions and policies to enhance forest management.
Pseudodynamic Hybrid Simulation of High-Speed Railway Bridge-Track System with Rotational Friction Damper
Authors: Guo Wei , Zeng Chen , Xie Xu , Bu Dan
Published: April 2020

This paper evaluates seismic performance of a three-span high-speed railway (HSR) simply supported bridge-track system equipped with multi-joints rotational friction damper (MRFD) using pseudodynamic hybrid simulation. In hybrid simulation, a simplified nonlinear model based on the reference of high-speed railway model is used as a numerical substructure. The experimental substructure is a rotational friction damper (RFD) specimen consisting of two rotational joints. The feedback-force of the RFD specimen is multiplied in different multiples to consider the different clamping force of MRFD with more rotational joints. Results of cyclic tests indicate that the RFD specimen has a good ability to mitigate seismic damage of bridge-track system. Then, pseudodynamic hybrid simulations were performed in the longitudinal direction of the bridge to examine the seismic performance of MRFD. The effect of various ground motions and the influence of different clamping forces of MRFD were investigated. Test results confirmed the applicability of MRFD in HSR bridge-track system.
Study on the Aerodynamic Characteristics and Galloping Instability of Conductors Covered with Sector-Shaped Ice by a Wind Tunnel Test
Authors: Li Jia-Xiang , Sun Jian , Ma Ye , Wang Shu-Hong , Fu Xing
Published: April 2020

Conductors with sector-shaped ice are susceptible to galloping. To prevent and control galloping, it is necessary to study the conductor aerodynamic characteristics. Wind tunnel tests were performed to study the influence of two shape parameters (ice thickness and ice angle) of a conductor with sector-shaped ice on the aerodynamic characteristics considering the roughness of the surface. In addition, the unstable areas for galloping are discussed according to Den Hartog theory and Nigol theory. The results show that with increasing ice thickness, the aerodynamic coefficient curves fluctuate more strongly, and galloping tends to occur; with increasing ice angle, the unstable area becomes larger according to Nigol theory, and the increasing drag coefficient will suppress the unstable areas according to Den Hartog theory. With the increasing two shape parameters, the most affected ranges of the aerodynamic coefficient curves are 150–180∘.
Frequency Comparison Function Method for Real-Time Identification of Breathing Crack at Welding Joint
Authors: Wang Xin , Wu Nan , Wang Quan
Published: April 2020

In this research, the frequency comparison function (FCF) method is proposed and studied to realize high-sensitive real-time crack identification at the welding joint area for a beam-type structure. This method is derived from the frequency response function (FRF). During FCF, we use the response signal collected from the designated point of the structure instead of the excitation. The standard deviation of the FCF amplitude curve is calculated to detect and evaluate the possible crack and its induced vibration perturbations afterward. Vibration responses are simulated in ANSYS by the use of the finite element analysis of a welded beam structure, and these signals are then analyzed with the FCF algorithm. It is concluded that FCF is an efficient method for breathing crack identification and can be easily applied under different excitation conditions, including harmonic and random ones. Meanwhile, FCF can be applied without any pre-processing algorithms such as filtering and smoothing. So, it can be used for real-time crack identification. By combining the FCF with the smart coating sensor composed of piezoelectric layers, the crack identification with high sensitivity is realized. The crack is detectable at its very early stage (starting from 3% of the beam thickness). Experimental studies under harmonic and random excitations are processed, and the results prove high sensitivity and feasibility of the proposed crack detection method.
Simulation of Dynamics During Deployment of Foldable Origami Structures
Authors: Zhang Qian , Liu Yangqing , Li Meng , Han Yunlong , Cai Jianguo , Feng Jian
Published: April 2020

Foldable origami-based structures are a type of deployable structures that are increasingly applied in the space and building industries. When folded, the small size of such structures facilitates transportation and storage. Meanwhile, the properties of their larger deployed state may be of interest to different applications. A stable working condition is established by locking the structure in its deployed state, as in the process of deployment, the driving forces may generate a dynamic effect, thus leading to instability of the system. Hence, the study of dynamic characteristics of such structures, including trajectory, duration, velocity, and acceleration is of paramount importance. In this paper, based on the general dynamic equation and Lagrange’s equations of the first kind, the finite element method is adopted to investigate the dynamic deployment of foldable plate structures in terms of the generalized nodal coordinates. The proposed geometric description of a quadrilateral plate element is based on a folding plate composed of refined triangular elements, which are used to approximate the real shells in the structure. Subsequently, a MATLAB framework is developed on the basis of the element using the Newmark integration and the Newton–Raphson iteration method to simulate the deployment process of the structure. Comparisons between MATLAB results and ADAMS results verify the reliability of the framework in analyzing the dynamic deployment of the foldable origami-based structures with sufficient accuracy.