bluuebunny/crossref_metadata_2025 huggingface dataset:
Orbit and sinonasal metastasis as presenting sign of renal cell carcinoma
Authors: Barajas-Ochoa Zalathiel , Suero-Abreu Giselle Alexandra , Barajas-Ochoa Aldo
Published: April 2021

Orbit and sinonasal metastases are rare. Renal cell carcinoma (RCC) can metastasise to this region. We present the case of a 49-year-old woman with weight loss, diplopia and a rapidly growing facial mass. The initial diagnosis was a primary tumour and patient underwent excisional biopsy, which showed findings consistent with a diagnosis of RCC. On a subsequent focused review of system, the patient reported having intermittent haematuria. Imaging studies revealed a complex right renal mass as the primary tumour. Metastatic RCC should be in the differential diagnosis of patients with facial masses, especially if associated with symptoms suggestive of a systemic involvement such as haematuria. Despite treatment, patients with metastatic RCC tend to have a dismal prognosis. However, early stage diagnosis of metastatic disease can considerably limit surgical complications and improve survival rate in these patients.
Chronic histiocytic intervillositis (CHI): an under-recognised condition with potential serious sequelae in pregnancy
Authors: Lee Ai Xin , Tan Brian Run Yi , Kho Chye Lee , Tan Kim Teng
Published: April 2021

Chronic histiocytic intervillositis (CHI) is a rare placental disorder associated with adverse pregnancy outcomes and high recurrence rates in subsequent pregnancies. We discuss a case of CHI diagnosed incidentally in a young primigravida who presented with a first trimester miscarriage. CHI is usually diagnosed after an adverse pregnancy outcome by microscopic placental histopathology. Currently, CHI is a poorly understood condition by clinicians in many aspects, including its aetiology and subsequent management of patients in their future pregnancies. This is due to the lack of awareness and underdiagnosis of CHI among general pathologists and obstetricians. The authors would like to highlight this interesting case to encourage more research on CHI to understand its pathophysiology and optimal management better. Clinicians should also focus on providing holistic care to this group of patients by considering the impact of adverse pregnancy outcomes on their emotional well-being.
COVID-19 multisystemic inflammatory syndrome in adults: a not to be missed diagnosis
Authors: Tung-Chen Yale , Algora-Martín Ana , Rodríguez-Roca Sonia , Díaz de Santiago Alberto
Published: April 2021

We report COVID-19 multisystemic inflammatory syndrome in an adult patient with an atypical presentation (mild abdominal pain) and a negative (repeated) reverse transcriptase-PCR, in the absence of lung involvement on lung ultrasound. In this case, focused cardiac ultrasound revealed signs of myopericarditis and enabled us to focus on the problem that was putting our patient in a perilous situation, with a quick, non-time-consuming and easy-to-access technique. Serology test was performed and SARS-CoV-2 infection was confirmed more than a week after admission to the coronary unit. As the patient had a general good appearance, the potential implications of missing this diagnosis could have been fatal.
Carney complex: a curious case of a rare cancer syndrome caused by a novel pathogenic mutation in thePRKAR1Agene
Authors: Gupta Nisha , Kitzler Thomas , Albrecht Steffen , Larouche Vincent
Published: April 2021

A 39-year-old woman was referred to the cancer genetics outpatient clinic for a clinical diagnosis of Carney complex (CNC) in her deceased brother. The patient had some characteristic clinical features such as periorbital lentigines and coarse facial features, suggestive of CNC; however, she did not meet major diagnostic criteria for CNC. Previous extensive investigations revealed a mild insulin-like growth factor 1 elevation, a stable left adrenal gland adenoma and a slightly enlarged pituitary gland. Single gene sequencing confirmed a novel pathogenic mutation in thePRKAR1Agene. This case, to our knowledge, is the first report of this mutation identified in a family of French-Canadian origin. This report broadens our understanding of the genotypic and phenotypic spectrum of this rare disease, while it highlights the value of a multidisciplinary approach in rare diseases, for genetic testing facilitated a timely diagnosis and enabled the initiation of early surveillance of CNC-related manifestations in our patient.
Effectiveness of treatments for acute and subacute mechanical non-specific low back pain: a systematic review with network meta-analysis
Authors: Gianola Silvia , Bargeri Silvia , Del Castillo Gabriele , Corbetta Davide , Turolla Andrea , Andreano Anita , Moja Lorenzo , Castellini Greta
Published: April 2021

Objective

To assess the effectiveness of interventions for acute and subacute non-specific low back pain (NS-LBP) based on pain and disability outcomes.

Design

A systematic review of the literature with network meta-analysis.

Data sources

Medline, Embase and CENTRAL databases were searched from inception until 17 October 2020.

Eligibility criteria for selecting studies

Randomised clinical trials (RCTs) involving adults with NS-LBP who experienced pain for less than 6 weeks (acute) or between 6 and 12 weeks (subacute).

Results

Forty-six RCTs (n=8765) were included; risk of bias was low in 9 trials (19.6%), unclear in 20 (43.5%), and high in 17 (36.9%). At immediate-term follow-up, for pain decrease, the most efficacious treatments against an inert therapy were: exercise (standardised mean difference (SMD) −1.40; 95% confidence interval (CI) −2.41 to –0.40), heat wrap (SMD −1.38; 95% CI −2.60 to –0.17), opioids (SMD −0.86; 95% CI −1.62 to –0.10), manual therapy (SMD −0.72; 95% CI −1.40 to –0.04) and non-steroidal anti-inflammatory drugs (NSAIDs) (SMD −0.53; 95% CI −0.97 to –0.09). Similar findings were confirmed for disability reduction in non-pharmacological and pharmacological networks, including muscle relaxants (SMD -0.24; 95% CI -0.43 to -0.04). Mild or moderate adverse events were reported in the opioids (65.7%), NSAIDs (54.3%) and steroids (46.9%) trial arms.

Conclusion

With uncertainty of evidence, NS-LBP should be managed with non-pharmacological treatments which seem to mitigate pain and disability at immediate-term. Among pharmacological interventions, NSAIDs and muscle relaxants appear to offer the best harm–benefit balance.
Infrastructure and operating processes of PIONEER, the HDR-UK Data Hub in Acute Care and the workings of the Data Trust Committee: a protocol paper
Authors: Gallier Suzy , Price Gary , Pandya Hina , McCarmack Gillian , James Chris , Ruane Bob , Forty Laura , Crosby Benjamin L , Atkin Catherine , Evans Ralph , Dunn Kevin W , Marston Eliot , Crawford Clark , Levermore Martin , Modhwadia Shekha , Attwood John , Perks Stephen , Doal Rima , Gkoutos Georgios , Dormer Richard , Rosser Andy , Fanning Hilary , Sapey Elizabeth
Published: April 2021

Introduction

Health Data Research UK designated seven UK-based Hubs to facilitate health data use for research. PIONEER is the Hub in Acute Care. PIONEER delivered workshops where patients/public citizens agreed key principles to guide access to unconsented, anonymised, routinely collected health data. These were used to inform the protocol.

Methods

This paper describes the PIONEER infrastructure and data access processes. PIONEER is a research database and analytical environment that links routinely collected health data across community, ambulance and hospital healthcare providers. PIONEER aims ultimately to improve patient health and care, by making health data discoverable and accessible for research by National Health Service, academic and commercial organisations. The PIONEER protocol incorporates principles identified in the public/patient workshops. This includes all data access requests being reviewed by the Data Trust Committee, a group of public citizens who advise on whether requests should be supported prior to licensed access.

Ethics and dissemination

East Midlands–Derby REC (20/EM/0158): Confidentiality Advisory Group (20/CAG/0084). www.PIONEERdatahub.co.uk
Cohort profile: development and characteristics of a retrospective cohort of individuals dispensed prescription opioids for non-cancer pain in British Columbia, Canada
Authors: Wilton James , Chong Mei , Abdia Younathan , Purssell Roy , MacInnes Aaron , Gomes Tara , Dart Richard C , Balshaw Robert F , Otterstatter Michael , Wong Stanley , Yu Amanda , Alvarez Maria , Janjua Naveed Zafar , Buxton Jane A
Published: April 2021

Purpose

Prescription opioids (POs) are widely prescribed for chronic non-cancer pain but are associated with several risks and limited long-term benefit. Large, linked data sources are needed to monitor their harmful effects. We developed and characterised a retrospective cohort of people dispensed POs.

Participants

We used a large linked administrative database to create the Opioid Prescribing Evaluation and Research Activities cohort of individuals dispensed POs for non-cancer pain in British Columbia (BC), Canada (1996–2015). We created definitions to categorise episodes of PO use based on a review of the literature (acute, episodic, chronic), developed an algorithm for inferring clinical indication and assessed patterns of PO use across a range of characteristics.

Findings to date

The current cohort includes 1.1 million individuals and 3.4 million PO episodes (estimated to capture 40%–50% of PO use in BC). The majority of episodes were acute (81%), with most prescribed for dental or surgical pain. Chronic use made up 3% of episodes but 88% of morphine equivalents (MEQ). Across the acute to episodic to chronic episode gradient, there was an increasing prevalence of higher potency POs (hydromorphone, oxycodone, fentanyl, morphine), long-acting formulations and chronic pain related indications (eg, back, neck, joint pain). Average daily dose (MEQ) was similar for acute/episodic but higher for chronic episodes. Approximately 7% of the cohort had a chronic episode and chronic pain was the characteristic most strongly associated with chronic PO use. Individuals initiating a chronic episode were also more likely to have higher social/material deprivation and previous experience with a mental health condition or a problem related to alcohol or opioid use. Overall, these findings suggest our episode definitions have face validity and also provide insight into characteristics of people initiating chronic PO therapy.

Future plans

The cohort will be refreshed every 2 years. Future analyses will explore the association between POs and adverse outcomes.
Feasibility and acceptability of breath research in primary care: a prospective, cross-sectional, observational study
Authors: Woodfield Georgia , Belluomo Ilaria , Boshier Piers R , Waller Annabelle , Fayyad Maya , von Wagner Christian , Cross Amanda J , Hanna George B
Published: April 2021

Objectives

To examine the feasibility and acceptability of breath research in primary care.

Design

Non-randomised, prospective, mixed-methods cross-sectional observational study.

Setting

Twenty-six urban primary care practices.

Participants

1002 patients aged 18–90 years with gastrointestinal symptoms.

Main outcome measures

During the first 6 months of the study (phase 1), feasibility of patient enrolment using face-to-face, telephone or SMS-messaging (Short Message Service) enrolment strategies, as well as processes for breath testing at local primary care practices, were evaluated. A mixed-method iterative study design was adopted and outcomes evaluated using weekly Plan-Do-Study-Act cycles, focus groups and general practitioner (GP) questionnaires.

During the second 6 months of the study (phase 2), patient and GP acceptability of the breath test and testing process was assessed using questionnaires. In addition a ‘single practice’ recruitment model was compared with a ‘hub and spoke’ centralised recruitment model with regards to enrolment ability and patient acceptability.

Throughout the study feasibility of the collection of a large number of breath samples by clinical staff over multiple study sites was evaluated and quantified by the analysis of these samples using mass spectrometry.

Results

1002 patients were recruited within 192 sampling days. Both ‘single practice’ and ‘hub and spoke’ recruitment models were effective with an average of 5.3 and 4.3 patients accrued per day, respectively. The ‘hub and spoke’ model with SMS messaging was the most efficient combined method of patient accrual. Acceptability of the test was high among both patients and GPs. The methodology for collection, handling and analysis of breath samples was effective, with 95% of samples meeting quality criteria.

Conclusions

Large-scale breath testing in primary care was feasible and acceptable. This study provides a practical framework to guide the design of Phase III trials examining the performance of breath testing in primary care.
Association between postsurgical pain and heart rate variability: protocol for a scoping review
Authors: So Vincent , Klar Gregory , Leitch Jordan , McGillion Michael , Devereaux P J , Arellano Ramiro , Parlow Joel , Gilron Ian
Published: April 2021

Introduction

Surgical interventions can elicit neuroendocrine responses and sympathovagal imbalance, ultimately affecting cardiac autonomic function. Cardiac complications account for 30% of postoperative complications and are the leading cause of morbidity and mortality following non-cardiac surgery. One cardiovascular parameter, heart rate variability (HRV), has been found to be predictive of postoperative morbidity and mortality. HRV is defined as variation in time intervals between heartbeats and is affected by cardiac autonomic balance. Furthermore, altered HRV has been shown to predict cardiovascular events in non-surgical settings. In multiple studies, experimentally induced pain in healthy humans leads to reduced HRV suggesting a causal relationship. In a different studies, chronic pain has been associated with altered HRV, however, in the setting of clinical pain conditions, it remains unclear how much HRV impairment is due to pain itself versus autonomic changes related to analgesia. We aim to review the available evidence describing the association between postsurgical pain and HRV alterations in the early postoperative period.

Methods and analysis

We will conduct a scoping review of relevant studies using detailed searches of MEDLINE and EMBASE, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. Included studies will involve participants undergoing non-cardiac surgery and investigate outcomes of (1) measures of pain intensity; (2) measures of HRV and (3) statistical assessment of association between #1 and #2. As secondary review outcomes included studies will also be examined for other cardiovascular events and for their attempts to control for analgesic treatment and presurgical HRV differences among treatment groups in the analysis. This work aims to synthesise available evidence to inform future research questions related to postsurgical pain and cardiac complications.

Ethics and dissemination

Ethics review and approval is not required for this review. The results will be submitted for publication in peer-reviewed journals.
Feasibility of a ballet-inspired low-impact at-home workout programme for adults with stroke: a mixed-methods exploratory study protocol
Authors: Lo Suzanne Hoi Shan , Chau Janita Pak Chun , Choi Kai Chow , Yeung Jonas , Li Siu Hung , Demers Marika
Published: April 2021

Introduction

Balancing problems are prominent in stroke survivors with unilateral paresis. Recent evidence supports that dance interventions are associated with significant improvements in gait, stability and walking endurance in people with neurological conditions. The aim of this study is to explore the feasibility of a novel ballet-inspired at-home workout programme (Footprints to Better Balance (FBB)) for stroke survivors.

Methods and analysis

A mixed-methods exploratory study incorporating a randomised controlled trial and qualitative evaluation will be conducted. We will recruit 40 adults with a first-ever ischaemic or haemorrhagic stroke and mild-moderate lower limb paresis from two acute stroke units. The intervention group will receive usual care plus FBB, an 8-week home-based programme with ballet-inspired workouts underpinned by Bandura’s principles of self-efficacy and outcome expectation. FBB will be delivered by trained lay and peer volunteers, with the support of volunteer healthcare professionals. Multiple data will be collected: Recruitment rate, adherence to FBB, semi-structured interviews and questionnaires on outcomes (balance, gait and memory) assessed at baseline and immediately post-intervention. The generalised estimating equations model will be used to compare differential changes on outcomes across time points between the two arms. Qualitative data will be coded and grouped to form themes and subthemes.

Ethics and dissemination

Ethical approval from the Joint Chinese University of Hong Kong-New Territories East Cluster Clinical Research Ethics Committee has been obtained. All eligible participants will provide written informed consent. Study results will be disseminated via publications in peer-reviewed journals and presentations at international conferences.

Trial registration number

NCT04460794
Protocol for a scoping review exploring the use of patient-reported outcomes in adult social care
Authors: Hughes Sarah E , Aiyegbusi Olalekan Lee , Lasserson Daniel S , Collis Philip , Cruz Rivera Samantha , McMullan Christel , Turner Grace M , Glasby Jon , Calvert Melanie
Published: April 2021

Introduction

Patient-reported outcomes (PROs) are measures of a person’s own views of their health, functioning and quality of life. They are typically assessed using validated, self-completed questionnaires known as patient-reported outcome measures (PROMs). PROMs are used in healthcare settings to support care planning, clinical decision-making, patient–practitioner communication and quality improvement. PROMs have a potential role in the delivery of social care where people often have multiple and complex long-term health conditions. However, the use of PROMs in this context is currently unclear. The objective of this scoping review is to explore the evidence relating to the use of PROMs in adult social care.

Methods and analyses

The electronic databases Medline (Ovid), PsychInfo (Ovid), ASSIA (ProQuest), Social Care Online (SCIE), Web of Science and EMBASE (Ovid) were searched on 29 September 2020 to identify eligible studies and other publically available documents published since 2010. A grey literature search and hand searching of citations and reference lists of the included studies will also be undertaken. No restrictions on study design or language of publication will be applied. Screening and data extraction will be completed independently by two reviewers. Quality appraisal of the included documents will use the Critical Appraisal Skills Programme and AACODS (Authority, Accuracy, Coverage, Objectivity, Date, Significance) checklists. A customised data charting table will be used for data extraction, with analysis of qualitative data using the framework method. The review findings will be presented as tables and in a narrative summary.

Ethics and dissemination

Ethical review is not required as scoping reviews are a form of secondary data analysis that synthesise data from publically available sources. Review findings will be shared with service users and other relevant stakeholders and disseminated through a peer-reviewed publication and conference presentations. This protocol is registered on the Open Science Framework (www.osf.io).
MyPal-Child study protocol: an observational prospective clinical feasibility study of the MyPal ePRO-based early palliative care digital system in paediatric oncology patients
Authors: Meyerheim Marcel , Karamanidou Christina , Payne Sheila , Garani-Papadatos Tina , Sander Annette , Downing Julia , Stamatopoulos Kostas , Ling Julie , Payne Cathy , Scarfò Lydia , Lokaj Petr , Maramis Christos , Graf Norbert
Published: April 2021

Introduction

Electronic patient-reported outcomes (ePROs) have tremendous potential to optimise palliative and supportive care for children with cancer, their families and healthcare providers. Particularly, these children and their families are subjected to multiple strains caused by the disease and its treatment. The MyPal digital health platform is designed to address these complex demands by offering pursuant ePRO-based functionalities via two mobile applications, one developed for children and the other for their parents.

Methods and analysis

In this observational prospective feasibility study, 100 paediatric oncology patients aged between 6 and 17 years and at least one of their parents/legal guardians will be recruited at three clinical sites in two European countries (Germany and Czech Republic). They will use the mobile applications which are part of the novel digital health platform. During a 6-month study period, participants will complete various ePROs via the applications addressing quality of life, satisfaction with care and impact of the disease on the family at monthly intervals. Additionally, priority-based symptom reporting is integrated into a serious game for children. Outcomes that will be assessed concern the feasibility and the evaluation of the newly designed digital health platform to contribute to the evidence base of clinical ePRO use in paediatric oncology and palliative care process.

Ethics and dissemination

The MyPal-Child study obtained ethical approval from the Ethics Committee responsible for the University of Saarland, that is, the Ärztekammer des Saarlandes, the Ethics Committee of the Medical School Hannover and the Ethics Committee of the University of Brno. Study results will be disseminated through scientific publications, presentations at international conferences, congresses and a final report to the European Commission. General publicly accessible information can be found on the project website (www.mypal-project.eu) and social media.

Trial registration numbers

U1111-1251-0043, DRKS00021458,NCT04381221.
Cognitive Outcomes after DEXmedetomidine sedation in cardiac surgery: CODEX randomised controlled trial protocol
Authors: Choi Stephen , Jerath Angela , Jones Philip , Avramescu Sinziana , Djaiani George , Syed Summer , Saha Tarit , Kaustov Lilia , Kiss Alex , D"Aragon Frédérick , Hedlin Peter , Rajamohan Raja , Couture Etienne J. , Singh Amara , Mapplebeck Josiane CS , Wong Sophia , Orser Beverley Anne
Published: April 2021

Introduction

Older patients undergoing cardiac surgery carry the highest risk for developing major postoperative neurocognitive disorder (postoperative NCD or P-NCD) with up to 25% incidence 3 months after surgery. P-NCD is associated with significant morbidity, mortality, loss of independence, premature retirement and increased healthcare costs. This multicentre randomised trial is investigating the efficacy of postoperative dexmedetomidine sedation in reducing the incidence of major P-NCD after cardiac surgery compared with standard protocols. CODEX will be the largest interventional trial with major P-NCD as the primary outcome.

Methods and analysis

CODEX is recruiting patients ≥60 years old, undergoing elective cardiac surgery and without pre-existing major cognitive dysfunction or dementia. Eligible participants are randomised to receive postoperative dexmedetomidine or standard institutional sedation protocols in the intensive care unit. Baseline preoperative cognitive function is assessed with the computer-based Cogstate Brief Battery. The primary outcome, major P-NCD, 3 months after surgery is defined as a decrease in cognitive function ≥1.96 SD below age-matched, non-operative controls. Secondary outcomes include delirium, major P-NCD at 6/12 months, depressive symptoms, mild P-NCD and quality of surgical recovery at 3/6/12 months. The specific diagnostic criteria used in this protocol are consistent with the recommendations for clinical assessment and management of NCD from the Nomenclature Consensus Working Group on perioperative cognitive changes. Intention-to-treat analysis will compare major P-NCD at 3 months between study groups.

Ethics and dissemination

CODEX was approved by Sunnybrook Health Sciences Centre Research Ethics Board (REB) (Project ID 1743). This will be the first multicentre, randomised controlled trial to assess the efficacy of a pharmacological intervention to reduce the incidence of major P-NCD after cardiac surgery in patients ≥60 years old. Dissemination of the study results will include briefings of key findings and interpretation, conference presentations and peer-reviewed publications.

Trial registration number

NCT04289142.
Patient outcomes and costs associated with functional medicine-based care in a shared versus individual setting for patients with chronic conditions: a retrospective cohort study
Authors: Beidelschies Michelle , Alejandro-Rodriguez Marilyn , Guo Ning , Postan Anna , Jones Tawny , Bradley Elizabeth , Hyman Mark , Rothberg Michael B
Published: April 2021

Objective

To compare outcomes and costs associated with functional medicine-based care delivered in a shared medical appointment (SMA) to those delivered through individual appointments.

Design

A retrospective cohort study was performed to assess outcomes and cost to deliver care to patients in SMAs and compared with Propensity Score (PS)-matched patients in individual appointments.

Setting

A single-centre study performed at Cleveland Clinic Center for Functional Medicine.

Participants

A total of 9778 patients were assessed for eligibility and 7323 excluded. The sample included 2455 patients (226 SMAs and 2229 individual appointments) aged ≥18 years who participated in in-person SMAs or individual appointments between 1 March 2017 and 31 December 2019. Patients had a baseline Patient-Reported Outcome Measurement Information System (PROMIS) Global Physical Health (GPH) score and follow-up score at 3 months. Patients were PS-matched 1:1 with 213 per group based on age, sex, race, marital status, income, weight, body mass index, blood pressure (BP), PROMIS score and functional medicine diagnostic category.

Primary and secondary outcome measures

The primary outcome was change in PROMIS GPH at 3 months. Secondary outcomes included change in PROMIS Global Mental Health (GMH), biometrics, and cost.

Results

Among 213 PS-matched pairs, patients in SMAs exhibited greater improvements at 3 months in PROMIS GPH T-scores (mean difference 1.18 (95% CI 0.14 to 2.22), p=0.03) and PROMIS GMH T-scores (mean difference 1.78 (95% CI 0.66 to 2.89), p=0.002) than patients in individual appointments. SMA patients also experienced greater weight loss (kg) than patients in individual appointments (mean difference −1.4 (95% CI −2.15 to −0.64), p<0.001). Both groups experienced a 5.5 mm Hg improvement in systolic BP. SMAs were also less costly to deliver than individual appointments.

Conclusion

SMAs deliver functional medicine-based care that improves outcomes more than care delivered in individual appointments and is less costly to deliver.
Testing for SARS-CoV-2 seroprevalence: experiences of a tertiary eye centre
Authors: Ziemssen Focke , Feng You-Shan , Schnichels Sven , Bayyoud Tarek , Ueffing Marius , Bartz-Schmidt Karl Ulrich , Martus Peter , Peter Andreas
Published: April 2021

Introduction

The actual prevalence of a SARS-CoV-2 infection and the individual assessment of being or having been infected may differ. Facing the great uncertainty—especially at the beginning of the pandemic—and the possibility of asymptomatic or mildly symptomatic, subclinical infections, we evaluate the experience of SARS-CoV-2 antibody screening at a tertiary clinical setting.

Methods and analysis

All employees of a tertiary eye centre and a research institute of ophthalmology were offered antibody testing in May 2020, using a sequential combination of different validated assays/antigens and point-of-care (POC) testing for a subset (NCT04446338). Before taking blood, a systematic inquiry into past symptoms, known contacts and a subjective self-assessment was documented. The correlations between serostatus, patient contacts and demographic characteristics were analysed. Different tests were compared by Kappa statistics.

Results

Among 318 participants, SARS-CoV-2 antibodies were detected in 9 employees. Chemiluminescence assays (chemiluminescence immunoassay and electrochemiluminescence) showed superior specificity and high reproducibility, compared with ELISA and POC results.

In contrast to the low seropositivity (2.8%) of healthcare workers, higher than that of the other departments of the hospital, a large proportion mistakenly assumed that they might have already been infected. Antiviral antibody titres increased and remained on a plateau for at least 3 months.

Conclusions

The great demand and acceptance confirmed the benefit of highly sensitive testing methods in the early phase of the pandemic. The coincidence of low seroprevalence and anxious employees may have contributed to internalising the need of hygiene measures.
Virtual tabletop simulations for primary care pandemic preparedness and response
Authors: Blaak Marlot Johanna , Fadaak Raad , Davies Jan M , Pinto Nicole , Conly John , Leslie Myles
Published: April 2021

Introduction

The COVID-19 pandemic prompted widescale use of clinical simulations to improve procedures and practices. We outline our deployment of a virtual tabletop simulation (TTS) method in primary care (PC) clinics across Alberta, Canada. We summarise the quality and safety improvements from this method and report end users’ perspectives on key elements.

Methods

Our virtual TTS used teleconferencing software alongside digital whiteboards to walk clinic stakeholders through patient scenarios. Participants reviewed and rehearsed their workflows and care practices. The goal was for staff to take ownership over gaps and codesigned solutions. After simulation sessions, follow-up interviews were conducted to collect feedback.

Results

These sessions helped PC staff identify and codesign solutions for clinical hazards and threats. These included the flow of patients through clinics, communications, redesignation of physical spaces, and adaptation of guidance for cleaning and personal protective equipment use. End users reported sessions provided neutral spaces to discuss practice changes and built confidence in delivering safe care during the pandemic.

Discussion

TTS has not been extensively deployed to improve clinical practice in outpatient environments. We show how virtual TTS can bridge gaps between knowledge and practice by offering a guided space to rehearse clinical changes. We show that virtual TTS can be used in multiple contexts to help identify hazards, improve safety and build confidence in professional teams adapting to rapid changes in both policies and practices. While our sessions were conducted in Alberta, our results suggest this method may be deployed in other contexts, including low-resource settings.
Oligoclonal IgG bands in chronic inflammatory polyradiculoneuropathies
Authors: Ruiz Marta , Puthenparampil Marco , Campagnolo Marta , Castellani Francesca , Salvalaggio Alessandro , Ruggero Susanna , Toffanin Elisabetta , Cacciavillani Mario , Gallo Paolo , Franciotta Diego , Briani Chiara
Published: April 2021

Background

Cerebrospinal fluid (CSF) albumincytologic dissociation represents a supportive diagnostic criterion of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP).Few studies have investigated possible systemic or intrathecal humoral immune response activation in CIDP.

Aim of our study was to investigate whether the search of oligoclonal IgG bands (OCBs) might provide additional data helpful in CIDP diagnostic work-up.

Methods

Forty-eight consecutive patients with CIDP (34 men, mean age 59.4, range 16–83) were recruited. CSF analysis included nephelometric measurement of albumin and IgG concentrations, calculation of QALB, QAlbLIM and intrathecal IgG synthesis, and OCBs detection with isoelectric focusing. Data were compared with those from CSF and serum of 32 patients with Guillain-Barré syndrome (GBS), 18 patients with anti-myelin associated glycoprotein (MAG) antibody neuropathy, 4 patients with multifocal motor neuropathy and 32 patients with non-inflammatory neuropathies (NINPs).

Results

Patients with CIDP and anti-MAG antibody neuropathy had significantly higher CSF albumin concentrations and QALB values than NINPs (p=0.0003 and p=0.0095, respectively). A total of 9 (19%) patients with CIDP presented identical serum and CSF OCBs (‘mirror pattern’) versus 3 patients (16.6%) with anti-MAG antibody neuropathy, 13 patients (40.6%) with GBS and 12.5% patients with NINPs. Only one patient with CIDP showed unique-to-CSF OCBs. First-line therapy was effective in 80.4% of patients with CIDP, irrespective of CSF findings.

Conclusions

Compared with NINP, CIDP, GBS and anti-MAG antibody neuropathies had a significantly increased CSF protein and blood–spinal nerve root barrier damage. Intrathecal humoral immune response is rare in our patients with CIDP. Systemic oligoclonal activation is more frequent, but not significantly different from what was detected in the control groups.
Physician-assisted suicide and physician-assisted euthanasia: evidence from abroad and implications for UK neurologists
Authors: Nath Uma , Regnard Claud , Lee Mark , Lloyd Kiran Alexander , Wiblin Louise
Published: April 2021

In this article, we consider the arguments for and against physician-assisted suicide (AS) and physician-assisted euthanasia (Eu). We assess the evidence around law and practice in three jurisdictions where one or both are legal, with emphasis on data from Oregon. We compare the eligibility criteria in these different regions and review the range of approved disorders. Cancer is the most common cause for which requests are granted, with neurodegenerative diseases, mostly motor neurone disease, ranking second. We review the issues that may drive requests for a physician-assisted death, such as concerns around loss of autonomy and the possible role of depression. We also review the effectiveness and tolerability of some of the life-ending medications used. We highlight significant variation in regulatory oversight across the different models. A large amount of data are missing or unavailable. We explore physician-AS and physician-assisted Eu within the wider context of end-of-life practice.
An unusual case of giant cell arteritis
Authors: Pauls Mathilde , Singh Mantegh , Martin Peter
Published: April 2021

A 73-year-old man presented with unsteadiness and general malaise and later had problems with cognition. This was initially diagnosed as benign paroxysmal positional vertigo, but he was later found to have giant cell arteritis. Neurologists and physicians should be aware that giant cell arteritis can present with encephalopathy rather than the more typical features of headache, jaw pain and visual disturbance.
Sources of flavoured e-cigarettes among California youth and young adults: associations with local flavoured tobacco sales restrictions
Authors: Gaiha Shivani Mathur , Henriksen Lisa , Halpern-Felsher Bonnie , Rogers Todd , Feld Ashley L , Gaber Jennifer , Andersen-Rodgers Elizabeth
Published: April 2021

Purpose

This study compares access to flavoured JUUL and other e-cigarettes from retail, online and social sources among underage and young adult e-cigarette users who live in California jurisdictions that restrict sales of flavoured tobacco with the rest of the state.

Methods

An online survey used social media advertisements to recruit participants (n=3075, ages 15–29) who lived in one of nine jurisdictions that restrict sales (n=1539) or in the rest of state, and oversampled flavoured tobacco users. Focusing on past-month e-cigarette users (n=908), multilevel models tested whether access to flavoured JUUL and other e-cigarettes from retail, online and social sources differed by local law (yes/no) and age group (15–20 or older), controlling for other individual characteristics.

Results

The percent of underage users who obtained flavoured JUUL and other e-cigarettes in the past month was 33.6% and 31.2% from retail, 11.6% and 12.7% online, and 76.0% and 70.9% from social sources, respectively. Compared with underage and young adult users in the rest of California, those in localities that restrict the sales of flavoured tobacco were less likely to obtain flavoured JUUL from retail sources (Adjusted OR=0.54, 95% CI 0.36 to 0.80), but more likely to obtain it from social sources (Adjusted OR=1.55, 95% CI 1.02 to 2.35). The same pattern was observed for other brands of flavoured e-cigarettes.

Conclusion

Although local laws may reduce access to flavoured e-cigarettes from retail sources, more comprehensive state or federal restrictions are recommended to close the loopholes for online sources. Dedicated efforts to curtail access from social sources are needed.
Assessment of natural regeneration of longleaf pine (Pinus palustris) 15 years post-regeneration control
Authors: Fan Zhaofei , Moser W. Keith , Poyner Cameron , Yang Shaoyang , Nepal Sunil , Kush John S. , Lauer Dwight K.
Published: April 2021

We assessed natural regeneration of longleaf pine (Pinus palustris Mill.) using the data collected from the Escambia Experimental Forest in southern Alabama. Fifteen years after the regeneration control, natural regeneration of longleaf pine remained patchy across a wide range of site and stand conditions; slightly more than half of all plots contained regeneration, but the density of seedlings and saplings varied significantly. The abundance of seedlings ≤1-year-old was positively related to stand age and time since last fire, but negatively related to overstory basal area. The abundance of seedlings and saplings was positively related to stand age, but negatively related to time since last fire and overstory basal area. The probability of achieving at least 15 000 seedlings·ha–1 that are older than 1 year but less than 1 m tall and at least 1250 saplings·ha–1 that are over 1 m tall was, respectively, positively related to the ratio of time since last fire to overstory basal area and the ratio of quadratic mean diameter to site index. A longer fire interval (> 2 to 3 years) should be adopted to naturally regenerate longleaf. We did not find clear zones of exclusion present in natural regeneration even though overstory trees, seedlings, and saplings tended to be repulsive spatially and >80% grass stage seedlings and saplings occurred outside tree crowns.
The effect of drag force on the body frequencies and the power spectrum of a bladeless wind turbine
Authors: Maftouni Negin , Dehghan Manshadi Mahsa , Mousavi Seyed Milad
Published: April 2021

New types of bladeless wind turbines and electricity generation are currently one of the most interesting topics in engineering. Electricity generation using structural vibration due to the resonance phenomenon is the concept behind a vortex bladeless turbine. The present study numerically investigated the effects of the drag force on the body frequency of an oscillating bladeless wind turbine. A two-dimensional numerical simulation was performed for a cylinder with a semi-circular cross-flow cross-section in two different cases. This research was conducted for both uncontrolled and controlled oscillating cylinders. The controlling process was performed using a pair of ring magnets as springs with a variable coefficient. The flow field, vibration, vortex shedding, structural frequencies, and resonance phenomena were studied in this research. Finally, the controlled and uncontrolled frequencies of the cylinder are explored, and the power spectra for various velocities are analyzed in two different states, namely, with and without a tuning system. From the results, it can be concluded that the usage of the controlling system in these turbines can significantly regulate the oscillations and increase the frequency value by limiting the vibration amplitude. According to this principle, it can be inferred that increasing the frequency of fluctuations greatly increases the production capacity of these turbines.
Continuous medium hypothesis-based study on the screw flight wear model and wear regularity in a screw ship unloader
Authors: Yang Weijie , Meng Wenjun , Dai Xiaobing , Yin Zhenxiao , Yao Fenglin , Yuan Yuan
Published: April 2021

Screw flight on a vertical screw conveyor, which is a spiral blade welded on an axial cylinder, is the core component of a screw ship unloader and can be seriously worn by the materials during long-term conveying. Damaged screw flights make the screw ship unloader unable to unload materials or even lead to an accident. Hence, we established a new screw flight wear model based on the Archard wear model and continuous medium hypothesis. Two influencing factors, speed and filling rate, were selected to study the wear law of the screw flight, and the wear law was verified experimentally. The results indicate that the experimental results were consistent with the calculation model. The wear rate of the screw flight was approximately parabola-increased with the increase in rotational speed, and the screw flight wear rate positively and linearly correlated with the filling rate.
Charged compact star in f(R, T) gravity in Tolman–Kuchowicz spacetime
Authors: Rej Pramit , Bhar Piyali , Govender Megan
Published: April 2021

In this current study, our main focus is on modeling the specific charged compact star SAX J 1808.4-3658 (M = 0.88 $$M_{\odot }$$

M
⊙

,  R = 8.9 km) within the framework of $$f(R,\,T)$$

f
(
R
,

T
)

modified gravity theory using the metric potentials proposed by Tolman–Kuchowicz (Tolman in Phys Rev 55:364, 1939; Kuchowicz in Acta Phys Pol 33:541, 1968) and the interior spacetime is matched to the exterior Reissner–Nordström line element at the surface of the star. Tolman–Kuchowicz metric potentials provide a singularity-free solution which satisfies the stability criteria. Here we have used the simplified phenomenological MIT bag model equation of state (EoS) to solve the Einstein–Maxwell field equations where the density profile ($$\rho $$
ρ
) is related to the radial pressure ($$p_{\mathrm{r}}$$

p
r

) as $$p_{\mathrm{r}}(r) = (\rho - 4B_{\mathrm{g}})/3$$

p
r

(
r
)

=

(
ρ
-
4

B
g

)

/
3

. Furthermore, to derive the values of the unknown constants $$a,\, b,\, B,\, C$$

a
,

b
,

B
,

C

and the bag constant $$B_{\mathrm{g}}$$

B
g

, we match our interior spacetime to the exterior Reissner–Nordström line element at the surface of stellar system. In addition, to check the physical validity and stability of our suggested model we evaluate some important properties, such as effective energy density, effective pressures, radial and transverse sound velocities, relativistic adiabatic index, all energy conditions, compactness factor and surface redshift. It is depicted from our current study that all our derived results lie within the physically accepted regime which shows the viability of our present model in the context of $$f(R,\,T)$$

f
(
R
,

T
)

modified gravity.
On the interplay between educational attainment and nutrition: a spatially-aware perspective
Authors: Azizi Fard Narges , De Francisci Morales Gianmarco , Mejova Yelena , Schifanella Rossano
Published: April 2021

Food choices are an integral part of wellbeing and longevity, yet poor nutrition is responsible for millions of deaths every year. Among the complex mosaic of determinants of food choices are demographic, socioeconomic, physiological, and also cultural. In this work, we explore the connection between educational attainment, as a proxy for cultural capital, and food purchases, as a proxy for food consumption. Unlike existing studies, which use diaries and surveys, we use a large-scale dataset of food-related products purchased from a major retailer in London over the course of one year. By using this high-resolution dataset, we are able to explore the spatial dependence of the various factors impacting food choices, and estimate their direct and indirect spatial effects. We characterize food consumption across two complementary dimensions of (1) diet composition, and (2) diet variety. By building spatial auto-regressive models on these variables, we obtain an improved fit compared to traditional regression, and illustrate the importance of spillover effects. Our results consistently confirm the association between a higher educational attainment and a healthier diet, even when controlling for spatial correlation. First, a low educational level is connected to diets high in carbohydrates and low in fibers. Second, it is also associated with higher consumption of sweets and red meats, while high educational level is linked to a greater consumption of fruits, vegetables, and fish. Third, highly-educated areas show an increased nutritional diversity, together with a lower caloric intake. Finally, we show the presence of spillover effects within the neighboring communities, which would need to be taken in consideration when designing public health policies and interventions.
Coupling resonance effect of interface delamination of laminates excited by horizontal shear wave sources on the surface
Authors: Guo Feng , Wu Jiu Hui
Published: April 2021

Coupling resonance effect of interface delamination of laminates excited by horizontal shear wave sources on the surface is studied by analytical methods based on forced propagation solutions deduced by surface perturbation methods, integral transformation methods and global-matrix methods. The influence of excitation sources on the interface shear stress is investigated. It is found that coupling resonance frequencies of interface shear stress are intrinsic properties of structures and are independent of excitation sources, at which even a very small perturbation can also lead to the interface stratification. The results provide the theoretical basis for layered and/or anti-layered design of laminates.
Periodic exciton–polariton solitons in semiconductor nanowires
Authors: Nji Nde Aboringong E. , Ndifon Ngek I. , Dikandé Alain M.
Published: April 2021

Exciton–polariton solitons are nonlinear quasiparticles composed of exciton–photon bound states due to the interaction of light with matter. In semiconductor micro-cavity systems, such as semiconductor micro and nanowires, polaritons are characterized by a negative mass which, combined with the repulsive nonlinear exciton–exciton interaction, leads to the generation of bright polariton solitons. In this work, we investigate the dynamics of bright exciton–polariton solitons in a finite-sized microcavity waveguide, assuming radiative losses to be balanced by the external pumping. Bright-soliton solutions to the model equations of motion, which consist of a periodic train of polariton pulses, are obtained in terms of Jacobi elliptic functions. Analytical expressions of the energies of both photonic and excitonic components of the pulse train are found. Results suggest that the size of a nanowire waveguide plays a relevant role in the quantitative estimate of the energy conveyed by polariton solitons propagating in the medium.
A Novel Multi-Criteria Risk Matrix to Assist in the Strategy Formulation Process: The Case of SMEs
Authors: Vasnier Jean-Marc , Messaadia Mourad , Maranzana Nicolas , Aoussat Ameziane
Published: April 2021

Small and medium-sized enterprises (SMEs) are the spine of the European economy and play a key role in adding value in all sectors of the economy. However, due to a lack of methodology and time, SME entrepreneurs struggle to formalize their strategies and too often remain ill-prepared to face today’s potential crises. This paper aims to propose a Risk Management (RM) tool to identify and assess the impact of risks on specific business strategic dimensions. The hypotheses and robustness of the model are tested using Monte Carlo simulation. The analysis shows that a reduced strategic risk matrix (size [Formula: see text]) could provide the same quality of information as a full strategic risk matrix (size [Formula: see text]) in about 80% of the cases, regardless of the weight of each criterion and the values of each risk factor. The results extend the limited use of RM tool in the field of SME Risk Management.