bluuebunny/crossref_metadata_2025 huggingface dataset:
Optimization of Turbine Cascade Squealer Tip Cooling Design by Combining Shaping and Flow Injection
Authors: Duan P. H. , He L.
Published: May 2021

In this study, a turbine cascade squealer tip is optimized by a multi-objective genetic algorithm (MOGA) with varying squealer heights and tip cooling configurations. The three objectives selected are the aerodynamic efficiency, the film cooling effectiveness, and the surface fluid temperature variance. The multi-scale methodology is implemented to reduce the computational cost and to skip the meshing of cooling holes. Two optimization approaches are compared: (a) a conventional method that optimizes an uncooled shape and the cooling configuration sequentially and (b) a method that optimizes shaping and cooling concurrently. The concurrent method is found to obtain better aerodynamic efficiency and heat transfer performance than the conventional optimization. Moreover, the aerodynamic efficiency ranking is changed by adding cooling to the uncooled blades. These observations are due to the strong interaction between the coolant and the tip leakage flow. They indicate that the coolant injected at the tip is not passive as expected in the conventional film cooling designs. By blocking the over tip leakage flow or forming a layer of air to level up the equivalent squealer cavity floor, the coolant can reduce the tip leakage loss, which contradicts the conventional wisdom that the added coolant should always lead to extra losses due to the extra mixing. The detailed observations of the flow field indicate that the influence of the squealer height towards the aerodynamic efficiency is caused by two competing effects: the blockage effect to reduce the tip leakage mass flowrate and the sudden expansion/contraction loss effect to generate additional loss.
Diagnostic Accuracy of Musculoskeletal Ultrasound on Long Head Biceps Tendon Pathologies
Authors: Ostrowski Jennifer L. , Beaumont Alexa , Dochterman Emily
Published: May 2021

Clinical Scenario:Pathologies of the long head of the biceps brachii (LHB) tendon are a source of shoulder pain in many people. It is important to have a reliable assessment of the LHB tendon to make an accurate diagnosis and provide the correct treatment or referral if necessary. Shoulder ultrasound is very accurate in the diagnosis of rotator cuff tears. However, its ability to detect pathologies of the LHB tendon is still unclear.Clinical Question:In patients with shoulder pain, can musculoskeletal ultrasound accurately diagnose LHB tendon pathologies?Summary of Key Findings:Four high-quality cohort studies met inclusion criteria and were included in the critical appraisal. The STrengthening the Reporting of OBservational studies in Epidemiology checklist was used to score the articles on methodology and consistency. Three studies evaluated accuracy in diagnosis of full-thickness tears and found high sensitivity (SN) and specificity (SP). Three studies evaluated accuracy in diagnosis of partial-thickness tears and found low SN and negative predictive value, but high SP and positive predictive value. Two studies evaluated tendon subluxation/dislocation and found high SN and SP. Two studies evaluated tendinitis and found moderate SN and high SP.Clinical Bottom Line:There is moderate to strong evidence to support the use of musculoskeletal ultrasound in diagnosis of LHB tendon pathology.Strength of Recommendation:There is grade B evidence that musculoskeletal ultrasound can accurately diagnose full-thickness tears and tendon subluxation/dislocation; can rule in partial-thickness tears (based on SP and positive predictive value), but not rule out partial-thickness tears; and can rule in tendinitis (based on SP and positive predictive value), but not rule out tendinitis.
Pharmacological activation of STING blocks SARS-CoV-2 infection
Authors: Li Minghua , Ferretti Max , Ying Baoling , Descamps Hélène , Lee Emily , Dittmar Mark , Lee Jae Seung , Whig Kanupriya , Kamalia Brinda , Dohnalová Lenka , Uhr Giulia , Zarkoob Hoda , Chen Yu-Chi , Ramage Holly , Ferrer Marc , Lynch Kristen , Schultz David C. , Thaiss Christoph A. , Diamond Michael S. , Cherry Sara
Published: May 2021

Pharmacological activation of STING blocks SARS-CoV-2 infection including variants of concern in vitro and in vivo.
Leptin increases GABAergic synaptogenesis through the Rho guanine exchange factor β-PIX in developing hippocampal neurons
Authors: Sahin Gulcan Semra , Luis Rodriguez-Llamas Jose , Dillon Crystal , Medina Igor , Appleyard Suzanne M. , Gaiarsa Jean-Luc , Wayman Gary A.
Published: May 2021

The hormone leptin promotes the formation of key neuronal connections in the developing hippocampus.
Distinct nutrient use in tumors
Authors: Foley John F.
Published: May 2021

Tumor cells and immune cells in the tumor microenvironment differentially take up nutrients.
Lactobacillus plantarum Reduces Low-Grade Inflammation and Glucose Levels in a Mouse Model of Chronic Stress and Diabetes
Authors: Youn Hyun Seong , Kim Jong-Hwa , Lee Ji Soo , Yoon Yeo Yeong , Choi Seong Jun , Lee Joo Young , Kim Wonyong , Hwang Kwang Woo
Published: May 2021

This study aimed to examine the effects of
Lactobacillus plantarum
, a lactic acid bacteria strain isolated from kimchi, on the development of low-grade inflammation and type 2 diabetes mellitus (T2DM) exacerbated by chronic stress. C57BL/6 mice were fed either a high-fat diet (HFD) and randomized into an HFD group or a group that was fed an HFD and subjected to chronic cold exposure-related stress (HFDS), or mice were fed a normal diet (ND) and randomized into an ND group or a group that was fed an ND and subjected to chronic cold exposure-related stress (NDS).
Lactobacillus plantarum
LRCC5310 (10
8
, 10
10
CFU) and LRCC5314 (10
8
, 10
10
CFU) as well as
L. gasseri
BNR17 (10
8
CFU), as a positive control, were administered orally twice every day to all the mice for 12 weeks.
Persistence Alters the Interaction between Chlamydia trachomatis and Its Host Cell
Authors: Brockett Mary R. , Liechti George W.
Published: May 2021

In response to stress, the obligate intracellular pathogenChlamydia trachomatisstops dividing and halts its biphasic developmental cycle. The infectious, extracellular form of this bacterium is highly susceptible to killing by the host immune response, and by pausing development,Chlamydiacan survive in an intracellular, “aberrant” state for extended periods of time.
Bioinformatic and Functional Characterization of Hsp70s in Myxococcus xanthus
Authors: Pan Zhuo , Zhang Zheng , Zhuo Li , Wan Tian-yu , Li Yue-zhong
Published: May 2021

Hsp70 proteins are highly conserved chaperones that occur in all kingdoms of life. Multiple copies of Hsp70s are often present in genome-sequenced prokaryotes, especially taxa with complex life cycles, such as myxobacteria.
Blocking Palmitoylation of Toxoplasma gondii Myosin Light Chain 1 Disrupts Glideosome Composition but Has Little Impact on Parasite Motility
Authors: Rompikuntal Pramod K. , Kent Robyn S. , Foe Ian T. , Deng Bin , Bogyo Matthew , Ward Gary E.
Published: May 2021

Gliding motility plays a central role in the life cycle of
T. gondii
and other apicomplexan parasites. The myosin motor thought to power motility is essential for virulence but distinctly different from the myosins found in humans.
Supplemental Material: Pure sediment-derived granites in a subduction zone
Authors: Xu Jian , al. et
Published: May 2021

Additional information on supplemental figures and tables.
Supplemental Material: Origin of syn-collisional granitoids in the Gangdese orogen: Reworking of the juvenile arc crust and the ancient continental crust
Authors: Tang Yu-Wei , Chen Long , al. et
Published: May 2021

Tables S1 and S2: zircon U-Pb ages, trace elements and Lu-Hf isotope data.
Polyethylene glycol versus lactulose in the treatment of hepatic encephalopathy: a systematic review and meta-analysis
Authors: Hoilat Gilles Jadd , Ayas Mohamad Fekredeen , Hoilat Judie Noemie , Abu-Zaid Ahmed , Durer Ceren , Durer Seren , Adhami Talal , John Savio
Published: May 2021

Background

Hepatic encephalopathy (HE) is defined as brain dysfunction that occurs because of acute liver failure or liver cirrhosis and is associated with significant morbidity and mortality. Lactulose is the standard of care till this date; however, polyethylene glycol (PEG) has gained the attention of multiple investigators.

Methods

We screened five databases namely PubMed, Scopus, Web of Science, Cochrane Library and Embase from inception to 10 February 2021. Dichotomous and continuous data were analysed using the Mantel-Haenszel and inverse variance methods, respectively, which yielded a meta-analysis comparing PEG versus lactulose in the treatment of HE.

Results

Four trials with 229 patients were included. Compared with lactulose, the pooled effect size demonstrated a significantly lower average HE Scoring Algorithm (HESA) Score at 24 hours (Mean difference (MD)=−0.68, 95% CI (−1.05 to –0.31), p<0.001), a higher proportion of patients with reduction of HESA Score by ≥1 grade at 24 hours (risk ratio (RR)=1.40, 95% CI (1.17 to 1.67), p<0.001), a higher proportion of patients with a HESA Score of grade 0 at 24 hours (RR=4.33, 95% CI (2.27 to 8.28), p<0.0010) and a shorter time to resolution of HE group (MD=−1.45, 95% CI (−1.72 to –1.18), p<0.001) in favour of patients treated with PEG.

Conclusion

PEG leads to a higher drop in the HESA Score and thus leads to a faster resolution of HE compared with lactulose.
Contexts of sedentary time and physical activity among ageing workers and recent retirees: cross-sectional GPS and accelerometer study
Authors: Pasanen Sanna , Halonen Jaana I , Pulakka Anna , Kestens Yan , Thierry Benoit , Brondeel Ruben , Pentti Jaana , Vahtera Jussi , Leskinen Tuija , Stenholm Sari
Published: May 2021

Objectives

We examined sedentary time and physical activity in different contexts among ageing workers, between their workdays and days off, and recent retirees, between their weekdays and weekend days.

Design

Cross-sectional study.

Setting

Finnish Retirement and Aging study and Enhancing physical activity and healthy ageing among recent retirees—Randomised controlled in-home physical activity trial.

Participants

137 workers (544 measurement days) and 53 retirees (323 days), who provided data for at least 1 workday/weekday and 1 day off/weekend day.

Primary and secondary outcome measures

Physical activity behaviour was measured with a combined Global Positioning System and accelerometer device (SenseDoc V.2.0), providing information on sedentary time, light physical activity and moderate-to-vigorous physical activity (MVPA) by locations (home or non-home) and trips (active travel, ie, speed <20 km/hour and passive travel, ie, speed ≥20 km/hour).

Results

Workers accumulated more sedentary time and physical activity at non-home locations than at home on workdays, while the opposite was confirmed for days off (p<0.01). Workers accrued more MVPA on days off than on workdays (34 vs 28 min, p<0.05), of which 9 min on workdays and 14 min on days off was accrued during active travel. Retirees’ physical activity behaviour did not differ between weekdays and weekend days (p>0.05). Regardless of the day, retirees accumulated 33 min of daily MVPA, of which 14 min was accrued during active travel.

Conclusions

Workers accumulated more MVPA on days off than on workdays, and their activity behaviour varied between workdays and days off at different locations. Our results showed that a large proportion of the MVPA was accumulated during travel at slower speeds, which suggests that active travel could be a feasible way to increase MVPA among older adults.

Trial registration number

NCT03320746.
Antithrombotic regimens in females with symptomatic lower extremity peripheral arterial disease: protocol for a systematic review and meta-analysis
Authors: Strauss Shira A , Jetty Prasad , Kobewka Daniel , Carrier Marc
Published: May 2021

Introduction

Patients with peripheral arterial disease (PAD) are at increased risk for systemic arterial thromboembolic events. Females represent a unique subset of patients with PAD, who differ from males in important ways: they have smaller diameter vessels, undergo lower extremity bypass less frequently and experience higher rates of graft occlusion, amputation and mortality than males. Females also trend towards higher rates of major coronary events and cardiovascular mortality. Current guidelines recommend monoantiplatelet therapy (MAPT) for secondary prevention in patients with symptomatic PAD. However, indications for more intensive antithrombotic therapy in this cohort—especially among females who are frequently under-represented in randomised controlled trials (RCTs)—remain unclear. As newer antithrombotic therapies emerge, some RCTs have demonstrated differential effects in females versus males. A systematic review is needed to quantify the rates of arterial thromboembolic and bleeding events with different antithrombotic regimens in females with symptomatic PAD.

Methods and analysis

We will search MEDLINE, Embase and the Cochrane Central Register of Controlled trials for published RCTs that include females with symptomatic PAD and compare full dose anticoagulation±antiplatelet therapy, dual pathway inhibition or dual antiplatelet therapy with MAPT. Title, abstract and full-text screening will be conducted in duplicate by three reviewers. Authors will be contacted to obtain sex-stratified outcomes as needed. Risk of bias will be assessed using the Cochrane Risk of Bias tool. Data will be extracted by independent reviewers and confirmed by a second reviewer. Quantitative synthesis will be conducted using Review Manager (RevMan) V.5 for applicable outcomes data. Planned subgroup analysis by PAD severity, vascular intervention and indication for antithrombotics will be conducted where data permits.

Ethics and dissemination

Ethics approval is waived as the study does not involve primary data collection. This review will be submitted for publication in a peer-reviewed journal and for presentation at national and international scientific meetings.

Trial registration number

This protocol was registered with the PROSPERO International Prospective
Register of Systematic Reviews (ID# CRD42020196933).
Identifying ethical values for guiding triage decisions during the COVID-19 pandemic: an Italian ethical committee perspective using Delphi methodology
Authors: Zeneli Anita , Brandi Giovanni , Di Pasquale Giuseppe , Orlandini Danilo , De Carolis Piero , Bravi Francesca , Pugliese Francesco , Poluzzi Elisabetta , Catena Fausto , Giovanardi Filippo , Valpiani Giorgia , Mantovani Renato , Magnanimi Eugenia , Iannone Primiano
Published: May 2021

Objectives

This study aimed to identify the guiding ethical principles that should be considered for critical resource allocation during pandemic emergency situations, and especially for the COVID-19 outbreak. The secondary objective was to define the priority to be assigned to each principle.

Setting

The study was conducted from March to June 2020 within the context of an ethical committee (EC) in Northern Italy.

Participants

Eleven EC members and five additional external healthcare and bioethical professionals, forming a multidisciplinary panel, took part in the study.

Primary and secondary outcome measures

The compilation of a list of ethical principles (maximum of 10 items) and their priority ranking and application within an emergency pandemic context was established as the expected outcome of this work.

Results

A consensus on 10 guiding ethical principles was reached by the multidisciplinary panel. Transparency ranked first on the priority list as the most frequently voted principle, followed by the number of lives saved, life-years saved, respect for individuals’ autonomy and equity. Other principles including life cycle, ‘sickest first’, reciprocity, instrumental value and lottery were also considered appropriate as potential tiebreakers. These principles were discussed and made consistent with the current Italian pandemic context by producing an explanatory document.

Conclusions

The identified principles could be used in preparedness plans to guide resource allocation during pandemic events. By combining their rank and relevance in relation to disease, health system organisations, social and economic settings, and critical resources at risk of scarcity, these principles could help to maximise the benefit of resource use for the community, thus reducing inequalities for individuals.
Cochlear implantation for tinnitus in adults with bilateral hearing loss: protocol of a randomised controlled trial
Authors: Assouly Kelly , Smit Adriana L , Stegeman Inge , Rhebergen Koenraad S , van Dijk Bas , Stokroos Robert
Published: May 2021

Introduction

Tinnitus is the perception of sound without an external stimulus, often experienced as a ringing or buzzing sound. Subjective tinnitus is assumed to origin from changes in neural activity caused by reduced or lack of auditory input, for instance due to hearing loss. Since auditory deprivation is thought to be one of the causes of tinnitus, increasing the auditory input by cochlear implantation might be a possible treatment. In studies assessing cochlear implantation for patients with hearing loss, tinnitus relief was seen as a secondary outcome. Therefore, we will assess the effect of cochlear implantation in patients with primarily tinnitus complaints.

Method and analysis

In this randomised controlled trial starting in January 2021 at the ENT department of the UMC Utrecht (the Netherlands), patients with a primary complaint of tinnitus will be included. Fifty patients (Tinnitus Functional Index (TFI)>32, Beck’s Depression Index <19, pure tone average at 0.5, 1, 2 kHz: bilateral threshold between ≥40 and ≤80 dB and hearing thresholds in the ear to be implanted (≥4 kHz) ≥50 dB) will be randomised towards cochlear implantation or no intervention. Primary outcome of the study is tinnitus burden as measured by the TFI. Outcomes of interest are tinnitus severity, hearing performances (tinnitus pitch and loudness, speech perception), quality of life, depression and patient-related changes. Outcomes will be evaluated prior to implantation and at 3 and 6 months after the surgery. The control group will receive questionnaires at 3 and 6 months after randomisation. We expect a significant difference between the cochlear implant recipients and the control group for tinnitus burden.

Ethics and dissemination

This research protocol was approved by the Institutional Review Board of the University Medical Center (UMC) Utrecht (NL70319.041.19, V5.0, January 2021). The trial results will be made accessible to the public in a peer-review journal.

Trial registration number

Trial registration numberNL8693; Pre-results.
Direct and mediated effects of treatment context on low back pain outcome: a prospective cohort study
Authors: Bishop Felicity , Al-Abbadey Miznah , Roberts Lisa , MacPherson Hugh , Stuart Beth , Carnes Dawn , Fawkes Carol , Yardley Lucy , Bradbury Katherine
Published: May 2021

Objectives

Contextual components of treatment previously associated with patient outcomes include the environment, therapeutic relationship and expectancies. Questions remain about which components are most important, how they influence outcomes and comparative effects across treatment approaches. We aimed to identify significant and strong contextual predictors of patient outcomes, test for psychological mediators and compare effects across three treatment approaches.

Design

Prospective cohort study with patient-reported and practitioner-reported questionnaire data (online or paper) collected at first consultation, 2 weeks and 3 months.

Setting

Physiotherapy, osteopathy and acupuncture clinics throughout the UK.

Participants

166 practitioners (65 physiotherapists, 46 osteopaths, 55 acupuncturists) were recruited via their professional organisations. Practitioners recruited 960 adult patients seeking treatment for low back pain (LBP).

Primary and secondary outcomes

The primary outcome was back-related disability. Secondary outcomes were pain and well-being. Contextual components measured were: therapeutic alliance; patient satisfaction with appointment systems, access, facilities; patients’ treatment beliefs including outcome expectancies; practitioners’ attitudes to LBP and practitioners’ patient-specific outcome expectancies. The hypothesised mediators measured were: patient self-efficacy for pain management; patient perceptions of LBP and psychosocial distress.

Results

After controlling for baseline and potential confounders, statistically significant predictors of reduced back-related disability were: all three dimensions of stronger therapeutic alliance (goal, task and bond); higher patient satisfaction with appointment systems; reduced patient-perceived treatment credibility and increased practitioner-rated outcome expectancies. Therapeutic alliance over task (ηp2=0.10, 95% CI 0.07 to 0.14) and practitioner-rated outcome expectancies (ηp2=0.08, 95% CI 0.05 to 0.11) demonstrated the largest effect sizes. Patients’ self-efficacy, LBP perceptions and psychosocial distress partially mediated these relationships. There were no interactions with treatment approach.

Conclusions

Enhancing contextual components in musculoskeletal healthcare could improve patient outcomes. Interventions should focus on helping practitioners and patients forge effective therapeutic alliances with strong affective bonds and agreement on treatment goals and how to achieve them.
COVID-19 health and social care access for autistic people: European policy review
Authors: Oakley Bethany , Tillmann Julian , Ruigrok Amber , Baranger Aurélie , Takow Christian , Charman Tony , Jones Emily , Cusack James , Doherty Mary , Violland Pierre , Wroczyńska Agnieszka , Simonoff Emily , Buitelaar Jan K , Gallagher Louise , Murphy Declan G M
Published: May 2021

Background

The global COVID-19 pandemic has had an unprecedented impact on European health and social care systems, with demands on testing, hospital and intensive care capacity exceeding available resources in many regions. This has led to concerns that some vulnerable groups, including autistic people, may be excluded from services.

Methods

We reviewed policies from 15 European member states, published in March–July 2020, pertaining to (1) access to COVID-19 tests; (2) provisions for treatment, hospitalisation and intensive care units (ICUs); and (3) changes to standard health and social care. In parallel, we analysed survey data on the lived experiences of 1301 autistic people and caregivers.

Results

Autistic people experienced significant barriers when accessing COVID-19 services. First, despite being at elevated risk of severe illness due to co-occurring health conditions, there was a lack of accessibility of COVID-19 testing. Second, many COVID-19 outpatient and inpatient treatment services were reported to be inaccessible, predominantly resulting from individual differences in communication needs. Third, ICU triage protocols in many European countries (directly or indirectly) resulted in discriminatory exclusion from lifesaving treatments. Finally, interruptions to standard health and social care left over 70% of autistic people without everyday support.

Conclusions

The COVID-19 pandemic has further exacerbated existing healthcare inequalities for autistic people, probably contributing to disproportionate increases in morbidity and mortality, mental health and behavioural difficulties, and reduced quality of life. An urgent need exists for policies and guidelines on accessibility of COVID-19 services to be updated to prevent the widespread exclusion of autistic people from services, which represents a violation of international human rights law.
Injury Prevention and long-term Outcomes following Trauma—the IPOT project: a protocol for prospective nationwide registry-based studies in Norway
Authors: Stenehjem Jo Steinson , Røise Olav , Nordseth Trond , Clausen Thomas , Natvig Bård , O Skurtveit Svetlana , Eken Torsten , Kristiansen Thomas , Gran Jon Michael , Rosseland Leiv Arne
Published: May 2021

Introduction

Traumatic injuries constitute a major cause of mortality and morbidity. Still, the public health burden of trauma in Norway has not been characterised using nationwide registry data. More knowledge is warranted on trauma risk factors and the long-term outcomes following trauma. The Injury Prevention and long-term Outcomes following Trauma project will establish a comprehensive research database. The Norwegian National Trauma Registry (NTR) will be merged with several data sources to pursue the following three main research topics: (1) the public health burden of trauma to society (eg, excess mortality and disability-adjusted life-years (DALYs)), (2) trauma aetiology (eg, socioeconomic factors, comorbidity and drug use) and (3) trauma survivorship (eg, survival, drug use, use of welfare benefits, work ability, education and income).

Methods and analysis

The NTR (n≈27 000 trauma patients, 2015–2018) will be coupled with the data from Statistics Norway, the Norwegian Patient Registry, the Cause of Death Registry, the Registry of Primary Health Care and the Norwegian Prescription Database. To quantify the public health burden, DALYs will be calculated from the NTR. To address trauma aetiology, we will conduct nested case–control studies with 10 trauma-free controls (drawn from the National Population Register) matched to each trauma case on birth year, sex and index date. Conditional logistic regression models will be used to estimate trauma risk according to relevant exposures. To address trauma survivorship, we will use cohort and matched cohort designs and time-to-event analyses to examine various post-trauma outcomes.

Ethics and dissemination

The project is approved by the Regional Committee for Medical Research Ethics. The project’s data protection impact assessment is approved by the data protection officer. Results will be disseminated to patients, in peer-reviewed journals, at conferences and in the media.
Prospective bladder cancer infrastructure for experimental and observational research on bladder cancer: study protocol for the ‘trials within cohorts’ study ProBCI
Authors: Richters Anke , Meijer Richard P , Mehra Niven , Boormans Joost L , van der Heijden Antoine G , van der Heijden Michiel S , Kiemeney Lambertus A , Aben Katja K
Published: May 2021

Introduction

A better understanding of the molecular profile of bladder tumours, the identification of novel therapeutic targets, and introduction of new drugs and has renewed research interest in the field of bladder cancer. We describe the design and setup of a Dutch Prospective Bladder Cancer Infrastructure (ProBCI) as a means to stimulate and accelerate clinically meaningful experimental and observational research.

Methods and analysis

ProBCI entails an open cohort of patients with bladder cancer in which the trials within cohorts (TwiCs) design can be embedded. Physicians in participating hospitals prospectively recruit invasive (≥T1) patients with bladder cancer on primary diagnosis for inclusion into the study. Extensive clinical data are collected and updated every 4 months, along with patient-reported outcomes and biomaterials. Informed consent includes participation in TwiCs studies and renewed contact for future studies. Consent for participation in questionnaires and molecular analyses that may yield incidental findings is optional.

Ethics and dissemination

The Dutch ProBCI is a unique effort to construct a nation-wide cohort of patients with bladder cancer including clinical data, patient-reported outcomes and biomaterial, to facilitate observational and experimental research. Data and materials are available for other research groups on request throughwww.probci.nl. Ethics approval was obtained from METC Utrecht (reference: NL70207.041.19).

Trial registration number

NCT04503577.
Implementation of different HIV self-testing models with implications for HIV testing services during the COVID-19 pandemic: study protocol for secondary data analysis of the STAR Initiative in South Africa
Authors: Majam Mohammed , Conserve Donaldson F , Zishiri Vincent , Haile Zelalem T , Tembo Angela , Phiri Jane , Hatzold Karin , Johnson Cheryl C , Venter Francois
Published: May 2021

Introduction

HIV self-testing (HIVST) presents a convenient, private approach that removes barriers to providing HIV testing services. The Self-Testing Africa (STAR) Initiative aims to scale up HIVST among priority and undertested populations. HIVST has the potential to help maintain testing services during the social distancing restrictions implemented to prevent the spread of COVID-19. This project evaluates linkage to confirmatory testing and treatment for HIV-positive clients for the STAR South Africa site.

Methods and analysis

This secondary data analysis protocol aims to evaluate different HIVST distribution models from a prospective study implemented during November 2017 and December 2020 by Ezintsha, a subdivision of Wits Reproductive Health and HIV Institute. Routinely collected distribution and self-reported HIVST outcomes data will be deidentified and analysed. The main outcomes of interest are linkage to care and treatment among HIVST users who report a reactive HIVST result. Additionally, we plan to determine sociodemographic factors associated with linkage to care and treatment among HIVST users. Descriptive statistics will be used to describe the variables of interest, and modified Poisson regression with robust variance estimation will be performed to identify factors associated with linkage to care and treatment among HIVST users who report a reactive HIVST result. Risk ratios and 95% CIs for the risk ratios will be reported.

Ethics and dissemination

The study protocol has been approved by the University of Witwatersrand Human Research Ethics Committee. The dissemination plan for the study findings will include presentations to local and international health authorities, international conferences and publications in open access journals.
Exploration of the impact of the COVID-19 pandemic on people with dementia and carers from black and minority ethnic groups
Authors: West Emily , Nair Pushpa , Barrado-Martin Yolanda , Walters Kate R , Kupeli Nuriye , Sampson Elizabeth L , Davies Nathan
Published: May 2021

Introduction

Despite community efforts to support and enable older and vulnerable people during the COVID-19 pandemic, many people with dementia and their family carers are still finding it difficult to adjust their daily living in light of the disruption that the pandemic has caused. There may be needs specific to black, Asian and minority ethnic (BAME) populations in these circumstances that remain thus far unexplored.

Objective

The aim of the study was to explore the effects of the COVID-19 pandemic on people living with dementia and their family carers of BAME backgrounds, in relation to their experiences of community dementia care and the impact on their daily lives.

Design

15 participants (persons with dementia and carers) were recruited for semistructured qualitative interviews. Respondents were of South Asian and Afro-Caribbean backgrounds. We used thematic analysis to analyse our data from a constructivist perspective, which emphasises the importance of multiple perspectives, contexts and values.

Results

There were a number of ways that the COVID-19 pandemic has impacted BAME persons with dementia and carers with regard to their experiences of dementia community care and the impact on their everyday lives. In particular we identified eight key themes, with subthemes: fear and anxiety, food and eating (encompassing food shopping and eating patterns), isolation and identity, community and social relationships, adapting to COVID-19, social isolation and support structures, and medical interactions. Fear and anxiety formed an overarching theme that encompassed all others.

Discussion

This paper covers unique and underexplored topics in a COVID-19-vulnerable group. There is limited work with these groups in the UK and this is especially true in COVID-19. The results showed that such impacts were far-reaching and affected not only day-to-day concerns, but also care decisions with long-ranging consequences, and existential interests around fear, faith, death and identity.
Single-centre retrospective analysis of the best timing for the QTc interval length assessment in neonates
Authors: Marcellino Alessia , Luchetti Jessica , Raponi Massimo , Falsaperla Raffaele , Pirone Carmelo , Fares Maria Katia , Ventriglia Flavia , Lubrano Riccardo
Published: May 2021

Objective

To evaluate the best timing for ECG screening in order to diagnose long QT syndrome and lower, at the same time, the false positives.

Design

We retrospectively evaluated the corrected QT (QTc) interval in the clinical reports of the ECG screening performed, as per internal protocol.

Setting

An outpatient setting in our Unit of Neonatology and Pediatrics, Santa Maria Goretti Hospital in Latina, Italy.

Patients

We enrolled 3467 healthy neonates between 14 and 30 days of life.

Interventions

The newborns with abnormal QTc interval were invited to subsequent revaluation every 21 days, until normalisation or necessity to refer to a tertiary paediatric cardiology centre.

Main outcome measures

Difference in QTc according to patients’ characteristics and number of false positives at second ECG evaluation.

Results

At first evaluation, 249 (7.2%) newborns had prolonged QTc. We did not find any significant difference in the QTc length according to gestational age (p=0.40) and birth weight (p=0.81). As expected, girls had longer QTc than boys (p=0.01). Only 11 out of 240 (4.6%) and 1 out of 238 infants (0.4%) had persistently prolonged QTc at second and third ECG evaluation, respectively. The QTc decreased significantly at second (p<0.0001) and third evaluation (p=0.0035).

Conclusions

In our study, we showed that a single screening performed in healthy infants after 60 days of life could reduce the risk of false positives, with a beneficial impact on public national health system and the chance to start early therapy in case of long QT syndrome.
Daily life participation in childhood chronic disease: a qualitative study on the child’s and parent’s perspective
Authors: Nap-van der Vlist Merel M , Berkelbach van der Sprenkel Emma E , Nijhof Linde N , Grootenhuis Martha A , van der Ent Cornelis K , Swart Joost F , van Royen-Kerkhof Annet , van Grotel Martine , van de Putte Elise M , Nijhof Sanne L , Kars Marijke C
Published: May 2021

Objective

To understand how a child with a stable chronic disease and his/her parents shape his/her daily life participation, we assessed: (1) the parents’ goals regarding the child’s daily life participation, (2) parental strategies regarding the child’s participation and () how children and their parents interrelate when their goals regarding participation are not aligned.

Methods

This was a qualitative study design using a general inductive approach. Families of children 8–19 years with a stable chronic disease (cystic fibrosis, autoimmune disease or postcancer treatment) were recruited from the PROactive study. Simultaneous in-depth interviews were conducted separately with the child and parent(s). Analyses included constant comparison, coding and categorisation.

Results

Thirty-one of the 57 invited families (54%) participated. We found that parents predominantly focus on securing their child’s well-being, using participation as a means to achieve well-being. Moreover, parents used different strategies to either support participation consistent with the child’s healthy peers or support participation with a focus on physical well-being. The degree of friction between parents and their child was based on the level of agreement on who takes the lead regarding the child’s participation.

Conclusions

Interestingly, parents described participation as primarily a means to achieve the child’s well-being, whereas children described participation as more of a goal in itself. Understanding the child’s and parent’s perspective can help children, parents and healthcare professionals start a dialogue on participation and establish mutual goals. This may help parents and children find ways to interrelate while allowing the child to develop his/her autonomy.
How does the effectiveness of strategies to improve healthcare provider practices in low-income and middle-income countries change after implementation? Secondary analysis of a systematic review
Authors: Arsenault Catherine , Rowe Samantha Y , Ross-Degnan Dennis , Peters David H , Roder-DeWan Sanam , Kruk Margaret E , Rowe Alexander K
Published: May 2021

Background

A recent systematic review evaluated the effectiveness of strategies to improve healthcare provider (HCP) performance in low-income and middle-income countries. The review identified strategies with varying effects, including in-service training, supervision and group problem-solving. However, whether their effectiveness changed over time remained unclear. In particular, understanding whether effects decay over time is crucial to improve sustainability.

Methods

We conducted a secondary analysis of data from the aforementioned review to explore associations between time and effectiveness. We calculated effect sizes (defined as percentage-point (%-point) changes) for HCP practice outcomes (eg, percentage of patients correctly treated) at each follow-up time point after the strategy was implemented. We estimated the association between time and effectiveness using random-intercept linear regression models with time-specific effect sizes clustered within studies and adjusted for baseline performance.

Results

The primary analysis included 37 studies, and a sensitivity analysis included 77 additional studies. For training, every additional month of follow-up was associated with a 0.19 %-point decrease in effectiveness (95% CI: –0.36 to –0.03). For training combined with supervision, every additional month was associated with a 0.40 %-point decrease in effectiveness (95% CI: –0.68 to –0.12). Time trend results for supervision were inconclusive. For group problem-solving alone, time was positively associated with effectiveness, with a 0.50 %-point increase in effect per month (95% CI: 0.37 to 0.64). Group problem-solving combined with training was associated with large improvements, and its effect was not associated with time.

Conclusions

Time trends in the effectiveness of different strategies to improve HCP practices vary among strategies. Programmes relying solely on in-service training might need periodical refresher training or, better still, consider combining training with group problem-solving. Although more high-quality research is needed, these results, which are important for decision-makers as they choose which strategies to use, underscore the utility of studies with multiple post-implementation measurements so sustainability of the impact on HCP practices can be assessed.
Life-limiting fetal conditions and pregnancy continuation: parental decision-making processes
Authors: Denney-Koelsch Erin , Cote-Arsenault Denise
Published: May 2021

Objectives

When parents are facing a life-limiting fetal condition (LLFC), decision making about prenatal and neonatal care is very stressful. To participate in successful shared decision making, interdisciplinary care teams need to understand factors that parents consider and the process by which they make decisions about care of their baby.

Methods

This study reports on findings about parental decision making from a larger longitudinal, naturalistic study of parents’ experiences of continuing pregnancy with an LLFC. Mothers and fathers over 18 were interviewed in person, on phone or via video, twice during pregnancy and twice after birth and death. Transcripts were professionally transcribed and verified. Data were analysed with iterative coding and theme identification, using within-case and cross-case comparison.

Results

Thirty parents (16 mothers, 13 fathers, 1 lesbian partner) from multiple US states and a range of racial/ethnic backgrounds were interviewed. Parents’ experience with decision making was difficult, stressful and time-sensitive. They described a three-phase process: (1) identifying the decision to be made, (2) conducting a risk–benefit analysis to weigh objective medical information and subjective factors (values and spirituality, impact on self, partner, baby and the other children) and (3) making a decision. Parents considered diagnostic and prognostic certainty, likelihood of a good outcome and avoidance of suffering and regrets.

Conclusion

For shared-decision making, healthcare providers must discuss objective medical information as well as recognise parents’ subjective values and priorities. This study expands on the literature on parental decision making around the numerous types of decisions after LLFC, informing obstetrics, neonatology and palliative care.
Provision and standards of care for treatment and follow-up of patients with Autoimmune Hepatitis (AIH)
Authors: Gordon Victoria Mary , Adhikary Ratul , Aithal Guruprasad P , Appleby Victoria , Das Debasish , Day James , Delahooke Toby , Dixon Selena , Elphick David , Hardie Claire , Heneghan Michael , Hoeroldt Barbara , Hooper Patricia , Hutchinson John , Jones Rebecca L , Khan Faisal , Metcalf Jane , Nkhoma Alick , Pelitari Stavroula , Prince Martin , Prosser Annell , Saksena Sushma , Sathyanarayana Vinay , Vani Deven , Yeoman Andrew , Gleeson Dermot
Published: May 2021

Background

Autoimmune hepatitis (AIH) is a substantial UK health burden, but there is variation in care, facilities and in opinion regarding management. We conducted an audit of service provision and care of patients with AIH in 28 UK hospitals.

Methods

Centres provided information about staffing, infrastructure and patient management (measured against predefined guideline-based standards) via a web-based data collection tool.

Results

Hospitals (14 university hospitals (UHs), 14 district general hospitals (DGHs)) had median (range) of 8 (3–23) gastroenterologists; including 3 (0–10) hepatologists. Eight hospitals (29%, all DGHs) had no hepatologist. In individual hospital departments, there were 50% (18–100) of all consultants managing AIH: in DGH’s 92% (20–100) vs 46% (17–100) in UHs. Specialist nurses managed AIH in only 18%. Seventeen (61%) hospitals had a histopathologist with a liver interest, these were more likely to find rosettes than those without (172/795 vs 50/368; p<0.001).

Of 999 steroid-treated patients with ≥12 months follow-up, 25% received steroids for <12 months. After 1 year of treatment, 82% of patients achieved normal serum alanine aminotransaminase (ALT); this was higher in UHs than DGHs. Three-monthly liver blood tests were inadequately recorded in 26%. Of potentially eligible patients with liver decompensation, transplantation was apparently not considered in 5% (n=7). The same standards were attained in different types of hospital.

Conclusion

Management of AIH in UK hospitals is often shared between most gastroenterologists. Blood test monitoring and treatment duration are not always in line with recommendations. Some eligible patients with decompensation are not discussed with transplant teams. Care might be improved by expanding specialist input and management by fewer designated consultants.
Training pathway for small bowel capsule endoscopy in the UK
Authors: Tai Foong Way David , Parker Clare , Sidhu Reena , McAlindon Mark , Davison Carolyn , Smith Geoff V , Panter Simon
Published: May 2021

The demand for small bowel (SB) capsule endoscopy (CE) is increasing in the UK. However, there remains a wide variation in the number of CE procedures performed in different centres. Across the UK there is a lack of a clear training pathway or certification process. A standardised national Joint Advisory Group (JAG) on Gastrointestinal Endoscopy approved a 1-year training and accreditation programme accessible to all professional groups that may wish to train in SB CE. Structured training is delivered using JAG-accredited CE courses and an electronic learning module. Prior to setting a knowledge-based assessment, a minimum of 50 SB CE cases are recommended to be read in tandem with a trainer at a local centre, with proficiency documented using Direct Observation of Procedural Skill (DOPS) assessments.
Machine learning model for predicting out-of-hospital cardiac arrests using meteorological and chronological data
Authors: Nakashima Takahiro , Ogata Soshiro , Noguchi Teruo , Tahara Yoshio , Onozuka Daisuke , Kato Satoshi , Yamagata Yoshiki , Kojima Sunao , Iwami Taku , Sakamoto Tetsuya , Nagao Ken , Nonogi Hiroshi , Yasuda Satoshi , Iihara Koji , Neumar Robert , Nishimura Kunihiro
Published: May 2021

Objectives

To evaluate a predictive model for robust estimation of daily out-of-hospital cardiac arrest (OHCA) incidence using a suite of machine learning (ML) approaches and high-resolution meteorological and chronological data.

Methods

In this population-based study, we combined an OHCA nationwide registry and high-resolution meteorological and chronological datasets from Japan. We developed a model to predict daily OHCA incidence with a training dataset for 2005–2013 using the eXtreme Gradient Boosting algorithm. A dataset for 2014–2015 was used to test the predictive model. The main outcome was the accuracy of the predictive model for the number of daily OHCA events, based on mean absolute error (MAE) and mean absolute percentage error (MAPE). In general, a model with MAPE less than 10% is considered highly accurate.

Results

Among the 1 299 784 OHCA cases, 661 052 OHCA cases of cardiac origin (525 374 cases in the training dataset on which fourfold cross-validation was performed and 135 678 cases in the testing dataset) were included in the analysis. Compared with the ML models using meteorological or chronological variables alone, the ML model with combined meteorological and chronological variables had the highest predictive accuracy in the training (MAE 1.314 and MAPE 7.007%) and testing datasets (MAE 1.547 and MAPE 7.788%). Sunday, Monday, holiday, winter, low ambient temperature and large interday or intraday temperature difference were more strongly associated with OHCA incidence than other the meteorological and chronological variables.

Conclusions

A ML predictive model using comprehensive daily meteorological and chronological data allows for highly precise estimates of OHCA incidence.