bluuebunny/crossref_metadata_2025 huggingface dataset:
How to approach the rupture of tubo‐ovarian abscess during pregnancy: A case report and literature review
Authors: Kim Young Ah , Chun Kyoung‐Chul , Koh Jae Whoan , Song Hyoun Suk , Kim Hee‐Sun
Published: February 2021

We present the case of a 26‐year‐old multiparous woman who experienced rupture of a tubo‐ovarian abscess during the second trimester of pregnancy. She presented with epigastric and right lower quadrant pain at 12 + 0 weeks' gestation. There were no other specific findings on the magnetic resonance imaging images. We recommended hospitalization to observe the changes in pain, but she refused confinement. About 3 weeks later, she revisited our emergency room at 15 + 4 weeks' gestation. She complained of worsening abdominal pain with fever. She underwent right salpingo‐oophorectomy and appendectomy due to uncontrollable, severe abdominal pain without any obstetric abnormal condition. There was a rupture site in the right adnexa, which was covered with pus. The rupture of tubo‐ovarian abscess during pregnancy is very rare. Therefore, obstetricians should carefully monitor the adnexal masses observed during pregnancy, which should be treated with caution, whether or not the patient is symptomatic.
Efficiency, access, and the mixed delivery of health care services
Authors: Canta Chiara
Published: February 2021

Universal health systems often rely on both pubic provision and contracting arrangements with private hospitals. This paper studies the optimal mix of public and private provision of health care services. We propose a model in which the regulator acts as athird‐party payer, and aims to ensure universal access to treatment at minimal cost. Patients need one unit of medical services and differ in the severity of illness. A private and a public hospital are available. Under incomplete contracts, ownership affects the regulatory constraints and the power of managerial incentives. Only the private manager internalizes profits, and has incentives to reject costly patients and to exert effort in cost reduction. Contracting with the private hospital is optimal when managerial effort is relatively effective in reducing costs. By using the public hospital as a last resort provider, the regulator can ensure access, provide incentives to the private manager, and internalize part of the resulting cost savings. Imposing a no‐dumping constraint on the private hospital reduces the power of incentives and is not always optimal.
Influence of head flexion and rotation on obstructive sleep apnea severity during supine sleep
Authors: Tate Albert , Kurup Veena , Shenoy Bindiya , Freakley Craig , Eastwood Peter R , Walsh Jennifer , Terrill Philip
Published: February 2021

Head posture influences the collapsibility of the passive upper airway during anaesthesia. However, little is known about the impact of head posture during sleep. The objective of this study was to develop and validate an instrument to measure head posture during supine sleep and to apply this instrument to investigate the influence of head posture on obstructive sleep apnea (OSA) severity. A customized instrument to quantify head flexion and rotation during supine sleep was developed and validated in a benchtop experiment. Twenty‐eight participants with suspected OSA were successfully studied using diagnostic polysomnography with the addition of the customized instrument. Head posture in supine sleep was discretized into four categories by two variables: head flexed or not (flexion >15°); and head rotated or not (rotation >45°). Sleep time in each posture and the posture‐specific apnea–hypopnea index (AHI) were quantified. Linear mixed‐effect modelling was applied to determine the influence of flexion and rotation on supine OSA severity. Twenty‐four participants had ≥15 min of supine sleep in at least one head‐posture category. Only one participant had ≥15 min of supine sleep time with the head extended. Head flexion was associated with a 12.9 events/h increase in the AHI (95% CI: 3.7–22.1, p = .007). Head rotation was associated with an 11.0 events/h decrease in the AHI (95% CI: 0.3–21.6, p = .04). Despite substantial interparticipant variability, head flexion worsened OSA severity, and head rotation improved OSA severity. Interventions to promote rotation and restrict flexion may have therapeutic benefit in selected patients.
The transcription factor TaLAX1 interacts with Q to antagonistically regulate grain threshability and spike morphogenesis in bread wheat
Authors: He Guanhua , Zhang Yunwei , Liu Pan , Jing Yexing , Zhang Lichao , Zhu Yingfang , Kong Xiuying , Zhao Huixian , Zhou Yun , Sun Jiaqiang
Published: February 2021

The domestication gene Q is largely responsible for the widespread cultivation of wheat because it confers multiple domestication traits. However, the underlying molecular mechanisms of how Q regulates these domestication traits remain unclear.

In this study, we identify a Q‐interacting protein TaLAX1, a basic helix–loop–helix transcription factor, through yeast two‐hybrid assays. Using biochemical and genetic approaches, we explore the roles of TaLAX1 in regulating wheat domestication traits.

Overexpression of TaLAX1 produces phenotypes, reminiscent of the q allele; loss‐of‐function Talax1 mutations confer compact spikes, largely similar to the Q‐overexpression wheat lines. The two transcription factors TaLAX1 and Q disturb each other’s activity to antagonistically regulate the expression of the lignin biosynthesis‐related gene TaKNAT7‐4D. More interestingly, a natural variation (InDel, +/− TATA), which occurs in the promoter of TaLAX1, is associated with the promoter activity difference between the D subgenome of bread wheat and its ancestor Aegilops tauschii accession T093.

This study reveals that the transcription factor TaLAX1 physically interacts with Q to antagonistically regulate wheat domestication traits and a natural variation (InDel, +/− TATA) is associated with the diversification of TaLAX1 promoter activity.
Bryophytes are not early diverging land plants
Authors: McDaniel Stuart F.
Published: February 2021

Phylogenetic trees have permeated biology. However, an understanding of how to interpret phylogenies has lagged behind, notably in publications outside of evolutionary biology. Here I argue that some language commonly used in plant systematics has contributed to the confusion by describing phylogenetic trees using intuitive but misleading terms reminiscent of Aristotle's Scala Naturae. These terms (perhaps inadvertently) misrepresent evolution, not as a process acting on all living species, but rather as a progression of successively diverging lineages leading to a group that represents a subjectively defined endpoint. My goal here is to show how thinking of the tree of life in terms of early‐diverging lineages and higher groups can distort evolutionary literacy, confound interdisciplinary communication, and potentially bias research agendas. I focus on the relationship between bryophytes and angiosperms as a case study, but the theme applies to all branches of the tree of life. Fortunately, evolutionary biologists have developed an easily understood alternative framework – tree thinking – which I highlight as a means to promote a clear understanding of phylogenies across sub‐disciplines of biology, and between practicing biologists and students, or members the public which funds much of our work.
Leadless pacemaker implantation in a patient with a fully magnetically levitated left ventricular assist device
Authors: Miyazaki Yuichiro , Wada Mitsuru , Yoshitake Koichi , Mochizuki Hiroki , Ishibashi Kohei , Noda Takashi , Fukushima Norihide , Kusano Kengo
Published: February 2021

Left ventricular assist device (LVAD) therapy is increasingly used in patients with end‐stage heart failure. However, LVADs are associated with challenges, especially in the presence of a cardiac implantable electronic device. Although a leadless pacemaker (PM), the Micra™ Transcatheter Pacing System, can be used with LVADs, data regarding HeartMate 3™ LVAD are limited. In this report, we present a patient with a HeartMate 3™ LVAD who underwent successful leadless PM implantation after the removal of an infected cardiac resynchronization therapy defibrillator.
Immune‐modulatory effects of lenalidomide inhibited the progression of lesions in a vitiligo mouse model
Authors: Pervaiz Naveed , Kaur Harjot , Parsad Davinder , Kumar Ravinder
Published: February 2021

Vitiligo, an autoimmune disorder, is associated with altered cytokine levels and T lymphocytes. Lenalidomide modulates immune system components by altering cytokine production and regulating T‐cell stimulation. In this study, effect of lenalidomide was checked on the development of vitiligo lesions, level of various cytokines, and T lymphocytes in the mouse model. The vitiligo mouse model was developed by immunizing C57BL/6 mouse with anti‐mouse tyrosine‐related protein 2. Lenalidomide was orally given to mice daily, and the effect was observed on the development of vitiligo lesions. The level of T lymphocytes in blood was checked by flow cytometry. Serum cytokine levels were checked by enzyme‐linked immunosorbent assay. Vitiligo lesions were found significantly smaller in lenalidomide‐treated mice models. It significantly decreased the serum levels of IFN‐γ, TNF‐α, IL‐1β, and IL‐6 but elevated the levels of IL‐4 and IL‐10. It non‐significantly elevated CD4+/CD8+ T‐cell ratio. Lenalidomide had an inhibitory effect on the development of vitiligo lesions in mice models by suppressing the serum level of pro‐inflammatory cytokines and increasing anti‐inflammatory cytokine levels. It modulated the immune response in vitiligo mice models toward an anti‐inflammatory profile suggesting its use in the management of vitiligo.
Multiple desmoplastic Spitz nevi with BRAF fusions in a patient with ring chromosome 7 syndrome
Authors: Roy Simon F. , Bastian Boris C. , Maguiness Sheilagh , Giubellino Alessio , Vemula Swapna S. , McCalmont Timothy H. , Yeh Iwei
Published: February 2021

Patients with non‐supernumerary ring chromosome 7 syndrome have an increased incidence of hemangiomas, café‐au‐lait spots, and melanocytic nevi. The mechanism for the increased incidence of these benign neoplasms is unknown. We present the case of a 22‐year‐old man with ring chromosome 7 and multiple melanocytic nevi. Two nevi, one on the right ear and the other on the right knee, were biopsied and diagnosed as desmoplastic Spitz nevi. Upon targeted next‐generation DNA sequencing, both harbored BRAF fusions. Copy number alterations and fluorescence in situ hybridization (FISH) for BRAF suggested that the fusions arose on the ring chromosome 7. Hence, one reason for increased numbers of nevi in patients with non‐supernumerary ring chromosome 7 syndrome may be increased likelihood of BRAF fusions, due to the instability of the ring chromosome.
The intersection of climate change with the era of COVID‐19
Authors: Zang Sheryl M. , Benjenk Ivy , Breakey Suellen , Pusey‐Reid Eleonor , Nicholas Patrice K.
Published: February 2021

The purpose of this integrative review is to examine recent literature on the intersection of SARS‐CoV‐2 (COVID‐19 novel coronavirus) and climate change that will lead to a greater understanding of the complexities of the urgent pandemic linked with the emerging climate crisis. A literature search for peer‐reviewed, English language, literature published since the pandemic emerged was conducted using Cumulated Index to Nursing and Allied Health Literature (CINAHL), PubMed, and the Cochrane Library. The final sample yielded a total of 22 commentaries, editorials, discussion papers, and a research study that explicitly addressed the intersection of COVID‐19 and climate change. Sixty articles emerged in the initial review of the intersection of the COVID‐19 pandemic and climate change with the final yield of 22 articles deemed valid for inclusion after full text review. With the emergence of COVID‐19 and scholarly discourse that addresses the intersection of the pandemic with climate change, key issues emerged that intersect with policy /advocacy, social justice, and nursing's public health role in clinical practice, education, policy/advocacy, and research/scholarship. Five themes that emerged included the role of public health in COVID‐19 and climate change efforts; global approach addressing human‐environment issues; intersection of COVID‐19 and climate change from a community and global perspective; impacts of COVID‐19, climate change and the environment and professional associations and specialty organizations’ views and responsibilities with a lens on COVID‐19 and climate change. Despite the importance of addressing racial inequities as well as systemic and structural racism that impacts those most affected by climate change and pandemics such as COVID‐19, no literature addressed this topic. Public health nursing has a critical role in addressing climate change and the pandemic response to COVID 19 in the 21st century.
Community engagement as a foundation for improving neighborhood health
Authors: García Alexandra A. , West Ohueri Chelsi , Garay Ricardo , Guzmán Monica , Hanson Kacey , Vasquez Monique , Zuñiga Julie , Tierney William
Published: February 2021

Objective

Health inequities and disparities are associated with non‐White race/ethnicity, immigrant status, income, and geographic location. Community engagement is essential to identify health and social needs and to plan health care and social services programs. To begin a larger community‐based participatory study, the purpose of this study was to explore community residents’ perceptions of barriers and facilitators to achieving and maintaining health.

Design, Sample, and Measurements

This qualitative descriptive study used focus group interviews. We recruited a convenience sample (n = 50) from community meetings and gathering for five audio‐recorded focus groups that used a semi‐structured interview guide. Transcripts were coded to identify common topics in each group and major themes across groups.

Results

Participants were predominantly women (58%), Hispanic/Latinx, and Spanish‐speaking (57%), who rented their homes (69%). Two main themes emerged: (a) social determinants as barriers to health and (b) need for trust to participate in health programs.

Conclusions

Although health care providers are frequently concerned about providing access to care, community members identified a variety of social determinants that affected their health. Listening and responding to community members’ priorities are the foundation to improving health in neighborhoods directly affected by inequities.
Political Ideology, Political Party, and Support for Greater Federal Spending on Environmental Protection in the United States: Evidence from the General Social Surveys, 1993–2018
Authors: Yen Steven T. , Zampelli Ernest M.
Published: February 2021

This paper focuses on the effects of political ideology and party affiliation on support for more government spending on environmental protection. Pooled‐sample results show that Liberals (Democrats) are more likely to support higher government spending on environmental protection than Moderates (Independents), who, in turn, are more likely to support higher spending levels than Conservatives (Republicans). The results persist even when we control for respondents' opinions concerning whether the federal government, in general, does too little or too much. When stratifying by party, ideological divisions generally narrow, while stratifying by ideology leads to slightly wider divisions between Democrats and Republicans. Together, these results suggest that when Liberals and Conservatives form opinions about government spending on the environment, party affiliation, to some degree, dampens the effects of ideology. Between 2014 and 2018 the probability of supporting more environmental spending increased, albeit slightly, for all ideologies and parties, but more so for Liberals and Democrats.
Neolocalism and Beyond––Sexing Up Rural Places*
Authors: Honkaniemi Tuomas , Syrjälä Henna , Lundström Niklas , Rajala Arto
Published: February 2021

In this paper, we revise the concept of neolocalism by showing how companies that sex up rural places update and add novel nuances to neolocalist marketing. As the positive aspects drawn from tradition, stories and history are at the center of neolocalism, we aim to highlight how the usually negatively perceived images of the rural may be turned into something positive, trendy, desirable, and eventually sexy in the marketing of rural areas and businesses. The data of this study consists of nine company interviews and four consumer focus groups (n = 17). Our findings show how three features—namely, the hybridization of rural and urban, generational experience of millennials, and minimalist visualization—combined construct ideas for new image creation for rural areas. The concept of sexing up places ushers in new possibilities for rural actors and regions by reducing the distinction between rural and urban via visual imagery that is a particularly good match for the generational experience of the millennials. In this way, the study offers a novel way to tackle the challenges faced by rural areas, such as depopulation and image loss.
THE VICTORIA INSTITUTE, BIBLICAL CRITICISM, ANDTHE FUNDAMENTALS
Authors: Mathieson Stuart
Published: February 2021

The Victoria Institute was established in London in 1865. Although billed as an anti‐evolutionary organization, and stridently anti‐Darwinian in its rhetoric, it spent relatively little time debating the theory of natural selection. Instead, it served as a haven for a specific set of intellectual commitments. Most important among these was the Baconian scientific methodology, which prized empiricism and induction, and was suspicious of speculation. Darwin's use of hypotheses meant that the Victoria Institute members were unconvinced that his work was truly scientific, but even more concerning for them was the specter of biblical criticism. This approach to biblical studies incorporated techniques from literary criticism, treating it as any other document. Since it also relied on hypotheses, the Victoria Institute members were similarly skeptical that biblical criticism was scientific, and spent much of their time attempting to refute it. In this way, they functioned as an incubator for the concerns that would animate the fundamentalist–modernist controversies of the early twentieth century.
Higher preprojective algebras, Koszul algebras, and superpotentials
Authors: Grant Joseph , Iyama Osamu
Published: February 2021

In this article we study higher preprojective algebras, showing that various known results for ordinary preprojective algebras generalize to the higher setting. We first show that the quiver of the higher preprojective algebra is obtained by adding arrows to the quiver of the original algebra, and these arrows can be read off from the last term of the bimodule resolution of the original algebra. In the Koszul case, we are able to obtain the new relations of the higher preprojective algebra by differentiating a superpotential and we show that when our original algebra is$d$-hereditary, all the relations come from the superpotential. We then construct projective resolutions of all simple modules for the higher preprojective algebra of a$d$-hereditary algebra. This allows us to recover various known homological properties of the higher preprojective algebras and to obtain a large class of almost Koszul dual pairs of algebras. We also show that when our original algebra is Koszul there is a natural map from the quadratic dual of the higher preprojective algebra to a graded trivial extension algebra.
Arithmetic purity of strong approximation for semi-simple simply connected groups
Authors: Cao Yang , Huang Zhizhong
Published: February 2021

In this article we establish the arithmetic purity of strong approximation for certain semisimple simply connected linear algebraic groups and their homogeneous spaces over a number field$k$. For instance, for any such group$G$and for any open subset$U$of$G$with${\mathrm {codim}}(G\setminus U, G)\geqslant 2$, we prove that (i) if$G$is$k$-simple and$k$-isotropic, then$U$satisfies strong approximation off any finite number of places; and (ii) if$G$is the spin group of a non-degenerate quadratic form which is not compact over archimedean places, then$U$satisfies strong approximation off all archimedean places. As a consequence, we prove that the same property holds for affine quadratic hypersurfaces. Our approach combines a fibration method with subgroup actions developed for induction on the codimension of$G\setminus U$, and an affine linear sieve which allows us to produce integral points with almost-prime polynomial values.
Ultrasound of the pleura in children, WFUMB review paper
Authors: Jaworska Joanna , Buda Natalia , Ciuca Ioana Mihaiela , Dong Yi , Fang Cheng , Feldkamp Axel , Jüngert Jörg , Kosiak Wojciech , Mentzel Hans Joachim , Pienar Corina , Rabat Jorge S. , Rafailidis Vasileios , Schrading Simone , Schreiber-Dietrich Dagmar , Dietrich Christoph F
Published: February 2021

Ultrasound (US) is an ideal diagnostic tool for paediatric patients owning to its high spatial and temporal resolution, real-time imaging, and lack of ionizing radiation and bedside availability. The lack of superficial adipose tissue and favorable acoustic windows in children makes US the first line of investigation for the evaluation of pleural and chest wall abnormali-ties. Lung parenchyma was previously thought to be inaccessible to ultrasound due to the presence of the air and bony thorax. The change in attitude and growing awareness of the diagnostic possibilities has led to lung ultrasound (LUS) being accepted as a valuable point of care method. In addition, the application of LUS has widened with improvements in technology such as higher resolution transducers, harmonic imaging and contrast-enhanced ultrasound. In the current World Federation of Societies for Ultrasound in Medicine and Biology (WFUMB) paper series the topic will be introduced, the technical requirements explained and the use of ultrasound in the lung and pleura in pediatric patients are discussed.
Ticks on small mammals from an ecotone region impacted by rural activities in Brazil

Authors: Moreira Rafael Quirino , Ramos Vanessa Do Nascimento , Suzin Adriane , Ramirez Diego Garcia , Roth Paulo Ricardo De Oliveira , Martins Maria Marlene , Correia Lima Anna Monteiro , Juan Szabó Matias Pablo
Published: February 2021

We evaluated the role of communities of small mammals from three distinct areas in a region of Cerrado mixed with Atlantic Forest remains for maintenance of tick fauna. Thirty-nine marsupials (Gracilinanus agilis, n = 34; Marmosa paraguaiana, n = 4; Didelphis albiventris, n = 1) and 33 rodents (Oecomys cleberi, n = 10; Nectomys squamipes, n = 4; Calomys tener, n = 4; Hylaeamys megacephalus, n = 4; Akodon sp., n = 3; Rattus rattus, n = 3; Cerradomys subflavus, n = 2; Mus musculus, n = 2; Rhipidomys macrurus, n = 1) were captured. Solely G. agilis and the four rodent species (N. squamipes, R. macrurus, C. subflavus and Akodon sp.) were infested. Four tick species were collected (Amblyomma dubitatum, Amblyomma sculptum, Ixodes loricatus and Ornithodoros mimon). A. dubitatum was the most abundant tick species on hosts. Capture success was higher in the dry season, but the infestation was similar in both seasons. Forested habitats, particularly riparian forests, resulted in higher number of hosts and ticks collected (from hosts and from vegetation), compared to pastures and anthropized sites. The association between C. subflavus and I. loricatus and between A. dubitatum and N. squamipes observed here is the first recorded in Cerrado biome. Areas with more patches of forest, including the Atlantic Forest fragments, tend to present a richest community of small mammals and associated ticks.
Bat biosonar signals
Authors: Simmons James A. , Auger Gregory J.
Published: February 2021

The Reflections series takes a look back on historical articles from The Journal of the Acoustical Society of America that have had a significant impact on the science and practice of acoustics.
Stories of Critical Moments Contributing to the Development of Applied Sport Psychology Practitioners
Authors: Wadsworth Nick , McEwan Hayley , Lafferty Moira , Eubank Martin , Tod David
Published: February 2021

This study explored the stories of critical moments experienced by applied sport psychology practitioners. The 13 recruited practitioners (eight male and five female) were in different stages of their development (trainee, neophyte, and experienced) and were asked to tell one story about a critical moment that significantly contributed to their development as applied practitioners. Narrative analysis was used to explore the stories of critical moments. Four distinct narrative structures were evident: Rebirth, Rags to Riches, Tragedy, and The Quest. There was one consistent narrative feature that supported these plots: Critical moments contribute toward an alignment between a practitioner’s beliefs and behavior, which supports the development of a congruent philosophy of practice and the environment they choose to work within. The authors recommend future research, such as the use of narrative analysis, to explore alternative narrative structures and the investigation of successful and unsuccessful consultancy experiences.
A Concept Evaluation Study of a New Combination Bictegravir plus Tenofovir Alafenamide Nanoformulation with Prolonged Sustained-Drug-Release Potency for HIV-1 Preexposure Prophylaxis
Authors: Mandal Subhra , Prathipati Pavan Kumar , Sunagawa Shawnalyn W. , Destache Christopher J.
Published: February 2021

The antiretroviral treatment (ART) approach is the best-prescribed approach to date for preexposure prophylaxis (PrEP) for high-risk individuals. However, the daily combination antiretroviral (cARV) regimen has become cumbersome for healthy individuals, leading to nonadherence.
Resistance Determinants and Their Genetic Context in Enterobacteria from a Longitudinal Study of Pigs Reared under Various Husbandry Conditions
Authors: Poulin-Laprade Dominic , Brouard Jean-Simon , Gagnon Nathalie , Turcotte Annie , Langlois Alexandra , Matte J. Jacques , Carrillo Catherine D. , Zaheer Rahat , McAllister Tim A. , Topp Edward , Talbot Guylaine
Published: February 2021

Antimicrobial resistance is a global threat that needs to be fought on numerous fronts along the One Health continuum. Vast quantities of antimicrobials are used in agriculture to ensure animal welfare and productivity and are arguably a driving force for the persistence of environmental and foodborne resistant bacteria.
Acetylene-Fueled Trichloroethene Reductive Dechlorination in a Groundwater Enrichment Culture
Authors: Gushgari-Doyle Sara , Oremland Ronald S. , Keren Ray , Baesman Shaun M. , Akob Denise M. , Banfield Jillian F. , Alvarez-Cohen Lisa
Published: February 2021

Understanding the complex metabolisms of microbial communities in contaminated groundwaters is a challenge. PCE and TCE are among the most common groundwater contaminants in the United States that, when exposed to certain minerals, exhibit a unique abiotic degradation pathway in which C
2
H
2
is a product.
Prostatic cyst in a pediatric patient with autosomal dominant polycystic kidney disease
Authors: Colaco Marc , Cannon Glenn M , Moritz Michael L
Published: February 2021

Autosomal dominant polycystic kidney disease (ADPKD) is the most common inheritable form of renal cystic disease and is associated with cysts in other organs. Prostatic cysts are rare though and have not been reported in the paediatric population. Reported is the presence of a prostatic cyst that was incidentally noted on routine sonogram in a 15 year old with ADPKD.
Utility of pattern recognition and multimodal imaging in the diagnosis and management of doyne honeycomb retinal dystrophy complicated with type one choroidal neovascular membrane
Authors: Parameswarappa Deepika Chennapura , Rani Padmaja Kumari
Published: February 2021

A 44-year-old woman presented with decreased vision in both eyes. The retina in both eyes had drusen distributed along vascular arcades, central macula and in peripapillary region. Macula had pigmented scarring and exudation. Fundus autofluorescence showed drusen. Optical coherence tomography showed drusen, subretinal and intraretinal fluid. Fundus fluorescein and indocyanine green angiography showed drusen, retinal pigment epithelial atrophy and vascular network. Younger age at presentation, bilateral symmetry, typical distribution of drusen along the arcades in a radiating pattern, peripapillary involvement, scarring and atrophy at macula were suggestive of doyne honeycomb retinal dystrophy. The reduced vision was due to macular atrophy and an active choroidal neovascular membrane. The patient was treated with antivascular endothelial growth factor injections for choroidal neovascular membrane. Our case highlights the importance of pattern recognition and multimodal imaging for diagnosing the type of macular dystrophy as doyne honeycomb retinal dystrophy, while simultaneously managing choroidal neovascular membrane.
Pilomatrixoma: a common tumour of head and neck, but rarely reported
Authors: Veena Korikkar Mahaling , Chandra Jagadish
Published: February 2021

Pilomatrixoma is a benign subcutaneous tumour arising from the sebaceous glands. Mutation in the CTNNB1 gene is seen, suggesting beta-catenin misregulation may be the cause of pilomatrixoma. The preoperative diagnosis may be improved by the awareness of the fact that pilomatrixoma is a common and benign skin tumour of the head and neck region. It presents as a well-defined mass, which may be firm to hard in consistency, usually attached to the skin, but not to the underlying tissue. The colour of overlying skin appears a reddish-brown tinge, indicating that it could be a case of pilomatrixoma. Here, we report a case of pilomatrixoma of the cheek in a woman along with the CT findings and histopathological appearances. Dental surgeons should consider it as one of the differential diagnosis in superficial head and neck swelling with calcification.
Bouveret syndrome: a rare form of gallstone ileus
Authors: Haering Don , Murphy Mattie , Craig John , Falk Gavin A
Published: February 2021

A 57-year-old woman presented with a 5-day history of worsening right upper quadrant pain, bilious emesis and approximately 20 pounds of weight loss. The patient was afebrile, without jaundice and had mild tenderness in her right upper quadrant. She noted an incidental finding of asymptomatic cholelithiasis on imaging 4 years earlier. An abdominal radiograph revealed pneumobilia and a large ectopic calculus. An abdominal CT scan confirmed pneumobilia, a large concretion completely obstructing the third portion of the duodenum and a soft tissue communication between the gallbladder and proximal duodenum. She was brought to the operating room for definitive treatment and had the obstructing gallstone removed via a transverse duodenotomy. Bouveret syndrome is a rare cause of small bowel obstruction that requires a high index of suspicion for diagnosis. It should be considered in older patients with clinical evidence of gastric or duodenal obstruction, particularly with a history of cholelithiasis.
Progressive midbrain clefts after head trauma and decompressive surgery: a report of two patients
Authors: Pramila Padma John , Mannam Pavithra , Chacko Ari George , Benjamin Rohit Ninan
Published: February 2021

This report describes two patients with acute-onset ptosis, oculomotor dysfunction, ataxia and drowsiness, referable to the midbrain tegmentum. Both patients had previously suffered severe closed head injuries requiring craniotomy for cerebral decompression. Serial brain scans in both cases revealed a newly developing cleft in the midbrain, with features suggestive of abnormal cerebrospinal fluid (CSF) flow across the aqueduct. A trial of acetazolamide was initiated to reduce CSF production, followed by a third ventriculostomy for CSF diversion in one patient, which resulted in arrested disease progression and partial recovery. There are only two previous reports in the literature of midbrain clefts that developed as remote sequelae of head trauma. We postulate that altered CSF flow dynamics in the aqueduct, possibly related to changes in brain compliance, may be contributory. Early recognition and treatment may prevent irreversible structural injury and possible death.
Metronidazole-induced reversible cerebellar dysfunction
Authors: John Kevin John , P Pillai Deep , Pillai Vinod , John John K
Published: February 2021

A 73-year-old man who presented with fever and abdominal discomfort was diagnosed to have a liver abscess. He was treated with antimicrobials which included metronidazole. One month into treatment, he developed neurological symptoms and signs that were suggestive of cerebellar pathology. MRI of the brain showed T2/fluid attenuated inversion recovery hyperintensities involving bilateral dentate, fastigial and interpositus nuclei. After excluding common aetiologies, the possibility of metronidazole-induced neurotoxicity was considered. After stopping metronidazole, his symptoms and signs resolved. A subsequent MRI scan of the brain showed reversal of changes. Neurotoxicity caused by metronidazole is an uncommon adverse effect of a commonly used antimicrobial drug and should be considered in the appropriate clinical scenario.
PulmonaryAggregatibacter actinomycetemcomitansinfection masquerades as malignancy in a patient with periodontitis
Authors: Turner Emma , Hastie Thomas , Sundaresan Pritam Daniel
Published: February 2021

A 49-year-old man with a 37.5 pack-year smoking history presented with a suspected neoplasm of the right lung following the discovery of a metabolically active mass on positron emission tomography-CT imaging. The patient, who demonstrated poor oral hygiene, had a history of irregular problem-oriented dental visitation. Having excluded malignancy through histologic investigations,Aggregatibacter actinomycetemcomitans—a well-established periodontal pathogen—was subsequently cultured from his pulmonary aspirate. The patient was therefore managed with systemic antimicrobials and adjunctive dental extractions to eliminate the likely source of infection, whereafter the mass resolved without complication. This case corroborates previous reports of extraoral isolation ofA. actinomycetemcomitans, which may mimic cancer clinically and radiographically. While a definitive causative link between untreated periodontitis and systemic infection remains to be elucidated, such cases present a compelling argument in favour of promoting oral health to prevent systemic disease.
Views and experiences of people with acne vulgaris and healthcare professionals about treatments: systematic review and thematic synthesis of qualitative research
Authors: Ip Athena , Muller Ingrid , Geraghty Adam W A , Platt Duncan , Little Paul , Santer Miriam
Published: February 2021

Objectives

The objective of this study was to systematically review and synthesise qualitative papers exploring views and experiences of acne and its treatments among people with acne, their carers and healthcare professionals (HCPs).

Design

Systematic review and synthesis of qualitative papers.

Methods

Papers were identified through Medline, EMBASE, PubMed, PsychINFO and CINAHL on 05 November 2019, forward and backward citation searching, Google Scholar and contacting authors. Inclusion criteria were studies reporting qualitative data and analysis, studies carried out among people with acne, their carers or HCPs and studies comprising different skin conditions, including acne. The title and abstracts of papers were independently screened by three researchers. Appraisal was carried out using the adapted Critical Appraisal Skills Programme tool. Thematic synthesis was used to synthesise findings.

Results

A total of 20 papers were included from six countries. Papers explored; experiences living with acne, psychosocial impact of acne, views on causation of acne, perceptions of acne treatments, ambivalence and ambiguity in young people’s experience of acne and HCPs’ attitudes towards acne management. Findings suggest that people often viewed acne as short-term and that this had implications for acne management, particularly long-term treatment adherence. People often felt that the substantial impact of acne was not recognised by others, or that their condition was ‘trivialised’ by HCPs. The sense of a lack of control over acne and control over treatment was linked to both psychological impact and treatment adherence. Concerns and uncertainty over acne treatments were influenced by variable advice and information from others.

Conclusions

People need support with understanding the long-term management of acne, building control over acne and its treatments, acknowledging the impact and appropriate information to reduce the barriers to effective treatment use.

PROSPERO registration number

CRD42016050525.
Link workers providing social prescribing and health and social care coordination for people with multimorbidity in socially deprived areas (the LinkMM trial): protocol for a pragmatic randomised controlled trial
Authors: Kiely Bridget , Clyne Barbara , Boland Fiona , O"Donnell Patrick , Connolly Deirdre , O"Shea Eamon , Smith Susan M
Published: February 2021

Introduction

Link workers are non-health or social care professionals based in primary care who support people to develop and achieve a personalised set of health and social goals by engaging with community resources. Link workers have been piloted in areas of deprivation, but there remains insufficient evidence to support their effectiveness. Multimorbidity is increasing in prevalence, but there are limited evidence-based interventions. This paper presents the protocol for a randomised controlled trial (RCT) that will test the effectiveness of link workers based in general practices in deprived areas in improving health outcomes for people with multimorbidity.

Methods and analysis

The protocol presents the proposed pragmatic RCT, involving 10 general practitioner (GP) practices and 600 patients. Eligible participants will be community dwelling adults with multimorbidity (≥two chronic conditions) identified as being suitable for referral to a practice-based link worker. Following baseline data collection, the patients will be randomised into intervention group that will meet the link worker over a1-month period, or a ‘wait list’ control that will receive usual GP care. Primary outcomes are health-related quality of life as assessed by EQ-5D-5L and mental health assessed by Hospital Anxiety and Depression Scale. Secondary outcomes are based on the core outcome set for multimorbidity. Data will be collected at baseline and on intervention completion at 1 month using questionnaires self-completed by participants and GP records. Parallel process and economic analyses will be conducted to explore participants’ experiences and examine cost-effectiveness of the link worker intervention.

Ethics and dissemination

Ethical approval has been granted by the Irish College of General Practitioners Ethics Committee. The findings will be published in peer-reviewed journals.

Trial registration number

ISRCTN10287737;

Pre-results.
Budget impact analysis of routinely using whole-genomic sequencing of six multidrug-resistant bacterial pathogens in Queensland, Australia
Authors: Gordon Louisa G , Elliott Thomas M , Forde Brian , Mitchell Brett , Russo Philip L , Paterson David L , Harris Patrick N A
Published: February 2021

Objective

To predict the cost and health effects of routine use of whole-genome sequencing (WGS) of bacterial pathogens compared with those of standard of care.

Design

Budget impact analysis was performed over the following 5 years. Data were primarily from sequencing results on clusters of multidrug-resistant organisms across 27 hospitals. Model inputs were derived from hospitalisation and sequencing data, and epidemiological and costing reports, and included multidrug resistance rates and their trends.

Setting

Queensland, Australia.

Participants

Hospitalised patients.

Interventions

WGS surveillance of six common multidrug-resistant organisms (Staphylococcus aureus, Escherichia coli, Enterococcus faecium, Klebsiella pneumoniae, Enterobacter sp and Acinetobacter baumannii) compared with standard of care or routine microbiology testing.

Primary and secondary outcomes

Expected hospital costs, counts of patient infections and colonisations, and deaths from bloodstream infections.

Results

In 2021, 97 539 patients in Queensland are expected to be infected or colonised with one of six multidrug-resistant organisms with standard of care testing. WGS surveillance strategy and earlier infection control measures could avoid 36 726 infected or colonised patients and avoid 650 deaths. The total cost under standard of care was $A170.8 million in 2021. WGS surveillance costs an additional $A26.8 million but was offset by fewer costs for cleaning, nursing, personal protective equipment, shorter hospital stays and antimicrobials to produce an overall cost savings of $30.9 million in 2021. Sensitivity analyses showed cost savings remained when input values were varied at 95% confidence limits.

Conclusions

Compared with standard of care, WGS surveillance at a state-wide level could prevent a substantial number of hospital patients infected with multidrug-resistant organisms and related deaths and save healthcare costs. Primary prevention through routine use of WGS is an investment priority for the control of serious hospital-associated infections.
Methodology for task-shifting evidence-based psychological treatments to non-licenced/lay health workers: protocol for a systematic review
Authors: Kanzler Kathryn E , Kilpela Lisa Smith , Pugh Jaqueline , Garcini Luz M , Gaspard Christine S , Aikens James , Reynero Erick , Tsevat Joel , Lopez Eliot Santana , Johnson-Esparza Yajaira , Ramirez Amelie G , Finley Erin P
Published: February 2021

Introduction

‘Task-shifting’ or ‘task-sharing’ is an effective strategy for delivering behavioural healthcare in lower resource communities. However, little is known regarding the actual steps (methods) in carrying out a task-shifting project. This paper presents a protocol for a systematic review that will identify steps in adapting an evidence-based psychological treatment for delivery by lay/non-licenced personnel.

Methods and analysis

A systematic review of peer-reviewed, published studies involving a non-licenced, non-specialist (eg, community health worker, promotor/a, peer and lay person) delivering an evidence-based psychological treatment for adults will be conducted. Study design of selected articles must include a statistical comparison (eg, randomised controlled trials, quasiexperimental trials, pre–post designs and pragmatic trials). Study selection will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Databases including PubMed, the Cochrane Library, Cochrane Central Register of Controlled Trials, SCOPUS, Cumulative Index to Nursing and Allied Health Literature, APA PsycInfo and Google Scholar will be searched from 2000 to 2020. Risk of bias will be assessed using the Cochrane Collaboration’s Risk of Bias (RoB 2) tool, and publication bias will be evaluated with the Cochrane GRADE approach. A narrative synthesis will be conducted for all included studies, and a summary table following Proctor’s framework for operationalising implementation strategies will be included. This protocol was developed following the 2015 guidelines of Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols.

Ethics and dissemination

This review will analyse data from published studies only; thus, it will not require institutional board review. Findings will be presented at conferences, to the broader community via the Community Health Worker Translational Advisory Board and social media, and the final systematic review will be published in a peer-reviewed journal.
Changes in physical activity and sedentary behaviours from before to during the COVID-19 pandemic lockdown: a systematic review
Authors: Stockwell Stephanie , Trott Mike , Tully Mark , Shin Jae , Barnett Yvonne , Butler Laurie , McDermott Daragh , Schuch Felipe , Smith Lee
Published: February 2021

Objective

In March 2020, several countries banned unnecessary outdoor activities during COVID-19, commonly called ‘lockdowns. These lockdowns have the potential to impact associated levels of physical activity and sedentary behaviour. Given the numerous health outcomes associated with physical activity and sedentary behaviour, the aim of this review was to summarise literature that investigated differences in physical activity and sedentary behaviour before vs during the COVID-19 lockdown.

Design, data sources and eligibility criteria

Electronic databases were searched from November 2019 to October 2020 using terms and synonyms relating to physical activity, sedentary behaviour and COVID-19. The coprimary outcomes were changes in physical activity and/or sedentary behaviour captured via device-based measures or self-report tools. Risk of bias was measured using the Newcastle-Ottawa Scale.

Results

Sixty six articles met the inclusion criteria and were included in the review (total n=86 981). Changes in physical activity were reported in 64 studies, with the majority of studies reporting decreases in physical activity and increases in sedentary behaviours during their respective lockdowns across several populations, including children and patients with a variety of medical conditions.

Conclusion

Given the numerous physical and mental benefits of increased physical activity and decreased sedentary behaviour, public health strategies should include the creation and implementation of interventions that promote safe physical activity and reduce sedentary behaviour should other lockdowns occur.
Gulf War Syndrome: a review of current knowledge and understanding
Authors: Minshall D
Published: February 2021

The 1991 Persian Gulf War was a resounding military success for coalition forces, who liberated Kuwait following the Iraqi invasion. The medical legacy we have from the conflict is the poorly understood, yet remarkable, phenomenon of Gulf War Syndrome, which surfaced soon after.

Epidemiological research has proven beyond doubt that Gulf War veterans report a wide variety of symptoms, in excess of appropriately matched control subjects, and experience worse general health. Numerous toxic environmental hazards have been suggested as causes of Gulf War Syndrome, yet exhaustive scientific study has failed to provide conclusive proof of any link. No novel or recognised disease has been found to account for the symptomatic burden of veterans, and the optimal treatment remains uncertain.

This understanding can be added to from an anthropological perspective, where the narratives of those afflicted provide further insight. The nature of military life was changing at the time of the Gulf War, challenging the identity and beliefs of some veterans and causing socio-cultural distress. The symptomatic presentation of Gulf War Syndrome can be considered an articulation of this disharmony. Gulf War Syndrome can also be considered within the group of post-combat disorders such as shellshock, the like of which have occurred after major wars in the last century. With the current withdrawal from Afghanistan, the Defence Medical Services (DMS) should heed the lessons of history.
Red Alert: diagnosis and management of the acute red eye
Authors: Welch J F , Dickie A K
Published: February 2021

The acute red eye represents a broad spectrum of disease encompassing benign self-limiting conditions to potentially vision-threatening ophthalmic or system disease. This article will review clinical principles essential for the diagnosis and treatment of red eye relevant to all Armed Forces primary care and emergency medicine practitioners.