bluuebunny/crossref_metadata_2025 huggingface dataset:
Application of Scalar Filtered Density Function to Turbulent Flows Under Supercritical Condition
Authors: Sheikhi Reza , Hadi Fatemeh
Published: May 2021

The scalar filtered density function (FDF) methodology is extended and employed for large eddy simulation (LES) of turbulent flows under supercritical condition. To describe real fluid behavior, the extended methodology incorporates the generalized heat and mass diffusion models along with real fluid thermodynamic relations which are derived using the cubic Peng–Robinson equation of state. These models are implemented within the stochastic differential equations comprising the scalar FDF transport. Simulations are conducted of a temporally developing mixing layer under supercritical condition and the results are assessed by comparing with data generated by direct numerical simulation (DNS) of the same layer. The consistency of the proposed FDF methodology is assessed. The LES-FDF predictions are shown to agree favorably with the DNS data and exhibit several key features pertaining to supercritical turbulent flows.
Ultra-Low Wear and Anti-Oxidation Properties of Microcrystalline Graphite Oxide-Magnesium Silicate Hydroxide Composite Nanoadditives in the Poly-Alpha-Olefin Base Oil
Authors: Wang Kai , Chang Qiuying , Gao Rongqin
Published: May 2021

Graphite-based materials and hydrothermal synthetic magnesium silicate hydroxide (MSH) had shown outstanding performances as lubricant additives. In this paper, microcrystalline graphite oxide-magnesium silicate hydroxide (MGO-MSH) composite additives using pre-oxidized MGO as one of the precursors were prepared at a mild hydration condition, and their tribological properties in poly-alpha-olefin oil (PAO 10) were demonstrated by a four-ball tester. The tribological results showed that the optimal concentration of MGO-MSH in oil was 0.3 wt% under 600 N, 600 rpm. Meanwhile, the average wear scar diameter of the ball samples tested in composite-suspending oil was reduced by 36.3% compared with that obtained by pure PAO 10. By means of scanning electron microscopy (SEM), Fourier transform infrared spectroscopy (FTIR), X-ray diffraction (XRD), Raman spectra, and X-ray photoelectron spectroscopy (XPS), it was verified that MGO was involved in the synthesis of MSH, and MSH was anchored on MGO during the hydrothermal process. In addition, it was confirmed that carbon-containing tribo-film was formed on the smooth wear region of the wear scar and was of excellent anti-oxidation wear properties.
Patella Apex Influences Patellar Ligament Forces and Ratio
Authors: Wheatley Mitchell G. A. , Clouthier Allison L. , Thelen Darryl G. , Rainbow Michael J.
Published: May 2021

The relationship between three-dimensional shape and patellofemoral mechanics is complicated. The Wiberg patella classification is a method of distinguishing shape differences in the axial plane of the patella that can be used to connect shape differences to observed mechanics. This study uses the Wiberg patella classification to differentiate variance in a statistical shape model describing changes in patella morphology and height. We investigate how patella morphology influences force distribution within the patellofemoral joint. The Wiberg type I patella has a more symmetrical medial and lateral facet while the type III patella has a larger lateral facet compared to medial. The second principal component of the statistical shape model described shape variation that qualitatively resembled the different Wiberg patellas. We generated patellofemoral morphologies from the statistical shape model and integrated them into a musculoskeletal model with a twelve degrees-of-freedom knee. We simulated an overground walking trial with these morphologies and recorded patellofemoral mechanics and ligament forces. An increase in patellar ligament force corresponded with an increase in patella height. Wiberg type III patellas had a sharper patella apex which related to lower ratios of quadriceps tendon forces to patellar ligament forces. The change in pivot point of the patella affects the ratio of forces as well as the patellofemoral reaction force. This study provides a better understanding of how patella morphology affects fundamental patella mechanics which may help identify at-risk populations for pathology development.
Analysis of Motion Characteristics of a Controllable Ventilated Supercavitating Vehicle Under Accelerations
Authors: Zou Wang , Liu Tingxu , Shi Yongkang , Wang Jiaxin
Published: May 2021

The development of a maneuverable underwater high-speed vehicle is worthy of attention and study using supercavitation drag reduction theory and technology. The supercavity shape determines the hydrodynamics of the vehicle, and especially during a maneuver, its unsteady characteristics have a significant impact on the motion stability of the vehicle. The three-dimensional dynamic model of a ventilated supercavitating vehicle is established using the unsteady supercavity dynamic model based on the rigid body dynamics theory as an extension of the vehicle's longitudinal dynamic model in our recent work. The vehicle's accelerating and decelerating motions are simulated in the straight flight state using a self-developed numerical method based on the vehicle's dynamic model with the designed control law. Motion characteristics are analyzed on the evolution laws of the vehicle's motion state variables and control variables and the supercavity's characteristic parameters (i.e., ventilation cavitation number, supercavity maximum diameter, and supercavity length) in the acceleration motions. The evolution laws in the accelerating and decelerating motions are compared, and the effects of the acceleration on the laws are further analyzed. This study lays the foundation for the in-depth study of the hydrodynamic characteristics and motion stability of ventilated supercavitating vehicles in maneuvering states.
Effect of Dielectric Material and Package Stiffness on the Power Generation in a Packaged Triboelectric Energy Harvesting System for Total Knee Replacement
Authors: Hossain Nabid Aunjum , Yamomo Geofrey George , Willing Ryan , Towfighian Shahrzad
Published: May 2021

The objectives of this study are to experimentally investigate the effects of the dielectric material and the package stiffness on the durability and the efficiency of a previously developed triboelectric-based instrumented knee implant prototype. The proposed smart knee implant may provide useful information about prosthesis health and its functionality after a total knee replacement (TKR) by routine monitoring of tibiofemoral load transfer without the need for any external power source. The triboelectric powered load sensing by the proposed TKR system needs to be functional throughout the entire life of a knee replacement. The power output of the triboelectric system depends on the surface charge generations and accumulations on its dielectric material, and the force that transmits through its housing into the tribo-materials. The properties of the dielectric material and the package stiffness can significantly influence the reliability of the proposed device. For such a TKR system, a compliant mechanism with the ideal material selection can improve its state of the art. We investigated the performance of three vertical contact mode triboelectric generators made with three different dielectric materials: polydimethylsiloxane (PDMS), fluorinated ethylene propylene (FEP), and polytetrafluoroethylene (PTFE). To investigate the effect of package stiffness, we tested two Ti–PDMS–Ti harvesters inside a polyethylene and a Ti6Al4V package. At 1500 N of sinusoidal loads, the harvesters could generate 67.73 μW and 19.81 μW of mean apparent power in parallel and single connections in the polyethylene package, which was 32 and 17 times greater than the power recorded in the Ti assembly, respectively.
Comparative Study of the Wear Behavior of B4C Monolayered and CrN/CrCN/DLC Multilayered Physical Vapor Deposition Coatings Under High Contact Loads: An Experimental Analysis
Authors: Silva F. J. G. , Casais R. C. B. , Baptista A. P. M. , Marques M. J. , Sousa V. M. C. , Alexandre R.
Published: May 2021

There are several ways to characterize the wear resistance of coatings in the laboratory, almost all of them applying relatively low contact pressure, both punctually and over surface contact. Pin-on-disc, reciprocal sliding, and micro-abrasion wear tests are quite common configurations for this purpose. Thus, a gap was identified in terms of characterization of hard physical vapor deposition (PVD) coatings subject to higher levels of contact pressure. This study aims to study and compare the wear behavior of two different coatings made by PVD, a B4C (Boron Carbide) monolayer, less used, and another following a multilayer structure of CrN/CrCN/DLC, to identify the wear mechanisms involved in quite different coatings. Both coatings were initially characterized in terms of chemical composition, thickness, morphology, structure, hardness, and adhesion to the substrate, being subsequently tested in laboratory equipment for wear tests following the block-on-ring configuration and relatively high levels of contact pressure, with a view to study the failure mechanisms of the coatings and their wearrate. CrN/CrCN/DLC multilayered coatings presented a better overall wear behavior, whereas B4C coating showed a good wear behavior regarding the load and configuration used, but in line with the behavior already observed when other wear testing configurations had been used. Thus, under the conditions imposed, CrN/CrCN/DLC coating is the best option when high contact pressure is applied to the coated surfaces.
A Generalized Model for Compliant Passive Bipedal Walking: Sensitivity Analysis and Implications on Bionic Leg Design
Authors: Smyrli Aikaterini , Bertos Georgios A. , Papadopoulos Evangelos
Published: May 2021

The passive behavior of a compliant biped walking model, subject to variations in its design, is investigated. A biped gait model is developed that allows for studying the effects of leg impedance, geometry, foot curvature, and inertial properties on the stable gait performed passively. A set of nondimensional parameters has been produced that fully defines the compass gait behavior, eliminating the dependence of our results on scale. Models emerging from parameter combinations were tested on their ability to perform stable passive walking on slope, and the characteristics of the gait performed in each case were recorded. Investigation of parameter ranges allowed us to draw relationships between various gait characteristics and specific, nondimensional parameter selections. By mapping the changes in system behavior under simple design variations, this work facilitates the selection of design parameters at an early stage of designing bionic walking equipment, including prostheses and exoskeletons.
Ultrasound based noninvasive real-time cell proliferation process monitoring
Authors: Keskinoğlu Cemil , Aydın Ahmet
Published: May 2021

The proliferation process's efficiency is related to the number of cells grown in culture and the maximum efficiency obtained at the stationary phase. Since the culture's growth speed is different for various cells and even for subgroups of the same cells, it is essential to monitor the process properly to obtain maximum efficiency. In this work, ultrasonic velocity measurement was performed noninvasively for wireless real-time monitoring of the suspension cell culture using a single integrated device to get maximum efficiency from the process by determining the phases. Using the advantage of the developed device's portability and wireless connectivity, the cells are monitored in the incubator without interfering with the actual process. Therefore, a real-time highly sampled growth curve is obtained, which was not possible to obtain with the currently used methods or the offline methods that are based on taking samples from the culture invasively. Filtering and curve fitting methods are also applied to the data to obtain a clean growth curve. The method developed as a result of this study ensures that the suspension cell culture was monitored most conveniently in the actual growth medium in real-time and noninvasively.
The Impact of Wearing and Perceiving Colors on Hormonal, Physiological, and Psychological Parameters in Cycling
Authors: Mentzel Stijn V. , Krenn Bjoern , Dreiskaemper Dennis , Strauss Bernd
Published: May 2021

This study examines the influence of wearing and perceiving colors in a cycling setting while also examining cortisol, heart rate, estimated maximum oxygen consumption, and subjective performance ratings. A total of 99 individuals completed the study, consisting of cortisol measurements, which compared baseline values to those after changing into a red or blue outfit, and a maximum cycling task performed wearing the same outfit while competing against a video opponent in red or blue. Each participant completed the protocol twice on separate days. Wearing a colored outfit showed no influence on cortisol levels. Regarding the cycling task, the participants wearing red had higher maximum heart rate values than when wearing blue. In addition, the results revealed increased maximum heart rate and maximum oxygen consumption values when perceiving an opponent in blue, especially when the participant also wore blue. No differences were found for the median heart rate or performance ratings.
Direct evidence of acid-base interactions in gecko adhesion
Authors: Singla Saranshu , Jain Dharamdeep , Zoltowski Chelsea M. , Voleti Sriharsha , Stark Alyssa Y. , Niewiarowski Peter H. , Dhinojwala Ali
Published: May 2021

Direct investigation of gecko setae-substrate contact provides clear evidence for acid-base interactions in gecko adhesion.
Preservation of lagging strand integrity at sites of stalled replication by Pol α-primase and 9-1-1 complex
Authors: van Schendel Robin , Romeijn Ron , Buijs Helena , Tijsterman Marcel
Published: May 2021

“Primase deserts” in
C. elegans
show how organisms protect genetic information when faced with roadblocks during copying of DNA.
Genome-scale CRISPR-Cas9 screen of Wnt/β-catenin signaling identifies therapeutic targets for colorectal cancer
Authors: Wan Chunhua , Mahara Sylvia , Sun Claire , Doan Anh , Chua Hui Kheng , Xu Dakang , Bian Jia , Li Yue , Zhu Danxi , Sooraj Dhanya , Cierpicki Tomasz , Grembecka Jolanta , Firestein Ron
Published: May 2021

Genome-scale CRISPR screen identifies KMT2A as a druggable target against Wnt/β-catenin signaling and colorectal cancer.
Functional coordination of BET family proteins underlies altered transcription associated with memory impairment in fragile X syndrome
Authors: Kim Seung-Kyoon , Liu Xihui , Park Jongmin , Um Dahun , Kilaru Gokhul , Chiang Cheng-Ming , Kang Mingon , Huber Kimberly M. , Kang Keunsoo , Kim Tae-Kyung
Published: May 2021

The coordination of BET family proteins is a feature of the gene regulatory network underlying memory behavior and FXS.
Targeting nucleotide metabolism as the nexus of viral infections, cancer, and the immune response
Authors: Ariav Yarden , Ch’ng James H , Christofk Heather R. , Ron-Harel Noga , Erez Ayelet
Published: May 2021

Understanding the dependence of cancers and virus-infected and immune cells on nucleotides can tilt the balance to benefit therapy.
Learning where to trust unreliable models in an unstructured world for deformable object manipulation
Authors: Mitrano P. , MConachie D. , Berenson D.
Published: May 2021

We plan for rope manipulation with an unreliable model by learning where to trust the model and how to recover when stuck.
Complete Genome Sequence of Bacillus cereus
Sensu Stricto
VKM B-370, Isolated from the Silkworm Bombyx mori
Authors: Piligrimova Emma G. , Buzikov Rustam M. , Kazantseva Olesya A. , Shadrin Andrey M.
Published: May 2021

Bacillus cereus
is a Gram-positive rod-shaped spore-forming bacterium widespread in different environmental niches. Here, we report the complete genome sequence of
Bacillus cereus
VKM B-370 from the All-Russian Collection of Microorganisms, the host strain for bacteriophages vB_BtS_B83, vB_BcM_Sam46, vB_BcM_Sam112, and Izhevsk.
Bilateral optic disc swelling resulting from lymphocytic meningitis and posterior uveitis secondary to syphilis
Authors: James Sunil , Thozhuthumparambil Karunakaran Pradeep
Published: May 2021

Idiopathic intracranial hypertension (IIH) is being diagnosed more often in the UK due to the rise in obesity. In fact, patients who present with bilateral optic disc swelling are habitually put on the papilloedema pathway, often without consideration of other diagnoses. We report the case of a middle-aged woman diagnosed with papilloedema and managed as IIH, until, cerebrospinal fluid (CSF) analysis revealed evidence of lymphocytic meningitis secondary to syphilis. The patient was treated successfully with intravenous antibiotics. Syphilis is the great masquerader and should be a diagnosis to consider in patients who have CSF findings incongruent with their clinical presentation.
Continuous and progressive ‘wash-in’ without ‘wash-out’ of contrast in adrenal mass: a useful feature of ganglioneuroma
Authors: Agrawal Neeti , Awasthi Avivar , Mahata Rahin , Chakraborty Partha Pratim
Published: May 2021

Computed tomography (CT) scan is a useful and widely performed diagnostic modality to evaluate adrenal masses. Nature of the mass determines the degree of attenuation both in unenhanced and in different phases of contrast enhancement. Benign neurogenic tumours like ganglioneuroma mimicks pheochromocytoma and adrenocortical carcinoma in non-contrast CT scan. The ‘adrenal protocol’ routinely calculates the wash-out pattern at delayed venous phase (DVP) (15 min) following contrast administration to differentiate majority of benign masses from the malignant ones. Ganglioneuromas typically exhibit continuous wash-in of contrast where enhancement gradually increases to attain its peak in DVP. Such wash-in pattern is different from the wash-out pattern observed in pheochromocytomas or adrenocortical adenomas or carcinomas. Presence of this wash-in pattern provides a useful clue to the clinician for underlying ganglioneuroma in hormonally inactive adrenal masses with suspicious morphological appearances. This wash-in pattern also effectively rules out any malignant potential of ganglioneuroma, and thus helps in preoperative decision-making.
Case of homozygous familial hypercholesterolaemia with premature coronary artery disease
Authors: Suresh Kumar Gayatri , Mathbout Mohammad F , Fahsah Ibrahim , Ghafghazi Shahab
Published: May 2021

Familial hypercholesterolaemia is a genetic disorder secondary to mutation of one or more of the genes critical for low-density lipoprotein cholesterol (LDL-C) metabolism; these mutation(s) cause highly elevated serum LDL-C, significantly increasing the risk of early cardiovascular events and mortality. Homozygous familial hypercholesterolaemia (HoFH) is rare and often leads to accelerated coronary atherosclerosis presenting within the first two decades of life. We report a case of a 14-year-old boy who presented after surviving a ventricular fibrillation cardiac arrest. His highly elevated LDL-C level prompted further workup and led to a diagnosis of HoFH. The treatment included medical therapy and coronary artery bypass grafting. The patient also required referral for lipid apheresis to meet goal LDL-C level, and an automated implantable cardioverter defibrillator for secondary prevention of sudden cardiac death. HoFH, if left untreated, can have devastating consequences Therefore, timely diagnosis initiating appropriate therapy is important.
Invasive pneumococcal disease: a diagnostic challenge due to multiple portals of causative bacteria
Authors: Tokushima Yoshinori , Tago Masaki , Tokushima Midori , Yamashita Shu-ichi
Published: May 2021

A 64-year-old woman was transferred to our hospital because of fever, painful swelling in upper jaw, back pain and dysuria. She was in shock and physical examinations revealed tenderness on maxillary sinus, cellulitis in the right foot, hypoesthesia in both lower extremities and groin, mild weakness in both lower extremities, and bladder and rectal dysfunctions. Blood examination showed elevated white cell count and C reactive protein, and urinalysis revealed urinary tract infection. Spinal MRI detected spondylodiscitis with epidural abscess. After detection ofStreptococcus pneumoniaeby cultures of blood and fluid from lumbar abscess, she was consequently diagnosed with invasive pneumococcal disease likely secondary to acute exacerbation of chronic sinusitis. Pyogenic spondylitis or epidural abscess is a rare but serious complication of invasive pneumococcal disease. Furthermore,S. pneumoniaeshould be suspected as a causative organism when seeing a patient with severe infectious diseases complicated with sinusitis.
Spinal cord stimulator for neuropathic pain in a patient with severe disability due to transverse myelitis
Authors: Martinez Villegas Hector Xavier , Hallo Alejandro , Cruz-Loor Soraya , Jacome-Calderon Karen
Published: May 2021

Transverse myelitis is an inflammatory disease of the central nervous system that disrupts nerve signals’ conduction. The illness is characterised by weakness in the lower limbs accompanied by paresthesia and urinary and bowel incontinence. The most disabling sequel is the onset of chronic neuropathic pain, which can severely limit the patient’s independence and negatively affect her quality of life. We present the case of a patient who received a spinal neurostimulator after a failure of conventional medical treatment. Masking pain through paresthesia, a mechanism provided by the device significantly reduces pain perception. The treatment success in our patient represents an advance in pain therapy.
What empirical research has been undertaken on the ethics of clinical research in India? A systematic scoping review and narrative synthesis
Authors: Paramasivan Sangeetha , Davies Philippa , Richards Alison , Wade Julia , Rooshenas Leila , Mills Nicola , Realpe Alba , Raj Jeffrey Pradeep , Subramani Supriya , Ives Jonathan , Huxtable Richard , Blazeby Jane M , Donovan Jenny L
Published: May 2021

Introduction

The post-2005 rise in clinical trials and clinical research conducted in India was accompanied by frequent reports of unethical practices, leading to a series of regulatory changes. We conducted a systematic scoping review to obtain an overview of empirical research pertaining to the ethics of clinical trials/research in India.

Methods

Our search strategy combined terms related to ethics/bioethics, informed consent, clinical trials/research and India, across nine databases, up to November 2019. Peer-reviewed research exploring ethical aspects of clinical trials/research in India with any stakeholder groups was included. We developed an evidence map, undertook a narrative synthesis and identified research gaps. A consultation exercise with stakeholders in India helped contextualise the review and identify additional research priorities.

Results

Titles/Abstracts of 9699 articles were screened, full text of 282 obtained and 80 were included. Research on the ethics of clinical trials/research covered a wide range of topics, often conducted with little to no funding. Studies predominantly examined what lay (patients/public) and professional participants (eg, healthcare staff/students/faculty) know about topics such as research ethics or understand from the information given to obtain their consent for research participation. Easily accessible groups, namely ethics committee members and healthcare students were frequently researched. Research gaps included developing a better understanding of the recruitment-informed consent process, including the doctor-patient interaction, in multiple contexts and exploring issues of equity and justice in clinical trials/research.

Conclusion

The review demonstrates that while a wide range of topics have been studied in India, the focus is largely on assessing knowledge levels across different population groups. This is a useful starting point, but fundamental questions remain unanswered about informed consent processes and broader issues of inequity that pervade the clinical trials/research landscape. A priority-setting exercise and appropriate funding mechanisms to support researchers in India would help improve the clinical trials/research ecosystem.
Vaccine safety issues at the turn of the 21st century
Authors: Conklin Laura , Hviid Anders , Orenstein Walter A , Pollard Andrew J , Wharton Melinda , Zuber Patrick
Published: May 2021

Global gains in vaccination coverage during the early 21st century have been threatened by the emergence of antivaccination groups that have questioned the effectiveness of vaccines to generate public distrust of vaccines and immunisation programmes. This manuscript summarises six key topics that have been at the centre of global discussions on vaccine safety during the early 21st century: thiomersal in multi-dose non-live vaccines, aluminium adjuvants used with several non-live vaccines, autism and auto-immune conditions as possible consequences of vaccination, a risk of immune overload with increasing numbers of vaccinations, and detrimental non-specific effects (NSEs) of vaccination. For each topic, we describe the hypothesis behind the public concern, the evidence reviewed by the WHO’s Global Advisory Committee for Vaccine Safety (GACVS) during 1999–2019, and any significant new data that has emerged since GACVS conclusions were made. Although the scientific evidence on these issues overwhelmingly supports the safety of vaccines, communication messages to caregivers and providers need to condense and convey scientific information in an appropriate way to address concerns contributing to vaccine distrust. In addition, there is need for further studies specifically designed to address both positive and negative NSE of vaccination. The role of GACVS will be increasingly important in evaluating the evidence and engaging the global community in promoting and assuring the safety of vaccines in the decades to come as we move into an era in which we use new vaccination platforms, antigens and formulations.
The health policy response to COVID-19 in Malawi
Authors: Mzumara Grace W , Chawani Marlen , Sakala Melody , Mwandira Lily , Phiri Elias , Milanzi Edith , Phiri Mphatso Dennis , Kazanga Isabel , O’Byrne Thomasena , Zulu Eliya M , Mitambo Collins , Divala Titus , Squire Bertie , Iroh Tam Pui-Ying
Published: May 2021

Malawi declared a state of national disaster due to the COVID-19 pandemic on 20th March 2020 and registered its first confirmed coronavirus case on the 2 April 2020. The aim of this paper was to document policy decisions made in response to the COVID-19 pandemic from January to August 2020. We reviewed policy documents from the Public Health Institute of Malawi, the Malawi Gazette, the Malawi Ministry of Health and Population and the University of Oxford Coronavirus Government Response Tracker. We found that the Malawi response to the COVID-19 pandemic was multisectoral and implemented through 15 focused working groups termed clusters. Each cluster was charged with providing policy direction in their own area of focus. All clusters then fed into one central committee for major decisions and reporting to head of state. Key policies identified during the review include international travel ban, school closures at all levels, cancellation of public events, decongesting workplaces and public transport, and mandatory face coverings and a testing policy covering symptomatic people. Supportive interventions included risk communication and community engagement in multiple languages and over a variety of mediums, efforts to improve access to water, sanitation, nutrition and unconditional social-cash transfers for poor urban and rural households.
Acute flaccid myelitis: long-term outcomes recorded in the CAPTURE study compared with paediatric transverse myelitis
Authors: Greenberg Benjamin , Plumb Patricia , Cutter Gary , Dean Janet , Desena Allen , Hopkins Sarah , Krishnan Chitra , Pardo Carlos , Recio Albert , Schreiner Teri , Yeh E Ann , McCreary Morgan
Published: May 2021

Background

Since 2014, the USA has documented three outbreaks of acute flaccid myelitis (AFM). Unique features and treatment responses of this myelitis variant have not been prospectively studied. This study prospectively measured outcomes in paediatric myelitis patients relative to treatments.

Methods

This was a prospective, multicentre, non-randomised, observational cohort study. The study duration was 5 years and the length of follow-up was 1 year. This study collected data from children and families in North America. Patients were enrolled at academic centres with expertise in myelitis or online via a web portal. Paediatric patients diagnosed with myelitis were eligible for enrolment in the study within 6 months of onset of symptoms. Patients were characterised as transverse myelitis (TM) or the AFM variant based on clinical and radiographic findings.

Results

The cohort of 90 patients included patients with AFM and TM. Of the 51 patients with AFM there was evidence of two clinically relevant patterns. This included a grey matter restricted form of AFM and a cohort with concomitant white matter that could explain lower extremity motor deficits in patients with lesions restricted to the cervical spine. The improvement in deficits with the use of corticosteroids was similar to what was observed in the TM cohort (p=0.97).

Conclusions

Clinicians should consider on a case by case basis the approach to therapy for AFM patients. Prospective controlled studies of long-term outcomes would be useful in this growing patient population.
Granulocyte and monocyte apheresis as an adjunctive therapy to induce and maintain clinical remission in ulcerative colitis: a systematic review and meta-analysis
Authors: Kiss Szabolcs , Németh Dávid , Hegyi Péter , Földi Mária , Szakács Zsolt , Erőss Bálint , Tinusz Benedek , Hegyi Péter Jenő , Sarlós Patrícia , Alizadeh Hussain
Published: May 2021

Objective

The goal of treatment in ulcerative colitis (UC) is to induce and maintain remission. The addition of granulocyte and monocyte apheresis (GMA) to conventional therapy may be a promising therapeutic alternative. In this meta-analysis, we aimed to assess the efficacy and safety profile of GMA as an adjunctive therapy.

Design

Systematic review and meta-analysis.

Methods

We searched four databases (MEDLINE, Embase, Web of Science and Cochrane Central Register of Controlled Trials) for randomised or minimised controlled trials which discussed the impact of additional GMA therapy on clinical remission induction and clinical remission maintenance compared with conventional therapy alone. Primary outcomes were clinical remission induction and maintenance, secondary outcomes were adverse events (AEs) and steroid-sparing effect. ORs with 95% CIs were calculated. Trial Sequential Analyses were performed to adjusts for the risk of random errors in meta-analyses.

Results

A total of 11 studies were eligible for meta-analysis. GMA was clearly demonstrated to induce and maintain clinical remission more effectively than conventional therapy alone (598 patients: OR: 1.93, 95% CI 1.28 to 2.91, p=0.002, I2=0.0% for induction; 71 patients: OR: 8.34, 95% CI 2.64 to 26.32, p<0.001, I2=0.0% for maintenance). There was no statistically significant difference in the number of AEs (OR: 0.27, 95% CI 0.05 to 1.50, p=0.135, I2=84.2%).

Conclusion

GMA appears to be more effective as an adjunctive treatment in inducing and maintaining remission in patients with UC than conventional therapy alone.

PROSPERO registration number

CRD42019134050.
Integrated community-based HIV and non-communicable disease care within microfinance groups in Kenya: study protocol for the Harambee cluster randomised trial
Authors: Genberg Becky L. , Wachira Juddy , Steingrimsson Jon A , Pastakia Sonak , Tran Dan N Tina , Said Jamil AbdulKadir , Braitstein Paula , Hogan Joseph W. , Vedanthan Rajesh , Goodrich Suzanne , Kafu Catherine , Wilson-Barthes Marta , Galárraga Omar
Published: May 2021

Introduction

In Kenya, distance to health facilities, inefficient vertical care delivery and limited financial means are barriers to retention in HIV care. Furthermore, the increasing burden of non-communicable diseases (NCDs) among people living with HIV complicates chronic disease treatment and strains traditional care delivery models. Potential strategies for improving HIV/NCD treatment outcomes are differentiated care, community-based care and microfinance (MF).

Methods and analysis

We will use a cluster randomised trial to evaluate integrated community-based (ICB) care incorporated into MF groups in medium and high HIV prevalence areas in western Kenya. We will conduct baseline assessments with n=900 HIV positive members of 40 existing MF groups. Group clusters will be randomised to receive either (1) ICB or (2) standard of care (SOC). The ICB intervention will include: (1) clinical care visits during MF group meetings inclusive of medical consultations, NCD management, distribution of antiretroviral therapy (ART) and NCD medications, and point-of-care laboratory testing; (2) peer support for ART adherence and (3) facility referrals as needed. MF groups randomised to SOC will receive regularly scheduled care at a health facility. Findings from the two trial arms will be compared with follow-up data from n=300 matched controls. The primary outcome will be VS at 18 months. Secondary outcomes will be retention in care, absolute mean change in systolic blood pressure and absolute mean change in HbA1c level at 18 months. We will use mediation analysis to evaluate mechanisms through which MF and ICB care impact outcomes and analyse incremental cost-effectiveness of the intervention in terms of cost per HIV suppressed person-time, cost per patient retained in care and cost per disability-adjusted life-year saved.

Ethics and dissemination

The Moi University Institutional Research and Ethics Committee approved this study (IREC#0003054). We will share data via the Brown University Digital Repository and disseminate findings via publication.

Trial registration number

NCT04417127.
Effective fertility counselling for transgender adolescents: a qualitative study of clinician attitudes and practices
Authors: Lai Timothy Chwan , Davies Cristyn , Robinson Kerry , Feldman Debi , Elder Charlotte Victoria , Cooper Charlie , Pang Ken C , McDougall Rosalind
Published: May 2021

Objective

Fertility counselling for trans and gender diverse (TGD) adolescents has many complexities, but there is currently little guidance for clinicians working in this area. This study aimed to identify effective strategies for—and qualities of—fertility counselling for TGD adolescents based on clinicians’ experiences.

Design

We conducted qualitative semi-structured individual interviews in 2019 which explored clinician experiences and fertility counselling practices, perspectives of the young person’s experience and barriers and facilitators to fertility preservation access. Data were analysed using thematic analysis.

Setting

This qualitative study examined experiences of clinicians at the Royal Children’s Hospital—a tertiary, hospital-based, referral centre and the main provider of paediatric TGD healthcare in Victoria, Australia.

Participants

We interviewed 12 clinicians from a range of disciplines (paediatrics, psychology, psychiatry and gynaecology), all of whom were involved with fertility counselling for TGD adolescents.

Results

Based on clinician experiences, we identified five elements that can contribute to an effective approach for fertility counselling for TGD adolescents: a multidisciplinary team approach; shared decision-making between adolescents, their parents and clinicians; specific efforts to facilitate patient engagement; flexible personalised care; and reflective practice.

Conclusions

Identification of these different elements can inform and hopefully improve future fertility counselling practices for TGD adolescents, but further studies examining TGD adolescents’ experiences of fertility counselling are also required.
Net survival differences of breast cancer between stages at diagnosis and age groups in the east coast region of West Malaysia: a retrospective cohort study
Authors: Hanis Tengku Muhammad , Yaacob Najib Majdi , Mohd Hairon Suhaily , Abdullah Sarimah
Published: May 2021

Objective

Estimation of the net survival of breast cancer helps in assessing breast cancer burden at a population level. Thus, this study aims to estimate the net survival of breast cancer at different cancer staging and age at diagnosis in the east coast region of West Malaysia.

Setting

Kelantan, Malaysia.

Participants

All breast cancer cases diagnosed in 2007 and 2011 identified from Kelantan Cancer Registry.

Design

This retrospective cohort study used a relative survival approach to estimate the net survival of patients with breast cancer. Thus, two data were needed; breast cancer data from Kelantan Cancer Registry and general population mortality data for Kelantan population.

Primary and secondary outcome measures

Net survival according to stage and age group at diagnosis at 1, 3 and 5 years following diagnosis.

Results

The highest net survival was observed among stage I and II breast cancer cases, while the lowest net survival was observed among stage IV breast cancer cases. In term of age at diagnosis, breast cancer cases aged 65 and older had the best net survival compared with the other age groups.

Conclusion

The age at diagnosis had a minimal impact on the net survival compared with the stage at diagnosis. The finding of this study is applicable to other populations with similar breast cancer profile.
Community health workers’ efforts to build health system trust in marginalised communities: a qualitative study from South Africa
Authors: Anstey Watkins Jocelyn , Griffiths Frances , Goudge Jane
Published: May 2021

Introduction

Community health workers (CHWs) enable marginalised communities, often experiencing structural poverty, to access healthcare. Trust, important in all patient–provider relationships, is difficult to build in such communities, particularly when stigma associated with HIV/AIDS, tuberculosis and now COVID-19, is widespread. CHWs, responsible for bringing people back into care, must repair trust. In South Africa, where a national CHW programme is being rolled out, marginalised communities have high levels of unemployment, domestic violence and injury.

Objectives

In this complex social environment, we explored CHW workplace trust, interpersonal trust between the patient and CHW, and the institutional trust patients place in the health system.

Design, participants, setting

Within the observation phase of a 3-year intervention study, we conducted interviews, focus groups and observations with patients, CHWs, their supervisors and, facility managers in Sedibeng.

Results

CHWs had low levels of workplace trust. They had recently been on strike demanding better pay, employment conditions and recognition of their work. They did not have the equipment to perform their work safely, and some colleagues did not trust, or value, their contribution. There was considerable interpersonal trust between CHWs and patients, however, CHWs’ efforts were hampered by structural poverty, alcohol abuse and no identification documents among long-term migrants. Those supervisors who understood the extent of the poverty supported CHW efforts to help the community. When patients had withdrawn from care, often due to nurses’ insensitive behaviour, the CHWs’ attempts to repair patients’ institutional trust often failed due to the vulnerabilities of the community, and lack of support from the health system.

Conclusion

Strategies are needed to build workplace trust including supportive supervision for CHWs and better working conditions, and to build interpersonal and institutional trust by ensuring sensitivity to social inequalities and the effects of structural poverty among healthcare providers. Societies need to care for everyone.
Safety and tolerability of oral lisdexamfetamine in adults with methamphetamine dependence: a phase-2 dose-escalation study
Authors: Ezard Nadine , Clifford Brendan , Dunlop Adrian , Bruno Raimondo , Carr Andrew , Liu Zhixin , Siefried Krista J , Lintzeris Nicholas
Published: May 2021

Objectives

To examine the safety of an agonist-type treatment, lisdexamfetamine (LDX), at 250 mg/day among adults with methamphetamine (MA) dependence.

Design

A dose-escalating, phase-2, open-label, single-group study of oral LDX at two Australian drug treatment services.

Setting

The study was conducted at two Australian stimulant use disorder treatment clinics.

Participants

There were 16 participants: at least 18 years old, MA dependent for at least the preceding 2 years using ICD-10 criteria, reporting use of MA on at least 14 of the preceding 28 days.

Interventions

Daily, supervised LDX of 100–250 mg, single-blinded to dose, ascending-descending regimen over 8 weeks (100–250 mg over 4 weeks; followed by 4-week dose reduction regimen, 250–100 mg). Participants were followed through to week 12.

Outcomes

Primary outcomes were safety, drug tolerability and regimen completion at the end of week 4. Participants were followed to week 12. Secondary outcomes included: change in MA use; craving; withdrawal; severity of dependence; risk behaviour; change in other substance use; medication acceptability; potential for non-prescription use; adherence and neurocognitive functioning.

Results

Fourteen of 16 participants (87.5%) completed escalation to 250 mg/day. Two participants withdrew from the trial in the first week: one relocated away from the study site, the other self-withdrew due to a possible, known side effect of LDX (agitation). There was one serious adverse event of suicidal ideation which resolved. All other adverse events were mild or moderate in severity and known side effects of LDX. No participant was withdrawn due to adverse events. MA use decreased from a median of 21 days (IQR: 16–23) to 13 days (IQR: 11–17) over the 4-week escalation period (p=0.013).

Conclusions

LDX at a dose of up to 250 mg/day was safe and well tolerated by study participants, warranting larger trials as a pharmacotherapy for MA dependence.

Trial registration number

ACTRN12615000391572.
Indian media professionals’ perspectives regarding the role of media in suicide prevention and receptiveness to media guidelines: a qualitative study
Authors: Armstrong Gregory , Vijayakumar Lakshmi , Cherian Anish , Krishnaswamy Kannan , Pathare Soumitra
Published: May 2021

Objectives

Crime reports of suicide incidents routinely feature in the Indian mass media, with minimal coverage of suicide as a broader public health issue. To supplement our recently published content analysis study, we undertook qualitative interviews to examine media professionals' perspectives and experiences in relation to media reporting of suicide-related news in India.

Design and setting

In 2017–2018, we undertook semistructured qualitative interviews with media professionals with experience reporting on suicide-related news. A semistructured interview guide was designed to initiate discussions around their perspectives and experiences in relation to reporting on suicide. Interviews were digitally audio-recorded and transcribed, and a deductive and inductive approach to thematic analysis was used.

Participants

Twenty-eight interviews were undertaken with media professionals in Delhi, Chandigarh and Chennai.

Results

A clear role for media in suicide prevention framed around educating and informing the public was articulated by several participants and a majority of participants also reported concerns and anecdotal accounts that their reporting may negatively influence vulnerable people in the population. Nonetheless, a fatalistic attitude towards suicide was evident among several participants including dismissing or minimising concerns around imitation suicides. Several participants also expressed doubts around the quality of suicide helplines in India and were hesitant to add such contact details to their reports. Participants were largely very receptive to the idea of developing voluntary media guidelines for the Indian context, although doubts were raised around compliance unless additional initiatives were taken to engage media professionals at the highest levels.

Conclusions

Our findings reveal the perspectives of media professionals operating in the Indian context and can be used to support constructive partnerships between media professionals and suicide prevention experts. There is a clear need for a genuine and sustained partnership between suicide prevention experts and media professionals at all levels.
Disease burden from COVID-19 symptoms among inpatients at the temporary military hospitals in Wuhan: a retrospective multicentre cross–sectional study
Authors: He Maihong , Li Xiaoxiao , Tan Qing , Chen Yong , Kong Yue , You Jianping , Lin Xian , Lin Ying , Zheng Qing
Published: May 2021

Objectives

We aimed to establish a set of disability weights (DWs) for COVID-19 symptoms, evaluate the disease burden of inpatients and analyse the characteristics and influencing factors of the disease.

Design

This was a multicentre retrospective cross-sectional descriptive study.

Setting

The medical records generated in three temporary military hospitals in Wuhan.

Participants

Medical records of 2702 inpatients generated from 5 February to 5 April 2020 were randomly selected for this study.

Primary and secondary outcome measures

DWs of COVID-19 symptoms were determined by the person trade-off approach. The inpatients’ medical records were analysed and used to calculate the disability-adjusted life years (DALYs). The mean DALY was evaluated across sex and age groups. The relationship between DALY and age, sex, body mass index, length of hospital stay, symptom duration before admission and native place was determined by multiple linear regression.

Results

For the DALY of each inpatient, severe expiratory dyspnoea, mild cough and sore throat had the highest (0.399) and lowest (0.004) weights, respectively. The average synthetic DALY and daily DALY were 2.29±1.33 and 0.18±0.15 days, respectively. Fever and fatigue contributed the most DALY at 31.36%, whereas nausea and vomiting and anxiety and depression contributed the least at 7.05%. There were significant differences between sex and age groups in both synthetic and daily DALY. Age, body mass index, length of hospital stay and symptom duration before admission were strongly related to both synthetic and daily DALY.

Conclusions

Although the disease burden was higher among women than men, their daily disease burdens were similar. The disease burden in the younger population was higher than that in the older population. Treatment at the hospitals relieved the disease burden efficiently, while a delay in hospitalisation worsened it.