bluuebunny/crossref_metadata_2025 huggingface dataset:
Adherence to the Class-Based Component of a Tai Chi Exercise Intervention for People Living With Dementia and Their Informal Carers
Authors: Barrado-Martín Yolanda , Heward Michelle , Polman Remco , Nyman Samuel R.
Published: January 2021

The objective of this study was to understand the experiences of people living with dementia and their informal carers’ taking part together (in dyads) in Tai Chi classes and the aspects influencing their adherence. Dyads’ experiences of taking part in Tai Chi classes for 20 weeks within the TACIT Trial were explored through class observations (n = 22 dyads), home-interviews (n = 15 dyads), and feedback. Data were inductively coded following thematic analysis. Tai Chi classes designed for people with dementia and their informal carers were enjoyable and its movements, easy to learn. Facilitators of participants' adherence were the socializing component and their enjoyment of the classes, whereas unexpected health problems were the main barrier. Finding the optimal level of challenge in the class setting might be crucial for people with dementia to feel satisfied with their progression over sessions and enable their continued participation.
Exploring Feelings of Pleasure and Purpose Associated With Older People’s Activities Using Ecological Momentary Analysis: An Observational Study
Authors: Hancock Karen E. , Downward Paul , Sherar Lauren B.
Published: January 2021

Momentary feelings of pleasure and purpose can be sources of intrinsic motivation, but momentary purpose is rarely studied. Activities, contexts, and feelings of retired/semiretired adults (n = 67, aged 50–78 years) were captured using ecological momentary assessment. Participants provided 2,065 valid responses to six daily smartphone surveys for 7 days. Physical activity was measured by waist-worn ActiGraph accelerometer. Pleasure (measured by affective happiness) and purpose outcomes were regressed on activities, context, and potential confounding variables. Interactions between activities and contexts were explored. Participants were highly active: 98.5% met physical activity guidelines. Sedentary activities were negatively associated with sense of purpose, especially when indoors. However, social sedentary activities were positively associated with feelings of happiness. Active, social outdoor activities were positively associated with both outcomes. Less sedentary participants experienced greater happiness and purpose during all their activities. Context matters: active, social, and outdoor activities seem to be more appealing to older adults.
A Meta-Study of Qualitative Research on Social Support Related to Physical Activity Among Older Adults
Authors: Beselt L. Jayne , Patterson Michelle C. , McDonough Meghan H. , Hewson Jennifer , MacKay Scott
Published: January 2021

Physical activity (PA) and social support have known benefits for the well-being and health of older adults, and social support is associated with PA behavior and positive affective experiences in PA contexts. The aim of this study was to synthesize qualitative research conducted on the experiences of social support related to PA among older adults (age ≥55 years). Following meta-study methodology, the authors searched nine databases and extracted information from 31 studies. Results were synthesized in terms of common themes and in light of theoretical and methodological perspectives used. The qualitative literature identifies supportive behaviors and social network outcomes which may be useful for informing how best to support older adults to be physically active. This literature rarely reflected the experiences of vulnerable populations, and future research should aim to further understand supportive behaviors which enable older adults to overcome barriers and challenges to being physically active.
Educational Podcasts in Kinesiology: A Scoping Review
Authors: McNamara Scott W.T. , Shaw Matthew , Wilson Kylie , Cox Angela
Published: January 2021

Educational podcasts are developed specifically for learning purposes. Preliminary research suggests that many college courses and practitioners regularly use educational podcasts and that this medium is a beneficial tool to use to supplement the learning process. However, there is limited scholarly work examining the use of educational podcasts within kinesiology fields. Thus, the purpose of this study was to conduct a scoping review of the literature on the use of educational podcasts in the field of kinesiology. The Preferred Reporting Items for Systematic Reviews extension for Scoping Reviews Checklist guided this investigation. Six databases were searched. Fourteen articles met the full inclusion criteria. Of these, 11 were data-driven research articles, and three were practitioner articles. Much of the research identified lacked critical information related to research design, instrument development, and findings. Thus, the authors recommend that more rigorous research in this area be conducted to discern the impact of educational podcasts within the field of kinesiology.
Fungal Communities Are Important Determinants of Bacterial Community Composition in Deadwood
Authors: Odriozola Iñaki , Abrego Nerea , TlÁskal Vojtěch , ZrůstovÁ Petra , Morais Daniel , Větrovský TomÁš , Ovaskainen Otso , Baldrian Petr
Published: January 2021

Understanding the interactive dynamics between fungal and bacterial communities is important to gain predictive knowledge on ecosystem functioning. However, little is known about the mechanisms behind fungal-bacterial associations and the directionality of species interactions.
Timing of closure of the Meso-Tethys Ocean: Constraints from remnants of a 141–135 Ma ocean island within the Bangong–Nujiang Suture Zone, Tibetan Plateau
Authors: Fan Jian-Jun , Niu Yaoling , Liu Yi-Ming , Hao Yu-Jie
Published: January 2021

Knowledge of the timing of the closure of the Meso-Tethys Ocean as represented by the Bangong–Nujiang Suture Zone, i.e., the timing of the Lhasa-Qiangtang collision, is critical for understanding the Mesozoic tectonics of the Tibetan Plateau. But this timing is hotly debated; existing suggestions vary from the Middle Jurassic (ca. 166 Ma) to Late Cretaceous (ca. 100 Ma). In this study, we describe the petrology of the Zhonggang igneous–sedimentary rocks in the middle segment of the Bangong–Nujiang Suture Zone and present results of zircon U–Pb geochronology, whole-rock geochemistry, and Sr–Nd isotope analysis of the Zhonggang igneous rocks. The Zhonggang igneous–sedimentary rocks have a thick basaltic basement (>2 km thick) covered by limestone with interbedded basalt and tuff, trachyandesite, chert, and poorly sorted conglomerate comprising limestone and basalt debris. There is an absence of terrigenous detritus (e.g., quartz) within the sedimentary and pyroclastic rocks. These observations, together with the typical exotic blocks-in-matrix structure between the Zhonggang igneous–sedimentary rocks and the surrounding flysch deposits, lead to the conclusion that the Zhonggang igneous–sedimentary rocks are remnants of an ocean island within the Meso-Tethys Ocean. This conclusion is consistent with the ocean island basalt-type geochemistry of the Zhonggang basalts and trachyandesites, which are enriched in light rare earth elements (LaN/YbN = 4.72–18.1 and 5.61–13.7, respectively) and have positive Nb–Ta anomalies (NbPM/ThPM > 1, TaPM/UPM > 1), low initial 87Sr/86Sr ratios (0.703992–0.705428), and positive mantle εNd(t) values (3.88–5.99). Zircon U–Pb dates indicate that the Zhonggang ocean island formed at 141–135 Ma; therefore, closure of the Meso-Tethys Ocean and collision of the Lhasa and Qiangtang terranes must have happened after ca. 135 Ma.
Short-term efficacy of latanoprostene bunod for the treatment of open-angle glaucoma and ocular hypertension: a systematic literature review and a network meta-analysis
Authors: Harasymowycz Paul , Royer Catherine , Cui Amy Xianying , Barbeau Martin , Jobin-Gervais Katherine , Mathurin Karine , Lachaine Jean , Beauchemin Catherine
Published: January 2021

Background/aims

To assess the comparative efficacy of latanoprostene bunod (LBN), a novel prostaglandin analogue (PGA), to other medications for open-angle glaucoma and ocular hypertension on lowering intraocular pressure (IOP).

Methods

A systematic literature review adapted from the Li et al (Ophthalmology, 2016) study was conducted. Medline, Embase and PubMed were searched for randomised controlled trials published between 1 January 2014 and 19 March 2020. Studies had to report IOP reduction after 3 months for at least two different treatments among placebo, PGAs (bimatoprost 0.01%, bimatoprost 0.03%, latanoprost, LBN, tafluprost, unoprostone) or apraclonidine, betaxolol, brimonidine, brinzolamide, carteolol, dorzolamide, levobunolol, timolol, travoprost. A Bayesian network meta-analysis was performed to provide the relative effect in terms of mean difference (95% credible interval) of IOP reduction and ranking probabilities. Surface under the cumulative ranking curve (SUCRA) was generated.

Results

A total of 106 trials were included with data for 18 523 participants. LBN was significantly more effective than unoprostone (−3.45 (−4.77 to −2.12)). Although relative effect was not significative, compared with other PGAs, LBN numerically outperformed latanoprost (−0.70 (−1.83 to 0.43)) and tafluoprost (−0.41 (−1.87 to 1.07)), was similar to bimatoprost 0.01% (-0.02(−1.59 to 1.55)) and was slightly disadvantaged by bimatoprost 0.03% (−0.17 (−1.42 to 1.07)). LBN was significantly more efficient than the beta-blockers apraclonidine, betaxolol, brimonidine, brinzolamide, carteolol, dorzolamide and timolol. According to SUCRA, LBN was ranked second after bimatoprost 0.03%, followed by bimatoprost 0.01%.

Conclusion

LBN was significantly more effective than the PGA unoprostone and most of the beta-blockers. Compared with the most widely used PGAs, LBN numerically outperformed latanoprost and travoprost and was similar to bimatoprost 0.01%.
Corneal sub-basal nerve plexus microneuromas in individuals with and without dry eye
Authors: Dermer Harrison , Hwang Jodi , Mittal Rhiya , Cohen Adam K , Galor Anat
Published: January 2021

Background/aim

An objective marker is needed to detect when corneal nerve abnormalities underlie neuropathic corneal pain (NCP), as symptoms often overlap with those of dry eye (DE). This study evaluated microneuroma (MN) frequency in various populations and investigated relationships between MN presence and DE clinical features in individuals with DE symptoms but without a history of refractive surgery, in order to eliminate refractive surgery as a potential confounder of nerve abnormalities.

Methods

This was a retrospective study that included individuals with and without DE symptoms who underwent a clinical evaluation for DE (symptom surveys and ocular surface evaluation) and in vivo confocal microscopy imaging. DE clinical features (including those suggestive of neuropathic pain) were compared based on MN presence using t-tests, χ2 analyses and Pearson’s correlation coefficients with 0.05 alpha level.

Results

MN frequencies did not significantly differ between individuals with DE symptoms (Dry Eye Questionnaire 5 score ≥6) and a history of refractive surgery (n=1/16, 6%), individuals with DE symptoms without a history of refractive surgery (n=26/119, 22%) and individuals without DE symptoms (n=2/18, 11%, p=0.22). Among individuals with DE symptoms without a history of refractive surgery, DE clinical features, including those indicative of NCP (burning sensation and sensitivity to light, wind and extreme temperatures), did not significantly differ based on MN presence (p>0.05).

Conclusion

MN frequencies did not significantly differ between individuals with and without DE symptoms. Their presence alone could not distinguish between DE subtypes, including features of NCP in our study population.
The relationship between rowing-related low back pain and rowing biomechanics: a systematic review
Authors: Nugent Frank James , Vinther Anders , McGregor Alison , Thornton Jane S , Wilkie Kellie , Wilson Fiona
Published: January 2021

Background

Low back pain (LBP) is common in rowers. Understanding rowing biomechanics may help facilitate prevention and improve rehabilitation.

Objectives

To define the kinematics and muscle activity of rowers and to compare with rowers with current or LBP history.

Design

Systematic review.

Data sources

EMBASE, MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Web of Science and Scopus from inception to December 2019. Grey literature was searched.

Study eligibility criteria

Experimental and non-experimental designs.

Methods

Primary outcomes were kinematics and muscle activity. Modified Quality Index (QI) checklist was used.

Results

22 studies were included (429 participants). Modified QI score had a mean of 16.7/28 points (range: 15–21). Thirteen studies investigated kinematics and nine investigated muscle activity. Rowers without LBP (‘healthy’) have distinct kinematics (neutral or anterior pelvic rotation at the catch, greater hip range of motion, flatter low back spinal position at the finish) and muscle activity (trunk extensor dominant with less flexor activity). Rowers with LBP had relatively greater posterior pelvic rotation at the catch, greater hip extension at the finish and less efficient trunk muscle activity. In both groups fatigue results in increased lumbar spine flexion at the catch, which is greater on the ergometer. There is insufficient evidence to recommend one ergometer type (fixed vs dynamic) over the other to avoid LBP. Trunk asymmetries are not associated with LBP in rowers.

Conclusion

Improving clinicians’ and coaches’ understanding of safe and effective rowing biomechanics, particularly of the spine, pelvis and hips may be an important strategy in reducing incidence and burden of LBP.
Recommendations for determining the validity of consumer wearable heart rate devices: expert statement and checklist of the INTERLIVE Network
Authors: Mühlen Jan M , Stang Julie , Lykke Skovgaard Esben , Judice Pedro B , Molina-Garcia Pablo , Johnston William , Sardinha Luís B , Ortega Francisco B , Caulfield Brian , Bloch Wilhelm , Cheng Sulin , Ekelund Ulf , Brønd Jan Christian , Grøntved Anders , Schumann Moritz
Published: January 2021

Assessing vital signs such as heart rate (HR) by wearable devices in a lifestyle-related environment provides widespread opportunities for public health related research and applications. Commonly, consumer wearable devices assessing HR are based on photoplethysmography (PPG), where HR is determined by absorption and reflection of emitted light by the blood. However, methodological differences and shortcomings in the validation process hamper the comparability of the validity of various wearable devices assessing HR. Towards Intelligent Health and Well-Being: Network of Physical Activity Assessment (INTERLIVE) is a joint European initiative of six universities and one industrial partner. The consortium was founded in 2019 and strives towards developing best-practice recommendations for evaluating the validity of consumer wearables and smartphones. This expert statement presents a best-practice validation protocol for consumer wearables assessing HR by PPG. The recommendations were developed through the following multi-stage process: (1) a systematic literature review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, (2) an unstructured review of the wider literature pertaining to factors that may introduce bias during the validation of these devices and (3) evidence-informed expert opinions of the INTERLIVE Network. A total of 44 articles were deemed eligible and retrieved through our systematic literature review. Based on these studies, a wider literature review and our evidence-informed expert opinions, we propose a validation framework with standardised recommendations using six domains: considerations for the target population, criterion measure, index measure, testing conditions, data processing and the statistical analysis. As such, this paper presents recommendations to standardise the validity testing and reporting of PPG-based HR wearables used by consumers. Moreover, checklists are provided to guide the validation protocol development and reporting. This will ensure that manufacturers, consumers, healthcare providers and researchers use wearables safely and to its full potential.
Early detection and management of major non-communicable diseases in urban primary healthcare facilities in Ethiopia: a study protocol for a type-3 hybrid implementation-effectiveness design
Authors: Yifter Helen , Omer Afrah , Gugsa Seid , Fekadu Abebaw , Kebede Abraham , Gebremariam Tewodros , Melkie Addisu , Deyessa Negussie
Published: January 2021

Introduction

Integrating early detection and management of non-communicable diseases in primary healthcare has an unprecedented role in making healthcare more accessible particularly in low- and middle-income countries such as Ethiopia. This study aims to design, implement and evaluate an evidence-based intervention guided by the HEARTS technical package and implementation guide to address barriers and facilitators of integrating early detection and management of hypertension, diabetes mellitus and cardiovascular diseases in primary healthcare settings of Addis Ababa.

Methodology

We will employ a type-3 hybrid implementation-effectiveness study from November 2020 to May 2022. This study will target patients ≥40 years of age. Ten health centres will be randomly selected from each subcity of Addis Ababa. The study will have four phases: (1) Baseline situational analysis (PEN facility-capacity assessment, 150 observations of patient healthcare provider interactions and 697 patient medical record reviews), (2) Consolidated Framework for Implementation Research (CFIR) inspired qualitative assessment of barriers and facilitators (20 in-depth interviews of key stakeholders), (3) Design of intervention protocol. The intervention will have capacity enhancement components including training of non-communicabledisease (NCDservice providers, provision of essential equipment/supporting materials and monthly monitoring and feedback and (4) Implementation monitoring and evaluation phase using the RE-AIM (reach, efficacy, adoption, implementation and maintenance) framework. Outcomes on early detection and management of NCDs will be assessed to examine the effectiveness of the study.

Ethics and dissemination plan

Ethical clearance was obtained from the Addis Ababa University, College of Health Sciences Institutional Review Board and Addis Ababa Health Bureau. We plan to present the findings from this research in conferences and publish them in peer-reviewed journals.
Real-world effectiveness of app-based treatment for urinary incontinence: a cohort study
Authors: Rygh Pontus , Asklund Ina , Samuelsson Eva
Published: January 2021

Objectives

The efficacy of app-based treatment for stress urinary incontinence (SUI) has been demonstrated in a randomised controlled trial (RCT). In this study, we investigate the user characteristics and the effectiveness of the same app when freely available, and compare these results with the RCT.

Design

Prospective cohort study.

Participants

During a 17-month period, 24 602 non-pregnant, non-postpartum women older than 18 years downloaded the app and responded anonymously to a questionnaire. Of these, 2672 (11%) responded to the 3-month follow-up.

Intervention

Three months’ use of the app Tät, containing information, a pelvic floor muscle training programme and lifestyle advice.

Main outcome measures

Change in symptom severity (International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF)) and subjective improvement (Patient Global Impression of Improvement (PGI-I)).

Results

Of the respondents, 88% lived in Sweden and 75% (18 384/24 602) were incontinent with a mean age of 45.5 (SD 14.1) years. The UI types, based on symptoms, were SUI (53%), urgency UI (12%), mixed UI (31%) and undefined (4%). The mean ICIQ-UI SF score was 8.2 (SD 4.0) at baseline. The mean ICIQ-UI SF score reduction at follow-up was 1.31 (95% CI: 1.19 to 1.44) with a larger reduction in those with more severe incontinence at baseline (severe/very severe 3.23 (95% CI: 2.85 to 3.61), moderate 1.41 (95% CI: 1.24 to 1.59) and slight 0.24 (95% CI 0.06 to 0.42). When the results were weighted to match the distribution of severity in the RCT, the ICIQ-UI SF score reduction was 2.2 compared with 3.9 in the RCT. Regarding PGI-I, 65% experienced improvement compared with 92% in the RCT.

Conclusions

The app Tät was effective for self-management of UI even in the real world. Although the reduction in incontinence symptoms was less than in the RCT, two-thirds of the users improved. App-based treatment reaches many women without requiring resources from ordinary healthcare services.
Developing and validating a model for predicting 7-day mortality of patients admitted from the emergency department: an initial alarm score by a prospective prediction model study
Authors: Hsieh Ming-Ju , Hsu Nin-Chieh , Lin Yu-Feng , Shu Chin-Chung , Chiang Wen-Chu , Ma Matthew Huei-Ming , Sheng Wang-Huei
Published: January 2021

Objectives

To set up a prediction model for the 7-day in-hospital mortality of patients admitted from the emergency department (ED) because it is high but no appropriate initial alarm score is available.

Design

This is a prospective cohort study for prediction model development.

Setting

In a tertiary referred hospital in northern Taiwan.

Participants

ED-admitted medical patients in hospitalist care wards were enrolled during May 2010 to October 2016. Two-thirds of them were randomly assigned to a derivation cohort for development of the model and cross-validation was performed in the validation cohort.

Primary outcome measured

7-day in-hospital mortality.

Results

During the study period, 8649 patients were enrolled for analysis. The mean age was 71.05 years, and 51.91% were male. The most common admission diagnoses were pneumonia (36%) and urinary tract infection (20.05%). In the derivation cohort, multivariable Cox proportional hazard regression revealed that a low Barthel Index Score, triage level 1 at the ED, presence of cancer, metastasis and admission diagnoses of pneumonia and sepsis were independently associated with 7 days in-hospital mortality. Based on the probability developed from the multivariable model, the area under the receiver operating characteristic curve in the derivation group was 0.81 (0.79–0.85). The result in the validation cohort was comparable. The prediction score modified by the six independent factors had high sensitivity of 88.03% and a negative predictive value of 99.51% for a cut-off value of 4, whereas the specificity and positive predictive value were 89.61% and 10.55%, respectively, when the cut-off value was a score of 6.

Conclusion

The 7-day in-hospital mortality in the hospitalist care ward is 2.8%. The initial alarm score could help clinicians to prioritise or exclude patients who need urgent and intensive care.
Study protocol for a randomised controlled feasibility trial of a virtual intervention (STRIDE) for symptom management, distress and adherence to adjuvant endocrine therapy after breast cancer
Authors: Jacobs Jamie M , Rapoport Chelsea S , Horenstein Arielle , Clay Madison , Walsh Emily A , Peppercorn Jeffrey , Temel Jennifer S , Greer Joseph A
Published: January 2021

Introduction

Patient adherence to adjuvant endocrine therapy (AET) after a diagnosis of hormone-sensitive breast cancer is poor. Previous interventions have failed to produce changes in adherence, address patient preferences or include theoretically informed and evidence-based components. Therefore, we iteratively developed a patient-centred, evidence-based, small-group, videoconference intervention to improve adherence and symptom management as well as reduce distress for patients taking AET after breast cancer (Symptom-Targeted Randomised Intervention for Distress and Adherence to Adjuvant Endocrine Therapy, STRIDE).

Methods and analysis

The current study is a non-blinded, randomised, controlled, feasibility trial of STRIDE compared with a medication monitoring control group. The primary objective is to examine the feasibility and acceptability of STRIDE, while secondary objectives are to assess changes in objective and subjective adherence, symptom distress and satisfaction with AET. Patients will be recruited from the Massachusetts General Hospital Cancer Center in Boston, Massachusetts. The total number of patients accrued will be 75, with ≥60 patients completing the study. All patients will store their AET in an electronic pill bottle for objective adherence monitoring. Patients randomly assigned to the STRIDE intervention will receive 6 weekly 1-hour sessions, in small groups of two, delivered via videoconferencing by a trained mental health professional. Patients assigned to the control group will store their medication in the electronic pill bottle and receive follow-up oncology care as usual. All participants will complete self-report psychosocial measures at baseline, 12 weeks and 24 weeks postbaseline.

Ethics and dissemination

The study is funded by the National Cancer Institute of the National Institutes of Health and is approved by the Dana-Farber/Harvard Cancer Center Institutional Review Board (Protocol #18–603, V.1.2, first approval date 1 February 2019). The study will be reported in accordance with the Consolidated Standards of Reporting Trials statement for non-pharmacological trials. Results will be published in peer-reviewed academic journals, presented at scientific meetings and disseminated to patient organisations and media outlets.

Trial registration number

NCT03837496; Pre-results.
Early perceptions and behavioural responses during the COVID-19 pandemic: a cross-sectional survey of UK adults
Authors: Atchison Christina , Bowman Leigh Robert , Vrinten Charlotte , Redd Rozlyn , Pristerà Philippa , Eaton Jeffrey , Ward Helen
Published: January 2021

Objective

To examine risk perceptions and behavioural responses of the UK adult population during the early phase of the COVID-19 epidemic in the UK.

Design

A cross-sectional survey.

Setting

Conducted with a nationally representative sample of UK adults within 48 hours of the UK Government advising the public to stop non-essential contact with others and all unnecessary travel.

Participants

2108 adults living in the UK aged 18 years and over. Response rate was 84.3% (2108/2500). Data collected between 17 March and 18 March 2020.

Main outcome measures

Descriptive statistics for all survey questions, including number of respondents and weighted percentages. Robust Poisson regression used to identify sociodemographic variation in: (1) adoption of social distancing measures, (2) ability to work from home, and (3) ability and (4) willingness to self-isolate.

Results

Overall, 1992 (94.2%) respondents reported at least one preventive measure: 85.8% washed their hands with soap more frequently; 56.5% avoided crowded areas and 54.5% avoided social events. Adoption of social distancing measures was higher in those aged over 70 years compared with younger adults aged 18–34 years (adjusted relative risk/aRR: 1.2; 95% CI: 1.1 to 1.5). Those with lowest household income were three times less likely to be able to work from home (aRR: 0.33; 95% CI: 0.24 to 0.45) and less likely to be able to self-isolate (aRR: 0.92; 95% CI: 0.88 to 0.96). Ability to self-isolate was also lower in black and minority ethnic groups (aRR: 0.89; 95% CI: 0.79 to 1.0). Willingness to self-isolate was high across all respondents.

Conclusions

Ability to adopt and comply with certain non-pharmaceutical interventions (NPIs) is lower in the most economically disadvantaged in society. Governments must implement appropriate social and economic policies to mitigate this. By incorporating these differences in NPIs among socioeconomic subpopulations into mathematical models of COVID-19 transmission dynamics, our modelling of epidemic outcomes and response to COVID-19 can be improved.
Managing the risk from children’s travel cups
Authors: Cameron Alice , Colbert Serryth Dominic , Macleod Alisdair , Gill Harinderjit S
Published: January 2021

Introduction

UK national newspapers have reported cases of children (and adults) who have got their tongue trapped in a Disney travel mug lid, causing extreme distress to the patients, their parents and ED staff. Potential risks include oral endotracheal intubation necessitating emergency tracheostomy to secure the airway, tongue necrosis and dental trauma. Although Disney has withdrawn their original mug from the global market, the same dangers can occur with other internationally available brands. Our aim was to design, test and present an alternative lid.

Methods and materials

We designed an alternative lid to fit onto the original Disney mug; our addition of two parallel bars prevented tongue protrusion into the lid. Prototypes of the original and new lids were three-dimensional printed for testing. A tongue substitute was developed and a representative 0.2 bar suction force was generated. The bottle was mounted in a material test machine, attached to the load cell fixture. Four samples each for the existing and new design were tested. The data were analysed by a custom Matlab script to extract the maximum force required to remove the tongues from the cup.

Results

The new design resulted in a significant (p=0.0286, Mann-Whitney U) reduction in pullout force. For the existing design, the median pullout force was 4.64 N (minimum 3.86 N, maximum 4.91 N), while it was 2.37 N (minimum 2.20 N, maximum 2.53 N) for the new design. Trauma to the materials used with the original lid design was evident but not observed with our design.

Conclusion

Our lid appears to offer a safer design that can avoid injuries. However, absolute safety remains unproved, as testing did not account for other body parts which may get trapped in the lid, nor did we test a range of tongue substitute sizes, and laboratory testing only was completed.
Implementation of a care bundle improves the management of patients with non-alcoholic fatty liver disease
Authors: Neilson Laura Jane , Macdougall Louise , Lee Phey Shen , Hardy Timothy , Beaton David , Chandrapalan Subashini , Ebraheem Alaa , Hussien Mohammed , Galbraith Sarah , Looi Shi , Oxenburgh Sophia , Phaw Naw April , Taylor William , Haigh Laura , Hallsworth Kate , Mansour Dina , Dyson Jessica K , Masson Steven , Anstee Quentin , McPherson Stuart
Published: January 2021

Background

Non-alcoholic fatty liver disease (NAFLD) is common and is associated with liver-related and cardiovascular-related morbidity. Our aims were: (1) to review the current management of patients with NAFLD attending hospital clinics in North East England (NEE) and assess the variability in care; (2) develop a NAFLD ‘care bundle’ to standardise care; (3) to assess the impact of implementation of the NAFLD care bundle.

Methods

A retrospective review was conducted to determine baseline management of patients with NAFLD attending seven hospitals in NEE. A care bundle for the management of NAFLD was developed including important recommendations from international guidelines. Impact of implementation of the bundle was evaluated prospectively in a single centre.

Results

Baseline management was assessed in 147 patients attending gastroenterology, hepatology and a specialist NAFLD clinic. Overall, there was significant variability in the lifestyle advice given and management of metabolic risk factors, with patients attending an NAFLD clinic significantly more likely to achieve >10% body weight loss and have metabolic risk factors addressed. Following introduction of the NAFLD bundle 50 patients were evaluated. Use of the bundle was associated with significantly better documentation and implementation of most aspects of patient management including management of metabolic risk factors, documented lifestyle advice and provision of NAFLD-specific patient advice booklets.

Conclusion

The introduction of an outpatient ‘care bundle’ led to significant improvements in the assessment and management of patients with NAFLD in the NEE and could help improve and standardise care if used more widely.
Donor acquired visceral leishmaniasis following liver transplantation
Authors: Dhaliwal Amritpal , Chauhan Abhishek , Aggarwal Dinesh , Davda Pretin , David Miruna , Amel-Kashipaz Rasoul , Brown Rachel , Dedicoat Martin , Clark Fiona , Shah Tahir , Elsharkawy Ahmed Mohamed , Ushiro-Lumb Ines , Chiodini Peter , El-Sherif Omar , Armstrong Matthew , Ferguson James W
Published: January 2021

Patients who undergo solid organ transplantation are at risk of opportunistic infection associated with immunosuppression. We report a case of confirmed donor derived visceral leishmaniasis (VL), in a patient following liver transplantation causing fever and pancytopenia. The diagnosis was confirmed by bone marrow biopsy, with confirmed positive donor serology, with no other route of transmission. To our knowledge, this is the first case report in the United Kingdom and Europe, of confirmed organ donor transmission of VL. This case report highlights an important consideration of donor derived infections, in the context of solid organ transplantation.
Michigan system for opioid overdose surveillance
Authors: Goldstick Jason , Ballesteros Amanda , Flannagan Carol , Roche Jessica , Schmidt Carl , Cunningham Rebecca M
Published: January 2021

Community rapid response may reduce opioid overdose harms, but is hindered by the lack of timely data. To address this need, we created and evaluated the Michigan system for opioid overdose surveillance (SOS). SOS integrates suspected fatal overdose data from Medical Examiners (MEs), and suspected non-fatal overdoses (proxied by naloxone administration) from the Michigan Emergency Medical Services (EMS) into a web-based dashboard that was developed with stakeholder feedback. Authorised stakeholders can view approximate incident locations and automated spatiotemporal data summaries, while the general public can view county-level summaries. Following Centers for Disease Control and Prevention (CDC) surveillance system evaluation guidelines, we assessed simplicity, flexibility, data quality, acceptability, sensitivity, positive value positive (PVP), representativeness, timeliness and stability of SOS. Data are usually integrated into SOS 1-day postincident, and the interface is updated weekly for debugging and new feature addition, suggesting high timeliness, stability and flexibility. Regarding representativeness, SOS data cover 100% of EMS-based naloxone adminstrations in Michigan, and receives suspected fatal overdoses from MEs covering 79.1% of Michigan’s population, but misses those receiving naloxone from non-EMS. PVP of the suspected fatal overdose indicator is nearly 80% across MEs. Because SOS uses pre-existing data, added burden on MEs/EMS is minimal, leading to high acceptability; there are over 300 authorised SOS stakeholders (~6 new registrations/week) as of this writing, suggesting high user acceptability. Using a collaborative, cross-sector approach we created a timely opioid overdose surveillance system that is flexible, acceptable, and is reasonably accurate and complete. Lessons learnt can aid other jurisdictions in creating analogous systems.
Biallelic variants in ZNF526 cause a severe neurodevelopmental disorder with microcephaly, bilateral cataract, epilepsy and simplified gyration
Authors: Dentici Maria Lisa , Alesi Viola , Quinodoz Mathieu , Robens Barbara , Guerin Andrea , Lebon Sébastien , Poduri Annapurna , Travaglini Lorena , Graziola Federica , Afenjar Alexandra , Keren Boris , Licursi Valerio , Capuano Alessandro , Dallapiccola Bruno , Superti-Furga Andrea , Novelli Antonio
Published: January 2021

Background

Next-generation sequencing, combined with international pooling of cases, has impressively enhanced the discovery of genes responsible for Mendelian neurodevelopmental disorders, particularly in individuals affected by clinically undiagnosed diseases. To date, biallelic missense variants in ZNF526 gene, encoding a Krüppel-type zinc-finger protein, have been reported in three families with non-syndromic intellectual disability.

Methods

Here, we describe five individuals from four unrelated families with an undiagnosed neurodevelopmental disorder in which we performed exome sequencing, on a combination of trio-based (4 subjects) or single probands (1 subject).

Results

We identified five patients from four unrelated families with homozygous ZNF526 variants by whole exome sequencing. Four had variants resulting in truncation of ZNF526; they were affected by severe prenatal and postnatal microcephaly (ranging from −4 SD to −8 SD), profound psychomotor delay, hypertonic–dystonic movements, epilepsy and simplified gyral pattern on MRI. All of them also displayed bilateral progressive cataracts. A fifth patient had a homozygous missense variant and a slightly less severe disorder, with postnatal microcephaly (−2 SD), progressive bilateral cataracts, severe intellectual disability and unremarkable brain MRI.

Mutant znf526 zebrafish larvae had notable malformations of the eye and central nervous system, resembling findings seen in the human holoprosencephaly spectrum.

Conclusion

Our findings support the role of ZNF526 biallelic variants in a complex neurodevelopmental disorder, primarily affecting brain and eyes, resulting in severe microcephaly, simplified gyral pattern, epileptic encephalopathy and bilateral cataracts.
Sexually transmitted infections (STI) and antenatal care (ANC) clinics in Malawi: effective platforms for improving engagement of men at high HIV risk with voluntary medical male circumcision services
Authors: Msungama Wezi , Menego Geoffrey , Shaba Frackson , Flowers Nicole , Habel Melissa , Bonongwe Abigail , Banda Masford , Shire Steven , Maida Alice , Auld Andrew , Phiri Sam John Peter , Dumbani Kayira , Buono Nicole , Luhanga Mishek , Kapito Martin , Gibson Hannah , Laube Catey , Toledo Carlos , Kim Evelyn , Davis Stephanie Marie
Published: January 2021

Introduction

Voluntary medical male circumcision (VMMC), an effective HIV prevention programme for men, is implemented in East and Southern Africa. Approximately 50% of VMMC clients are aged below 15 years. More targeted interventions to reach older men and others at higher short-term HIV risk are needed.

Methods

We implemented a quality improvement project testing the effectiveness of an active referral-based VMMC recruitment approach, targeting men attending STI clinics and those escorting partners to antenatal care (ANC) clinics, at Bwaila Hospital in Lilongwe, Malawi. We compared the proportions aged older than 15 years among men who received VMMC following referral from STI and ANC clinics with those among men referred from standard community mobilisation. We also analysed referral cascades to VMMC.

Results

In total, 330 clients were circumcised after referral from STI (242) and ANC (88) clinics, as compared with 3839 other clients attributed to standard community mobilisation. All clients from ANC and STI clinics were aged over 15 years, as compared with 69% from standard community mobilisation. STI clinics had a higher conversion rate from counselling to VMMC than ANC (12% vs 9%) and a higher contribution to total circumcisions performed at the VMMC clinic (6% vs 2%).

Conclusions

Integrating VMMC recruitment and follow-up in STI and ANC clinics co-located with VMMC services can augment demand creation and targeting of men at risk of HIV, based on age and STI history. This approach can be replicated at least in similar health facilities with ANC and STI services in close proximity to VMMC service delivery.
Online self-sampling kits to screen multipartner MSM for HIV and other STIs: participant characteristics and factors associated with kit use in the first 3 months of the MemoDepistages programme, France, 2018
Authors: Rahib Delphine , Delagreverie Heloïse , Gabassi Audrey , Le Thi Thanh-Thuy , Vassel Eleonore , Vodosin Pierre , Leveau Benjamin , Pisoni Amandine , Tuaillon Edouard , Digne Julien , Icard Vinca , Delaugerre Constance , Lydié Nathalie
Published: January 2021

Objectives

In 2017, to reduce the proportion of men who have sex with men (MSM) in the undiagnosed HIV population in France (38%), HIV screening is advised each 3 months and STI screening is advised each year in multipartner MSM. Despite the range of testing solutions, over 40% of MSM were not tested for HIV and over 50% for STIs in the past year. Based on international experiments that offer screening solutions via online advertising, the French National Health Agency launched a programme (MemoDepistages) to provide a free self-sampling kit (SSK) for HIV and STIs. This article analyses the sociodemographic and behavioural characteristics of MSM in terms of kit acceptance and sample return.

Methods

Participants were registered for the programme online after ordering an SSK. The study included men aged over 18 years, living in one of the four selected French regions, and willing to disclose their postal and email address; they had health insurance, acknowledged more than one male partner in the past year, indicated a seronegative or unknown HIV status and were not taking medically prescribed pre-exposure prophylaxis drugs. Samples were collected by users and posted directly to the laboratory. Characteristics associated with kit acceptance and sample return were analysed using logistic regression.

Results

Overall, 7158 eligible MSM were offered to participate in the programme, with 3428 ordering the kit (47.9%) and 1948 returning their sample, leading to a return rate of 56.8% and an overall participation rate of 27.2%. Acceptance and return rates were strongly associated with sociodemographic characteristics, mainly education level but not with behavioural characteristics. Non-college graduates had lower acceptance (44.2%) and return rates (47.7%).

Conclusion

The programme rapidly recruited a large number of MSM. It removed geographical inequalities related to screening access.
Small biased body size of salmon fry preyed upon by piscivorous fish in riverine and marine habitats
Authors: Hasegawa Koh , Honda Kentaro , Yoshiyama Taku , Suzuki Kengo , Fukui Sho
Published: January 2021

Predator–prey interactions must be considered when aiming to enhance populations by releasing artificially reared individuals into natural environments. Released individuals create an abundance of prey for predators, and a basic hypothesis of predator–prey interactions suggests that predators select large prey due to the high caloric content. An alternative hypothesis is that small individuals are vulnerable to predation due to their poor predator avoidance. This study tested these hypotheses using stocked chum (Oncorhynchus keta) and masu (Oncorhynchus masou) salmon fry and piscivorous salmonids in marine and riverine habitats in Hokkaido, Japan. Stomach contents were sampled from predators, and fork length of prey fry was measured. Then, their fork length was compared with whole stocked fry (range of mean fork length (±SD): 45.8 ± 2.55 to 49.2 ± 2.76 mm) for each habitat. As a result, prey fry were ∼3%–6% smaller than whole stocked fry, even under a prey-abundant condition (i.e., just after hatchery reared salmon fry were stocked). Piscivorous salmonids pursue schooling fry, and small fry may be easily caught due to their slow speed in avoiding predators.
Ecological effects and causal synthesis of oil sands activity impacts on river ecosystems: water synthesis review
Authors: Culp Joseph M. , Droppo Ian G. , di Cenzo Peter D. , Alexander Alexa C. , Baird Donald J. , Beltaos Spyros , Bickerton Greg , Bonsal Barrie , Brua Robert B. , Chambers Patricia A. , Dibike Yonas , Glozier Nancy E. , Kirk Jane L. , Levesque Lucie , McMaster Mark , Muir Derek C.G. , Parrott Joanne L. , Peters Daniel L. , Pippy Kerry , Roy James W.
Published: January 2021

Oil sands development in the lower Athabasca River watershed has raised considerable public and scientific concerns regarding perceived effects on environmental health. To address this issue for tributaries and the mainstem of the Athabasca River in the Athabasca Oil Sands Region, the Water Component of the Joint Oil Sands Monitoring (JOSM) plan produced monitoring assessments for seven integrated themes: atmospheric deposition, tributary water quality, river mainstem water quality, groundwater quality and quantity, water quality and quantity modelling, benthic invertebrate condition, and fish health. Our review integrates and synthesizes the large and diverse datasets assembled in the seven JOSM theme assessments to (i) evaluate possible environmental effects based on known sources and candidate proximal causes and (ii) determine the importance of cause-and-effect pathways related to contaminant, sediment, and nutrient inputs. Although JOSM research identified ecological effects that appear to be associated with contaminant exposure, the source of this exposure is confounded by co-location of, and inability to differentiate between, oil sands operations (principally released by atmospheric emission) and inputs from the natural bitumen outcrops (e.g., erosional material transported by surface and groundwater flows). Nutrient enrichment from treated municipal sewage effluent was the dominant ecological effect observed for the mainstem Athabasca River, associated with increased fish size and changes in invertebrate assemblages, likely because this pollution source is discharged directly into the river. If the direct release of treated oil sands process water occurs in the future, then the potential ecological impact of these direct industry releases will need to be evaluated carefully. The ecological causal assessment method proved to be a useful tool for better understanding how stressor sources relate to ecological effects through candidate proximate causes. Factors that confound our ability to assess the ecological effects of oil sands development focus on our inability to adequately differentiate between contaminants supplied from natural and anthropogenic contaminant sources. Our causal synthesis identifies options for changes in future monitoring to better anticipate and detect degradation in the ecosystem health of the lower Athabasca River and its tributaries.