bluuebunny/crossref_metadata_2025 huggingface dataset:
Optimal C-type filter design for wireless power transfer system by using support vector machines
Authors: Calgan Haris
Published: July 2023

The rapid increase in the number of Electrical Vehicles (EVs) will bring difficulties in the management of charging process and pose serious grid problems at low voltage levels. Particularly, with employment of wireless power transfer (WPT) system in a charging station, harmonic interference will increase. The main reason of that poor power quality lies on high frequency square wave output of transmitter side of WPT. In this study, a support vector machine (SVM) is proposed to design an optimal C-type passive filter in order to mitigate voltage and current total harmonic distortions (THD) of WPT system. Hereby, SVM-based model is constructed which consists of THD indices and power factor (PF) as outputs whereas filter parameters are inputs. The main aim of optimization process is minimization of distortions and correction of PF while searching the filter parameters. Particle swarm optimization (PSO) algorithm is employed to find the optimal filter parameters. To show the efficiency of proposed method, simulation studies are carried out on Matlab®/SimulinkTM environment. It is observed that voltage total harmonic distortion (THDv) and current total harmonic distortion (THDi) are calculated as 1.03%, 2.23%, respectively, and the power factor is improved to 0.995% when the designed C-type filter is utilized.
Micron-Sized Particle Transport and Deposition in Internal Cooling Duct With Elliptical Pin Fins
Authors: Liu Jiawei , Yu Kuahai , Peng Chuqi , Yao Shile , Xin Shihong
Published: July 2023

The particle deposition in the internal cooling duct reduces the heat transfer efficiency, increases the instability of aero-engine operation, and brings serious challenges to the design of turbine blades. In this paper, the energy dissipation collision theory is used to predict the particle transport and deposition in the cooling duct with different pin fins. The effects of pin aspect ratio and inlet Reynolds number Re on the deposition rate, as well as heat transfer efficiency and overall thermal performance, are investigated. The results show that the endwall deposition rate is much higher than the pin deposition rate. The pin adhesion rate decreases with the increase of inlet Reynolds number. Increasing Re has little effect on the endwall deposition rate for the cooling duct with pin fins of the aspect ratio of 1 and 1.5, while it leads to an increase in heat transfer efficiency and a reduction in pin deposition rate. For the cooling duct with pin fins of the aspect ratio of 2, the endwall deposition rate increases with the increase of Re. A larger pin aspect ratio decreases the heat transfer efficiency of the cooling duct, but increasing the aspect ratio is helpful to improve the overall thermal performance and reduce the deposition rate. To account for particle deposition and thermal performance, the aspect ratio of 1.5 is recommended.
9 MV LINAC Photoneutron Interrogation of Uranium With Advanced Acoustically Tensioned Metastable Fluid Detectors
Authors: Boyle Nathan , Ozerov Stepan , Harabagiu Catalin , Taleyarkhan Rusi P.
Published: July 2023

Active special nuclear material (SNM) photoneutron interrogation research with acoustically tensioned metastable fluid detector (ATMFD) sensor technology is discussed, which provides evidence for enabling real-time detection of SNM even when deployed under extreme 15,000 R h−1 (9 MeV endpoint) X-ray beams. Experiments to detect 3.2 kg depleted uranium (DU) are described with the use of two designs of the economical acoustically tensioned metastable fluid detector (E-ATMFD), viz., E-ATMFD.Ver.0 and E-ATMFD.Ver.1, respectively, at standoffs ranging from 0.1 m to 10 m—including with the E-ATMFD directly within the interrogating beam. Under similar conditions and with 100% photon rejection (i.e., 0 cpm with beam on, and without SNM), the E-ATMFD.Ver.1 design operating at ∼0.9 W of drive power was shown capable of ∼6× (600%) higher gain over E-ATMFD.Ver.0 operating at ∼7 W (with beam on and with SNM). The sensitivity gain rises to ∼27× (i.e., 2700%) with the E-ATMFD.Ver.1 operating at 0.99 W and a background count rate of ∼1 cpm. The E-ATMFD.Ver.1 demonstrated 100% photon blindness (0 cpm) while operating at ∼0.56 W drive power and placed directly within the beam under 15,000 R/h; including the SNM target led to a count rate of up to 50 cpm—revealing the E-ATMFD.Ver.1 is potential field capable of detecting U-based SNMs within seconds from photofission neutron signals, even when deployed directly within the intense (15,000 R/h) high energy (9 MeV endpoint X-Ray) interrogating photon beam.
Infrared Thermography—A Novel Tool for Monitoring Fracture Healing: A Critically Appraised Topic With Evidence-Based Recommendations for Clinical Practice
Authors: Castonguay Tristan , Dover Geoff
Published: July 2023

Clinical Scenario: Stress fractures are one of the most common injuries in athletes. Unfortunately, they are hard to diagnose, require multiple radiology exams and follow-up which leads to more exposure to radiation and an increase in cost. Stress fractures that are mismanaged can lead to serious complications and poorer outcomes for the athlete. During the rehabilitation process, it would be beneficial to be able to monitor the healing of fractures to know when it is safe to gradually allow a patient to a return to sport because the return to activity is not usually objective and based on pain level. Clinical Question: Can infrared thermography (IRT) be a useful tool to measure the pathophysiological state of the fracture healing? The aim of this critically appraised topic is to analyze the current evidence of IRT for measuring the temperature change in fractures to provide recommendations for medical practitioners. Summary of Key Findings: For this critically appraised topic, we examined 3 articles that compared medical imaging and IRT over multiple time points during the follow-up. The 3 articles concluded that a 1 °C asymmetry in temperature followed by a return to normal (less than 0.3 °C) temperature during the healing process of fractures can be monitored using IRT. Clinical Bottom Line: Once the patient has been diagnosed with a fracture, IRT can safely be used to monitor the evolution of a fracture. When the thermogram progresses from a hot thermogram to a cold thermogram, the healing is considered good enough to return to sport. Strength of Recommendation: Grade 2 evidence exists to support IRT being used by clinicians to monitor fracture healing. Due to the limited research and novelty of the technology, the current recommendations are for following the treatment of the fracture once the initial diagnosis is made.
Isolation and Genomic Characterization of a Heat-Labile Enterotoxin 1-Producing Escherichia fergusonii Strain from a Human
Authors: Okuno Miki , Tsuru Nami , Yoshino Shuji , Gotoh Yasuhiro , Yamamoto Takeshi , Hayashi Tetsuya , Ogura Yoshitoshi
Published: July 2023

Escherichia fergusonii
, a species closely related to
Escherichia coli
, is known to cause sporadic conditions in humans, including diarrhea. However, the critical virulence factors in
E. fergusonii
clinical isolates remain to be identified.
Impact of childhood burns on academic performance: a matched population-based cohort study
Authors: Halim Nicole , Holland Andrew J A , McMaugh Anne , Cameron Cate M , Lystad Reidar P , Badgery-Parker Tim , Mitchell Rebecca
Published: July 2023

Objective

This study aimed to compare academic performance and high school completion of young people hospitalised for a burn compared with young people not hospitalised for an injury.

Design

A retrospective population-based matched case-comparison cohort study.

Participants

Young people aged ≤18 years hospitalised for a burn during 2005–2018 in New South Wales, Australia, with age, sex and residential postcode-matched peers not hospitalised for any injury during 1 July 2001 and 31 December 2018.

Main outcome measures

Performance below the national minimum standard (NMS) on the National Assessment Plan for Literacy and Numeracy assessments and not completing high school.

Results

Young females hospitalised for a burn had a 72% higher risk of poorer reading compared with their peers (adjusted relative risk (ARR) 1.72; 95% CI 1.33 to 2.23), while young males hospitalised with a burn showed no higher risk (ARR 1.14; 95% CI 0.91 to 1.43). Young males (ARR 1.05; 95% CI 0.81 to 1.35) and females (ARR 1.34; 95% CI 0.93 to 1.94) hospitalised with a burn had no higher risk of not reaching the NMS for numeracy compared with peers. Young people hospitalised with a burn had at least twice the risk of not completing year 10 (ARR 3.86; 95% CI 1.68 to 8.86), year 11 (ARR 2.45; 95% CI 1.89 to 3.18) and year 12 (ARR 2.09; 95% CI 1.63 to 2.67) compared with matched counterparts.

Conclusions

Young females hospitalised with a burn displayed poorer academic performance for reading compared with matched peers, while males and females were more likely to leave school earlier. Identifying unmet learning support needs of young burn survivors should be investigated.
Isolated tricuspid valve Group B Streptococcal endocarditis with septic pulmonary embolism and multiple mycotic aneurysms of the pulmonary arteries
Authors: Ramirez Bryan Paul , Huibonhoa Julian Alexander , Punzalan Felix Eduardo , Rodriguez Benjamin Francis,
Published: July 2023

A diabetic woman in her 30s was admitted to our medical centre for persistent fever associated with worsening cough, easy fatigability and pleuritic chest pain noted after childbirth. Investigations revealed an isolated tricuspid valve endocarditis from Group BStreptococcus. Despite appropriate antibiotic coverage, her symptoms persisted with worsening dyspnoea; hence, a CT pulmonary angiogram was done which showed septic pulmonary embolism and multiple mycotic aneurysms of the pulmonary arteries. She was treated with antibiotics and underwent tricuspid valve replacement and was discharged well with a return to her baseline functional capacity on subsequent follow-ups.
Valproate overdose leading to hyperammonaemic encephalopathy
Authors: Sharma Deepak S , Gupta Sandeep , Sharma Priyanka
Published: July 2023

Sodium valproate is a commonly prescribed anticonvulsant medication; however, it can cause uncommon side effects such as hyperammonaemia and encephalopathy. We present the case of a male in his early 50s brought to the emergency department after being found collapsed by his wife, with an empty bottle of sodium valproate tablets. The patient developed hyperammonaemic encephalopathy due to sodium valproate overdose and was treated with supportive care and renal replacement therapy. This case highlights the importance of recognising the potential complications of sodium valproate and its prompt treatment.
Persistence of severe global inequalities in the burden of blindness and vision loss from 1990 to 2019: findings from the Global Burden of Disease Study 2019
Authors: Li Yuancun , Wang Hongxi , Guan Zhiqiang , Guo Chengyao , Guo Pi , Du Yali , Yin Shengjie , Chen Binyao , Jiang Jiao , Ma Yueting , Jing Liu , Huang Yingzi , Zheng Ke , Ma Qian , Zhou Ruiqing , Chen Min , Congdon Nathan , Qiu Kunliang , Zhang Mingzhi
Published: July 2023

Aims

To assess the global burden and economic inequalities in the distribution of blindness and vision loss between 1990 and 2019.

Methods

A secondary analysis of the Global Burden of Diseases, Injuries and Risk Factors Study (GBD) 2019. Data for disability-adjusted life-years (DALYs) due to blindness and vision loss were extracted from the GBD 2019. Data for gross domestic product per capita were extracted from the World Bank database. Slope index of inequality (SII) and concentration index were computed to assess absolute and relative cross-national health inequality, respectively.

Results

Countries with high, high-middle, middle, low-middle and low Socio-demographic Index (SDI) had decline of age-standardised DALY rate of 4.3%, 5.2%, 16.0%, 21.4% and 11.30% from 1990 to 2019, respectively. The poorest 50% of world citizens bore 59.0% and 66.2% of the burden of blindness and vision loss in 1990 and 2019, respectively. The absolute cross-national inequality (SII) fell from −303.5 (95% CI −370.8 to −236.2) in 1990 to −256.0 (95% CI −288.1 to −223.8) in 2019. The relative inequality (concentration index) for global blindness and vision loss remained essentially constant between 1991 (−0.197, 95% CI −0.234 to −0.160) and 2019 (−0.193, 95% CI −0.216 to −0.169).

Conclusion

Though countries with middle and low-middle SDI were the most successful in decreasing burden of blindness and vision loss, a high level of cross-national health inequality persisted over the past three decades. More attention must be paid to the elimination of avoidable blindness and vision loss in low-income and middle-income countries.
Association between contrast sensitivity function and structural damage in primary open-angle glaucoma
Authors: Pang Ruiqi , Peng Jieting , Cao Kai , Sun Yunxiao , Pei Xue-Ting , Yang Diya , Lu Zhong-Lin , Wang Ningli
Published: July 2023

Aims

To evaluate the association between contrast sensitivity function (CSF) and glaucomatous structural damage in primary open-angle glaucoma (POAG).

Methods

A cross-sectional study was performed with 103 patients (103 eyes) aged 25–50 years who had POAG without any other ocular disease. CSF measurements were obtained by the quick CSF method, a novel active learning algorithm that covers 19 spatial frequencies and 128 contrast levels. The peripapillary retinal nerve fibre layer (pRNFL), macular ganglion cell complex (mGCC), radial peripapillary capillary (RPC) and macular vasculature were measured by optical coherence tomography and angiography. Correlation and regression analyses were used to assess the association of area under log CSF (AULCSF), CSF acuity and contrast sensitivities at multiple spatial frequencies with structural parameters.

Results

AULCSF and CSF acuity were positively associated with pRNFL thickness, RPC density, mGCC thickness and superficial macular vessel density (p<0.05). Those parameters were also significantly associated with contrast sensitivity at 1, 1.5, 3, 6, 12, 18 cycles per degree spatial frequencies (p<0.05) and, the lower the spatial frequency, the higher the correlation coefficient. RPC density (p=0.035, p=0.023) and mGCC thickness (p=0.002, p=0.011) had significant predictive value for contrast sensitivity at 1 and 1.5 cycles per degree, with adjustedR2of 0.346 and 0.343, respectively.

Conclusions

Full spatial frequency contrast sensitivity impairment, most notably at low spatial frequencies, is a characteristic change in POAG. Contrast sensitivity is a potential functional endpoint for the measurement of glaucoma severity.
Prevalence of fear of hypoglycemia in adults with type 1 diabetes using a newly developed screener and clinician’s perspective on its implementation
Authors: Peter Megan E , Rioles Nicole , Liu Jingwen , Chapman Katherine , Wolf Wendy A , Nguyen Huyen , Basina Marina , Akturk Halis Kaan , Ebekozien Osagie , Perez-Nieves Magaly , Poon Jiat Ling , Mitchell Beth
Published: July 2023

Introduction

Fear of hypoglycemia (FoH) affects quality of life, emotional well-being, and diabetes management among people with type 1 diabetes (PwT1D). American Diabetes Association’s (ADA) guidelines recommend assessing FoH in clinical practice. However, existing FoH measures are commonly used in research and not in clinical practice. In this study, prevalence of FoH was assessed in PwT1D using a newly developed FoH screener for clinical practice; its association with established measures and outcomes was also determined. In addition, healthcare providers’ (HCPs) perspectives on implementing FoH screener into real-world practice were explored.

Research design and methods

This multiphase observational study used mixed methods in two phases. First, we collected a cross-sectional survey (including the screener) from PwT1D (≥18 years) from T1D Exchange Quality Improvement Collaborative adult clinics. Pearson correlations and regression analyses were performed on diabetes outcome measures using screener scores. Second, we conducted focus groups among HCPs who treat PwT1D and descriptive analysis to summarize results.

Results

We included 553 PwT1D. Participants had a mean±SD age of 38.9±14.2 years and 30% reported a high FoH total score. Regression analyses showed that higher A1c and higher number of comorbidities were significantly associated with high FoH (p<0.001). High FoH worry and behavior scores were significantly associated with 8-Item Patient Health Questionnaire and 7-Item Generalized Anxiety Disorder Scale scores. Participants with ≥1 severe hypoglycemia event(s) and impaired awareness of hypoglycemia had higher odds of high FoH. Eleven HCPs participated in focus group interviews; they expressed that the FoH screener is clinically necessary and relevant but poses implementation challenges that must be addressed.

Conclusions

Our results demonstrate FoH is common in PwT1D and affects their psychosocial well-being and diabetes management. In alignment with ADA position statement, HCP focus group results emphasize importance of screening for FoH. Implementing this newly developed FoH screener may help HCPs identify FoH in PwT1D.
Prevalence of externalising disorder comorbidities in adolescents: a systematic review and meta-analysis protocol
Authors: Norozpour Marzieh , Pourshahbaz Abbas , Poursharifi Hamid , Dolatshahi Behrooz , Habibi Nastaran
Published: July 2023

Introduction

Externalising disorders are some of the most prevalent problems in childhood and particularly during adolescence that can change into more severe psychopathology in adulthood if left unattended. In the research literature, these disorders include attention deficit/hyperactivity disorder, oppositional/defiant disorder, conduct disorder and substance use disorders. The comorbidity prevalence of these disorders is significant and cannot be considered a random factor. The dimensional structure of psychopathology has always been studied by researchers to address disorder comorbidities and aetiology. There has always been controversy over the number of spectra and the lower levels. Currently, the new top-down, Hierarchical Taxonomy of Psychopathology model conceptualising psychopathology is being used, which is a dimensional classification system for the different spectra of psychopathology based on a combination of conceptual modelling and factor analysis of symptoms. This systematic review investigates the comorbidity prevalence of spectra of externalising disorders to provide valuable information and feedback on this model.

Methods and analysis

This systematic review will include all the studies conducted from 1/1/1990 to 1/12/2020 to examine the prevalence and comorbidity of each of the externalising disorders in the general population, schools and outpatients using any instrument (questionnaires or interviews). There will be no language restrictions in selecting the studies. The studies are age restricted and must be conducted on adolescents only, but there are no restrictions on the gender and nationality of the participants.

Ethics and dissemination

This systematic review is based on previously published articles and therefore will not require ethical approval. The results of the systematic review will be disseminated as publication in a peer-reviewed journal and conference presentation.

PROSPERO registration number

CRD42022327629.
Smartphone-based versus traditional face-to-face collaborative care for community-dwelling older adults living with dementia in China: protocol for an implementation science-based sequential multiple assignment randomised trial
Authors: Wan Yang , Cai Yan , Liao Shiyi , Zhao Qin , Wang Yangyang , Song Xiaozhen , Meng Steven Siyao , Ji Xiaoyi , Wu Yue , Qiu Peiyuan
Published: July 2023

Introduction

The high costs of institutional care and the burdensome demands of home care are challenging for families of adults with dementia. The collaborative care model (CCM) provides a potential solution to these challenges. Leveraging advancements in mobile technologies, smartphone-based management could offer a feasible means of providing collaborative care in a community setting. Therefore, this study aims to establish a CCM for home-cared older adults with dementia to determine the best strategy to deliver collaborative care, including both the channel and frequency of delivery.

Methods and analysis

This study will be conducted in the communities of Chengdu city, Sichuan province, China. It is designed under the framework of implementation science. In the first stage, intervention strategies for community-dwelling older adults with dementia and their caregivers will be developed using Delphi methods and focus group interviews. The second stage will involve designing a sequential multiple assignment randomised trial to compare the effectiveness of face-to-face intervention versus a WeChat mini program-based intervention. This comparison will involve 358 pairs of older adults with dementia and their caregivers, with the frequency of intervention also assessed. Follow-up evaluations will be implemented at the 6th, 12th and 18th months post-intervention initiation. Primary outcomes encompass the proportion of patients demonstrating an improvement in quality of life and the proportion of caregivers exhibiting a reduction in caregiver burden. Analysis will be based on the intention-to-treat principle, and the generalised estimating equation approach will be used. Incremental cost-effectiveness ratios will be used to evaluate the cost-effectiveness of different delivery methods and frequencies.

Ethics and dissemination

This study has received approval from the Ethics Committee of West China Fourth Hospital/School of Public Health, Sichuan University (Gwll2022004). Informed consent will be obtained for all participants. The findings of the study will be disseminated through peer-reviewed scientific journals.

Trial registration number

ChiCTR2200057945.
Lower haemoglobin-to-red blood cell distribution width ratio is independently associated with frailty in community-dwelling older adults: a cross-sectional study
Authors: Zhu Mengpei , Wei Chao , Yang Xiongjun , Huang Yumei , Xu Yushuang , Xiong Zhifan
Published: July 2023

Objectives

The importance of blood cell markers in frailty has been studied. However, research on haemoglobin-to-red blood cell distribution width ratio (HRR) and frailty in older persons is still limited. We investigated the association between HRR and frailty in older adults.

Design

Cross-sectional population-based study.

Setting

Community-dwelling older adults older than 65 years were recruited from September 2021 to December 2021.

Participants

A total of 1296 community-dwelling older adults (age ≥65 years) in Wuhan were included in the study.

Main outcome measures

The main outcome was the presence of frailty. The Fried Frailty Phenotype Scale was used to evaluate the frailty status of the participants. Multivariable logistic regression analysis was performed to determine the relationship between HRR and frailty.

Results

A total of 1296 (564 men) older adults were included in this cross-sectional study. Their mean age was 70.89±4.85 years. Receiver operating characteristic curve analysis showed that HRR is a good predictor of frailty in older people, the area under the curve (AUC) was 0.802 (95% CI: 0.755 to 0.849), and the highest sensitivity was 84.5% and the specificity was 61.9% with the optimal critical values 9.97 (p<0.001). Multiple logistic regression analysis indicated that lower HRR (<9.97) (OR: 3.419, 1.679 to 6.964, p=0.001) is independently associated with frailty in older people, even after adjusting confounding factors.

Conclusion

Lower HRR is closely associated with an increased risk of frailty in older people. Lower HRR may be an independent risk factor for frailty in community-dwelling older adults.
Cultural adaptation of a UK evidence-based problem-solving intervention to support Polish prisoners at risk of suicidal behaviour: a cross-sectional survey using an Ecological Validity Model
Authors: Perry Amanda E , Zawadzka Maja , Lapinski Piotr , Moore Keeley , Rychlik Jaroslaw , Nowak Beata
Published: July 2023

Objective

To complete a cultural adaptation of a UK evidence-based problem-solving intervention to support Polish prisoners at risk of suicidal behaviour.

Design

A cross-sectional survey participatory design using an Ecological Validity Model.

Setting

The study was a collaboration between: the Academy of Justice, in Warsaw, the University of Lodz, two Polish prisons (ZK Raciborz and ZK Klodzko) and the University of York (UK).

Methods

The adaptation process included an examination of the use of language, metaphors and content (ie, culturally appropriate and syntonic language), the changing of case study scenarios (relevance and acceptability) and maintenance of the theoretical underpinning of the problem-solving model (intervention comprehensibility and completeness). Four stages used: (1) a targeted demonstration for Polish prison staff, (2) a wider audit of the skills with Polish prison staff and students, (3) forward and back-translation of the adapted package, and (4) two iterative consultations with participants from stages (1) and (2) and prison officers from two Polish prisons.

Participants

Self-selecting volunteer participants included: targeted prison staff (n=10), prison staff from the wider Polish penitentiary system (n=39), students from the University of Lodz (n=28) and prison officers from two Polish prisons (n=12).

Main outcomes and measures

Acceptability and feasibility of the training package, reported in a series of knowledge user surveys.

Results

The recognised benefits of using the skills within the training package included: enhancing communication, reflective development, collaborative working, changing behaviour, empowering decision-making, relevance to crisis management situations and use of open-ended questions. The skills were endorsed to be used as part of future penitentiary training for prison officers in Poland.

Conclusions

The skills had widespread appeal for use across the Polish penitentiary system. The materials were deemed relevant while adhering to the comprehensibility of the intervention. Further evaluation of the intervention should be explored using a randomised controlled trial design.
Characteristics, clinical course and outcome of ventilated patients at a non-surgical intensive care unit in Germany: a single-centre, retrospective observational cohort analysis
Authors: Grünewaldt Achim , Peiffer Kai-Henrik , Bojunga Jörg , Rohde Gernot G U
Published: July 2023

Objectives

The objective of this study was to evaluate epidemiological characteristics, clinical course and outcome of mechanically ventilated non-surgical intensive care unit (ICU) patients, with the aim of improving the strategic planning of ICU capacities.

Design

We conducted a retrospective observational cohort analysis. Data from mechanically ventilated intensive care patients were obtained by investigating electronic health records. The association between clinical parameters and ordinal scale data of clinical course was evaluated using Spearman correlation and Mann-Whitney U test. Relations between clinical parameters and in-hospital mortality rates were examined using binary logistic regression analysis.

Setting

A single-centre study at the non-surgical ICU of the University Hospital of Frankfurt, Germany (tertiary care-level centre).

Participants

All cases of critically ill adult patients in need of mechanical ventilation during the years 2013–2015 were included. In total, 932 cases were analysed.

Results

From a total of 932 cases, 260 patients (27.9%) were transferred from peripheral ward, 224 patients (24.1%) were hospitalised via emergency rescue services, 211 patients (22.7%) were admitted via emergency room and 236 patients (25.3%) via various transfers. In 266 cases (28.5%), respiratory failure was the reason for ICU admission. The length of stay was higher in non-geriatric patients, patients with immunosuppression and haemato-oncological disease or those in need of renal replacement therapy. 431 patients died, which corresponds to an all-cause in-hospital mortality rate of 46.2%. 92 of 172 patients with presence of immunosuppression (53.5%), 111 of 186 patients (59.7%) with pre-existing haemato-oncological disease, 27 of 36 patients (75.0%) under extracorporeal membrane oxygenation (ECMO) therapy, and 182 of 246 patients (74.0%) undergoing renal replacement therapy died. In logistic regression analysis, these subgroups and older age were significantly associated with higher mortality rates.

Conclusions

Respiratory failure was the main reason for ventilatory support at this non-surgical ICU. Immunosuppression, haemato-oncological diseases, the need for ECMO or renal replacement therapy and older age were associated with higher mortality.
Lifestyle changes during the COVID-19 pandemic in Brazil: results from three consecutive cross-sectional web surveys
Authors: Ribeiro-Alves Marcelo , Lucieri Costa Giovanna , Corrêa da Mota Jurema , de Azevedo Cardoso Taiane , Cerezer Keila , Martini Thais , Soriano de Sousa Marina Ururahy , Bastos Francisco I , Balanzá-Martínez Vicent , Kapczinski Flavio , De Boni Raquel Brandini
Published: July 2023

Objective

The importance of a healthy lifestyle in preventing morbidity and mortality is well-established. The COVID-19 pandemic brought about significant lifestyle changes globally, but the extent of these changes in the Brazilian population remains unclear. The objective of this study was to evaluate changes in lifestyle among the Brazilian general population during the first year of the pandemic.

Design

Three consecutive anonymous web surveys were carried out: survey 1 (S1)—April 2020, S2—August 2020 and S3—January 2021.

Setting

Brazil.

Participants

The study included 19 257 (S1), 1590 (S2) and 859 (S3) participants from the general population, who were ≥18 years, of both sexes, with access to the internet, self-reporting living in Brazil and who agreed to participate after reading the informed consent.

Primary outcome

Lifestyle changes were assessed using the Short Multidimensional Instrument for Lifestyle Evaluation—Confinement (SMILE-C). The SMILE-C assesses lifestyle across multiple domains including diet, substance use, physical activity, stress management, restorative sleep, social support and environmental exposures. We used a combination of bootstrapping and linear fixed-effect modelling to estimate pairwise mean differences of SMILE-C scores overall and by domain between surveys.

Results

In all the surveys, participants were mostly women and with a high education level. Mean SMILE-C scores were 186.4 (S1), 187.4 (S2) and 190.5 (S3), indicating a better lifestyle in S3 as compared with S1. The pairwise mean differences of the overall SMILE-C scores were statistically significant (p<0.001). We also observed a better lifestyle over time in all domains except for diet and social support.

Conclusions

Our findings indicate that individuals from a large middle-income country, such as Brazil, struggled to restore diet and social relationships after 1 year of the pandemic. These findings have implications for monitoring the long-term consequences of the pandemic, as well as future pandemics.
Study protocol: the ILANA study – exploring optimal implementation strategies for long-acting antiretroviral therapy to ensure equity in clinical care and policy for women, racially minoritised people and older people living with HIV in the UK – a qualitative multiphase longitudinal study design
Authors: Farooq Hamzah Z , Apea Vanessa , Kasadha Bakita , Ullah Sadna , Hilton-Smith Gill , Haley Amber , Scherzer Jenny , Hand James , Paparini Sara , Phillips Rachel , Orkin Chloe M
Published: July 2023

Introduction

Cabotegravir and rilpivirine (CAB+RPV long-acting (LA)) is recommended as a treatment for HIV-1 allowing people living with HIV to receive 2 monthly injectable treatment, rather than daily pills. Providing injectable therapy in a system designed to provide and manage study participants on oral treatments poses logistical challenges namely how resources are used to accommodate patient preference within constrained health economies with capacity limitations. In this pragmatic multicentre study, we aim to understand the implementation of CAB-RPV-LA administration in two settings via mixed methods to explore perspectives of participants and the clinical team delivering CAB+RPV LA.

Methods and analysis

Women, racially minoritised people and older people are chronically under-represented in HIV clinical trials so the ILANA trial has set recruitment caps to ensure recruitment of 50% women, 50% ethnically diverse people and 30% over 50 years of age to include a more representative study population. Using a mixed-methods approach, the primary objective is to identify and evaluate the critical implementation strategies for CAB+RPV LA in both hospital and community settings. Secondary objectives include evaluating feasibility and acceptability of CAB+RPV LA administration at UK clinics and community settings from the perspective of HIV care providers, nurses and representatives at community sites, evaluating barriers to implementation, the utility of implementation strategies and adherence.

Ethics and dissemination

Ethical approval has been obtained from the Health Research Authority Research Ethics Committee (REC reference: 22/PR/0318). The dissemination strategy has been formulated with the SHARE Collaborative Community Advisory Board to maximise the impact of this work on clinical care and policy. This strategy draws on and leverages existing resources within the participating organisations, such as their academic infrastructure, professional relationships and community networks. The strategy will leverage the Public Engagement Team and press office to support dissemination of findings.

Trial registration number

NCT05294159.
Clinical effects of Kneipp hydrotherapy: a systematic review of randomised controlled trials
Authors: Ortiz Miriam , Koch Anna Katharina , Cramer Holger , Linde Klaus , Rotter Gabriele , Teut Michael , Brinkhaus Benno , Haller Heidemarie
Published: July 2023

Objective

Hydrotherapy is a traditional prevention and treatment strategy. This study’s aim is to systematically review all available randomised controlled trials (RCTs) investigating clinical effects of hydrotherapy according to Kneipp which is characterised by cold water applications.

Methods

RCTs on disease therapy and prevention with Kneipp hydrotherapy were included. Study participants were patients and healthy volunteers of all age groups. MEDLINE (via PubMed), Scopus, Central, CAMbase, and opengrey.eu were systematically searched through April 2021 without language restrictions and updated by searching PubMed until April 6th 2023. Risk of bias was assessed using the Cochrane tool version 1.

Results

Twenty RCTs (N=4247) were included. Due to high heterogeneity of the RCTs, no meta-analysis was performed. Risk of bias was rated as unclear in most of the domains. Of 132 comparisons, 46 showed significant positive effects in favour of hydrotherapy on chronic venous insufficiency, menopausal symptoms, fever, cognition, emotional function and sickness absenteeism. However, 81 comparisons showed no differences between groups and 5 were in favour of the respective control group. Only half of the studies reported safety issues.

Conclusion

Although RCTs on Kneipp hydrotherapy seem to show positive effects in some conditions and outcomes, it remains difficult to ascertain treatment effects due to the high risk of bias and heterogeneity of most of the considered studies. Further high-quality RCTs on Kneipp hydrotherapy are urgently warranted.

PROSPERO registration number

CRD42021237611.
Diabetes status and other factors as correlates of risk for thrombotic and thromboembolic events during SARS-CoV-2 infection: A nationwide retrospective case–control study usingCerner Real-World Data™
Authors: Tallon Erin M , Gallagher Mary Pat , Staggs Vincent S , Ferro Diana , Murthy Deepa Badrinath , Ebekozien Osagie , Kosiborod Mikhail N , Lind Marcus , Manrique-Acevedo Camila , Shyu Chi-Ren , Clements Mark A
Published: July 2023

Objectives

We sought to examine in individuals with SARS-CoV-2 infection whether risk for thrombotic and thromboembolic events (TTE) is modified by presence of a diabetes diagnosis. Furthermore, we analysed whether differential risk for TTEs exists in type 1 diabetes mellitus (T1DM) versus type 2 diabetes mellitus (T2DM).

Design

Retrospective case–control study.

Setting

The December 2020 version of theCerner Real-World DataCOVID-19 database is a deidentified, nationwide database containing electronic medical record (EMR) data from 87 US-based health systems.

Participants

We analysed EMR data for 322 482 patients >17 years old with suspected or confirmed SARS-CoV-2 infection who received care between December 2019 and mid-September 2020. Of these, 2750 had T1DM; 57 811 had T2DM; and 261 921 did not have diabetes.

Outcome

TTE, defined as presence of a diagnosis code for myocardial infarction, thrombotic stroke, pulmonary embolism, deep vein thrombosis or other TTE.

Results

Odds of TTE were substantially higher in patients with T1DM (adjusted OR (AOR) 2.23 (1.93–2.59)) and T2DM (AOR 1.52 (1.46–1.58)) versus no diabetes. Among patients with diabetes, odds of TTE were lower in T2DM versus T1DM (AOR 0.84 (0.72–0.98)).

Conclusions

Risk of TTE during COVID-19 illness is substantially higher in patients with diabetes. Further, risk for TTEs is higher in those with T1DM versus T2DM. Confirmation of increased diabetes-associated clotting risk in future studies may warrant incorporation of diabetes status into SARS-CoV-2 infection treatment algorithms.
Living with vaccine-induced immune thrombocytopenia and thrombosis: a qualitative study
Authors: Bennett Paul , Celik Filiz , Winstanley Jenna , Hunt Beverley J , Pavord Sue
Published: July 2023

Objectives

To explore the experiences of people up to 18 months after being diagnosed with vaccine-induced immune thrombocytopenia and thrombosis (VITT).

Design

A semistructured qualitative study, conducted via Zoom, of a cohort of people with VITT.

Setting

Participants discussed their experiences of hospitalisation and following discharge.

Participants

14 individuals diagnosed with VITT, recruited via a Facebook support group and advertising on Twitter.

Results

Thematic analysis identified challenges of obtaining medical care and diagnosis; fear of the severity of symptoms and unclear prognosis; and lack of family support due to isolation imposed by the COVID-19 pandemic. Once home, participants experienced continued significant symptoms; fear of recurrence; inadequate medical knowledge of their condition; and difficulties coping with residual physical disabilities and psychosocial losses. Also reported were feelings of isolation and abandonment due to lack of government support.

Conclusions

This is a significantly challenged group of people, with multiple health, financial, social and psychological losses. These losses have been compounded by experiences of limited governmental and societal recognition of the problems they face.
Mepolizumab for treatment of adolescents and adults with eosinophilic oesophagitis: a multicentre, randomised, double-blind, placebo-controlled clinical trial
Authors: Dellon Evan S , Peterson Kathryn A , Mitlyng Benjamin L , Iuga Alina , Bookhout Christine E , Cortright Lindsay M , Walker Kacie B , Gee Timothy S , McGee Sarah J , Cameron Brenderia A , Galanko Joseph A , Woosley John T , Eluri Swathi , Moist Susan E , Hirano Ikuo
Published: July 2023

Objective

We aimed to determine whether mepolizumab, an anti-IL-5 antibody, was more effective than placebo for improving dysphagia symptoms and decreasing oesophageal eosinophil counts in eosinophilic oesophagitis (EoE).

Methods

We conducted a multicentre, randomised, double-blind, placebo-controlled, trial. In the first part, patients aged 16–75 with EoE and dysphagia symptoms (per EoE Symptom Activity Index (EEsAI)) were randomised 1:1 to 3 months of mepolizumab 300 mg monthly or placebo. Primary outcome was change in EEsAI from baseline to month 3 (M3). Secondary outcomes included histological, endoscopic and safety metrics. In part 2, patients initially randomised to mepolizumab continued 300 mg monthly for 3 additional months (mepo/mepo), placebo patients started mepolizumab 100 mg monthly (pbo/mepo), and outcomes were reassessed at month 6 (M6).

Results

Of 66 patients randomised, 64 completed M3, and 56 completed M6. At M3, EEsAI decreased 15.4±18.1 with mepolizumab and 8.3±18.0 with placebo (p=0.14). Peak eosinophil counts decreased more with mepolizumab (113±77 to 36±43) than placebo (146±94 to 160±133) (p<0.001). With mepolizumab, 42% and 34% achieved histological responses of <15 and ≤6 eos/hpf compared with 3% and 3% with placebo (p<0.001 and 0.02). The change in EoE Endoscopic Reference Score at M3 was also larger with mepolizumab. At M6, EEsAI decreased 18.3±18.1 points for mepo/mepo and 18.6±19.2 for pbo/mepo (p=0.85). The most common adverse events were injection-site reactions.

Conclusions

Mepolizumab did not achieve the primary endpoint of improving dysphagia symptoms compared with placebo. While eosinophil counts and endoscopic severity improved with mepolizumab at 3 months, longer treatment did not yield additional improvement.

Trial registration number

NCT03656380.
Independent external validation of the QRISK3 cardiovascular disease risk prediction model using UK Biobank
Authors: Parsons Ruth E , Liu Xiaonan , Collister Jennifer A , Clifton David A , Cairns Benjamin J , Clifton Lei
Published: July 2023

Objective

To externally evaluate the performance of QRISK3 for predicting 10 year risk of cardiovascular disease (CVD) in the UK Biobank cohort.

Methods

We used data from the UK Biobank, a large-scale prospective cohort study of 403 370 participants aged 40–69 years recruited between 2006 and 2010 in the UK. We included participants with no previous history of CVD or statin treatment and defined the outcome to be the first occurrence of coronary heart disease, ischaemic stroke or transient ischaemic attack, derived from linked hospital inpatient records and death registrations.

Results

Our study population included 233 233 women and 170 137 men, with 9295 and 13 028 incident CVD events, respectively. Overall, QRISK3 had moderate discrimination for UK Biobank participants (Harrell’s C-statistic 0.722 in women and 0.697 in men) and discrimination declined by age (<0.62 in all participants aged 65 years or older). QRISK3 systematically overpredicted CVD risk in UK Biobank, particularly in older participants, by as much as 20%.

Conclusions

QRISK3 had moderate overall discrimination in UK Biobank, which was best in younger participants. The observed CVD risk for UK Biobank participants was lower than that predicted by QRISK3, particularly for older participants. It may be necessary to recalibrate QRISK3 or use an alternate model in studies that require accurate CVD risk prediction in UK Biobank.
Parameters associated with improvement of systolic function in patients with heart failure
Authors: Schöps Liv Borum , Sengeløv Morten , Modin Daniel , Jørgensen Peter Godsk , Bruun Niels Eske , Fritz-Hansen Thomas , Gislason Gunnar , Wolsk Emil , Schou Morten , Biering-Sørensen Tor
Published: July 2023

Aims

Identifying clinical and echocardiographic parameters associated with improvement in systolic function in outpatients with heart failure with reduced ejection fraction (HFrEF) could lead to more targeted treatment improving systolic function and outcome.

Methods

In a retrospective cohort study, echocardiographic examinations from the first and final visit of 686 patients with HFrEF at the heart failure clinic at Gentofte Hospital were retrieved and analysed. Parameters associated with left ventricular ejection fraction (LVEF) improvement and survival according to LVEF improvement were assessed using linear regression and Cox regression, respectively. Beta-coefficients (β-coef) are standardised. Strain values are absolute.

Results

While undergoing heart failure treatment, 559 (81.5%) patients improved systolic function ( Δ LVEF >0%), with 100 (14.6%) being super responders defined by LVEF improvement >20%. After multivariable adjustment, LVEF improvement was significantly associated with a less impaired global longitudinal strain (β-coef 0.25, p<0.001), higher tricuspid annular plane systolic excursion (β-coef 0.09, p=0.018), smaller left ventricular internal dimension in diastole (β-coef −0.15, p=0.011), lower E-wave/A-wave ratio (β-coef −0.13, p=0.003), higher heart rate (β-coef 0.18, p<0.001) and absence of ischaemic cardiomyopathy (β-coef −0.11, p=0.010) and diabetes (β-coef −0.081, p=0.033) at baseline. Mortality incidence rates differed with LVEF improvement ( Δ LVEF <0% vs Δ LVEF >0%, 8.3 vs 4.3 per 100 person years, p=0.012). Greater improvement in LVEF was associated with significantly lower mortality risk (tertile 1 vs tertile 3, HR 3.23, 95% CI 1.39 to 7.51, p=0.006).

Conclusion

In this outpatient HFrEF cohort, most patients improved systolic function. Heart failure aetiology, comorbidities and echocardiographic measures of heart structure and function were significantly, independently associated with future LVEF improvement. Greater LVEF improvement was significantly associated with lower mortality.
Prospects of returning to work after lumbar spine surgery for patients considering disability pension: a nationwide study based on data from the Norwegian Registry for Spine Surgery
Authors: Hammer Lovise , Ingebrigtsen Tor , Gulati Sasha , Hara Sozaburo , Nygaard Øystein , Hara Karen Walseth , Solberg Tore
Published: July 2023

Objectives

To assess the odds for not returning to work (non-RTW) 1 year after treatment among patients who had applied for or were planning to apply for disability pension (DP-applicant) prior to an operation for degenerative disorders of the lumbar spine.

Methods

This population-based cohort study from the Norwegian Registry for Spine surgery included 26 688 cases operated for degenerative disorders of the lumbar spine from 2009 to 2020. The primary outcome was RTW (yes/no). Secondary patient-reported outcome measures (PROMs) were the Oswestry Disability Index, Numeric Rating Scales for back and leg pain, EuroQoL five-dimension and the Global Perceived Effect Scale. Logistic regression analysis was used to investigate associations between being a DP-applicant prior to surgery (exposure), possible confounders (modifiers) at baseline and RTW 12 months after surgery (outcome).

Results

The RTW ratio for DP-applicants was 23.1% (having applied: 26.5%, planning to apply 21.1%), compared with 78.6% among non-applicants. All secondary PROMs were more favourable among non-applicants. After adjusting for all significant confounders (low expectations and pessimism related to working capability, not feeling wanted by the employer and physically demanding work), DP-applicants with under 12 months preoperative sick leave had 3.8 (95% CI 1.8 to 8.0) higher odds than non-applicants for non-RTW 12 months after surgery. The subgroup having applied for disability pension had the strongest impact on this association.

Conclusion

Less than a quarter of the DP-applicants returned to work 12 months after surgery. This association remained strong, also when adjusted for the confounders as well as other covariates related RTW.