bluuebunny/crossref_metadata_2025 huggingface dataset:
Vibration of a Vertical Rotor Partially Filled With Liquid
Authors: Ide Katsuki , Kazao Yukihiko , Watanabe Shunzo , Yabu Tomohiko , Sakai Takuhiko
Published: March 2021

Using an experimental apparatus incorporating a hollow cylindrical rotor (partially filled with liquid) fitted to a vertically suspended shaft, we clarified the pressure mode shape, frequency, etc. of the liquid by directly measuring the pressure fluctuation while varying the amount of liquid and the rotating speed, and studied in detail the relationship between whirling vibration of the rotor and fluctuation of the liquid inside the rotor.

On that basis, we propose a practical method for estimating the region of unstable vibration. Results of estimation by this method were checked against the results of an experiment conducted using three types of differently shaped rotor.

According to many studies conducted in the past, the frequency of unstable vibration is almost constant. In the present experiment, however, the frequency of unstable vibration showed a characteristic tendency to increase with increasing rotational speed. The vibration that was observed in the experiment was found to be an unstable vibration caused chiefly by axial fluctuation of the liquid inside the rotor. It was also found that in the rotational speed range where the difference between the rotor rotating speed and the natural frequency of fluctuation of the free surface of the liquid becomes almost equal to the natural frequency of the rotor, a resonance occurs that causes the unstable vibration. Concerning the vibration studied here, we developed a practical method of estimating the region of unstable vibrations and showed that the method should be universally applicable.
Noncontacting Vibration Measurement Using a Massless Interferometric Accelerometer
Authors: Li Keyu
Published: March 2021

An interferometric strain measurement technique is extended to vibration measurements. The technique is based on two micro-indentations placed on an object surface using a combination of diffraction and interference of laser light. Relative displacements between the two indentations and derivatives of in-plane and out-of-plane vibrational displacements are measured by analyzing the phase shift of the interference fringe patterns. The technique can be used to study bending stress and deflection problems in vibrational beams, plates and shells. The displacement derivatives are measured in real time, from which time derivatives or the velocity and acceleration of the displacement derivative as well as vibrational frequency can be determined. The technique has advantages over an accelerometer in that it is noncontacting and does not require attachment of the transducer to the object which could alter the object behavior. In addition, it has many desirable features such as being extremely compact, massless, and applicable to hostile environments such as those associated with production and elevated temperatures.
Experimental Spatial Power Flow Using a Scanning Laser Doppler Vibrometer
Authors: Blotter Jonathan D. , West Robert L.
Published: March 2021

An experimental spatial power flow (ESPF) method which computes the energy path continuously over the surface of a vibrating structure is presented. The ESPF method is a novel approach based on a spatially dense representation of the system’s dynamics obtained by solving for the 3-D complex-valued velocity field from experimental data acquired by a scanning laser Doppler vibrometer (SLDV). Quintic B-spline surfaces used to represent the extracted velocity field allow the power flow to be computed continuously over the surface of the structure. The active and reactive power flow components are kept separate throughout the solution. To validate the ESPF concept, power flow results of a prescribed velocity field were compared with simulated experimental results. The power flow computed from the prescribed velocity field compared closely to the power flow computed from the simulated experimental results indicating the validity of the ESPF concept. The ESPF method was then applied to a simply supported thin steel plate. The experimental power flow results distinctly show the locations of the energy sources and sinks and identify the energy path in the plate.
Engineered glycomaterial implants orchestrate large-scale functional repair of brain tissue chronically after severe traumatic brain injury
Authors: Latchoumane Charles-Francois V. , Betancur Martha I. , Simchick Gregory A. , Sun Min Kyoung , Forghani Rameen , Lenear Christopher E. , Ahmed Aws , Mohankumar Ramya , Balaji Nivedha , Mason Hannah D. , Archer-Hartmann Stephanie A. , Azadi Parastoo , Holmes Philip V. , Zhao Qun , Bellamkonda Ravi V. , Karumbaiah Lohitash
Published: March 2021

Engineered glycomaterial implants orchestrate large-scale repair after severe traumatic brain injury.
Long-term (1990–2019) monitoring of forest cover changes in the humid tropics
Authors: Vancutsem C. , Achard F. , Pekel J.-F. , Vieilledent G. , Carboni S. , Simonetti D. , Gallego J. , Aragão L. E. O. C. , Nasi R.
Published: March 2021

Three decades of satellite observations provide unprecedented information about forest change trajectories in the humid tropics.
A modular approach toward producing nanotherapeutics targeting the innate immune system
Authors: van Leent Mandy M. T. , Meerwaldt Anu E. , Berchouchi Alexandre , Toner Yohana C. , Burnett Marianne E. , Klein Emma D. , Verschuur Anna Vera D. , Nauta Sheqouia A. , Munitz Jazz , Prévot Geoffrey , van Leeuwen Esther M. , Ordikhani Farideh , Mourits Vera P. , Calcagno Claudia , Robson Philip M. , Soultanidis George , Reiner Thomas , Joosten Rick R. M. , Friedrich Heiner , Madsen Joren C. , Kluza Ewelina , van der Meel Roy , Joosten Leo A. B. , Netea Mihai G. , Ochando Jordi , Fayad Zahi A. , Pérez-Medina Carlos , Mulder Willem J. M. , Teunissen Abraham J. P.
Published: March 2021

Modular production methods allow the efficient development of nanoimmunotherapies targeting the innate immune system.
Toroidal polar topology in strained ferroelectric polymer
Authors: Guo Mengfan , Guo Changqing , Han Jian , Chen Shulin , He Shan , Tang Tongxiang , Li Qian , Strzalka Joseph , Ma Jing , Yi Di , Wang Ke , Xu Ben , Gao Peng , Huang Houbing , Chen Long-Qing , Zhang Shujun , Lin Yuan-Hua , Nan Ce-Wen , Shen Yang
Published: March 2021

Polarization hits a bull's-eye

Polymer-based ferroelectric materials are attractive because they can be solution processed cheaply and have much greater flexibility than ceramics. Guo
et al.
found concentric circular bands of polarization in a ferroelectric polymer that look like a bull's-eye target (see the Perspective by Martin). This self-organized toroidal texture is aligned perpendicularly to the axis of the polymer chains, allowing the authors to demonstrate selective absorption of infrared radiation and manipulation of terahertz radiation. This distinct structure in a polymer could be of interest for exploring and using other exotic effects.

Science
, this issue p.
1050
; see also p.
992
Scaling behavior of stiffness and strength of hierarchical network nanomaterials
Authors: Shi Shan , Li Yong , Ngo-Dinh Bao-Nam , Markmann Jürgen , Weissmüller Jörg
Published: March 2021

A two-stage lightweighting

Dealloying allows voids to be created in metals, decreasing the weight of the material. However, when the solid fraction is below about 30%, the mechanical properties rapidly degrade. Shi
et al.
discovered that two dealloying steps allow for the creation of a silver-gold alloy with a solid fraction as low as 12%. Unexpectedly, this process does not degrade the mechanical properties while allowing for large samples to be synthesized. The strategy should be applicable to other alloy systems, providing a pathway for creating strong and lightweight materials.

Science
, this issue p.
1026
Combined liver–cytokine humanization comes to the rescue of circulating human red blood cells
Authors: Song Yuanbin , Shan Liang , Gbyli Rana , Liu Wei , Strowig Till , Patel Amisha , Fu Xiaoying , Wang Xiaman , Xu Mina L. , Gao Yimeng , Qin Ashley , Bruscia Emanuela M. , Tebaldi Toma , Biancon Giulia , Mamillapalli Padmavathi , Urbonas David , Eynon Elizabeth , Gonzalez David G. , Chen Jie , Krause Diane S. , Alderman Jonathan , Halene Stephanie , Flavell Richard A.
Published: March 2021

A red-letter day for RBC research

The study of primary human red blood cell (huRBC) disorders such as sickle cell disease (SCD) and infectious diseases such as malaria has been hampered by a lack of in vivo models of human erythropoiesis. Song
et al.
transferred human fetal liver cells into MISTRG mice, which are immunodeficient and are genetically engineered with several human genes involved in hematopoiesis. This approach was unsuccessful because mature huRBCs are rapidly destroyed in the mouse liver. They then used CRISPR-Cas9 to mutate these mice into a fumarylacetoacetate hydrolase–deficient strain, allowing them to replace the mouse liver with engrafted human hepatocytes. These mice exhibited enhanced human erythropoiesis and circulating huRBC survival and could recapitulate SCD pathology when reconstituted with SCD-derived HSCs.

Science
, this issue p.
1019
Sequential C–F bond functionalizations of trifluoroacetamides and acetates via spin-center shifts
Authors: Yu You-Jie , Zhang Feng-Lian , Peng Tian-Yu , Wang Chang-Ling , Cheng Jie , Chen Chen , Houk Kendall N. , Wang Yi-Feng
Published: March 2021

Sequentially snipping off fluorines

It is often useful in pharmaceutical or agrochemical research to modify the properties of carbon compounds by appending one or more fluorine atoms. However, the methods used to prepare mono-, di-, or trifluorocarbon centers tend to differ from each other in inconvenient ways. Yu
et al.
developed a radical reaction that can successively remove one or two fluorine atoms from trifluoromethyl groups adjacent to amides or esters. The mechanism relies on a spin-center shift after attack at the carbonyl oxygen by a boryl radical.

Science
, this issue p.
1232
Comment on “Increased growing-season productivity drives earlier autumn leaf senescence in temperate trees”
Authors: Norby Richard J.
Published: March 2021

Zani
et al
. (Research Articles, 27 November 2020, p. 1066) propose that enhancement of deciduous tree photosynthesis in a CO
2
-enriched atmosphere will advance autumn leaf senescence. This premise is not supported by consistent observations from free-air CO
2
enrichment (FACE) experiments. In most FACE experiments, leaf senescence or abscission was not altered or was delayed in trees exposed to elevated CO
2
.
Surgical adhesions: A sticky macrophage problem
Authors: Herrick Sarah E. , Allen Judith E.
Published: March 2021

Body-cavity macrophages superaggregate in a platelet-like response to wounding
Bacteriophages against Vibrio coralliilyticus and Vibrio tubiashii: Isolation, Characterization, and Remediation of Larval Oyster Mortalities
Authors: Richards Gary P. , Watson Michael A. , Madison David , Soffer Nitzan , Needleman David S. , Soroka Douglas S. , Uknalis Joseph , Baranzoni Gian Marco , Church Karlee M. , Polson Shawn W. , Elston Ralph , Langdon Chris , Sulakvelidze Alexander
Published: March 2021

Shellfish hatcheries encounter episodic outbreaks of larval oyster mortalities, jeopardizing the economic stability of hatcheries and the commercial shellfish industry. Shellfish pathogens like
Vibrio coralliilyticus
and
Vibrio tubiashii
have been recognized as major contributors of larval oyster mortalities in U.S.
Engineering of the Small Noncoding RNA (sRNA) DsrA Together with the sRNA Chaperone Hfq Enhances the Acid Tolerance of Escherichia coli
Authors: Lin Zhanglin , Li Jiahui , Yan Xiaofang , Yang Jingduan , Li Xiaofan , Chen Ping , Yang Xiaofeng
Published: March 2021

Many of the traditional studies on bacterial acid tolerance generally focused on improving cell survival under extreme-pH conditions, but cell growth under less harsh acidic conditions is more relevant to industrial applications. Under normal conditions, the general stress response sigma factor RpoS is maintained at low levels in the growth phase through a number of mechanisms.
A Point Mutation in the Transcriptional Repressor PerR Results in a Constitutive Oxidative Stress Response in Clostridioides difficile 630Δ
erm
Authors: Troitzsch Daniel , Zhang Hao , Dittmann Silvia , Düsterhöft Dorothee , Möller Timon Alexander , Michel Annika-Marisa , Jänsch Lothar , Riedel Katharina , Borrero-de Acuña José Manuel , Jahn Dieter , Sievers Susanne
Published: March 2021

The intestinal pathogen
Clostridioides difficile
is one of the major challenges in medical facilities nowadays. In order to better combat the bacterium, detailed knowledge of its physiology is mandatory.
C. difficile
strain 630Δ
erm
was generated in a laboratory from the patient-isolated strain
C. difficile
630 (H. A. Hussain, A. P. Roberts, and P. Mullany, J Med Microbiol 54:137–141, 2005,
https://doi.org/10.1099/jmm.0.45790-0
) and represents a reference strain for many researchers in the field, serving as the basis for the construction of insertional gene knockout mutants using the ClosTron system (J. T. Heap, O. J. Pennington, S. T. Cartman, G. P. Carter, and N. P. Minton, J Microbiol Methods 70:452–464, 2007,
https://doi.org/10.1016/j.mimet.2007.05.021
).
Gastroenterological and hepatic manifestations of patients with COVID-19, prevalence, mortality by country, and intensive care admission rate: systematic review and meta-analysis
Authors: Shehab Mohammad , Alrashed Fatema , Shuaibi Sameera , Alajmi Dhuha , Barkun Alan
Published: March 2021

Background and aims

Patients infected with the SARS-CoV-2 usually report fever and respiratory symptoms. However, multiple gastrointestinal (GI) manifestations such as diarrhoea and abdominal pain have been described. The aim of this study was to evaluate the prevalence of GI symptoms, elevated liver enzymes and mortality of patients with COVID-19.

Methods

A systematic review and meta-analysis of published studies that included a cohort of patients infected with SARS-CoV-2 were performed from 1 December 2019 to 15 December 2020. Data were collected by conducting a literature search using PubMed, Embase, Scopus, and Cochrane according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We analysed pooled data on the prevalence of individual GI symptoms and elevated liver enzymes and performed subanalyses to investigate the relationship between GI symptoms/elevated liver enzymes, geographical location, mortality, and intensive care unit (ICU) admission.

Results

The available data of 78 798 patients positive for SARS-CoV-2 from 158 studies were included in our analysis. The most frequent manifestations were diarrhoea (16.5%, 95% CI 14.2% to 18.4%), nausea (9.7%, 95% CI 9.0% to 13.2%) and elevated liver enzymes (5.6%, 95% CI 4.2% to 9.1%). The overall mortality and GI mortality were 23.5% (95% CI 21.2% to 26.1%) and 3.5% (95% CI 3.1% to 6.2%), respectively. Subgroup analysis showed non-statistically significant associations between GI symptoms/elevated liver enzymes and ICU admissions (OR=1.01, 95% CI 0.55 to 1.83). The GI mortality was 0.9% (95% CI 0.5% to 2.2%) in China and 10.8% (95% CI 7.8% to 11.3%) in the USA.

Conclusion

GI symptoms/elevated liver enzymes are common in patients with COVID-19. Our subanalyses showed that the presence of GI symptoms/elevated liver enzymes does not appear to affect mortality or ICU admission rate. Furthermore, the proportion of GI mortality among patients infected with SARS-CoV-2 varied based on geographical location.
Correlates of e-cigarette use among active duty US military personnel: implications for cessation policy
Authors: Godby Sarah , Dierst-Davies R , Kogut D , Degiorgi Winslow L , Truslow M M , Tuttle J , Koeppl P , Marshall-Aiyelawo K , Elenberg K
Published: March 2021

Background

Electronic cigarette (or e-cigarette) use has grown substantially since its US market introduction in 2007. Although marketed as a safer alternative to traditional cigarettes, studies have shown they can also be a gateway to their use. The purpose of this investigation is to identify factors associated with different patterns of tobacco use among active duty military personnel.

Methods

A secondary analysis was conducted using the 2014 Defense Health Agency Health Related Behaviors survey data. Results are based on 45 986 US military respondents, weighted to 1 251 606. Both univariate and regression analyses were conducted to identify correlates.

Results

In 2014, approximately 7.8% of respondents reported using e-cigarettes at least once in the past year. Among e-cigarette users, 49% reported exclusive e-cigarette use. Prevalence of exclusive use is highest among white people (58%), Navy (33%), men (83%) and persons with income ≤$45 000 (65%). Regression comparing exclusive cigarette with exclusive e-cigarette users revealed higher odds of being Air Force (OR=2.19; CI 1.18 to 4.06) or Navy (OR=2.25; CI 1.14 to 4.41) personnel and being male (OR=1.72; CI 1.12 to 2.64), and more likely to not receive smoking cessation messaging from healthcare providers in the last 12 months (OR=2.88; CI 1.80 to 4.62). When comparing exclusive e-cigarette users with poly-tobacco users, e-cigarette users had higher odds of being Hispanic (OR=2.20; CI 1.02 to 4.78), college educated (OR=4.25; CI 1.22 to 14.84) and not receiving tobacco prevention/cessation messaging (OR=4.80; CI 2.79 to 8.27).

Conclusion

The results demonstrate that exclusive e-cigarette users in the military have unique characteristics when compared with groups of other/mixed tobacco users. Findings can inform cessation and prevention efforts to improve both the overall health and combat readiness of active duty military personnel.
Survey of the use of laser protective eyewear among international retina specialists: a European vitreoretinal society study
Authors: Siddiqui Mohammad Z , Ellabban Abdallah A , Soliman Mohamed K , Gini Giampaolo , Kurup Shree , Uwaydat Sami H , Sallam Ahmed B
Published: March 2021

Objective

To report the trends for the use of eye protection methods during retinal laser in clinic and operating room.

Methods and analysis

Retrospective analysis of a 14-item survey questionnaire submitted to the European Vitreoretinal Society members.

Results

Responses from 630 members were analysed. Most of the respondents practised in Europe (52.7%), followed by North America (21.0%). The majority of respondents had laser filters in the microscope for the operating surgeon (92.1%), or used protective goggles (6.8%). Only 38.9% of respondents indicated that auxiliary staff in the operative room used protective goggles during laser treatment. Three-dimensional retina viewing system was used by only 22.5% of respondents, of those, 34.5% reported use of laser protection goggles by the operating surgeon. Rates of laser protection by auxiliary staff were 62.9% for indirect laser and 60.8% for slit lamp laser. We found a higher rate for use of laser protection by auxiliary staff in North America-based practices for endolaser (p<0.00001), laser indirect ophthalmoscope (p<0.00001) and slit lamp laser (p=0.00033) compared with the rest of the world.

Conclusion

The use of laser protection methods is routinely adopted by the physicians in the operating room and clinic, but less so by their assisting or auxiliary staff.
Driving quality improvement with a massive open online course (MOOC)
Authors: Guest Cheryl , Wainwright Philip , Herbert Margaret , Smith Iain Murray
Published: March 2021

Background

Quality improvement (QI) is a priority for national regulatory bodies in health and care in the UK. However, many health and care staff do not know where to go for support in gaining the required skills and knowledge in QI. This paper reviews Improvement Fundamentals, a massive open online course (MOOC), designed to address this gap, run by an improvement team in the national regulatory body.

Methods

In 2015, National Health Service (NHS) Improving Quality (subsequently the sustainable improvement team in NHS England) established Improvement Fundamentals: a programme of online, self-directed courses in QI for those involved in heath or social care. The programme ran in two cycles: twice in 2015, followed by a re-launch in 2018 (this programme also ran into 2019). A mixed-methods evaluation was carried out of the 2015 programme involving surveys, interviews and social listening. The 2018–2019 programme was evaluated using post-course surveys of participants and activity data from the platform.

Outcomes

Since the start of the 2015 programme, 604 improvement projects have been developed, run and submitted for formal assessment, with some demonstrating clear improvements in services. Themes from participant feedback on both programmes have included improved understanding of QI tools and methods; greater energy for QI; a greater sense of community and connectedness in participants’ work and increased confidence in using QI tools and techniques.

Discussion

Both programmes delivered benefits for participants, and the team’s investment in improvement skills on these programmes has helped to increase capability for future change endeavours. The collaborative nature of the programmes has been key to their successes.

Conclusion

Improvement Fundamentals demonstrates that MOOCs can be instrumental in driving forward improvements in health and care. The programmes may have utility as a model for future MOOCs, both in QI and other topics, to help drive further improvements in health and care.
Decision-making for the infant sleep environment among families with children considered to be at risk of sudden unexpected death in infancy: a systematic review and qualitative metasynthesis
Authors: Pease Anna , Garstang Joanna J , Ellis Catherine , Watson Debbie , Ingram Jenny , Cabral Christie , Blair Peter S , Fleming Peter J
Published: March 2021

Background

Advice to families to sleep infants on their backs, avoid smoke exposure, reduce excess bedcovering and avoid specific risks associated with cosleeping has greatly reduced sudden unexpected death in infancy (SUDI) rates worldwide. The fall in rates has not been equal across all groups, and this advice has been less effective for more socially deprived families. Understanding decision-making processes of families with infants at risk would support the development of more effective interventions.

Aim

To synthesise the qualitative evidence on parental decision-making for the infant sleep environment among families with children considered to be at increased risk of SUDI.

Methods

This study was one of three related reviews of the literature for the Child Safeguarding Practice Review Panel’s National Review in England into SUDI in families where the children are considered at risk of harm. A systematic search of eight online databases was carried out in December 2019. Metasynthesis was conducted, with themes extracted from each paper, starting with the earliest publication first.

Results

The wider review returned 3367 papers, with 16 papers (across 13 studies) specifically referring to parental decision-making. Six overall themes were identified from the synthesis: (1) knowledge as different from action; (2) external advice must be credible; (3) comfort, convenience and disruption to the routine; (4) plausibility and mechanisms of protection; (5) meanings of safety and risk mitigation using alternative strategies; and (6) parents’ own expertise, experience and instincts.

Conclusion

Interventions that are intended to improve the uptake of safer sleep advice in families with infants at risk of sleep-related SUDI need to be based on credible advice with mechanisms of protection that are understandable, consistent with other sources, widened to all carers of the infant and fit within the complex practice of caring for infants.
Association between influenza vaccination and hospitalisation or all-cause mortality in people with COVID-19: a retrospective cohort study
Authors: Wilcox Christopher R , Islam Nazrul , Dambha-Miller Hajira
Published: March 2021

Introduction

Recent evidence suggests that influenza vaccination may offer protection against COVID-19 severity. Our aim was to quantify the association between influenza vaccination status and risk of hospitalisation or all-cause mortality in people diagnosed with COVID-19.

Methods

A retrospective cohort study using routinely collected health records from patients registered to a General Practitioner (GP) practice in South West England within the Electronic Care and Health Information Analytics database. The cohort included 6921 people with COVID-19 during the first wave of the pandemic (1 January–31 July 2020). Data on influenza vaccination, hospitalisation and all-cause mortality were ascertained through linked clinical and demographic records. We applied propensity score methods (stabilised inverse probability of treatment weight) to quantify the association between influenza vaccination status and COVID-19 outcomes (hospitalisation or all-cause mortality).

Results

2613 (38%) participants received an influenza vaccination between 1 January 2019 and COVID-19 diagnosis. Receipt of influenza vaccination was associated with a significantly lower odds of hospitalisation or all-cause mortality (adjusted OR: 0.85, 95% CI 0.75 to 0.97, p=0.02), and 24% reduced odds of all-cause mortality (adjusted OR: 0.76, 95% CI 0.64 to 0.90).

Discussion

Influenza vaccination was associated with a 15%–24% lower odds of severe COVID-19 outcomes. The current UK influenza vaccination programme needs urgent expansion as an integral component of the ongoing response plans to the COVID-19 pandemic.
‘It’s not one size fits all’: a qualitative study of patients’ and healthcare professionals’ views of self-management for bronchiectasis
Authors: Kelly Carol Ann , Tsang Anthony , Lynes Dave , Spencer Sally
Published: March 2021

Background

Bronchiectasis is a chronic respiratory condition that impacts significantly on individuals and healthcare services. Self-management is recommended in clinical guidelines for bronchiectasis as an intervention to enable patients to manage their condition, yet there is little evidence to support it.

Methods

Three face to face focus groups (17 adults with bronchiectasis) were conducted at three National Health Service (NHS) sites in North West England. Additionally, semi-structured telephone interviews were undertaken with 11 healthcare professionals (HCPs), including doctors, nurses and physiotherapists. Thematic analysis identified common themes and occurrences verified by independent audit.

Findings

Four common overarching themes were identified:the meaning of self-management;benefits;barriersandinfluencers to self-management; subthemes varied. Both groups recognised component interventions. Patients highlighted that self-management enabled them to learn what works and moderate behaviour. Aspects of delivery and structure were important to HCPs but a ‘make do’ culture was evident. Benefits for both groups included empowering patients. Common barriers for patients were time, mood and lack of access to support which could mitigate engagement with self-management. HCPs identified barriers including patient characteristics and lack of resources. Influencers for patients were peer, carer and psychosocial support, for HCPs influencers were individual patient attributes, including ability and motivation, and HCP characteristics such as knowledge and understanding about bronchiectasis.

This is the first study to explore patients’ and HCPs’ views of self-management for bronchiectasis. The need for an individual, flexible and responsive self-management programme specific to bronchiectasis was evident. Personal characteristics of patients and HCPs could affect the uptake and engagement with self-management and HCPs knowledge of the disease is a recognised precursor to effective self-management. The study identified key aspects for consideration during development, delivery and sustainability of self-management programmes and findings suggest that patients’ psychosocial and socioeconomic circumstances may affect adoption and activation of self-management behaviours.
Gender differences in mental health symptoms and risk factors in Australian elite athletes
Authors: Walton Courtney C , Rice Simon , Gao Caroline X , Butterworth Matt , Clements Matti , Purcell Rosemary
Published: March 2021

Objectives

To examine gender differences in the reporting of, and contributors to, mental health symptoms.

Methods

This was a cross-sectional observational study of adult athletes within a national elite sporting system (n=523; women=292;56%), who completed a battery of assessments including measures of mental health and adverse life events. Group differences across a range of scores were examined, followed by gender-stratified bootstrapped linear regression and meta-regression on measures where gender differences were observed.

Results

Women athletes reported higher rates of mental health symptoms, and lower rates of mental well-being, although there were no differences in general psychological distress or life satisfaction. Women reported experiencing several adverse life events at higher rates than men; particularly interpersonal conflict, financial hardship and discrimination. Low self-esteem was consistently associated with poorer mental health outcomes for all athletes. While a range of factors were associated with poor mental health in men or women athletes, meta-regression suggested that experiencing financial difficulty and social media abuse were more uniquely associated with mental health symptoms in men.

Conclusion

Gender differences in mental health in elite athletes are apparent. Approaches to increasing well-being are required in elite sport.
Leisure time physical activity throughout adulthood is associated with lower medicare costs: evidence from the linked NIH-AARP diet and health study cohort
Authors: Coughlan Diarmuid , Saint-Maurice Pedro F , Carlson Susan A , Fulton Janet , Matthews Charles E
Published: March 2021

Background

There is limited information about the association between long-term leisure time physical activity (LTPA) participation and healthcare costs. The purpose of this study was to investigate the association between LTPA over adulthood with later life healthcare costs in the USA.

Methods

Using Medicare claims data (between 1999 and 2008) linked to the National Institutes of Health-American Association of Retired Persons (NIH-AARP) Diet and Health Study, we examined associations between nine trajectories of physical activity participation throughout adulthood with Medicare costs.

Results

Compared with adults who were consistently inactive from adolescence into middle age, average annual healthcare costs were significantly lower for maintainers, adults who maintained moderate (–US$1350 (95% CI: –US$2009 to –US$690) or −15.9% (95% CI: −23.6% to −8.1%)) or high physical activity levels (–US$1200 (95% CI: –US$1777 to –US$622) or −14.1% (95% CI: −20.9% to −7.3%)) and increasers, adults who increased physical activity levels in early adulthood (–US$1874 (95% CI: US$2691 to –US$1057) or −22.0% (95% CI: −31.6% to −12.4%)) or in middle age (–US$824 (95% CI: –US$1580 to –US$69 or −9.7% (95% CI −18.6% to −0.8%)). For the four trajectories where physical activity decreased, the only significant difference was for adults who increased physical activity levels during early adulthood with a decline in middle age (–US$861 (95% CI:–US$1678 to –US$45) or −10.1% (95% CI: −19.7% to −0.5%)).

Conclusion

Our analyses suggest the healthcare cost burden in later life could be reduced through promotion efforts supporting physical activity participation throughout adulthood.
Low versus high level of physical resemblance in simulation for the acquisition of basic surgical skill: a meta-analysis
Authors: Consorti Fabrizio , Panzera Gianmarco
Published: March 2021

Background

Many studies explored the use of simulation in basic surgical education, with a variety of devices, contexts and outcomes, with sometimes contradictory results.

Objectives

The objectives of this meta-analysis were to focus the effect that the level of physical resemblance in a simulation has on the development of basic surgical skill in undergraduate medical students and to provide a foundation for the design and implementation of a simulation, with respect to its effectiveness and alignment with the learning outcomes.

Study selection

We searched PubMed and Scopus database for comparative randomised studies between simulations with a different level of resemblance. The result was synthesised as the standardised mean difference, under a random effect model.

Findings

We selected 12 out of 2091 retrieved studies, reporting on 373 undergraduate students (mean of subjects 15.54±6.89). The outcomes were the performance of simple skills and the time to complete a task. Two studies reported a scoring system; seven studies reported time for a task; and three studies reported both. The total number of measures included in the meta-analysis was 456 for score and 504 for time. The pooled effect size did not show any significant advantage in a simulation of a high level of physical resemblance over a lower level, both for the scoring system (−0.19, 95% CI −0.44 to 0.06) and for time (−0.14, 95% CI −0.54 to 0.27).

Conclusion

Simulations with a low level of physical resemblance showed the same effect as the simulation using a higher level of resemblance on the development of basic surgical skills in undergraduate students.
Phenomenological analysis of maladaptive daydreaming associated with internet gaming addiction: a case report
Authors: Sharma Prerna , Mahapatra Ananya
Published: March 2021

Maladaptive daydreaming (MD) is an immersive fantasy activity that leads to distress and socio-occupational dysfunction. MD has many features suggestive of behavioural addiction, but research exploring the phenomenology of this clinical construct is limited. MD has also been purported to be a maladaptive strategy to cope with distress, but often leads to uncontrollable absorption in fantasy world, social withdrawal and neglected aspects of everyday life. In this paper, we report the case of a 16-year-old boy who developed internet gaming disorder and MD after experiencing cyberbullying from his peers. The patient engaged in vivid, fanciful imagery that lasted for hours, leading to social dysfunction and academic deterioration. Baseline assessment revealed a Maladaptive Daydreaming Scale-16 score of 65 (cut-off 50) and an Internet Gaming Test-20 score of 86 (cut-off 71). The patient was managed primarily with psychological intervention. The therapy focused on behaviour modification and cognitive restructuring. Patients in clinical setting should be questioned about MD when presenting with excessive use of technology or other forms of behavioural addictions. Further studies are necessary to determine the biopsychosocial factors of MD and its correlates. There is also a need to study treatment and management approaches for treating MD.
Colorectal cancer risk following polypectomy in a multicentre, retrospective, cohort study: an evaluation of the 2020 UK post-polypectomy surveillance guidelines
Authors: Cross Amanda J , Robbins Emma C , Pack Kevin , Stenson Iain , Patel Bhavita , Rutter Matthew D , Veitch Andrew M , Saunders Brian P , Duffy Stephen W , Wooldrage Kate
Published: March 2021

Objective

Colonoscopy surveillance aims to reduce colorectal cancer (CRC) incidence after polypectomy. The 2020 UK guidelines recommend surveillance at 3 years for ‘high-risk’ patients with ≥2 premalignant polyps (PMPs), of which ≥1 is ‘advanced’ (serrated polyp (or adenoma) ≥10 mm or with (high-grade) dysplasia); ≥5 PMPs; or ≥1 non-pedunculated polyp ≥20 mm; ‘low-risk’ patients without these findings are instead encouraged to participate in population-based CRC screening. We examined the appropriateness of these risk classification criteria and recommendations.

Design

Retrospective analysis of patients who underwent colonoscopy and polypectomy mostly between 2000 and 2010 at 17 UK hospitals, followed-up through 2017. We examined CRC incidence by baseline characteristics, risk group and number of surveillance visits using Cox regression, and compared incidence with that in the general population using standardised incidence ratios (SIRs).

Results

Among 21 318 patients, 368 CRCs occurred during follow-up (median: 10.1 years). Baseline CRC risk factors included age ≥55 years, ≥2 PMPs, adenomas with tubulovillous/villous/unknown histology or high-grade dysplasia, proximal polyps and a baseline visit spanning 2–90 days. Compared with the general population, CRC incidence without surveillance was higher among those with adenomas with high-grade dysplasia (SIR 1.74, 95% CI 1.21 to 2.42) or ≥2 PMPs, of which ≥1 was advanced (1.39, 1.09 to 1.75). For low-risk (71%) and high-risk (29%) patients, SIRs without surveillance were 0.75 (95% CI 0.63 to 0.88) and 1.30 (1.03 to 1.62), respectively; for high-risk patients after first surveillance, the SIR was 1.22 (0.91 to 1.60).

Conclusion

These guidelines accurately classify post-polypectomy patients into those at high risk, for whom one surveillance colonoscopy appears appropriate, and those at low risk who can be managed by non-invasive screening.
Community prevalence, mechanisms and outcome of mitral or tricuspid regurgitation
Authors: Cahill Thomas J , Prothero Anthony , Wilson Jo , Kennedy Andrew , Brubert Jacob , Masters Megan , Newton James D , Dawkins Sam , Enriquez-Sarano Maurice , Prendergast Bernard D , Myerson Saul G
Published: March 2021

Objective

The study aims were (1) to identify the community prevalence of moderate or greater mitral or tricuspid regurgitation (MR/TR), (2) to compare subjects identified by population screening with those with known valvular heart disease (VHD), (3) to understand the mechanisms of MR/TR and (4) to assess the rate of valve intervention and long-term outcome.

Methods

Adults aged ≥65 years registered at seven family medicine practices in Oxfordshire, UK were screened for inclusion (n=9504). Subjects with known VHD were identified from hospital records and those without VHD invited to undergo transthoracic echocardiography (TTE) within the Oxford Valvular Heart Disease Population Study (OxVALVE). The study population ultimately comprised 4755 subjects. The severity and aetiology of MR and TR were assessed by integrated comprehensive TTE assessment.

Results

The prevalence of moderate or greater MR and TR was 3.5% (95% CI 3.1 to 3.8) and 2.6% (95% CI 2.3 to 2.9), respectively. Primary MR was the most common aetiology (124/203, 61.1%). Almost half of cases were newly diagnosed by screening: MR 98/203 (48.3%), TR 69/155 (44.5%). Subjects diagnosed by screening were less symptomatic, more likely to have primary MR and had a lower incidence of aortic valve disease. Surgical intervention was undertaken in six subjects (2.4%) over a median follow-up of 64 months. Five-year survival was 79.8% in subjects with isolated MR, 84.8% in those with isolated TR, and 59.4% in those with combined MR and TR (p=0.0005).

Conclusions

Moderate or greater MR/TR is common, age-dependent and is underdiagnosed. Current rates of valve intervention are extremely low.
Identification of work-related injury emergency department visits using International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes
Authors: Bush Ashley M , Bunn Terry L , Liford Madison
Published: March 2021

Introduction

Emergency department (ED) visit discharge data are a less explored population-based data source used to identify work-related injuries. When using discharge data, work-relatedness is often determined by the expected payer of workers’ compensation (WC). In October 2015, healthcare discharge data coding systems transitioned to the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM). ICD-10-CM’s structure offers potential new work-related codes to enhance work-related injury surveillance. This study identified work-related ED visits using relevant ICD-10-CM work-related injury codes. Cases identified using this method were compared with those identified using the WC expected payer approach.

Methods

State ED visit discharge data (2016–2019) were analysed using the CDC’s discharge data surveillance definition. Injuries were identified using a diagnosis code or an external cause-of-injury code in any field. Injuries were assessed by mechanism and expected payer. Literature searches and manual review of ICD-10-CM codes were conducted to identify possible work-related injury codes. Descriptive statistics were performed and assessed by expected payer.

Results

WC was billed for 87 361 injury ED visits from 2016 to 2019. Falls were the most frequent injury mechanism. The 246 ICD-10-CM work-related codes identified 36% more work-related ED injury visits than using WC as the expected payer alone.

Conclusion

This study identified potential ICD-10-CM codes to expand occupational injury surveillance using discharge data beyond the traditional WC expected payer approach. Further studies are needed to validate the work-related injury codes and support the development of a work-related injury surveillance case definition.
Exploring injury intentionality and mechanism via ICD-10-CM injury codes and self-reported injury in a large, urban emergency department
Authors: Clery Michael J , Hudson Philip Joseph , Moore Jasmine C , Mercer Kollar Laura M , Wu Daniel T
Published: March 2021

Health systems capture injuries using International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Clinical Modification (ICD-10-CM) diagnostic codes and share data with public health to inform injury surveillance. This study analyses provider-assigned ICD-10-CM injury codes among self-reported injuries to determine the effectiveness of ICD-10-CM coding in capturing injury and assault.

Methods

Self-reported injury screen records from an urban, level 1 trauma centre collected between 20 November 2015 and 30 September 2019 were compared with corresponding provider-assigned ICD-10-CM codes discerning the frequency in which intentions are indicated among patients reporting (1) any injury and (2) assault.

Results

Of 380 922 patients screened, 32 788 (8.61%) reported any injury and 6763 (1.78%) reported assault. ICD-10-CM codes had a sensitivity of 67.40% (95% CI 66.89% to 67.91%) for any injury and specificity of 89.79% (95% CI 89.69% to 89.89%]). For assault, ICD-10-CM codes had sensitivity of 2.25% (95% CI 1.91% to 2.63%) and specificity of 99.97% (95% CI 99.97% 99.98%).

Discussion

This study found provider-assigned ICD-10-CM had limited sensitivity to identify injury and low sensitivity for assault. This study more fully characterises ICD-10-CM coding system effectiveness in identifying assaults.
Multisite medical record review of emergency department visits for traumatic brain injury
Authors: Gabella Barbara A , Hathaway Jeanne E , Hume Beth , Johnson Jewell , Costich Julia F , Slavova Svetla , Liu Ann Y
Published: March 2021

Background

In 2016, the CDC in the USA proposed codes from the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) for identifying traumatic brain injury (TBI). This study estimated positive predictive value (PPV) of TBI for some of these codes.

Methods

Four study sites used emergency department or trauma records from 2015 to 2018 to identify two random samples within each site selected by ICD-10-CM TBI codes for (1) intracranial injury (S06) or (2) skull fracture only (S02.0, S02.1-, S02.8-, S02.91) with no other TBI codes. Using common protocols, reviewers abstracted TBI signs and symptoms and head imaging results that were then used to assign certainty of TBI (none, low, medium, high) to each sampled record. PPVs were estimated as a percentage of records with medium-certainty or high-certainty for TBI and reported with 95% confidence interval (CI).

Results

PPVs for intracranial injury codes ranged from 82% to 92% across the four samples. PPVs for skull fracture codes were 57% and 61% in the two university/trauma hospitals in each of two states with clinical reviewers, and 82% and 85% in the two states with professional coders reviewing statewide or nearly statewide samples. Margins of error for the 95% CI for all PPVs were under 5%.

Discussion

ICD-10-CM codes for traumatic intracranial injury demonstrated high PPVs for capturing true TBI in different healthcare settings. The algorithm for TBI certainty may need refinement, because it yielded moderate-to-high PPVs for records with skull fracture codes that lacked intracranial injury codes.
Interrupted time series analysis of cannabis coding in Colorado during the ICD-10-CM transition
Authors: Hall Katelyn E , Yang Hannah , Goulding DeLayna , Contreras Elyse , James Katherine A
Published: March 2021

The International Classification of Diseases, 10thRevision, Clinical Modification (ICD-10-CM), implemented in 2015, has more codes than ICD-9-CM for events involving cannabis. We examined cannabis indicator trends across the transition from ICD-9-CM to ICD-10-CM in Colorado, where state law regulates adult cannabis use. Using 2011 to 2018 data from hospital and emergency department (ED) discharges, we calculated monthly rates per 1000 discharges for two indicators: (1) cannabis use disorders and (2) poisoning and adverse effects of psychodysleptics. Immediate, point-of-transition (level) and gradual, post-transition (slope) changes across the ICD-9-CM to ICD-10-CM transition were tested using interrupted time series models adjusted for legalisation, seasonality and autocorrelation. We observed a level increase and slope increase in the rate of ED discharges with cannabis use disorders. Hospital discharges with cannabis use disorders had a negative slope change after the transition and no level change. ED discharges with poisoning and adverse effects of psychodysleptics showed an increase in slope after the transition. No effects of the transition were observed on hospital discharges with poisoning and adverse effects of psychodysleptics. Shifts in the level and slope of cannabis indicator rates after implementation of the new coding scheme suggest the use of caution when interpreting trends spanning the ICD-9-CM to ICD-10-CM transition.
Self-harm injury hospitalisations: an analysis of case selection criteria
Authors: Imm Pamela , Grogan Brittany , Diallo Ousmane
Published: March 2021

Background

This study explores the impact of using different criteria to identify nonfatal hospitalisations with self-harm injuries using 2017–2018 Wisconsin discharge data.

Methods

Using International Classification of Diseases, 10th Revision, Clinical Modification codes, we classified records by three mutually exclusive selection criteria: subset A--principal diagnosis of injury, and any code for self-harm, initial encounter only; subset B--non-injury principal diagnosis, and any code for self-harm, initial encounter only; subset C--any principal diagnosis, and any code for self-harm, subsequent and sequelae encounters only. These categories were used to conduct two separate logistic regression models. Model 1 analysed the impact of surveillance limited to a principal diagnosis of injury, initial self-harm encounter (subset B compared with A). Model 2 analysed the impact if limited to initial encounters for self-harm, regardless of principal diagnosis (subset C compared with (A+B)). Both patient-level and visit-level analyses were conducted.

Results

For both patient-level models, subsets that included additional records based on an expansion of selection criteria were significantly more likely to include children (model 1: OR 2.8, model 2: OR 2.9; compared with those 25–54 years), those with mental health disorders (model 1: OR 6.5, model 2: OR 4.3) and rural residents (model 1: OR 1.2, model 2: OR 1.4). Drug-related disorder and means of self-harm were significantly different among subsets for both models. Visit-level analyses revealed similar results.

Discussion

Expanding case selection criteria would better capture the scale of hospitalisation for nonfatal self-harm. Using restrictive selection criteria may result in biased understanding of the affected populations, potentially impacting the development of policy and prevention programmes.