bluuebunny/crossref_metadata_2025 huggingface dataset:
Exploring applicability, interoperability and integrability of Blockchain-based digital twins for asset life cycle management
Authors: Götz Christopher Santi , Karlsson Patrik , Yitmen Ibrahim
Published: November 2020

Purpose

The blockchain-based digital twin has been recognized as a prominent technological ecosystem featuring synergies with both established and emergent information management practice. The purpose of this research is to explore the applicability, interoperability and integrability of a blockchain-based digital twin for asset life cycle management and develop a model of framework which positions the digital twin within a broader context of current management practice and technological availability.

Design/methodology/approach

A systematic literature review was performed to map use cases of digital twin, IoT, blockchain and smart contract technologies. Surveys of industry professionals and analyses were conducted focussing on the mapped use cases' life cycle–centric applicability, interoperability and integrability with current asset life cycle management practice, exploring decision support capabilities and industry insights. Lastly, a model of framework was developed based on the use case, interoperability and integrability findings.

Findings

The results support approaching digitization initiatives with blockchain-based digital twins and the positioning of the concept as both a strategic tool and a multifunctional on-field support application. Integrability enablers include progression towards BIM level 3, decentralized program hubs, modular cross-technological platform interfaces, as well as mergeable and scalable blockchains.

Practical implications

Knowledge of use cases help highlight the functionality of an integrated technological ecosystem and its connection to comprehensive sets of asset life cycle management aspects. Exploring integrability enablers contribute to the development of management practice and solution development as user expectations and technological prerequisites are interlinked.

Originality/value

The research explores asset life cycle management use cases, interoperability and integrability enablers of blockchain-based digital twins and positions the technological ecosystem within current practice and technological availability.
Evolving face of workplace learning and development: a case of an Indian HR consulting firm
Authors: Naim Mohammad Faraz
Published: November 2020

Purpose

The purpose of this paper is to illustrate existing learning and development (L&D) practices of an Indian HR consulting firm.

Design/methodology/approach

Structured interviews were conducted with 24 delivery managers to collect primary data and then content was analysed to develop the case study.

Findings

Mentoring, cross-training, knowledge sharing, job rotation, eLearning and social media–enabled learning tools are instrumental in executing L&D strategy of the case company.

Research limitations/implications

The author recognises the scope of this study is limited to the HR consulting sector in India, and it lacks empirical investigation.

Practical implications

Organisations must implement a holistic L&D strategy.

Originality/value

It is one of the first studies to explore L&D practices in the context of Indian HR consulting sector.
Relationships of the stand‐up time to falls and fractures in patients with rheumatoid arthritis: Results from the CHIKARA study
Authors: Tada Masahiro , Yamada Yutaro , Mandai Koji , Hidaka Noriaki
Published: November 2020

Aim

Patients with rheumatoid arthritis (RA) have a higher risk of falls and fractures due to muscle weakness and painful joints of the lower extremities. Evaluation of muscle functions is important to predict falls and fractures. The aim was to investigate the relationships of muscle functions with falls and fractures in RA patients.

Methods

Stand‐up muscle power, speed, and stabilizing time were evaluated by a muscle function analyzer in 90 RA patients in the CHIKARA study (UMIN000023744). The relationships of the muscle functions with falls, fractures, body composition, Disease Activity Score of 28 joints ‐ erythrocyte sedimentation rate (DAS28‐ESR), modified Health Assessment Questionnaire (mHAQ) scores, Steinbrocker class, stage, sarcopenia, and frailty were investigated in a cross‐sectional study.

Results

Each parameter of muscle function was related to age, falls, frailty, and the leg muscle score. However, only stabilizing time was related with fractures (r = .217, P = .04). When stabilizing time was ≥ 1.13 and ≥1.36 seconds, the odds ratios for falls and fractures were increased 6.2‐fold compared to < 1.13 seconds (95% CI: 1.2‐20.1, P = .002) and 11.4‐fold compared to <1.36 seconds (95% CI: 1.7‐92.5, P = .071), respectively. Sarcopenia and skeletal muscle mass were not significantly related to each muscle function. There was a negative correlation between DAS28‐ESR and power. Steinbrocker class and mHAQ had negative correlations with power and speed.

Conclusions

Sarcopenia and skeletal muscle mass were not adequate indicators of muscle functions in RA patients. Analyzing muscle functions is helpful to predict falls and fractures. Patients with extended stabilizing times should recognize the increased risk of falls and fractures.
Cross‐country differences in age trends in alcohol consumption among older adults: a cross‐sectional study of individuals aged 50 years and older in 22 countries
Authors: Calvo Esteban , Allel Kasim , Staudinger Ursula M. , Castillo‐Carniglia Alvaro , Medina José T. , Keyes Katherine M.
Published: November 2020

Background and Aims

Age‐related changes in physiological, metabolic and medication profiles make alcohol consumption likely to be more harmful among older than younger adults. This study aimed to estimate cross‐national variation in the quantity and patterns of drinking throughout older age, and to investigate country‐level variables explaining cross‐national variation in consumption for individuals aged 50 years and older.

Design

Cross‐sectional observational study using previously harmonized survey data.

Setting

Twenty‐two countries surveyed in 2010 or the closest available year.

Participants

A total of 106 180 adults aged 50 years and over.

Measurements

Cross‐national variation in age trends were estimated for two outcomes: weekly number of standard drink units (SDUs) and patterns of alcohol consumption (never, ever, occasional, moderate and heavy drinking). Human Development Index and average prices of vodka were used as country‐level variables moderating age‐related declines in drinking.

Findings

Alcohol consumption was negatively associated with age (risk ratio = 0.98; 95% confidence interval = 0.97, 0.99; P‐value < 0.001), but there was substantial cross‐country variation in the age‐related differences in alcohol consumption [likelihood ratio (LR) test P‐value < 0.001], even after adjusting for the composition of populations. Countries’ development level and alcohol prices explained 31% of cross‐country variability in SDUs (LR test P‐value < 0.001) but did not explain cross‐country variability in the prevalence of heavy drinkers.

Conclusions

Use and harmful use of alcohol among older adults appears to vary widely across age and countries. This variation can be partly explained both by the country‐specific composition of populations and country‐level contextual factors such as development level and alcohol prices.
Inequality and the Economic Cycle: Disabled Employees’ Experience of Work during the Great Recession in Britain
Authors: Jones Melanie , Hoque Kim , Wass Victoria , Bacon Nick
Published: November 2020

Using unique questions introduced into the 2011 British Workplace Employment Relations Study, a detailed matched employee–employer survey, this article compares disabled and non‐disabled employees’ experience of the 2008–2009 recession to contribute a cyclical perspective on disability‐related disadvantage at work. We find that disabled employees are more likely to report recession‐induced changes to workload, work organization, wages and access to training, even after controlling for personal, job and workplace characteristics. There is limited evidence that workplace equality characteristics moderate these relationships to protect disabled employees. These findings have particular resonance in the context of the COVID‐19 recession.
Exploring systematic biases, rooting methods and morphological evidence to unravel the evolutionary history of the genus Ficus (Moraceae)
Authors: Rasplus Jean‐Yves , Rodriguez Lillian Jennifer , Sauné Laure , Peng Yang‐Qiong , Bain Anthony , Kjellberg Finn , Harrison Rhett D. , Pereira Rodrigo A.S. , Ubaidillah Rosichon , Tollon‐Cordet Christine , Gautier Mathieu , Rossi Jean‐Pierre , Cruaud Astrid
Published: November 2020

Despite many attempts in the Sanger sequencing era, the phylogeny of fig trees remains unresolved, which limits our ability to analyze the evolution of key traits that may have contributed to their evolutionary and ecological success. We used restriction‐site‐associated DNA sequencing (c. 420 kb) and 102 morphological characters to elucidate the relationships between 70 species of Ficus. To increase phylogenetic information for higher‐level relationships, we targeted conserved regions and assembled paired reads into long loci to enable the retrieval of homologous loci in outgroup genomes. We compared morphological and molecular results to highlight discrepancies and reveal possible inference bias. For the first time, we recovered a monophyletic subgenus Urostigma (stranglers) and a clade with all gynodioecious Ficus. However, we show, with a new approach based on iterative principal component analysis, that it is not (and will probably never be) possible to homogenize evolutionary rates and GC content for all taxa before phylogenetic inference. Four competing positions for the root of the molecular tree are possible. The placement of section Pharmacosycea as sister to other fig trees is not supported by morphological data and considered a result of a long‐branch attraction artefact to the outgroups. Regarding morphological features and indirect evidence from the pollinator tree of life, the topology that divides Ficus into monoecious versus gynodioecious species appears most plausible. It seems most likely that the ancestor of fig trees was a freestanding tree and active pollination is inferred as the ancestral state, contrary to previous hypotheses. However, ambiguity remains on the ancestral breeding system. Despite morphological plasticity, we advocate restoring a central role to morphology in our understanding of the evolution of Ficus, as it can help detect systematic errors that appear more pronounced with larger molecular datasets.
Traffic video‐based intelligent traffic control system for smart cities using modified ant colony optimizer
Authors: Ragavan Krishnasamy , Venkatalakshmi Krishnan , Vijayalakshmi Kandasamy
Published: November 2020

Road traffic congestion is a serious problem in today's world and it happens because of urbanization and population growth. The traffic reduces the transport efficiency in the city, increases the waiting time and travel time, and also increases the usage of fuel and air pollution. To overcome these issues this papers propose an intelligent traffic control system using the Internet of Vehicles (IoV). The vehicles or nodes present in the IoV can communicate between themselves. This technique helps in determining the traffic intensity and the best route to reach the destination. The area of study used in this paper is Vellore city in Tamilnadu, India. The city map is separated into many segments of equal size and Ant Colony Algorithm (AOC) is applied to the separated maps to find the optimal route to reach the destination. Further, Support Vector Machine (SVM) is used to calculate the traffic density and to model the heavy traffic. The proposed algorithm performs better in finding the optimal route when compared to that of the existing path selection algorithms. From the results, it is evident that the proposed IoV‐based route selection method provides better performance.
Spindle cell tumor with CD34 and S100 co‐expression and distinctive stromal and perivascular hyalinization showing EML4‐ALK fusion
Authors: Abs Diane , Landman Samuel , Osio Amélie , Lepesant Pauline , Schneider Pierre , Obadia Déborah , Moguelet Philippe , Farges Cécile , Poirot Brigitte , Lehmann‐Che Jacqueline , Lebbé Céleste , Battistella Maxime
Published: November 2020

Recently, a novel group of CD34+ and S100+ spindle cell tumors with distinctive stromal and perivascular hyalinization showing recurrent gene fusions involving RAF1, BRAF, NTRK1/2/3, and RET has been identified. ALK rearrangements have been rarely reported in this group of tumors. We report a 24‐year‐old woman with a 1.5‐cm pink mass of the scalp. The tumor was made of spindle cells organized in fascicles or haphazardly arranged in a patternless architecture, with areas of stromal and perivascular hyalinization. The tumor cells diffusely expressed CD34 and S100, without SOX‐10 expression. The tumor showed diffuse immunopositivity for ALK. RNA sequencing using next‐generation sequencing (NGS) detected an EML4‐ALK fusion. This case extends the spectrum of this newly described group of CD34+/S100+ spindle cell tumors at the molecular‐genetic level. Dermatopathologists should be aware of this recent entity, as it may fall in the differential diagnosis of many other spindle cell tumors with CD34 expression. NGS‐based techniques should be performed when facing spindle cell tumors with similar morphology and immunophenotype. Identification of kinase fusions is essential for the precise classification and better knowledge of these tumors, and for targeted therapy in rare aggressive cases.
Significant structural evolution of a long‐term fallow soil in response to agricultural management practices requires at least 10 years after conversion
Authors: Bacq‐Labreuil Aurelie , Neal Andrew L. , Crawford John , Mooney Sacha J. , Akkari Elsy , Zhang Xiaoxian , Clark Ian , Ritz Karl
Published: November 2020

Agricultural practices can have significant effects on the physical and biological properties of soil. The aim of this study was to understand how the physical structure of a compromised soil, arising from long‐term bare‐fallow management, was modified by adopting different field management practices. We hypothesized that changing agricultural practices from bare‐fallow to arable or grassland would influence the modification of pore structure via an increase in porosity and pore connectivity, and a more homogenous distribution of pore sizes, and that this change exerts a rapid evolution of soil structure following conversion. Soil aggregates (<2 mm) collected in successive years from field plots subjected to three contrasting managements were studied: bare‐fallow, bare‐fallow converted to arable, and bare‐fallow converted to grassland. Soil structure was assessed by X‐ray computed tomography on the aggregates at 1.5 μm resolution, capturing detail relevant to soil biophysical processes. The grassland system increased porosity, diversity of pore sizes, pore connectivity and pore‐surface density significantly over the decade following conversion. However, measured at this resolution, the evolution of most of these metrics of soil structure required approximately 10 years post‐conversion to show a significant effect. The arable system did not influence soil structural evolution significantly. Only pore size distribution was modified in grassland in a shorter time frame (2 years post‐conversion). Hence, evolution of soil structural characteristics appears to require at least a decadal timescale following conversion to grassland.

Highlights

The physical structure of a compromised soil was modified by adopting plant‐based field management practices.

Conversion to grassland increased pore size diversity after 2 years.

Porosity, pore connectivity and pore surface density showed a significant modification between 7 and 10 years after conversion.
A Rubric for the Detection of Students in Crisis
Authors: Burkhardt Amy , Lottridge Susan , Woolf Sherri
Published: November 2020

For some students, standardized tests serve as a conduit to disclose sensitive issues of harm or distress that may otherwise go unreported. By detecting this writing, known as crisis papers, testing programs have a unique opportunity to assist in mitigating the risk of harm to these students. The use of machine learning to automatically detect such writing is necessary in the context of online tests and automated scoring. To achieve a detection system that is accurate, humans must first consistently label the data that are used to train the model. This paper argues that the existing guidelines are not sufficient for this task and proposes a three‐level rubric to guide the collection of the training data. In showcasing the fundamental machine learning procedures for creating an automatic text classification system, the following evidence emerges as support of the operational use of this rubric. First, hand‐scorers largely agree with one another in assigning labels to text according to the rubric. Additionally, when this labeled data are used to train a baseline classifier, the model exhibits promising performance. Recommendations are made for improving the hand‐scoring training process, with the ultimate goal of quickly and accurately assisting students in crisis.
Fire regimes are linked to precipitation patterns in the southeastern U.S.
Authors: Fill Jennifer M. , Crandall Raelene M.
Published: November 2020

See Commentary on: https://onlinelibrary.wiley.com/doi/10.1111/gcb.14727; See also Letter to the Editor on: https://onlinelibrary.wiley.com/doi/10.1111/gcb.15399
Professional judgement in clinical practice (part 1): Recovering original, moderate evidence‐based health care
Authors: Mugerauer Robert
Published: November 2020

Evidence‐based medicine announced its entry as heralding a new paradigm in health care practices, but it has been widely criticized for lacking a coherent theoretical basis. This paper presents the first part of a three‐article series examining the epistemological, practical, and ethical dimensions of strong EBM, as well as considering alternatives that promise potential solutions to chronic conceptual and practical problems. While the focus is on the details of the arguments and evidence in thoughtful debates over the last 30 years, it is worthwhile to keep in mind the overall trajectory of modern thought, because strong EBM continues discredited positivist positions, thus repeating its major assumptions and inadequacies, now transferred to the medical sphere and vocabulary. Part 1 of the series examines the development of strong EBM by clarifying and critiquing its somewhat discontinuous accounts of scientific knowledge and epistemology, evidence, the differences between statistical probability in regard to populations and understanding the health of individuals, and its claims for direct transfer of research findings to clinical settings—all of which raises more questions regarding its application to provider‐patient decision making, pedagogy, and policy.
Characterization of the new HLA‐B*35:482, detected in a potential hematopoietic stem cell donor
Authors: Ananeva Anastasiia , Sergeeva Iuliia , Gaifullina Raushania , Shagimardanova Elena
Published: November 2020

One nucleotide substitution in codon 4 of HLA‐B*35:01:01:01 results in a novel allele, HLA‐B*35:482.
Surplus and stress control autumn timing
Authors: Rollinson Christine R.
Published: November 2020

Climate change might cause an early shedding of leaves if trees have stored enough carbon
Deep diving with
Clio
Authors: Das Jnaneshwar , Trembath-Reichert Elizabeth
Published: November 2020

An autonomous underwater vehicle, named
Clio
, can sample ocean basin–scale biogeochemistry at depths up to 6000 m.
PAPPA-mediated adipose tissue remodeling mitigates insulin resistance and protects against gestational diabetes in mice and humans
Authors: Rojas-Rodriguez Raziel , Ziegler Rachel , DeSouza Tiffany , Majid Sana , Madore Aylin S. , Amir Nili , Pace Veronica A. , Nachreiner Daniel , Alfego David , Mathew Jomol , Leung Katherine , Moore Simas Tiffany A. , Corvera Silvia
Published: November 2020

A signaling pathway involving the placenta and adipose tissue underlies the development of gestational diabetes.
Tau and other proteins found in Alzheimer’s disease spinal fluid are linked to retromer-mediated endosomal traffic in mice and humans
Authors: Simoes Sabrina , Neufeld Jessica L. , Triana-Baltzer Gallen , Moughadam Setareh , Chen Emily I. , Kothiya Milankumar , Qureshi Yasir H. , Patel Vivek , Honig Lawrence S. , Kolb Hartmuth , Small Scott A.
Published: November 2020

Endosomal secreted proteins can be detected in the CSF and inform on how Alzheimer’s defective trafficking pathway can contribute to disease spread.
“Gli”-ful neighbors induce epithelial metaplasia
Authors: Sengupta Shaon
Published: November 2020

Gli1
+
mesenchymal stromal cells induce epithelial metaplasia.
Clinical and economic impact of intensive care unit-acquired bloodstream infections in Taiwan: a nationwide population-based retrospective cohort study
Authors: Wang Yung-Chih , Shih Shu-Man , Chen Yung-Tai , Hsiung Chao Agnes , Kuo Shu-Chen
Published: November 2020

Objectives

To estimate the clinical and economic impact of intensive care unit-acquired bloodstream infections in Taiwan.

Design

Retrospective cohort study.

Setting

Nationwide Taiwanese population in the National Health Insurance Research Database and the Taiwan Nosocomial Infections Surveillance (2007–2015) dataset.

Participants

The first episodes of intensive care unit-acquired bloodstream infections in patients ≥20 years of age in the datasets. Propensity score-matching (1:2) of demographic data, comorbidities and disease severity was performed to select a comparison cohort from a pool of intensive care unit patients without intensive care unit-acquired infections from the same datasets.

Primary and secondary outcome measures

The mortality rate, length of hospitalisation and healthcare cost.

Results

After matching, the in-hospital mortality of 14 234 patients with intensive care unit-acquired bloodstream infections was 44.23%, compared with 33.48% for 28 468 intensive care unit patients without infections. The 14-day mortality rate was also higher in the bloodstream infections cohort (4323, 30.37% vs 6766 deaths, 23.77%, respectively; p<0.001). Furthermore, the patients with intensive care unit-acquired bloodstream infections had a prolonged length of hospitalisation after their index date (18 days (IQR 7–39) vs 10 days (IQR 4–21), respectively; p<0.001) and a higher healthcare cost (US$16 038 (IQR 9667–25 946) vs US$10 372 (IQR 6289–16 932), respectively; p<0.001). The excessive hospital stay and healthcare cost per case were 12.69 days and US$7669, respectively. Similar results were observed in subgroup analyses of various WHO’s priority pathogens and Candida spp.

Conclusions

Intensive care unit-acquired bloodstream infections in critically ill patients were associated with increased mortality, longer hospital stays and higher healthcare costs.
Patients’ aged ≥65 years dispositions during ambulance assignments, including factors associated with non-conveyance to hospital: a longitudinal and comparative study
Authors: Forsgärde Elin-Sofie , Elmqvist Carina , Fridlund Bengt , Svensson Anders , Andersson Richard , Rööst Mattias
Published: November 2020

Objectives

Patients ≥65 years old represent 30%–50% of all ambulance assignments (AAs), and the knowledge of which care level they are disposed to is limited and diverging. The aim of this study was therefore to describe and compare characteristics of patients’ aged ≥65 years dispositions during AA, including determining changes over time and factors associated with non-conveyance to hospitals.

Design

A longitudinal and comparative database study.

Setting

Ambulance service in a Swedish region.

Participants

32 085 AAs with patients ≥65 years old during the years 2014, 2016 and 2018. Exclusion criteria: AAs with interhospital patient transfers and lack of patients’ dispositions data.

Outcome measures

Dependent factors: conveyance and non-conveyance to hospitals. Independent factors: age, sex, symptom, triage level, scene, time, day and season.

Results

The majority (n=29 060; 90.6%) of patients’ dispositions during AA were conveyance to hospitals. In total, the most common symptoms were circulatory (n=4953; 15.5%) and respiratory (n=4529; 14.1%). A significant increase, p<0.01, of non-conveyance to hospitals was shown during 2014 and 2018, from 801 (7.8%) to 1295 (11.4%). Increasing age was associated with decreasing odds of non-conveyance, 85–89 years (OR=0.85, 95 % CI=0.72 to 0.99) and 90 years or older (OR=0.80, 95 % CI=0.68 to 0.93). Several factors were associated with non-conveyance, for example, symptoms of diabetes (OR=8.57, 95 % CI=5.99 to 12.26) and mental disorders (OR=5.71, 95 % CI=3.85 to 8.48) in comparison with infections.

Conclusions

The study demonstrates several patient characteristics, and factors associated with non-conveyance to hospitals, such as age, symptom, triage level, scene, time, day and season. The increasing non-conveyance trend highlights the importance of further studies on optimal care levels for patients ≥65 years old.
Associations between multimorbidity and glycaemia (HbA1c) in people with type 2 diabetes: cross-sectional study in Australian general practice
Authors: Chiang Jason I , Furler John , Mair Frances , Jani Bhautesh D , Nicholl Barbara I , Thuraisingam Sharmala , Manski-Nankervis Jo-Anne
Published: November 2020

Objectives

To explore the prevalence of multimorbidity as well as individual and combinations of long-term conditions (LTCs) in people with type 2 diabetes (T2D) attending Australian general practice, using electronic health record (EHR) data. We also examine the association between multimorbidity condition count (total/concordant(T2D related)/discordant(unrelated)) and glycaemia (glycated haemoglobin, HbA1c).

Design

Cross-sectional study.

Setting

Australian general practice.

Participants

69 718 people with T2D with a general practice encounter between 2013 and 2015 captured in the MedicineInsight database (EHR Data from 557 general practices and >3.8 million Australian patients).

Primary and secondary outcome measures

Prevalence of multimorbidity, individual and combinations of LTCs. Multivariable linear regression models used to examine associations between multimorbidity counts and HbA1c (%).

Results

Mean (SD) age 66.42 (12.70) years, 46.1% female and mean (SD) HbA1c 7.1 (1.4)%. More than 90% of participants with T2D were living with multimorbidity. Discordant conditions were more prevalent (83.4%) than concordant conditions (69.9 %). The three most prevalent discordant conditions were: painful conditions (55.4%), dyspepsia (31.6%) and depression (22.8%). The three most prevalent concordant conditions were hypertension (61.4%), coronary heart disease (17.1%) and chronic kidney disease (8.5%). The three most common combinations of conditions were: painful conditions and hypertension (38.8%), painful conditions and dyspepsia (23.1%) and hypertension and dyspepsia (22.7%). We found no associations between any multimorbidity counts (total, concordant and discordant) or combinations and HbA1c.

Conclusions

Multimorbidity was common in our cohort of people with T2D attending Australian general practice, but was not associated with glycaemia. Although we did not explore mortality in this study, our results suggest that the increased mortality in those with multimorbidity and T2D observed in other studies may not be linked to glycaemia. Interestingly, discordant conditions were more prevalent than concordant conditions with painful conditions being the second most common comorbidity. Better understanding of the implications of different patterns of multimorbidity in people with T2D will allow more effective tailored care.
Prompt closure versus gradual weaning of external ventricular drainage for hydrocephalus in adult patients with aneurysmal subarachnoid haemorrhage: a systematic review
Authors: Capion Tenna , Lilja-Cyron Alexander , Juhler Marianne , Mathiesen Tiit Illimar , Wetterslev Jørn
Published: November 2020

Objectives

To summarise the evidence on benefits and harms of prompt closure versus gradual weaning of external ventricular drainage (EVD) in patients with hydrocephalus following aneurysmal subarachnoid haemorrhage (aSAH) based on randomised clinical trials (RCTs) in humans.

Setting

RCTs comparing prompt closure versus gradual weaning of EVD in adult patients with hydrocephalus following aSAH were included.

Participants

Patients aged equal to or greater than 18 years with an EVD due to hydrocephalus following aSAH were eligible for inclusion.

Primary and secondary outcome measures

Primary outcomes were all-cause mortality, any serious adverse event, rate of ventriculoperitoneal (VP) shunt placement and quality of life. Secondary outcomes were patients with shunt failure, hospital and neuro intensive care unit (NICU) length of stay (LOS) and complications related to treatment with an EVD. Data permitted report of rate of VP shunt placement, and hospital and NICU LOS.

Results

Six studies were assessed in full text. One RCT with 81 patients was included. Rate of VP shunt placement was 63.4% in the rapid weaning group (ie, prompt closure of the EVD; 41 patients) and 62.5% in the gradual weaning group (40 patients; p=0.932). LOS in hospital and NICU was significantly shorter in the rapidly weaned group compared with the gradually weaned group (mean 19.1 vs 21.5 days in hospital (p=0.03); and mean 14.1 vs 16.9 days in NICU (p=0.0002)). Data were insufficient to conduct meta-analysis, trial sequential analysis or subgroup analysis of heterogeneity and sensitivity. One RCT is currently ongoing.

Conclusions

We found insufficient evidence to favour any of the two strategies for EVD discontinuation in patients with hydrocephalus following aSAH.

PROSPERO registration number

CRD42018108801.
Protocol for the cultural adaptation of pulmonary rehabilitation and subsequent testing in a randomised controlled feasibility trial for adults with chronic obstructive pulmonary disease in Sri Lanka
Authors: Jayamaha Akila R , Perera Chamilya H , Orme Mark W , Jones Amy V , Wijayasiri Upendra K D C , Amarasekara Thamara D , Karunatillake Ravini S , Fernando Amitha , Seneviratne Anthony L P , Barton Andy , Jones Rupert , Yusuf Zainab K , Miah Ruhme B , Malcolm Dominic , Matheson Jesse A , Free Robert C , Manise Adrian , Steiner Michael C , Wimalasekera Savithri W , Singh Sally J
Published: November 2020

Introduction

International guidelines recommend pulmonary rehabilitation (PR) should be offered to adults living with chronic obstructive pulmonary disease (COPD), but PR availability is limited in Sri Lanka. Culturally appropriate PR needs to be designed and implemented in Sri Lanka. The study aims to adapt PR to the Sri Lankan context and determine the feasibility of conducting a future trial of the adapted PR in Sri Lanka.

Methods and analysis

Eligible participants will be identified and will be invited to take part in the randomised controlled feasibility trial, which will be conducted in Central Chest Clinic, Colombo, Sri Lanka. A total of 50 participants will be recruited (anticipated from April 2021) to the trial and randomised (1:1) into one of two groups; control group receiving usual care or the intervention group receiving adapted PR. The trial intervention is a Sri Lankan-specific PR programme, which will consist of 12 sessions of exercise and health education, delivered over 6 weeks. Focus groups with adults living with COPD, caregivers and nurses and in-depth interviews with doctors and physiotherapist will be conducted to inform the Sri Lankan specific PR adaptations. After completion of PR, routine measures in both groups will be assessed by a blinded assessor. The primary outcome measure is feasibility, including assessing eligibility, uptake and completion. Qualitative evaluation of the trial using focus groups with participants and in-depth interviews with PR deliverers will be conducted to further determine feasibility and acceptability of PR, as well as the ability to run a larger future trial.

Ethics and dissemination

Ethical approval was obtained from the ethics review committee of Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Lanka and University of Leicester, UK. The results of the trial will be disseminated through patient and public involvement events, local and international conference proceedings, and peer-reviewed journals.

Trial registration number

ISRCTN13367735
How can patient experience scores be used to predict quality inspection ratings? A retrospective cross-sectional study of national primary care datasets in the UK
Authors: Tallett Amy , Poots Alan J , Graham Chris , Peters Michele , Corbett Rory , Sizmur Steve , Forder Julien
Published: November 2020

Objectives

The relationship between patient feedback in the General Practice Patient Survey (GPPS) and Care Quality Commission (CQC) inspections of practices was investigated to understand whether there is an association between patient views and regulator ratings of quality. The specific aims were to understand whether patients’ self-reported experiences of primary care can predict CQC inspection ratings of GP practices by: (i) Measuring the association between GPPS results and CQC inspection ratings of GP practices; (ii) Building a predictive model of GP practice quality ratings that use GPPS results; and (iii) Evaluating the predictive model for risk stratification.

Design

Retrospective analysis of routinely collected data using decision tree modelling.

Setting

Primary care: GP practices in England.

Primary and secondary outcome measures

GPPS scores and GP practice CQC inspection ratings during 2018.

Results

Most GP practices (72%, 974/1350) were rated as ‘Good’ overall by CQC. Simply assuming that all practices will be rated as ‘Good’ results in a correct prediction 72% of the time, and it was not possible to improve on this overall level of predictive accuracy using decision tree modelling (correct in 73% of cases). However, a set of GPPS questions were found to have value in identifying practices at elevated risk of a poor inspection rating.

Conclusions

Although there were some associations between GPPS data and CQC inspection ratings, there were limitations to the use of GPPS data for predictive analysis. This is a likely result of the majority of CQC inspections of GPs resulting in a ‘Good’ or ‘Outstanding’ rating. However, some GPPS questions were found to have value in identifying practices at higher risk of an ‘Inadequate’ or ‘Requires Improvement’ rating, and this may be valuable for surveillance purposes. For example, the CQC could use key questions from the survey to target inspection planning.
Needs of LMIC-based tobacco control advocates to counter tobacco industry policy interference: insights from semi-structured interviews
Authors: Matthes Britta Katharina , Robertson Lindsay , Gilmore Anna B
Published: November 2020

Introduction

Advocacy is vital for advancing tobacco control and there has been considerable investment in this area. While much is known about tobacco industry interference (TII), there is little research on advocates’ efforts in countering TII and what they need to succeed. We sought to examine this and focused on low- and middle-income countries (LMICs) where adoption and implementation of the Framework Convention on Tobacco Control (FCTC) tend to remain slower and weaker.

Method

We interviewed 22 advocates from eight LMICs with recent progress in a tobacco control policy. We explored participants’ experiences in countering TII, including the activities they undertake, challenges they encounter and how their efforts could be enhanced. We used Qualitative Description to analyse transcripts and validated findings through participant feedback.

Results

We identified four main areas of countering activities: (1) generating and compiling data and evidence, (2) accessing policymakers and restricting industry access, (3) working with media and (4) engaging in a national coalition. Each area was linked to challenges, including (1) lack of data, (2) no/weak implementation of FCTC Article 5.3, (3) industry ties with media professionals and (4) advocates’ limited capacity. To address these challenges, participants suggested initiatives, including access to country-specific data, building advocates’ skills in compiling and using such data in research and monitoring, and in coalition development; others aiming at training journalists to question and investigate TII; and finally, diverse interventions intended to advance a whole-of-government approach to tobacco control. Structural changes to tobacco control funding and coordination were suggested to facilitate the proposed measures.

Conclusion

This research highlights that following years of investment in tobacco control in LMICs, there is growing confidence in addressing TII. We identify straightforward initiatives that could strengthen such efforts. This research also underscores that more structural changes to enhance tobacco control capacity building should be considered.
Hospital end-of-life care: families’ free-text notes
Authors: Kurkowski Sandra , Radon Johannes , Vogt Annika R , Weber Martin , Stiel Stephanie , Ostgathe Christoph , Heckel Maria
Published: November 2020

Background

Palliative care strives to improve quality of life for patients with incurable diseases. This approach includes adequate support of the patients’ loved ones. Consequently, loved ones have personal experiences of providing end-of-life care for their next. This is a resource for information and may help to investigate the loved ones’ perspectives on need for improvements.

Aim

To identify further quality aspects considered important by loved ones to improve the quality of care at the end of life as an addition to quantitative results from the Care of the Dying Evaluation for the German-speaking area (CODE-GER) questionnaire.

Design

Within the validation study of the questionnaire ‘Care of the Dying Evaluation’ (CODETM) GER, loved ones were asked to comment (free text) in parallel on each item of the CODE-GER. These free-text notes were analysed with the qualitative content analysis method by Philipp Mayring.

Setting/participants

Loved ones of patients (n=237), who had died an expected death in two university hospitals (palliative and non-palliative care units) during the period from April 2016 to March 2017.

Results

993 relevant paragraphs were extracted out of 1261 free-text notes. For loved ones, important aspects of quality of care are information/communication, respect of the patient’s and/or loved one’s will, involvement in decision-making at the end of life (patient’s volition) and having the possibility to say goodbye.

Conclusions

It is important for loved ones to be taken seriously in their sorrows, to be informed, that the caregivers respect the patients’ will and to be emotionally supported.

Trial registration number

This study was registered at the German Clinical Trials Register (DRKS00013916).
Professionals guidance about palliative medicine in chronic heart failure: a mixed-method study
Authors: Ament Stephanie M C , van den Beuken-Everdingen Marieke , Maessen José M C , Boyne Josiane , Schols Jos M G A , Stoffers Henri E J H , Bellersen Louise , Brunner-La Rocca Hans-Peter , Engels Yvonne , Janssen Daisy J A
Published: November 2020

Introduction

Healthcare professionals (HCPs) experience difficulties in timely recognising and directing palliative care (PC) needs of their patients with chronic heart failure (CHF). The aim of this study was to develop a comprehensive tool to enable HCPs in timely recognising and directing PC needs in CHF.

Methods

A four-stage mixed-method study was performed. Stage 1: identification of needs and questions of patients and families; stage 2: prioritisation and refinement of the needs and questions; stage 3a: testing and online feedback on V.1; stage 3b: selecting and refining care recommendations; stage 4: testing and review of V.2. Iterative reviews followed each step in the development process to ensure a wide range of stakeholder input. In total, 16 patients, 12 family members and 54 HCPs participated.

Results

A comprehensive set of 13 PC needs was identified, redefined and tested. The resulting tool, called Identification of patients with HeARt failure with PC needs (I-HARP), contains an introduction prompt with open questions to start the conversation, 13 closed screening questions with additional in-depth questions, and recommendations on actions for identified needs.

Conclusion

I-HARP contains an evidence-based set of questions and palliative CHF care suggestions for HCPs in the Netherlands. The resulting tool, approved by HCPs, patients and family members, is a promising guidance for HCP to timely recognise and direct PC needs in CHF.
Evaluation of a mental health drop-in centre offering brief transdiagnostic psychological assessment and treatment for children and adolescents with long-term physical conditions and their families: a single-arm, open, non-randomised trial
Authors: Catanzano Matteo , Bennett Sophie D , Kerry Ellie , Liang Holan , Heyman Isobel , Coughtrey Anna E , Fifield Kate , Taylor Chloe , Dalgleish Tim , Xu Laila , Shafran Roz
Published: November 2020

Background

Children and young people with long-term physical conditions have significantly elevated mental health needs. Transdiagnostic, brief psychological interventions have the potential to increase access to evidence-based psychological treatments for patients who attend health services primarily for physical health needs.

Objective

A non-randomised study was conducted to assess the impact of brief, transdiagnostic psychological interventions in children and young people presenting at a drop-in mental health centre in the reception area of a paediatric hospital.

Methods

186 participants attending a transdiagnostic mental health drop-in centre were allocated to assessment and psychological intervention based on a clinical decision-making algorithm. Interventions included signposting, guided self-help based on a modular psychological treatment and referral to the hospital’s paediatric psychology service. The primary transdiagnostic mental health outcome measure was the parent-reported Strengths and Difficulties Questionnaire (SDQ), which was given at baseline and 6 months post-baseline.

Findings

There was a significant positive impact of attending the drop-in mental health centre on the SDQ (Cohen’s d=0.22) and on the secondary outcome measure of Paediatric Quality of life (Cohen’s d=0.55).

Conclusions

A mental health drop-in centre offering brief, transdiagnostic assessment and treatment may reduce emotional and behavioural symptoms and improve quality of life in children and young people with mental health needs in the context of long-term physical conditions. A randomised controlled trial to investigate the specificity of any effects is warranted.

Clinical implications

Drop-in centres for mental health needs may increase access and have beneficial effects for children and young people with physical conditions.
Antimetabolite pemetrexed primes a favorable tumor microenvironment for immune checkpoint blockade therapy
Authors: Lu Chia-Sing , Lin Ching-Wen , Chang Ya-Hsuan , Chen Hsuan-Yu , Chung Wei-Chia , Lai Wei-Yun , Ho Chao-Chi , Wang Tong-Hong , Chen Chi-Yuan , Yeh Chen-Lin , Wu Sean , Wang Shu-Ping , Yang Pan-Chyr
Published: November 2020

Background

The immune checkpoint blockade (ICB) targeting programmed cell death-1 (PD-1) and its ligand (PD-L1) has been proved beneficial for numerous types of cancers, including non-small-cell lung cancer (NSCLC). However, a significant number of patients with NSCLC still fail to respond to ICB due to unfavorable tumor microenvironment. To improve the efficacy, the immune-chemotherapy combination with pemetrexed, cis/carboplatin and pembrolizumab (anti-PD-1) has been recently approved as first-line treatment in advanced NSCLCs. While chemotherapeutic agents exert beneficial effects, the underlying antitumor mechanism(s) remains unclear.

Methods

Pemetrexed, cisplatin and other chemotherapeutic agents were tested for the potential to induce PD-L1 expression in NSCLC cells by immunoblotting and flow cytometry. The ability to prime the tumor immune microenvironment was then determined by NSCLC/T cell coculture systems and syngeneic mouse models. Subpopulations of NSCLC cells responding differently to pemetrexed were selected and subjected to RNA-sequencing analysis. The key signaling pathways were identified and validated in vitro and in vivo.

Results

Pemetrexed induced the transcriptional activation ofPD-L1(encoded byCD274) by inactivating thymidylate synthase (TS) in NSCLC cells and, in turn, activating T-lymphocytes when combined with the anti-PD-1/PD-L1 therapy. Nuclear factor κB (NF-κB) signaling was activated by intracellular reactive oxygen species (ROSs) that were elevated by pemetrexed-mediated TS inactivation. The TS−ROS−NF-κB regulatory axis actively involves in pemetrexed-induced PD-L1 upregulation, whereas when pemetrexed fails to induce PD-L1 expression in NSCLC cells, NF-κB signaling is unregulated. In syngeneic mouse models, the combinatory treatment of pemetrexed with anti-PD-L1 antibody created a more favorable tumor microenvironment for the inhibition of tumor growth.

Conclusions

Our findings reveal novel mechanisms showing that pemetrexed upregulates PD-L1 expression and primes a favorable microenvironment for ICB, which provides a mechanistic basis for the combinatory chemoimmunotherapy in NSCLC treatment.
National Institutes of Health grant opportunities for the neurointerventionalist: preparation and choosing the right mechanism
Authors: Kan Peter , Levitt Michael R , Mack William J , Starke Robert M , Sheth Kevin N , Albuquerque Felipe C , Mokin Maxim
Published: November 2020

Objective

The goal of this article is to provide recommendations for the early career neurointerventionalist in writing a successful grant application to the National Institutes of Health (NIH) and similar funding agencies.

Methods

The authors reviewed NIH rules and regulations and also reflected on their own collective experience in writing NIH grant proposals in the area of cerebrovascular disease and neurointerventional surgery.

Results

A strong proposal should address an important scientific problem where there is a gap in knowledge. The solution offered needs to be innovative but at the same time based on a strong scientific premise. The proposed research must be feasible to implement and investigate in the researcher’s environment.

Conclusion

Successful grant writing is critical in funding and enhancing research. The information in the article may aid in the preparation stage of grant writing for early career neurointerventionalists.