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Kangpeng Li, Qiang Zhang Department of Orthopedics, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, People’s Republic of ChinaCorrespondence: Qiang Zhang, Email ditanzq@163.com

Whilst increasing literature elucidates academic ableism and its impact upon faculty and PhD students, far less attention is paid to aspiring academics who are excluded from academia altogether. Through a first-person narrative, this article explores the experiences of a disabled postgraduate seeking a PhD placement, who is largely unable to leave home owing to the interplay between 'rare' and neglected health conditions and an ableist society. The impact of academic exclusions, notably institutional resistance to providing remote access, is explored through the lens of psycho-emotional disablism. It is contended that, for all the talk of equality, diversity and inclusion, the academy represents yet another landscape of power and exclusion where disabled people struggle to be recognised as fully-fledged citizens. The emergence of long Covid and persistent threat of infection adds urgency to the academic and wider social need to include disabled people who are unable to leave the home. [ABSTRACT FROM AUTHOR]

Jianing Li,1 Yongsheng Zhang,2 Ying Tong3 1Heilongjiang University of Chinese Medicine, Harbin, People’s Republic of China; 2Harbin Institute of Technology, Harbin, People’s Republic of China; 3First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, People’s Republic of ChinaCorrespondence: Ying Tong, Email tongying@hljucm.edu.cn

Yanting Ma,1 Yongyuan Li,2 Zhanfeng Zhang,3 Guomei Du,4 Ting Huang,1 Zhongzhi Zhao,5 Shou Liu,1 Zhancui Dang1 1Department of Public Health, Qinghai University Medical College, Xining, Qinghai, People’s Republic of China; 2Disease Control department, Huangzhong District health Bureau, Xining, Qinghai, People’s Republic of China; 3Huangzhong District, Duoba County Health Services Center, Xining, Qinghai, People’s Republic of China; 4Clinical Laboratory, Qinghai Red Cross Hospital, Xining, Qinghai, People’s Republic of China; 5Disease control department, Qinghai Provincial Center for Endemic Disease Control and Prevention, Xining, Qinghai, People’s Republic of ChinaCorrespondence: Shou Liu; Zhancui Dang, Department of Public Health, Qinghai University Medical College, No. 16 Kunlun Drive, Chengxi District, Xining, Qinghai, 810001, People’s Republic of China, Email liushou2004@aliyun.com; yxyyy2019@163.com

Yiwen Zhang,1 Wei Wang,2,* Lili Xu,1 Zhexun Lian,3 Jiale Huang,4 Yaowei Chang,5 Junjie Guo,3 Yangang Wang,1,* Kexiu Song,6 Hongwei Ji7,8,* 1Department of Endocrinology, Affiliated Hospital of Qingdao University, Qingdao, People’s Republic of China; 2Department of Hematology, Affiliated Hospital of Qingdao University, Qingdao, People’s Republic of China; 3Department of Cardiology, Affiliated Hospital of Qingdao University, Qingdao, People’s Republic of China; 4Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China; 5Department of Cardiology, QingPu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai, People’s Republic of China; 6Department of International Medicine, Affiliated Hospital of Qingdao University, Qingdao, People’s Republic of China; 7Tsinghua Medicine, Tsinghua University, Beijing, People’s Republic of China; 8Department of Internal Medicine, Beijing Tsinghua Changgung Hospital, Beijing, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yangang Wang, Department of Endocrinology, Affiliated Hospital of Qingdao University, Qingdao, People’s Republic of China, Email wangyg@qdu.edu.cn Hongwei Ji, Tsinghua Medicine, Tsinghua University, Beijing, People’s Republic of China, Email hongweijicn@gmail.com

Yanyan Song Department of Cardiovascular Surgery, General Hospital of Ningxia Medical University, Yinchuan, 750004, People’s Republic of ChinaCorrespondence: Yanyan Song, Department of Cardiovascular Surgery, General Hospital of Ningxia Medical University, No. 804 Shengli South Street, Xingqing District, Yinchuan, 750004, People’s Republic of China, Email nxfysyy@163.com

Yanyan Song, Jian Yang Department of Cardiovascular Surgery, General Hospital of Ningxia Medical University, Yinchuan, 750004, People’s Republic of ChinaCorrespondence: Yanyan Song, Department of Cardiovascular Surgery, General Hospital of Ningxia Medical University, No. 804 Shengli South Street, Xingqing District, Yinchuan, 750004, People’s Republic of China, Email nxfysyy@163.com

Song Wang,1,* Jing Song,2,* Xiaolian Jiang1 1West China School of Nursing/West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China; 2Bengbu Medical University, Bengbu, Anhui, People’s Republic of China*These authors contributed equally to this workCorrespondence: Xiaolian Jiang, West China School of Nursing/West China Hospital, Sichuan University, No. 37, Guoxue Lane, Wuhou District, Chengdu, Sichuan, 610041, People’s Republic of China, Email jangxaolianhl@163.com

BackgroundMany parents develop stress-related symptoms and depression when their preterm infant is hospitalised in the neonatal intensive care unit (NICU) after birth. We reviewed the evidence of parent well-being with preterm infants hospitalised in single family rooms (SFRs) or in open bay neonatal units (OBUs).MethodsFor this systematic review and meta-analysis, we searched MEDLINE, EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Clinicaltrials.gov, and International Clinical Trials Registry Platform (ICTRP) databases from inception through 22 November 2019 using controlled terms and text words related to prematurity and NICU-design. We included randomised and non-randomised studies comparing outcomes in parents with preterm infants admitted to SFRs or OBUs. Methodological quality was assessed using Cochrane Collaboration's Risk of Bias Tool for randomised controlled trials and the Risk of Bias Tool for Non-Randomised Studies of Interventions (ROBINS-I). Outcomes included: parental stress, satisfaction, participation (presence/involvement/skin-to-skin care), self-efficacy, parent-infant-bonding, depression, anxiety, post-traumatic stress, empowerment, and degree of family-centred care. Summary estimates were calculated using random effects models with standardised mean differences (SMDs). PROSPERO registration: CRD42016050643.FindingsWe identified 614 unique publications. Eleven study populations (1, 850 preterm infants, 1, 549 mothers and 379 fathers) were included. All but one study were at serious to critical risk of bias. SFRs were associated with higher levels of parental presence, involvement, and skin-to-skin care. Upon discharge, SFRs were associated with lower stress levels (n = 828 parents, SMD-0·30,95%CI -0·50;-0·09, p

What happens when you add a "not relevant" response option to the unipolar response scales of personality state items? In an experimental experience sampling study with a between-person design (total N = 248; n = 3,253 observations), we compared personality states measured with a unipolar response scale including or not including a "not relevant" response option. Overall, "not relevant" responses were quite prevalent but varied between items. Certain characteristics of the situation (particularly sociality) but not of the person predicted the use of the "not relevant" response option. Additionally, means and distributions of personality states significantly differed between the different response scales, but their associations with other relevant constructs did not. Overall, this study emphasizes the importance of systematically addressing how personality states should be measured and provides first evidence that a "not relevant" response option might be an important aspect to consider for the measurement of personality states. [ABSTRACT FROM AUTHOR]

Introduction: Observational studies suggested lung function is inversely associated with cardiovascular disease (CVD) although these studies could be confounded. We conducted a two sample Mendelian randomisation study using summary statistics from genome-wide association studies (GWAS) to clarify the role of lung function in CVD and its risk factors, and conversely the role of CVD in lung function.Methods: We obtained genetic instruments for forced expiratory volume in 1 s (FEV1: 260) and forced vital capacity (FVC: 320) from publicly available UK Biobank summary statistics (n=421 986) and applied to GWAS summary statistics for coronary artery disease (CAD) (n=184 305), stroke (n=446 696), atrial fibrillation (n=1 030 836) and heart failure (n=977 320) and cardiovascular risk factors. Inverse variance weighting was used to assess the impact of lung function on these outcomes, with various sensitivity analyses. Bidirectional Mendelian randomisation was used to assess reverse causation.Results: FEV1 and FVC were inversely associated with CAD (OR per SD increase, 0.72 (95% CI 0.63 to 0.82) and 0.70 (95%CI 0.62 to 0.78)), overall stroke (0.87 (95%CI 0.77 to 0.97), 0.90 (95% CI 0.82 to 1.00)) and some stroke subtypes. FEV1 and FVC were inversely associated with type 2 diabetes and systolic blood pressure. Sensitivity analyses produced similar findings although the association with CAD was attenuated after adjusting for height (eg, OR for 1SD FEV10.95 (0.75 to 1.19), but not for stroke or type 2 diabetes. There was no strong evidence for reverse causation.Conclusion: Higher lung function likely protect against CAD and stroke. [ABSTRACT FROM AUTHOR]

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Background: Diaphragmatic sleep disordered breathing (dSDB) has been recently identified as sleep dysfunction secondary to diaphragmatic weakness in Duchenne muscular dystrophy (DMD). However, scoring criteria for the identification of dSDB are missing.This study aimed to define and validate dSDB scoring criteria and to evaluate whether dSDB severity correlates with respiratory progression in DMD., Methods: Scoring criteria for diaphragmatic apnoea (dA) and hypopnoeas (dH) have been defined by the authors considering the pattern observed on cardiorespiratory polygraphy (CR) and the dSDB pathophysiology.10 sleep professionals (physiologists, consultants) blinded to each other were involved in a two-round Delphi survey to rate each item of the proposed dSDB criteria (Likert scale 1-5) and to recognise dSDB among other SDB. The scorers' accuracy was tested against the authors' panel.Finally, CR previously conducted in DMD in clinical setting were rescored and diaphragmatic Apnoea-Hypopnoea Index (dAHI) was derived. Pulmonary function (forced vital capacity per cent of predicted, FVC%pred), overnight oxygen saturation (SpO2) and transcutaneous carbon dioxide (tcCO2) were correlated with dAHI., Results: After the second round of Delphi, raters deemed each item of dA and dH criteria as relevant as 4 or 5. The agreement with the panel in recognising dSDB was 81%, kappa 0.71, sensitivity 77% and specificity 85%.32 CRs from DMD patients were reviewed. dSDB was previously scored as obstructive. The dAHI negatively correlated with FVC%pred (r=-0.4; p<0.05). The total number of dA correlated with mean overnight tcCO2 (r 0.4; p<0.05)., Conclusions: dSDB is a newly defined sleep disorder that correlates with DMD progression. A prospective study to evaluate dSDB as a respiratory measure for DMD in clinical and research settings is planned., Competing Interests: Competing interests: FT reports participation to Scientific Advisory boards for Roche UK and teaching initiatives for Biogen UK, Avexis UK, Roche UK and Italy, Breas UK. MD, DR, AAZ and FA report no disclosures. FM reports participation in Scientific Advisory boards and teaching initiatives for Biogen, Roche and Novartis. He is a member of the Rare Disease Scientific Advisory Board for Pfizer. He is involved as an investigator in clinical trials from Novartis, Biogen and Roche. In addition, he is the principal investigator of the SMA REACH UK clinical network, partially funded by Biogen., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Letter to the Editor

Firomsa Bekele Department of Pharmacy, College of Health Science, Mettu University, Mettu, EthiopiaCorrespondence: Firomsa BekeleDepartment of Pharmacy, College of Health Science, Mettu University, Mettu, EthiopiaEmail firomsabekele21@gmail.com View the original paper by Mr Hasen and colleagues

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George Hazell Department of Medicine, Imperial College London, London, UKCorrespondence: George HazellImperial College School of Medicine, Imperial College London, South Kensington Campus, Sir Alexander Fleming Building, London, UKEmail george.hazell16@imperial.ac.uk View the original paper by Dr Ganesananthan and colleagues

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Background: Juvenile idiopathic arthritis (JIA)-associated uveitis typically presents as a silent chronic anterior uveitis and can lead to blindness. Adherence to current screening guidelines is hampered by complex protocols which rely on the knowledge of specific JIA characteristics. The Multinational Interdisciplinary Working Group for Uveitis in Childhood identified the need to simplify screening to enable local eye care professionals (ECPs), who carry the main burden, to screen children with JIA appropriately and with confidence., Methods: A consensus meeting took place in January 2023 in Barcelona, Spain, with an expert panel of 10 paediatric rheumatologists and 5 ophthalmologists with expertise in paediatric uveitis. A summary of the current evidence for JIA screening was presented. A nominal group technique was used to reach consensus., Results: The need for a practical but safe approach that allows early uveitis detection was identified by the panel. Three screening recommendations were proposed and approved by the voting members. They represent a standardised approach to JIA screening taking into account the patient's age at the onset of JIA to determine the screening interval until adulthood., Conclusion: By removing the need for the knowledge of JIA categories, antinuclear antibody positivity or treatment status, the recommendations can be more easily implemented by local ECP, where limited information is available. It would improve the standard of care on the local level significantly. The proposed protocol is less tailored to the individual than the 'gold standard' ones it references and does not aim to substitute those where they are being used with confidence., Competing Interests: Competing interests: IF, MB and HP: no competing interest. SAH is supported by the National Institutes for Health (NIH) National Eye Institute under Award Numbers R01EY030521 and R01 EY034565. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or the views or policies of the Department of Health and Human Services, nor does the mention of trade names, commercial products or organisations imply endorsement by the US government. RB, JC-H, TC, JHdB, JD-C, CE, MG, HI, SK, EM, EN, RKS, GS, ALS, JT and JA: no competing interest., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

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Syeda Zoha Zehra Rizvi,1 Syeda Sakina Zehra2 1Jinnah Sindh Medical University, Karachi, Pakistan; 2Karachi Medical and Dental College, Karachi, PakistanCorrespondence: Syeda Zoha Zehra RizviJinnah Sindh Medical University, B-349, Block 6, Gulshan-e-Iqbal, Karachi, PakistanTel +923342721995Email syedazohazehra@gmail.com We have read the paper entitled “Effects of Grit on the Academic Performance of Medical Students” by Alzerwi1 published in Advances in Medical Education and Practice. We congratulate and thank the author for bringing this issue, and followup to the article. View the original paper by Alzerwi

Background: The British Thoracic Society (BTS) has organised intermittent audits of hospital oxygen use in UK hospitals since 2008. Manual audits are time-consuming and subject to human errors. Oxygen prescribing and bedside observations including National Early Warning Scores (NEWS2 scores) are undertaken within an integrated electronic medical record (EMR) at this hospital., Methods: The hospital's Business Information team were commissioned in late 2019 to devise a bespoke automated audit of oxygen prescribing and use. A summary report displays the oxygen saturation alongside the oxygen prescription status of every patient in the hospital except for critical care units which do not use NEWS2. The display has a 'traffic-light' colour scheme (green within target range, amber or red if below range or if above range on supplemental oxygen), with a graph showing oxygen use and saturation levels for patients with each prescribed target range. Clinicians can access raw data including oxygen saturation, oxygen device and flow rate for each individual patient., Results: Over 51 audits involving 34 352 sets of observations, an average of 6.0% involved use of oxygen and 88.6% of these had a valid oxygen prescription. During the first wave of the COVID-19 pandemic in spring 2020, the monthly percentage of observations involving oxygen use increased to a peak of 10.4% followed by a rise to 10.6% during the second wave and 7.4% during the third (Omicron) wave. Oxygen use returned to baseline after each wave., Conclusions: In hospitals with integrated EMRs, it is possible to automate all fundamental aspects of the BTS oxygen audits and to monitor oxygen use at individual patient level and a hospital-wide level. This could be particularly valuable during major events such as the COVID-19 pandemic. This methodology could be extended to other clinical audits where the audit questions relate to routinely collected EMR data., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Abstract Introduction The aims of this study were to investigate the correlation between lymphatic drainage and the sentinel lymph node (SLN) status of the subregions in the context of the clinic-pathological parameters of the tumour and the coverage of the axillary volumes by standard and high tangential fields (STgF and HTgF) for whole breast radiotherapy and axillary reverse mapping (ARM). Patients and methods 933 women with early breast cancer and clinically negative axillary status underwent breast surgery and SLN biopsy followed by axillary lymph node dissection in SLN-positive cases. The subregional localisation of the SLN(s) was registered and statistically analysed with the clinic-pathological characteristics of the breast tumour. In node-positive patients treated with breast-conserving therapy in whom the SLNs were found in the anterior or posterior axillary subregions, the axillary volumes were contoured using the Radiation Therapy Oncology Group contouring atlas (n = 61). Results In 91.1% (n = 797) of the cases, the SLN appeared in the anterior, posterior or central subregions. Using HTgF, Level I or II were completely covered in 65.6% (40/61) and 6.6% (4/61) of the cases, respectively. With STgF, the complete coverage was 0% for both levels. 6.8% (n = 63) of all cases had one positive lymph node in the expected ARM lymph node regions. Discussion A SLN is more than likely to be present in the anterior, posterior and central axillary subregions. Tangential fields allow only limited coverage of the axillary volumes. Preserving the lateral subregion during ARM may increase the possibility of understaging. [ABSTRACT FROM AUTHOR]

Background: Chronic lung disease is a leading contributor to the global disease burden; however, beyond tobacco smoke, we do not fully understand what risk factors contribute to lung function decline in low-income and middle-income countries.Methods: We collected sociodemographic and clinical data in a randomly selected, age-stratified, sex-stratified and site-stratified population-based sample of 3048 adults aged ≥35 years from four resource-poor settings in Peru. We assessed baseline and annual pre-bronchodilator and post-bronchodilator lung function over 3 years. We used linear mixed-effects models to assess biological, socioeconomic and environmental risk factors associated with accelerated lung function decline.Results: Mean±SD enrolment age was 55.4±12.5 years, 49.2% were male and mean follow-up time was 2.36 (SD 0.61) years. Mean annual pre-bronchodilator FEV1 decline was 30.3 mL/year (95% CI 28.6 to 32.0) and pre-bronchodilator FVC decline was 32.2 mL/year (30.0 to 34.4). Using multivariable linear mixed-effects regression, we found that urban living, high-altitude dwelling and having hypertension accounted for 25.9% (95% CI 15.7% to 36.1%), 21.3% (11.1% to 31.5%) and 15.7% (3.7% to 26.9%) of the overall mean annual decline in pre-bronchodilator FEV1/height2, respectively. Corresponding estimates for pre-bronchodilator FVC/height2 were 42.1% (95% CI% 29.8% to 54.4%), 36.0% (23.7% to 48.2%) and 15.8% (2.6% to 28.9%) of the overall mean annual decline, respectively.Conclusion: Urbanisation, living at high altitude and hypertension were associated with accelerated lung function decline in a population with low daily smoking prevalence. [ABSTRACT FROM AUTHOR]

Policing is recognized as a highly stressful occupation, encompassing stressors not commonly encountered in other fields. In response, police-specific stress scales have been developed and used when studying police work. Despite changes in the composition of police personnel, most studies examining police working conditions focus on sworn police officers (SPO), excluding employees without police education (EWPE). To advance research and practice on stress in the police, align results, and increase the possibilities for comparisons across studies using police-specific measures (PSMs) we conducted a psychometric evaluation of the two scales in the Police Stress Questionnaire (PSQ). We examined whether adding “Not Applicable” to the response scales would reduce vulnerability and make the PSQ more robust.Based on a survey with a randomised sample (N = 560) of SPO and EWPE in the Norwegian Police, we tested the original factor structures of the PSQ through Confirmatory Factor Analysis including tests of factor structures from previous studies.For all models, the indicators of fit indicated a poor fit with either our whole or stratified sample. The response choice ‘Not Applicable’ provided extended information for SPOs and EWPEs on the PSQ.To promote aligning results and enabling comparisons across studies using the PSQ, we suggest treating the PSQ scales as formative indexes, rather than reflective scales. Adding “Not Applicable” to the response scale offers an influential elaboration of the PSQ with beneficial and extended information. Generalised studies of stress in the police should include the entire population working there. [ABSTRACT FROM AUTHOR]

Samit GhosalDepartment of Endocrinology, Nightingale Hospital, Kolkata, IndiaI read with interest the “Thorough QTc study” with teneligliptin by Erande et al.1 It came as a surprise to me that the basic structure required to conduct such a trial as per the ICH E14 recommendations for the industry was not followed.2 The recommended design to conduct such a trial was not universally followed (Table1).View the original paper by Erande and colleagues

Muscle mitochondrial dysfunction is implicated in intensive care unit-acquired weakness, but there is no serum biomarker of muscle mitochondrial function for critical illness survivors. Higher serum growth differentiation factor-15 (GDF-15) is a biomarker of inherited mitochondrial myopathy disease and is associated with mortality in several age-related diseases. Among 142 older (age ≥ 65 years) survivors of acute respiratory failure, we found that higher serum GDF-15 measured during the week prior to hospital discharge was cross-sectionally associated with weaker diaphragm, limb and hand-grip strength, and longitudinally associated with lower rates of functional recovery over 6 months, independent of age, sex, pre-existing disability, comorbidity, frailty, Acute Physiology and Chronic Health Evaluation II scores and concurrent interleukin-6 levels. [ABSTRACT FROM AUTHOR]

Objectives: Policing is recognized as a highly stressful occupation, encompassing stressors not commonly encountered in other fields. In response, police-specific stress scales have been developed and used when studying police work. Despite changes in the composition of police personnel, most studies examining police working conditions focus on sworn police officers (SPO), excluding employees without police education (EWPE). To advance research and practice on stress in the police, align results, and increase the possibilities for comparisons across studies using police-specific measures (PSMs) we conducted a psychometric evaluation of the two scales in the Police Stress Questionnaire (PSQ). We examined whether adding "Not Applicable" to the response scales would reduce vulnerability and make the PSQ more robust., Method: Based on a survey with a randomised sample ( N = 560) of SPO and EWPE in the Norwegian Police, we tested the original factor structures of the PSQ through Confirmatory Factor Analysis including tests of factor structures from previous studies., Results: For all models, the indicators of fit indicated a poor fit with either our whole or stratified sample. The response choice 'Not Applicable' provided extended information for SPOs and EWPEs on the PSQ., Conclusions: To promote aligning results and enabling comparisons across studies using the PSQ, we suggest treating the PSQ scales as formative indexes, rather than reflective scales. Adding "Not Applicable" to the response scale offers an influential elaboration of the PSQ with beneficial and extended information. Generalised studies of stress in the police should include the entire population working there., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.