bluuebunny/crossref_metadata_2025 huggingface dataset:
Outcomes of patients on second‐ and third‐line ART enrolled in ART adherence clubs in Maputo, Mozambique
Authors: Finci I. , Flores A. , Gutierrez Zamudio A. G. , Matsinhe A. , de Abreu E. , Issufo S. , Gaspar I. , Ciglenecki I. , Molfino L.
Published: September 2020

Objectives

Adherence clubs (AC) offer patient‐centred access to antiretroviral therapy (ART) while reducing the burden on health facilities. AC were implemented in a health centre in Mozambique specialising in patients with a history of HIV treatment failure. We explored the impact of AC on retention in care and VL suppression of these patients.

Methods

We performed a retrospective analysis of patients enrolled in AC receiving second‐ or third‐line ART. The Kaplan–Meier estimates were used to analyse retention in care in health facility, retention in AC and viral load (VL) suppression (VL < 1000 copies/mL). Predictors of attrition and VL rebound (VL ≥ 1000 copies/mL) were assessed using multivariable proportional hazards regression.

Results

The analysed cohort contained 699 patients, median age 40 years [IQR: 35–47], 428 (61%) female and 97% second‐line ART. Overall, 9 (1.3%) patients died, and 10 (1.4%) were lost to follow‐up. Retention in care at months 12 and 24 was 98.9% (95% CI: 98.2–99.7) and 96.4% (95% CI: 94.6–98.2), respectively. Concurrently, 85.8% (95% CI: 83.1–88.2) and 80.9% (95% CI: 77.8–84.1) of patients maintained VL suppression. No association between predictors and all‐cause attrition or VL rebound was detected. Among 90 patients attending AC and simultaneously having VL rebound, 64 (71.1%) achieved VL resuppression, 10 (11.1%) did not resuppress, and 14 (15.6%) had no subsequent VL result.

Conclusion

Implementation of AC in Mozambique was successful and demonstrated that patients with a history of HIV treatment failure can be successfully retained in care and have high VL suppression rate when enrolled in AC. Expansion of the AC model in Mozambique could improve overall retention in care and VL suppression while reducing workload in health facilities.
DISCRIMINATION OF EXTRACTED ANIMAL FATS USING LASER-INDUCED BREAKDOWN SPECTROSCOPY ASSISTED WITH PRINCIPAL COMPONENT ANALYSIS
Authors: Hanasil Nur Syaida , Raja Ibrahim Raja Kamarulzaman , Duralim Maisarah , Sapingi Husni Hani Jameela
Published: September 2020

This study focuses on the discrimination of extracted animal fats in liquid form using laser induced breakdown spectroscopy (LIBS) technique assisted with principal component analysis (PCA). The interaction of laser and liquid sample produces liquid splashing due to strong shock wave effect and subsequently generates lower intensity of LIBS signals. LIBS difficulties in liquid are resolved using paper substrate to enhance LIBS emission intensity. Laser pulse from Q-switched Nd:YAG laser with energy of 220 mJ and frequency of 1 Hz was used to ablate extracted animal fats. The obtained LIBS spectra of extracted animal fats were further evaluated using PCA. LIBS spectra are compressed and visualised as data points in the score plot of PCA. PCA results demonstrated that data points from different extracted animal fats were clustered separately in the score plot with variance greater than 90%. The findings show LIBS system assisted with PCA was capable to differentiate various extracted animal fats.
THE EFFECT OF DESIGN PARAMETERS ON THE FORCE AND ENERGY REQUIREMENT FOR CUTTING OIL PALM FRONDS USING MAGNETIC FORCE
Authors: Ahmad Mohd Rizal , Jamaludin Nordin , Jelani Abdul Razak , Bakri Azwan , Shuib Abd Rahim
Published: September 2020

Effects of design parameters (magnetic driving force (M), cutting angle (S) and frond moisture content  (MC) on the specific cutting force (SCF) and specific cutting energy (SCE) for cutting oil palm fronds are investigated. Two types of linear magnetic actuators (500 N and 750 N) and three cutting angles (30o, 45o, and 60o) were tested on two levels of frond moisture content (<50% and >50% moisture content). Experiments conducted revealed that cutting angle and frond moisture content have a significant effect on SCF and SCE, but not the magnetic force. The minimum values of SCF and SCE were 0.3866N/cm2 and 2.0459N/cm, respectively (cutting angle of 45o, moisture content >50%), while the maximum values of SCF and SCE were 2.9432 N/cm2 and 4.1219 N/cm, respectively (cutting angle of 60o and moisture content <50%). The study also revealed that cutting drier fronds (low moisture content) increased the SCF and SCE significantly. A prototype of an oil palm magnetic cutter was developed. Functional tests carried out showed its cutting performance was 254-frond/hour, proving that magnetic force was capable to be used as cutter’s actuator.
EFFECT OF Mn AND Ti ADDITION ON THE CRYSTALLOGRAPHIC STRUCTURE AND MAGNETIC PROPERTIES OF SrFe12O19
Authors: Adi Wisnu Ari , Yunasfi Yunasfi , Sarwanto Yosef , Majidi Muhammad Aziz
Published: September 2020

The synthesis and characterization of composition SrFe12-(x+y)MnxTiyO19 (x = y and x ≠ y) compound by using solid state reaction have been performed. The raw materials were SrCO3, Fe2O3, MnCO3, and TiO2. The mixed powder was compacted at 5000 psi into pellets and sintered at 1050°C in the air at atmosphere pressure for 15 hours and furnace cooling. The refinement results of x-ray diffraction pattern show that the doping composition (x = y) was a single phase while the doping composition (x ≠ y) was multi phase. We concluded that effect of substitution upon magnetic properties revealed that total magnetization, remanence and coercivity changed with substitution due to preferential site occupancy of substituted Mn2+ and Ti4+ ions. The coercivity decreases with increase in Mn and Ti concentration. This effect is related with Fe3+ magnetic moment changes after they have already substituted Mn2+ and Ti4+ ions. Since the coercivity and total magnetization may be controlled by substitution while maintaining resistive properties, making this material useful for microwave absorber.
ANALYSIS OF ARTOCARPUS HETEROPHYLLUS PEEL AS A NATURAL COAGULANT USING RESPONSE SURFACE METHODOLOGY (RSM)
Authors: Mardarveran Priyatharishini , Mohd Mokhtar Nadzirah
Published: September 2020

The chemical coagulants used in the process of wastewater treatment causes negative implications on environment and human health. Exploration on natural coagulants as environmental friendly solution has been widely carried out. In present research, Artocarpus heterophyllus (jackfruit) peel is used as coagulant in treating domestic wastewater. This study aimed to assess optimum pH of wastewater and coagulant dosage by varying them to achieve the maximum removal rate of total suspended solid (TSS), biological oxygen demand (BOD), chemical oxygen demand (COD) and turbidity. The studied range for pH of wastewater was pH 1-3 and dosage of coagulant within 50–70 mg/L. Response surface methodology (RSM) based on central composite design (CCD) implied in optimization of this coagulation process. Treatment using this natural coagulant enabled maximum reduction of turbidity, TSS, BOD and COD up to 80.7 %, 77.5 %, 34.3 % and 34.6 % respectively under optimum condition of pH 2.1 and dosage of 58 mg/L. These findings revealed higher reduction in turbidity and TSS. Thus, this study indicates the promising potential of the Artocarpus heterophyllus peel extract as an alternative bio-based coagulating agent for effective pre-treatment of wastewater.
STATISTICAL OPTIMIZATION AND CHARACTERIZATION OF ACOUSTICALLY EXTRACTED ANANAS COMOSUS PEEL POWDER WITH ENHANCED ANTIOXIDANT CAPACITY
Authors: Yahya Nur Azzanizawaty , Abdul Wahab Roswanira , Abdul Hamid Mariani , Mahat Naji Arafat , Mohamed Huri Mohamad Afiq , Attan Nursyafreena , Hashim Siti Ernieyanti
Published: September 2020

Ananas comosus (L.) Merr is one of many commercially popular fruits in the cannery food industry that contributes to the increasingly mounting agro-industrial waste. In this study, a four−factor−three−level Box−Behnken design (BBD) that comprised of sonication time (A), solvent ratio (B), amplitude (C) and liquid−solid ratio (D) for the ultrasound−assisted extraction (UAE) of pineapple peels (PP) was utilized to optimize the yield of total phenolic content (TPC). Under an optimized UAE condition [5 min; 50 % of ethanol: water; 65 % of amplitude; 35:1 mL/g of liquid−solid ratio], the highest TPC from PP of 708.10 mg gallic acid equivalent (GAE)/g DW was achieved. Antioxidant capacity analysis of PP revealed a high total flavonoid content (TFC) with the IC50 for 2,2−diphenyl−1−picrylhydrazyl (DPPH), and ferric reducing antioxidant power (FRAP) of 1146.86 ± 11.83 mg QE/g, 11.83 mg/mL and 1578.07 ± 25.96 µM Fe (II)/100g, respectively. High-performance liquid chromatography (HPLC) analysis revealed that the major flavonoid in the phenolic profile of PP extracts being catechin followed by quercetin and gallic acid. The UAE of PP extracts exhibited higher TPC than known conventional extraction techniques, thus indicating its efficacy to recover satisfactory quantities of phenolics in PP under optimized conditions.
The insulin‐sensitizing effect of a single exercise bout is similar in type I and type II human muscle fibres
Authors: Larsen Magnus R. , Steenberg Dorte E. , Birk Jesper B. , Sjøberg Kim A. , Kiens Bente , Richter Erik A. , Wojtaszewski Jørgen F. P.
Published: September 2020

Key points

 Rodent studies suggest muscle fibre type‐specific insulin response in the recovery from exercise.

 The current study investigates muscle fibre type‐specific insulin action in the recovery from exercise in healthy subjects.

 In type I and type II muscle fibres, key proteins in glucose metabolism are similarly regulated by insulin during recovery from exercise.

 Our findings imply that both type I and type II muscle fibres contribute to the phenomenon of increased insulin sensitivity in the recovery from a single bout of exercise in humans.

Human skeletal muscle consists of slow‐twitch (type I) and fast‐twitch (type II) muscle fibres. Muscle insulin action, regulating glucose uptake and metabolism, is improved following a single exercise bout. Rodent studies suggest that this phenomenon is confined to specific muscle fibre types. Whether this phenomenon is also confined to specific fibre types in humans has not been described. To investigate this, nine healthy men underwent a euglycaemic hyperinsulinaemic clamp (EHC) in the recovery from a single bout of one‐legged knee‐extensor exercise. Pools of type I and type II fibres were prepared from muscle biopsies taken in the rested and prior exercised leg before and after the EHC. AMPK γ3 and TBC1D4 – two key proteins regulating muscle insulin action following exercise – were higher expressed in type II than type I fibres. However, phosphor‐regulation of TBC1D4 was similar between fibre types when related to the total amount of TBC1D4 protein. The activating dephosphorylation of glycogen synthase was also similar in the two fibre types. Thus, insulin‐induced regulation of key proteins important for transport and intracellular flux of glucose towards glycogen storage in the recovery from exercise, does not differ between fibre types. In conclusion, the insulin‐sensitizing effect of a single bout of exercise includes both type I and type II fibres in human skeletal muscle. This may be an important observation for future pharmacological strategies targeting muscle insulin sensitivity in humans.
Algunas reflexiones a propósito de la nueva vía en las causas de los santos
Authors: Hernández Rodríguez María Victoria
Published: September 2020

La traducción a lengua española de los primeros comentarios al motu proprio Maiorem hac dilectionem es motivo, en este artículo que la acompaña, para proponer algunas reflexiones sobre la nueva vía aprobada y promulgada por el Papa Francisco para las beatificaciones y canonizaciones. En concreto, se tratarán consideraciones concernientes a los criterios de prueba, establecidos en el art. 2 del motu proprio, como la locución adverbial “al menos” y “a corto plazo” y la expresión “ejercicio ordinario de las virtudes”. Estas son cuestiones abiertas que la praxis de la Congregación para las Causas de los Santos perfilará y completará con esmero y prudencia a medida que examinará los supuestos que serán propuestos por esta nueva vía.
Algal Biomass Harvesting Using Low-Grade Waste Heat: Evaluation of Overall Heat Transfer Coefficient in a Heat Exchanger
Authors: Garoma Temesgen , Yazdi Ramin E.
Published: September 2020

This study is part of a broader study on a novel method for harvesting algae by evaporation, and it investigated the feasibility of heating algal biomass using low-grade waste heat in a heat exchanger. Computational fluid dynamic (CFD) analysis was performed with ansysfluent, and the results were verified with experiments. The results of CFD analysis showed the overall heat transfer coefficient increased by 4, 13, and 100% as inlet gas temperature increased from 150 to 245 °C, liquid mass flow rate increased from 1.82 to 9.1 g/s, and gas mass flow increased from 2.2 to 13.2 g/s, respectively. It was also observed the overall heat transfer coefficient was not significantly affected with variations of properties of the liquid (thermal conductivity, density, and viscosity), thermal conductivity of the tube wall, and thickness of the tube banks, but it was sensitive to thermal conductivity of the gas. The experimental data were analyzed with logarithmic mean temperature difference (LMTD), number of transfer units (NTU), and Nusselt number correlation methods. There was an excellent agreement between the overall heat transfer coefficient calculated with the LMTD and NTU methods. The coefficients calculated with the LMTD method and Nusselt number correlation exhibited slight variations. This is likely because the LMTD is a theoretical method covering all experimental conditions and material properties, but Nusselt number correlation is an empirical approach based on correlations. The overall heat transfer coefficient calculated by CFD was slightly overestimated because the CFD analysis assumed complete insulation.
Evaluation of Steam Turbine Blades Surface Cracks Detectability by Nondestructive Methods
Authors: Veselá J. , Mareš P. , Zahrádka P. , Patera J.
Published: September 2020

This article describes methods suitable for crack detection on low pressure steam turbine blades, not including the blade root. These cracks, which are initiated in the corrosion pitting, can cause serious damage to the steam turbine blade leading to its breakaway. Therefore, the detection of these cracks on the early stages of blade fracture is very important. Several methods for detecting of surface cracks (ultrasonic Rayleigh waves, eddy current with flexible array probe, etc.) has been tested on artificial flaws, which were manufactured into turbine blades. The comparison of all these methods is described as well as the evaluation of their advantages and disadvantages. Simulations of ultrasonic testing are also presented in this article.
Lessons from transforming second-year honors physics lab
Authors: Doucette Danny , D'Urso Brian , Singh Chandralekha
Published: September 2020

New technology like the Arduino microcontroller platform presents an opportunity to transform Beyond the First Year (BFY) physics labs to better prepare physics students for work in research labs and beyond. The flexibility, low cost, and power of these devices provide an attractive way for students to learn to use and master research-grade instrumentation. Therefore, we introduced new technology, including Arduino Due microcontroller boards, to a second-year honors physics lab in order to provide improved learning experiences for students. This transformation was implemented in three lab modules and focused on diminishing the black box nature of the traditional labs while encouraging students to engage in troubleshooting. The importance of troubleshooting was made evident to students by the instructor emphasizing it as an inevitable and central part of experimentation. This lab transformation also required that students perform work that was “above and beyond” the scope of the assigned experimental work for part of the course credit. While the technological aspects of the transformation were received well by a majority of students, our observations during the initial implementation suggested a need for some modifications to instructional practices in order to improve the learning and experiences for all students. In particular, we find that many students can benefit from additional scaffolding in order to complete above and beyond work. Similarly, we find that students in general, and under-represented students such as women, in particular, may need thoughtful intervention from the instructor, e.g., in order to avoid becoming isolated when the lab work is designed for pair work. Otherwise, some students may be left to work alone with a disproportionate work-load if students choose their own partners. With these lessons taken into account, recent student experiences in the transformed lab were notably improved.
Hormonal Contraceptive Use, Menstrual Dysfunctions, and Self-Reported Side Effects in Elite Athletes in Denmark
Authors: Oxfeldt Mikkel , Dalgaard Line B. , Jørgensen Astrid A. , Hansen Mette
Published: September 2020

Objective: To identify the prevalence of hormonal contraceptive (HC) use, menstrual cycle disturbances, and self-perceived physical and emotional symptoms related to the menstrual cycle/pill cycle in elite female athletes. Methods: One hundred eighty-six Danish elite female athletes completed an online questionnaire to assess menstrual status and history, use of HCs, and self-perceived physical and emotional symptoms related to the menstrual cycle or HC use. Results: Fifty-seven percent of elite female athletes in Denmark use HC, with 74% using combined HCs and 26% using progestin only. Sixty percent of oral contraceptive users reported having manipulated their menstrual cycle by continuous oral contraceptive use. Forty-nine percent of non-HC users had a regular menstrual cycle, while 51% experienced menstrual disturbances, with 1 athlete being primary amenorrheic and 13 athletes having secondary amenorrhea. Menstrual disturbances were experienced by a larger proportion of endurance athletes (69%) compared with athletes performing power and technical disciplines. In endurance athletes amenorrhea was associated with a higher cardiovascular training volume (P < .001). Negative symptoms related to the menstrual/pill cycle were reported by both HC and non-HC users, whereas positive physical symptoms were experienced more often among the non-HC (14%) versus HC users (2%) (P < .01). Notably, 13% of the athletes reported that negative symptoms sometimes/always caused them to not participate in or complete the scheduled training. Conclusion: HC use is common among elite athletes, and continuation of HC is used to manipulate the menstrual cycle in relation to sport competitions. HC use does not abolish dysmenorrhea, but it may reduce emotional-related side effects. Menstrual disturbances are frequent in endurance athletes and are associated with cardiovascular training volume.
Athlete-Reported Outcome Measures for Monitoring Training Responses: A Systematic Review of Risk of Bias and Measurement Property Quality According to the COSMIN Guidelines
Authors: Jeffries Annie C. , Wallace Lee , Coutts Aaron J. , McLaren Shaun J. , McCall Alan , Impellizzeri Franco M.
Published: September 2020

Background: Athlete-reported outcome measures (AROMs) are frequently used in research and practice but no studies have examined their psychometric properties. Objectives: Part 1—identify the most commonly used AROMs in sport for monitoring training responses; part 2—assess risk of bias, measurement properties, and level of evidence, based on the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines. Study Appraisal and Synthesis Methods: Methodological quality of the studies, quality of measurement properties, and level of evidence were determined using the COSMIN checklist and criteria. Results: Part 1—from 9446 articles screened for title and abstract, 310 out of 334 full texts were included; 53.9% of the AROMs contained multiple items, while 46.1% contained single items. Part 2—from 1895 articles screened for title and abstract, 71 were selected. Most measurement properties of multiple-item AROMs were adequate, but content validity and measurement error were inadequate. With the exclusion of 2 studies examining reliability and responsiveness, no validity studies were found for single items. Conclusions: The measurement properties of multiple-item AROMs derived from psychometrics were acceptable (with the exclusion of content validity and measurement error). The single-item AROMs most frequently used in sport science have not been validated. Additionally, nonvalidated modified versions of the originally nonvalidated items are common. Until proper validation studies are completed, all conclusions based on these AROMs are questionable. Established reference methods, such as those of clinimetrics, should be used to develop and assess the validity of AROMs.
Daily alcohol intake triggers aberrant synaptic pruning leading to synapse loss and anxiety-like behavior
Authors: Socodato Renato , Henriques Joana F. , Portugal Camila C. , Almeida Tiago O. , Tedim-Moreira Joana , Alves Renata L. , Canedo Teresa , Silva Cátia , Magalhães Ana , Summavielle Teresa , Relvas João B.
Published: September 2020

Binge drinking may cause anxiety by triggering microglia to destroy excitatory synapses.
Immune responses to SARS-CoV-2 infection in hospitalized pediatric and adult patients
Authors: Pierce Carl A. , Preston-Hurlburt Paula , Dai Yile , Aschner Clare Burn , Cheshenko Natalia , Galen Benjamin , Garforth Scott J. , Herrera Natalia G. , Jangra Rohit K. , Morano Nicholas C. , Orner Erika , Sy Sharlene , Chandran Kartik , Dziura James , Almo Steven C. , Ring Aaron , Keller Marla J. , Herold Kevan C. , Herold Betsy C.
Published: September 2020

Differences in immune responses to SARS-CoV-2 in children and adults are linked to clinical outcomes.
Resistance against Membrane-Inserting MmpL3 Inhibitor through Upregulation of MmpL5 in Mycobacterium tuberculosis
Authors: Li Ming , Nyantakyi Samuel Agyei , Go Mei-Lin , Dick Thomas
Published: September 2020

Spiroketal indolyl Mannich bases (SIMBs) present a novel class of membrane-inserting antimycobacterials with efficacy in a tuberculosis mouse model. SIMBs exert their antibacterial activity by two mechanisms. The indolyl Mannich base scaffold causes permeabilization of bacteria, and the spiroketal moiety contributes to inhibition of the mycolic acid transporter MmpL3. Here, we show that low-level resistance to SIMBs arises by mutations in the transcriptional repressor MmpR5, resulting in upregulation of the efflux pump MmpL5.
The Class A Carbapenemases BKC-1 and GPC-1 Both Originate from the Bacterial Genus
Shinella
Authors: Kieffer Nicolas , Ebmeyer Stefan , Larsson D. G. Joakim
Published: September 2020

Comparative genomics identified the environmental bacterial genus
Shinella
as the most likely origin of the class A carbapenemases BKC-1 and GPC-1. Available sequences and PCR analyses of additional
Shinella
species revealed homologous β-lactamases showing up to 85.4% and 93.3% amino acid identity to both enzymes, respectively. The genes conferred resistance to β-lactams once expressed in
Escherichia coli
.
bla
BKC-1
likely evolved from a putative ancestral
Shinella
gene with higher homology through duplication of a gene fragment.
In Vitro
Activity of Cefiderocol, a Siderophore Cephalosporin, against Multidrug-Resistant Gram-Negative Bacteria
Authors: Mushtaq Shazad , Sadouki Zahra , Vickers Anna , Livermore David M. , Woodford Neil
Published: September 2020

Cefiderocol is a parenteral siderophore cephalosporin with a catechol-containing 3′ substituent. We evaluated its MICs against Gram-negative bacteria, using iron-depleted Mueller-Hinton broth. The panel comprised 305 isolates of
Enterobacterales
, 111 of
Pseudomonas aeruginosa
, and 99 of
Acinetobacter baumannii
, all selected for carbapenem resistance and multidrug resistance to other agents. At 2 and 4 μg/ml, cefiderocol inhibited 78.
Formulation, Pharmacological Evaluation, and Efficacy Studies of Occidiofungin, a Novel Antifungal
Authors: Ravichandran Akshaya , Escano Jerome , Lee Jung Hwa , Ross Matthew K. , Austin Frank , Orugunty Ravi , Lu Shi-En , Smith Leif
Published: September 2020

Occidiofungin is a nonribosomally synthesized cyclic lipopeptide that possesses broad-spectrum antifungal properties at submicromolar concentrations. This report explores multiple routes of administration and formulations of occidiofungin, as well as its toxicity in mice. Further, infection studies were performed in mice to assess the application of occidiofungin for treating systemic and intravaginal yeast infections. Formulations for intravenous and intravaginal administration of occidiofungin were prepared.
Inositol-Requiring Enzyme 1α Promotes Zika Virus Infection through Regulation of Stearoyl Coenzyme A Desaturase 1-Mediated Lipid Metabolism
Authors: Huang Yanxia , Lin Quanshi , Huo Zhiting , Chen Cancan , Zhou Shili , Ma Xiaocao , Gao Huixin , Lin Yuxia , Li Xiaobo , He Junfang , Zhang Ping , Liu Chao
Published: September 2020

Zika virus (ZIKV) has been linked to serious neurologic disorders and causes widespread concern in the field of global public health. Inositol requiring enzyme 1α (IRE1α) is an ER-related transmembrane protein that mediates unfolded protein response (UPR) pathway. Here, we revealed that IRE1α is a proviral factor for ZIKV replication both in culture cells and mice model, which relies on its kinase and RNase activities. Importantly, we further provided evidence that upon ZIKV infection, IRE1α is activated and splices
XBP1
mRNA which enhances the expression of monounsaturated fatty acids rate-limiting enzyme stearoyl coenzyme A (stearoyl-CoA) desaturase 1 (SCD1) and subsequent lipid droplet production. Our data uncover a novel mechanism of IRE1α proviral effect by modulating lipid metabolism, providing the first evidence of a close relationship between IRE1α-mediated UPR, lipid metabolism, and ZIKV replication and indicating IRE1α inhibitors as potentially effective anti-ZIKV agents.
Engineering of Long-Circulating Peptidoglycan Hydrolases Enables Efficient Treatment of Systemic Staphylococcus aureus Infection
Authors: Sobieraj Anna M. , Huemer Markus , Zinsli Léa V. , Meile Susanne , Keller Anja P. , Röhrig Christian , Eichenseher Fritz , Shen Yang , Zinkernagel Annelies S. , Loessner Martin J. , Schmelcher Mathias
Published: September 2020

Life-threatening infections with
Staphylococcus aureus
are often difficult to treat due to the increasing prevalence of antibiotic-resistant bacteria and their ability to persist in protected niches in the body. Bacteriolytic enzymes are promising new antimicrobials because they rapidly kill bacteria, including drug-resistant and persisting cells, by destroying their cell wall. However, when injected into the bloodstream, these enzymes are not retained long enough to clear an infection. Here, we describe a modification to increase blood circulation time of the enzymes and enhance treatment efficacy against
S. aureus
-induced bloodstream infections. This was achieved by preselecting enzyme candidates for high activity in human blood and coupling them to serum albumin, thereby preventing their elimination by kidney filtration and blood vessel cells.
Alcohol consumption and fruits and vegetable intake among older adults in Ghana: a cross-sectional survey based on WHO-SAGE Wave 2 data
Authors: Tachi Kenneth , Tetteh John , Yawson Alfred Edwin , Agyei-Nkansah Adwoa , Archampong Timothy
Published: September 2020

Background

Alcohol consumption and inadequate fruits and vegetable (FnV) intake are major reasons for the shift from communicable to non-communicable diseases (NCDs) over the years. The older Ghanaian adult is at high risk of NCD and data on alcohol and FnV consumption are required to guide policy to mitigate its effect. This analysis aimed to determine the factors associated with alcohol consumption and assess the relationship between alcohol consumption and FnV intake among Ghanaians aged 50 years and older.

Methods

This analysis used WHO Study on Global Ageing and Adult Health (SAGE) Wave 2, Ghana data set conducted between 2014 and 2015. Data on demographic characteristics, FnV intake, and alcohol consumption were collated and analysed. Multivariable Poisson, logistic and probit regression analyses were performed to assess the associations between alcohol consumption and inadequate FnV intake.

Results

A total of 3533 Ghanaians aged 50 years and older, 41.0% men and 59.0% women, were included in this study. The prevalence of lifetime alcohol consumption was 22.8% (95% CI 20.7% to 25.1%). Alcohol consumption was significantly associated with sex, age group, marital status, religion, place of residence and history of smoking. The prevalence of adequate FnV intake was 52.6% with a mean daily intake of 6.45 servings: 2.98 for fruits and 3.47 for vegetables. There was a significant positive correlation between inadequate FnV intake and alcohol consumption. Inadequate FnV consumption was significantly higher among lifetime alcohol consumers compared with non-alcohol consumers. (Poisson estimate; adjusted Prevalence Ratio (aPR) (95% CI)=1.35 (1.12 to 1.63), logistic estimate; adjusted Old Ratio (aOR) (95% CI)=1.13 (1.05 to 1.21) and probit estimate; adjusted normalized coefficient (aβ) (95% CI)=0.19 (0.07 to 0.31))

Conclusion

About a quarter and nearly half of older Ghanaian adults consume alcohol and inadequate FnV, respectively. Alcohol consumption is significantly associated with inadequate FnV intake. Interventions to address inadequate FnV intake among older adults in Ghana should also include policies that regulate the use of alcohol in this population.
Protocol for a prospective cohort study: Prevention of Transmissions by Effective Colonisation Tracking in Neonates (PROTECT-Neo)
Authors: Götting Tim , Reuter Sandra , Jonas Daniel , Hentschel Roland , Henneke Philipp , Klotz Daniel , Hock Simone , Wolkewitz Martin , Blümel Benjamin , Häcker Georg , Grundmann Hajo , Mutters Nico
Published: September 2020

Introduction

Transmissions of opportunistic bacterial pathogens between neonates increase the risk of infections with negative repercussions, including higher mortality, morbidity and permanent disabilities. The probability of transmissions between patients is contingent on a set of intrinsic (patient-related) and extrinsic (ward-related) risk factors that are not clearly quantified. It is the dual objective of the Prevention of Transmissions by Effective Colonisation Tracking-Neo study to determine the density of transmission events in a level III neonatal intensive care unit (NICU) and to identify risk factors that may be causally associated with transmission events.

Methods and analysis

A full cohort of patients treated in a 17-bed level III NICU will be prospectively followed and transmission events between two or more patients will be documented. A transmission event occurs when isogenic isolates from two different patients can be identified. Isolates will be obtained by routine weekly screening. Isogenicity will be determined by whole-genome sequencing. During the study, relevant intrinsic and extrinsic risk factors will be recorded. Specimen and data will be collected for 1 year. We postulate that transmission density increases during episodes when demand for intensive care cannot be met by existing staff, and that threshold dynamics have a bearing on cohorting and hand hygiene performance. Poisson logistic regression, proportional hazard and multilevel competing risk models will be used to estimate the effect of explanatory variables.

Ethics and dissemination

This study has been approved by the local ethics committee (study ID 287/18). The results will be published in peer-reviewed medical journals, communicated to participants, the general public and all relevant stakeholders.

Trial registration number

The German Clinical Trials Registry (DRKS00017733); Pre-results.
Antibiotic-induced changes in the human gut microbiota for the most commonly prescribed antibiotics in primary care in the UK: a systematic review
Authors: Elvers Karen T , Wilson Victoria J , Hammond Ashley , Duncan Lorna , Huntley Alyson L , Hay Alastair D , van der Werf Esther T
Published: September 2020

Objective

The gut microbiota influences many aspects of human health. We investigated the magnitude and duration of changes in gut microbiota in response to antibiotics commonly prescribed in UK primary care.

Methods

We searched MEDLINE, EMBASE and AMED, all years up to May 2020 including all study designs, collecting and analysing data on the effect of antibiotics prescribed for respiratory and urinary tract infections. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Cochrane standard methods. Risk of bias was evaluated using the Critical Appraisal Skills Programme. Narrative synthesis was used to report the themes emerging from the data.

Main outcome measures

Primary outcomes were antibiotic-induced changes in the composition and/or diversity of the gut microbiota. Secondary outcome was the time for the microbiota to return to baseline.

Results

Thirty-one articles with low or unclear risk of bias showed that antibiotics impact the gut microbiota by causing rapid and diminished levels of bacterial diversity and changes in relative abundances. After cessation of treatment, gut bacteria recover, in most individuals, to their baseline state within a few weeks. Some studies suggested longer term effects from 2 to 6 months. Considerable heterogeneity in methodology makes the studies prone to biases and other confounding factors. Doxycycline was associated with a marked short-term decrease inBifidobacteriumdiversity. Clarithromycin decreased the populations of Enterobacteria, and the anaerobic bacteriaBifidobacteriumsp andLactobacillussp in numbers and diversity for up to 5 weeks. Phenoxymethylpenicillin, nitrofurantoin and amoxicillin had very little effect on the gut microbiome.

Conclusions

Despite substantial heterogeneity of the studies and small sample sizes, there is evidence that antibiotics commonly used in primary care influence the composition of the gastrointestinal microbiota. Larger population-based studies are needed to fully understand how antibiotics modulate the microbiota, and to determine if these are associated with (longer term) health consequences.

PROSPERO registration number

CRD42017073750.
Increasing the uptake of long-acting reversible contraception in general practice: the Australian Contraceptive ChOice pRoject (ACCORd) cluster randomised controlled trial longitudinal follow-up protocol
Authors: Mazza Danielle , Amos Natalie , Watson Cathy J , McGeechan Kevin , Haas Marion , Peipert Jeffrey F , Lucke Jayne , Taft Angela , McNamee Kathleen , Black Kirsten I
Published: September 2020

Introduction

Through addressing main barriers to the uptake of long-acting reversible contraceptives (LARCs) among Australian women, the Australian Contraceptive ChOice pRoject (ACCORd) trialled an educational intervention targeting general practitioners (GPs) and provided those in the intervention group with a rapid referral service for quick insertion. The cluster randomised controlled trial resulted in greater uptake of LARC in the intervention group. This protocol paper describes a longitudinal follow-up to the ACCORd Study to assess the long-term efficacy and cost-effectiveness of the intervention.

Methods and analysis

Women participants (patients of ACCORd GPs) completed a baseline, 6-month and 12-month survey. These participants will be invited to complete an additional follow-up survey 3 years post completion of their baseline interview. Based on the original ACCORd Study tools, the online survey will address long-term outcomes including contraceptive continuation rates and reproductive history, any unintended pregnancies, satisfaction and concerns with their current contraceptive method, and an assessment of quality of life. We will analyse data using binary regression models with generalised estimating equations and robust standard errors to account for clustering.

Discussion

Demonstration of sustained use, effectiveness at reducing unwanted pregnancies and cost-effectiveness of this strategy among this cohort of Australian primary care patients, will strengthen the policy and programme urgency of addressing wider dissemination of these strategies and replicating the study elsewhere.

Ethics and dissemination

The ACCORd Study received approval from the Monash University Human Research Ethics Committee: CF16/188-201000080. Additionally, an amendment to conduct this 3-year longitudinal follow-up survey has been approved. The trial follow-up outcomes will be disseminated through formal academic pathways, including journal articles, national and international conferences and reports as well as using more ‘mainstream’ strategies such as seminars, workshops and media engagement. Additionally, outcomes will be communicated through policy briefs to Australian state and federal governments.

Trail registration number

This trial is registered with the Australian and New Zealand Trials Registry ACTRN12615001346561. Recruitment and data collection have been completed for the baseline, 6-month and 12-month surveys. Data collection for the 3-year survey commenced in August 2019.
Overcoming barriers to engagement and adherence to a home-based physical activity intervention for patients with heart failure: a qualitative focus group study
Authors: Okwose Nduka C , O'Brien Nicola , Charman Sarah , Cassidy Sophie , Brodie David , Bailey Kristian , MacGowan Guy A , Jakovljevic Djordje G , Avery Leah
Published: September 2020

Objectives

Clinical guidelines recommend regular physical activity for patients with heart failure to improve functional capacity and symptoms and to reduce hospitalisation. Cardiac rehabilitation programmes have demonstrated success in this regard; however, uptake and adherence are suboptimal. Home-based physical activity programmes have gained popularity to address these issues, although it is acknowledged that their ability to provide personalised support will impact on their effectiveness. This study aimed to identify barriers and facilitators to engagement and adherence to a home-based physical activity programme, and to identify ways in which it could be integrated into the care pathway for patients with heart failure.

Design

A qualitative focus group study was conducted. Data were analysed using thematic analysis.

Participants

A purposive sample of 16 patients, 82% male, aged 68±7 years, with heart failure duration of 10±9 years were recruited.

Intervention

A 12-week behavioural intervention targeting physical activity was delivered once per week by telephone.

Results

Ten main themes were generated that provided a comprehensive overview of the active ingredients of the intervention in terms of engagement and adherence. Fear of undertaking physical activity was reported to be a significant barrier to engagement. Influences of family members were both barriers and facilitators to engagement and adherence. Facilitators included endorsement of the intervention by clinicians knowledgeable about physical activity in the context of heart failure; ongoing support and personalised feedback from team members, including tailoring to meet individual needs, overcome barriers and increase confidence.

Conclusions

Endorsement of interventions by clinicians to reduce patients’ fear of undertaking physical activity and individual tailoring to overcome barriers are necessary for long-term adherence. Encouraging family members to attend consultations to address misconceptions and fear about the contraindications of physical activity in the context of heart failure should be considered for adherence, and peer-support for long-term maintenance.

Trial registration number

NCT03677271.
Nurse-led patient-centred intervention to increase written advance directives for outpatients in early-stage palliative care: study protocol for a randomised controlled trial with an embedded explanatory qualitative study
Authors: Iglesias Katia , Busnel Catherine , Dufour Florian , Pautex Sophie , Séchaud Laurence
Published: September 2020

Introduction

Discussing the evolution of life-threatening diseases and end-of-life issues remains difficult for patients, relatives and professionals. Helping people discuss and formalise their preferences in end-of-life care, as planned in the Go Wish intervention, could reduce health-related anxiety in the advance care planning (ACP) and advance directive (AD) process. The aims of this study are (1) to test the effectiveness of the Go Wish intervention among outpatients in early-stage palliative care and (2) to understand the role of defence mechanisms in end-of-life discussions among nurses, patients and relatives.

Methods and analysis

A mixed-methods study will be performed. A cluster randomised controlled trials with three parallel arms will be conducted with 45 patients with chronic progressive diseases impacting life expectancy in each group: (1) Group A, Go Wish intervention for patients and their relatives; (2) Group A, Go Wish intervention for patients alone and (3) Group B, for patients (with a waiting list), who will receive the standardised information on ADs (usual care). Randomisation will be at the nurse level as each patient is referred to one of the 20 participating nurses (convenience sample of 20 nurses). A qualitative study will be conducted to understand the cognitive and emotional processes and experiences of nurses, patients and relatives confronted with end-of-life discussions. The outcome measurements include the completion of ADs (yes/no), anxiety, quality of communication about end-of-life care, empowerment, quality of life and attitudes towards ADs.

Ethics and dissemination

The study protocol has been approved by the Human Research Ethics Committee of the Canton of Geneva, Switzerland (no. 2019–00922). The findings will be disseminated to practice (nurses, patients and relatives), to national and international scientific conferences, and peer-reviewed journals covering nursing science, psychology and medicine.

Trial registration number

NCT04065685.
Is it necessary for children to receive professional fluoride in addition to regular fluoride toothpaste? Protocol for a systematic review
Authors: Yu Lintong , Yu Xueqian , Li Yueyang , Li Jun , Hua Fang , Song Guangtai
Published: September 2020

Introduction

Regular toothbrushing with fluoride toothpaste is a fundamental intervention for caries prevention. Professional fluoride application (PFA) is widely considered a beneficial supplement to the routine use of fluoride toothpaste. However, some recent studies have failed to demonstrate the preventive effect of PFA. In addition, an increasing number of studies have highlighted the potential adverse effects of fluoride. However, little information exists on the effectiveness of additional PFA. The objective of this review is to systematically analyse the efficacy of PFA in addition to regular fluoride toothpaste among children under the age of 16.

Method and analysis

We will search the PubMed, Embase, Google Scholar and Cochrane Central Register of Controlled Trials databases for randomised controlled trials without language or publication date restrictions. Additional studies will be identified by manually searching the reference lists of the included studies and relevant reviews. At least two authors will carry out the selection of studies independently and in duplicate. The Cochrane Risk of Bias tool will be used to assess the risk of bias of the included studies. The random effects model will be used for meta-analyses. The data synthesis will be conducted using Review Manager software (RevMan V.5.3). The Grading of Recommendation, Assessment, Development and Evaluation will be used to assess the quality of supporting evidence for each major comparison.

Ethics and dissemination

There is no need for ethical approval. The results of this review will be disseminated through peer-reviewed publications and social networks.

PROSPERO registration number

CRD42020165270
Variation in changes in the incidence of colorectal cancer by age and association with screening uptake: an observational study
Authors: Clark Gavin RC , Anderson Annie S , Godfrey Thomas G , Strachan Judith A , Fraser Callum G , Steele Robert JC
Published: September 2020

Objectives

In developed countries, the incidence of colorectal cancer (CRC) has declined in the over 50 years age group but increased in younger people. We studied CRC incidence by age and the influence of screening uptake.

Design

Age-standardised and sex-standardised incidences for CRC from 1997 to 2017 were obtained from the Scottish Cancer Registry (SCR). In addition, linkage between the Scottish Bowel Screening Database and the SCR allowed investigation of any association between screening participation and CRC incidence.

Setting

Scotland and the Scottish Bowel Screening Programme, in which guaiac faecal occult blood test screening was piloted from March 2000 and fully rolled by December 2009.

Participants

From the introduction of screening in 2000 through to 2017, 2 395 172 were invited to participate, of whom 1 487 999 participated at least once.

Main outcome measures

Incidence of CRC.

Results

In the screening age range (50–74 years), CRC incidence peaked at 156.5 cases per 100 000 in 2010 after full roll-out of screening across Scotland but fell to 123.9 per 100 000 in 2017. However, under 50 years, there was a rise from 5.3 cases per 100 000 in 2000 to 6.8 per 100 000 in 2017. When CRC incidence was examined in those who had been offered screening, incidence fell in the participant group more than in the non-participant group after roll-out of screening was complete. Analysis of cumulative incidence demonstrated that CRC incidence in the participant group remained consistently below that of the non-participant from around 7 years of follow-up.

Conclusions

The incidence of CRC in Scotland has declined in the over 50 years age group but increased in younger people. It is likely that population screening has contributed to the reduction in CRC incidence in the over 50 years age group.
Ability of fabric face mask materials to filter ultrafine particles at coughing velocity
Authors: O'Kelly Eugenia , Pirog Sophia , Ward James , Clarkson P John
Published: September 2020

Objective

We examined the ability of fabrics which might be used to create home-made face masks to filter out ultrafine (0.02–0.1 µm) particles at the velocity of adult human coughing.

Methods

Twenty commonly available fabrics and materials were evaluated for their ability to reduce air concentrations of ultrafine particles at coughing face velocities. Further assessment was made on the filtration ability of selected fabrics while damp and of fabric combinations which might be used to construct home-made masks.

Results

Single fabric layers blocked a range of ultrafine particles. When fabrics were layered, a higher percentage of ultrafine particles were filtered. The average filtration efficiency of single layer fabrics and of layered combination was found to be 35% and 45%, respectively. Non-woven fusible interfacing, when combined with other fabrics, could add up to 11% additional filtration efficiency. However, fabric and fabric combinations were more difficult to breathe through than N95 masks.

Conclusions

The current coronavirus pandemic has left many communities without access to N95 face masks. Our findings suggest that face masks made from layered common fabric can help filter ultrafine particles and provide some protection for the wearer when commercial face masks are unavailable.