bluuebunny/crossref_metadata_2025 huggingface dataset:
Lessons from Timor: Shells are poor taxonomic indicators in Asperitas land snails (Stylommatophora, Dyakiidae)
Authors: Köhler Frank , Criscione Francesco , Hallan Anders , Hyman Isabel , Kessner Vince
Published: September 2020

The limacoid land snail Asperitas Gude, 1911 encompasses several vividly coloured, yet poorly known species that are distributed throughout the Lesser Sunda Islands, Sulawesi, and the Moluccas. We examined the variation in shell morphology, including the use of geometric morphometrics, and reproductive anatomy of snails from Timor and several adjacent islands. These studies revealed that none of the taxa described from Timor and considered to be endemic to this island could be reliably distinguished from any of the others. In addition to the systematic ambiguity of morphological characteristics, we uncovered rather low amounts of genetic differentiation in the mitochondrial marker cytochrome c oxidase subunit I that was not consistent with the current taxonomy. Based on these observations, we conclude that there is just a single Asperitas species on Timor that exhibits notable variability in shell characters and body colour. This variability is ascribed to the combined effects of polymorphic colour patterns with locally varying selection in different habitats and along altitudinal gradients. Individuals from the adjacent islands of Flores, Sumbawa, Solor and Romang, which are deemed to represent distinct species‐level taxa, exhibit similar amounts of variation in shell and body colour. They exhibit a consistent reproductive anatomy and overall negligible amounts of mitochondrial differentiation from the populations on Timor. Patterns in shell variation do not lend support to previously held ideas that different Sunda Islands harbour distinct radiations of polytypic Asperitas species. By contrast, we suggest that the taxonomic diversity of Asperitas has been overestimated for the over‐reliance on shell features and that many presently accepted taxa are likely mere synonyms of fewer and more widespread species.
Administración y enajenación de bienes temporales eclesiásticos a la luz del Concilio Vaticano II. Parte II: Lumen Gentium, cap. VI; Presbyterorum Ordinis n.o 17, y Perfectae Caritatis n.o 13
Authors: Garceranth Ramos Ismael Arturo
Published: September 2020

Los documentos conciliares Lumen Gentium, Presbyterorum Ordinis y Perfectae Caritatis fueron fuente para la posterior elaboración de ciertos cánones del Código de Derecho Canónico (CIC, por sus siglas en latín) (Juan Pablo II, 1983) referidos a la administración y enajenación de bienes eclesiásticos, en especial de aquellos pertenecientes a los institutos religiosos.

Este artículo se ubica dentro del Libro V del CIC (Juan Pablo II, 1983) y guarda relación y continuidad con otros artículos del mismo autor que también nacieron del Libro en mención. Estos artículos han sido publicados en revistas anteriores de esta colección de Universitas Canonica. De manera particular, se destaca la primera parte del presente artículo, titulado “Administración y enajenación de bienes temporales eclesiásticos de institutos religiosos a la luz del Concilio Vaticano II: Lumen Gentium, cap. VI, Presbyterorum Ordinis no. 17 y Perfectae Caritatis no. 13” (Parte I), en el que se aborda el tema en mención y su relación con el decreto Presbyterorum Ordinis no. 17.

Continuando con esta temática, y para un segundo momento, en el presente artículo estudiaremos el Capítulo VI de la Constitución Dogmática Lumen Gentium y, finalmente, en un tercer artículo, con el mismo fin y la misma metodología, analizaremos el no. 13 del decreto Perfectae Caritatis.
Polymer-coated nanoparticle protein corona formation potentiates phagocytosis of bacteria by innate immune cells and inhibits coagulation in human plasma
Authors: Ortega Van A. , Bahniuk Markian S. , Memon Sharyar , Unsworth Larry D. , Stafford James L. , Goss Greg G.
Published: September 2020

Nanoparticles (NPs) that are exposed to blood are coated with an assortment of proteins that establish their biological identity by forming the interface between the NP and the cells and tissues of the body. The biological relevance of this protein corona is often overlooked during toxicological assessments of NPs. However, accurate interpretation of biological outcomes following exposure to NPs, including activation of coagulation, opsonization of pathogens, and cellular phagocytosis, must take this adsorbed proteome into account. In this study, we examined protein coronas on the surface of five poly(acrylic acid) (PAA) metal-oxide NPs (TiO2, CeO2, Fe2O3, ZnO, and PAA-capsules) following exposure to human plasma for key markers of various host response pathways, including humoral immunity and coagulation. We also evaluated the impacts of pre-exposing serum proteins to PAA-NPs on the opsonization and phagocytosis of bacteria by two immune cell lines. Results demonstrated that each PAA-NP type adsorbed a unique profile of blood proteins and that protein-coated PAA-NPs significantly inhibited human plasma coagulation with PAA-zinc oxide NPs and their associated proteome fully abrogating clotting. Protein-coated PAA-NPs also resulted in a 50% increase in phagocytic activity of RBL-2H3 cells and a 12.5% increase in phagocytic activity in the RAW 264.7 cell line. We also identified numerous structural, coagulation, and immune-activating proteins in the adsorbed protein corona, which resulted in altered biological function. Overall, our findings demonstrate that the formation of protein coronas on the surface of NPs plays an important role in directing the biological outcomes of opsonization, cell phagocytosis, and blood coagulation.
Energy-dense Li metal anodes enabled by thin film electrolytes
Authors: Ioanniti Marina Maria , Hu Fei , Tenhaeff Wyatt E.
Published: September 2020

Next-generation, energy-dense, rechargeable lithium batteries require Li metal anodes that provide ten times the specific capacity of state-of-the-art graphite anodes. But, there are many challenges to the successful utilization of Li anodes, including high chemical reactivity and the propensity to deposit into non-dense, high surface area morphologies, which can result in dendritic growth and significant, associated safety hazards, such as short-circuiting and potential combustion of the liquid electrolyte. Solid-state thin film electrolytes have been used to address both of these challenges. In this review, we will provide an overview of thin film battery designs, highlighting the role of thin film electrolytes, lithium phosphorous oxynitride (LiPON) in particular, in enabling highly reversible, efficient cycling of Li metal anodes. We then discuss progress in thin film electrolyte compositions and vacuum deposition processing that has occurred in roughly the past 20 years. It will be shown how these novel electrolyte compositions and processing capabilities have been used to integrate thin film electrolytes with bulk Li metal anodes required for large format energy storage cells, such as those used in consumer electronics and electric vehicles. We end the review with a brief outlook on the outstanding questions and potential future research directions.
Differential Ratings of Perceived Match and Training Exertion in Girls’ Soccer
Authors: Wright Matthew D. , Songane Francisco , Emmonds Stacey , Chesterton Paul , Weston Matthew , Mclaren Shaun J.
Published: September 2020

Purpose: To understand the validity of differential ratings of perceived exertion (dRPE) as a measure of girls’ training and match internal loads. Methods: Using the centiMax scale (CR100), session dRPE for breathlessness (sRPE-B) and leg muscle exertion (sRPE-L) were collected across a season of training (soccer, resistance, and fitness) and matches from 33 players (15 [1] y). Differences and associations between dRPE were examined using mixed and general linear models. The authors’ minimal practical important difference was 8 arbitrary units (AU). Results: Mean (AU [SD] ∼16) sRPE-B and sRPE-L were 66 and 61 for matches, 51 and 49 for soccer, 86 and 67 for fitness, and 45 and 58 for resistance, respectively. Session RPE-B was rated most likely harder than sRPE-L for fitness (19 AU; 90% confidence limits: ±7) and most likely easier for resistance (−13; ±2). Match (5; ±4) and soccer (−3; ±2) differences were likely to most likely trivial. The within-player relationships between sRPE-B and sRPE-L were very likely moderate for matches (r = .44; 90% confidence limits: ±.12) and resistance training (.38; ±.06), likely large for fitness training (.51; ±.22), and most likely large for soccer training (.56; ±.03). Shared variance ranged from 14% to 35%. Conclusions: Practically meaningful differences between dRPE following physical training sessions coupled with low shared variance in all training types and matches suggest that sRPE-B and sRPE-L represent unique sensory inputs in girls’ soccer players. The data provide evidence for the face and construct validity of dRPE as a measure of internal load in this population.
Can Practicum Teaching Change Preservice Physical Education Teacher Value Orientations?
Authors: Zhu Qiao , Shen Hejun , Chen Ang
Published: September 2020

The purpose of the study was to determine the extent to which practicum teaching could lead to value orientation change of preservice physical education teachers. A group of preservice physical education teachers (N = 28) in China were randomly assigned to practicum-teach either a health-related fitness unit or a traditional sport unit. Their value orientations were measured before and after the practicum teaching. Their middle school learners were tested for knowledge gain. A repeated-measures model shows that the practicum teaching led to little change in their value orientations. The learners in the health-fitness curriculum gained more knowledge than those in the traditional curriculum. The findings suggest that an attempt to influence the value orientation in one practicum teaching experience may not be successful. The findings imply that physical education teacher education training programs may emphasize not only how to teach (via teaching methods courses), but also nurturing the values of teaching to meet the society needs.
COVID-19 in children and young people
Authors: Snape Matthew D. , Viner Russell M.
Published: September 2020

Children have a low risk of COVID-19 and are disproportionately harmed by precautions
Immune life history, vaccination, and the dynamics of SARS-CoV-2 over the next 5 years
Authors: Saad-Roy Chadi M. , Wagner Caroline E. , Baker Rachel E. , Morris Sinead E. , Farrar Jeremy , Graham Andrea L. , Levin Simon A. , Mina Michael J. , Metcalf C. Jessica E. , Grenfell Bryan T.
Published: September 2020

Imperfect future immunity

Humans are infected by several seasonal and cross-reacting coronaviruses. None provokes fully protective immunity, and repeat infections are the norm. Vaccines tend to be less efficient than natural infections at provoking immunity, and there are risks of adverse cross-reactions. Saad-Royet al.used a series of simple models for a variety of immune scenarios to envisage immunological futures for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with and without vaccines. The model outcomes show that our imperfect knowledge about the imperfect coronavirus immune landscape can give rise to diverging scenarios ranging from recurring severe epidemics to elimination. It is critical that we accurately characterize immune responses to SARS-CoV-2 for translation into managing disease control.

Science, this issue p.811
Emerging immunotherapies in multiple myeloma
Authors: Shah Urvi A , Mailankody Sham
Published: September 2020

Despite considerable advances in treatment approaches in the past two decades, multiple myeloma remains an incurable disease. Treatments for myeloma continue to evolve with many emerging immunotherapies. The first immunotherapy used to treat hematologic cancers, including multiple myeloma, was an allogeneic stem cell transplant. In the mid-2000s, immunomodulatory drugs thalidomide, lenalidomide, and subsequently pomalidomide were proven to be effective in multiple myeloma and substantially improved survival. The next wave of immunotherapies for multiple myeloma included the monoclonal antibodies daratumumab and elotuzumab, which were approved by the Food and Drug Administration in 2015. Subsequently, a variety of immunotherapies have been developed for multiple myeloma, including chimeric antigen receptor T cells, bispecific antibodies, antibody drug conjugates, and checkpoint inhibitors. Many of these emerging treatments target the B cell maturation antigen, which is expressed on plasma cells, although several other novel receptors are also being studied. This review summarizes the evidence of these various immunotherapies, their mechanism of action, and data from clinical trials regarding the treatments’ safety and efficacy.
The cost-effectiveness of using performance-based financing to deliver the basic package of health services in Afghanistan
Authors: Salehi Ahmad S , Borghi Josephine , Blanchet Karl , Vassall Anna
Published: September 2020

Performance-based financing (PBF) is a mechanism to improve the quality and the utilisation of health benefit packages. There is a dearth of economic evaluations of PBF in the ‘real world’. Afghanistan implemented PBF between 2010 and 2015 and evaluated the programme using a pragmatic cluster-randomised control trial. We conducted a cost-effectiveness analysis of the PBF programme in Afghanistan, compared with the standard of care, from the provider payer’s perspective. The incremental cost-effectiveness ratio of PBF compared with the standard of care was US$1242 per disability-adjusted life year averted; not cost-effective when compared with an opportunity cost threshold of US$349. Incentive payments were the main contributor to PBF financial cost (70%) followed by data verification (23%), staff time (5%) and administration (2%). The unit cost per case of antenatal care (ANC), skilled birth attendance (SBA) and postnatal care (PNC) services in the standard of care was US$0.96 (95% CI 0.92–1.0), US$4.8 (95% CI 4.1–6.3) and US$1.3 (95% CI 1.2–1.4), respectively, whereas the cost of ANC, SBA and PNC services per case in PBF areas were US$4.72 (95% CI 4.68–5.7), US$48.5 (95% CI 48.0–52.5) and US$5.4 (95% CI 5.1–5.9), respectively. To conclude, our study found that PBF, as implemented in the Afghan context, was not the best use of funds to strengthen the delivery of maternal and child health services. The cost-effectiveness of alternative PBF designs needs to be appraised before using PBF at scale to support health benefit packages. PBF needs to be considered in the context of funding the range of constraints that inhibit health service performance improvement.
Impact evaluations of drug decriminalisation and legal regulation on drug use, health and social harms: a systematic review
Authors: Scheim Ayden I , Maghsoudi Nazlee , Marshall Zack , Churchill Siobhan , Ziegler Carolyn , Werb Dan
Published: September 2020

Objectives

To review the metrics and findings of studies evaluating effects of drug decriminalisation or legal regulation on drug availability, use or related health and social harms globally.

Design

Systematic review with narrative synthesis.

Data sources

We searched MEDLINE, Embase, PsycINFO, Web of Science and six additional databases for publications from 1 January 1970 through 4 October 2018.

Inclusion criteria

Peer-reviewed articles or published abstracts in any language with quantitative data on drug availability, use or related health and social harms collected before and after implementation ofde juredrug decriminalisation or legal regulation.

Data extraction and synthesis

Two independent reviewers screened titles, abstracts and articles for inclusion. Extraction and quality appraisal (modified Downs and Black checklist) were performed by one reviewer and checked by a second, with discrepancies resolved by a third. We coded study-level outcome measures into metric groupings and categorised the estimated direction of association between the legal change and outcomes of interest.

Results

We screened 4860 titles and 221 full-texts and included 114 articles. Most (n=104, 91.2%) were from the USA, evaluated cannabis reform (n=109, 95.6%) and focussed on legal regulation (n=96, 84.2%). 224 study outcome measures were categorised into 32 metrics, most commonly prevalence (39.5% of studies), frequency (14.0%) or perceived harmfulness (10.5%) of use of the decriminalised or regulated drug; or use of tobacco, alcohol or other drugs (12.3%). Across all substance use metrics, legal reform was most often not associated with changes in use.

Conclusions

Studies evaluating drug decriminalisation and legal regulation are concentrated in the USA and on cannabis legalisation. Despite the range of outcomes potentially impacted by drug law reform, extant research is narrowly focussed, with a particular emphasis on the prevalence of use. Metrics in drug law reform evaluations require improved alignment with relevant health and social outcomes.
Psychosocial factors and indoor environmental quality in respiratory symptom reports of pupils: a cross-sectional study in Finnish schools
Authors: Savelieva Kateryna , Elovainio Marko , Lampi Jussi , Ung-Lanki Sari , Pekkanen Juha
Published: September 2020

Objectives

Poor indoor environmental quality (IEQ) in schools is related to higher respiratory symptoms of pupils, but little is known about the importance of other factors. This study examined the associations between different psychosocial factors and other pupils’ individual and allergic characteristics, beyond school IEQ, and reporting of respiratory symptoms in pupil-administered and parent-administered questionnaires.

Setting

All primary and secondary schools in two areas of Helsinki, Finland.

Participants

Primary school pupils (grade 3–6, n=8775, 99 school buildings) and secondary school pupils (grade 7–9, n=3410, 30 school buildings) reported their respiratory symptoms, as well as psychosocial factors and individual characteristics. Parents of primary school pupils (grade 1–6, n=3540, 88 school buildings) also filled in questionnaires, but the response rate was low (20% in 2017 and 13% in 2018).

Main outcome measure

Respiratory symptoms were reported in relation to the school environment and in general (without such relation) by pupils or parents.

Results

Worry about IEQ and low school satisfaction, and asthma and hay fever were related to higher reporting of respiratory symptoms in three samples. The variance between schools in respiratory symptoms was low (intraclass correlation=0.6%–2.4%). Psychosocial factors, especially worry about school’s IEQ, explained more of the variance between schools in symptoms than IEQ among secondary school pupils and parents, but not among primary school pupils for symptoms in general. Worry about IEQ also modified the associations between IEQ and respiratory symptoms, but only in parental reports.

Conclusion

In addition to IEQ, psychosocial factors and pupils’ individual and allergic characteristics were related to higher reporting of respiratory symptoms in all three samples. Psychosocial factors explained more variance between schools than IEQ, although it was 2.4% at most. Other factors beyond IEQ should be considered when interpreting symptom reporting in indoor air questionnaires.
Awareness, usage and perceptions of authorship guidelines: an international survey of biomedical authors
Authors: Schroter Sara , Montagni Ilaria , Loder Elizabeth , Eikermann M , Schäffner Elke , Kurth Tobias
Published: September 2020

Objectives

To investigate authors’ awareness and use of authorship guidelines, and to assess their perceptions of the fairness of authorship decisions.

Design

A cross-sectional online survey.

Setting and participants

Corresponding authors of research papers submitted in 2014 to 18 BMJ journals.

Results

3859/12 646 (31%) researchers responded. They worked in 93 countries and varied in research experience. Of these, 1326 (34%) reported their institution had an authorship policy providing criteria for authorship; 2871 (74%) were ‘very familiar’ with the International Committee of Medical Journal Editors’ authorship criteria and 3358 (87%) reported that guidelines were beneficial when preparing manuscripts. Furthermore, 2609 (68%) reported that their use was ‘sometimes’ or ‘frequently’ encouraged in their research setting. However, 2859 respondents (74%) reported that they had been involved in a study at least once where someone was added as an author who had not contributed substantially (honorary authorship), and 1305 (34%) where someone was not listed as an author but had contributed substantially (ghost authorship). Only 740 (19%) reported that they had never experienced either honorary or ghost authorship; 1115 (29%) reported that they had experienced both at least once. There was no clear pattern in experience of authorship misappropriation by continent. For their last coauthored article, 2187 (57%) reported that explicit authorship criteria had been used to determine eligibility, and 3088 (80%) felt that the decision made was fair. When institutions frequently encouraged use of authorship guidelines, authorship eligibility was more likely to be discussed early (817 of 1410, 58%) and perceived as fairer (1273 of 1410, 90%) compared with infrequent encouragement (974 of 2449, 40%, and 1891 of 2449, 74%).

Conclusions

Despite a high level of awareness of authorship guidelines and criteria, these are not so widely used; more explicit encouragement of their use by institutions may result in more favourable use of guidelines by authors.
Study protocol for an observational study of cerebrospinal fluid pressure in patients with degenerative cervical myelopathy undergoing surgical deCOMPression of the spinal CORD: the COMP-CORD study
Authors: Zipser Carl Moritz , Pfender Nikolai , Spirig Jose Miguel , Betz Michael , Aguirre Jose , Hupp Markus , Farshad Mazda , Curt Armin , Schubert Martin
Published: September 2020

Introduction

Degenerative cervical myelopathy (DCM) is a disabling spinal disorder characterised by sensorimotor deficits of upper and lower limbs, neurogenic bladder dysfunction and neuropathic pain. When suspected, cervical MRI helps to reveal spinal cord compression and rules out alternative diagnoses. However, the correlation between radiological findings and symptoms is weak. Cerebrospinal fluid pressure (CSFP) analysis may complement the appreciation of cord compression and be used for intraoperative and postoperative monitorings in patients undergoing surgical decompression.

Methods and analysis

Twenty patients diagnosed with DCM undergoing surgical decompression will receive standardised lumbar CSFP monitoring immediately before, during and 24 hours after operation. Rest (ie, opening pressure, CSF pulsation) and stimulated (ie, Valsalva, Queckenstedt’s) CSFP—findings in DCM will be compared with 20 controls and results from CSFP monitoring will be related to clinical and neurophysiological findings. Arterial blood pressure will be recorded perioperatively and postoperatively to calculate spinal cord perfusion pressure and spinal vascular reactivity index. Furthermore, measures of CSFP will be compared with markers of spinal cord compression by means of MR imaging.

Ethics and dissemination

The study protocol conformed to the latest revision of the Declaration of Helsinki and was approved by the local Ethics Committee of the University Hospital of Zurich (KEK-ZH number PB-2016-00623). The main publications from this study will cover the CSFP fluid dynamics and pressure analysis preoperative, perioperative and postoperative correlated with imaging, clinical scores and neurophysiology. Other publications will deal with preoperative and postoperative spinal perfusion. Furthermore, we will disseminate an analysis on waveform morphology and the correlation with blood pressure and ECG. Parts of the data will be used for computational modelling of cervical stenosis.

Trial registration number

ClinicalTrials.gov Registry (NCT02170155).
Effect of vascular simulation training on practice performance in residents: a retrospective cohort study
Authors: Yang Lin , Li Yanzi , Liu Jianlin , Liu Yamin
Published: September 2020

Objective

This study aims to investigate the teaching effect of vascular simulation training (ST) in rotating vascular residents.

Design

Retrospective cohort study.

Setting and participants

A total of 95 vascular residents were included from 2015 to 2018 in a university affiliated centre western China, and divided into an ST group and a conventional training (CT) group. The ST group received ST and CT, and the CT group only received CT.

Primary outcome measures

Theoretical scores were assessed, and the technique parameters, complications and radiation damage of the procedures were analysed.

Results

The mean scores (8.74±1.09 vs 8.13±1.31) and the rate of willingness for retraining (93.62% vs 79.17%) in residents were higher in the ST group than in the conventional training (CT) group (p<0.05). The success rate of arterial puncture was significantly higher in the ST group (78.72% vs 58.33%, p=0.03); however, the incidence of complications was similar between the two groups (p>0.05). The time of the puncture procedure was significantly lower (9.56±5.24 vs 12.15±6.87 min), and the comfort score of the patient (5.49±1.72 vs 4.71±1.57) was higher in the ST group than in the CT group (p<0.05). At the end of the assessment, the learning time for angiography (3.65±0.64 vs 4.07±0.77 months) and the complete procedure time (33.81±10.11 vs 41.32±12.56 min) were lower in the ST group than in the CT group (p<0.01). The fluo time for angiography (489.33±237.13 vs 631.47±243.65 s) and the cumulative air kerma (401.30±149.06 vs 461.16±134.14 mGy) were significantly decreased in ST group (p<0.05).

Conclusion

The application of a vascular simulation system can significantly improve the clinical performance of residents and reduce the radiation damage from a single intervention procedure in patients.
Task-shifted approaches to postdiagnostic dementia support: a qualitative study exploring professional views and experiences
Authors: Wheatley Alison , Bamford Claire , Brunskill Greta , Harrison Dening Karen , Allan Louise , Rait Greta , Robinson Louise
Published: September 2020

Objectives

To explore the views of commissioners, service development leads, service managers and senior staff in selected dementia services on increasing the role of primary care in postdiagnostic support for people with dementia.

Design

Qualitative semi-structured telephone interviews and a focus group.

Setting

Participants were drawn from National Health Service (NHS) Clinical Commissioning Groups, social care commissioning and a range of dementia services across primary care, secondary mental healthcare, social care and the third sector. All participants were based in England or Wales.

Participants

61 professionals, comprising 25 commissioners or service development leads; 25 service managers; and 11 team leads or senior staff.

Results

Participants had varied views on whether a primary care-based approach for postdiagnostic support for people with dementia and their families was appropriate, achievable and/or desirable. Potential benefits of a task-shifted approach were continuity and a more holistic approach to care; familiarity for both patients and staff; and reduction of stigma. Key challenges included the capacity, ability and inclination of primary care to deliver postdiagnostic support for people with dementia and their families. We discovered a number of conceptual challenges to implementing a task-shifted and task-shared approach, including uncertainties around the nature of postdiagnostic support, the definition of primary care and identification of tasks that could be shifted to primary care.

Conclusions

Our data highlight the concerns of key professional staff around greater involvement of primary care in postdiagnostic support for dementia. Further research is needed to achieve a shared understanding and consensus over what postdiagnostic support means in the context of dementia. We will be undertaking such research in the next phase of our programme.
Prevalence of non-contrast CT abnormalities in adults with reversible cerebral vasoconstriction syndrome: protocol for a systematic review and meta-analysis
Authors: Gotesman Ryan Daniel , Niznick Naomi , Dewar Brian , Fergusson Dean A , Shorr Risa , Shamy Michel , Dowlatshahi Dar
Published: September 2020

Introduction

Reversible cerebral vasoconstriction syndrome (RCVS) is characterised by severe, recurrent thunderclap headaches (TCHs) and vasoconstriction of cerebral arteries that resolve within 3 months. Abnormalities on non-contrast CT (NCCT) such as ischaemic strokes, intracerebral haemorrhage and subarachnoid haemorrhages are frequently observed on brain imaging of patients with RCVS though their prevalence varies considerably between studies. The aim of this systematic review and meta-analysis is to estimate the prevalence of NCCT abnormalities seen on neuroimaging of adult patients with RCVS.

Methods and analysis

We will search the Medline, Embase and the Cochrane Library databases for studies on the prevalence of NCCT abnormalities on neuroimaging of patients with RCVS. Search results will be screened for eligibility by title and abstract. Suitable studies will be fully reviewed and relevant data extracted using a data abstraction form. The studies will be assessed for methodological quality, risk of bias and heterogeneity. Prevalence estimates across studies will be pooled using a random-effects model and subgroup analysis will be performed to assess the impact of age, sex, publication year and study design on prevalence of vascular lesions. Sensitivity analysis will be used to investigate the robustness of the findings. This protocol has been devised using the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols 2015 checklist.

Ethics and dissemination

Formal ethics is not required as primary data will not be collected. The findings of this study will be disseminated through a peer-reviewed publication and conference presentations.

Trial registration number

CRD42020190637.
Improving medication safety practice at a community hospital: a focus on bar code medication administration scanning and pain reassessment
Authors: Ho Jackie , Burger David
Published: September 2020

Introduction

In the USA over 30% of medication errors occur at the point of administration. Among non-surgical patients in US hospitals exposed to opioids, 0.6% experience a severe opioid-related adverse event. In September 2018, Sierra View Medical Center identified two areas of opportunity for quality improvement: bedside bar code medication administration (BCMA) and pain reassessments. At baseline (April 2018 to September 2018) only 81% of medications were scanned prior to administration with pain reassessments completed only 41% of the time 1 hour postopioid administration.

Objective

To improve BCMA scanning rates (goal ≥95%) and pain reassessments within 1 hour postopioid administration (goal ≥90%).

Methods

Implementation methods included data transparency, weekly dashboards, education and plan-do-study-act (PDSA) cycles informed by feedback from key stakeholders.

Results

Following a series of PDSA cycle implementations, barcode medication administration (BCMA) scanning rates improved by 14% (from 81% to 95%) and pain reassessments improved by 50% (from 41% to 91%), sustained 17 months postproject implementation (October 2018 to February 2019). The number of adverse drug events (ADEs) related to administration errors decreased by 17% (estimated annual cost savings of $120 750–239 725 per year) and opioid-related ADEs decreased by 2.6% (estimated annual cost savings of $72 855–80 928 per year).

Conclusion

Adopting John Kotter’s model for change, developing performance dashboards and sustaining engagement among stakeholders on a weekly basis improved bar code medication scanning rates and pain reassessment compliance. The stakeholders created momentum for change in both practice and culture resulting in improved patient safety with a favourable financial impact.
Impact of palliative care consult service in inpatient hospital setting: a systematic literature review
Authors: Janberidze Elene , Poláková Kristýna , Bankovská Motlová Lucie , Loučka Martin
Published: September 2020

Objectives

Despite a number of studies on effectiveness of palliative care, there is a lack of complex updated review of the impact of in-hospital palliative care consult service. The objective is to update information on the impact of palliative care consult service in inpatient hospital setting.

Methods

This study was a systematic literature review, following the standard protocols (Preferred Reporting Items for Systematic Reviews and Meta-Analyses, Joanna Briggs Institute tools) to ensure the transparent and robust review procedure. The effect of palliative care consult service was classified as being associated with improvement, no difference, deterioration or mixed results in specific outcomes. PubMed, Scopus, Academic Search Ultimate and SocINDEX were systematically searched up to February 2020. Studies were included if they focused on the impact of palliative care consult service caring for adult palliative care patients and their families in inpatient hospital setting.

Results

After removing duplicates, 959 citations were screened of which 49 full-text articles were retained. A total of 28 different outcome variables were extracted. 18 of them showed positive effects within patient, family, staff and healthcare system domains. No difference was observed in patient survival and depression. Inconclusive results represented patient social support and staff satisfaction with care.

Conclusions

Palliative care consult service has a number of positive effects for patients, families, staff and healthcare system. More research is needed on factors such as patient spiritual well-being, social support, performance, family understanding of patient diagnosis or staff stress.
Evaluation of current medical approaches for COVID-19: a systematic review and meta-analysis
Authors: Wang Meng , Wu Ting , Zuo Zhihong , You Yaxian , Yang Xinyuan , Pan Liangyu , Hu Ying , Luo Xuan , Jiang Liping , Xia Zanxian , Deng Meichun
Published: September 2020

Background

Because of the lack of vaccination, it is urgent to find effective antiviral agents for COVID-19 treatment.

Method

Online databases were searched for articles published before or on 22 June 2020. Studies reporting the effectiveness and safety of antiviral agents for COVID-19 were analysed.

Results

A total of 42 studies were included in this analysis. Hydroxychloroquine (HCQ) was not associated with the incidence of death (risk ratio (RR)=1.08; 95% CI 0.81 to 1.44) and severe cases (RR=1.05; 95% CI 0.61 to 1.81). Patients treated with HCQ obtained few benefits with respect to the clearance of viral RNA and were more likely to have adverse reactions. HCQ treatment could shorten the body temperature recovery time (weighted mean difference = −1.04; 95% CI −1.64 to −0.45). Lopinavir/ritonavir (LPV/r) (RR=0.90; 95% CI 0.76 to 1.07) and Arbidol (RR=1.09; 95% CI 0.92 to 1.29) were not associated with the negative conversion rate. Integrative Chinese-Western medicine alleviated clinical symptoms and decreased the incidence of severe cases (RR=0.38; 95% CI 0.25 to 0.59). Remdesivir treatment reduced the 14-day mortality rate of patients with severe COVID-19 (RR=0.64; 95% CI 0.44 to 0.94). Convalescent plasma (CP) tended to increase the negative conversion rate (RR=2.47; 95% CI 1.70 to 3.57).

Conclusion

HCQ, LPV/r and Arbidol bring little benefit in COVID-19 treatment. Integrative Chinese-Western medicine improved the clinical symptoms of patients with COVID-19. Remdesivir and CP might be the potential treatments for patients with severe COVID-19. However, large-scale clinical randomised trials are needed to validate our conclusions.
Therapeutic efficacy and safety of a human fusion construct targeting the TWEAK receptor Fn14 and containing a modified granzyme B
Authors: Alvarez de Cienfuegos Ana , Cheung Lawrence H , Mohamedali Khalid A , Whitsett Timothy G , Winkles Jeffrey A , Hittelman Walter N , Rosenblum Michael G
Published: September 2020

Background

Antibody-drug conjugates are an exceptional and useful therapeutic tool for multiple diseases, particularly for cancer treatment. We previously showed that the fusion of the serine protease granzyme B (GrB), the effector molecule or T and B cells, to a binding domain allows the controlled and effective delivery of the cytotoxic payload into the target cell. The production of these constructs induced the formation of high molecular aggregates with a potential impact on the efficacy and safety of the protein.

Methods

Our laboratory designed a new Fn14 targeted fusion construct designated GrB(C210A)-Fc-IT4 which contains a modified GrB payload for improved protein production and preserved biological activity. We assessed the construct’s enzymatic activity, as well as in vitro cytotoxicity and internalization into target cells. We also assessed pharmacokinetics, efficacy and toxicology parameters in vivo.

Results

GrB(C210A)-Fc-IT4 protein exhibited high affinity and selective cytotoxicity within the nanomolar range when tested against a panel of Fn14-positive human cancer cell lines. The construct rapidly internalized into target cells, activating the caspase cascade and causing mitochondrial membrane depolarization. Pharmacokinetic studies in mice revealed that GrB(C210A)-Fc-IT4 displayed a bi-exponential clearance from plasma with a fast initial clearance (t1/2α=0.36 hour) followed by a prolonged terminal-phase plasma half-life (t1/2β=35 hours). Mice bearing MDA-MB-231 orthotopic tumor xenografts treated with vehicle or GrB(C210A)-Fc-IT4 construct (QODx5) demonstrated tumor regression and long-term (>80 days) suppression of tumor growth. Treatment of mice bearing established, subcutaneous A549 lung tumors showed impressive, long-term tumor suppression compared with a control group treated with vehicle alone. Administration of GrB(C210A)-Fc-IT4 (100 mg/kg total dose) was well-tolerated by mice and resulted in significant reduction of tumor burden in a lung cancer patient-derived xenograft model. Toxicity studies revealed no statistically significant changes in aspartate transferase, alanine transferase or lactate dehydrogenase in treated mice. Histopathological analysis of tissues from treated mice did not demonstrate any specific drug-related changes.

Conclusion

GrB(C210A)-Fc-IT4 demonstrated excellent, specific cytotoxicity in vitro and impressive in vivo efficacy with no significant toxicity in normal murine models. These studies show GrB(C210A)-Fc-IT4 is an excellent candidate for further preclinical development.
The rationales for and challenges with employing arts-based health services research (ABHSR): a qualitative systematic review of primary studies
Authors: Majid Umair , Kandasamy Sujane
Published: September 2020

Health services research (HSR) is an interdisciplinary field that investigates and improves the design and delivery of health services from individual, group, organisational and system perspectives. HSR examines complex problems within health systems. Qualitative research plays an important role in aiding us to develop a nuanced understanding of patients, family, healthcare providers, teams and systems. However, the overwhelming majority of HSR publications using qualitative research use traditional methods such as focus groups and interviews. Arts-based research—artistic and creative forms of data collection such as dance, drama and photovoice—have had limited uptake in HSR due to the lack of clarity in the methods, their rationales and potential impacts. To address this uncertainty, we conducted a qualitative systematic review of studies that have employed arts-based research in HSR topics. We searched four databases for peer-reviewed, primary HSR studies. Using conventional content analysis, we analysed the rationales for using arts-based approaches in 42 primary qualitative studies. We found four rationales for using arts-based approaches for HSR: (1) Capture aspects of a topic that may be overlooked, ignored or not conceptualised by other methods (ie, quantitative and interview-based qualitative methods). (2) Allow participants to reflect on their own experiences. (3) Generate valuable community knowledge to inform intervention design and delivery. (4) Formulate research projects that are more participatory in nature. This review provides health services researchers with the tools, reasons, rationales and justifications for using arts-based methods. We conclude this review by discussing the practicalities of making arts-based approaches commensurable to HSR.
Ataxia telangiectasia: what the neurologist needs to know
Authors: Tiet May Yung , Horvath Rita , Hensiek Anke E
Published: September 2020

Ataxia telangiectasia is an autosomal recessive DNA repair disorder characterised by complex neurological symptoms, with an elevated risk of malignancy, immunodeficiency and other systemic complications. Patients with variant ataxia telangiectasia—with some preserved ataxia telangiectasia-mutated (ATM) kinase activity—have a milder and often atypical phenotype, which can lead to long delays in diagnosis. Clinicians need to be aware of the spectrum of clinical presentations of ataxia telangiectasia, especially given the implications for malignancy surveillance and management. Here, we review the phenotypes of ataxia telangiectasia, illustrated with case reports and videos, and discuss its pathological mechanisms, diagnosis and management.
Cerebral venous thrombosis: a practical guide
Authors: Ulivi Leonardo , Squitieri Martina , Cohen Hannah , Cowley Peter , Werring David J
Published: September 2020

All neurologists need to be able to recognise and treat cerebral venous thrombosis (CVT). It is difficult to diagnose, partly due to its relative rarity, its multiple and various clinical manifestations (different from ‘conventional’ stroke, and often mimicking other acute neurological conditions), and because it is often challenging to obtain and interpret optimal and timely brain imaging. Although CVT can result in death or permanent disability, it generally has a favourable prognosis if diagnosed and treated early. Neurologists involved in stroke care therefore also need to be aware of the treatments for CVT (with varying degrees of supporting evidence): the mainstay is prompt anticoagulation but patients who deteriorate despite treatment can be considered for endovascular procedures (endovascular thrombolysis or thrombectomy) or neurosurgery (decompressive craniotomy). This review summarises current knowledge on the risk factors, diagnosis, treatment and prognosis of CVT in adults, and highlights some areas for future research.
Association of elevated hs-CRP and multiple infarctions with outcomes of minor stroke or TIA: subgroup analysis of CHANCE randomised clinical trial
Authors: Wang Guangyao , Jing Jing , Li Jiejie , Pan Yuesong , Yan Hongyi , Meng Xia , Zhao Xingquan , Liu Liping , Li Hao , Wang David Z , Wang Yongjun , Wang Yilong
Published: September 2020

Background and purpose

The relationship of high-sensitive C-reactive protein (hs-CRP) levels and infarction numbers with the prognosis of stroke is uncertain. This study evaluated the association of different hs-CRP levels and infarction numbers with the prognosis of acute minor ischaemic stroke or transient ischaemic attack (TIA).

Methods

A subset of 807 patients with both hs-CRP measurement and baseline MRI was included from the Clopidogrel in High-risk Patients with Acute Non-disabling Cerebrovascular Events trial. The primary efficacy outcome was the occurrence of an ischaemic stroke at the 1-year follow-up. Infarction numbers were classified as multiple acute infarctions (MAIs), single acute infarction and no acute infarction (NAI). The association between different hs-CRP levels with different infarction numbers and the risk of any outcome was analysed using multivariable Cox regression models.

Results

Among the 807 patients, 84 (10.4%) patients had a recurrent ischaemic stroke within 1 year. After adjustment for conventional confounding factors, patients with both elevated hs-CRP levels and MAIs were associated with approximately 4.7-fold of risk of ischaemic stroke within 1 year (16.7% vs 3.5%, HR 4.68, 95% CI 1.54 to 14.23, p=0.007), compared with those with non-elevated hs-CRP levels and NAI. Similar results were observed for the composite events.

Conclusions

Combined elevated hs-CRP levels and MAIs may increase 1-year stroke risk stratification efficiency in patients with minor ischaemic stroke or TIA compared with using those markers alone, which indicated that the combination of inflammatory and imaging markers might improve the effectiveness of risk stratification concerning minor ischaemic stroke or TIA.

ClinicalTrials.gov Registry (NCT00979589).
Isolation of dermatophytes from dogs and cats in the South of England between 1991 and 2017
Authors: Long Sarah , Carveth Hope , Chang Yu‐Mei , O'Neill Dan , Bond Ross
Published: September 2020

Background

Since the epidemiology of canine and feline dermatophytosis might evolve in response to chronological, sociological and ecological factors, the authors studied the occurrence of dermatophyte pathogens over 27 years subsequent to the last major UK survey.

Methods

Dermatophyte culture submission records from dogs and cats to the Royal Veterinary College Diagnostic Laboratory in England between 1991 and 2017 were reviewed. Samples were routinely cultured aerobically at 26°C for up to four weeks on Sabouraud's dextrose agar containing cycloheximide and chloramphenicol; dermatophytes were identified using conventional phenotypic methods.

Results

Proportional isolation from cats (15.9 per cent of 1389) exceeded that of dogs (8.1 per cent of 2193) (P<0.001). Together, Microsporum canis and Trichophyton mentagrophytes accounted for 91.9 per cent (n=203) and 80.2 per cent (n=142) of isolations from cats and dogs, respectively. M canis was more frequently (P<0.001) isolated from cats and dogs under two years of age. Dermatophytes were more frequent (P≤0.001) in samples from first‐opinion rather than referral practice, and from Jack Russell and Yorkshire terriers and from Persian and chinchilla cats (P≤0.002).

Conclusions

M canis and T mentagrophytes remain the most common agents of canine and feline dermatophytosis in the South of England; continued clinical vigilance is required.