bluuebunny/crossref_metadata_2025 huggingface dataset:
Presumed pseudo‐Pelger–Huët anomaly and basophilia secondary to chronic lymphocytic leukemia in a dog
Authors: Martínez‐Caro Javier , Agulla Beatriz , Viñeta Clàudia , Roura Xavier , Mesalles Montse , Pastor Josep
Published: April 2024

A 10‐year‐old neutered male Maltese dog was presented for an investigation of lymphocytosis. The dog was up‐to‐date on vaccinations and deworming. Physical examination did not reveal any significant abnormalities. A complete blood cell count (CBC) showed mild leukocytosis with moderate lymphocytosis, basophilia, and moderate neutropenia, but no significant left shift or toxic change. Serum biochemistry and urinalysis were unremarkable. All performed tests for infectious agents common in this geographical region were negative. No significant abnormalities were found on abdominal ultrasound examination. Multiparametric flow cytometry of peripheral blood showed a CD8+ T‐cell lymphocytosis, and PCR for antigen receptor rearrangement revealed a clonal expansion of the T‐cell receptor gamma chain genes. A clinical diagnosis of chronic lymphocytic leukemia (CLL) was made, and follow‐up was recommended. On Day 48 post‐presentation, the CBC showed mild non‐regenerative anemia (NRA), moderate leucocytosis due to moderate to marked lymphocytosis, basophilia, and a marked increase in hyposegmented neutrophils with mild toxic change in the absence of neutrophilia or neutropenia. Treatment with chlorambucil and prednisolone was initiated. On Days 87 and 197 post‐presentation, the CBC showed mild NRA, with progressively decreasing numbers of hyposegmented neutrophils. The dog remained without clinical signs. Basophilia and probable pseudo‐Pelger–Huët anomaly were possibly secondary to CLL. To the authors' knowledge, this is the first report of these two hematologic conditions secondary to CLL in dogs. Recognition of a pseudo‐Pelger–Huët anomaly is clinically relevant to avoid misinterpretation as a marked left shift due to severe inflammation and prevent unnecessary urgent therapeutic actions.
Identification and enzymatic properties of arginine decarboxylase from
Aspergillus oryzae
Authors: Murakami Yui , Ikuta Soichiro , Fukuda Wakao , Akasaka Naoki , Maruyama Jun-ichi , Shinma Shuichi , Fukusaki Eiichiro , Fujiwara Shinsuke
Published: April 2024

Aspergillus oryzae
spores, when sprinkled onto steamed rice and allowed to propagate, are referred to as rice
“koji
.” Agmatine, a natural polyamine derived from arginine through the action of arginine decarboxylase (ADC), is abundantly produced by solid state-cultivated rice
koji
of
A. oryzae
RIB40 under low pH conditions, despite the apparent absence of ADC orthologs in its genome. Mass spectrometry imaging revealed that agmatine was accumulated inside rice
koji
at low pH conditions, where arginine was distributed. ADC activity was predominantly observed in substrate mycelia and minimally in aerial mycelia. Natural ADC was isolated from solid state-cultivated
A. oryzae
rice
koji
containing substrate mycelia, using ammonium sulfate fractionation, ion exchange, and gel-filtration chromatography. The purified protein was subjected to sodium dodecyl sulfate poly-acrylamide gel electrophoresis (SDS-PAGE), and the detected peptide band was digested for identification by liquid chromatography-tandem mass spectrometry (LC-MS/MS). The gene AO090102000327 of strain RIB40 was identified, previously annotated as phosphatidylserine decarboxylase (PSD), and encoded a 483-amino acid peptide. Recombinant protein encoded by AO090102000327 was expressed in
Escherichia coli
cells cultivated at 20°C, resulting in the detection of 49 kDa and 5 kDa peptides. The protein exhibited pyruvoyl-dependent decarboxylase activity, favoring arginine over ornithine and showing no activity with phosphatidylserine. The gene was designated
Ao-adc1. Ao
-ADC1 expression in rice
koji
at pH 4–6 was confirmed through western blotting using the anti-
Ao
-ADC1 serum. These findings indicate that
Ao-adc1
encodes arginine decarboxylase involved in agmatine production.

IMPORTANCE

Gene AO090102000327 in
A. oryzae
RIB40, previously annotated as a PSD, falls into a distinct clade when examining the phylogenetic distribution of PSDs. Contrary to the initial PSD annotation, our analysis indicates that the protein encoded by AO090102000327 is expressed in the substrate mycelia area of solid state-cultivated
A. oryzae
rice
koji
and functions as an arginine decarboxylase (ADC). The clade to which
Ao-
ADC1 belongs includes three other
Ao-
ADC1 paralogs (AO090103000445, AO090701000800, and AO090701000802) that presumably encode ADC rather than PSDs. Regarding PSD, AO090012000733 and AO090005001124 were speculated to be nonmitochondrial and mitochondrial PSDs in
A. oryzae
RIB40, respectively.
A
Burkholderia cenocepacia
-like environmental isolate strongly inhibits the plant fungal pathogen
Zymoseptoria tritici
Authors: Song Tingting , Gupta Suyash , Sorokin Yael , Frenkel Omer , Cytryn Eddie , Friedman Jonathan
Published: April 2024

Fungal phytopathogens cause significant reductions in agricultural yields annually, and overusing chemical fungicides for their control leads to environmental pollution and the emergence of resistant pathogens. Exploring natural isolates with strong antagonistic effects against pathogens can improve our understanding of their ecology and develop new treatments for the future. We isolated and characterized a novel bacterial strain associated with the species
Burkholderia cenocepacia
, termed APO9, which strongly inhibits
Zymoseptoria tritici
, a commercially important pathogenic fungus causing
Septoria tritici
blotch in wheat. Additionally, this strain exhibits inhibitory activity against four other phytopathogens. We found that physical contact plays a crucial role for APO9’s antagonistic capacity. Genome sequencing of APO9 and biosynthetic gene cluster (BGC) analysis identified nine classes of BGCs and three types of secretion systems (types II, III, and IV), which may be involved in the inhibition of
Z. tritic
i and other pathogens. To identify genes driving APO9’s inhibitory activity, we screened a library containing 1,602 transposon mutants and identified five genes whose inactivation reduced inhibition efficiency. One such gene encodes for a diaminopimelate decarboxylase located in a terpenoid biosynthesis gene cluster. Phylogenetic analysis revealed that while some of these genes are also found across the
Burkholderia
genus, as well as in other
Betaproteobacteria
, the combination of these genes is unique to the
Burkholderia cepacia
complex. These findings suggest that the inhibitory capacity of APO9 is complex and not limited to a single mechanism, and may play a role in the interaction between various
Burkholderia
species and various phytopathogens within diverse plant ecosystems.

IMPORTANCE

The detrimental effects of fungal pathogens on crop yields are substantial. The overuse of chemical fungicides contributes not only to environmental pollution but also to the emergence of resistant pathogens. Investigating natural isolates with strong antagonistic effects against pathogens can improve our understanding of their ecology and develop new treatments for the future. We discovered and examined a unique bacterial strain that demonstrates significant inhibitory activity against several phytopathogens. Our research demonstrates that this strain has a wide spectrum of inhibitory actions against plant pathogens, functioning through a complex mechanism. This plays a vital role in the interactions between plant microbiota and phytopathogens.
Plasmodium yoelii
surface-related antigen (PySRA) modulates the host pro-inflammatory responses via binding to CD68 on macrophage membrane
Authors: Feng Xin , Yu Jia-Li , Sun Yi-Fan , Du Chen-Yan , Shen Yao , Zhang Lu , Kong Wei-Zhong , Han Su , Cheng Yang
Published: April 2024

Malaria, one of the major infectious diseases in the world, is caused by the
Plasmodium
parasite.
Plasmodium
antigens could modulate the inflammatory response by binding to macrophage membrane receptors. As an export protein on the infected erythrocyte membrane,
Plasmodium
surface-related antigen (SRA) participates in the erythrocyte invasion and regulates the immune response of the host. This study found that the F2 segment of
P. yoelii
SRA activated downstream MAPK and NF-κB signaling pathways by binding to CD68 on the surface of the macrophage membrane and regulating the inflammatory response. The anti-PySRA-F2 antibody can protect mice against
P. yoelii
, and the pro-inflammatory responses such as IL-1β, TNF-α, and IL-6 after infection with
P. yoelii
are attenuated. These findings will be helpful for understanding the involvement of the pathogenic mechanism of malaria with the exported protein SRA.
Lipoic acid attachment to proteins: stimulating new developments
Authors: Cronan John E.
Published: April 2024

Lipoic acid-modified proteins are essential for central metabolism and pathogenesis. In recent years, the
Escherichia coli
and
Bacillus subtilis
lipoyl assembly pathways have been modified and extended to archaea and diverse eukaryotes including humans. These extensions include a new pathway to insert the key sulfur atoms of lipoate, several new pathways of lipoate salvage, and a novel use of lipoic acid in sulfur-oxidizing bacteria. Other advances are the modification of
E. coli
LplA for studies of protein localization and protein-protein interactions in cell biology and in enzymatic removal of lipoate from lipoyl proteins. Finally, scenarios have been put forth for the evolution of lipoate assembly in archaea.
Investigation of Plasma Flow Velocity in the Helical Magnetic Open Trap SMOLA
Authors: Inzhevatkina A. A. , Ivanov I. A. , Postupaev V. V. , Sudnikov A. V. , Tolkachev M. S. , Ustyuzhanin V. O.
Published: April 2024

The physics of confinement of plasma rotating in the magnetic field with linear helical symmetry is studied at the SMOLA open trap at Budker Institute of Nuclear Physics of the Siberian Branch of the Russian Academy of Sciences. The factor characterizing the quality of plasma confinement in the system is its flow velocity. The paper describes the diagnostics applied, which is based on the Mach probe used under the conditions of nonmagnetized plasma; this diagnostics made it possible to determine the longitudinal flow velocity in the experiments. In different operating regimes of the device, the measured longitudinal flow velocity was (0.5−5) × 106 cm/s. It is discussed how the velocity depends on the magnetic field corrugation. The reverse flow of trapped particles returning to the confinement zone was detected.
Tele-ICU enabled management of an organ donor in an under-resourced setting
Authors: Dasari Prudhvi , Reddy Maheeja , Parmar Dileep Singh , Britto Carl
Published: April 2024

A man in his 30s was involved in a road traffic crash in a small town in India, not equipped to deal with cases of brainstem death. He was declared brain-dead after a few hours. The patient’s information was forwarded to organ specialists across the country, with the goal of preserving the patient’s organs for donation via a tele-ICU model. The team comprising bedside doctors and remote intensivists communicating via an indigenously developed tele-ICU platform managed the patient for 24 hours, following treatment protocols and providing critical care to ensure that the patient’s vital organs were optimally perfused. The following morning, specialist teams from a nearby city arrived at the local hospital to retrieve the patient’s organs. This fast-tracked organ retrieval and transplant process were made possible through advances in technology and the involvement of specialists from other parts of the country through this tele-ICU model.
Mycoplasma hominisperitonitis after oocyte donation
Authors: Mendoza Cediel Pablo , Garcia Teruel David , Viedma Moreno Esther , Perez Pomata Maria Teresa
Published: April 2024

We report the case of a young, immunocompetent, non-pregnant woman diagnosed with acute abdomen 3 weeks after an ultrasound-guided transvaginal oocyte retrieval (TVOR). Peritoneal fluid, obtained during exploratory laparoscopy, yieldedMycoplasma hominisas the sole pathogen. The patient’s symptoms and signs improved after 24-hour treatment with intravenous clindamycin, ampicillin and gentamycin. Complete resolution was achieved with oral doxycycline for 14 days.
Shared genetic aetiology of Alzheimer’s disease and age-related macular degeneration by APOC1 and APOE genes
Authors: Zhang Xueli , Zhu Zhuoting , Huang Yu , Shang Xianwen , O'Brien Terence J , Kwan Patrick , Ha Jason , Wang Wei , Liu Shunming , Zhang Xiayin , Kiburg Katerina , Bao Yining , Wang Jing , Yu Honghua , He Mingguang , Zhang Lei
Published: April 2024

Background

Alzheimer’s disease (AD) and age-related macular degeneration (AMD) share similar pathological features, suggesting common genetic aetiologies between the two. Investigating gene associations between AD and AMD may provide useful insights into the underlying pathogenesis and inform integrated prevention and treatment for both diseases.

Methods

A stratified quantile–quantile (QQ) plot was constructed to detect the pleiotropy among AD and AMD based on genome-wide association studies data from 17 008 patients with AD and 30 178 patients with AMD. A Bayesian conditional false discovery rate-based (cFDR) method was used to identify pleiotropic genes. UK Biobank was used to verify the pleiotropy analysis. Biological network and enrichment analysis were conducted to explain the biological reason for pleiotropy phenomena. A diagnostic test based on gene expression data was used to predict biomarkers for AD and AMD based on pleiotropic genes and their regulators.

Results

Significant pleiotropy was found between AD and AMD (significant leftward shift on QQ plots). APOC1 and APOE were identified as pleiotropic genes for AD–AMD (cFDR <0.01). Network analysis revealed that APOC1 and APOE occupied borderline positions on the gene co-expression networks. Both APOC1 and APOE genes were enriched on the herpes simplex virus 1 infection pathway. Further, machine learning-based diagnostic tests identified that APOC1, APOE (areas under the curve (AUCs) >0.65) and their upstream regulators, especially ZNF131, ADNP2 and HINFP, could be potential biomarkers for both AD and AMD (AUCs >0.8).

Conclusion

In this study, we confirmed the genetic pleiotropy between AD and AMD and identified APOC1 and APOE as pleiotropic genes. Further, the integration of multiomics data identified ZNF131, ADNP2 and HINFP as novel diagnostic biomarkers for AD and AMD.
Predictive factors of clot propagation in patients with superficial venous thrombosis towards deep venous thrombosis and pulmonary embolism: a systematic review and meta-analysis
Authors: van Royen Florien Sophie-Anne , van Smeden Maarten , van Doorn Sander , Rutten Frans H , Geersing Geert-Jan
Published: April 2024

Objective

A subset of patients with superficial venous thrombosis (SVT) experiences clot propagation towards deep venous thrombosis (DVT) and/or pulmonary embolism (PE). The aim of this systematic review is to identify all clinically relevant cross-sectional and prognostic factors for predicting thrombotic complications in patients with SVT.

Design

Systematic review.

Data sources

PubMed/MEDLINE and Embase were systematically searched until 3 March 2023.

Eligibility criteria

Original research studies with patients with SVT, DVT and/or PE as the outcome and presenting cross-sectional or prognostic predictive factors.

Data extraction and synthesis of results

The CHecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling (CHARMS) checklist for prognostic factor studies was used for systematic extraction of study characteristics. Per identified predictive factor, relevant estimates of univariable and multivariable predictor—outcome associations were extracted, such as ORs and HRs. Estimates of association for the most frequently reported predictors were summarised in forest plots, and meta-analyses with heterogeneity were presented. The Quality in Prognosis Studies (QUIPS) tool was used for risk of bias assessment and Grading of Recommendations, Assessment, Development and Evaluations (GRADE) for assessing the certainty of evidence.

Results

Twenty-two studies were included (n=10 111 patients). The most reported predictive factors were high age, male sex, history of venous thromboembolism (VTE), absence of varicose veins and cancer. Pooled effect estimates were heterogenous and ranged from OR 3.12 (95% CI 1.75 to 5.59) for the cross-sectional predictor cancer to OR 0.92 (95% CI 0.56 to 1.53) for the prognostic predictor high age. The level of evidence was rated very low to low. Most studies were scored high or moderate risk of bias.

Conclusions

Although the pooled estimates of the predictors high age, male sex, history of VTE, cancer and absence of varicose veins showed predictive potential in isolation, variability in study designs, lack of multivariable adjustment and high risk of bias prevent firm conclusions. High-quality, multivariable studies are necessary to be able to identify individual SVT risk profiles.

PROSPERO registration number

CRD42021262819.
Labour Care Guide implementation as a decision-making tool for monitoring labour among healthcare providers in Uganda: protocol for a mixed-methods study
Authors: Mugyenyi Godfrey R , Byamugisha Josaphat , Tumuhimbise Wilson , Atukunda Esther , Yarine Fajardo T
Published: April 2024

Introduction

The new WHO Labour Care Guide (LCG), also regarded as the ‘next-generation partograph’, is a core component of 2018 WHO consolidated guidelines on intrapartum care for positive childbirth experience. The Ugandan Ministry of Health is in the process of adopting the new WHO LCG with no local context-specific data to inform this transition. We will explore potential barriers and facilitators to healthcare providers’ (HCPs) sustained engagement in labour monitoring in Mbarara city, Southwestern Uganda, and use the data to refine the new WHO LCG and develop a suitable implementation strategy to effectively integrate LCG into routine maternity care in Uganda. We shall then assess effectiveness, validity and other preliminary implementation outcomes of using the new LCG in detecting prolonged labour.

Methods and analysis

The study will use a mixed-methods approach to identify key LCG user perspectives to refine and customise the WHO LCG among 120 HCPs and stakeholders involved in maternity care and labour monitoring within facilities in Southwestern Uganda. The refined prototype will be deployed and used to monitor labour in all 14 basic and comprehensive emergency obstetric and newborn care facilities in the study area. We will review labour outcomes of 520 patients monitored using the new LCG and compare these outcomes with a historical cohort of 520 patients monitored using the partograph. The main effectiveness outcome will be the proportion of women diagnosed with prolonged labour and/or obstructed labour.

Ethics and dissemination

Ethical approval was obtained from the Mbarara University of Science and Technology Research Ethics Committee (MUST-2023-808) and Uganda National Council for Science and Technology (HS2864ES). We shall obtain written informed consent from each participant. The results of this study will be published in international peer-reviewed journals and presented to the Ugandan Ministry of Health as policy briefs and at selected national/international conferences.

Trial registration number

NCT05979194.
Functional therapy and adenotonsillectomy clinical trial for class II malocclusion (FACT-II): protocol for a randomised controlled trial
Authors: Guo Feiyang , Lv Chenxing , Tang Bojun , Lin Lizhuo , Zhang Chen , Zheng Jie , Zhao Tingting , He Hong
Published: April 2024

Introduction

Class II malocclusion with mandibular retrognathia is a common complication of paediatric obstructive sleep apnoea (OSA), often accompanied by transverse maxillary deficiency. In early orthodontic treatment, a twin block (TB) is a regular functional appliance for correcting this malocclusion. For paediatric OSA, the most common risk factor is adenotonsillar hypertrophy (AHT). Untreated AHT may lead to the persistence and worsening of obstructive sleep-disordered breathing traits, including habitual mouth breathing. Additionally, the clockwise mandibular rotation associated with AHT-induced pharyngeal crowding can undermine the effectiveness and stability of TB treatment. Adenotonsillectomy (T&A) is currently the first-line treatment for paediatric OSA. This proposed trial will investigate the impact of T&A surgery timing on the efficacy and stability of TB functional treatment in children with class II mandibular retrognathia and ATH.

Methods and analysis

This will be a single-centre, parallel-group, superiority randomised controlled trial with participants randomised to intervention (T&A followed by TB treatment) or control arms (TB treatment followed by T&A) in a 1:1 ratio. A total of 40 patients aged 8–14 years, diagnosed with class II mandibular retrognathia and co-existing ATH-induced OSA, and indicated for both T&A surgery and TB treatment, will be recruited at the School and Hospital of Stomatology, Wuhan University. The primary outcomes will be the changes in the apnoea-hypopnoea index and the point A-nasion-point B angle from baseline to postorthodontic treatment between the two groups. Secondary outcomes will include other dental, skeletal, upper airway and soft tissue changes, as well as subjective sleep-related and oral-related quality of life. Outcome changes within each group and between groups will be analysed.

Ethics and dissemination

This study is approved by the Ethics Committee of the School and Hospital of Stomatology, Wuhan University (no. 2022-D07). The research findings will be faithfully disseminated through scientific conferences or published articles.

Trial registration number

ChiCTR2200061703 (https://www.chictr.org.cn).
Multicentre double-blind randomised placebo-controlled trial evaluating the efficacy of the meningococcal B vaccine, 4CMenB (Bexsero), againstNeisseria gonorrhoeaeinfection in men who have sex with men: the GoGoVax study protocol
Authors: Seib Kate L , Donovan Basil , Thng Caroline , Lewis David A , McNulty Anna , Fairley Christopher K , Yeung Barbara , Jin Fengyi , Fraser Doug , Bavinton Benjamin R , Law Matthew , Chen Marcus Y , Chow Eric P F , Whiley David M , Mackie Brent , Jennings Michael P , Jennison Amy V , Lahra Monica M , Grulich Andrew E
Published: April 2024

Introduction

Gonorrhoea, the sexually transmissible infection caused byNeisseria gonorrhoeae, has a substantial impact on sexual and reproductive health globally with an estimated 82 million new infections each year worldwide.N. gonorrhoeaeantimicrobial resistance continues to escalate, and disease control is largely reliant on effective therapy as there is no proven effective gonococcal vaccine available. However, there is increasing evidence from observational cohort studies that the serogroup B meningococcal vaccine four-component meningitis B vaccine (4CMenB) (Bexsero), licensed to prevent invasive disease caused byNeisseria meningitidis, may provide cross-protection against the closely related bacteriumN. gonorrhoeae. This study will evaluate the efficacy of 4CMenB againstN. gonorrhoeaeinfection in men (cis and trans), transwomen and non-binary people who have sex with men (hereafter referred to as GBM+).

Methods and analysis

This is a double-blind, randomised placebo-controlled trial in GBM+, either HIV-negative on pre-exposure prophylaxis against HIV or living with HIV (CD4 count >350 cells/mm3), who have had a diagnosis of gonorrhoea or infectious syphilis in the last 18 months (a key characteristic associated with a high risk ofN. gonorrhoeaeinfection). Participants are randomised 1:1 to receive two doses of 4CMenB or placebo 3 months apart. Participants have 3-monthly visits over 24 months, which include testing forN. gonorrhoeaeand other sexually transmissible infections, collection of demographics, sexual behaviour risks and antibiotic use, and collection of research samples for analysis ofN. gonorrhoeae-specific systemic and mucosal immune responses. The primary outcome is the incidence of the first episode ofN. gonorrhoeaeinfection, as determined by nucleic acid amplification tests, post month 4. Additional outcomes consider the incidence of symptomatic or asymptomaticN. gonorrhoeaeinfection at different anatomical sites (ie, urogenital, anorectum or oropharynx), incidence byN. gonorrhoeaegenotype and antimicrobial resistance phenotype, and level and functional activity ofN. gonorrhoeae-specific antibodies.

Ethics and dissemination

Ethical approval was obtained from the St Vincent’s Hospital Human Research Ethics Committee, St Vincent’s Hospital Sydney, NSW, Australia (ref: 2020/ETH01084). Results will be disseminated in peer-reviewed journals and via presentation at national and international conferences.

Trial registration number

NCT04415424.
Predictors and long-term patterns of medication adherence to glaucoma treatment in Denmark—an observational registry study of 30 100 Danish patients with glaucoma
Authors: Kolko Miriam , Faergemann Hansen Rikke , G Dal Louise , Sabelström Emma , Brandel Magnus , Hoiberg Bentsen Andreas , Falch-Joergensen Anne Cathrine
Published: April 2024

Background

Self-treatment with glaucoma medication (eye drops) has been associated with adherence challenges. Poor adherence results in worse outcomes in terms of visual field loss.

Objective

To investigate patterns in medication adherence among Danish patients with glaucoma in relation to selected predictors of adherence, long-term adherence patterns, and long-term societal economic consequences of poor adherence.

Methods and analysis

This register-based study included 30 100 glaucoma patients followed for 10 years between 2000 and 2018. Glaucoma was identified from the Danish national registers by diagnosis of Open Angle Glaucoma and/or by redeemed prescriptions of glaucoma medication. Logistic regression models were applied to estimate patient characteristics related to medical adherence. Diagnosis-related group fees were applied to estimate healthcare costs.

Results

High adherence in the first year(s) of treatment was less likely among men (ORfirst year: 0.78, 95% CI: 0.75 to 0.82), younger individuals and among those with a positive Charlson Comorbidity Index (CCI) score (ORfirst year/CCI≥3: 0.71, 95% CI: 0.63 to 0.80). Adherence in the first year and in the first two years was associated with adherence in the fifth (ORfirst year: 4.55, 95% CI: 4.30 to 4.82/ORfirst two years: 6.47, 95% CI: 6.10 to 6.86) as with adherence in the 10th year with slightly lower estimates. Being medical adherent was related to higher costs related to glaucoma medication after 5 and 10 years comparing with poor adherence, whereas poor adherence was associated with a marked increase in long-term costs for hospital contacts.

Conclusion

Increasing age, female sex and low comorbidity score are correlated with better adherence to glaucoma treatment. Adherence in the first years of treatment may be a good predictor for future adherence. In the long term, patients with poor adherence are overall more expensive to society in terms of hospital contacts.
Implementation of a quality improvement initiative for standardising essential newborn care in a teaching public hospital in rural central India
Authors: Jain Manish , Meshram Payal , Bang Akash , Chauhan Varsha , Datta Vikram , Dhanireddy Ramasubbareddy
Published: April 2024

Objective

Our aim was to refine the essential newborn care practices by employing the multidisciplinary peer team-led quality improvement (QI) projects.

Design

In 2017, concerning the same, the department focused on early initiation of breast feeding, prevention of hypothermia within an hour of life and rational usage of antibiotics among babies admitted to neonatal intensive care unit (NICU). Baseline data reported the rate of initiation of breast feeding, hypothermia and antibiotic exposure rate as 35%, 78% and 75%, respectively. Root causes were analysed and a series of Plan-Do-Study-Act cycles were conducted to test the changes. The process of change was studied through run charts (whereas control charts were used for study purpose).

Result

After the implementation of the QI projects, the rate of initiation of breast feeding was found to be improved and sustained from 35% to 90%, the incidence of hypothermia got reduced from 78% to 10% and the antibiotic exposure rate declined from 75% to 40%. Along with the improvement in indicators related to essential newborn care, down the stream we found a decrease in the percentage of culture-positive sepsis rate in the NICU.

Conclusion

Peer team-led QI initiatives in a resource-limited setting proved beneficial in improving essential newborn care practices.
Achieving optimal cord management: a multidisciplinary quality improvement initiative
Authors: Burgess-Shannon Jessica , Clarke Rebecca , Rowell Victoria , Aladangady Narendra
Published: April 2024

Optimal cord management (OCM), defined as waiting at least 60 seconds (s) before clamping the umbilical cord after birth, is an evidence-based intervention that improves outcomes for both term and preterm babies. All major resuscitation councils recommend OCM for well newborns.

National Neonatal Audit Programme (NNAP) benchmarking data identified our tertiary neonatal unit as a negative outlier with regard to OCM practice with only 12.1% of infants receiving the recommended minimum of 60 s. This inspired a quality improvement project (QIP) to increase OCM rates of ≥ 60 s for infants <34 weeks. A multidisciplinary QIP team (Neonatal medical and nursing staff, Obstetricians, Midwives and Anaesthetic colleagues) was formed, and robust evidence-based quality improvement methodologies employed. Our aim was to increase OCM of ≥ 60 s for infants born at <34 weeks to at least 40%.

The percentage of infants <34 weeks receiving OCM increased from 32.4% at baseline (June–September 2022) to 73.6% in the 9 months following QIP commencement (October 2022–June 2023). The intervention period spanned two cohorts of rotational doctors, demonstrating its sustainability. Rates of admission normothermia were maintained following the routine adoption of OCM (89.2% vs 88.5%), which is a complication described by other neonatal units.

This project demonstrates the power of a multidisciplinary team approach to embedding an intervention that relies on collaboration between multiple departments. It also highlights the importance of national benchmarking data in allowing departments to focus QIP efforts to achieve long-lasting transformational service improvements.
Cross-sectional study of personal protective equipment use, training and biosafety preparedness among healthcare workers during the first months of the SARS-CoV-2 pandemic in Brazil
Authors: Muner Kerstin , Kilgour Julia , Ometto Tatiana , Brandão Ana Pérola Drulla , dos Santos Andrea Pires , Guimarães Ana Marcia Sá
Published: April 2024

Objectives

Brazil has high rates of COVID-19 and tuberculosis among healthcare workers (HCWs). Personal protective equipment (PPE) is essential for their protection. We aimed to evaluate PPE use, training, and preparedness among HCWs in the early months of the SARS-CoV-2 pandemic in Brazil.

Methods

A cross-sectional study was performed using questionnaires available to HCWs through a website created to provide PPE guidelines. χ2test and robust Poisson regression identified factors associated with HCWs treating COVID-19 patients (TCOVID-19), lack of training on PPE use and N95 respirator reuse. The speech content of open-ended questions was analysed.

Results

We analysed 1410 questionnaires collected from April to July 2020 representing 526 Brazilian cities. HCWs-TCOVID-19 had fewer years of work experience, were more likely to reuse PPE, and reported higher stress levels and lower biosafety at the workplace than HCWs not TCOVID-19 patients. Fearful concerns, limited PPE access and pandemic unpreparedness were common among HCWs. Lack of PPE training was associated with the profession and no N95 respirator fit tests. N95 reuse during the pandemic, common to 78% of the HCWs, was associated with the reuse of PPE during the pandemic and reuse of N95 before the pandemic.

Conclusions

We report the unpreparedness of HCWs and institutions to handle the pandemic, with low rates of training and N95 respirator fit testing and high PPE reuse. N95 reuse was a pre-established practice. This chronic unpreparedness to deal with airborne pathogens may have contributed to one of the highest global rates of tuberculosis and COVID-19 among HCWs.
Systematic review of the effects of patient errors using inhaled delivery systems on clinical outcomes in COPD
Authors: Halpin David M G , Mahler Donald A
Published: April 2024

Background

Errors using inhaled delivery systems for COPD are common and it is assumed that these lead to worse clinical outcomes. Previous systematic reviews have included patients with both asthma and COPD and much of the evidence related to asthma. More studies in COPD have now been published. Through systematic review, the relationship between errors using inhalers and clinical outcomes in COPD, including the importance of specific errors, was assessed.Methods

Electronic databases were searched on 27 October 2023 to identify cohort, case–control or randomised controlled studies, which included patients with COPD, an objective assessment of inhaler errors and data on at least one outcome of interest (forced expiratory volume in 1 s, (FEV1), dyspnoea, health status and exacerbations). Study quality was assessed using the Newcastle and Ottawa scales. A narrative synthesis of the results was performed as there was insufficient detail in the publications to allow quantitative synthesis. There was no funding for the review.

Results

19 publications were included (7 cohort and 12 case–control) reporting outcomes on 6487 patients. 15 were considered low quality, and most were confounded by the absence of adherence data. There was weak evidence that lower error rates are associated with better FEV1, symptoms and health status and fewer exacerbations. Only one considered the effects of individual errors and found that only some were related to worse outcomes.

Conclusion

Evidence about the importance of specific errors using inhalers and outcomes would optimise the education and training of patients with COPD. Prospective studies, including objective monitoring of inhalation technique and adherence, are needed.

PROSPERO registration number

CRD42023393120.
Virtual reality-based cognitive–behavioural therapy for the treatment of anxiety in patients with acute myocardial infarction: a randomised clinical trial
Authors: Li Yuanyuan , Peng Juan , Yang Pingyuan , Weng Jiajun , Lu Yan'e , Liu Jiajia , Xu Shikun , Guan Lihua , Huang Dong , Wang Qibing , Qian Juying , Zhao Zexin , Wei Yabin , Ge Junbo , Huang Xiao
Published: April 2024

Background

The presence of mental health conditions is pervasive in patients who experienced acute myocardial infarction (AMI), significantly disrupting their recovery. Providing timely and easily accessible psychological interventions using virtual reality-based cognitive–behavioural therapy (VR-CBT) could potentially improve both acute and long-term symptoms affecting their mental health.

Aims

We aim to examine the effectiveness of VR-CBT on anxiety symptoms in patients with AMI who were admitted to the intensive care unit (ICU) during the acute stage of their illness.

Methods

In this single-blind randomised clinical trial, participants with anxiety symptoms who were admitted to the ICU due to AMI were continuously recruited from December 2022 to February 2023. Patients who were Han Chinese aged 18–75 years were randomly assigned (1:1) via block randomisation to either the VR-CBT group to receive VR-CBT in addition to standard mental health support, or the control group to receive standard mental health support only. VR-CBT consisted of four modules and was delivered at the bedside over a 1-week period. Assessments were done at baseline, immediately after treatment and at 3-month follow-up. The intention-to-treat analysis began in June 2023. The primary outcome measure was the changes in anxiety symptoms as assessed by the Hamilton Anxiety Rating Scale (HAM-A).

Results

Among 148 randomised participants, 70 were assigned to the VR-CBT group and 78 to the control group. The 1-week VR-CBT intervention plus standard mental health support significantly reduced the anxiety symptoms compared with standard mental health support alone in terms of HAM-A scores at both post intervention (Cohen’s d=−1.27 (95% confidence interval (CI): −1.64 to −0.90, p<0.001) and 3-month follow-up (Cohen’s d=−0.37 (95% CI: −0.72 to −0.01, p=0.024). Of the 70 participants who received VR-CBT, 62 (88.6%) completed the entire intervention. Cybersickness was the main reported adverse event (n=5).

Conclusions

Our results indicate that VR-CBT can significantly reduce post-AMI anxiety at the acute stage of the illness; the improvement was maintained at the 3-month follow-up.

Trial registration number

The trial was registered atwww.chictr.org.cnwith the identifier: ChiCTR2200066435.
Flourishing and the scope of medicine and public health
Authors: VanderWeele Tyler J
Published: April 2024

A framework is put forward for the proper scope of considerations concerning flourishing within medicine, psychiatry, clinical counselling, public health and public policy. Each of these disciplines and associated institutional practices have distinctive contributions to make in advancing flourishing within society. In each case, there are also various aspects of flourishing that extend beyond each practice’s purview; and yet to restrict attention only to health, narrowly conceived, limits what each of these practices can in fact accomplish. A clearer understanding of what aspects of flourishing do, and do not, lie within the bounds of each discipline and practice has the potential to better enable the pursuit of societal well-being.
Review of codelists used to define hypertension in electronic health records and development of a codelist for research
Authors: Massen Georgie May , Stone Philip W , Kwok Harley H Y , Jenkins Gisli , Allen Richard J , Wain Louise V , Stewart Iain , Quint Jennifer Kathleen
Published: April 2024

Background and aims

Hypertension is a leading risk factor for cardiovascular disease. Electronic health records (EHRs) are routinely collected throughout a person’s care, recording all aspects of health status, including current and past conditions, prescriptions and test results. EHRs can be used for epidemiological research. However, there are nuances in the way conditions are recorded using clinical coding; it is important to understand the methods which have been applied to define exposures, covariates and outcomes to enable interpretation of study findings. This study aimed to identify codelists used to define hypertension in studies that use EHRs and generate recommended codelists to support reproducibility and consistency.

Eligibility criteria

Studies included populations with hypertension defined within an EHR between January 2010 and August 2023 and were systematically identified using MEDLINE and Embase. A summary of the most frequently used sources and codes is described. Due to an absence of Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT) codelists in the literature, a recommended SNOMED CT codelist was developed to aid consistency and standardisation of hypertension research using EHRs.

Findings

375 manuscripts met the study criteria and were eligible for inclusion, and 112 (29.9%) reported codelists. The International Classification of Diseases (ICD) was the most frequently used clinical terminology, 59 manuscripts provided ICD 9 codelists (53%) and 58 included ICD 10 codelists (52%). Informed by commonly used ICD and Read codes, usage recommendations were made. We derived SNOMED CT codelists informed by National Institute for Health and Care Excellence guidelines for hypertension management. It is recommended that these codelists be used to identify hypertension in EHRs using SNOMED CT codes.

Conclusions

Less than one-third of hypertension studies using EHRs included their codelists. Transparent methodology for codelist creation is essential for replication and will aid interpretation of study findings. We created SNOMED CT codelists to support and standardise hypertension definitions in EHR studies.
Advance care planning in British Columbia: awareness and engagement (2012–2020)
Authors: Carter Rachel Zoe , Hassan Eman , Barwich Doris
Published: April 2024

Objectives

This study examines trends in advance care planning (ACP) awareness, engagement, attitude and experiences among the public in British Columbia (BC), Canada, from 2012 to 2020. This time period is of relevance as it includes provincial education initiatives. We also explored demographic characteristics associated with lower ACP awareness and engagement, to inform future initiatives.

Methods

Longitudinal data from two provincial polls in 2016 and 2020, along with BC-specific data extracted from a national poll in 2012, were analysed to investigate ACP awareness, engagement and attitudes. Demographic characteristics associated with ACP were examined using binomial and ordinal logistic regression.

Results

We observed an increase in awareness of ACP between 2012 and 2020 (from 15.2% to 32.9%). A significant rise in engagement was also observed, with more respondents reporting ACP conversations with healthcare providers between 2016 and 2020 (8.8%–14%) and documenting their healthcare wishes since 2012 (11.6%–28.0%). Demographic analysis revealed that older, female and more educated individuals were more likely to participate in ACP activities.

Conclusions

This study highlights positive trends in ACP awareness and engagement in BC over the study period. Despite lower rates in some variables, the observed increases suggest increasing awareness over time, with potential for further improvement. However, disparities persist among different demographic groups, highlighting the need for targeted efforts to improve ACP knowledge and participation, especially among younger adults, males, single individuals and those with lower education levels.
A polyphenol-rich cranberry supplement improves muscle oxidative capacity in healthy adults
Authors: Parenteau Francis , Denis Antoine , Roberts Mary , Comtois Alain Steve , Bergdahl Andreas
Published: April 2024

Cranberries are rich in polyphenols, have a high antioxidant capacity, and may protect against exercise-induced free radical production. Mitochondria are known producers of free radical in skeletal muscle, and preventing overproduction of radicals may be a viable approach to improve muscle health. This study aimed to investigate the effect of a polyphenol-rich cranberry extract (CE) on muscle oxidative capacity and oxygenation metrics in healthy active adults. 17 participants (9 males and 8 females) were tested at: (i) baseline, (ii) 2 h following an acute CE dose (0.7 g/kg of body mass), and (iii) after 4 weeks of daily supplement consumption (0.3 g/kg of body mass). At each time point, muscle oxidative capacity was determined using near-infrared spectroscopy to measure the recovery kinetics of muscle oxygen consumption following a 15–20 s contraction of the vastus lateralis. Cranberry supplementation over 28 days significantly improved muscle oxidative capacity (k-constant, 2.8 ± 1.8 vs. 3.9 ± 2.2; p = 0.02). This was supported by a greater rate of oxygen depletion during a sustained cuff occlusion (−0.04 ± 0.02 vs. −0.07 ± 0.03; p = 0.02). Resting muscle oxygen consumption was not affected by cranberry consumption. Our results suggest that cranberry supplementation may play a role in improving mitochondrial health, which could lead to better muscle oxidative capacity in healthy active adult populations.
Assessing the influence of climate on the growth of green ash trees from five Plant Hardiness Zones growing in a range-wide provenance test near the species’ northern range limit
Authors: Schaberg Paul G. , Murakami Paula F. , Hansen Christopher F. , Hawley Gary J.
Published: April 2024

Green ash is threatened with extirpation from emerald ash borer (EAB) attack. Because green ash has an extensive range, its restoration could require both breeding for EAB resistance and possible adaptation to a variety of environmental gradients. We assessed the growth and climate sensitivity of green ash from five Plant Hardiness Zones (PHZs) growing in a range-wide provenance test in Vermont. Although there tended to be greater growth among trees from the warmest PHZ (7), differences were rarely statistically distinguishable. For trees from all PHZs, growth was positively correlated with precipitation in the current year and negatively correlated with precipitation the year before (a possible legacy effect). Growth was negatively associated with temperature the year of ring formation but positively associated with temperatures the year before. Growth was often positively correlated with winter snow but was negatively associated with spring or fall snow for the warmest PHZs. Climate correlations for PHZ 3 were unusual in that (1) only positive correlations were detected, (2) no legacy effects were noted, and (3) despite being from the coldest region, no correlations with snow were found. Growth increased over time for the warmest PHZs during a period of simultaneous increases in temperature and precipitation.
Multiple mixed solutions of the nonlocal sine-Gordon equation
Authors: Li Jian , Duan Junsheng , Li Yan , Li Chuanzhong
Published: April 2024

In this paper, we propose the nonlocal sine-Gordon equation from the AKNS system by the Parity and the Time symmetries. Moreover, the main work is to construct the Darboux transformation for the nonlocal sine-Gordon equation. In particular, various types of solutions are obtained by taking a seed solution, such as, soliton solutions, kink solutions, mixed solutions.
Search for the anomalous ZZZ and $$ZZ\gamma $$ gauge couplings through the process $$e^+e^- \rightarrow ZZ $$ with unpolarized and polarized beams
Authors: Cetinkaya V. , Spor S. , Gurkanli E. , Köksal M.
Published: April 2024

This work offers the constraints on the anomalous neutral triple gauge couplings for the process $$e^+e^- \rightarrow ZZ $$

e
+

e
-

→
Z
Z

at the CLIC with $$\sqrt{s}=3$$

s

=
3

TeV. The realistic CLIC detector environments and their effects are considered in our analysis. The study is planned for the decays of produced Z bosons to a pair of charged leptons (electrons or muons) and neutrino pairs. The bounds on the anomalous neutral triple gauge couplings defining CP-violating $$C_{\widetilde{B}W}/{\Lambda ^4}$$

C

B
~

W

/

Λ
4

coupling and three CP-conserving $$C_{WW}/{\Lambda ^4}$$

C

WW

/

Λ
4

, $$C_{BW}/{\Lambda ^4}$$

C

BW

/

Λ
4

, and $$C_{BB}/{\Lambda ^4}$$

C

BB

/

Λ
4

couplings are obtained. Also, the effects and advantages of polarization for incoming electron beams in these calculations are investigated.