bluuebunny/crossref_metadata_2025 huggingface dataset:
The impact of diabetes on young transplant recipients: An American perspective
Authors: Loera Jackquelin M. , Barrett Spencer C. , Zhang Theodore S. , Anand Adrish , Awan Ahmed A. Y. , Murthy Bhamidipati V. R. , O'Mahony Christine A. , Goss John A. , Rana Abbas A.
Published: January 2022

Despite advancements in diabetic care, diabetic kidney transplant recipients have significantly worse outcomes than non‐diabetics.

Aim

Our study aims to demonstrate the impact of diabetes, types I and II, on American young adults (18–40 years old) requiring kidney transplantation.

Methods

Using the United Network for Organ Sharing database, we conducted a population cohort study that included all first‐time, kidney‐only transplant recipients during 2002–2019, ages 18–40 years old. Patients were grouped according to indication for transplant. Primary outcomes were cumulative all‐cause mortality and death‐censored graft failure. Death‐censored graft failure and patient survival at 1, 5, and 10 years were calculated via the Kaplan–Meier method. Multivariate Cox regression was used to assess for potential confounders.

Results

Of 42 466 transplant recipients, 3418 (8.1%) had end‐stage kidney disease associated with diabetes. At each time‐point, cumulative mortality was higher in diabetics compared to patients with non‐diabetic causes of renal failure. Conversely, cumulative graft failure was similar between the groups. Adjusted hazard ratios for all‐cause mortality and graft failure in diabetics were 2.99 (95% CI 2.67–3.35; p < .01) and 0.98 (95% CI 0.92–1.05, p < .01), respectively.

Conclusion

Diabetes mellitus in young adult kidney transplant recipients is associated with a nearly three‐fold increase in mortality, reflecting a relatively vulnerable patient population. Identifying the underlying causes of poor outcomes in this population should be a priority for future study.
Diversity and Inclusion Favoritism: Creating Distributive Injustices That Erode Organizational Identity
Authors: Fuller LaJuan Perronoski
Published: January 2022

Diversity and inclusion concepts remain unclear, which has generated an explosion of new viewpoints to pursue distributive justice. These variations suggest the need for a criterion to recognize partiality or prejudices in diversity and inclusion practices. This study applies the social identity approach to investigate the impact of diversity and inclusion distributive injustices on an employee’s organizational identity. Research on perceived employee distributive injustice (PEDI) suggests organizations that favor a person's social categorization or identity may more likely create unfair compensations and incentive biases. This study hypothesizes that distributive injustices can recognize diversity and inclusion practices that negatively affect an employee’s organizational identity. The study consists of 451 full-time US employees. A Cronbach's alpha coefficient for distributive injustice is .94, and organizational identity is .92. The findings confirm that leaders and HR professionals who implement diversity and inclusion practices that favor a social characteristic or identity will erode organizational identity.
Effect of Long-Term Classical Ballet Dance Training on Postactivation Depression of the Soleus Hoffmann-Reflex
Authors: Obata Hiroki , Kim GeeHee , Ogawa Tetsuya , Sekiguchi Hirofumi , Nakazawa Kimitaka
Published: January 2022

Classical ballet dancing is a good model for studying the long-term activity-dependent plasticity of the central nervous system in humans, as it requires unique ankle movements to maintain ballet postures. The purpose of this study was to investigate whether postactivation depression is changed through long-term specific motor training. Eight ballet dancers and eight sedentary subjects participated in this study. The soleus Hoffmann reflexes were elicited at after the completion of a slow, passive dorsiflexion of the ankle. The results demonstrated that the depression of the soleus Hoffmann reflex (i.e., postactivation depression) was larger in classical ballet dancers than in sedentary subjects at two poststretch intervals. This suggests that the plastic change through long-term specific motor training is also expressed in postactivation depression of the soleus Hoffmann reflex. Increased postactivation depression would strengthen the supraspinal control of the plantarflexors and may contribute to fine ankle movements in classical ballet dancers.
A versatile and robust cell purification system with an RNA-only circuit composed of microRNA-responsive ON and OFF switches
Authors: Fujita Yoshihiko , Hirosawa Moe , Hayashi Karin , Hatani Takeshi , Yoshida Yoshinori , Yamamoto Takuya , Saito Hirohide
Published: January 2022

MicroRNA-responsive ON and OFF switches provide a safe and time-saving method for purifying a wide range of cell types.
Giant and bidirectionally tunable thermopower in nonaqueous ionogels enabled by selective ion doping
Authors: Liu Sijing , Yang Yuewang , Huang He , Zheng Jiongzhi , Liu Gongze , To Tsz Ho , Huang Baoling
Published: January 2022

The giant thermopower of an ionic liquid–based ionogel can be tuned within an ultrawide range by selective ion doping.
Dynamic detection and reversal of myocardial ischemia using an artificially intelligent bioelectronic medicine
Authors: Ganzer Patrick D. , Loeian Masoud S. , Roof Steve R. , Teng Bunyen , Lin Luan , Friedenberg David A. , Baumgart Ian W. , Meyers Eric C. , Chun Keum S. , Rich Adam , Tsao Allison L. , Muir William W. , Weber Doug J. , Hamlin Robert L.
Published: January 2022

Potentially damaging “heart stress” is reversed using reactive nerve stimulation controlled by artificial intelligence.
Calcineurin and huntingtin form a calcium-sensing machinery that directs neurotrophic signals to the nucleus
Authors: Scaramuzzino Chiara , Cuoc Emeline C. , Pla Patrick , Humbert Sandrine , Saudou Frédéric
Published: January 2022

Neurotrophin-bearing endosomes respond to local calcium concentrations to self-direct long-range retrograde transport.
Wearable aptamer-field-effect transistor sensing system for noninvasive cortisol monitoring
Authors: Wang Bo , Zhao Chuanzhen , Wang Zhaoqing , Yang Kyung-Ae , Cheng Xuanbing , Liu Wenfei , Yu Wenzhuo , Lin Shuyu , Zhao Yichao , Cheung Kevin M. , Lin Haisong , Hojaiji Hannaneh , Weiss Paul S. , Stojanović Milan N. , Tomiyama A. Janet , Andrews Anne M. , Emaminejad Sam
Published: January 2022

A smartwatch was developed for noninvasive stress biomarker data acquisition that provides real-time feedback to the wearer.
High-throughput and high-content bioassay enables tuning of polyester nanoparticles for cellular uptake, endosomal escape, and systemic in vivo delivery of mRNA
Authors: Rui Yuan , Wilson David R. , Tzeng Stephany Y. , Yamagata Hannah M. , Sudhakar Deepti , Conge Marranne , Berlinicke Cynthia A. , Zack Donald J. , Tuesca Anthony , Green Jordan J.
Published: January 2022

Quantitative bioassay enables the development of next-generation biodegradable polymeric nanoparticles for in vivo mRNA delivery.
A Li
2
S-based all-solid-state battery with high energy and superior safety
Authors: Liu Yuzhao , Meng Xiangyu , Wang Zhiyu , Qiu Jieshan
Published: January 2022

Safe redox chemistry of Li2S and Si in solid-state polymer electrolyte enables a high-energy and reliable all-solid-state battery.
All-in-one flexible supercapacitor with ultrastable performance under extreme load
Authors: Na You Wan , Cheon Jae Yeong , Kim Jae Ho , Jung Yeonsu , Lee Kyunbae , Park Jae Seo , Park Ji Yong , Song Ki Su , Lee Sang Bok , Kim Taehoon , Yang Seung Jae
Published: January 2022

All-in-one hybrid composite fiber integrates ultrahigh energy storage performance and superior mechanical stability.
A Sensitive and Rapid Wastewater Test for SARS-COV-2 and Its Use for the Early Detection of a Cluster of Cases in a Remote Community
Authors: Daigle Jade , Racher Kathleen , Hazenberg Justin , Yeoman Allan , Hannah Heather , Duong Diep , Mohammed Umar , Spreitzer Dave , Gregorchuk Branden S. J. , Head Breanne M. , Meyers Adrienne F. A. , Sandstrom Paul A. , Nichani Anil , Brooks James I. , Mulvey Michael R. , Mangat Chand S. , Becker Michael G.
Published: January 2022

Wastewater-based surveillance is a powerful tool that provides an unbiased measure of COVID-19 prevalence in a community. This work describes a sensitive wastewater rapid test for SARS-CoV-2 based on a widely distributed technology, the GeneXpert.
Development of Common Leaf-Footed Bug Pests Depends on the Presence and Identity of Their Environmentally Acquired Symbionts
Authors: Hunter Martha S. , Umanzor Edwin F. , Kelly Suzanne E. , Whitaker Shaira Marie , Ravenscraft Alison
Published: January 2022

Leptoglossus zonatus
and
L. phyllopus
are important polyphagous pests, and both species have been well-studied but generally without regard to their dependance on a bacterial symbiont. Our results indicate that the central role of
Burkholderia
in the biology of these insects, as well as in other leaf-footed bugs, should be considered in future studies of coreid life history, ecology, and pest management.
Nanobody-Functionalized Cellulose for Capturing SARS-CoV-2
Authors: Sun Xin , Yang Shaobo , Al-Dossary Amal A. , Broitman Shana , Ni Yun , Guan Ming , Yang Mengdi , Li Jiahe
Published: January 2022

The ongoing efforts to address the COVID-19 pandemic center around the development of diagnostics, preventative measures, and therapeutic strategies. In comparison to existing work, we have provided a complementary strategy to capture SARS-CoV-2 by functionalized cellulose materials through paper-based diagnostics as well as virus filtration in perishable samples.
Host Contributions to the Force of Borrelia burgdorferi and Babesia microti Transmission Differ at Edges of and within a Small Habitat Patch
Authors: Goethert Heidi K. , Telford Sam R.
Published: January 2022

Habitat fragmentation is thought to be a main factor in the emergence of Lyme disease and other deer tick-transmitted infections. The patchwork of forest and edges promotes altered biodiversity, favoring the abundance of generalist rodents, such as white footed mice, heretofore considered a key tick and reservoir host in the northeastern United States.
Tools for Detecting a “Superbug”: Updates on Candida auris Testing
Authors: Lockhart Shawn R. , Lyman Meghan M. , Sexton D. Joseph
Published: January 2022

Candida auris
is an emerging yeast species that has the unique characteristics of patient skin colonization and rapid transmission within health care facilities and the ability to rapidly develop antifungal resistance. When
C. auris
first started to appear in clinical microbiology laboratories, it could be identified only by using DNA sequencing.
Combination of Mycological Criteria: a Better Surrogate to Identify COVID-19-Associated Pulmonary Aspergillosis Patients and Evaluate Prognosis?
Authors: Dellière Sarah , Dudoignon Emmanuel , Voicu Sébastian , Collet Magalie , Fodil Sofiane , Plaud Benoit , Chousterman Benjamin , Bretagne Stéphane , Azoulay Elie , Mebazaa Alexandre , Dépret François , Mégarbane Bruno , Alanio Alexandre
Published: January 2022

Diagnosis of coronavirus disease 2019 (COVID-19)-associated pulmonary aspergillosis (CAPA) remains unclear especially in nonimmunocompromised patients. The aim of this study was to evaluate seven mycological criteria and their combination in a large homogenous cohort of patients.
Dengue Virus NS1 Uses Scavenger Receptor B1 as a Cell Receptor in Cultured Cells
Authors: Alcalá Ana C. , Maravillas José L. , Meza David , Ramirez Octavio T. , Ludert Juan E. , Palomares Laura A.
Published: January 2022

Dengue is the most common viral disease transmitted to humans by mosquitoes. The dengue virus NS1 is a multifunctional glycoprotein necessary for viral replication.
A Pseudorabies Virus Serine/Threonine Kinase, US3, Promotes Retrograde Transport in Axons via Akt/mToRC1
Authors: Esteves Andrew D. , Koyuncu Orkide O. , Enquist Lynn W.
Published: January 2022

Neurons are highly polarized cells with axons that can reach centimeters in length. Communication between axons at the periphery and the distant cell body is a relatively slow process involving the active transport of chemical messengers.
Antiviral CD19+CD27+Memory B Cells Are Associated with Protection from Recurrent Asymptomatic Ocular Herpesvirus Infection
Authors: Dhanushkodi Nisha R. , Prakash Swayam , Srivastava Ruchi , Coulon Pierre-Gregoire A. , Arellano Danielle , Kapadia Rayomand V. , Fahim Raian , Suzer Berfin , Jamal Leila , Vahed Hawa , BenMohamed Lbachir
Published: January 2022

Reactivation of herpes simplex virus 1 (HSV-1) from latently infected neurons of the trigeminal ganglia (TG) leads to blinding recurrent herpetic disease in symptomatic (SYMP) individuals. Although the role of T cells in herpes immunity against blinding recurrent herpetic disease is heavily explored, the role of B cells is less investigated.
Enterovirus 71 Activates GADD34 via Precursor 3CD to Promote IRES-Mediated Viral Translation
Authors: Li Hui , Li Wenqian , Zhang Shuangling , Qiu Manman , Li Zhuoran , Lin Yongquan , Tan Juan , Qiao Wentao
Published: January 2022

Identification of host factors involved in viral replication is an important approach in discovering viral pathogenic mechanisms and identifying potential therapeutic targets. Previously, we screened host proteins that were upregulated by EV71 infection.
Characterization of the O-Glycoproteome of Porphyromonas gingivalis
Authors: Veith Paul D. , Shoji Mikio , Scott Nichollas E. , Reynolds Eric C.
Published: January 2022

Porphyromonas gingivalis
is an oral pathogen primarily associated with severe periodontal disease and further associated with rheumatoid arthritis, dementia, cardiovascular disease, and certain cancers. Protein glycosylation can be important for a variety of reasons including protein function, solubility, protease resistance, and thermodynamic stability.
Specific Strains of Honeybee Gut
Lactobacillus
Stimulate Host Immune System to Protect against Pathogenic Hafnia alvei
Authors: Lang Haoyu , Duan Huijuan , Wang Jieni , Zhang Wenhao , Guo Jun , Zhang Xue , Hu Xiaosong , Zheng Hao
Published: January 2022

Honeybees are essential pollinators supporting global agricultural economies and food supplies. Recent honeybee decline has been linked to several factors, while pathogen infection is considered one of the most significant contributing factors.
Geochronology and geochemistry of the Huntington Formation, Olds Ferry terrane, Blue Mountains province, northern U.S. Cordillera: Implications for accreted terrane correlation and assembly
Authors: Ware Bryant , Tumpane Kyle P. , Kurz Gene A. , Schmitz Mark D. , Northrup Clyde J.
Published: January 2022

The Olds Ferry terrane is the more inboard of two accreted volcanic arc terranes in the late Paleozoic–early Mesozoic Blue Mountains province of the northern U.S. Cordillera. We present geologic, geochronologic, and geochemical data from the volcano-sedimentary Huntington Formation of the Olds Ferry arc that place the terrane within a firm temporal and tectonomagmatic context, and establish its identity as a fringing arc terrane along the Triassic to Early Jurassic Cordilleran margin. The Huntington Formation is divided into two unconformity-bounded informal members: a Norian (ca. 220 Ma) lower member comprising a sequence of mafic-intermediate volcanics, massive volcaniclastic breccias, and minor carbonates deposited unconformably onto the 237.7 Ma Brownlee pluton and intruded by the 210.0 Ma Iron Mountain pluton; and a Rhaetian through Pleinsbachian (<210–187.0 Ma) upper member composed of massive conglomerates, abundant rhyodacite to rhyolite effusive and pyroclastic flows, and interlayered sandstone turbidites, deposited with angular unconformity onto the lower member. An erosional hiatus and regional tilting produced an angular unconformity separating the Huntington Formation from the overlying basal conglomerates of the late Early to Middle Jurassic Weatherby Formation of the Izee forearc basin transgressive onlap sequence. Huntington Formation volcanic rocks are isotopically enriched relative to depleted mantle and coeval igneous rocks in the outboard Wallowa terrane. A temporal evolution to more radiogenic 87Sr/86Sr ratios (0.7036–0.7057) and εNd values (+5.4 to +3.1) in the upper member volcanics suggests increasing involvement of continental-derived material in their petrogenesis. Precambrian xenocrystic zircons in both lower and upper member volcaniclastic rocks strongly support a proximal location of the Olds Ferry terrane to cratonal North America during much of its history. The chronology and tectonostratigraphic architecture of the Olds Ferry terrane allows its robust correlation to other fringing-arc terranes along the U.S. and Canadian Cordillera.
Are fluid inclusions in gypsum reliable paleoenvironmental indicators? An assessment of the evidence from the Messinian evaporites
Authors: Bigi D. , Lugli S. , Manzi V. , Roveri M.
Published: January 2022

The paleosalinity of water from which the gypsum precipitated during the Messinian salinity crisis is a controversial issue. Recent microthermometry studies on primary fluid inclusions in gypsum provided very low salinity values not compatible with precipitation from seawater, and suggested strong mixing between seawater and nonmarine waters enriched in calcium sulfate. We applied a new microthermometric protocol on gypsum crystals from nine Mediterranean sections that were experimentally stretched to measure a larger population of fluid inclusions. The results show salinities ranging from 9 to 238 wt‰ NaCl equivalent, largely falling within the evaporation path of normal seawater. The data from previous studies were obtained mostly from those fluid inclusions capable of nucleating a stable bubble after a weak stretching, which probably correspond to those having a lower salinity acquired through post-depositional crack-and-seal processes. Our data suggest instead that the primary gypsum precipitated from a marine brine, later modified by post-trapping processes during tectonics and exhumation.
Multi-proxy evidence of Caribbean-sourced marine incursions in the Neogene of Western Amazonia, Brazil
Authors: Leandro Lilian M. , Linhares Ana P. , De Lira Mota Marcelo A. , Fauth Gerson , Santos Alessandra , Villegas-Martín Jorge , Vieira Carlos E.L. , Bruno Mauro D.R. , Lee Bridget , Baecker-Fauth Simone , Lopes Fernando M. , Ramos Maria I.F.
Published: January 2022

The timing of continental-scale marine flooding events in Western Amazonia during the Neogene is still an unsolved question. Despite broad proxy-based evidence of such events, the pathways and duration of late Miocene marine incursions remain controversial. We provide coupled calcareous and organic microfossil and geochemical data from six onshore cores from Neogene sequences of the Solimões Basin, Brazil. Our records support minor marine influence in the early Miocene (23.0, 21.1, 18.6, and 16.3 Ma), middle Miocene (14.9, 13.7, and 12.9 Ma) and early Pliocene (4.7, 4.2–4.1, and 3.8 Ma), and conspicuous marine incursions in the late Miocene (11.1–8.8 Ma) suggested by the consistent presence of salinity-indicative microfossils and geochemical data. Our findings challenge the view of major marine incursions in the early and middle Miocene in the studied area. We propose for the first time a new late Miocene incursion (LMI) event as the main marine flooding event in Western Amazonia during the Neogene. These onshore records are compared with three offshore cores from the Atlantic and Pacific Oceans. The similarity between microfossil assemblages of the Solimões Basin and the Caribbean Sea, and evidence of increased runoff from the Orinoco river drainage system, strongly suggest the Caribbean Sea as the primary source area of the marine incursions, supporting a Venezuelan seaway. We further show for the first time the potential linkage between Neogene marine incursions (mainly the LMI) into the Solimões Basin and major disturbances in the global carbon cycle.
Experimental evidence on the origin of Ca-rich carbonated melts formed by interaction between sedimentary limestones and mantle-derived ultrabasic magmas
Authors: Lustrino Michele , Luciani Natascia , Stagno Vincenzo , Narzisi Silvia , Masotta Matteo , Scarlato Piergiorgio
Published: January 2022

In this experimental study, we documented the formation of strongly ultrabasic and ultracalcic melts through the interaction of melilititic and basanitic melts with calcite. Three strongly to moderately SiO2-undersaturated volcanic rocks from the Bohemian Massif (central Europe) were mixed with 10, 30, and 50 wt% CaCO3 and melted at 1100, 1200, and 1300 °C at 2 kbar to evaluate the maximum amount of carbonate that can be assimilated by natural ultrabasic melts at shallow depths. Experiments revealed a surprisingly complete dissolution of the CaCO3, only rarely reaching carbonate saturation, with typical liquidus phases represented by olivine, spinel, melilite, and clinopyroxene. Only in the runs with the most SiO2-undersaturated compositions did abundant monticellite form instead of clinopyroxene. For all starting mixtures, strongly ultrabasic (SiO2 down to 15.6 wt%), lime-rich (CaO up to 43.6 wt%), ultracalcic (CaO/Al2O3 up to ~27) melt compositions were produced at 1200 and 1300 °C, with up to ~25 wt% dissolved CO2. When present, quenched olivine showed much higher forsterite content (Fo95–97) than olivine in the natural samples (Fo79–85). The two major results of this study are (1) silicate-carbonatite melt compositions do not necessarily imply the existence of carbonatitic components in the mantle, because they are also produced during limestone assimilation, and (2) Fo-rich olivines cannot be used to infer any primitive character of the melt nor high potential temperature (Tp).
Metformin in pregnancy and risk of adverse long-term outcomes: a register-based cohort study
Authors: Brand Kerstin M G , Saarelainen Laura , Sonajalg Jaak , Boutmy Emmanuelle , Foch Caroline , Vääräsmäki Marja , Morin-Papunen Laure , Schlachter Judith ,   CLUE Study Group, Hakkarainen Katja M , Korhonen Pasi
Published: January 2022

Introduction

This study aimed to investigate if maternal pregnancy exposure to metformin is associated with increased risk of long-term and short-term adverse outcomes in the child.

Research design and methods 

This register-based cohort study from Finland included singleton children born 2004–2016 with maternal pregnancy exposure to metformin or insulin (excluding maternal type 1 diabetes): metformin only (n=3967), insulin only (n=5273) and combination treatment (metformin and insulin; n=889). The primary outcomes were long-term offspring obesity, hypoglycemia, hyperglycemia, diabetes, hypertension, polycystic ovary syndrome, and challenges in motor–social development. In a sensitivity analysis, the primary outcomes were investigated only among children with maternal gestational diabetes. Secondary outcomes were adverse outcomes at birth. Analyses were conducted using inverse- probability of treatment weighting (IPTW), with insulin as reference.

Results  

Exposure to metformin or combination treatment versus insulin was not associated with increased risk of long-term outcomes in the main or sensitivity analyses. Among the secondary outcomes, increased risk of small for gestational age (SGA) was observed for metformin (IPTW-weighted OR 1.65, 95% CI 1.16 to 2.34); increased risk of large for gestational age, preterm birth and hypoglycemia was observed for combination treatment. No increased risk was observed for neonatal mortality, hyperglycemia, or major congenital anomalies.

Conclusions 

This study found no increased long-term risk associated with pregnancy exposure to metformin (alone or in combination with insulin), compared with insulin. The increased risk of SGA associated with metformin versus insulin suggests caution in pregnancies with at-risk fetal undernutrition. The increased risks of adverse outcomes at birth associated with combination treatment may reflect confounding by indication or severity.
Predictors of arterial stiffness in adolescents and adults with type 1 diabetes: a cross-sectional study
Authors: Love Kaitlin M , Horton William B , Patrie James T , Jahn Linda A , Hartline Lee M , Barrett Eugene J
Published: January 2022

Introduction

Individuals with type 1 diabetes have increased arterial stiffness compared with age-matched healthy controls. Our aim was to determine which hemodynamic and demographic factors predict arterial stiffness in this population.

Research design and methods

Carotid-femoral pulse wave velocity (cfPWV) was examined in 41 young adults and adolescents with type 1 diabetes without microvascular complications. Two ordinary least squares regression analyses were performed to determine multivariate relationships between cfPWV (loge) and (1) age, duration of diabetes, sex, and hemoglobin A1c and (2) augmentation index (AIx), mean arterial pressure, flow-mediated dilation (FMD), and heart rate. We also examined differences in macrovascular outcome measures between sexes.

Results

Age, sex, and FMD provided unique predictive information about cfPWV in these participants with type 1 diabetes. Despite having similar cardiovascular risk factors, men had higher cfPWV compared with women but no differences were observed in other macrovascular outcomes (including FMD and AIx).

Conclusions

Only age, sex, and FMD were uniquely associated with arterial stiffness in adolescents and adults with uncomplicated type 1 diabetes. Women had less arterial stiffness and similar nitric oxide-dependent endothelial function compared with men. Larger, prospective investigation is warranted to determine the temporal order of and sex differences in arterial dysfunction in type 1 diabetes.
Innovative, enhanced community management of non-hypoxaemic chest-indrawing pneumonia in 2–59-month-old children: a cluster-randomised trial in Africa and Asia
Authors:   EMPIC Study Group
Published: January 2022

Introduction

The WHO recommends oral amoxicillin for 2–59-month-old children with chest-indrawing pneumonia presenting at the health facility. Community-level health workers (CLHWs) are not allowed to treat these children when presented at the community level. This study aimed to evaluate whether CLHWs can safely and effectively treat children 2–59 months-old with chest indrawing with a 5-day course of oral amoxicillin in a few selected countries in Africa and Asia, especially when a referral is not feasible.

Methods

We conducted a prospective multicountry cluster-randomised, open-label, non-inferiority trial in rural areas of four countries (Bangladesh, Ethiopia, India and Malawi) from September 2016 to December 2018. Children aged 2–59 months having parents/caregivers reported cough and/or difficult breathing presenting to a CLHW were screened for enrolment. CLHWs in the intervention clusters assessed children for hypoxaemia and treated non-hypoxaemic chest-indrawing pneumonia with two times per day oral amoxicillin (50 mg/kg body weight per dose) for 5 days at the community level. CLHWs in the control clusters identified chest indrawing and referred them to a referral-level health facility for treatment. Study supervisors performed pulse oximetry in the control clusters except in Bangladesh. Children were assessed for the primary outcome (clinical treatment failure) up to day 14 after enrolment. The accuracy and impact of pulse oximetry by CLHWs in the intervention clusters were also assessed.

Results

In 208 clusters, 1688 CLHWs assessed 62 363 children with cough and/or difficulty breathing. Of these, 4013 non-hypoxaemic 2–59-month-old children with chest-indrawing pneumonia were enrolled. We excluded 116 children from analysis, leaving 3897 for intention-to-treat analysis. In the intervention clusters, 4.3% (90/2081) failed treatment, including five deaths, while in the control clusters, 4.4% (79/1816) failed treatment, including five deaths. The adjusted risk difference was -0.01 (95% CI −1.5% to 1.5%), which satisfied the prespecified non-inferiority criterion. CLHWs correctly performed pulse oximetry in 91.1% (2001/2196) of cases in the intervention clusters.

Conclusions

The community treatment of non-hypoxaemic children with chest-indrawing pneumonia with 5-day oral amoxicillin by trained, equipped and supervised CLHWs is non-inferior to currently recommended facility-based treatment. These findings encourage a review of the existing strategy of community-based management of pneumonia.

Trial registration

ACTRN12617000857303; The Australian New Zealand Clinical Trials Registry.
Characteristics and impacts of nutritional programmes to address undernutrition of adults living with HIV in sub-Saharan Africa: a systematic review of evidence
Authors: Tesfay Fisaha Haile , Javanparast Sara , Gesesew Hailay , Mwanri Lillian , Ziersch Anna
Published: January 2022

Objectives

Although some studies have identified various challenges affecting nutritional programmes to effectively tackle undernutrition among people living with HIV, evidence about the characteristics and impacts of these programmes on weight-related nutritional outcomes varies based on country contexts, specific programme goals and the implementation processes. This systematic review sought to synthesise evidence on the characteristics and impact of nutritional programmes on weight-related nutritional outcomes of people living with HIV in sub-Saharan Africa.

Design

Systematic review.

Data sources

We searched for primary studies published in the following databases: Web of Science, Medline, Scopus, ScienceDirect, ProQuest and Google Scholar, supplemented by checking reference lists of included papers.

Eligibility criteria

Studies published from 2005 to 10 July 2020 and reporting on the weight-related nutritional outcomes of undernourished people enrolled in nutritional programmes in HIV care in sub-Saharan Africa were included.

Data extraction and synthesis

Data were extracted using a data extraction proforma. Weight-related nutritional outcomes of people living with HIV before and after enrolment in a nutritional programme were compared and narratively synthesised.

Results

Sixteen studies assessing the impact of nutritional programmes in HIV care on weight-related nutritional outcomes were included. Of these, 13 examined nutritional programmes implemented in health facilities and the remaining three were delivered outside of health facilities. Nutritional recovery (defined differently in the studies) ranged from 13.1% to 67.9%. Overall programme failure rate, which included default after enrolment in a nutritional programme or non-response, ranged from 37.6% to 48.0%. More specifically, non-response to a nutritional programme ranged from 21.0% to 67.4% and default from the programme ranged from 19.0% to 70.6%. Key sociodemographic, clinical and nutritional characteristics that affect nutritional recovery, non-response and default were also identified.

Conclusions and recommendations

Nutritional programmes in HIV care have led to some improvements in weight-related nutritional outcomes among people living with HIV. However, the programmes were characterised by a high magnitude of default and non-response. To improve desired weight-related nutritional outcomes of people living with HIV, a holistic approach that addresses longer-term determinants of undernutrition is needed.

PROSPERO registration number

CRD42020196827.
Marijuana smoking and asthma: a protocol for a meta-analysis
Authors: Lei Jincheng , Shao Mingjie
Published: January 2022

Introduction

Recent studies have raised the concern on the risk of asthma in marijuana smokers; however, the results remain controversial and warrant further investigation. With a growing number of marijuana smokers, examining the association between marijuana smoking and asthma and quantifying such association through meta-analysis have important implications for public health and clinical decision-making. In view of this, the present protocol aims to detail a comprehensive plan of meta-analysis on the association aforementioned. The findings are expected to strengthen the current knowledge base pertaining to the potential adverse effects of marijuana smoking on pulmonary health and to facilitate the development of prevention strategies for asthma.

Methods and analysis

The MEDLINE/PubMed, Web of Science and EMBASE databases will be searched systematically from inception to 1 September 2021 to retrieve the relevant observational studies focusing on the association between marijuana smoking and asthma. Both unadjusted and adjusted effect sizes, such as OR, relative risk, HR and the corresponding 95% CIs will be extracted for pooled analyses. Heterogeneity and publication bias across the included studies will be examined. The Newcastle-Ottawa Quality Scale will be used to assess the quality and risk of bias. Statistical software Review Manager V.5.3 and Stata V.11.0 will be used for statistical analyses.

Ethics and dissemination

Since no private and confidential patient data will be included in the reporting, approval from an ethics committee is not required. The results will be published in a peer-reviewed journal or disseminated in the relevant conferences. The study raises no ethical issue.

OSF registration number

10.17605/OSF.IO/UPTXC.
Characterising activity and diet compositions for dementia prevention: protocol for the ACTIVate prospective longitudinal cohort study
Authors: Smith Ashleigh E , Wade Alexandra T , Olds Timothy , Dumuid Dorothea , Breakspear Michael J , Laver Kate , Goldsworthy Mitchell R , Ridding Michael C , Fabiani Monica , Dorrian Jillian , Hunter Montana , Paton Bryan , Abdolhoseini Mahmoud , Aziz Fayeem , Mellow Maddison L , Collins Clare , Murphy Karen J , Gratton Gabriele , Keage Hannah , Smith Ross T , Karayanidis Frini
Published: January 2022

Introduction

Approximately 40% of late-life dementia may be prevented by addressing modifiable risk factors, including physical activity and diet. Yet, it is currently unknown how multiple lifestyle factors interact to influence cognition. The ACTIVate Study aims to (1) explore associations between 24-hour time-use and diet compositions with changes in cognition and brain function; and (2) identify duration of time-use behaviours and the dietary compositions to optimise cognition and brain function.

Methods and analysis

This 3-year prospective longitudinal cohort study will recruit 448 adults aged 60–70 years across Adelaide and Newcastle, Australia. Time-use data will be collected through wrist-worn activity monitors and the Multimedia Activity Recall for Children and Adults. Dietary intake will be assessed using the Australian Eating Survey food frequency questionnaire. The primary outcome will be cognitive function, assessed using the Addenbrooke’s Cognitive Examination-III. Secondary outcomes include structural and functional brain measures using MRI, cerebral arterial pulse measured with diffuse optical tomography, neuroplasticity using simultaneous transcranial magnetic stimulation and electroencephalography, and electrophysiological markers of cognitive control using event-related potential and time frequency analyses. Compositional data analysis, testing for interactions between time point and compositions, will assess longitudinal associations between dependent (cognition, brain function) and independent (time-use and diet compositions) variables.

Conclusions

The ACTIVate Study will be the first to examine associations between time-use and diet compositions, cognition and brain function. Our findings will inform new avenues for multidomain interventions that may more effectively account for the co-dependence between activity and diet behaviours for dementia prevention.

Ethics and dissemination

Ethics approval has been obtained from the University of South Australia’s Human Research Ethics committee (202639). Findings will be disseminated through peer-reviewed manuscripts, conference presentations, targeted media releases and community engagement events.

Trial registration number

Australia New Zealand Clinical Trials Registry (ACTRN12619001659190).
Impacts of COVID-19 and SARS-CoV-2 on male reproductive function: a systematic review and meta-analysis protocol
Authors: Li Xinyun , Lu Hua , Li Fangyuan , Zhang Qi , Wang Tong , Qiang Lingxia , Yang Qian
Published: January 2022

Introduction

COVID-19 pandemic caused by SARS-CoV-2 has become a global health challenge. SARS-CoV-2 can infect host cells via the ACE2 receptor, which is widely expressed in the corpus cavernosum, testis and male reproductive tract, and participates in erection, spermatogenesis and androgen metabolism. Also, the immune response and persistent fever resulting from COVID-19 may lead to damage of the testicular activity, consequently compromising male fertility.

Methods and analysis

PubMed, MEDLINE, EMBASE, Web of Science, Cochrane Library, China National Knowledge Infrastructure, China Science and Technology Journal database, Chinese Biomedical Databases and Wanfang Data will be systematically searched for observational studies (case–control and cohort) published up to March 2021 in English or in Chinese literature on the impacts of COVID-19 and SARS-CoV-2 on male reproductive function. This protocol will follow the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines and Meta-analysis of Observational Studies in Epidemiology. The primary outcome will be semen parameters, and the additional outcomes will include: (a) detection of SARS-COV-2 in semen, (b) male sexual hormones, (c) sperm DNA fragmentation index, (d) erectile function, (e) evaluation of testis and also the male genital tract. Two reviewers will independently extract data from the included studies based on a predesigned data extraction form. The risk of bias of included studies will be evaluated through the Newcastle-Ottawa Scale for observational studies. Review Manager software V.5.3 will be used for statistical analysis. Q statistic and I² test will be performed to assess the heterogeneity among studies. Sensitivity analysis will be used to explore the robustness of pooled effects. We will use the Grading of Recommendations Assessment, Development and Evaluation system to assess the quality of evidence.

Ethics and dissemination

Ethical approval is not required and results will be published in a peer-reviewed journal.

PROSPERO registration number

CRD42021245161.
Nationwide evaluation of the advanced clinical practitioner role in England: a cross-sectional survey
Authors: Fothergill Lauren Jade , Al-Oraibi Amani , Houdmont Jonathan , Conway Joy , Evans Catrin , Timmons Stephen , Pearce Ruth , Blake Holly
Published: January 2022

Background and study objective

In response to growing pressures on healthcare systems, the advanced clinical practice (ACP) role has been implemented widely in the UK and internationally. In England, ACP is a level of practice applicable across various healthcare professions, who exercise a level of autonomy across four domains, referred to as the four pillars of practice (education, leadership, research and clinical practice). A national framework for ACP was established in 2017 to ensure consistency across the ACP role, however current ACP governance, education and support is yet to be evaluated. This study aimed to analyse data from a national survey of the ACP role to inform the development and improvement of policies relating to ACP in the National Health Service (NHS) in England.

Design

A cross-sectional survey with free-text comments.

Setting

The survey was distributed across primary and secondary levels of care to three distinct groups in England, including individual ACPs, NHS provider organisations and Trusts and primary care settings.

Participants

A total of 4365 surveys were returned, from ACP staff (n=4013), NHS provider organisations and Trusts (n=166) and primary care organisations (n=186).

Results

Considerable variation was found in role titles, scope of practice, job descriptions and educational backgrounds of ACPs. Differing approaches to governance were noted, which led to inconsistent ACP frameworks in some organisations. A further challenge highlighted included committing time to work across the four pillars of advanced practice, particularly the research pillar. ACPs called for improvements in supervision and continuing professional development alongside further support in navigating career pathways.

Conclusions

A standardised approach may support ACP workforce development in England and enable ACPs to work across the four pillars of practice. Due to the wide uptake of ACP roles internationally, this study has relevance across professions for global healthcare workforce transformation
Enhancing the learning and transfer of preprocedural communication skills during clerkship using audio-visual material: a prospective case-controlled study over 2 years
Authors: Chiang Dung-Hung , Chen Chung-Ting , Wang Tse-Yao , Yang Ying-Ying , Huang Chia-Chang , Li Tzu-Hao , Huang Shiau-Shian , Kao Shou-Yen , Chen Chen-Huan , Hou Ming-Chih , Sheu Wayne Huey-Herng
Published: January 2022

Objective/design/setting

This study aims to develop preprocedural communication-specific framework that emphasises the use of audiovisual materials and compares its acceptability by trainees with a regular module.

Trainees

Between October 2018 and July 2021, 96 medical clerks were enrolled and randomly divided into regular and intervention groups. Another 48 trainees whose did not join the framework-based training but complete self-assessments were enrolled as the control group.

Interventions

In the intervention training module, the key steps of preprocedural communication-specific skills were structuralised into a framework using the acronym of OSCAR.

Primary and secondary outcome measures

This study compared the acceptability of trainees for two modules by measuring the degree of increase in the end-of-rotation and follow up (4 weeks later) competency from baseline by trainees’ self-assessments and physician assessments after serial trainings.

Results

In comparison with regular group trainees, greater degree of improvements (framework-1 statement: 111%±13% vs 27%±5%, p<0.001; framework-2 statement: 77%±9% vs 48%±2%, p<0.05; skill-1 statement: 105%±9% vs 48%±3%, p<0.001); skill-2 statement: 71%±11% vs 50%±9%, p<0.05) were noted in the framework-related and skill-related statement 1–2 (the familiarity and confidence to use the framework and skills) than those of intervention group. At the end-of-rotation stage, the trainees ability to use the ‘A-step: using audiovisual materials’ of the OSCAR was significantly improved (229%±13%, p<0.001), compared with other steps. In the intervention group, the degree of improvement of the end-of-rotation data of trainees’ self-assessment from baseline was significantly correlated with the degree of the improvement in physicians’ assessment data in the aspects of skills, framework and steps in framework (R=0.872, p<0.01; R=0.813, p<0.001; R=0.914, p<0.001).

Conclusions

The OSCAR framework-based intervention module is well accepted by medical clerks and motivates them to integrate the acquired skills in clinical practice, which leads to trainees’ primary care patients being satisfied with their preprocedural communication.
Hypertensive response to exercise in adult patients with repaired aortic coarctation
Authors: Meijs Timion A , Muller Steven A , Minderhoud Savine C S , de Winter Robbert J , Mulder Barbara J M , van Melle Joost P , Hoendermis Elke S , van Dijk Arie P J , Zuithoff Nicolaas P A , Krings Gregor J , Doevendans Pieter A , Spiering Wilko , Witsenburg Maarten , Roos-Hesselink Jolien W , van den Bosch Annemien E , Bouma Berto J , Voskuil Michiel
Published: January 2022

Objective

The clinical and prognostic implications of a hypertensive response to exercise after repair of coarctation of the aorta (CoA) remain controversial. We aimed to determine the prevalence of a hypertensive response to exercise, identify factors associated with peak exercise systolic blood pressure (SBP) and explore the association of peak exercise SBP with resting blood pressure and cardiovascular events during follow-up.

Methods

From the Dutch national CONgenital CORvitia (CONCOR) registry, adults with repaired CoA who underwent exercise stress testing were included. A hypertensive response to exercise was defined as a peak exercise SBP ≥210 mm Hg in men and ≥190 mm Hg in women. Cardiovascular events consisted of coronary artery disease, stroke, aortic complications and cardiovascular death.

Results

Of the original cohort of 920 adults with repaired CoA, 675 patients (median age 24 years (range 16–72 years)) underwent exercise stress testing. Of these, 299 patients (44%) had a hypertensive response to exercise. Mean follow-up duration was 10.1 years. Male sex, absence of a bicuspid aortic valve and elevated resting SBP were independently associated with increased peak exercise SBP. Peak exercise SBP was positively predictive of office SBP (β=0.11, p<0.001) and 24-hour SBP (β=0.05, p=0.03) at follow-up, despite correction for baseline SBP. During follow-up, 100 patients (15%) developed at least 1 cardiovascular event. Peak exercise SBP was not significantly associated with the occurrence of cardiovascular events (HR 0.994 (95% CI 0.987 to 1.001), p=0.11).

Conclusions

A hypertensive response to exercise was present in nearly half of the patients in this large, prospective cohort of adults with repaired CoA. Risk factors for increased peak exercise SBP were male sex, absence of a bicuspid aortic valve and elevated resting SBP. Increased peak exercise SBP independently predicted hypertension at follow-up. These results support close follow-up of patients with a hypertensive response to exercise to ensure timely diagnosis and treatment of future hypertension.
Vessel wall imaging with advanced flow suppression in the characterization of intracranial aneurysms following flow diversion with Pipeline embolization device
Authors: Raz Eytan , Goldman-Yassen Adam , Derman Anna , Derakhshani Ahrya , Grinstead John , Dehkharghani Seena
Published: January 2022

Background

High-resolution vessel wall MRI (VWI) is increasingly used to characterize intramural disorders of the intracranial vasculature unseen by conventional arteriography.

Objective

To evaluate the use of VWI for surveillance of flow diverter (FD) treated aneurysms.

Materials and methods

Retrospective study of 28 aneurysms (in 21 patients) treated with a FD (mean 57 years; 14 female). All examinations included VWI and a contemporaneously obtained digital subtraction angiogram. Multiplanar pre- and post-gadolinium 3D, variable flip-angle T1 black-blood VWI was obtained using delay alternating nutation for tailored excitation (DANTE) at 3T. 3D time-of-flight MR angiography (MRA) was also carried out. Images were assessed for in-stent stenosis, aneurysm occlusion, presence and pattern/distribution of aneurysmal or parent vessel gadolinium enhancement.

Results

The VWI-MRI was performed on average at 361±259 days after the intervention. Follow-up DSA was performed at 338±254 days postintervention. Good or excellent black-blood angiographic quality was recorded in 22/28 (79%) pre-contrast and 21/28 (75%) post-contrast VWI, with no cases excluded for image quality. Aneurysm enhancement was noted in 24/28 (85.7%) aneurysms, including in 79% of angiographically occluded aneurysms and 100% of angiographically non-occluded aneurysms. Enhancement of the stented parent-vessel wall occurred significantly more often when aneurysm enhancement was present (92% vs 33%, p=0.049).

Conclusion

Advanced VWI produces excellent depiction of FD-treated aneurysms, with robust evaluation of the parent vessel and aneurysm wall to an extent not achievable with conventional MRI/MRA. Gadolinium enhancement may, however, continue even after enduring catheter angiographic occlusion, confounding interpretation, and requiring cognizance of this potentially prolonged effect in such patients.