bluuebunny/crossref_metadata_2025 huggingface dataset:
The end of Nudge and the beginning of The Behavioral Code?
Authors: van der Heijden Jeroen
Published: June 2022

Scholars of regulation have long engaged with behavioral oriented research to assess its value for regulatory theory and practice. This book review discusses two recent publications in this area: Nudge: The Final Edition by Richard Thaler and Cas Sunstein (2021) and The Behavioral Code: The Hidden Ways the Law Makes Us Better or Worse by Benjamin van Rooij and Adam Fine (2021).
The Conversion of Gottfried Rabe: Visual Propaganda and Conversion in Early Seventeenth‐Century Germany☆
Authors: Christ Martin
Published: June 2022

This article considers visual and textual descriptions of conversions to Lutheranism by focusing on the former Augustinian monk Gottfried Rabe, who delivered his revocation sermon in Wittenberg in 1601 and features on two woodcuts as well as on a commemorative medal. Through a close analysis of the visual tropes and symbolism in these under‐studied sources, broader questions about Lutheranism at the turn of the sixteenth century are raised, including the role of the University of Wittenberg, the positions of Martin Luther and the Czech reformer Jan Hus as role models of conversions to Lutheranism and the Catholic responses to such conversions at this point in time. The article argues that the different media promoted different images of Rabe, showing a range of possible interpretations of the conversion and its place within the different confessions.
An interdisciplinary program for emerging leaders in patient safety
Authors: Oates Kim , Burgess Annette , Clark Tyler
Published: June 2022

Background

Having previously shown that an interprofessional immersive course, AELPS (Academy for Emerging Leaders in Patient Safety) can change the way young clinicians think about patient safety, we surveyed them between 1 and 5 years later to determine its longer‐term influence on careers, relationships with colleagues and with patients.

Methods

All alumni from 2016 to 2019 (n = 116) were invited to complete a survey on the usefulness of their AELPS experience in: obtaining their current position; doing patient safety projects; understanding and working with patients; improving communication skills; breaking down hierarchies; networking; mentoring and using new skills in the workplace. Data were analysed using descriptive statistics and thematic analysis.

Results

Response rate was 56%. Over 85% reported ongoing improvement in medication safety knowledge, communication with patients, use of graded assertiveness, communicating more effectively with colleagues, seeking views of their patients about treatment options and seeing things from the patient perspective. Sixty seven per cent agreed that AELPS helped them in their career choice and 57% agreed it had helped them obtain their current position. Skills transferred to the workplace included ability to make improvements, establish education initiatives and model patient‐centred care. Stumbling blocks included a hierarchal culture and lack of accountability for patient safety practices in some hospitals.

Discussion

An intensive, interdisciplinary program on patient safety can provide future health leaders with ongoing tools to improve communication, understand the patient view and speak up on behalf of the patient, all factors that contribute to improving safety of patients.
Harmony without equality: Schiller's theory of virtue
Authors: Reshenin Semyon
Published: June 2022

In this paper I reconstruct Schiller's theory of virtue from his essay “On grace and dignity” and discuss how it fits into Kant's moral philosophy. According to Schiller, a virtuous person – a beautiful soul – is characterised by harmony between reason and sensibility. I show that despite some misleading textual clues and interpretations based on them, Schiller does not regard the harmony between reason and sensibility as an equal partnership. On the contrary, just like Kant, Schiller fully recognises the priority of reason. The difference between their positions is more subtle. Whereas Kant holds that sensibility must be overtly subordinated to reason, Schiller believes that there should be a semblance of an equal partnership between reason and sensibility, provided that the latter is sufficiently ennobled.
Polidocanol monotherapy for a superficial orbital venous malformation in a horse
Authors: Stonex Tara M. , Zibura Ashley E. , Andres Michael , Gilger Brian C. , Oh Annie
Published: June 2022

Objective

To describe the use of 1% polidocanol as the sole treatment for a superficial orbital venous malformation in a horse.

Animal

A 23‐year‐old Welsh Cobb cross gelding with a distensible swelling affecting the left lower eyelid, and secondary palpebral margin abnormalities and superficial keratitis.

Procedure

Color flow Doppler ultrasonography revealed non‐pulsatile blood flow within the tortuous vascular network most consistent with a superficial orbital venous malformation appearing to involve the lateral palpebral and transverse facial veins. An intravenous catheter was placed within the lateral aspect of the venous malformation, and agitated saline was slowly injected into the vessel while simultaneously ultrasound imaging the medial aspect in which the bubbles were observed coursing across, consistent with lateral to medial flow. Contrast venography confirmed a corkscrew vessel along the ventral aspect of the orbital rim. Under standing sedation, 1% polidocanol solution was administered slowly through the intravenous catheter while manual pressure was applied on the medial and lateral aspects of the venous malformation.

Results

Ultrasonography performed immediately after administration of polidocanol confirmed venous stasis, and formation of a thrombus. No adverse side effects were noted. The venous malformation and associated palpebral margin abnormalities and superficial keratitis resolved at the time of re‐examination at 4 months.

Conclusion and Clinical Relevance

Polidocanol as the sole treatment for a superficial orbital venous malformation in a horse was well tolerated and led to clinical resolution. Sclerosant monotherapy may be a safe treatment option for superficial orbital venous malformations.
Hindbrain catecholaminergic inputs to the paraventricular thalamus scale feeding and metabolic efficiency in stress‐related contexts
Authors: Dumont Clarisse , Li Guangping , Castel Julien , Luquet Serge , Gangarossa Giuseppe
Published: June 2022

The regulation of food intake and energy balance relies on the dynamic integration of exteroceptive and interoceptive signals monitoring nutritional, metabolic, cognitive, and emotional states. The paraventricular thalamus (PVT) is a central hub that, by integrating sensory, metabolic, and emotional states, may contribute to the regulation of feeding and homeostatic/allostatic processes. However, the underlying PVT circuits still remain elusive. Here, we aimed at unravelling the role of catecholaminergic (CA) inputs to the PVT in scaling feeding and metabolic efficiency. First, using region‐specific retrograde disruption of CA projections, we show that PVT CA inputs mainly arise from the hindbrain, notably the locus coeruleus (LC) and the nucleus tractus solitarius. Second, taking advantage of integrative calorimetric measurements of metabolic efficiency, we reveal that CA inputs to the PVT scale adaptive feeding and metabolic responses in environmental, behavioural, physiological, and metabolic stress‐like contexts. Third, we show that hindbrainTH→PVT inputs contribute to modulating the activity of PVT as well as lateral and dorsomedial hypothalamic neurons. In conclusion, the present study, by assessing the key role of CA inputs to the PVT in scaling homeostatic/allostatic regulations of feeding patterns, reveals the integrative and converging hindbrainTH→PVT paths that contribute to whole‐body metabolic adaptations in stress‐like contexts.

Key points

The paraventricular thalamus (PVT) is known to receive projections from the hindbrain. Here, we confirm and further extend current knowledge on the existence of hindbrainTH→PVT catecholaminergic inputs, notably from the locus coeruleus and the nucleus tractus solitarius, with the nucleus tractus solitarius representing the main source.

Disruption of hindbrainTH→PVT inputs contributes to the modulation of PVT neuron activity.

HindbrainTH→PVT inputs scale feeding strategies in environmental, behavioural, physiological, and metabolic stress‐like contexts.

HindbrainTH→PVT inputs participate in regulating metabolic efficiency and nutrient partitioning in stress‐like contexts.

HindbrainTH→PVT inputs, directly and/or indirectly, contribute to modulating the downstream activity of lateral and dorsomedial hypothalamic neurons.
Overturn Prevention Simulation of a Truck With Corner Nozzles
Authors: Levin Jeffrey , Chen Shih-Hsiung
Published: June 2022

This paper investigates the performance of an aerodynamic device called corner nozzles (CN) on a truck to improve its crosswind stability. The CN consists of two air-guiding plates that are attached to the base of the truck. The plates are governed by CN turning angle (α) and parameterized from 45 deg to 90 deg. Computational fluid dynamics (CFD) is used to simulate a 1/8th truck model called ground transportation system (GTS) at a Reynolds number (Re) of 1.6 × 106 and yaw angles (Ψ) = 2.5 deg–14 deg. At α = 90 deg, the rolling moment (Cr) and side force coefficients (Csf) of the GTS can be reduced by 6–8%. The CN performs better in improving the crosswind stability as Ψ increases. The CN decreases the pressure coefficient (Cp) values on both windward and leeward surfaces. The CN geometry causes the flow turning effect which increases the fluid pressure as it flows through the CN’s channel, emitting a high-pressure fluid from its outlet. Hence, increasing the overall Cp values downstream of the truck. As α increases, the reductions in Cp on side surfaces and the flow turning effect become more pronounced. It will be shown that the total Cr and Csf of the truck are affected by the Cp distributions on the windward and leeward surfaces. The CN addition affects the Cp distribution on these side surfaces and is able to reduce the total magnitude of Cr and Csf of the truck.
Study of SnO/ɛ-Ga2O3 p–n diodes in planar geometry
Authors: Parisini A. , Mazzolini P. , Bierwagen O. , Borelli C. , Egbo K. , Sacchi A. , Bosi M. , Seravalli L. , Tahraoui A. , Fornari R.
Published: June 2022

SnO/ε-Ga2O3 vertical p–n diodes with planar geometry have been fabricated on c-plane Al2O3 and investigated by current–voltage measurements. The effects of the in-plane conduction through the Si-doped ε-Ga2O3 layer on the diode performance and their relevance have been evaluated. A significant series resistance is observed, which shows typical features of the variable range hopping transport observed in Si-doped ε-Ga2O3; this in-plane transport mechanism is probably induced by the columnar domain structure of this polymorph. The dependence of the series resistance on the geometry of the diode supports the interpretation. A simple equivalent model is presented to describe the experimental behavior of the diode, supported by preliminary impedance spectroscopy investigation.
Light-activated molecular machines are fast-acting broad-spectrum antibacterials that target the membrane
Authors: Santos Ana L. , Liu Dongdong , Reed Anna K. , Wyderka Aaron M. , van Venrooy Alexis , Li John T. , Li Victor D. , Misiura Mikita , Samoylova Olga , Beckham Jacob L. , Ayala-Orozco Ciceron , Kolomeisky Anatoly B. , Alemany Lawrence B. , Oliver Antonio , Tegos George P. , Tour James M.
Published: June 2022

The increasing occurrence of antibiotic-resistant bacteria and the dwindling antibiotic research and development pipeline have created a pressing global health crisis. Here, we report the discovery of a distinctive antibacterial therapy that uses visible (405 nanometers) light-activated synthetic molecular machines (MMs) to kill Gram-negative and Gram-positive bacteria, including methicillin-resistant
Staphylococcus aureus
, in minutes, vastly outpacing conventional antibiotics. MMs also rapidly eliminate persister cells and established bacterial biofilms. The antibacterial mode of action of MMs involves physical disruption of the membrane. In addition, by permeabilizing the membrane, MMs at sublethal doses potentiate the action of conventional antibiotics. Repeated exposure to antibacterial MMs is not accompanied by resistance development. Finally, therapeutic doses of MMs mitigate mortality associated with bacterial infection in an in vivo model of burn wound infection. Visible light–activated MMs represent an unconventional antibacterial mode of action by mechanical disruption at the molecular scale, not existent in nature and to which resistance development is unlikely.
A systems biology approach identifies candidate drugs to reduce mortality in severely ill patients with COVID-19
Authors: Fava Vinicius M. , Bourgey Mathieu , Nawarathna Pubudu M. , Orlova Marianna , Cassart Pauline , Vinh Donald C. , Cheng Matthew Pellan , Bourque Guillaume , Schurr Erwin , Langlais David
Published: June 2022

Despite the availability of highly efficacious vaccines, coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) lacks effective drug treatment, which results in a high rate of mortality. To address this therapeutic shortcoming, we applied a systems biology approach to the study of patients hospitalized with severe COVID. We show that, at the time of hospital admission, patients who were equivalent on the clinical ordinal scale displayed significant differential monocyte epigenetic and transcriptomic attributes between those who would survive and those who would succumb to COVID-19. We identified messenger RNA metabolism, RNA splicing, and interferon signaling pathways as key host responses overactivated by patients who would not survive. Those pathways are prime drug targets to reduce mortality of critically ill patients with COVID-19, leading us to identify tacrolimus, zotatifin, and nintedanib as three strong candidates for treatment of severely ill patients at the time of hospital admission.
Nonlinear elasticity, yielding, and entropy in amorphous solids
Authors: Pan Deng , Ji Teng , Baggioli Matteo , Li Li , Jin Yuliang
Published: June 2022

The holographic duality has proven successful in linking seemingly unrelated problems in physics. Recently, intriguing correspondences between the physics of soft matter and gravity are emerging, including strong similarities between the rheology of amorphous solids, effective field theories for elasticity, and the physics of black holes. However, direct comparisons between theoretical predictions and experimental/simulation observations remain limited. Here, we study the effects of nonlinear elasticity on the mechanical and thermodynamic properties of amorphous materials responding to shear, using effective field and gravitational theories. The predicted correlations among the nonlinear elastic exponent, the yielding strain/stress, and the entropy change due to shear are supported qualitatively by simulations of granular matter models. Our approach opens a path toward understanding the complex mechanical responses of amorphous solids, such as mixed effects of shear softening and shear hardening, and offers the possibility to study the rheology of solid states and black holes in a unified framework.
Globally ubiquitous negative effects of nitrogen dioxide on crop growth
Authors: Lobell David B. , Di Tommaso Stefania , Burney Jennifer A.
Published: June 2022

Nitrogen oxides (NO
x
) are among the most widely emitted pollutants in the world, yet their impacts on agriculture remain poorly known. NO
x
can directly damage crop cells and indirectly affect growth by promoting ozone (O
3
) and aerosol formation. We use satellite measures of both crop greenness and NO
x
during 2018–2020 to evaluate crop impacts for five major agricultural regions. We find consistent negative associations between NO
2
and greenness across regions and seasons. These effects are strongest in conditions where O
3
formation is NO
x
limited but remain significant even in locations where this pathway is muted, suggesting a role for direct NO
x
damage. Using simple counterfactuals and leveraging published relationships between greenness and growth, we estimate that reducing NO
x
levels to the current fifth percentile in each region would raise yields by ~25% for winter crops in China, ~15% for summer crops in China, and up to 10% in other regions.
In Vitro
Activity and Clinical Efficacy of Faropenem against Third-Generation Cephalosporin-Resistant
Escherichia coli
and
Klebsiella pneumoniae
Authors: Ishikawa Kazuhiro , Uehara Yuki , Mori Nobuyoshi , Mikami Yumiko , Tokioka Sayuri , Kobayashi Daiki , Goke Hisa , Inukai Tatsuya , Sakurai Aki , Doi Yohei , Kawakami Sayoko , Kayama Shizuo , Sugai Motoyuki , Nakamura Shigeki
Published: June 2022

Faropenem (FRPM) is active against extended-spectrum β-lactamase (ESBL)-producing
Enterobacterales
, but evidence for its efficacy is lacking. This study determined the correlation between the susceptibility by disk diffusion method and the MIC of FRPM for third-generation cephalosporin-resistant
Escherichia coli
and
Klebsiella pneumoniae
, and the effectiveness of FRPM for the treatment of urinary tract infection (UTI) caused by these two bacteria in a retrospective cohort analysis.
Bacterial Pneumonia and Respiratory Culture Utilization among Hospitalized Patients with and without COVID-19 in a New York City Hospital
Authors: Weidmann Maxwell D. , Berry Gregory J. , Zucker Jason E. , Huang Simian , Sobieszczyk Magdalena E. , Green Daniel A.
Published: June 2022

COVID-19 is associated with prolonged hospitalization and a high risk of intubation, which raises concern for bacterial coinfection and antimicrobial resistance. Previous research has shown a wide range of bacterial pneumonia rates for COVID-19 patients in a variety of clinical and demographic settings, but none have compared hospitalized COVID-19 patients to patients testing negative for severe acute respiratory syndrome coronavirus (SARS-CoV-2) in similar care settings.
Listeria-Vectored Multiantigenic Tuberculosis Vaccine Enhances Protective Immunity against Aerosol Challenge with Virulent Mycobacterium tuberculosis in BCG-Immunized C57BL/6 and BALB/c Mice
Authors: Jia Qingmei , Masleša-Galić Saša , Nava Susana , Horwitz Marcus A.
Published: June 2022

TB, one of the world's most important infectious diseases, afflicts approximately 10 million people and kills approximately 1.5 million people annually. The current vaccine, BCG, developed over a century ago, has been administered to about 5 billion people, mostly in infancy, but is only modestly protective.
Reciprocal Inclusion of Microbiomes and Environmental Justice Contributes Solutions to Global Environmental Health Challenges
Authors: Choudoir Mallory J. , Eggleston Erin M.
Published: June 2022

Generations of colonialism, industrialization, intensive agriculture, and anthropogenic climate change have radically altered global ecosystems and by extension, their environmental microbiomes. The environmental consequences of global change disproportionately burden racialized communities, those with lower socioeconomic status, and other systematically underserved populations.
Unusual Hypermucoviscous Clinical Isolate of Klebsiella pneumoniae with No Known Determinants of Hypermucoviscosity
Authors: Dey Tamal , Chakrabortty Ardhendu , Kapoor Aastha , Warrier Anuja , Nag Vijaya Lakshmi , Sivashanmugam Karthikeyan , Shankar Manoharan
Published: June 2022

Hypermucoviscosity is a characteristic of hypervirulent
Klebsiella pneumoniae
strains, which are capable of causing invasive disease in community settings. This study reports phenotyping and genomic analysis of an unusual clinical isolate of
Klebsiella pneumoniae
, P34, which exhibits hypermucoviscosity and yet does not harbor
rmp
(
r
egulator of
m
ucoid
p
henotype) genes, which are known determinants of hypermucoviscosity (
rmpA
and
rmpD
).
GpsB Coordinates Cell Division and Cell Surface Decoration by Wall Teichoic Acids in Staphylococcus aureus
Authors: Hammond Lauren R. , Sacco Michael D. , Khan Sebastian J. , Spanoudis Catherine , Hough-Neidig Abigail , Chen Yu , Eswara Prahathees J.
Published: June 2022

Cytokinesis in bacteria involves an intricate orchestration of several key cell division proteins and other factors involved in building a robust cell envelope. Presence of teichoic acids is a signature characteristic of the Gram-positive cell wall.
Roles of SmeYZ, SbiAB, and SmeDEF Efflux Systems in Iron Homeostasis of Stenotrophomonas maltophilia
Authors: Wu Chao-Jung , Chen Yu , Li Li-Hua , Wu Cheng-Mu , Lin Yi-Tsung , Ma Cheng-Hua , Yang Tsuey-Ching
Published: June 2022

Efflux pumps display high efficiency of drug extrusion, which underlies their roles in multidrug resistance. In addition, efflux pumps have physiological functions, and their expression is tightly regulated by various environmental and physiological signals.
On Use of Slots in Modelling Cracks in Ultrasonic Testing
Authors: Aleshin N. P. , Mogil’ner L. Yu. , Shchipakov N. A. , Kusyi A. G. , Tishkin V. V. , Degtyarev M. N.
Published: June 2022

The possibility of a rigorous theoretical solution of the three-dimensional problem of scattering of elastic waves at the tip of a vertical crack in a weld is analyzed. It is shown that in the general case of ultrasound scattering on a flat target, the three-dimensional problem can be reduced to a two-dimensional one. On this basis, for an arbitrary direction of sounding a crack in a weld, the dependence of the signal from the crack tip on the direction to the receiver was assessed. It is noted that the wave size of the crack tip is much smaller than the wave size of the end of the grooves that can be made to simulate defects in welded joints. As a result, it was found that the nature of the scattering of elastic waves by the tip of the crack differs from the nature of scattering on the grooves, including in cases where the opening of the grooves is minimal, based on the possibility of their manufacture. The results of an experimental verification of the obtained theoretical estimates on samples of steel and aluminum are presented. It is shown that at the ends of the grooves (in contrast to the crack tips), even with their minimal openings, conditions are created for the formation of a scattered field of the type of specular reflection from a volumetric cavity—a side-drilled hole.
Total endoluminal repair of aorto-oesophageal fistula
Authors: Vara Sarina , Jayanthi Naga Venkatesh , Gadhvi Vijay , Thapar Ankur
Published: June 2022

A woman in her 50s presented to the Emergency Department, following massive haematemesis, having swallowed a single tooth denture 3 years previously. Endoscopy initially revealed profuse bleeding at 20cm from the incisors, initially treated with an oesophageal covered stent. Following ongoing haematemesis, a thoracic and abdominal CT angiogram demonstrated an aorto-oesophageal fistula, which was successfully treated with a thoracic endograft and left tube thoracostomy. The patient remains well to 1 year. This is the first case to demonstrate successful use of covered stents in both the aorta to stop exsanguination, as well as the oesophagus to prevent mediastinitis and avoid the need for thoracotomy and hypothermic circulatory arrest in a critically ill patient.
Primary pigmented nodular adrenal disease presenting as hypertensive crisis
Authors: Oza Chirantap Markand , Mehta Sajili , Khadilkar Vaman , Khadilkar Anuradha
Published: June 2022

We present a case of a young girl who presented with hypertensive crisis and recent onset weight gain with hirsutism. On evaluation for Cushing syndrome (CS), her cortisol concentration was high, showed a paradoxical cortisol rise on dexamethasone suppression and the adrenocorticotropic hormone (ACTH) was low. Adrenal imaging showed normal adrenal morphology. Genetic diagnosis of primary pigmented nodular adrenal disease (PPNAD) was made. She was operated for bilateral adrenalectomy and histopathology confirmed the diagnosis of PPNAD. Our case highlights the rare aetiology of PPNAD as a cause of CS resulting in a hypertensive crisis. To the best of our knowledge, this is the youngest case of ACTH independent CS presenting as hypertensive encephalopathy.
Bilateral genu varum deformity correction in an adult by medial opening-wedge high tibial osteotomy without internal fixation
Authors: Vaishya Raju , Vaish Abhishek , Ansari Aabid Husain , Suryant Sumit
Published: June 2022

A young adult man in 20s presented with bow leg deformity of both the knees, since childhood and bilateral knee pain for the last 4 years. Plain radiographs of both the knees confirmed bilateral genu varum deformity, more on the right side (16.2°) as compared with left (12.3°). He was managed surgically by a single-stage bilateral medial opening wedge high tibial osteotomy, using a synthetic bone substitute of a tri calcium phosphate. After the healing of osteotomies at 3 months, the patient was pain free and walked comfortably with normal lower limb alignment.
IgG4-related disease presenting with multiorgan involvement
Authors: Tellez Roberto , Bromfield Brittany , Basinger Hayden , Slivka Adam
Published: June 2022

Immunoglobulin G4-related disease (IgG4-RD) is a rare fibroinflammatory immune-mediated condition which can affect multiple organ systems and form mass-like lesions. Initial presentation can mimic other diseases such as pancreatic malignancy when there is pancreatic involvement or tuberculosis (TB) when there are pulmonary lesions or hypertrophic pachymeningitis (HP). Here, we report a novel case of IgG4-RD presenting as bilateral subdural haematomas with additional findings. Our patient is a male who presented with headaches and blurred vision. Physical examination showed disconjugate gaze with a fixed pupil. Trauma survey radiologic imaging revealed a pancreatic mass concerning for malignancy. Subsequent workup found hypophysitis with optic chiasm compression and hypopituitarism, mediastinal lymphadenopathy and HP. Laboratory values showed an elevated serum IgG4 level and latent TB. Our case adds to the existing IgG4-RD literature by highlighting a unique presentation. It is important to maintain it on the differential diagnosis especially in multisystemic presentations with competing diagnoses.
Extension of cervical screening intervals with primary human papillomavirus testing: observational study of English screening pilot data
Authors: Rebolj Matejka , Cuschieri Kate , Mathews Christopher S , Pesola Francesca , Denton Karin , Kitchener Henry
Published: June 2022

Objectives

To provide updated evidence about the risk of cervical intraepithelial neoplasia grade 3 or higher (CIN3+) and cervical cancer after a negative human papillomavirus (HPV) test in primary cervical screening, by age group and test assay.

Design

Observational study.

Setting

Real world data from the English HPV screening pilot’s first and second rounds (2013-16, follow-up to end of 2019).

Participants

1 341 584 women.

Interventions

Cervical screening with HPV testing or liquid based cytological testing (cytology or smear tests). Women screened with cytology were referred to colposcopy after high grade cytological abnormalities or after borderline or low grade abnormalities combined with a positive HPV triage test. Women screened with HPV testing who were positive were referred at baseline if their cytology triage test showed at least borderline abnormalities or after a retest (early recall) at 12 and 24 months if they had persistent abnormalities.

Main outcome measures

Detection of CIN3+ and cervical cancer after a negative HPV test.

Results

For women younger than 50 years, second round detection of CIN3+ in this study was significantly lower after a negative HPV screen in the first round than after cytology testing (1.21/1000v4.52/1000 women screened, adjusted odds ratio 0.26, 95% confidence interval 0.23 to 0.30), as was the risk of interval cervical cancer (1.31/100 000v2.90/100 000 woman years, adjusted hazard ratio 0.44, 0.23 to 0.84). Risk of an incident CIN3+ detected at the second screening round in the pilot five years after a negative HPV test was even lower in women older than 50 years, than in three years in women younger than 50 years (0.57/1000v1.21/1000 women screened, adjusted odds ratio 0.46, 0.27 to 0.79). Women with negative HPV tests at early recall after a positive HPV screening test without cytological abnormalities had a higher detection rate of CIN3+ at the second routine recall than women who initially tested HPV negative (5.39/1000v1.21/1000 women screened, adjusted odds ratio 3.27, 95% confidence interval 2.21 to 4.84). Detection after a negative result on a clinically validated APTIMA mRNA HPV test was similar to that after clinically validated cobas and RealTime DNA tests (for CIN3+ at the second round 1.32/1000v1.14/1000 women screened, adjusted odds ratio 1.05, 0.73 to 1.50).

Conclusions

These data support an extension of the screening intervals, regardless of the test assay used: to five years after a negative HPV test in women aged 25-49 years, and even longer for women aged 50 years and older. The screening interval for HPV positive women who have negative HPV tests at early recall should be kept at three years.
Understanding geographical variations in health system performance: a population-based study on preventable childhood hospitalisations
Authors: Silwal Pushkar Raj , Exeter Daniel , Tenbensel Tim , Lee Arier
Published: June 2022

Objective

To investigate interdistrict variations in childhood ambulatory sensitive hospitalisation (ASH) over the years.

Design

Observational population-based study over 2008–2018 using the Primary Health Organisation Enrolment Collection (PHO) and the National Minimum Dataset hospital events databases.

Setting

New Zealand primary and secondary care.

Participants

All children aged 0–4 years enrolled in the PHO Enrolment Collection from 2008 to 2018.

Main outcome measure

ASH.

Results

Only 1.4% of the variability in the risk of having childhood ASH (intracluster correlation coefficient=0.014) is explained at the level of District Health Board (DHB), with the median OR of 1.23. No consistent time trend was observed for the adjusted childhood ASH at the national level, but the DHBs demonstrated different trajectories over the years. Ethnicity (being a Pacific child) followed by deprivation demonstrated stronger relationships with childhood ASH than the geography and the health system input variables.

Conclusion

The variation in childhood ASH is explained only minimal at the DHB level. The sociodemographic variables also only partly explained the variations. Unlike the general ASH measure, the childhood ASH used in this analysis provides insights into the acute conditions sensitive to primary care services. However, further information would be required to conclude this as the DHB-level performance variations.
RECIST 1.1 versus mRECIST for assessment of tumour response to molecular targeted therapies and disease outcomes in patients with hepatocellular carcinoma: a systematic review and meta-analysis
Authors: Yu Hongli , Bai Yuping , Xie Xiaoyu , Feng Yuemin , Yang Yao , Zhu Qiang
Published: June 2022

Objectives

Response Evaluation Criteria in Solid Tumours version 1.1 (RECIST 1.1) and modified RECIST (mRECIST) are commonly used to assess tumour response. Which one is better to evaluate efficacy after molecular targeted therapies in hepatocellular carcinoma (HCC) patients is still controversial. A systemic review was performed to compare the objective response rate (ORR) and disease control rate (DCR) and a meta-analysis was conducted to compare the correlation between objective response and overall survival (OS).

Design

Systematic review and meta-analysis using the Grading of Recommendations Assessment, Development and Evaluation approach.

Data sources

EMBASE, PubMed, Web of Science and Cochrane Library were searched through 31 December 2021.

Eligibility criteria

We included studies assessing the efficacy of molecular targeted therapy for HCC according to both RECIST 1.1 and mRECIST.

Data extraction and synthesis

Two investigators extracted data independently. The consistency between RECIST 1.1 vs mRECIST is measured by the k coefficient. HRs with corresponding 95% CIs were used for meta-analysis.

Results

23 studies comprising 2574 patients were included in systematic review. The ORR according to mRECIST is higher than RECIST1.1 (15.9% vs 7.8%, p<0.001). The DCR is similar (68.4% vs 67.2%, p=0.5). The agreement of tumour response is moderate for objective response (k=0.499) and perfect for progressive disease (k=0.901), calculated from 8 studies including 372 patients. OS was significantly longer in response group than non-response group according to mRECIST (HR 0.56, 95% CI 0.41 to 0.78, p=0.0004) calculated from 7 studies including 566 patients, however, the RECIST1.1 could not distinguish the OS well (HR 0.68, 95% CI 0.44 to 1.05, p=0.08). Subgroup analusis by type of treatment was conducted.

Conclusions

mRECIST may be more accurate than RECIST 1.1 in assessing ORR after molecular targeted therapies in HCC patients and can better assess the prognosis. However, the performance of both criteria in assessing disease progression is identical.

PROSPERO registration number

CRD42020200895.

Ethics approval

Ethics approval is not required in this meta-analysis.
Economic impact of cholera in households in rural southern Malawi: a prospective study
Authors: Hsiao Amber , Ramani Enusa , Seo Hye-Jin , Pak GiDeok , Vuntade Dan , M’bang’ombe Maurice , Ngwira Bagrey , Quentin Wilm , Marks Florian , Mogasale Vittal
Published: June 2022

Introduction

Cholera remains a significant contributor to diarrhoeal illness, especially in sub-Saharan Africa. Few studies have estimated the cost of illness (COI) of cholera in Malawi, a cholera-endemic country. The present study estimated the COI of cholera in Nsanje, southern Malawi, as part of the Cholera Surveillance in Malawi (CSIMA) programme following a mass cholera vaccination campaign in 2015.

Methods

Patients ≥12 months of age who were recruited as part of CSIMA were invited to participate in the COI survey. The COI tool captured household components of economic burden, including direct medical and non-medical costs, and indirect lost productivity costs.

Results

Between April 2016 and March 2020, 40 cholera cases were enrolled in the study, all of whom participated in the COI survey. Only two patients had any direct medical costs and five patients reported lost wages due to illness. The COI per patient was US$14.34 (in 2020), more than half of which was from direct non-medical costs from food, water, and transportation to the health centre.

Conclusion

For the majority of Malawians who struggle to subsist on less than US$2 a day, the COI of cholera represents a significant cost burden to families. While cholera treatment is provided for free in government-run health centres, additional investments in cholera control and prevention at the community level and financial support beyond direct medical costs may be necessary to alleviate the economic burden of cholera on households in southern Malawi.
Understanding the implementation of interventions to improve the management of frailty in primary care: a rapid realist review
Authors: Alharbi Khulud , Blakeman Thomas , van Marwijk Harm , Reeves David , Tsang Jung Yin
Published: June 2022

Objective

Identifying and managing the needs of frail people in the community is an increasing priority for policy makers. We sought to identify factors that enable or constrain the implementation of interventions for frail older persons in primary care.

Design

A rapid realist review.

Data sources

Cochrane Library, SCOPUS and EMBASE, and grey literature. The search was conducted in September 2019 and rerun on 8 January 2022.

Eligibility criteria for selecting studies

We considered all types of empirical studies describing interventions targeting frailty in primary care.

Analysis

We followed the Realist and Meta-narrative Evidence Syntheses: Evolving Standards quality and publication criteria for our synthesis to systematically analyse and synthesise the existing literature and to identify (intervention-context-mechanism-outcome) configurations. We used normalisation processes theory to illuminate mechanisms surrounding implementation.

Results

Our primary research returned 1755 articles, narrowed down to 29 relevant frailty intervention studies conducted in primary care. Our review identified two families of interventions. They comprised: (1) interventions aimed at the comprehensive assessment and management of frailty needs; and (2) interventions targeting specific frailty needs. Key factors that facilitate or inhibit the translation of frailty interventions into practice related to the distribution of resources; patient engagement and professional skill sets to address identified need.

Conclusion

There remain challenges to achieving successful implementation of frailty interventions in primary care. There were a key learning points under each family. First, targeted allocation of resources to address specific needs allows a greater alignment of skill sets and reduces overassessment of frail individuals. Second, earlier patient involvement may also improve intervention implementation and adherence.

PROSPERO registration number

The published protocol for the review is registered with PROSPERO (CRD42019161193).
Vocational and psychosocial predictors of medical negligence claims among Australian doctors: a prospective cohort analysis of the MABEL survey
Authors: Bradfield Owen M , Bismark Marie , Scott Anthony , Spittal Matthew
Published: June 2022

Objective

To understand the association between medical negligence claims and doctors’ sex, age, specialty, working hours, work location, personality, social supports, family circumstances, self-rated health, self-rated life satisfaction and presence of recent injury or illness.

Design and setting

Prospective cohort study of Australian doctors.

Participants

12 134 doctors who completed the Medicine in Australia: Balancing Employment and Life survey between 2013 and 2019.

Primary outcome measure

Doctors named as a defendant in a medical negligence claim in the preceding 12 months.

Results

649 (5.35%) doctors reported being named in a medical negligence claim during the study period. In addition to previously identified demographic factors (sex, age and specialty), we identified the following vocational and psychosocial risk factors for claims: working full time (OR=1.48, 95% CI 1.13 to 1.94) or overtime hours (OR 1.70, 95% CI 1.29 to 2.23), working in a regional centre (OR 1.69, 95% CI 1.37 to 2.08), increasing job demands (OR 1.16, 95% CI 1.04 to 1.30), low self-rated life satisfaction (OR 1.43, 95% CI 1.08 to 1.91) and recent serious personal injury or illness (OR 1.40, 95% CI 1.13 to 1.72). Having an agreeable personality was mildly protective (OR 0.91, 95% CI 0.83 to 1.00). When stratified according to sex, we found that working in a regional area, low self-rated life satisfaction and not achieving work–life balance predicted medical negligence claims in male, but not female, doctors. However, working more than part-time hours and having a recent personal injury or illness predicted medical negligence claims in female, but not male, doctors. Increasing age predicted claims more strongly in male doctors. Personality type predicted claims in both male and female doctors.

Conclusions

Modifiable risk factors contribute to an increased risk of medical negligence claims among doctors in Australia. Creating more supportive work environments and targeting interventions that improve doctors’ health and well-being could reduce the risk of medical negligence claims and contribute to improved patient safety.
Protocol for a scoping review of the use of information and communication technology platforms for the delivery and utilisation of transgender healthcare
Authors: Cui Jialiang , Prankumar Sujith Kumar , Wong Horas TH , Addo Isaac Yeboah , Tumwine Christopher , Noor Muhammad Naveed
Published: June 2022

Introduction

In recent years, there has been strong interest in making digital health and social tools more accessible, particularly among vulnerable and stigmatised groups such as transgender people. While transgender people experience unique physical, mental and sexual health needs, not much is currently known about the extent to which they use information and communication technologies such as short messaging service and videoconferencing to access health services. In this paper, we discuss our protocol for a scoping review of the literature about the delivery and utilisation of digitally mediated health services for transgender populations.

Methods and analysis

This scoping review of the provision and experience of telemedicine among transgender people will follow the methodological framework developed by Arksey and O’Malley. The search will be conducted using three online databases, namely PubMed, CINAHL and Scopus, with additional literature explored using Google Scholar to identify grey literature. Relevant English-language studies will be shortlisted after completing a title and abstract review based on defined inclusion criteria. Following that, a final list of included studies will be compiled after a full-text review of the shortlisted articles has been completed. To enable the screening process, a team of researchers will be assigned refereed publications explicitly referring to the provision and experience of transgender healthcare through telemedicine. Screening performed independently will then collaboratively be reviewed to maintain consistency.

Ethics and dissemination

The research is exempt from ethics approval since our analysis is based on extant research into the use of digital technologies in providing healthcare to transgender people. The results of this study will be disseminated through peer-reviewed academic publications and presentations. Our analysis will guide the design of further research and practice relating to the use of digital communication technologies to deliver healthcare services to transgender people.
Clinicodemographic profile and predictors of poor outcome in hospitalised COVID-19 patients: a single-centre, retrospective cohort study from India
Authors: Tiwari Lokesh , Gupta Prakriti , N Yankappa , Banerjee Amrita , Kumar Yogesh , Singh Prashant K , Ranjan Alok , Singh C M , Singh Prabhat Kumar
Published: June 2022

Objectives

Primary objective was to study the clinicodemographic profile of hospitalised COVID-19 patients at a tertiary-care centre in India. Secondary objective was to identify predictors of poor outcome.

Setting

Single centre tertiary-care level.

Design

Retrospective cohort study.

Participants

Consecutively hospitalised adults patients with COVID-19.

Primary and secondary outcome measures

Primary outcome variable was in-hospital mortality. Covariables were known comorbidities, clinical features, vital signs at the time of admission and on days 3–5 of admission, and initial laboratory investigations.

Results

Intergroup differences were tested using χ2 or Fischer’s exact tests, Student’s t-test or Mann-Whitney U test. Predictors of mortality were evaluated using multivariate logistic regression model. Out of 4102 SARS-CoV-2 positive patients admitted during 1-year period, 3268 (79.66%) survived to discharge and 834 (20.33%) died in the hospital. Mortality rates increased with age. Death was more common among males (OR 1.51, 95% CI 1.25 to 1.81). Out of 261 cases analysed in detail, 55.1% were in mild, 32.5% in moderate and 12.2% in severe triage category. Most common clinical presentations in the subgroup were fever (73.2%), cough/coryza (65.5%) and breathlessness (54%). Hypertension (45.2%), diabetes mellitus (41.8%) and chronic kidney disease (CKD; 6.1%) were common comorbidities. Disease severity on admission (adjusted OR 12.53, 95% CI 4.92 to 31.91, p<0.01), coagulation defect (33.21, 3.85–302.1, p<0.01), CKD (5.67, 1.08–29.64, p=0.04), high urea (11.05, 3.9–31.02, p<0.01), high prothrombin time (3.91, 1.59–9.65, p<0.01) and elevated ferritin (1.02, 1.00–1.03, p=0.02) were associated with poor outcome on multivariate regression. A strong predictor of mortality was disease progression on days 3–5 of admission (adjusted OR 13.66 95% CI 3.47 to 53.68).

Conclusion

COVID-19 related mortality in hospitalised adult patients at our center was similar to the developed countries. Progression in disease severity on days 3–5 of admission or days 6–13 of illness onset acts as ‘turning point’ for timely referral or treatment intensification for optimum use of resources.
Integration of planetary health in undergraduate and postgraduate medical education: protocol for a scoping review
Authors: Moloo Husein , Selvam Rajajee , Seguin Nieve , Zhang Lisa , Lacaille-Ranger Ariane , Sikora Lindsey , McIsaac Daniel I
Published: June 2022

Introduction

Despite climate change being recognised as the greatest health threat of the 21st century, current medical education curricula do not reflect the urgency of the climate crisis. Preparing for climate-related health repercussions requires educational institutions to disseminate planetary health knowledge in a systematic way. We sought to evaluate the extent of the literature on the inclusion of planetary health in undergraduate and postgraduate medical education to guide curricular development.

Methods and analysis

A scoping review is being undertaken with a search strategy developed with a health sciences librarian. The search strategy was run on the following databases from inception to 22 June 2021: Medline, Embase, APA PsycINFO, CINAHL, Global Health, Scopus. This scoping review is being conducted as per methodology that has been previously outlined. Studies that discuss the implementation of planetary health education within undergraduate and postgraduate medical education will be included, whether they discuss formal inclusion or supplemental courses. To supplement our database search, data from the Health and Environment Adaptive Task Force’s National Report on Planetary Health Education, the Planetary Health Report Card and the Association for Medical Education in Europe Consensus Statement on Planetary Health and Education for Sustainable Healthcare will be included. As we anticipate varying methodologies, the data analysis will consist of both a quantitative and a qualitative component. Outcomes will be categorised within the domains of the Planetary Health Education Framework, which incorporates concepts of systems thinking, social justice and interconnection within nature as they apply to education for planetary health.

Ethics and dissemination

As no intervention or patient recruitment will be required, research ethics board approval is not applicable. We plan to disseminate our results via publication in a peer-reviewed journal or conference presentation.

Trial registration number

This protocol has been registered in Open Science Framework (10.17605/OSF.IO/7M6GZ).