bluuebunny/crossref_metadata_2025 huggingface dataset:
Proximal Joint Compliance as a Passive Method for Ground Reaction Force Redirection During Legged Locomotion
Authors: Gurney Jason
Published: August 2024

Ground reaction forces (GRFs) are a critical component of legged locomotion, and controlling their direction leads to more stable, efficient, and robust performance. The novelty of this work is to studying passive proximal joint (hips/shoulders) compliance for the purpose of redirecting the GRF passively. Previous works have redirected the GRF actively or studied passive proximal joint compliance for purposes such as swing phase efficiency, but passive methods of stance-phase GRF redirection are under-developed. This paper analyzes the relationship between hip compliance and the GRF direction analytically and with simulations of a trotting quadruped. The results show increased GRF redirection, on average, with increased joint stiffness, for a range of cases. An example method of utilizing this relationship to improve locomotion performance is presented by simulating online compliance adaptation. By adapting the compliance parameter during locomotion, the cost of locomotion was reduced toward the known minimum within the parameter space explored. These results support the conclusion that adjusting the hip compliance provides a passive way of redirecting the GRF, which leads to improved locomotion performance. Other systems can utilize this knowledge to passively improve their own performance.
Ultrasonography for the optimal selection of patients suitable for single session arteriography and endovascular revascularization in severe peripheral artery disease
Authors: Spinu Mihail , Gligor Rares Ioan , Olinic Maria , Homorodean Calin , Ober Mihai Claudiu , Tataru Dan , Sabiescu Bogdan , Onea Laurentiu , Achim Alexandru , Laza Leontin , Olinic Dan Mircea
Published: August 2024

Aims: Peripheral artery disease (PAD) represents a high burden on the healthcare and social assistance systems. Revascularization reduces symptoms, amputation rate and increases the chances of social reintegration. Our aim was to evaluate the benefits of vascular duplex ultrasonography (DUS) for identifying patients suitable for direct percutaneous transluminal angioplasty (PTA) without the need for a prior angiography.Material and methodsː We included in the study 251 patients with PAD evaluated by DUS. Depending on the DUS findings the patients were split in two groups: group I, 143 patients (57%), in which selective angiography and direct PTA was performed and group 2, 108 patients (43%), in which invasive arteriography was considered necessary prior to a decision for revascularization. Resultsː The first group had a similar success rate (92.3% vs. 86.1%; p=0.111), but with a reduction in radioscopy time (minutes) (17.2 vs. 20.8; p=0.013), iodine contrast volume (ml) (190 vs. 227.5; p<0.001), days of hospitalization (4 vs. 7; p<0.001) and by 44.75% (p<0.001) of hospitalization costs when compared to the second group.Conclusionsː DUS allows the optimal selection of patients who can benefit from direct PTA. This strategy has a high success rate, with a significant decrease in radioscopy exposure time, volume of iodine contrast needed, duration and hospitalization costs, when compared to arteriography and PTA in two different sessions.
Geoacoustic inversion using Bayesian optimization with a Gaussian process surrogate model
Authors: Jenkins William F. , Gerstoft Peter , Park Yongsung
Published: August 2024

Geoacoustic inversion can be a computationally expensive task in high-dimensional parameter spaces, typically requiring thousands of forward model evaluations to estimate the geoacoustic environment. We demonstrate Bayesian optimization (BO), an efficient global optimization method capable of estimating geoacoustic parameters in seven-dimensional space within 100 evaluations instead of thousands. BO iteratively searches parameter space for the global optimum of an objective function, defined in this study as the Bartlett power. Each step consists of fitting a Gaussian process surrogate model to observed data and then choosing a new point to evaluate using a heuristic acquisition function. The ideal acquisition function balances exploration of the parameter space in regions with high uncertainty with exploitation of high-performing regions. Three acquisition functions are evaluated: upper confidence bound, expected improvement (EI), and logarithmically transformed EI. BO is demonstrated for both simulated and experimental data from a shallow-water environment and rapidly estimates optimal parameters while yielding results comparable to differential evolution optimization.
Highly oxidized intraplate basalts and deep carbon storage
Authors: Dong Xu-Han , Wang Shui-Jiong , Wang Wenzhong , Huang Shichun , Li Qiu-Li , Liu Chengshuai , Gao Ting , Li Shuguang , Wu Shitou
Published: August 2024

Deep carbon cycle is crucial for mantle dynamics and maintaining Earth’s habitability. Recycled carbonates are a strong oxidant in mantle carbon-iron redox reactions, leading to the formation of highly oxidized mantle domains and deep carbon storage. Here we report high Fe
3+
/∑Fe values in Cenozoic intraplate basalts from eastern China, which are correlated with geochemical and isotopic compositions that point to a common role of carbonated melt with recycled carbonate signatures. We propose that the source of these highly oxidized basalts has been oxidized by carbonated melts derived from the stagnant subducted slab in the mantle transition zone. Diamonds formed during the carbon-iron redox reaction were separated from the melt due to density differences. This would leave a large amount of carbon (about four times of preindustrial atmospheric carbon budget) stored in the deep mantle and isolated from global carbon cycle. As such, the amounts of subducted slabs stagnated at mantle transition zone can be an important factor regulating the climate.
Application of a microbial and pathogen source tracking toolbox to identify infrastructure problems in stormwater drainage networks: a case study
Authors: Carson Liam R. , Goodman Clint , van Duin Bert , Neumann Norman F.
Published: August 2024

Water scarcity and increasing urbanization are forcing municipalities to consider alternative water sources, such as stormwater, to fill in water supply gaps or address hydromodification of receiving urban streams. Mounting evidence suggests that stormwater is often contaminated with human feces, even in stormwater drainage systems separate from sanitary sewers. Pinpointing sources of human contamination in drainage networks is challenging given the diverse sources of fecal pollution that can impact these systems and the non-specificity of traditional fecal indicator bacteria (FIB) for identifying these host sources. As such, we used a toolbox approach that encompassed microbial source tracking (MST), FIB monitoring, and bacterial pathogen monitoring to investigate microbial contamination of stormwater in an urban municipality. We demonstrate that human sewage frequently contaminated stormwater (in >50% of routine samples), based on the presence of the human fecal marker HF183, and often exceeded microbial water quality criteria.
Arcobacter butzleri
, a pathogen of emerging concern, was also detected in >50% of routine samples, with 75% of these pathogen-positive samples also being positive for the human fecal marker HF183, suggesting human municipal sewage as the likely source for this pathogen. MST and FIB were used to track human fecal pollution in the drainage network to the most likely point source of contamination, for which a sewage cross-connection was identified and confirmed using tracer dyes. These results point to the ubiquitous presence of human sewage in stormwater and also provide municipalities with the tools to identify sources of anthropogenic contamination in storm drainage networks.

IMPORTANCE

Water scarcity, increased urbanization, and population growth are driving municipalities worldwide to consider stormwater as an alternative water source in urban environments. However, many studies suggest that stormwater is relatively poor in terms of microbial water quality, is frequently contaminated with human sewage, and therefore could represent a potential health risk depending on the type of exposure (e.g., irrigation of community gardens). Traditional monitoring of water quality based on fecal bacteria does not provide any information about the sources of fecal pollution contaminating stormwater (i.e., animals/human feces). Herein, we present a case study that uses fecal bacterial monitoring, microbial source tracking, and bacterial pathogen analysis to identify a cross-connection that contributed to human fecal intrusion into an urban stormwater network. This microbial toolbox approach can be useful for municipalities in identifying infrastructure problems in stormwater drainage networks to reduce risks associated with water reuse.
Tectonostratigraphic evolution of a marginal basin during the transition from arc collision to subduction: The case of the northern Pacific forearc of Colombia
Authors: León Santiago , Parra Mauricio , Marulanda U. Mateo , Monsalve Gaspar , Jaramillo Carlos , Vallejo-Hincapié Felipe , Valencia Víctor A.
Published: August 2024

The forearc of the northern Pacific region of Colombia (Atrato basin) initially formed in an intra-oceanic setting related to the Central American arc, and its sedimentary record provides a unique opportunity to study the evolution of source-to-sink systems during the transition from arc collision to subduction. Intracrustal weaknesses, and the highly oblique approach to the continental South American paleomargin, favored an initial soft collision of the island arc and associated marginal basins during the Early Miocene. This is suggested by the lack of widespread deformation in the collisional front and the accumulation of hemipelagic rocks with little terrestrial input, sourced by the colliding arc and the continental paleomargin. A regional unconformity associated with a shift toward terrigenous deposition is attributed to a harder collision and subsequent buoyancy-driven uplift of the oceanic terrane ca. 15–13 Ma. The final docking of the oceanic arc and related basins to the continent and coeval surface uplift near the suture zone ca. 12–7 Ma marked the transition from collision to subduction and the establishment of the Atrato basin as a continental forearc. This was accompanied by postcollisional arc magmatism, shallowing of accumulation depths to nearshore conditions, and a dramatic decrease in the sediment contribution of the continental paleomargin. Subsequent shallow subduction of the Coiba microplate caused the Late Miocene uplift of the coastal Baudó Range and the fragmentation of the Atrato basin into inner and outer (coastal) segments. This episode drove a shift from predominantly transverse to longitudinal drainage systems and the final transition from marine to terrestrial settings in northwestern Colombia.
Supplemental Material: Lawsonite-eclogite records subduction rheology and slab detachment, Faro, Yukon-Tanana Terrane, Yukon Territory, Canada
Authors: Faber Carly , Rowe Christie D.
Published: August 2024

Figure S1 includes large thin section scans for all samples. Figure S2 comprises electron backscatter diffraction (EBSD) large area maps for samples F09c and F11. Figure S3 includes additional isopleths or garnet core estimates for samples F09c and F11. Figure S4 includes EBSD GROD (grain reference orientation deviation) maps for two garnets in eclogite showing minor internal misorientation consistent with fragmented compositional zoning. Tables S1–S9 include: (S1) a table of all samples and sample mineralogy; (S2) X-ray fluorescence data for samples F09c, F11, and F13c; (S3) all garnet analyses for Fig. 4A; (S4) all clinopyroxene analyses for Fig. 4B; (S3S5) all amphibole analyses for Fig. 4D; (S6) all lawsonite analyses for Fig. 4E; (S7) all white mica analyses for samples F09c and F11; (S8) all epidote group mineral analyses for samples F09c and F11; and (S9) all chlorite analyses for samples F09c and F11.
Promotion of Physical Activity by Health Professionals (PROMOTE-PA): protocol for effectiveness outcomes in a hybrid type I effectiveness-implementation cluster randomised controlled trial
Authors: Baldwin Jennifer Naomi , Purcell Kate , Hassett Leanne , Tiedemann Anne , Pinheiro Marina , Savage Roslyn , Wang Belinda , Haynes Abby , West Kerry , Noetel Michael , Richards Bethan , Jennings Matthew , Gupta Sandeep , Smith Ben J , Treacy Daniel , Halliday Mark , Harvey Lisa A , Phongsavan Philayrath , Rogers Kris , Howard Kirsten , Bauman Adrian , Hamdorf Phil , Shaw Ayden , Walkley Jeff , Dwyer Genevieve , Lonsdale Chris , Reece Lindsey , Clutterbuck Georgina , Lovitt Lorraine , Sturnieks Daina , Sherrington Catherine
Published: August 2024

Promotion of physical activity by health professionals can increase physical activity participation among patients, however, implementing physical activity promotion within hospital systems is lacking. The Promotion of Physical Activity by Health Professionals (PROMOTE-PA) study is a hybrid type I effectiveness-implementation cluster randomised controlled trial evaluating the effectiveness of support for physical activity promotion by health professionals on physical activity participation of patients. Health professionals delivering outpatient healthcare services within four local health districts and one specialty health network in New South Wales, Australia will be included. The target patient population is children (5–17 years) and adults (18+ years) who are willing to receive additional support to be more physically active. The evidence-based intervention is brief physical activity promotion informed by the ‘5As’ physical activity counselling model and behavioural theory, embedded into routine clinical practice. Our multi-faceted strategy to support implementation of physical activity promotion was developed based on preliminary research and consultation with key stakeholders. The implementation strategy includes education and training as well as a selection of the following (tailored to each clinical team): community referral strategies, experts and clinical mentors, and clinical champions. 30 outpatient clinical teams will be randomised to receive the implementation strategy immediately or after a 3-month delay (waitlist control). Each team will seek to recruit 10–30 patients (n=approx. 720) to report moderate-vigorous physical activity (minutes per week, primary outcome), frequency of balance and strength exercise, mobility, and quality of life at baseline, 3-month and 6-month post patient recruitment. This study aims to address the increasing burden of physical inactivity in a high-risk population using the existing health workforce.

Trial registration numberAustralian and New Zealand Clinical Trials Registry (ACTRN12623000920695).
Prevalence, determinants and care-seeking behaviour for anxiety and depression in Nepalese population: a secondary analysis of data from Nepal Demographic and Health Survey 2022
Authors: Pandey Achyut Raj , Adhikari Bikram , Bista Bihungum , Lamichhane Bipul , Joshi Deepak , K C Saugat Pratap , Sharma Shreeman , Baral Sushil
Published: August 2024

Objective

To determine the prevalence and factors associated with anxiety and depression and the care-seeking behaviour among Nepalese population.

Design and settings

Secondary analysis of the data from nationally representative Nepal Demographic and Health Survey 2022.

Participants

Analysed data of 12 355 participants (7442 females and 4913 males) aged 15–49 years.

Outcome measures

Depression and anxiety were assessed using Patient Health Questionnaire-9 (PHQ-9) and Generalised Anxiety Disorder Assessment (GAD-7) tools, respectively.

Statistical analysis

We performed weighted analysis to account for the complex survey design. We presented categorical variables as frequency, per cent and 95% confidence interval (CI), whereas numerical variables were presented as median, inter-quartile range (IQR) and 95% CI. We performed univariate and multivariable logistic regression to determine factors associated with anxiety and depression, and results were presented as crude OR (COR), adjusted OR (AOR) and their 95% CI.

Results

The prevalence of depression and anxiety were 4.0% (95% CI 3.5 to 4.5) and 17.7% (95% CI 16.5 to 18.9), respectively. Divorced or separated participants were found to have higher odds of developing anxiety (AOR 2.40, 95% CI 1.74 to 3.31) and depression (AOR 3.16, 95% CI 1.84 to 5.42). Among ethnic groups, Janajati had lower odds of developing anxiety (AOR 0.77, 95% CI 0.65 to 0.92) and depression (AOR 0.67, 95% CI 0.49 to 0.93) compared with Brahmin/Chhetri. Regarding disability, participants with some difficulty had higher odds of developing anxiety (AOR 1.81, 95% CI 1.56 to 2.10) and depression (AOR 1.94, 95% CI 1.51 to 2.49), and those with a lot of difficulty had higher odds of anxiety (AOR 2.09, 95% CI 1.48 to 2.96) and depression (AOR 2.04, 95% CI 1.06 to 3.90) compared with those without any disability. Among those who had symptoms of anxiety or depression, only 32.9% (95% CI 30.4 to 34.4) sought help for the conditions.

Conclusions

Marital status and disability status were positively associated with anxiety and depression, whereas Janajati ethnicity had relatively lower odds of experiencing anxiety and depression. It is essential to develop interventions and policies targeting females and divorced individuals to help reduce the burden of anxiety and depression in Nepal.
Demographic and geographic distribution of diabetes and pre-diabetes risk in rural settings: results from a cross-sectional, countywide rural health survey in Sullivan County, New York
Authors: Lee David C , Ross Leah , Quintero Arias Carolina , Rony Melissa , Patel Rahi , Jensen Erica , Petcu Robert , Imas Daniel , Elbel Brian , Thorpe Lorna E , Anthopolos Rebecca
Published: August 2024

Objective

To perform a detailed characterisation of diabetes burden and pre-diabetes risk in a rural county with previously documented poor health outcomes in order to understand the local within-county distribution of diabetes in rural areas of America.

Design, setting, and participants

In 2021, we prospectively mailed health surveys to all households in Sullivan County, a rural county with the second-worst health outcomes of all counties in New York State. Our survey included questions on demographics, medical history and the American Diabetes Association’s Pre-diabetes Risk Test.

Primary outcome and methods

Our primary outcome was an assessment of diabetes burden within this rural county. To help mitigate non-response bias in our survey, raking adjustments were performed across strata of age, sex, race/ethnicity and health insurance. We analysed diabetes prevalence by demographic characteristics and used geospatial analysis to assess for clustering of diagnosed diabetes cases.

Results

After applying raking procedures for the 4725 survey responses, our adjusted diagnosed diabetes prevalence for Sullivan County was 12.9% compared with the 2019 Behavioural Risk Factor Surveillance System (BRFSS) estimate of 8.6%. In this rural area, diagnosed diabetes prevalence was notably higher among non-Hispanic Black (21%) and Hispanic (15%) residents compared with non-Hispanic White (12%) residents. 53% of respondents without a known history of pre-diabetes or diabetes scored as high risk for pre-diabetes. Nearest neighbour analyses revealed that hotspots of diagnosed diabetes were primarily located in the more densely populated areas of this rural county.

Conclusions

Our mailed health survey to all residents in Sullivan County demonstrated higher diabetes prevalence compared with modelled BRFSS estimates that were based on small telephone samples. Our results suggest the need for better diabetes surveillance in rural communities, which may benefit from interventions specifically tailored for improving glycaemic control among rural residents.
Effect of home-based and remotely supervised combined exercise and cognitive intervention on older adults with mild cognitive impairment (COGITO): study protocol for a randomised controlled trial
Authors: Hong Chenlu , Tai TakChing , Zhou Jianwei , Gao Changqing , Shi Jianfei , Huang Jinsong , Xu Xuebing , Du Yushan , Liu Guangwen , Guan Boyuan , Ning Xin , Liu Xinran , Liu Zhaorui , Luo Yanan
Published: August 2024

Introduction

Mild cognitive impairment (MCI) is an intermediate phase between normal cognitive ageing and dementia and poses a serious threat to public health worldwide; however, it might be reversible, representing the best opportunity for secondary prevention against serious cognitive impairment. As a non-pharmacological intervention for those patients, interventions that combine physical exercise and cognitive training, whether delivered simultaneously or sequentially, may have superior effects on various cognitive domains, including global cognition, memory, executive function and attention. The supportive evidence remains incomplete. This study aims to assess the effectiveness of a combined exercise and cognitive intervention in Chinese older adults with mild cognitive impairment (COGITO), empowered by digital therapy and guided by the Health Action Process Model and the Theory of Planned Behaviour (HAPA-TPB theory) in a home-based setting.

Methods and analysis

This study is a randomised controlled, assessor-blinded multi-centre study. Four parallel groups will include a total of 160 patients, receiving either a combined exercise and cognitive intervention, an isolated exercise intervention, an isolated cognitive intervention or only health education. These interventions will be conducted at least twice a week for 50 min each session, over 3 months. All interventions will be delivered at home and remotely monitored through RehabApp and Mini-programme, along with an arm-worn heart rate telemetry device. Specifically, supervisors will receive participants’ real-time training diaries, heart rates or other online monitoring data and then provide weekly telephone calls and monthly home visits to encourage participants to complete their tasks and address any difficulties based on their training information. Eligible participants are community-dwelling patients with no regular exercise habit and diagnosed with MCI. The primary outcome is cognitive function assessed by the Alzheimer’s Disease Assessment Scale-Cognitive (ADAS-Cog) and Community Screening Instrument for Dementia (CSI-D), with baseline and three follow-up assessments. Secondary outcomes include quality of life, physical fitness, sleep quality, intrinsic capacity, frailty, social support, adherence, cost-effectiveness and cost-benefit.

Ethics and dissemination

The study was approved by the Institutional Review Board of Peking University. Research findings will be presented to stakeholders and published in peer-reviewed journals and at provincial, national and international conferences.

Trial registration number

ChiCTR2300073900.
Integrating programme theory into the development of a core outcome set for technology-assisted counselling interventions in dementia: study protocol of the ProCOS study
Authors: Bauernschmidt Dorothee , Wittmann Janina , Bieber Anja , Meyer Gabriele
Published: August 2024

Introduction

Due to the increasing number of persons with dementia, the need for family and professional support is growing. Counselling services aim to support family dementia caregivers and the use of information and communication technology may improve accessibility to counselling. The effectiveness of technology-based counselling in dementia remains unclear so far. Few randomised controlled trials have been conducted assessing heterogeneous outcomes. Theoretical underpinnings for the development and evaluation of these complex interventions were lacking in most cases. We therefore aim to formulate an initial programme theory of a technology-assisted counselling intervention for family dementia caregivers and to create the data basis for the consensus process of a core outcome set.

Methods and analysis

The methodological approaches for developing a programme theory and a core outcome set will be integrated. In a scoping review, data on the characteristics, theoretical foundations of counselling interventions and outcomes of clinical studies will be collected. The lifeworld perception of relevant stakeholders on the importance of counselling in family caregiving will be explored in a phenomenological substudy using semistructured interviews. The synthesis of data from the literature review and the qualitative substudy will be performed by developing a logic model. Mechanisms of action and assumed causal relationships are explicated in the elements of programme theory (theory of change, outcomes chain and theory of action). An initial programme theory is then formulated. In addition, a ‘long list’ of outcomes and assessment instruments will be compiled.

Ethics and dissemination

The ethics committee of the Medical Faculty of the Martin Luther University Halle-Wittenberg approved the study protocol (no. 2023–093).

Findings will be reported to participants and the funding organisation and disseminated in peer-reviewed journals and at national and international conferences.

Trial registration number

The ProCOS (Development and evaluation of a technology-assissted counselling intervention for family caregivers of persons with dementia - Programme theory and preparation of a core outcome set) project is registered with the Core Outcome Measures in Effectiveness Trials initiative (https://www.comet-initiative.org/Studies/Details/2884).
COVID-19 pandemic impact on hypertension management in North East London: an observational cohort study using electronic health records
Authors: Rison Stuart Christopher Gorthorn , Redfern Oliver C , Mathur Rohini , Dostal Isabel , Carvalho Chris , Raisi-Estabragh Zahra , Robson John
Published: August 2024

Objective

There are established inequities in the monitoring and management of hypertension in England. The COVID-19 pandemic had a major impact on primary care management of long-term conditions such as hypertension. This study investigated the possible disproportionate impact of the pandemic across patient groups.

Design

Open cohort of people with diagnosed hypertension.

Settings

North East London primary care practices from January 2019 to October 2022.

Participants

All 224 329 adults with hypertension registered in 193 primary care practices.

Outcomes

Monitoring and management of hypertension were assessed using two indicators: (i) blood pressure recorded within 1 year of the index date and (ii) blood pressure control to national clinical practice guidelines.

Results

The proportion of patients with a contemporaneous blood pressure recording fell from a 91% pre-pandemic peak to 62% at the end of the pandemic lockdown and improved to 77% by the end of the study. This was paralleled by the proportion of individuals with controlled hypertension which fell from a 73% pre-pandemic peak to 50% at the end of the pandemic lockdown and improved to 60% by the end of the study. However, when excluding patients without a recent blood pressure recording, the proportions of patients with controlled hypertension increased to 81%, 80% and 78% respectively.

Throughout the study, in comparison to the White ethnic group, the Black ethnic group was less likely to achieve adequate blood pressure control (ORs 0.81 (95% CI 0.78 to 0.85, p<0.001) to 0.87 (95% CI 0.84 to 0.91, p<0.001)). Conversely, the Asian ethnic group was more likely to have controlled blood pressure (ORs 1.09 (95% CI 1.05 to 1.14, p<0.001) to 1.28 (95% CI 1.23 to 1.32, p<0.001)). Men, younger individuals, more affluent individuals, individuals with unknown or unrecorded ethnicity or those untreated were also less likely to have blood pressure control to target throughout the study.

Conclusion

The COVID-19 pandemic had a greater impact on blood pressure recording than on blood pressure control. Inequities in blood pressure control persisted during the pandemic and remain outstanding.
Survival status and predictors of mortality among severely acute malnourished under-5 children admitted to stabilisation centers in selected government hospitals in Addis Ababa, Ethiopia, 2022: a retrospective cohort study
Authors: Abdu Amanuel Nuredin , Murugan Rajalakshmi , Tilahun Sosina Workineh
Published: August 2024

Objective

This study aims to assess the survival status and predictors of mortality among under-5 children with severe acute malnutrition in Addis Ababa, Ethiopia.

Design

A retrospective cohort study was employed on randomly selected 422 medical records of children under the age of 5 admitted to stabilisation centres in Addis Ababa, Ethiopia. Survival analysis and Cox regression analysis were conducted to determine time spent before the outcome and predictors of desired outcome.

Settings

The stabilisation centres in four governmental hospitals in Addis Ababa, Ethiopia: Tikur Anbessa Specialised Hospital, Zewditu Memorial Hospital, Yekatit 12 Hospital and Tirunesh Beijing Hospital

Participants

Of 435 severely malnourished children under the age of 5 admitted to four governmental hospitals in Addis Ababa, Ethiopia, from January 2020 to December 2022, we were able to trace 422 complete records. The remaining 13 medical records were found to be incomplete due to missing medical history information for those children.

Primary and secondary outcome measures

The primary outcome is the survival status of under-5 children with severe acute malnutrition after admission to the stabilisation centres. The secondary outcome is predictors of survival among these children.

Results

Of 422 children, 44 (10.4%) died, with an incidence rate of 10.3 per 1000 person-days. The median hospital stay was 8 days. Full vaccination (adjusted HR (AHR) 0.2, 95% CI 0.088 to 0.583, p<0.05), feeding practices (F-75) (AHR 0.2, 95% CI 0.062 to 0.651, p<0.01), intravenous fluid administration (AHR 3.7, 95% CI 1.525 to 8.743, p<0.01), presence of HIV (AHR 2.2, 95% CI 1.001 to 4.650, p<0.05), pneumonia (AHR 2.2, 95% CI 1.001 to 4.650, p<0.01) and occurrence of shock (AHR3.5, 95% CI 1.451 to 8.321, p<0.01) were identified as significant predictors of mortality.

Conclusion

The study identified a survival rate slightly higher than the acceptable range set by the social and public health economics study group. Factors like vaccination status, HIV, pneumonia, shock, intravenous fluid and the absence of feeding F-75 predicted mortality.
Trends in urine sampling rates of general practice patients with suspected lower urinary tract infections in England, 2015–2022: a population-based study
Authors: Ciaccio Laura , Fountain Holly , Beech Elizabeth , Brown Colin S , Demirjian Alicia , Gerver Sarah , Muller-Pebody Berit , Bou-Antoun Sabine
Published: August 2024

Objectives

Inappropriate prescribing of antibiotics is a key driver of antimicrobial resistance. This study aimed to describe urine sampling rates and antibiotic prescribing for patients with lower urinary tract infections (UTIs) in English general practice.

Design

A retrospective population-based study using administrative data.

Setting

IQVIA Medical Research Database (IMRD) data from general practices in England, 2015–2022.

Participants

Patients who have consulted with an uncomplicated UTI in England general practices captured in the IMRD.

Outcome measures

Trends in UTI episodes (episodes were defined as UTI diagnosis codes occurring within 14 days of each other), testing and antibiotic prescribing on the same day as initial UTI consultation were assessed from January 2015 to December 2022. Associations, using univariate and multivariate logistic regressions, were examined between consultation and demographic factors on the odds of a urine test.

Results

There were 743 350 UTI episodes; 50.8% had a urine test. Testing rates fluctuated with an upward trend and large decline in 2020. Same-day UTI antibiotic prescribing occurred in 78.2% of episodes. In multivariate modelling, factors found to decrease odds of a urine test included age ≥85 years (0.83, 95% CI 0.82 to 0.84), consultation type (remote vs face to face, 0.45, 95% CI 0.45 to 0.46), episodes in London compared with the South (0.74, 95% CI 0.72 to 0.75) and increasing practice size (0.77, 95% CI 0.76 to 0.78). Odds of urine tests increased in males (OR 1.11, 95% CI 1.10 to 1.13), for those episodes without a same-day UTI antibiotic (1.10, 95% CI 1.04 to 1.16) for episodes for those with higher deprivation status (Indices of Multiple Deprivation 8 vs 1, 1.51, 95% CI 1.48 to 1.54). Compared with 2015, 2016–2019 saw increased odds of testing while 2020 and 2021 saw decreases, with 2022 showing increased odds.

Conclusion

Urine testing for UTI in general practice in England showed an upward trend, with same-day antibiotic prescribing remaining consistent, suggesting greater alignment to national guidelines. The COVID-19 pandemic impacted testing rates, though as of 2022, they began to recover.
Optimal approach to ultrasound-guided quadratus lumborum blocks for postoperative analgesia in elective caesarean section: protocol for systematic review and meta-analysis
Authors: Li Yan , Zhang Donghang , Wang Na
Published: August 2024

Introduction

Ultrasound-guided quadratus lumborum blocks are commonly used for postoperative analgesia during caesarean section. Ultrasound-guided quadratus lumborum blocks can be performed through four approaches, including lateral, posterior, anterior, and intramuscular quadratus lumborum blocks. This systematic review and meta-analysis aims to determine the optimal approach to ultrasound-guided quadratus lumborum blocks for postoperative analgesia in elective caesarean section.

Methods and analysis

The PubMed, EMBASE, Cochrane Library and Web of Science databases will be systematically searched from their inception to 30 July 2024. Randomised controlled trials that compared the analgesic effects of different ultrasound-guided quadratus lumborum block approaches in elective caesarean section will be included. Only publications in English will be eligible for inclusion. The total postoperative analgesic consumption over 24 hours will be the primary outcome. The time to first analgesic request, postoperative pain scores at rest and during movement, and incidence of adverse effects will be secondary outcomes. RevMan V.5.4 will be used for the statistical analysis. Network meta-analysis will be used for indirect comparisons between different approaches across studies. The Grading of Recommendations Assessment, Development and Evaluation approach will be used to assess the quality of evidence for each outcome.

Ethics and dissemination

Ethical approval was not required. The results of this study will be submitted to peer-reviewed journals.

PROSPERO registration number

CRD42024503694.
Role of men in women’s health service utilisation in northern Nigeria: a qualitative study of women, men and provider perspectives
Authors: Sinai Irit , Azogu Olajumoke , Dabai Shehu Salisu , Waseem Saba
Published: August 2024

Background

The 2018 Nigeria Demographic and Health Survey shows poor maternal health in northern Nigeria. Contraceptive use remains low and maternal mortality high. Studies show that cultural norms related to men’s decision-making role in the family significantly contribute to this phenomenon.

Objectives

The assessment was designed to identify barriers to service delivery and utilisation of maternal-health and family-planning services in three northern Nigerian states, focusing on aspects of service delivery affected by husband involvement.

Design

Qualitative design included 16 focus group discussions and 12 in-depth interviews with facility clients, and 16 in-depth interviews with healthcare providers, in each of the three states.

Setting

Primary healthcare facilities in three northern Nigeria states: Bauchi, Kebbi and Sokoto.

Participants

Women who came to the facility for family-planning services (n=233 in 24 focus groups); women who came for antenatal care (n=97 in 12 focus groups); men married to women who either received antenatal care or delivered in a facility (n=96 in 12 focus groups); mothers of newborns who delivered in a facility (n=36) and healthcare providers (n=48).

Results

We found gender barriers to contraceptive use and to obtaining maternal healthcare, with some women requiring their husband’s permission to use services, even in emergencies. Several supply-side barriers exacerbate the situation. Many healthcare providers would not provide women with a family-planning method without their husbands’ presence or approval; some male providers would not admit a woman to deliver in a facility if her husband objected to her being treated by a man and there was no female provider present and some facilities do not have the infrastructure to accommodate men.

Conclusion

Despite years of programming, barriers to women’s family-planning and maternal-health service utilisation persist. State governments in northern Nigeria should invest in additional provider training, improving infrastructure and hiring more female healthcare providers.
Political economy analysis of health taxes (tobacco, alcohol drink and sugar-sweetened beverage): qualitative study of three provinces in Indonesia
Authors: Ahsan Abdillah , Amalia Nadira , Rahmayanti Krisna Puji , Adani Nadhila , Wiyono Nur Hadi , Endawansa Althof , Utami Maulida Gadis , Miranti Yuniar Adela , Anastasia Erika Valentina , Pertiwi Yuyu Buono Ayuning
Published: August 2024

Objective

Efforts to implement health tax policies to control the consumption of harmful commodities and enhance public health outcomes have garnered substantial recognition globally. However, their successful adoption remains a complex endeavour. This investigates the challenges and opportunities surrounding health tax implementation, with a particular focus on subnational government in Indonesia, where the decentralisation context of health tax remains understudied.

Design

Employing a qualitative methodology using a problem-driven political economy analysis approach.

Setting

We are collecting data from a total of 12 focus group discussions (FGDs) conducted between July and September 2022 in three provinces—Lampung, Special Region of/Daerah IstimewaYogyakarta and Bali, each chosen to represent a specific commodity: tobacco, sugar-sweetened beverages (SSBs) and alcoholic beverages—we explore the multifaceted dynamics of health tax policies.

Participant

These FGDs involved a mean of 10 participants in each FGD, representing governmental institutions, non-governmental organisations and consumers.

Results

Our findings reveal that health tax policies have the potential to contribute significantly to public health. Consumers understand tobacco’s health risks, and cultural factors influence both tobacco and alcohol consumption. For SSBs, the consumers lack awareness of long-term health risks is concerning. Finally, bureaucratic complexiting and decentralised government hinder implementation for all three commodities.

Conclusion

Furthermore, this study underscores the importance of effective policy communication. It highlights the importance of earmarking health tax revenues for public health initiatives. It also reinforces the need to see health taxes as one intervention as part of a comprehensive public health approach including complementary non-fiscal measures like advertising restrictions and standardised packaging. Addressing these challenges is critical for realising the full potential of health tax policies.
Evaluation of the knowledge, attitude and practice towards ischaemic stroke among healthcare workers in neurology and neurosurgery department: a cross-sectional study in Shaanxi province, China
Authors: Chen Wanhong , Li Wenqiang , Wang Yugang , Chen Dan , Yu Liping , Yuan Xingyun
Published: August 2024

Objectives

Healthcare workers play an important role in the timely recognition and treatment of patients who had an ischaemic stroke. However, their knowledge, attitude and practice (KAP) towards ischaemic stroke have not been well studied. This study aimed to assess the KAP towards ischaemic stroke among healthcare workers in the neurology and neurosurgery department in Shaanxi province, China.

Design

Cross-sectional study.

Setting

Medical centres in Shaanxi province.

Participants

Healthcare workers in the neurology and neurosurgery department at Shaanxi province.

Primary and secondary outcome measures

Demographic characteristics and KAP towards ischaemic stroke were collected by a self-designed questionnaire.

Results

A total of 259 (96.6%) valid questionnaires were collected. Their mean KAP scores were 19.56±3.72 (total score: 23), 36.56±3.56 (total score: 40) and 27.45±3.00 (total score: 30), respectively. Multivariate logistic regression analysis demonstrated that education (bachelor’s degree or above vs college or below: OR=2.704 (1.286–5.685), p=0.009), gender (female vs male: OR=0.401 (0.227–0.710), p=0.002) and professional title (intermediate vs no title: OR=0.280 (0.107–0.731), p=0.009) were independently associated with good knowledge; knowledge score (OR=1.266 (1.157–1.387), p<0.001) and hospital (private hospital vs public hospital: OR=0.544 (0.313–0.944), p=0.030) were independently associated with good attitude; and attitude score (OR=1.480 (1.326–1.652), p<0.001), gender (female vs male: OR=0.511 (0.264–0.993), p=0.047) and occupation (other healthcare workers vs physicians: OR=0.252 (0.129–0.495), p<0.001) were independently associated with good practice.

Conclusion

The healthcare workers in the neurology and neurosurgery department demonstrated a satisfactory KAP towards ischaemic stroke. Targeted and tailored training programmes might be an optional way to improve their practice.
Formative qualitative evaluation of an improvement programme delivered in an English hospital trust to reduce harm from pressure ulcers
Authors: Dallow Anna , Goldthorpe Katharine , Murphy Peter , Phipps Denham , Rostami Paryaneh
Published: August 2024

Background

Pressure ulcers (PUs) are a leading cause of preventable harm globally and can cause patients significant pain, infection and, in rare incidents, death. There is a strong evidence base for how to improve PUs and one UK healthcare trust used this evidence to develop a quality improvement (QI) programme using the Institute of Healthcare Improvement’s Breakthrough Series collaborative model. 20 teams, from both acute and community settings, participated in the first two phases of the collaborative. The delivery of both phases used virtual delivery using the Institute of Healthcare Improvement’s improvement model. This study sought to formatively evaluate the early phases of the collaborative, to support learning and continual improvements to the collaborative programme and other collaboratives delivered by the organisation based on the formative evaluation.

Methods

Semi-structured interviews were conducted with purposively sampled participants to explore their perspectives about the implementation of the programme, interventions tested as part of the ‘change package’ provided and the pandemic’s impact.

Results

A total of seven participants were interviewed, including acute ward managers, a charge nurse (deputy ward manager), a wound healing community nurse and a team leader community nurse. Interview durations varied from 9 min to 28 min. The interviews were kept short and stopped when data saturation was achieved as it was an extremely pressurised time for the organisation where the highest escalation alert was triggered on numerous occasions.

Conclusion

A sustained reduction in PUs was achieved during the evaluation period and participants felt that the approach helped to achieve this, regardless of the adaptations made to the delivery method due to the pandemic. To support improvements, it is vital to ensure systems such as data collection are accurate and timely. The necessity for building strong foundations for QI capability must not be underestimated, as greater QI knowledge leads to better engagement and outcomes.
Family-centred care interventions in neonatal intensive care units: a scoping review of randomised controlled trials providing a menu of interventions, outcomes and measurement methods
Authors: Mariani Ilaria , Vuillard Cecilia Laure Juliette , Bua Jenny , Girardelli Martina , Lazzerini Marzia
Published: August 2024

Background

Benefits of different types of family-centred care (FCC) interventions in neonatal intensive care units (NICUs) have been reported. However, a comprehensive review of existing FCC intervention studies was lacking.

Objective

This review aimed at synthesising the characteristics of FCC interventions, related outcomes and measurement methods in randomised controlled trials (RCTs) in NICU, and providing menus of options to favour implementation and further research.

Methods

We searched PubMed, EMBASE, Web of Science and the Cochrane Library up to 31 January 2022. Interventions were mapped according to five categories as defined by a previous Cochrane review. We described outcome types, measurement populations, measurement methods and timelines. Subgroup analyses were also performed.

Results

Out of 6583 studies identified, 146 met eligibility criteria. Overall, 52 (35.6%) RCTs tested more than one category of intervention, with a large variety of combinations, with the most frequent category of intervention being the educational (138 RCTs, 94.5%). We identified a total of 77 different intervention packages, and RCTs comparing the same interventions were lacking. The 146 RCTs reported on 425 different outcomes, classified in 13 major categories with parental mental health (61 RCTs, 41.8% of total RCTs) being the most frequent category in parents, and neurobehavioural/developmental outcomes being the most frequent category in newborns (62 RCTs, 42.5%). For several categories of outcomes almost every RCT used a different measurement method. Educational interventions targeting specifically staff, fathers, siblings and other family members were lacking or poorly described. Only one RCT measured outcomes in health workers, two in siblings and none considered other family members.

Conclusions

A large variety of interventions, outcomes and measurement methods were used in FCC studies in NICU. The derived menus of options should be helpful for researchers and policy makers to identify interventions most suitable in each setting and to further standardise research methods.