bluuebunny/crossref_metadata_2025 huggingface dataset:
Closing the science gap in 3D metal printing
Authors: Polonsky Andrew T. , Pollock Tresa M.
Published: May 2020

X-ray imaging and modeling reveal how metal powders absorb energy and can create defects
Toward artificial photosynthesis
Authors: Gaut Nathaniel J. , Adamala Katarzyna P.
Published: May 2020

Microfluidics lights the way to a synthetic plant-like cell
Laninamivir-Interferon Lambda 1 Combination Treatment Promotes Resistance by Influenza A Virus More Rapidly than Laninamivir Alone
Authors: Adams Simone E. , Lugovtsev Vladimir Y. , Kan Anastasia , Bovin Nicolai V. , Donnelly Raymond P. , Ilyushina Natalia A.
Published: May 2020

Each year, 5% to 20% of the population of the United States becomes infected with influenza A virus. Combination therapy with two or more antiviral agents has been considered a potential treatment option for influenza virus infection. However, the clinical results derived from combination treatment with two or more antiviral drugs have been variable. We examined the effectiveness of cotreatment with two distinct classes of anti-influenza drugs, i.e., neuraminidase (NA) inhibitor, laninamivir, and interferon lambda 1 (IFN-λ1), against the emergence of drug-resistant virus variantsin vitro.
Repurposing Fenamic Acid Drugs To Combat Multidrug-Resistant Neisseria gonorrhoeae
Authors: Seong Young Jin , Alhashimi Marwa , Mayhoub Abdelrahman , Mohammad Haroon , Seleem Mohamed N.
Published: May 2020

The rise of extensively drug-resistant and multidrug-resistant strains of
Neisseria gonorrhoeae
has occurred in parallel with the increasing demand for new drugs. However, the current methods of drug discovery are burdened with rigorous assessments and require more time than can be spared until gonococcal infections become difficult to control. To address this urgency, we utilized a drug-repurposing strategy and identified three clinically approved anthranilic acid drugs (tolfenamic acid, flufenamic acid, and meclofenamic acid) with potent antigonococcal activity, inhibiting 50% of the strains (MIC
50
) from 4 to 16 μg/ml.
UL88 Mediates the Incorporation of a Subset of Proteins into the Virion Tegument
Authors: Kumar Rinki , Cruz Linda , Sandhu Praneet K. , Buchkovich Nicholas J.
Published: May 2020

A better understanding of the role and functions of tegument proteins in HCMV, many of which remain uncharacterized, will contribute to our understanding of the biology of HCMV. The virus has a large genome, greater than 230 kb, and functional annotation of these genes is important for identifying novel targets for improving therapeutic intervention. This study identifies a role for a viral tegument protein with unknown function, UL88, in maintaining the proper tegument composition of HCMV virions. Virions produced in the absence of UL88 exhibit decreased fitness and require more genomes per infectious unit.
Complete Genome Sequences of Three Neisseria gonorrhoeae Isolates from Thailand with Multidrug Resistance and Multilocus Sequence Type 1903
Authors: Cherdtrakulkiat Thitima , Wongsurawat Thidathip , Jenjaroenpun Piroon , Sutheeworapong Sawannee , Leelawiwat Wanna , Hickey Andrew C. , Dunne Eileen F. , Raengsakulrach Boonyos , Tribuddharat Chanwit
Published: May 2020

Multilocus sequence typing (MLST) sequence type 1903 (ST1903) is the most common ST of ceftriaxone-resistant
Neisseria gonorrhoeae
. Here, we report three completed genome sequences of MLST ST1903
N. gonorrhoeae
isolates collected from patients at Faculty of Medicine Siriraj Hospital, a university hospital in Bangkok, Thailand, in 2009 to 2011.
The Olympic-Wallowa lineament: A new look at an old controversy
Authors: Reidel Stephen P. , Fecht Karl R. , Hutter (Harrold) Ingrid L. , Tolan Terry L. , Chamness Mickie A.
Published: May 2020

The Olympic-Wallowa lineament (OWL) is an alignment of geologic structures extending nearly 650 km across the Pacific Northwest (PNW) and has been a controversial feature since it was first described nearly 80 years ago. It extends from the Olympic Peninsula–Puget Sound area of western Washington to the Wallowa Mountains of northeast Oregon, crossing through the Columbia Basin and forming the southern boundary of the Pasco and Walla Walla Basins. Within the Columbia Basin, the OWL is a wide zone that aligns with >250 km of folds and faults that are part of the Yakima fold and thrust belt. Although the OWL is recognized to be active with deformation continuing from the Miocene to Recent, there are two competing end-member interpretations on the style of deformation: that of a major through-going, dextral strike-slip or oblique-slip fault and that of a series of thrusted anticlines. We focus on that portion of the OWL in the central Columbia Basin that extends from the Walla Walla River in northeast Oregon to Rattlesnake Mountain in central Washington. East of Wallula Gap, the OWL is expressed as the Wallula fault zone along the north flank of the Horse Heaven Hills anticline and the south fork of the Walla Walla River, while west of Wallula Gap, there are three structural alignments: the Rattlesnake-Wallula structural alignment, the Horse Heaven Hills–Badlands structural alignment, and the Horn Rapids–Badger Coulee structural alignment. Except for the Horse Heaven Hills anticline, the structural trends west of Wallula Gap mainly consist of a series of doubly plunging, northeast-verging anticlines. We demonstrate that the OWL consists of north-verging, thrusted anticlines whose orientation and structure are controlled by a basement fault without any evidence of strike-slip or significant oblique-slip fault movement since at least the middle Miocene. The difference in structural deformation of the portion of the OWL to the east of Wallula Gap versus that to the west appears to be controlled by the thickness of pre-basalt sediment within the central Columbia Basin and structures therein.
Impact of Pore Architecture on the Hydroconversion of Long Chain Alkanes over Micro and Mesoporous Catalysts
Authors: Vaugon Laura , Finiels Annie , Cacciaguerra Thomas , Hulea Vasile , Galarneau Anne , Aquino Cindy , Dath Jean-Pierre , Minoux Delphine , Gerardin Corine , Fajula François
Published: May 2020

n-Hexadecane hydroconversion has been investigated in a series of bifunctionnal metal/acid catalysts featuring distinct well-defined pore architectures. The acidic components were prepared from dealuminated Y zeolites with Si/Al of 15 and 30 post treated in alkaline medium to generate ordered or non-ordered secondary networks of mesopores and from aluminated ordered mesoporous materials MCM-41, MCM-48, KIT-6 type materials and amorphous silica gel. Activity relates linearly to the strength and number of strong Brönsted acid sites, while selectivity, more precisely the yield in isomerization products, scales directly with the mesopore volume of the catalyst. The architecture of the mesoporous network, namely the ordering, interconnectivity, homogeneity of the mesopores, affects little catalytst behavior. Confrontation of catalytic data with diffusion measurements suggests the existence of an optimal mesopore size above which the number of strong Brönsted sites and the mesopore volume are the only parameters governing catalytic performance.
Iatrogenic thyroid pseudoaneurysm following thyroid nodule radiofrequency ablation
Authors: Appaduray Shaun Previn , Too Chow Wei
Published: May 2020

A 54-year-old Chinese woman presented for radiofrequency ablation (RFA) of benign thyroid nodules. A few hours after the procedure, the patient developed neck swelling and tenderness. Doppler ultrasound (US) images of the neck revealed haematoma with a vascular hypoechoic mass at the RFA site, suspicious for pseudoaneurysm. These findings were confirmed on subsequent on-table fluoroscopy following direct US-guided needle puncture and injection of contrast, demonstrating opacification of the mass and extravasation. Successful occlusion of the pseudoaneurysm was performed using US-guided thrombin injection. The patient made a good recovery with follow-up US 1 month later showing no recurrence of haematoma or pseudoaneurysm.
Evidence from the Kaduna State Health Accounts on the pattern of sub-national health spending in Nigeria, 2016
Authors: Azubuike Chukwuemeka Emmanuel , Ogundeji Yewande Kofoworola , Butawa Nuha , Orji Nneka , Dogo Paul , Ohiri Kelechi
Published: May 2020

Health accounts provide accurate estimates of health expenditure, which are important for effective resource allocation and planning in the health sector. In Nigeria, four rounds of health accounts have been conducted at the national level. However, the national estimates do not necessarily reflect realities at the subnational level and may only provide limited information for decision making at that level. This study highlights the pattern of health spending in Kaduna State from the 2016 Health Accounts, with a view to providing more reliable evidence for decision making in the state.

Health accounts expenditure surveys were administered to government, donors, non-governmental organizations (NGOs), private health insurance organisations and employers in the health sector for the reference year 2016. Household health expenditure was derived from a household survey administered across a representative sample of 1024 households selected from six local government areas across the three senatorial districts in the state. We estimated disease expenditure by deploying a health provider survey across a sample of 100 health facilities. Analysis was conducted using Microsoft Excel, Stata and the Health Accounts Production Tool.

Findings show that current health expenditure (CHE) accounted for only 7% of the total health expenditure in 2016. Out-of-pocket spending among households was about 81% of CHE, compared with a national average of 71.5% of CHE between 2010 and 2014. The health expenditure findings highlight several policy imperatives for the Kaduna State Health System. Primary among these is the heavy dependence on out-of-pocket financing for health, which has negative implications on vulnerable households. A shift to pooled prepaid mechanisms would reduce the financial burden on the most vulnerable households in Kaduna State. In addition, considering the government’s current contribution to health expenditure, there is a strong need for increased government prioritisation of the Kaduna State health sector.
Community-based health insurance and healthcare service utilisation, North-West, Ethiopia: a comparative, cross-sectional study
Authors: Atnafu Desta Debalkie , Tilahun Hiwot , Alemu Yihun Mulugeta
Published: May 2020

Objectives

The objective of this study was to compare differences in healthcare utilisation between community-based health insurance member households and non-member households and to identify factors for community-based health insurance enrolment in South Achefer District.

Design

Comparative, cross-sectional study.

Settings

Community-based.

Participants

A total of 652 selected households (326 insured and 326 uninsured households) participated in the study.

Methods

A two-sample t-test (for proportions) and χ2(for categorical data) were computed.

Main outcome measure

Utilisation of healthcare.

Results

There was a significant difference in the rate of healthcare utilisation between insured (50.5%) and uninsured (29.3%) households (χ2=27.864, p<0.001). Significant variations of enrolment status in community-based health insurance were observed in the following variables: educational status, family size, occupation, marital status, travel time to the nearest health institution, perceived quality of care, first choice of place for treatment during illness and expected healthcare cost of a recent treatment.

Conclusions

Utilisation of health services among insured households with community-based health insurance was higher. Educational status, family size, occupation, marital status, travel time to the nearest health institution, perceived quality of care, first choice of place for treatment during illness and expected healthcare cost of a recent treatment should be emphasised to enhance community health insurance enrolment.
Study protocol for a randomised controlled trial: treatment of early intrauterine growth restriction with low molecular weight heparin (TRACIP)
Authors: Mazarico Edurne , Peguero Anna , Camprubí Marta , Rovira Carlota , Gomez Roig Maria Dolores , Oros Daniel , Ibáñez-Burillo Patricia , Schoorlemmer Jon , Masoller Narcís , Tàssies Maria Dolors , Figueras Francesc
Published: May 2020

Introduction

The incidence of intrauterine growth restriction (IUGR) is estimated at about 3% of pregnancies, and it is associated with 30% of all perinatal mortality and severe morbidity with adverse neurodevelopmental and cardiovascular health consequences in adult life. Early onset IUGR represents 20%–30% of all cases and is highly associated with severe placental insufficiency. The existing evidence suggests that low molecular weight heparin (LMWH) has effects beyond its antithrombotic action, improving placental microvessel structure and function of pregnant women with vascular obstetric complications by normalising proangiogenic and antiapoptotic protein levels, cytokines and inflammatory factors. The objective of our study is to demonstrate the effectiveness of LMWH in prolonging gestation in pregnancies with early-onset IUGR.

Methods and analysis

This is a multicentre, triple-blind, parallel-arm randomised clinical trial. Singleton pregnancies qualifying for early (20–32 weeks at diagnosis) placental IUGR (according to Delphi criteria) will be randomised to subcutaneous treatment with bemiparin 3500 IU/0.2 mL/day or placebo from inclusion at diagnosis to the time of delivery. Analyses will be based on originally assigned groups (intention-to-treat). The primary objective will be analysed by comparing gestational age and prolongation of pregnancy (days) in each group with Student’s t-tests for independent samples and by comparing Kaplan-Maier survival curves (from inclusion to delivery, log-rank test). A linear regression model for gestational age at birth will consider the following covariates: gestational age at inclusion (continuous) and pre-eclampsia (binary).

Ethics and dissemination

The study will be conducted in accordance with the principles of Good Clinical Practice. This study was approved by the Clinical Research Ethics Committee (CEIC) of Sant Joan de Déu Hospital, on 13 July 2017. The trial is registered in the public registrywww.clinicaltrial.gov. according to Science Law 14/2011, and the results will be published in an open access journal.

Trial registration number

NCT03324139; Pre-results.
Effects of a 6-month self-rehabilitation programme in addition to botulinum toxin injections and conventional physiotherapy on limitations of patients with spastic hemiparesis following stroke (ADJU-TOX): protocol study for a randomised controlled, investigator blinded study
Authors: Bonnyaud Celine , Gallien Philippe , Decavel Pierre , Marque Philippe , Aymard Claire , Pellas Frédéric , Isner Marie-Eve , Boyer François Constant , Muller François , Daviet Jean-Christophe , Dehail Patrick , Perrouin-Verbe Brigitte , Bayle Nicolas , Coudeyre Emmanuel , Perennou Dominic , Laffont Isabelle , Ropers Jacques , Domingo-Saidji Nabila-Yasmine , Bensmail Djamel , Roche Nicolas
Published: May 2020

Introduction

Home-based self-rehabilitation programmes combined with botulinum toxin injections (BTIs) appear to be a relevant approach to increase the recommended intensive rehabilitation of patients with spasticity following a stroke. The literature highlights a lack of evidence of beneficial effects of this adjuvant therapy to reduce limitations of patients with stroke. The aim of this study is to assess the effects of a 6-month self-rehabilitation programme in adjunction to BTI, in comparison with BTI alone, to reduce limitations of patients with spasticity following a stroke.

Methods and analysis

220 chronic patients will participate to this multicentre, prospective, randomised, controlled, assessor blinded study. All patients will benefit from two successive BTI (3 months apart), and patients randomised in the self-rehabilitation group will perform in adjunction 6 months of self-rehabilitation at home. All patients continue their conventional physiotherapy. The main outcome is the primary treatment goal (PTG), which will be determined jointly by the patient and the medical doctor using Goal Attainment Scaling. Impairments and functions, quality of life, mood and fatigue will be assessed. Botulinum toxin will be injected into the relevant muscles according to the PTG. Patients in the self-rehab group will be taught the self-rehabilitation programme involving respectively 10 min of stretching, 10 min of strengthening and 10 min of task-oriented exercises, corresponding to their PTG. Compliance to the self-rehabilitation programme will be monitored.

Ethics and dissemination

Patients will sign written informed consent. Ethical approval was obtained from ethics committee. The results will be disseminated in a peer-reviewed journal and presented at international congresses. The results will also be disseminated to patients.

Trial registration number

NCT02944929.
Conservative care with or without manipulative therapy in the management of back and/or neck pain in Danish children aged 9–15: a randomised controlled trial nested in a school-based cohort
Authors: Dissing Kristina Boe , Hartvigsen Jan , Wedderkopp Niels , Hestbæk Lise
Published: May 2020

Background

A substantial number of children experience spinal pain, that is, back and/or neck pain. Today, no ‘gold-standard’ treatment for spinal pain in children exists, but manipulative therapy is increasingly being used in spite of a lack of evidence of its effectiveness. This study investigates the effectiveness of adding manipulative therapy to other conservative care for spinal pain in a school-based cohort of Danish children aged 9–15 years.

Methods and findings

The design was a two-arm pragmatic randomised controlled trial, nested in a longitudinal open cohort study in Danish public schools. 238 children from 13 public schools were randomised individually from February 2012 to April 2014. A text message system and clinical examinations were used for data collection. Interventions included either (1) advice, exercises and soft-tissue treatment or (2) advice, exercises and soft-tissue treatment plus manipulative therapy. The primary outcome was number of recurrences of spinal pain. Secondary outcomes were duration of spinal pain, change in pain intensity and Global Perceived Effect.

We found no significant difference between groups in the primary outcome (control group median 1 (IQR 1–3) and intervention group 2 (IQR 0–4), p=0.07). Children in the group receiving manipulative therapy reported a higher Global Perceived Effect: OR 2.22, (95% CI 1.19 to 4.15). No adverse events were reported. Main limitations are the potential discrepancy between parental and child reporting and that the study population may not be comparable to a normal care-seeking population.

Conclusions

Adding manipulative therapy to other conservative care in school children with spinal pain did not result in fewer recurrent episodes. The choice of treatment—if any—for spinal pain in children therefore relies on personal preferences, and could include conservative care with and without manipulative therapy. Participants in this trial may differ from a normal care-seeking population.

Trial registration number

NCT01504698; Results.
Efficacy and safety of electroacupuncture on treating depression-related insomnia: a study protocol for a multicentre randomised controlled trial
Authors: Yin Xuan , Dong Bo , Liang Tingting , Yin Ping , Li Xia , Lin Xiang , Zhou Shuang , Qian Xiaolu , Lao Lixing , Xu Shifen
Published: May 2020

Introduction

Sleep disorders including insomnia occur frequently in depressive patients. Acupuncture is a widely recognised therapy to treat depression and sleep disorders in clinical practice. This multicentre randomised controlled trial (RCT) is aimed to investigate the efficacy and safety of electroacupuncture (EA) in the treatment of depression patients with insomnia.

Methods and analysis

We describe a protocol for a multicentre RCT. A total of 270 eligible patients in three different healthcare centres in Shanghai will be randomly assigned to one of these three groups: treatment group (EA + standard care), control A group (sham electroacupuncture + standard care) and control B group (standard care). Treatment will be given three times per week for 8 consecutive weeks. The primary outcome is the Pittsburgh Sleep Quality Index. The secondary outcomes are sleep parameters recorded in the actigraphy, Hamilton Rating Scale for Depression score and Self-rating Anxiety Scale score. Daily dose of patients’ antidepressant and sedative-hypnotic medication will be recorded in the dairy. All adverse effects will be assessed by the Treatment Emergent Symptom Scale. Outcomes will be evaluated at baseline, 4 weeks post-treatment and 8 weeks post-treatment, as well as at 1-month, 3-month and 6-month follow-up.

Ethics and dissemination

The trial has been approved by the Ethics Committee of Shanghai Municipal Hospital of Traditional Chinese Medicine (2017SHL-KY-04). Written informed consent will be obtained from all participants. The results of this study will be published in peer-reviewed journals or presented at academic conferences.

Trial registration number

NCT03122080; Pre-results.
Effectiveness of traditional lectures and case methods in Swedish general practitioners’ continuing medical education about COPD: a cluster randomised controlled trial
Authors: Sandelowsky Hanna , Krakau Ingvar , Modin Sonja , Ställberg Björn , Johansson Sven-Erik , Nager Anna
Published: May 2020

Objectives

To study the effects of continuing medical education (CME) about chronic obstructive pulmonary disease (COPD) for general practitioners (GPs) by comparing two commonly used CME methods with each other and no CME (reference group).

Design

A pragmatic cluster randomised controlled trial with primary healthcare centres (PHCCs) as units of randomisation.

Setting, participants and interventions

24 PHCCs in Stockholm County, Sweden, were randomised into two CME intervention arms: case method learning (CM) (n=12) and traditional lectures (TL) (n=12). A reference group without CME (n=11) was recruited separately. GPs (n=255) participated in the study arm to which their PHCC was allocated: CM, n=87; TL, n=93; and reference, n=75. Two 2-hour CME seminars were given in a period of 3 months.

Primary outcome measures

Changes in scores between baseline and 12 months on a 13-item questionnaire about evidence-based COPD management (0–2 points/question, maximum total score 26 points).

Results

133 (52%) GPs completed the questionnaire both at baseline and 12 months. Both CM and TL resulted in small yet significantly higher total scores at 12 months than at baseline (CM, 10.34 vs 11.44; TL, 10.21 vs 10.91; p<0.05); there were few significant differences between these CME methods. At both baseline and 12 months, all three groups’ scores were generally high on questions about smoking cessation support and low on those that measured spirometry interpretation skills, interprofessional care and management of multimorbidity.

Conclusions

Neither short CM nor short TL CME sessions substantially improve GPs’ skills in managing COPD. It is justified to challenge the use of these common CME methods as a strategy for improving GPs’ level of knowledge about management of COPD and other complex chronic diseases characterised by multimorbidity.

Trial registration number

NCT02213809; Results.
Ecological study on the use of hormonal contraception, abortions and births among teenagers in the Nordic countries
Authors: Hognert Helena , Skjeldestad Finn Egil , Gemzell-Danielsson Kristina , Heikinheimo Oskari , Milsom Ian , Lidegaard Øjvind , Lindh Ingela
Published: May 2020

Objectives

Compare hormonal contraceptive use, birth and abortion rates among teenagers in the Nordic countries. A secondary aim was to explore plausible explanations for possible differences between countries.

Design

Ecological study using national registry data concerning births and abortions among all women aged 15–19 years residing in Denmark, Finland, Iceland, Norway and Sweden 2008–2015. Age-specific data on prescriptions for hormonal contraceptives for the period 2008–2015 were obtained from national databases in Denmark, Norway and Sweden.

Setting

Denmark, Finland, Iceland, Norway and Sweden.

Participants

Women 15–19 years old in all Nordic countries (749 709) and 13–19 years old in Denmark, Norway and Sweden (815 044).

Results

Both annual birth rates and abortion rates fell in all the Nordic countries during the study period. The highest user rate of hormonal contraceptives among 15–19-year-olds was observed in Denmark (from 51% to 47%) followed by Sweden (from 39% to 42%) and Norway (from 37% to 41%). Combined oral contraceptives were the most commonly used methods in all countries. The use of long-acting reversible contraceptives (LARC), implants and the levonorgestrel-releasing intrauterine systems, were increasing, especially in Sweden and Norway. In the subgroup of 18–19-year-old teenagers, the user rates of hormonal contraceptives varied between 63% and 61% in Denmark, 56% and 61% in Norway and 54% and 56% in Sweden. In the same subgroup, the steepest increase of LARC was seen, from 2% to 6% in Denmark, 2% to 9% in Norway and 7% to 17% in Sweden.

Conclusions

Birth and abortion rates continuously declined in the Nordic countries among teenagers. There was a high user rate of hormonal contraceptives, with an increase in the use of LARC especially among the oldest teenagers.
Evaluation of a digital platform for osteoarthritis treatment: study protocol for a randomised clinical study
Authors: Nero Håkan , Ranstam Jonas , Kiadaliri Aliasghar Ahmad , Dahlberg Leif E
Published: May 2020

Introduction

Despite favourable results from structured face-to-face treatment of osteoarthritis (OA) in Sweden through the Better management of patients with OsteoArthritis (BOA) initiative, only around 20% of people with knee or hip OA receive the primary treatment recommended by international guidelines (ie, information, exercise, weight management). In 2014, a digital treatment programme named Joint Academy was introduced in Sweden, based on the same concept as the face-to-face BOA programme. In line with BOA, Joint Academy follows national and international guidelines and best practice for OA treatment. Results from observational studies suggest that this digital treatment is a valuable alternative to the traditional treatment approach and can positively impact patients’ function and pain. However, conclusions from such studies commonly suggest that more rigorous testing is necessary to ascertain the benefits of digital treatment delivery for people with OA.

Methods and analysis

A randomised clinical trial will be performed, comparing regular face-to-face care according to BOA with the digital version, Joint Academy. A total of 270 participants with clinically diagnosed knee OA will be recruited at primary care centres and randomised to either standard treatment (BOA) for 3 months, or the experimental group (digital intervention programme). Both groups will receive educational sessions and exercises yet with a difference in programme deliverance. The objective of the trial is to evaluate the effectiveness of the online treatment programme, in comparison with BOA. The two treatment groups will be compared with respect to the number of repetitions of the 30 s chair stand test at 3, 6 and 12 months, using a mixed model repeated measures analysis of variance.

Ethics and dissemination

Ethical approval has been attained from the Regional Board of Ethics in Lund, Sweden (Dnr 2017/719). Results will be published in peer-reviewed journals.

Trial registration number

NCT03328741.
Morita Therapy for depression (Morita Trial): an embedded qualitative study of acceptability
Authors: Sugg Holly Victoria Rose , Frost Julia , Richards David A
Published: May 2020

Objective

To explore the views of UK-based recipients of Morita Therapy (MT) on the acceptability of MT.

Design

Qualitative study nested within a pilot randomised controlled trial of MT (a Japanese psychological therapy largely unknown in the UK) versus treatment as usual, using post-treatment semistructured interviews analysed with a framework approach.

Setting and participants

Participants who received MT as part of the Morita Trial, recruited for the trial from General Practice record searches in Devon, UK. Data from 16 participants were purposively sampled for analysis.

Results

We identified five themes which, together, form a model of how different participants viewed and experienced MT. Overall, MT was perceived as acceptable by many participants who emphasised the value of the approach, often in comparison to other treatments they had tried. These participants highlighted how accepting and allowing difficulties as natural phenomena and shifting attention from symptoms to external factors had facilitated symptom reduction and a sense of empowerment. We found that how participants understood and related to the principles of MT, in light of their expectations of treatment, was significantly tied to the extent to which MT was perceived as acceptable. Our findings also highlighted the distinction between MT in principle and practice, with participants noting challenges of engaging with the process of therapy such as fear and discomfort around rest, needing sufficient support from the therapist and others, and the commitment of treatment.

Conclusions

People in the UK can accept the premise of MT, and consider the approach beneficial and novel. Therefore, proceeding to a large-scale trial of MT is appropriate with minor modifications to our clinical protocol. Participants’ expectations and understandings of treatment play a key role in acceptability, and future research may investigate these potential moderators of acceptability in MT.

Trial registration numberC

ISRCTN17544090; Pre-results.
Socioeconomic differences in experiences with treatment of coronary heart disease: a qualitative study from the perspective of elderly patients
Authors: Schröder Sara Lena , Fink Astrid , Richter Matthias
Published: May 2020

Objectives

This qualitative study aims to analyse socioeconomic differences in patients’ experiences along the treatment pathway for coronary heart disease (CHD).

Design

A longitudinal qualitative study using in-depth semistructured interviews to explore patients’ experiences with treatment was conducted. We analysed the transcripts of the records according to qualitative content analysis and identified differences between patients with lower and higher socioeconomic status (SES) by comparing and contrasting the narratives.

Setting

The University Hospital in Halle (Saale), Germany.

Participants

41 elderly patients (aged 59–80 years) who suffered from CHD.

Results

From various patient’s experiences along the pathway of care which were found to differ according to SES we derived three major themes: (1) information: patients with higher SES had greater knowledge about treatment and could use medical records as sources of information; (2) illness perception: patients with lower SES focused on improving symptoms and survival, while patients with higher SES focused on physical performance and disease management; and (3) perceived role in healthcare: patients with lower SES tended to delegate responsibility to healthcare professionals.

Conclusions

Differences in the patient’s knowledge about treatment, their perceived role in healthcare and illness perception can be the factors and mechanisms that contribute to explain socioeconomic inequalities in the treatment of CHD. These factors should be considered in quantitative studies to better understand the disparities in treatment and mortality. We suggest that improving patient–physician communication and patient knowledge can change the patient’s understanding of CHD and their perceived role in healthcare and reduce inequalities in CHD treatment.

Trial registration number

DRKS00007839.
Barriers and facilitators to employment for young adults with mental illness: a scoping review
Authors: Gmitroski Taryn , Bradley Christl , Heinemann Lyn , Liu Grace , Blanchard Paige , Beck Charlotte , Mathias Steve , Leon Adelena , Barbic Skye Pamela
Published: May 2020

Objectives

The issue of gaining employment for those with mental illness is a growing global concern. For many in the young adult population, who are at a transitional age, employment is a central goal. In response, we conducted a scoping review to answer the question, ‘What are the barriers and facilitators to employment for young adults with mental illness?’

Design

We conducted a scoping review in accordance to the Arksey and O’Malley framework. We performed a thorough search of Medline, EMBASE, CINAHL, ABI/INFORM, PsycINFO and Cochrane. We included studies that considered young adults aged 15–29 years of age with a mental health diagnosis, who were seeking employment or were included in an employment intervention.

Results

Our search resulted in 24 research articles that focused on employment for young adults with mental illness. Four main themes were extracted from the literature: (1) integrated health and social services, (2) age-exposure to employment supports, (3) self-awareness and autonomy and (4) sustained support over the career trajectory.

Conclusions

Our review suggests that consistent youth-centred employment interventions, in addition to usual mental health treatment, can facilitate young adults with mental illness to achieve their employment goals. Aligning the mental health and employment priorities of young adults may result in improved health and social outcomes for this population while promoting greater engagement of young adults in care.
SAFETEL randomised controlled feasibility trial of a safety planning intervention with follow-up telephone contact to reduce suicidal behaviour: study protocol
Authors: O’Connor Rory C , Lundy Jenna-Marie , Stewart Corinna , Smillie Susie , McClelland Heather , Syrett Suzy , Gavigan Marcela , McConnachie Alex , Smith Michael , Smith Daniel J , Brown Gregory K , Stanley Barbara , Simpson Sharon Anne
Published: May 2020

Introduction

There are no evidence-based interventions that can be administered in hospital settings following a general hospital admission after a suicide attempt.

Aim

To determine whether a safety planning intervention (SPI) with follow-up telephone support (SAFETEL) is feasible and acceptable to patients admitted to UK hospitals following a suicide attempt.

Methods and analysis

Three-phase development and feasibility study with embedded process evaluation. Phase I comprises tailoring an SPI with telephone follow-up originally designed for veterans in the USA, for use in the UK. Phase II involves piloting the intervention with patients (n=30) who have been hospitalised following a suicide attempt. Phase III is a feasibility randomised controlled trial of 120 patients who have been hospitalised following a suicide attempt with a 6-month follow-up. Phase III participants will be recruited from across four National Health Service hospitals in Scotland and randomised to receive either the SPI with telephone follow-up and treatment as usual (n=80) or treatment as usual only (n=40). The primary outcomes are feasibility outcomes and include the acceptability of the intervention to participants and intervention staff, the feasibility of delivery in this setting, recruitment, retention and intervention adherence as well as the feasibility of collecting the self-harm re-admission to hospital outcome data. Statistical analyses will include description of recruitment rates, intervention adherence/use, response rates and estimates of the primary outcome event rates, and intervention effect size (Phase III). Thematic analyses will be conducted on interview and focus group data.

Ethics and dissemination

The East of Scotland Research Ethics Service (EoSRES) approved this study in March 2017 (GN17MH101 Ref: 17/ES/0036). The study results will be disseminated via peer-reviewed publication and conference presentations. A participant summary paper will also be disseminated to patients, service providers and policy makers alongside the main publication.

Trial registration number

ISRCTN62181241.
Submissions from the SPRINT Data Analysis Challenge on clinical risk prediction: a cross-sectional evaluation
Authors: Jackevicius Cynthia A , An JaeJin , Ko Dennis T , Ross Joseph S , Angraal Suveen , Wallach Joshua D , Koh Maria , Song Jeeeun , Krumholz Harlan M
Published: May 2020

Objectives

To collate and systematically characterise the methods, results and clinical performance of the clinical risk prediction submissions to the Systolic Blood Pressure Intervention Trial (SPRINT) Data Analysis Challenge.

Design

Cross-sectional evaluation.

Data sources

SPRINT Challenge online submission website.

Study selection

Submissions to the SPRINT Challenge for clinical prediction tools or clinical risk scores.

Data extraction

In duplicate by three independent reviewers.

Results

Of 143 submissions, 29 met our inclusion criteria. Of these, 23/29 (79%) reported prediction models for an efficacy outcome (20/23 [87%] of these used the SPRINT study primary composite outcome, 14/29 [48%] used a safety outcome, and 4/29 [14%] examined a combined safety/efficacy outcome). Age and cardiovascular disease history were the most common variables retained in 80% (12/15) of the efficacy and 60% (6/10) of the safety models. However, no two submissions included an identical list of variables intending to predict the same outcomes. Model performance measures, most commonly, the C-statistic, were reported in 57% (13/23) of efficacy and 64% (9/14) of safety model submissions. Only 2/29 (7%) models reported external validation. Nine of 29 (31%) submissions developed and provided evaluable risk prediction tools. Using two hypothetical vignettes, 67% (6/9) of the tools provided expected recommendations for a low-risk patient, while 44% (4/9) did for a high-risk patient. Only 2/29 (7%) of the clinical risk prediction submissions have been published to date.

Conclusions

Despite use of the same data source, a diversity of approaches, methods and results was produced by the 29 SPRINT Challenge competition submissions for clinical risk prediction. Of the nine evaluable risk prediction tools, clinical performance was suboptimal. By collating an overview of the range of approaches taken, researchers may further optimise the development of risk prediction tools in SPRINT-eligible populations, and our findings may inform the conduct of future similar open science projects.
Effectiveness and cost-effectiveness of acupuncture with Doin therapy for chronic neck pain: a study protocol for a multicentre, randomised controlled clinical trial
Authors: Lee Sook-Hyun , Lee Jinho , Lee Yoon Jae , Kim Me-riong , Cho Jae Heung , Kim Koh-Woon , Ha In-Hyuk
Published: May 2020

Introduction

Doin therapy is a manual therapy used in Korean rehabilitation medicine. Recently, the use of acupuncture with Doin has increased in clinics and clinical trials have demonstrated its effects. However, well-designed studies examining the efficacy and cost-effectiveness of acupuncture with Doin therapy are rare.

Methods and analysis

This multicentre, assessor-blinded, randomised controlled trial with two parallel groups aims to evaluate the clinical effects and cost-effectiveness of acupuncture with Doin therapy. A total of 124 patients (with a neck pain duration of 6 months or longer and a Numeric Rating Scale ≥5) will be recruited at five Korean medicine hospitals. Patients will be randomly allocated to acupuncture with Doin therapy (n=62) and acupuncture alone (n=62) for 5 weeks of treatment. This study will be carried out with outcome assessor and statistician blinding. The primary outcome measure will consist of improvement in neck pain using the Visual Analogue Scale at 6 weeks. The secondary outcomes including measures of pain, functional disability, health-related quality of life and economic evaluation will be conducted at 6 weeks, and 3, 6, 9 and 12 months after treatment

Ethics and dissemination

The project is approved by the Institutional Review Board (IRB) of the Jaseng Hospital of Korean Medicine and the Kyung Hee University Korean Medicine Hospital at Gangdong. Dissemination will occur after the findings from this study are published in other peer reviewed journals.

Trial registration numbers

NCT03558178; KCT0003068; Pre-results.
Cost-effectiveness of a combined classroom curriculum and parental intervention: economic evaluation of data from the Steps Towards Alcohol Misuse Prevention Programme cluster randomised controlled trial
Authors: Agus Ashley , McKay Michael , Cole Jonathan , Doherty Paul , Foxcroft David , Harvey Séamus , Murphy Lynn , Percy Andrew , Sumnall Harry
Published: May 2020

Objectives

This study aimed to assess the cost-effectiveness of the Steps Towards Alcohol Misuse Prevention Programme (STAMPP) compared with education as normal (EAN) in reducing self-reported heavy episodic drinking (HED) in adolescents.

Design

This is a cost-effectiveness analysis from a public sector perspective conducted as part of a cluster randomised trial.

Setting

This study was conducted in 105 high schools in Northern Ireland and in Scotland.

Participants

Students in school year 8/S1 (aged 11–12) at baseline were included in the study.

Interventions

This is a classroom-based alcohol education curricula, combined with a brief alcohol intervention for parents/carers.

Outcome measures

The outcome of this study is the cost per young person experiencing HED avoided due to STAMPP at 33 months from baseline.

Results

The total cost of STAMPP was £85 900, equivalent to £818 per school and £15 per pupil. Due to very low uptake of the parental component, we calculated costs of £692 per school and £13 per pupil without this element. Costs per pupil were reduced further to £426 per school and £8 per pupil when it was assumed there were no additional costs of classroom delivery if STAMPP was delivered as part of activities such as personal, social, health and economic education. STAMPP was associated with a significantly greater proportion of pupils experiencing a heavy drinking episode avoided (0.08/8%) and slightly lower public sector costs (mean difference −£17.19). At a notional willingness-to-pay threshold of £15 (reflecting the cost of STAMPP), the probability of STAMPP being cost-effective was 56%. This level of uncertainty reflected the substantial variability in the cost differences between groups.

Conclusions

STAMPP was relatively low cost and reduced HED. STAMPP was not associated with any clear public sector cost savings, but neither did it increase them or lead to any cost-shifting within the public sector categories. Further research is required to establish if the cost-effectiveness of STAMPP is sustained in the long term.

Trial registration number

ISRCTN47028486; Results.
Copattern of depression and alcohol use in medical care patients: cross-sectional study in Germany
Authors: Guertler Diana , Moehring Anne , Krause Kristian , Batra Anil , Eck Sandra , Freyer-Adam Jennis , Ulbricht Sabina , Rumpf Hans-Jürgen , Bischof Gallus , John Ulrich , Meyer Christian
Published: May 2020

Objective

To predict depressive symptom severity and presence of major depression along the full alcohol use continuum.

Design

Cross-sectional study.

Setting

Ambulatory practices and general hospitals from three sites in Germany.

Participants

Consecutive patients aged 18–64 years were proactively approached for an anonymous health screening (participation rate=87%, N=12 828). Four continuous alcohol use measures were derived from an expanded Alcohol Use Disorder Identification Test (AUDIT): alcohol consumption in grams per day and occasion, excessive consumption in days per months and the AUDIT sum score. Depressive symptoms were assessed for the worst 2-week period in the last 12 months using the Patient Health Questionnaire (PHQ-8). Negative binomial and logistic regression analyses were used to predict depressive symptom severity (PHQ-8 sum score) and presence of major depression (PHQ-8 sum score≥10) by the alcohol use measures.

Results

Analyses revealed that depressive symptom severity and presence of major depression were significantly predicted by all alcohol use measures after controlling for sociodemographics and health behaviours (p<0.05). The relationships were curvilinear: lowest depressive symptom severity and odds of major depression were found for alcohol consumptions of 1.1 g/day, 10.5 g/occasion, 1 excessive consumption day/month, and those with an AUDIT score of 2. Higher depressive symptom severity and odds of major depression were found for both abstinence from and higher levels of alcohol consumption. Interaction analyses revealed steeper risk increases in women and younger individuals for most alcohol use measures.

Conclusion

Findings indicate that alcohol use and depression in medical care patients are associated in a curvilinear manner and that moderation by gender and age is present.
Learning a new way of living together: a qualitative study exploring the relationship changes and intervention needs of patients with cardiovascular disease and their partners
Authors: Tulloch Heather , Bouchard Karen , Clyde Matthew J , Madrazo Lorenzo , Demidenko Natasha , Johnson Susan , Greenman Paul
Published: May 2020

Objectives

Cardiovascular disease (CVD) not only affects the patient, but has implications for the partner. Emerging evidence suggests that supportive couple relationships enhance CVD outcomes and reduce patient and partner distress. To date, however, little research has been done to address the couple relationship as a potentially important component of cardiac care. This article examines the impact of CVD on the couple relationship and assesses the perceived needs and desired intervention components of patients with CVD and their partners.

Design

Qualitative study using directed and conventional content analysis.

Setting

Single-centre, tertiary cardiac care hospital that serves a population of 1.4 million in the Champlain region of Ontario, Canada.

Participants

Patients with CVD and their partners (n=32, 16 couples) participated in focus groups. Patients were mainly male (75%), white (87.5%), aged 64.4 years (range 31–81 years), with varied cardiac diagnoses (50% coronary artery disease; 18.75% valve disease; 18.75% heart failure; 12.5% arrhythmia).

Results

Five categories were generated from the data reflecting changes within the couple relationship as a result of CVD: (1) emotional and communication disconnection; (2) overprotection of the patient; (3) role changes; (4) adjustment to lifestyle changes; and (5) positive relationship changes. Three categories were constructed regarding intervention needs and desired resources: (1) practical resources; (2) sharing with peers; and (3) relationship enhancement.

Conclusions

Overall, the data suggest that there were profound changes in the couple relationship as a result of CVD, and that there is considerable need to better support the caregiving spouses and the couple as a unit. These results call for interventions designed to provide instrumental support, peer-sharing opportunities and relationship quality enhancement to help couples cope with CVD. Future studies should examine whether couples-based programming embedded into cardiac rehabilitation can be effective at improving relationship quality and reducing patient and partner stress in the aftermath of a cardiac event.