bluuebunny/crossref_metadata_2025 huggingface dataset:
Acoustic scattering in lined panel cavities with membrane interfaces
Authors: Safdar Muhammad , Ahmed Naveed , Afzal Muhammad , Wahab Abdul
Published: August 2023

Noise control strategies are extremely important in industry. Acoustic liners and elastic membranes, which absorb or attenuate sound waves, are key components in ducting systems for active and passive noise reduction. In this article, we design and examine a reactive liner panel cavity with flexible interfaces. The lined panel cavity system is comprised of elastic membranes at the interfaces. The aim is to couple the incoming duct modes with the flexible components and then with the localized modes in the lined region. The governing equations for the lined panel cavity system are solved using a mode-matching technique that assures continuity of the normal velocities at the interfaces and can handle a range of strong coupling and higher-order edge conditions in contrast to the coupled mode theory. The aim is to investigate the effects of reactive liners and elastic membrane interfaces on wave scattering through the proposed acoustic enclosure design. The scattering performance of the proposed lined panel cavity is evaluated in terms of the reflected and transmitted energy flux as well as transmission loss. Analysis shows that the resonances at the membrane interfaces coupled to the linear cavities have a direct impact on power variations and the maximum transmission loss.
Effects of a School-Based Physical Activity Intervention on Adolescents’ Mental Health: A Cluster Randomized Controlled Trial
Authors: Ahmed Kazi Rumana , Horwood Sharon , Kolbe-Alexander Tracy , Khan Asaduzzaman
Published: August 2023

Background: The aim of this study was to evaluate the effectiveness of a school-based multicomponent physical activity intervention on mental health of adolescents. Methods: A clustered, randomized, controlled trial was employed in 8 high schools in Dhaka, Bangladesh, which were randomly assigned to either an intervention or control group; 40 students in grades 8 and 9 from each school took part in the trial (n = 160/group). Students in the intervention schools participated in a 12-week physical activity intervention with multiple components (eg, supervised circuits, lunchtime sports, health education, infographics), while control schools received no intervention. Participants completed baseline and postintervention surveys measuring depressive symptoms (Center for Epidemiologic Studies Depression Scale) and life satisfaction (Cantril Ladder), along with other sociodemographic and behavioral characteristics. Linear mixed-effects modeling was used to evaluate the intervention effects. Results: Depressive symptoms in the intervention group decreased at postintervention, but remained stable in the control group. There was an increase in life satisfaction in the intervention group and a decrease in the control group. Multivariable modeling showed that students in the intervention group had a significantly lower level of depressive symptoms (β = −4.60; 95% confidence interval, −5.76 to −3.46) and higher level of life satisfaction (β = 1.43; 95% confidence interval, 0.77 to 2.10) compared with their counterparts in the control group. Sensitivity analyses supported the positive effects of the intervention. Conclusions: Our school-based, multicomponent physical activity intervention is effective in improving mental health indicators in adolescents. Future trials should be ramped up to include schools in rural and regional settings, using robust measures  of mental well-being.
Decitabine disrupts EBV genomic epiallele DNA methylation patterns around CTCF binding sites to increase chromatin accessibility and lytic transcription in gastric cancer
Authors: Preston-Alp Sarah , Caruso Lisa Beatrice , Su Chenhe , Keith Kelsey , Soldan Samantha S. , Maestri Davide , Madzo Jozef , Kossenkov Andrew , Napoletani Giorgia , Gewurz Benjamin , Lieberman Paul M. , Tempera Italo
Published: August 2023

Epstein-Barr virus (EBV) is associated with 10% of human gastric carcinomas, which are distinguished by a CpG island methylator phenotype. In gastric carcinoma tumors and cell lines, the EBV genome also exhibits a high degree of 5-methyl cytosine (5mC) marks, which are propagated by host DNA methyltransferases (DNMT) with each cell cycle. Therefore, we sought to determine the effect of DNMT inhibition by the small molecule Decitabine (DCB) on EBV genomic 5mC and chromatin structure in two tumor-derived gastric cancer cell lines, YCCEL1 and SNU719. Decitabine effects on EBV genomic 5mC, chromatin structure, and viral gene expression were profiled by reduced representation bisulfite sequencing, ATAC-seq, and RNA-seq, respectively. Decitabine treatment resulted in global viral genome hypomethylation and a global increase in open chromatin. The most striking finding resulted from analyzing the methylation pattern from single RRBS sequencing reads, showing that the EBV genome contains a heterogeneous pool of epigenetic states, each of which is eroded upon Decitabine treatment. We observed heterogeneous 5mC epiallele patterns around EBV genomic CTCF binding sites and lytic gene transcriptional start sites. These results highlight the importance of 5mC in maintaining EBV genomic chromatin structure and latency. Furthermore, the presence of 5mC epialleles suggests EBV
+
gastric cancers harbor transcriptionally distinct EBV episomes, which may exert distinct functional roles in maintaining latency and driving tumorigenesis.

IMPORTANCE

Epstein-Barr virus (EBV) latency is controlled by epigenetic silencing by DNA methylation [5-methyl cytosine (5mC)], histone modifications, and chromatin looping. However, how they dictate the transcriptional program in EBV-associated gastric cancers remains incompletely understood. EBV-associated gastric cancer displays a 5mC hypermethylated phenotype. A potential treatment for this cancer subtype is the DNA hypomethylating agent, which induces EBV lytic reactivation and targets hypermethylation of the cellular DNA. In this study, we identified a heterogeneous pool of EBV epialleles within two tumor-derived gastric cancer cell lines that are disrupted with a hypomethylating agent. Stochastic DNA methylation patterning at critical regulatory regions may be an underlying mechanism for spontaneous reactivation. Our results highlight the critical role of epigenetic modulation on EBV latency and life cycle, which is maintained through the interaction between 5mC and the host protein CCCTC-binding factor.
Complete genome sequence of
Exiguobacterium profundum
TSS-3 isolated from an extremely saline-alkaline spring located in Ixtapa, Chiapas-México
Authors: Rincón-Rosales Reiner , Rogel Marco A. , Rincón-Molina Clara Ivette , Guerrero Gabriela , Manzano-Gómez Luis Alberto , López-López Aline , Rincón Molina Francisco A. , Martínez-Romero Esperanza
Published: August 2023

We report the complete genome sequence of
Exiguobacterium profundum
TSS-3, a strain isolated from the sediment of an extremely saline-alkaline spring located in Ixtapa, Chiapas-México (16° 47´ LN and 92° 54´ LO). Its genome is composed of a 2.8-Mb chromosome and a small 4.6-Kb plasmid.
Complete genome sequences of bacteria isolated from cockroaches collected in a Bangladeshi hospital
Authors: Workman Sean D. , Islam Saiful , Akter Shamima , Nasrin Tamanna , Haque Fazlul , Yost Christopher K. , Mohanta Moni Krishno
Published: August 2023

We report the complete genome sequences of four bacterial strains that were isolated from
Blattella germanica
(German cockroaches) that were found in three wards of the Rajshahi Medical College Hospital. Multiple antibiotic resistance genes were identified in each genome, with one genome containing multiple plasmid-encoded resistance genes.
Detection of bacterial and protozoan pathogens in individual bats and their ectoparasites using high-throughput microfluidic real-time PCR
Authors: Corduneanu Alexandra , Zając Zbigniew , Kulisz Joanna , Wozniak Aneta , Foucault-Simonin Angélique , Moutailler Sara , Wu-Chuang Alejandra , Peter Áron , Sándor Attila D. , Cabezas-Cruz Alejandro
Published: August 2023

Among the most studied mammals in terms of their role in the spread of various pathogens with possible zoonotic effects are bats. These are animals with a very complex lifestyle, diet, and behavior. They are able to fly long distances, thus maintaining and spreading the pathogens they may be carrying. These pathogens also include vector-borne parasites and bacteria that can be spread by ectoparasites such as ticks and bat flies. In the present study, high-throughput screening was performed and we detected three bacterial pathogens:
Bartonella
spp.,
Neoehrlichia mikurensis
and
Mycoplasma
spp., and a protozoan parasite:
Theileria
spp. in paired samples from bats (blood and ectoparasites). In the samples from the bat-arthropod pairs, we were able to detect
Bartonella
spp. and
Mycoplasma
spp. which also showed a high phylogenetic diversity, demonstrating the importance of these mammals and the arthropods associated with them in maintaining the spread of pathogens. Previous studies have also reported the presence of these pathogens, with one exception,
Neoehrlichia mikurensis
, for which phylogenetic analysis revealed less genetic divergence. High-throughput screening can detect more bacteria and parasites at once, reduce screening costs, and improve knowledge of bats as reservoirs of vector-borne pathogens.

IMPORTANCE

The increasing number of zoonotic pathogens is evident through extensive studies and expanded animal research. Bats, known for their role as reservoirs for various viruses, continue to be significant. However, new findings highlight the emergence of
Bartonella
spp., such as the human-infecting
B. mayotimonensis
from bats. Other pathogens like
N. mikurensis
,
Mycoplasma
spp., and
Theileria
spp. found in bat blood and ectoparasites raise concerns, as their impact remains uncertain. These discoveries underscore the urgency for heightened vigilance and proactive measures to understand and monitor zoonotic pathogens. By deepening our knowledge and collaboration, we can mitigate these risks, safeguarding human and animal well-being.
The gut microbiota induces melanin deposits that act as substrates for
fimA
-mediated aggregation of
Salmonella
Typhimurium and enhance infection of the German cockroach vector
Authors: Turner Matthew , Van Hulzen Landen , Pietri Jose E.
Published: August 2023

When
Salmonella
Typhimurium is ingested by German cockroaches, the bacteria replicate in the gut and persist for at least 7 d, enabling transmission in the feces. However, the mechanisms that facilitate survival and persistence in the cockroach gut remain poorly detailed. We previously reported the formation of biofilm-like aggregate populations of
S
. Typhimurium in the gut of cockroaches upon ingestion. We also reported that deletion of the type-1 fimbrial subunit of
S
. Typhimurium,
fimA
, leads to a reduced bacterial load in the cockroach gut. Here, we link these observations and provide further insight into the mechanism and function of
S
. Typhimurium aggregation in the gut of the cockroach. We show that
S
. Typhimurium but not
Escherichia coli
forms aggregated populations in the cockroach gut, and that aggregate formation requires
fimA
but not the biofilm formation-related genes
csgA
and
csgD
. Furthermore, we show that
S
. Typhimurium aggregates are formed using small granular deposits present in the cockroach gut, which exhibit properties consistent with melanin, as substrates. These melanin deposits are prevalent in the guts of both immature and adult cockroaches from laboratory colonies and are correlated with increased gut bacterial density while being entirely absent in gnotobiotic cockroaches reared without exposure to environmental bacteria, indicating they are induced as a response to the gut microbiota. When cockroaches lacking melanin deposits in the gut are fed
S
. Typhimurium, they exhibit lower rates of infection than those harboring melanin deposits, demonstrating that microbiota-induced melanin deposits enhance infection of the gut of the vector.

IMPORTANCE

Cockroaches, including the German cockroach (
Blattella germanica
), can be both mechanical and biological vectors of pathogenic bacteria. Together, our data reveal a novel mechanism by which
S
. Typhimurium interacts with the cockroach gut and its microbiota that promotes infection of the vector. These findings exemplify the emerging but underappreciated complexity of the relationship between cockroaches and
S
. Typhimurium.
Impact of the new membrane-targeting lipoglycopeptide antibiotic MCC5145 on the treatment of bacteremic pneumococcal pneumonia in mice
Authors: Ogunniyi Abiodun D. , Nguyen Hang Thi , Hansford Karl A. , Cooper Matthew A. , Trott Darren J. , Blaskovich Mark A. T.
Published: August 2023

Bacteremic
Streptococcus pneumoniae
pneumonia is one of the most severe forms of invasive pneumococcal disease (IPD) and with particularly high case-fatality rates among the elderly and individuals with comorbidities, exacerbated by rising antibiotic resistance and time to initiation of therapy. Here, we examined the efficacy of the preclinical “vancapticin” glycopeptide MCC5145 against fulminant infection by
S. pneumoniae
serotype 2 strain D39 in a bioluminescent, neutropenic mouse model of bacteremic pneumonia. MCC5145 is a semisynthetic vancomycin derivative chemically modified at the
C
-terminus with a membrane-targeting motif designed to preferentially bind the anionic bacterial surface. We show that similar to vancomycin, subcutaneous administration of MCC5145 to mice 1 day after intranasal infection with a bioluminescent derivative of
S. pneumoniae
D39 elicited time and concentration-dependent reduction in total flux in the lungs and blood. Together, our finding supports the further development of MCC5145 as a potential new treatment option for pneumonia and/or bacteremic pneumonia in clinical settings, particularly for immunocompromised individuals.

IMPORTANCE

S. pneumoniae
(the pneumococcus) causes severe community acquired lung and blood infection, especially among the elderly and people with underlying medical conditions and/or weakened immune systems. The rising incidence of antibiotic resistance and delays between diagnosis of infection and commencement of effective therapy make treatment difficult and result in high mortality rates. In this work, we show that a new derivative (MCC5145) of an existing antibiotic (vancomycin) rapidly eradicated lethal pneumococcal challenge from the lungs and blood of mice with a suppressed immune system. Our findings support that MCC5145 is a promising option for the treatment of lung and blood infections caused by the pneumococcus at point-of-care settings, particularly for the elderly and individuals with a weakened immune system.
Reconstructing the paleoenvironment of an oxygenated Mesoproterozoic shoreline and its record of life
Authors: Slotznick Sarah P. , Swanson-Hysell Nicholas L. , Zhang Yiming , Clayton Katherine E. , Wellman Charles H. , Tosca Nicholas J. , Strother Paul K.
Published: August 2023

The Nonesuch Formation microbiota provide a window into ca. 1075 Ma life within the interior of ancient North America. The Nonesuch water body formed following the cessation of widespread volcanism within the Midcontinent Rift as the basin continued to subside. In northern Michigan and Wisconsin, USA, the Copper Harbor Conglomerate records terrestrial alluvial fan and fluvial plain environments that transitioned into subaqueous lacustrine deposition of the Nonesuch Formation. These units thin toward a paleotopographic high associated with the Brownstone Falls angular unconformity. Due to these “Brownstone Highlands,” we were able to explore the paleoenvironment laterally at different depths in contemporaneous deposits. Rock magnetic data constrain that when the lake was shallow, it was oxygenated as evidenced by an oxidized mineral assemblage. Oxygen levels were lower at greater depth—in the deepest portions of the water body, anoxic conditions are recorded. An intermediate facies in depth and redox between these endmembers preserves detrital magnetite and hematite, which can be present in high abundance due to the proximal volcanic highlands. This magnetic facies enabled the development of a paleomagnetic pole based on both detrital magnetite and hematite that constrains the paleolatitude of the lake to 7.1 ± 2.8°N. Sediments of the intermediate facies preserve exquisite organic-walled microfossils, with microfossils being less diverse to absent in the anoxic facies where amorphous organic matter is more likely to be preserved. The assemblage of cyanobacteria and eukaryotes (both photoautotrophs and heterotrophs) lived within the oxygenated waters of this tropical Mesoproterozoic water body.
High-temperature altered oceanic crust recycling into oceanic-island basalt−like mantle produces alkaline continental crust driven by mélange diapirs: Insights from isotopic tracing and numerical modeling
Authors: Liu Huichuan , Huangfu Pengpeng , Zhu Guangyou
Published: August 2023

Genesis of the large-volume alkaline crust at active continental margin is still enigmatic for geologists worldwide. The point at issue is whether or not subducted oceanic crusts get involved and how they interact with the mantle source of the alkaline crust. Late Mesozoic juvenile alkaline crusts with high εNd(t)-εHf(t) values are widely distributed in the Great Xing’an Range of NE China, as parts of an arc magmatic belt related to the Mongol-Okhotsk Ocean closure. We carried out multi-isotope analyses and 2-D high-resolution numerical modeling to trace the mantle source nature of the alkaline crust. The alkaline rocks show similar trace elements with the I-type enriched mantle and are originated from an upwelling oceanic-island basalt−like mantle. Their high field strength element depleted arc features indicate the crustal material addition in the source region. Low δ18O, mantle-like Sr-Nd-Hf and light Mg isotope compositions, limited δ7Li variations, no Nd-Hf decoupling, and our mixing calculation preclude continental crustal assimilation, marine-sediment melt and/or altered oceanic crust (AOC)−fluid metasomatism, and bulk marine sediment involvement, and provide evidence of the bulk AOC addition in the mantle source. Lower δ18O values than the mantle and relatively low δ7Li values further confirmed the involved AOC to be a high-temperature (high-T) AOC. Our multi-isotope tracing successfully fingerprints the recycled high-T AOC into the source region of the alkaline juvenile crust. Then, our 2-D high-resolution numerical modeling reconstructs the high-T AOC recycling processes driven by mélange melting.
Foundations of Mathematical Education in the Digital Age
Authors: Semenov A. L. , Abylkassymova A. E. , Polikarpov S. A.
Published: August 2023

This article formulates the foundations of modern mathematical education that meet the new goals and objectives of mathematical education dictated by changes in mathematics itself over the last century, by changes in its role in the modern digital world, and by changes in the world. The basic system of concepts is described, starting from which the whole modern mathematics of the finite, as well as primary mathematical education, is built. For all levels of mathematical education and for all learners, the ability to solve problems whose solutions are not known (to the student) and to do it independently with the help and support of a motivating teacher is a fundamental skill. A significant role is played by a computer mathematical experiment and the transfer of tasks with solutions having been found by the student to the computer. This article also describes the actual state of affairs in the Russian mass education system and proposes the necessary actions to implement the formulated principles of modern mathematical education in Russia. Most of the articles presented in this issue demonstrate and detail the implementation of the formulated principles.
Computer Experiment in Teaching Mathematics
Authors: Shabat G. B. , Semenov A. L.
Published: August 2023

A mathematical experiment has always been a key source for a mathematical discovery. Over the past 50 years, thanks to digital technologies, its role in mathematical research has grown significantly. Digital technologies have opened up fundamentally new opportunities for experimentation in mathematics education, bringing mathematical education closer to mathematical research for the majority of students. This tendency is especially desirable in the modern world, where it becomes possible thanks to digital technologies. The article discusses the results of the authors’ work over the past decades on the application of a computer mathematical experiment at different levels of school and university education. Particular attention is paid to dynamic geometry environments. The possibilities of using computer algebra systems are also discussed. A project concerning schoolchildren’s work on generalizations of Napoleon’s theorem is considered in detail.
A New Course “Algebra + Computer Science”: What Should Be Its Outcomes and Where It Should Start
Authors: Borovik A. , Kondratiev V.
Published: August 2023

The words “Programming is the second literacy” were coined more than 40 years ago [13], but never came to life. The paper develops and details that old slogan by proposing that the mainstream mathematics education in schools should merge with education in computer science/programming. Of course, this means a deep structural reform of school mathematics education. We are not talking about adapting the 20th century mathematics to the 21st century—as it outlined in [10, 19], we mean the 21st century mathematics education for the 21st century mathematics. To the best of our knowledge, this paper is perhaps the first known attempt to start a proper feasibility study for this reform. The scope of the paper does not allow us to touch the delicate socio-political (and financial) sides of the reform, we are looking only at general curricular and didactic aspects and possible directions of the reform. In particular, we indicate approaches to development of a Domain Specifiic Language (DSL) as a basis for all programming aspects of a new course.
Diffuse large B-cell lymphoma presenting as an ileocaecal mass in a post-transplant patient
Authors: Patel Shyam , Choi Won-Tak , Andreadis Charalambos , Singh Aparajita
Published: August 2023

Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin’s lymphoma. Extranodal involvement, including the gastrointestinal tract, occurs frequently. However, colorectal involvement is extremely rare. We present a case of a man in his 20s with prior renal transplantation on immunosuppression for 10 years who developed symptoms of gas and bloating associated with unintentional weight loss. Colonoscopy revealed a large fungating mass at the ileocaecal valve, and a biopsy of this lesion confirmed stage IV DLBCL. Endoscopy should be considered for early workup of vague gastrointestinal symptoms, even in younger patients, if they have been on long-standing immunosuppression.
Association of body indices and risk of mortality in patients with type 2 diabetes
Authors: Li Chia-Ing , Liu Chiu-Shong , Lin Chih-Hsueh , Yang Shing-Yu , Li Tsai-Chung , Lin Cheng-Chieh
Published: August 2023

Introduction

A body shape index (ABSI) is independently associated with mortality in general population, but studies on the predictability of ABSI in the risk of mortality in patients with type 2 diabetes (T2D) are limited. We aimed to examine the independent and joint association of ABSI, body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), and body roundness index (BRI) with mortality in patients with T2D.

Research design and methods

The study included 11 872 patients (46.5% women) aged 30 years and older and who took part in diabetes care management program of a medical center in Taiwan. Body indices were evaluated by anthropometric measurements at baseline between 2001 and 2016, and their death status was followed up through 2021. Multivariate Cox regression models were used to assess the effect of body indices on mortality.

Results

During a mean follow-up of 10.2 years, 560 cardiovascular disease (CVD) deaths and 3043 deaths were recorded. For ABSI, WC, WHR, WHtR and BRI, all-cause mortality rates were statistically significantly greater in Q4 versus Q2. For BMI and WHtR, all-cause mortality rates were also statistically significantly greater in Q1 versus Q2. The combination of BMI and ABSI exhibited a superiority in identifying risks of all-cause mortality and CVD mortality (HRs: 1.45 and 1.37, both p<0.01).

Conclusions

Combined use of ABSI and BMI can contribute to the significant explanation of the variation in death risk in comparison with the independent use of BMI or other indices.
Feasibility and acceptability of Saheli, a WhatsApp Chatbot, on COVID-19 vaccination among pregnant and breastfeeding women in rural North India
Authors: El Ayadi Alison M , Singh Pushpendra , Duggal Mona , Kumar Vijay , Kaur Jasmeet , Sharma Preetika , Vosburg Kathryn Bradford , Diamond-Smith Nadia G
Published: August 2023

Introduction

Pregnant and breastfeeding women are priority targets for COVID-19 vaccination due to adverse maternal and fetal consequences of perinatal COVID-19 infection and the opportunity for protecting infants through maternal antibodies. Saheli (‘female friend’) is a WhatsApp-deployed chatbot providing evidence-based guidance on COVID-19 for pregnant and breastfeeding women.

Objectives

To understand the feasibility and acceptability of Saheli and its impact on COVID-19 vaccination.

Methods

We pilot-tested Saheli among pregnant and breastfeeding participants of pre-existing WhatsApp educational groups led by a community-based non-governmental organisation in Haryana, India from January to March 2022 using a pre/post design.

Results

829 unique participants completed precommunity surveys or postcommunity surveys; 238 completed both. 829 individuals used Saheli, including 88% postintervention survey participants. Users reported Saheli was easy to engage with (79%), easy to understand (91%), quick (83%) and met their information needs (97%). 89% indicated it improved their COVID-19 knowledge a lot, 72% recommended it to others and 88% shared chatbot-derived information with others. Most participants received ≥1 COVID-19 vaccine (86% vs 88%, preintervention to postintervention); full vaccination was 55% and 61%, respectively. Vaccination over time increased marginally for ≥1 dose (OR 1.15, 95% CI 0.99 to 1.36) and significantly for 2 doses (OR 1.21, 95% CI 1.09 to 1.34), and increases were significant among pregnant (≥1 dose) and breastfeeding participants (2 doses). Vaccine hesitancy was low. Chatbot use was high, yet individual chatbot engagement did not alter COVID-19 vaccination.

Conclusion

Chatbots are a promising health education strategy due to high acceptability and deployment potential. Interpreting community chatbot impact must acknowledge the co-occurring constellation of multilevel interventions, community and pandemic factors.
Systematic literature review of the barriers and facilitators of frugal innovation for surgical care in low-income and middle-income countries
Authors: Brown Cyan Brittany , McDermott Lisa
Published: August 2023

Objective

Globally, 5 billion people lack access to safe surgery and annually, only 6% of surgeries occur in low-income countries. Surgical frugal innovations can reduce cost and optimise the function for the context; however, there is limited evidence about what enables success.

Design

A systematic literature review (SLR) was performed to understand the barriers and facilitators of frugal innovation for surgical care in low-income and middle-income countries (LMICs).

Data sources

Web of Science, PubMed, Embase at Ovid, Google Scholar and EThOs were searched.

Eligibility criteria for selecting studies

Inclusion criteria were original research in English containing a frugal surgical innovation. Research must be focused on LMICs. Studies were excluded if the content was not focused on LMICs or did not pertain to barriers and facilitators. 26 studies from 2006 to 2021 were included. The GRADE tool was used to assess overall review quality.

Results

Results were analysed using the modified consolidated framework for implementation research. The lack of formal evidence regarding frugal innovation in LMICs was the most reported barrier. The adaptability of frugal innovations to the context was the most reported facilitator. The limitations of this study were that most frugal innovations are not included in formal literature and that only English studies were included.

Conclusion

Frugal surgical innovations that are highly adaptable to the local context hold significant potential to scale and positively affect healthcare access and outcomes. Furthermore, supporting formal research about frugal innovations is important when aiming to innovate for health equity.
Prevalence of MRI lesions in men responding to a GP-led invitation for a prostate health check: a prospective cohort study
Authors: Moore Caroline M , Frangou Elena , McCartan Neil , Santaolalla Aida , Kopcke Douglas , Brembilla Giorgio , Hadley Joanna , Giganti Francesco , Marsden Teresa , Van Hemelrijck Mieke , Gong Fiona , Freeman Alex , Haider Aiman , Tuck Steve , Pashayan Nora , Callender Thomas , Green Saran , Brown Louise C , Punwani Shonit , Emberton Mark
Published: August 2023

Objective

In men with a raised prostate-specific antigen (PSA), MRI increases the detection of clinically significant cancer and reduces overdiagnosis, with fewer biopsies. MRI as a screening tool has not been assessed independently of PSA in a formal screening study. We report a systematic community-based assessment of the prevalence of prostate MRI lesions in an age-selected population.

Methods and analysis

Men aged 50–75 were identified from participating general practice (GP) practices and randomly selected for invitation to a screening MRI and PSA. Men with a positive MRI or a raised PSA density (≥0.12 ng/mL2) were recommended for standard National Health Service (NHS) prostate cancer assessment.

Results

Eight GP practices sent invitations to 2096 men. 457 men (22%) responded and 303 completed both screening tests. Older white men were most likely to respond to the invitation, with black men having 20% of the acceptance rate of white men.

One in six men (48/303 men, 16%) had a positive screening MRI, and an additional 1 in 20 men (16/303, 5%) had a raised PSA density alone. After NHS assessment, 29 men (9.6%) were diagnosed with clinically significant cancer and 3 men (1%) with clinically insignificant cancer.

Two in three men with a positive MRI, and more than half of men with clinically significant disease had a PSA <3 ng/mL.

Conclusions

Prostate MRI may have value in screening independently of PSA. These data will allow modelling of the use of MRI as a primary screening tool to inform larger prostate cancer screening studies.

Trial registration number

NCT04063566.
Study protocol for the ‘preventing functional decline in acutely hospitalised older patients (PREV_FUNC)’ study: effects of two multicomponent exercise programmes on physical function – a three-armed randomised controlled trial
Authors: Welmer Anna-Karin , Sandberg Linda , Sandlund Christina , Björck Caroline , Hagströmer Maria , Hamilton Julia , Helgstrand Gunilla , Lindgren Charlotte , Nordstrand Linda , Sandstedt Petter , Kivipelto Miia , Boström Anne-Marie
Published: August 2023

Introduction

Acutely hospitalised older patients often live with frailty and have an increased risk of impaired physical function. Previous studies suggest that exercise might mitigate the risk of physical impairment; however, further research is needed to compare the effect of different types of exercise interventions. In this paper, we report a protocol for a trial that aims to examine (1) if multicomponent exercise interventions (interventions that include both mobility and strengthening exercises) have effects on physical function compared with usual care in older adults and (2) if a comprehensive multicomponent exercise programme is more effective than a simple multicomponent exercise programme that only include walking and sit-to-stand exercises.

Methods and analysis

This is a three-armed randomised controlled trial, with two intervention groups (comprehensive and simple exercise programme) and a control group receiving usual care. We will include 320 participants aged ≥75 years from geriatric medical departments of four hospitals in Stockholm, Sweden. Assessments will be conducted at hospital admission, discharge and 3 months thereafter concerning physical function (primary outcome), activities of daily living, health-related quality of life, sarcopenia and falls. The number of readmissions will be registered up to 1 year after discharge. Data will be analysed with linear mixed effects models, according to the intention-to-treat approach.

Ethics and dissemination

Ethical approval for this trial has been granted by the Swedish Ethical Review Authority (approval number 2022-03032-01). Data collection will consider the information requirement, the requirement of consent, confidentiality obligations and the utilisation requirement. Trial findings will be disseminated through multiple channels, including scientific publications and conferences, and workshops with healthcare professionals and the public.

Trial registration number

NCT05366075
Effects of sleep duration, perceived organisational support and personal resilience on anxiety in non-hospitalised residents during the COVID-19 pandemic: a survey study in Ningbo, China
Authors: Zhang Yiqing , Ma Jingjing , Xu Qihang , Rong Yuezheng , Lu Shunshun , Wang Zhengzheng
Published: August 2023

Objective

This study assessed the association between sleep duration, perceived organisational support (POS), personal resilience and anxiety among non-hospitalised residents during the COVID-19 pandemic in Ningbo, China.

Methods

In this cross-sectional study, an online survey was conducted from 27 January 2023 to 5 February 2023, involving non-hospitalised residents over 14 years old in Ningbo. We received 1938 valid responses. The study used the General Demographic Characteristics Scale, the Generalised Anxiety Disorder Scale, Brief Resilient Coping Scale and the POS questionnaire.

Results

Among the 1938 valid questionnaires, 1068 (55.1%) participants reported anxiety. Multivariate logistic regression analysis revealed that high organisational support (β=–0.34, adjusted OR (aOR) 0.71, 95% CI 0.51 to 0.98, p=0.038), moderate resilience (β=–0.26, aOR 0.77, 95% CI 0.63 to 0.95, p=0.013), high resilience (β=–0.67, aOR 0.51, 95% CI 0.36 to 0.73, p<0.001) and sleep duration of ≥7 hours (β=–1.00, aOR 0.37, 95% CI 0.28 to 0.49, p<0.001) were significantly associated with anxiety. Participant characteristics were not associated with anxiety.

Conclusions

During the COVID-19 pandemic, organisational support, personal resilience and adequate sleep duration were associated with anxiety among non-hospitalised residents. These findings highlight the importance of increasing organisational support, implementing interventions that promote resilience and stress management, ensuring sufficient rest and sleep duration, and helping residents better manage anxiety.
Use of artificial intelligence in the detection of primary prostate cancer in multiparametric MRI with its clinical outcomes: a protocol for a systematic review and meta-analysis
Authors: Thomas Maya , Murali Sanjana , Simpson Benjamin Scott S , Freeman Alex , Kirkham Alex , Kelly Daniel , Whitaker Hayley C , Zhao Yi , Emberton Mark , Norris Joseph M
Published: August 2023

Introduction

Multiparametric MRI (mpMRI) has transformed the prostate cancer diagnostic pathway, allowing for improved risk stratification and more targeted subsequent management. However, concerns exist over the interobserver variability of images and the applicability of this model long term, especially considering the current shortage of radiologists and the growing ageing population. Artificial intelligence (AI) is being integrated into clinical practice to support diagnostic and therapeutic imaging analysis to overcome these concerns. The following report details a protocol for a systematic review and meta-analysis investigating the accuracy of AI in predicting primary prostate cancer on mpMRI.

Methods and analysis

A systematic search will be performed using PubMed, MEDLINE, Embase and Cochrane databases. All relevant articles published between January 2016 and February 2023 will be eligible for inclusion. To be included, articles must use AI to study MRI prostate images to detect prostate cancer. All included articles will be in full-text, reporting original data and written in English. The protocol follows the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols 2015 checklist. The QUADAS-2 score will assess the quality and risk of bias across selected studies.

Ethics and dissemination

Ethical approval will not be required for this systematic review. Findings will be disseminated through peer-reviewed publications and presentations at both national and international conferences.

PROSPERO registration number

CRD42021293745.
Decision Aids in the ICU: a scoping review
Authors: Lei Yuling , Zhou Qi , Tao Yuexian
Published: August 2023

Objective

The purpose of this scoping review was to synthesise the effectiveness and acceptability of decision aids for critically ill patients and family members in the intensive care unit (ICU).

Methods

A systematic search of four electronic databases and grey literature was undertaken to identify relevant studies on the application of decision aids in the ICU, without publication date restriction, through March 2023. The methodological framework proposed by Arksey and O’Malley was used to guide the scoping review.

Results

Fourteen papers were ultimately included in this review. However, only nine decision aids were available, and it is noteworthy that many of these studies focused on the iterative development and testing of individual decision aids. Among the included studies, 92% (n=13) were developed in North America, with a primary focus on goals of care and life-sustaining treatments. The summary of the effect of decision aid application revealed that the most common indicators were the level of knowledge and code status, and some promising signals disappeared in randomised trials.

Conclusions

The complexity of treatment decisions in the ICU exceeds the current capabilities of existing decision aids. There is a clear gap in decision aids that are tailored to different cultural contexts, highlighting the need to expand the scope of their application. In addition, rigorous quality control is very important for randomised controlled trial, and indicators for assessing the effectiveness of decision aids need to be further clarified.
Knowledge support for optimising antibiotic prescribing for common infections in general practices: evaluation of the effectiveness of periodic feedback, decision support during consultations and peer comparisons in a cluster randomised trial (BRIT2) – study protocol
Authors: van Staa Tjeerd , Sharma Anita , Palin Victoria , Fahmi Ali , Cant Harriet , Zhong Xiaomin , Jury Francine , Gold Natalie , Welfare William , Ashcroft Darren , Tsang Jung Yin , Elliott Rachel Ann , Sutton Christopher , Armitage Chris , Couch Philip , Moulton Georgina , Tempest Edward , Buchan Iain Edward
Published: August 2023

Introduction

This project applies a Learning Healthcare System (LHS) approach to antibiotic prescribing for common infections in primary care. The approach involves iterations of data analysis, feedback to clinicians and implementation of quality improvement activities by the clinicians. The main research question is, can a knowledge support system (KSS) intervention within an LHS implementation improve antibiotic prescribing without increasing the risk of complications?

Methods and analysis

A pragmatic cluster randomised controlled trial will be conducted, with randomisation of at least 112 general practices in North-West England. General practices participating in the trial will be randomised to the following interventions: periodic practice-level and individual prescriber feedback using dashboards; or the same dashboards plus a KSS. Data from large databases of healthcare records are used to characterise heterogeneity in antibiotic uses, and to calculate risk scores for clinical outcomes and for the effectiveness of different treatment strategies. The results provide the baseline content for the dashboards and KSS. The KSS comprises a display within the electronic health record used during the consultation; the prescriber (general practitioner or allied health professional) will answer standard questions about the patient’s presentation and will then be presented with information (eg, patient’s risk of complications from the infection) to guide decision making. The KSS can generate information sheets for patients, conveyed by the clinicians during consultations. The primary outcome is the practice-level rate of antibiotic prescribing (per 1000 patients) with secondary safety outcomes. The data from practices participating in the trial and the dashboard infrastructure will be held within regional shared care record systems of the National Health Service in the UK.

Ethics and dissemination

Approved by National Health Service Ethics Committee IRAS 290050. The research results will be published in peer-reviewed journals and also disseminated to participating clinical staff and policy and guideline developers.

Trial registration number

ISRCTN16230629.
Role of fatty liver in the epidemic of advanced chronic liver disease among people with HIV: protocol for the Canadian LIVEHIV multicentre prospective cohort
Authors: Cinque Felice , Saeed Sahar , Kablawi Dana , Ramos Ballesteros Luz , Elgretli Wesal , Moodie Erica E M , Price Colleen , Monteith Ken , Cooper Curtis , Walmsley Sharon L , Pick Neora , Murray Melanie C M , Cox Joseph , Kronfli Nadine , Costiniuk Cecilia T , de Pokomandy Alexandra , Routy Jean-Pierre , Lebouché Bertrand , Klein Marina B , Sebastiani Giada
Published: August 2023

Introduction

Advanced chronic liver disease (ACLD) is a major cause of death for people with HIV (PWH). While viral hepatitis coinfections are largely responsible for this trend, metabolic dysfunction-associated steatotic liver disease (MASLD) is an emerging concern for PWH. We aimed to assess the contribution of MASLD to incident ACLD in PWH.

Methods and analysis

This multicentre prospective observational cohort study will enrol 968 consecutive HIV monoinfected patients from four Canadian sites, excluding subjects with alcohol abuse, liver disease other than MASLD, or ACLD at baseline. Participants will be followed annually for 4 years by clinical evaluation, questionnaires, laboratory testing and Fibroscan to measure liver stiffness measurement (LSM) and controlled attenuation parameter (CAP). The primary outcome will be incidence of ACLD, defined as LSM>10 kPa, by MASLD status, defined as CAP≥285 dB/m with at least one metabolic abnormality, and to develop a score to classify PWH according to their risk of ACLD. Secondary outcomes will include health-related quality of life (HRQoL) and healthcare resource usage. Kaplan-Meier survival method and Cox proportional hazards regression will calculate the incidence and predictors of ACLD, respectively. Propensity score methods and marginal structural models will account for time-varying exposures. We will split the cohort into a training set (to develop the risk score) and a validation set (for validation of the score). HRQoL scores and healthcare resource usage will be compared by MASLD status using generalised linear mixed effects model.

Ethics and dissemination

This protocol has been approved by the ethics committees of all participating institutions. Written informed consent will be obtained from all study participants. The results of this study will be shared through scientific publications and public presentations to advocate for the inclusion of PWH in clinical trials of MASLD-targeted therapies and case-finding of ACLD in PWH.
Sleep-disordered breathing and cardiovascular disease: who and why to test and how to intervene?
Authors: Vazir Ali , Kapelios Chris J
Published: August 2023

Sleep-disordered breathing (SDB) is common in individuals with established cardiovascular disease (CVD), particularly those with heart failure (HF). There are two main types of SDB, central sleep apnoea (CSA) and obstructive sleep apnoea (OSA) which frequently overlap as mixed SDB. Investigating for SDB could be considered in patients with excessive daytime sleepiness, male sex, high body mass index, low ejection fraction, atrial fibrillation (AF), in patients with no dipping blood pressure pattern, recurrent paroxysms of nocturnal dyspnoea or when an apnoea is witnessed. Excessive daytime sleepiness is less likely to be reported by patients with HF than by the general population. In patients with CVD and OSA, continuous positive airway pressure (CPAP) ventilation for over 4 hours daily reduced the risk of major adverse cardiovascular events, but there was no reduction in mortality. In patients with AF and OSA treated with AF ablation, CPAP use was associated with a reduced risk of recurrence of AF. In patients with HF and OSA, small studies have demonstrated that CPAP improves symptoms, brain natriuretic peptide levels and ejection fraction, but data on survival are lacking. Treatment remains unclear in patients with HF and CSA. The presence of CSA may be a defensive adaptive response to HF, and effectively treating CSA as demonstrated in a randomised clinical trial of adaptive servo-ventilation caused more harm than benefit when compared to optimal medical therapy. Thus, the focus of treating CSA should remain on improving the underlying HF by optimising medical therapy and, if indicated, cardiac resynchronisation therapy.
Management of secondary mitral regurgitation: from drugs to devices
Authors: Barnes Cara , Sharma Harish , Gamble James , Dawkins Sam
Published: August 2023

Severe secondary mitral regurgitation carries a poor prognosis with one in five patients dying within 12 months of diagnosis. Fortunately, there are now a number of safe and effective therapies available to improve outcomes. Here, we summarise the most up-to-date treatments. Optimal guideline-directed medical therapy is the mainstay therapy and has been shown to reduce the severity of mitral regurgitation in 40–45% of patients. Rapid medication titration protocols reduce heart failure hospitalisation and facilitate earlier referral for device therapy. The pursuit of sinus rhythm in patients with atrial fibrillation has been shown to significantly reduce mitral regurgitation severity, as has the use of cardiac resynchronisation devices in patients who meet guideline-directed criteria. Finally, we highlight the key role of mitral valve intervention, particularly transcatheter edge-to-edge repair (TEER) for management of moderate-severe mitral regurgitation in carefully selected patients with poor left ventricular systolic function, with a number needed to treat of 3.1 to reduce heart failure hospitalisation and 5.9 to reduce all-cause death. To slow the rapid accumulation of morbidity and mortality, we advocate a proactive approach with accelerated medical optimisation, followed by management of atrial fibrillation and cardiac resynchronisation therapy if indicated, then, rapid referral to the Heart Team for consideration of mitral valve intervention in patients with ongoing symptoms and at least moderate-severe mitral regurgitation. Mitral TEER has been shown to be ‘reasonably cost-effective’ (but not cost-saving) in the UK in selected patients, although TEER remains underused with only 6.5 procedures per million population (pmp) compared with Germany (77 pmp), Switzerland (44 pmp) and the USA (32 pmp).