bluuebunny/crossref_metadata_2025 huggingface dataset:
The relationship between wasting and stunting in young children: A systematic review
Authors: Thurstans Susan , Sessions Natalie , Dolan Carmel , Sadler Kate , Cichon Bernardette , Isanaka Sheila , Roberfroid Dominique , Stobaugh Heather , Webb Patrick , Khara Tanya
Published: September 2021

In 2014, the Emergency Nutrition Network published a report on the relationship between wasting and stunting. We aim to review evidence generated since that review to better understand the implications for improving child nutrition, health and survival. We conducted a systematic review following PRISMA guidelines, registered with PROSPERO. We identified search terms that describe wasting and stunting and the relationship between the two. We included studies related to children under five from low‐ and middle‐income countries that assessed both ponderal growth/wasting and linear growth/stunting and the association between the two. We included 45 studies. The review found the peak incidence of both wasting and stunting is between birth and 3 months. There is a strong association between the two conditions whereby episodes of wasting contribute to stunting and, to a lesser extent, stunting leads to wasting. Children with multiple anthropometric deficits, including concurrent stunting and wasting, have the highest risk of near‐term mortality when compared with children with any one deficit alone. Furthermore, evidence suggests that the use of mid‐upper‐arm circumference combined with weight‐for‐ageZscore might effectively identify children at most risk of near‐term mortality. Wasting and stunting, driven by common factors, frequently occur in the same child, either simultaneously or at different moments through their life course. Evidence of a process of accumulation of nutritional deficits and increased risk of mortality over a child's life demonstrates the pressing need for integrated policy, financing and programmatic approaches to the prevention and treatment of child malnutrition.
The genetic basis of floral mechanical isolation between two hummingbird‐pollinated Neotropical understorey herbs
Authors: Kay Kathleen M. , Surget‐Groba Yann
Published: September 2021

Floral divergence can contribute to reproductive isolation among plant lineages, and thus provides an opportunity to study the genetics of speciation, including the number, effect size, mode of action and interactions of quantitative trait loci (QTL). Moreover, flowers represent suites of functionally interrelated traits, but it is unclear to what extent the phenotypic integration of the flower is underlain by a shared genetic architecture, which could facilitate or constrain correlated evolution of floral traits. Here, we examine the genetic architecture of floral morphological traits involved in an evolutionary switch from bill to forehead pollen placement between two species of hummingbird‐pollinated Neotropical understorey herbs that are reproductively isolated by these floral differences. For the majority of traits, we find multiple QTL of relatively small effect spread throughout the genome. We also find substantial colocalization and alignment of effects of QTL underlying different floral traits that function together to promote outcrossing and reduce heterospecific pollen transfer. Our results are consistent with adaptive pleiotropy or linkage of many co‐adapted genes, either of which could have facilitated a response to correlated selection and helped to stabilize divergent phenotypes in the face of low levels of hybridization. Moreover, our results indicate that floral mechanical isolation can be consistent with an infinitesimal model of adaptation.
Adaptive approximate Bayesian computation by subset simulation for structural model calibration
Authors: Barros José , Chiachío Manuel , Chiachío Juan , Cabanilla Frank
Published: September 2021

This paper provides a new approximate Bayesian computation (ABC) algorithm with reduced hyper‐parameter scaling and its application to nonlinear structural model calibration problems. The algorithm initially takes the ABC‐SubSim algorithm structure and sequentially estimates the algorithm hyper‐parameter by autonomous adaptation following a Markov chain approach, thus avoiding the error associated to modeler's choice for these hyper‐parameters. The resulting algorithm, named BC‐SubSim, simplifies the application of ABC‐SubSim method for new users while ensuring better measure of accuracy in the posterior distribution and improved computational efficiency. A first numerical application example is provided for illustration purposes and to provide a comparative and sensitivity analysis of the algorithm with respect to initial ABC‐SubSim algorithm. Moreover, the efficiency of the method is demonstrated in two nonlinear structural calibration case studies where the BC‐SubSim is used as a tool to infer structural parameters with quantified uncertainty based on test data. The results confirm the suitability of the method to tackle with a real‐life damage parameter inference and its superiority in relation to the original ABC‐SubSim.
Inactivation of RNase P in Escherichia coli significantly changes post‐transcriptional RNA metabolism
Authors: Mohanty Bijoy K. , Kushner Sidney R.
Published: September 2021

Ribonuclease P (RNase P), which is required for the 5'‐end maturation of tRNAs in every organism, has been shown to play a limited role in other aspects of RNA metabolism in Escherichia coli. Using RNA‐sequencing (RNA‐seq), we demonstrate that RNase P inactivation affects the abundances of ~46% of the expressed transcripts in E. coli and provide evidence that its essential function is its ability to generate pre‐tRNAs from polycistronic tRNA transcripts. The RNA‐seq results agreed with the published data and northern blot analyses of 75/83 transcripts (mRNAs, sRNAs, and tRNAs). Changes in transcript abundances in the RNase P mutant also correlated with changes in their half‐lives. Inactivating the stringent response did not alter the rnpA49 phenotype. Most notably, increases in the transcript abundances were observed for all genes in the cysteine regulons, multiple toxin‐antitoxin modules, and sigma S‐controlled genes. Surprisingly, poly(A) polymerase (PAP I) modulated the abundances of ~10% of the transcripts affected by RNase P. A comparison of the transcriptomes of RNase P, RNase E, and RNase III mutants suggests that they affect distinct substrates. Together, our work strongly indicates that RNase P is a major player in all aspects of post‐transcriptional RNA metabolism in E. coli.
Communication before communicative intentions
Authors: Armstrong Josh
Published: September 2021

This paper explores the significance of intelligent social behavior among non‐human animals for philosophical theories of communication. Using the alarm call system of vervet monkeys as a case study, I argue that interpersonal communication (or what I call “minded communication”) can and does take place in the absence of the production and recognition of communicative intentions. More generally, I argue that evolutionary theory provides good reasons for maintaining that minded communication is both temporally and explanatorily prior to the use of communicative intentions. After developing these negative points about the place of communicative intentions in detail, I provide a novel alternative account according to which minded communication is characterized in terms of patterns of action and response that function to coordinate the representational mental states of agents. I show that an account which centers on patterns of representational coordination of this sort is well suited to capture the theoretical roles associated with minded communication and that it does so in a way that provides a good fit with comparative facts about the presence of minded communication among non‐human animals.
Powered sheaths for lead extraction
Authors: Bencardino Gianluigi , Ruscio Eleonora , Scacciavillani Roberto
Published: September 2021

Transvenous lead extraction (TLE) has seen a rapid expansion in the past 20 years. The procedure has changed from early techniques involving simple manual traction that frequently proved themselves ineffective for chronically implanted leads, and carried significant periprocedural risks including death, to the availability of a wide range of more efficacious techniques and tools, providing the skilled extractor with a well‐equipped armamentarium. The reduction in morbidity and mortality associated with these new extraction techniques has widened indications to TLE from prevalent use in life‐threatening situations, such as infection and sepsis, to a more widespread use even in noninfectious situations such as malfunctioning leads. Powered sheaths have been a remarkable step forward in this improvement in TLE procedures and recent registries at high‐volume centers report high success rates with exceedingly low complication rates. This review is aimed at describing technical features of powered sheaths as well as reported performance during TLE procedures.
Fungicide resistance management: Maximizing the effective life of plant protection products
Authors: Corkley Isabel , Fraaije Bart , Hawkins Nichola
Published: September 2021

Effective crop protection is vital to safeguard food security, but growers are reliant on a limited toolbox in the face of diverse and evolving pathogens. New crop protection methods need to be developed, but it is also important to prolong the effective life of existing products through resistance management. Some core principles in fungicide resistance management, such as using different modes of action and limiting repeat applications of any single mode of action, are long established. However, other aspects have been long debated, such as using higher or lower dose rates, mixtures or alternations, and whether to spray protectively or only if a disease threshold is reached. Continuing research into these questions uses a range of approaches, including modelling, experimental trials, and ongoing monitoring of pathogen populations. Molecular diagnostics allow higher throughput monitoring and earlier detection of emerging resistance. Resistance management guidelines must also be continually updated as new fungicides, and other crop protection measures, are introduced. However, designing optimal resistance management strategies is only half of the story, because a strategy will only be effective if growers follow it in practice. This is more difficult where there are hard trade‐offs between reducing selection for resistance in the future and achieving greater disease control in the present, or where there is a choice between a strategy that would be optimal on average or one that minimizes the risk of control failure in any year. Therefore, communication with farmers is an aspect of resistance management that must not be overlooked.
Beneficial effects of abscisic acid and melatonin in overcoming drought stress in cotton (Gossypium hirsutumL.)
Authors: Hu Wei , Zhang Jipeng , Yan Ke , Zhou Zhiguo , Zhao Wenqing , Zhang Xuandi , Pu Yanhong , Yu Runxing
Published: September 2021

Pot experiments were performed to study the effects of abscisic acid (ABA) and melatonin (MT) on cotton drought tolerance and to explore their combined effects. ABA or MT spraying promoted water status and antioxidant capacity of drought‐stressed leaves, which was conducive to scavenge ROS, finally increasing lint yield. However, the mitigation mechanisms of ABA and MT on drought were not identical, which were mainly manifested as: (1) ABA increased the relative water content (RWC) of drought‐stressed leaves via, reducing water loss, but MT increased it via, promoting water uptake efficiency; (2) for enzymatic antioxidant system, ABA and MT might modulate different kinds of superoxide dismutase to catalyze the reduction of O2−under drought; and (3) for ascorbic acid (AsA)‐glutathione (GSH) cycle, MT increased the glutathione reductase activity in drought‐stressed leaves, but ABA did not. ABA + MT spraying led to higher leaf RWC and total antioxidant capacity than single hormone under drought, leading to a lower H2O2level. For the enzymatic antioxidant system, single hormone treatment affectedCu/ZnSODorMnSODexpression, but ABA + MT upregulated both genes in drought‐stressed leaves. Hormones combined application also had higherCATexpression than single hormone. For AsA‐GSH cycle, ABA + MT had higher dehydroascorbic acid reductase activity than single hormone, resulting in higher AsA content. Moreover, hormones combined application caused higher ascorbate peroxidase activity than single hormone, suggesting that their combination synergistically improved the ability of AsA to eliminate ROS. All these confirmed that ABA plus MT had synergistic effects on improving crop drought resistance.
Effects of age and season on conception rate of Mediterranean Italian Dairy Buffalo (Bubalus bubalis) following oestrus synchronization and fixed‐time artificial insemination
Authors: Otava Gabriel , Squicciarini Stefano , Marc Simona , Suici Tijana , William Onan Gary , Hutu Ioan , Torda Iuliu , Mircu Calin
Published: September 2021

The objective of this project was to report the effects of season and age on conception rate amongst Italian Mediterranean Buffalo subjected to an Ovsynch/Resynch (O/R) reproductive management protocol. The study utilized nulliparous (heifers), primiparous buffalo cows (PBC) and multiparous buffalo cows (MBC). The primiparous and multiparous groups were subjected to the synchronization protocol throughout the entire year, but heifers were synchronized and inseminated only during the spring/summer seasons. The conception rate obtained following the OvSynch oestrus synchronization protocol, applied during spring, was 68.4% for heifers, 83.3% for PBC and 67.7% for MBC. The overall total conception rates following the complete O/R protocol were 84.27%, 94.4% and 79%. Conception rates achieved during summer were heifers 52%, PBC 47.2% and MBC 49%, whilst overall conception rates following the full O/R protocol were 72%, 69.8% and 58.2% respectively. In the autumn seasons, PBC conceived 58.9% and MBC 52.1% following initial Ovsynch, which improved to total overall conception rates of 87.5% and 78.7% following the full O/R protocol. Similarly, in the winter season, PBC experienced a conception rate of 47.5% following Ovsynch and 72.5% after a follow‐up Resynch. MBC experienced 60.0% and 74.4% conception following Ovsynch and full O/R, respectively, during winter. Total conception rates during all seasons were quite acceptable following the O/R protocol. There was a significant decrease from spring to summer in conception rate for all parity groups, but heifers were not a severely affected as older buffalo cows. This finding agrees with that of other investigators indicating that heifer fertility is not as negatively impacted by long photoperiod and higher ambient temperature as that of older animals. The O/R protocol as utilized in this study is an effective means of reproductive management for dairy buffalo cows and is effective for improving fertility during out‐of‐season breeding.
Role of soil biota in grassland restorations in high nutrient soils
Authors: Cheeke Tanya E. , Schneider Mary , Saify Alifya , Brauner Megan , Bunn Rebecca
Published: September 2021

Soil biota are abundant in grasslands; however, disturbances such as invasions or conversion to agriculture may alter soil communities in ways that reduce the success of native species and/or increase the competitiveness of invasive plants. Predicting the magnitude and direction of these effects on plant growth remains challenging, particularly in high nutrient soils, which can impact plant‐microbe and plant–plant interactions in different ways. In greenhouse experiments, invasive and native Palouse prairie plants were grown individually and in a community with soil from a Palouse prairie remnant, soil invaded by Bromus tectorum, a nutrient release treatment, or no treatment. We tested (1) whether arbuscular mycorrhizal fungal infectivity and function of soil biota differ in invaded versus remnant prairie soil; (2) if growth responses to soil biota are related to plant nutrient demands; (3) if individual plant responses to soil biota predict competitive outcomes; and (4) if successional status predicts plant growth response to soil biota in high nutrient soils. We found no difference in mycorrhizal inoculation potential or function in invaded versus remnant prairie soil. We show a continuum of plant growth responses to soil biota, which correlate with nutrient responses, even under the high baseline soil nutrient conditions. We found that growth response to soil biota may increase with native plant successional stage. Understanding how different plant species respond to soil biota and assessing functionality of soil biota at a site will help managers plan restorations in high nutrient soils, and inform whether inoculations may be beneficial at a particular site.
Comparative Study of Government Response Measures and Epidemic Trends for COVID‐19 Global Pandemic
Authors: Wang Chenyang , Zhang Hui , Gao Yang , Deng Qing
Published: September 2021

The ongoing novel coronavirus (COVID‐19) epidemic has evolved into a full range of challenges that the world is facing. Health and economic threats caused governments to take preventive measures against the spread of the disease. This study aims to provide a correlation analysis of the response measures adopted by countries and epidemic trends since the COVID‐19 outbreak. This analysis picks 13 countries for quantitative assessment. We select a trusted model to fit the epidemic trend curves in segments and catch the characteristics based on which we explore the key factors of COVID‐19 spread. This review generates a score table of government response measures according to the Likert scale. We use the Delphi method to obtain expert judgments about the government response in the Likert scale. Furthermore, we find a significant negative correlation between the epidemic trend characteristics and the government response measure scores given by experts through correlation analysis. More stringent government response measures correlate with fewer infections and fewer waves in the infection curves. Stringent government response measures curb the spread of COVID‐19, limit the number of total infectious cases, and reduce the time to peak of total cases. The clusters of the results categorize the countries into two specific groups. This study will improve our understanding of the prevention of COVID‐19 spread and government response.
Organized elite power and clean energy: A study of negative policy experimentations with renewable portfolio standards
Authors: Jang Sojin , Yi Hongtao
Published: September 2021

Renewable Portfolio Standards (RPS) is one of the most widely adopted clean energy policies in the U.S. However, organized elite power groups, backed by ample political and economic resources, have been known to lead RPS termination efforts. In the context of state renewable energy politics, organized elite power includes legislators affiliated with American Legislative Exchange Council (ALEC) and anti‐renewable energy business groups. Focusing on the roles of organized elite power, this study investigates the drivers of the formulation of RPS rollback (goal freeze) and termination bills, which we refer to collectively as negative policy experimentations. We find that RPS termination attempts are explained by the presence of ALEC legislators and anti‐renewable energy business groups, whereas RPS goal freeze bills are better explained by conditions of policy operations. This study contributes to the policy process theory by providing critical insights into the post adoption decisions, including policy termination and rollback legislations, with a focus on the role of organized elite power.
Complexity, tacit knowledge and the scope for technological catch‐up
Authors: Bekkers Eddy , Landesmann Michael , Macskasi Indre
Published: September 2021

We study the determinants of sectoral patterns of technological catch‐up of emerging economies. In particular, we test the hypotheses that technological catch‐up is slower in tacit knowledge‐intensive sectors, operationalised by measures of complex task intensity, in sectors with a high skill intensity, with a high degree of export sophistication, and higher income elasticity. Employing trade data from United Nations Comtrade and production data from the United Nations Industrial Development Organization (UNIDO) between 1960 and 2000 covering manufacturing sectors, we find that catch‐up is slower in more tacit knowledge‐intensive sectors, as well as in skill‐intensive and export sophisticated sectors. With more recent Global Trade Analysis Project (GTAP) data from 1997 to 2011, we find instead that catch‐up is faster in more tacit knowledge‐intensive manufacturing sectors, whereas catch‐up is slower in more tacit knowledge‐intensive services sectors. We discuss three potential explanations for the changing association of catch‐up with tacit knowledge intensity.
Seed dynamics of Aeschynomene denticulata and Aeschynomene indica
Authors: Martins Matheus B. , Munhos Taline Fonseca , Schaedler Carlos E. , Agostinetto Dirceu , Andres André
Published: September 2021

Jointvetch (Aeschynomene spp., Fabaceae) is considered a problematic broadleaf weed for rice production in Brazil, the United States, and Asia. Seed dormancy is particularly important for the perpetuation of annual weeds, representing the only link between different generations and thus the source of all future weed infestations. Seed dynamics in annual species are complex and related to many biotic and abiotic factors. The objectives of this study were to determine whether dormancy occurs in Aeschynomene denticulata and Aeschynomene indica seeds, and, if so, what is the most efficient method to break it. In addition, the persistence of seeds in soil also was investigated for both species. Three experiments were conducted, two in lab conditions and one in field conditions. The first experiment consisted of germination tests conducted in controlled conditions to determine whether seeds have dormancy. The second experiment tested the effectiveness of preheating, precooling, potassium nitrate, gibberellic acid, water soaking, chemical scarification, and mechanical scarification as dormancy breaking methods. Finally, the third experiment evaluated seedbank longevity for 1‐year period in the rice‐cultivated soil during which seeds were buried and recovered every 3 months. Variations in physical dormancy are present at different levels in both species due to seed‐coat impermeability to water absorption. Meanwhile, A. denticulata can persist over a year in soil seed bank but A. indica seeds only persisted for half a year.
Impact of maternal late gestation undernutrition on surfactant maturation, pulmonary blood flow and oxygen delivery measured by magnetic resonance imaging in the sheep fetus
Authors: Ren Jiaqi , Darby Jack R. T. , Lock Mitchell C. , Holman Stacey L. , Saini Brahmdeep S. , Bradshaw Emma L. , Orgeig Sandra , Perumal Sunthara R. , Wiese Michael D. , Macgowan Christopher K. , Seed Mike , Morrison Janna L.
Published: September 2021

Restriction of fetal substrate supply has an adverse effect on surfactant maturation in the lung and thus affects the transition from in utero placental oxygenation to pulmonary ventilation ex utero. The effects on surfactant maturation are mediated by alteration in mechanisms regulating surfactant protein and phospholipid synthesis. This study aimed to determine the effects of late gestation maternal undernutrition (LGUN) and LGUN plus fetal glucose infusion (LGUN+G) compared to Control on surfactant maturation and lung development, and the relationship with pulmonary blood flow and oxygen delivery () measured by magnetic resonance imaging (MRI) with molecules that regulate lung development. LGUN from 115 to 140 days’ gestation significantly decreased fetal body weight, which was normalized by glucose infusion. LGUN and LGUN+G resulted in decreased fetal plasma glucose concentration, with no change in fetal arterial compared to control. There was no effect of LGUN and LGUN+G on the mRNA expression of surfactant proteins (SFTP) and genes regulating surfactant maturation in the fetal lung. However, blood flow in the main pulmonary artery was significantly increased in LGUN, despite no change in blood flow in the left or right pulmonary artery and to the fetal lung. There was a negative relationship between left pulmonary artery flow and to the left lung with SFTP‐B and GLUT1 mRNA expression, while their relationship with VEGFR2 was positive. These results suggest that increased pulmonary blood flow measured by MRI may have an adverse effect on surfactant maturation during fetal lung development.

image

Key points

Maternal undernutrition during gestation alters fetal lung development by impacting surfactant maturation. However, the direction of change remains controversial.

We examined the effects of maternal late gestation maternal undernutrition (LGUN) on maternal and fetal outcomes, signalling pathways involved in fetal lung development, pulmonary haemodynamics and oxygen delivery in sheep using a combination of molecular and magnetic resonance imaging (MRI) techniques.

LGUN decreased fetal plasma glucose concentration without affecting arterial . Surfactant maturation was not affected; however, main pulmonary artery blood flow was significantly increased in the LGUN fetuses.

This is the first study to explore the relationship between in utero MRI measures of pulmonary haemodynamics and lung development. Across all treatment groups, left pulmonary artery blood flow and oxygen delivery were negatively correlated with surfactant protein B mRNA and protein expression in late gestation.
We’ve Come a Long Way, But We Could Be Doing Better: Gendered Commentary in U.S. Media Coverage of the 1999 and 2019 Women’s World Cup
Authors: Díaz McConnell Eileen , Christopherson Neal , Janning Michelle
Published: September 2021

In 2019, the U.S. Women’s National Team earned its fourth FIFA Women’s World Cup. Has gendered commentary in media coverage about the U.S. Women’s National Team changed since winning their first World Cup 20 years ago? Drawing on 188 newspaper articles published in three U.S. newspapers in 2019, the analyses contrast media representations of the 2019 team with a previous study focused on coverage of the 1999 team. Our analysis shows important shifts in the coverage over time. The 1999 team was popular because of their contradictory femininity in which they were “strong-yet-soft.” By 2019, the team’s popularity was rooted in their talent, hard work, success, and refusal to be silent about persisting gender-based disparities in sport and the larger society.
Importance and impact of diversity in paediatric medical education
Authors: Shanmugavadivel Dhurgshaarna , Buonsenso Danilo , Chantiluke Kaylita , Arora Michelle
Published: September 2021

Despite the increasing diversity of the UK population, we continue to see inequalities in health outcomes in patients of ethnic minorities. Unfortunately, this increasing diversity is not reflected in educational resources, which often continue to feature few images of patients with darker skin tones. Given the lack of diversity in these resources, it is unsurprising that healthcare professionals find it challenging recognising, diagnosing and managing presentations of clinical conditions in darker skinned patients. The development of new online, accessible image banks of medical conditions in different skin tones, such as Skin Deep, aims to facilitate increasing diversity in educational materials and hence improve delivery of equal standards of care to all patients.
Natural disasters, population displacement and health emergencies: multiple public health threats in Mozambique
Authors: Mugabe Vánio A , Gudo Eduardo S , Inlamea Osvaldo F , Kitron Uriel , Ribeiro Guilherme S
Published: September 2021

In early 2019, following the 2015–2016 severe drought, the provinces of Sofala and Cabo Delgado, Mozambique, were hit by Cyclones Idai and Kenneth, respectively. These were the deadliest and most destructive cyclones in the country’s history. Currently, these two provinces host tens of thousands of vulnerable households due to the climatic catastrophes and the massive influx of displaced people associated with violent terrorist attacks plaguing Cabo Delgado. The emergence of the COVID-19 pandemic added a new challenge to this already critical scenario, serving as a real test for Mozambique’s public health preparedness. On the planetary level, Mozambique can be viewed as a ‘canary in the coal mine’, harbingering to the world the synergistic effects of co-occurring anthropogenic and natural disasters. Herein, we discuss how the COVID-19 pandemic has accentuated the need for an effective and comprehensive public health response in a country already deeply impacted by health problems associated with natural disasters and population displacement.
Associations between cardiometabolic risks and physical activity in early adulthood: a cross-sectional study
Authors: Yen Hsin-Yen , Li Ching
Published: September 2021

Objectives

Young adults’ physical activity (PA) is a foundation of creating future healthy lifestyles. The purpose of this study was to explore differences in PA, sedentary behaviour, walkability and health beliefs among young adults with different levels of cardiometabolic risks and the influence of moderate-to-vigorous PA.

Design

A cross-sectional study was conducted using a structured questionnaire.

Participants

Totally, 1149 valid responses were received for a response rate of 86.32%. According to the self-reported worst health condition, participants were categorised into healthy adults, and adults at levels 1 (overweight), 2 (obese), 3 (hypertensive, hyperlipidaemic, and/or hyperglycaemic), and 4 (with a diagnosis of cardiometabolic diseases) of cardiometabolic risks.

Primary outcome measures

PA, sedentary time, walkability and health beliefs.

Results

Significant differences in PA (F=3.78, p<0.01) and sedentary time (F=2.39, p<0.05) among groups with various cardiometabolic risk levels were found. Healthy adults and adults at level 1 risk had significantly higher PA than adults at risk levels 2 and 3. Young adults at risk level 3 were less likely to participate in moderate-to-vigorous PA than were healthy adults (OR=0.64 (95% CI 0.41 to 0.99), p<0.05). Individuals who perceived that there were more recreational facilities (OR=1.27 (1.05 to 1.53), p<0.05), who had higher benefits of exercise (OR=1.73 (1.30 to 2.31), p<0.001), and who had lower barriers to exercise (OR=0.42 (0.32 to 0.55), p<0.001) were more likely to participate in moderate-to-vigorous PA.

Conclusions

Being aware of body weight changes could be a danger sign of a lack of PA. Developing environmental and psychological strategies to promote engaging in PA is necessary to promote the cardiometabolic health of young adults.
Capturing patient-reported and quality of life outcomes with use of shorter regimens for drug-resistant tuberculosis: mixed-methods substudy protocol, TB PRACTECAL-PRO
Authors: Stringer Beverley , Lowton Karen , James Nicola , Nyang"wa Bern-Thomas
Published: September 2021

Introduction

People living with multidrug-resistant tuberculosis currently have few options for effective treatment and cure. Regimens that are available are toxic, may involve injections and take up to 2 years to complete treatment, with success rates as low as 50%. The TB-PRACTECAL trial is evaluating shorter, more tolerable regimens of oral drugs; we detail the substudy within this trial, PRACTECAL-PRO, which aims to evaluate patient experiences and perspectives on treatment, to understand outcomes more fully.

Methods and analysis

We are conducting a mixed-methods evaluation within both investigational and standard of care arms within the TB-PRACTECAL trial, using sequential quality of life (QoL) surveys and in-depth interviews. Data collection involves the Short Form 12 (SF-12) and St George’s Respiratory Questionnaire (SGRQ), collected at up to four fixed timepoints, from baseline, to up to 12 months later. Healthy volunteers will be surveyed to establish locally relevant controls. We will also purposively sample participants for qualitative data collection and analysis, to provide rich explanation of QoL scores. The study will be implemented in all six TB-PRACTECAL study sites in Uzbekistan, South Africa and Belarus. QoL surveys will be scored and analysed according to SF-12 and SGRQ developers’ manuals. Differences between scores at baseline and later timepoints will be evaluated as well as graphical exploration of group score trajectories of investigational and standard of care arms.

Ethics and dissemination

Ethics approval was obtained from the Médecins Sans Frontières Ethics Review Board. Local ethics approval has been obtained in Uzbekistan, Belarus and South Africa. Results of the substudy will be shared with local health authorities, the WHO and submitted for publication in a peer-reviewed journal.

Trial registration number

NCT03942354; Pre-results.
Vertebroplasty in patients with multiple myeloma with vertebral compression fractures: protocol for a single-blind randomised controlled trial
Authors: Wickstroem Line Adsboell , Carreon Leah , Lund Thomas , Abildgaard Niels , Lorenzen Marianne Dyrby , Andersen Mikkel Østerheden
Published: September 2021

Introduction

Multiple myeloma (MM) is a plasma cell cancer where about 1/3 of the patients present with pathological fractures at the time of diagnosis. Despite treatment, the majority of the patients will develop additional fractures. Because survival and prognosis has improved significantly over the last two decades for patients with MM, there is an increased need to focus on optimal fracture treatment. Traditionally, fracture pain is treated conservatively with opioids, bisphosphonates, bracing and radiation therapy. Vertebral augmentation has been used for the last three decades as a minimally invasive treatment option for vertebral compression fractures, but the evidence base for the efficacy is weak. We describe a trial assessing the impact of vertebroplasty on clinical outcome in the treatment of patients with MM with painful vertebral fractures.

Methods

100 patients with MM with painful vertebral fractures will be randomised in a prospective, single-blinded, multicentre, clinical trial where patients are randomised to either usual care or usual care supplemented with vertebroplasty with a possibility of crossover 4 weeks after randomisation. The primary outcome will be change in Oswestry Disability Index at 4 weeks.

Analysis

Primary and secondary outcomes are assessed at baseline and at 4, 8, 26 and 52 weeks. Categorical data will be presented by means of frequencies and related percentages; continuous data will be displayed by means of descriptive statistics.

Ethics and dissemination

The study has been evaluated by the Regional Committees on Health Research for Southern Denmark (S-20200075) and notified and approved by the Region of Southern Denmark and listed in the internal record, journal no. 20/22355. All participants provide consent. The protocol will follow the SPIRIT (Standard Protocol Items for Randomized Trials) statement. The Danish Myeloma Patient Organization supports the study. Findings will be disseminated in peer-reviewed publications and presented at national and international conferences.

Trial registration number

NCT04533217.
Efficacy of positive psychotherapy in reducing negative and enhancing positive psychological outcomes: a meta-analysis of randomised controlled trials
Authors: Hoppen Thole Hilko , Morina Nexhmedin
Published: September 2021

Objective

Positive psychotherapy (PPT) aims at increasing positive affect, meaning and engagement. We aimed to synthesise the available evidence on PPT efficacy.

Design

We conducted a preregistered systematic literature search and meta-analysis of randomised controlled trials examining the efficacy of PPT for increasing positive (eg, satisfaction with life) or decreasing negative psychological outcomes (eg, depression).

Data sources

Medline, PsycINFO and Web of Science from 2006 (ie, inception of PPT) to February 2020 as well as related systematic reviews and meta-analyses.

Results

We included 20 randomised controlled trial with a total of 1360 participants. Moderate effect sizes were found for increasing positive outcomes (g=−0.72, 95% CI: −1.31 to −0.14, k=10, numbers needed to treat (NNT)=2.55) and reducing negative outcomes (g=0.48, 95% CI: 0.18 to 0.78, k=8, NNT=3.76) when PPT was compared with waitlist control conditions at post-treatment assessment. When compared with active control conditions, PPT yielded large effect sizes for increasing positive outcomes (g=−0.92, 95% CI: −1.74 to −0.11, k=6, NNT=2.05) and reducing depression (g=0.94, 95% CI: 0.18 to 1.70, k=6, NNT=2.03) at post-treatment assessment. No significant differences in efficacy were found when compared with established treatments such as cognitive–behavioural therapy. Evidence was found to support an association between trial quality and effect sizes. For positive outcomes, higher trial quality was related to larger effect size. Whereas higher trial quality was associated with smaller effect size for depression. Follow-up assessments remained too scarce for most planned analyses.

Conclusions

Our findings support the short-term efficacy of PPT. However, results are to be regarded with due caution in the light of low number of trials. More high-quality trials that assess efficacy at follow-ups are needed to draw firmer conclusions on the long-term efficacy of PPT.

PROSPERO registration number

CRD42020173567.
Characterising fetal alcohol spectrum disorder in Canada: a national database protocol study
Authors: Cook Jocelynn , Unsworth Kathy , Flannigan Katherine
Published: September 2021

Introduction

Fetal alcohol spectrum disorder (FASD) is one of the most common neurodevelopmental disorders in North America. It is a complex disability, associated with challenges in cognitive, behavioural and socialemotional functioning, as well as an increased risk of physical and mental health comorbidities, and difficulties in daily living across the lifespan. Previous attempts to characterise the profile of this population have been hampered by differences in data collected across studies, regional discrepancies in terminology and definitions, and a lack of tools to integrate comprehensive datasets.

Methods and analysis

The goals of this study are to use the Canadian National FASD Database, a national repository of FASD assessment-related information, to better understand the functional profile, comorbidities, intervention needs and difficulties in daily living experienced by individuals assessed for FASD across the lifespan. We will also examine what factors may be the most sensitive predictors of receiving an FASD diagnosis. Data will be analysed from over 3500 records collected between 2010 and 2021 (ongoing) from 26 FASD diagnostic clinics in seven provinces and territories. Data collection is ongoing, and analysis will be performed on a biannual basis to continue to hone our understanding of the profiles, needs and outcomes of individuals assessed for FASD in Canada. This research is critical for refining FASD assessment and diagnostic practice, enabling accurate and early identification of individuals with FASD, and connecting individuals with FASD and their families to comprehensive and effective services and resources to support healthy developmental trajectories.

Ethics and dissemination

Ethics approval for the National FASD Database Project was obtained from the Ottawa Health Science Network Research Ethics Board. As new knowledge is gained from this project, findings will be disseminated through publications, presentations and feedback to participating clinics, with the ultimate goal of informing FASD research, practice and policy.
Predictors of district nursing care utilisation for community-living people in the Netherlands: an exploratory study using claims data
Authors: Veldhuizen Jessica Desirée , Mikkers Misja Chiljon , Schuurmans Marieke J , Bleijenberg Nienke
Published: September 2021

Objective

To explore predictors of district nursing care utilisation for community-living (older) people in the Netherlands using claims data. To cope with growing demands in district nursing care, knowledge about the current utilisation of district nursing care is important.

Setting

District nursing care as a part of primary care.

Participants

In this nationwide study, claims data were used from the Dutch risk adjustment system and national information system of health insurers. Samples were drawn of 5500 pairs of community-living people using district nursing care (cases) and people not using district nursing care (controls) for two groups: all ages and aged 75+ years (total N=22 000).

Outcome measures

The outcome was district nursing care utilisation and the 114 potential predictors included predisposing factors (eg, age), enabling factors (eg, socioeconomic status) and need factors (various healthcare costs). The random forest algorithm was used to predict district nursing care utilisation. The performance of the models and importance of predictors were calculated.

Results

For the population of people aged 75+ years, most important predictors were older age, and high costs for general practitioner consultations, aid devices, pharmaceutical care, ambulance transportation and occupational therapy. For the total population, older age, and high costs for pharmaceutical care and aid devices were the most important predictors.

Conclusions

People in need of district nursing care are older, visit the general practitioner more often, and use more and/or expensive medications and aid devices. Therefore, close collaboration between the district nurse, general practitioner and the community pharmacist is important. Additional analyses including data regarding health status are recommended. Further research is needed to provide an evidence base for district nursing care to optimise the care for those with high care needs, and guide practice and policymakers’ decision-making.
Effect of melatonin and melatonin agonists on postoperative sleep quality in adult patients: a protocol for systematic review and meta-analysis with trial sequential analysis
Authors: Tsukinaga Akito , Mihara Takahiro , Takeshima Teppei , Tomita Makoto , Goto Takahisa , Yamanaka Takeharu
Published: September 2021

Introduction

The circadian rhythm of melatonin secretion is disturbed after general anaesthesia, leading to postoperative sleep disturbance. Small studies investigating the preventive effect of melatonin administration on postoperative sleep disturbance have not reached any conclusions. Therefore, we will conduct a systematic review and meta-analysis to obtain conclusive results.

Methods and analysis

We prepared this protocol following the 2015 Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Protocols guidelines. We will conduct a search for randomised controlled trials that evaluated the effect of melatonin and melatonin agonists on postoperative sleep quality in adult patients undergoing general anaesthesia or regional anaesthesia with sedation. We will exclude patients undergoing regional anaesthesia without sedation. Relevant studies will be searched in the following eight databases: MEDLINE, the Cochrane Central Register of Controlled Trials, Embase, Web of Science and four preregistration sites from inception to 1 January 2021. No language restrictions will be applied. Two authors will independently scan and select eligible studies and perform data extraction and assessment of the risk of bias. The Visual Analogue Scale scores for sleep quality will be combined as the mean difference with a 95% CI using a random-effect model; we will use I2to assess heterogeneity. We will evaluate the quality of trials using the Cochrane methodology and assess the quality of evidence using the Grading of Recommendation Assessment, Development and Evaluation approach. If appropriate, trial sequential analysis will be performed.

Ethics and dissemination

No ethical approval is required for this meta-analysis, as it does not include individual patient data. We will disseminate the results of this meta-analysis in a peer-reviewed journal.

PROSPERO registration number

CRD42020180167.
Outcomes evaluating quality of life and their measurement properties in early-onset scoliosis: protocol for a systematic review
Authors: Baird Charles , Archer James , Gardner Adrian , Rushton Alison B , Heneghan Nicola R
Published: September 2021

Introduction

Early-onset scoliosis (EOS) is a rare spinal deformity affecting children under the age of 10. Both the condition and its treatment have associated morbidity and can impact quality of life. Understanding this impact can be achieved by using appropriate patient-reported and/or carer-reported outcome measures. The aim of the review described in this protocol is to evaluate the evidence on measurement properties relevant to health-related quality of life outcomes in the EOS population. The focus will be on outcome measures relevant to patients undergoing treatment of EOS under the age of 10.

Methods/analysis

This protocol is reported in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol and COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) methodology. The MEDLINE, EMBASE, EMCARE, PubMed, PsychINFO and CINAHL databases will be searched using a two-stage search strategy. The first stage will identify measures of HRQoL used in EOS through screening of titles and abstracts. The second stage will assess the measurement properties of those measures identified through screening of full-text articles. The measurement properties of interest are the ‘reliability’, ‘validity’ and ‘responsiveness’ of the instrument. Only English language articles will be considered. Two reviewers will independently review the search results against the eligibility criteria, perform data extraction and assess for risk of bias, with disputes handled by a third reviewer. Data will be quantitatively pooled where possible or reported as a narrative synthesis. The summarised results for each measurement property will be rated against the criteria for good measurement properties following the COSMIN methodology. Two reviewers will assess the body of evidence for each measurement property using modified Grading of Recommendations, Assessment, Development and Evaluation guidelines.

Ethics and dissemination

No ethical approval is required for this review and the results will be submitted for publication in peer-reviewed publications.

PROSPERO registration number

CRD42020219721.