bluuebunny/crossref_metadata_2025 huggingface dataset:
Struggles over waste: Preparing for re-use in the Danish waste sector
Authors: Moalem Rikke Marie , Remmen Arne , Hirsbak Stig , Kerndrup Søren
Published: September 2022

A circular economy (CE) aims to reduce waste and encourages keeping products, components, and materials circulating in the economy. Furthermore, following the European waste hierarchy, preparing for re-use (PfR) is regarded as a better waste management option than recycling. Nevertheless, too many products with a reuse potential end up as waste. This includes residuals from products that have no major value and are therefore not demanded by the current system. As a result, products are prematurely recycled. This contradicts both the priority order of the waste hierarchy and the principles of a CE. This article investigates the potential of and constraints to reusing products that are disposed of at municipal recycling stations. It aims to improve our understanding of these issues and offers possible solutions that could enable municipal waste companies to transition from waste to resource management and reach the upper levels of the waste hierarchy, preparing waste for re-use. Interviews with relevant stakeholders, desk studies and knowledge obtained from participating in waste conferences over the past 3 years are all used to analyze PfR practice at five municipal waste management companies in Denmark. Pioneers with respect to circularity in the waste sector, which have been experimenting with and initiating PfR schemes concerning a range of products, including building materials, furniture, white goods and bicycles, are considered because they support the inner cycles of the CE. However, results reveal that the current transition consists of complex processes connected to an ambivalent legal framework and struggles over access and rights to resources. Further, a more coherent conceptual understanding of PfR is needed as the current understanding has a too narrow focus on restoring product value rather than coupling PfR processes to the market. Thus, challenges to achieving higher PfR rates seem to go beyond engaging in strategic partnerships, creating financial incentives and setting separate targets for PfR. Consequently, a more holistic investigation appears to be necessary to deepen our understanding of processes of resource management and use and the contestation that exists over these. Furthermore, a wider mapping of the actors operating in the tension area of PfR, including their willingness to cooperate and negotiate a zone of agreement, could prove beneficial to practitioners and policy developers alike.
Direct yaw moment control and state observer design for four in-wheel motor drive electric vehicles based on super-twisting algorithm
Authors: Xu Tao , Zhao Youqun , Zhao Qixian , Wang Qiuwei , Deng Huifan , Lin Fen
Published: September 2022

In order to improve the handling stability for four in-wheel motor drive electric vehicles (4IWMD EVs), a novel direct yaw moment control (DYC) strategy is proposed in this paper. To begin with, the problem formulation is stated by considering modeling errors and external disturbance. To obtain direct yaw moment output, a direct yaw moment controller is given by using conventional sliding mode theory at first. In order to deal with large gains of sign function, which brings severe chattering problem in conventional first-order sling mode (FOSM) control, an improved adaptive second-order sliding mode control strategy is proposed based on super-twisting algorithm (STA) to estimate vehicle model errors and external lumped disturbance. In addition, taking the cost problem in practice into account, an integral sliding mode observer (ISMO) is constructed to estimate and calculate the actual values of sideslip angle indirectly on the basis of STA. Furthermore, a composite control strategy is proposed according to stability analysis, combining adaptive second-order sliding mode controller with ISMO. Eventually, comparative simulations are conducted in Carsim and Simulink. The results show that proposed control strategy can achieve superior tracking performance under the premise of tackling chattering phenomenon, and the response curves are smoother. Meanwhile, the influence of uncertain disturbance proves to be weakened significantly with STA-based scheme while performances of other control strategies are seriously affected, which verifies the robustness and effectiveness of proposed control strategy.
Underestimating Counterparts’ Learning Goals Impairs Conflictual Conversations
Authors: Collins Hanne K. , Dorison Charles A. , Gino Francesca , Minson Julia A.
Published: September 2022

Given the many contexts in which people have difficulty engaging with views that disagree with their own—from political discussions to workplace conflicts—it is critical to understand how conflictual conversations can be improved. Whereas previous work has focused on strategies to change individual-level mindsets (e.g., encouraging open-mindedness), the present study investigated the role of partners’ beliefs about their counterparts. Across seven preregistered studies ( N = 2,614 adults), people consistently underestimated how willing disagreeing counterparts were to learn about opposing views (compared with how willing participants were themselves and how willing they believed agreeing others would be). Further, this belief strongly predicted greater derogation of attitude opponents and more negative expectations for conflictual conversations. Critically, in both American partisan politics and the Israeli-Palestinian conflict, a short informational intervention that increased beliefs that disagreeing counterparts were willing to learn about one’s views decreased derogation and increased willingness to engage in the future. We built on research recognizing the power of the situation to highlight a fruitful new focus for conflict research.
The power of relationship-based supervision in supporting social work retention: A case study from long-term ethnographic research in child protection
Authors: Warwick Lisa , Beddoe Liz , Leigh Jadwiga , Disney Tom , Ferguson Harry , Cooner Tarsem Singh
Published: September 2022

Supervision is a core component of professional support and development in social work. In many settings, and perhaps particularly in children’s services, it is valued as crucial in safe decision-making, practice reflection, professional development and staff support. Research has demonstrated that supervision and staff support also contribute to social worker retention in child welfare services. Drawing on data gathered in a 15-month ethnographic, longitudinal study of child protection work that included observations of supervision, we were able to observe the impact of supportive supervisory relationships on social workers’ decision-making about staying in their current workplace. This article presents a single case that demonstrates the potential impact of effective relationship-based supervision on retention and calls for a more humane approach to social work supervision against dominant managerial themes that have increasingly burdened the profession.
Artificial intelligence software in pulmonary nodule assessment
Authors: Smith Dugal , Melville Phillip , Fozzard Nicolette , Zhang Jason , Deonarine Patricia , Nirthanan Selvanayagam , Sivakumaran Pathmanathan
Published: September 2022

Background:

This study tests the impact of the addition of autonomous computed tomography (CT) interpreting software to radiologist assessment of pulmonary nodules.

Methods:

Computed tomography scans for nodule assessment were identified retrospectively. Lung cancer risk factors, initial radiologist (RAD) report, Philips Lung Nodule software report (computer-aided nodule (CAD)) and radiologist report following the review of CT images and CAD (RAD + CAD) were collected. Follow-up recommendations based on current guidelines were derived from each report.

Results:

In all, 100 patients were studied. Median maximal diameter of the largest nodule reported by RAD and RAD + CAD were similar at 10.0 and 9.0 mm, respectively ( p = 0.06) but were reported as larger by CAD at 11.8 mm ( p < 0.001). Follow-up recommendations derived from RAD + CAD were less intensive in 23 (23%) and more intensive in 34 (34%) than that of RAD.

Discussion:

This study suggests that autonomous software use can alter radiologist assessment of pulmonary nodules such that suggested follow-up is altered.
Incidentally Detected Malignancies in Lung Explants
Authors: Razia Deepika , Arjuna Ashwini , Trahan Amy , Hahn Mary F. , Abdelrazek Hesham , Omar Ashraf , Tokman Sofya , Hashimi Abdul Samad , Huang Jasmine , Smith Michael A. , Bremner Ross M. , Walia Rajat
Published: September 2022

Introduction: Incidentally detected malignancies in lung explants portend risk of early cancer recurrence and metastases with posttransplant immunosuppression. We present a series of lung transplant recipients with previously unverified malignancies in native lung explants. Design: We reviewed the histopathology, radiographic imaging, and management of lung explant malignancies at our institution over 10 years (2011-2020). Endpoints were survival and allograft rejection. Results: An explant malignancy was found in 1.3% (11/855) of lung transplant recipients (6 [55%] men; median age 68 years; 6 [55%] ex-smokers [median pack-years, 25]). Nine (82%) were adenocarcinoma, 1 (9%) was squamous cell carcinoma (SCC), and 1 (9%) was follicular lymphoma. Three patients (27%) had multifocal involvement (≥3 lobes), 4 (36%) had nodal involvement, and the median (range) tumor size was 2.7 (0.4-19) cm. The median interval between last imaging and transplant was 58 (29-144) days. Mycophenolate mofetil was discontinued or reduced in all; everolimus was used in 2 patients, and cisplatin-pemetrexed chemotherapy was used in 2 patients. The prevalence of acute cellular rejection and chronic rejection was 27% and 9%, respectively. Lung recipients with cancer had significantly lower survival than those without (36.4% vs 67.3%, p = 0.002); median survival was 27 (17, 65) months in 4 recipients who were alive and cancer-free at the end of the study period. Conclusions: Unidentified malignancies, commonly adenocarcinoma, can be detected in explanted native lungs. Pneumonectomy may be curative in SCC, lymphoproliferative disorders, and stage I adenocarcinoma. Modulating immunosuppression to prevent allograft rejection and tumor proliferation is warranted.
Standardised aspiration first approach reduces materials used and cost of thrombectomy procedure in anterior circulation large vessel occlusion stoke
Authors: O’Cearbhaill Roisin M , O’Herlihy Fergus , Herlihy Darragh , Alderson Jack , Brennan Paul , Power Sarah , O’Hare Alan , Thornton John
Published: September 2022

Purpose

The aim of this study is to compare the volume of equipment and equipment costs in a cohort of consecutive patients with anterior circulation large vessel occlusion treated with a standardised aspiration first approach to those treated with a stent retriever first approach.

Methods

The equipment used in each case was recorded from a prospectively maintained equipment log. We then compared the volume of equipment used in each group. The cost of this equipment was calculated for each group based on local prices. Estimated equipment costs were then compared.

Results

Our patient cohort consisted of 127 consecutive patients who were treated with a non-standardised stent retriever first technique (group A), 127 consecutive patients who underwent a new standardised aspiration first technique (group B), and 126 consecutive patients reflecting more recent practise where an aspiration first approach has been an established practise in our department (group C). Standardised aspiration first approach results in reduced equipment usage in thrombectomy procedures. The total equipment cost per case in the stent retriever first group (group A) was significantly higher at €4726.4 ($4818.3) versus €3093.1 ($3153.2) in the aspiration first group (group B), a reduction of 34.6% and €2798.5 ($2852.9) in the current practise group (group C), a reduction of 40.8%. There was no statistically significant difference in cost between groups B and C (p  =  0.57).

Conclusion

The standardised aspiration first technique utilised a reduced volume of equipment and confers a 40.8% reduced cost per procedure compared to a stent retriever first approach.
Serial Focus Groups: A Longitudinal Design for Studying Interactive Discourse
Authors: Baden Christian , Pasitselska Olga , Aharoni Tali , Tenenboim-Weinblatt Keren
Published: September 2022

Focus group methods specialize in the analysis of interactive discourse, but are only rarely employed as a stand-alone method to study such phenomena, owing to inherent limitations concerning the comparability and generalizability of findings. In this paper, we argue that focus groups undergo three kinds of transformations, involving changes in participants’ cognitive states, social ties, and discursive behavior, which raise both analytic challenges and valuable opportunities for the study of shared meanings and interactive negotiation processes in society. Introducing Serial Focus Groups, we extend familiar focus group designs as a method for studying interactive discourse in a longitudinal perspective, capitalizing on the analytic potentials raised by these transformations. Reviewing the methodological literature and drawing upon two large-scale focus group studies of socially interactive sense-making, we argue that serial focus groups can help overcome some of the limitations of cross-sectional focus groups and offer valuable new opportunities for analysis and validation.
Application of a nutrition support protocol to encourage optimisation of nutrient intake in provincial academy rugby union athletes in New Zealand: Practical considerations and challenges from a team-based case study
Authors: Roberts Charlie J , Gill Nicholas D , Beaven Christopher M , Posthumus Logan R , Sims Stacy T
Published: September 2022

Provincial academies represent an important bridge between amateur and professional level rugby union in New Zealand. Athletes are provided with professional-level coaching; however, limited direct nutrition support is available. Congested training schedules and the requirement to work or study due to a lack of financial support may present a challenge towards athletes meeting nutrition requirements. The aim of the study was to facilitate improvement in nutrient intake, body composition and subjective well-being in provincial academy athletes via the implementation of a nutrition-support protocol based around behaviour change techniques. Significant increases in total energy (pre: 2492 ± 762 kcal; post: 2614 ± 625 kcal), relative energy (pre: 24.4 ± 7.5 kcal·kg; 25.5 ± 6.0 kcal·kg), total protein (pre: 131.1 ± 41.8 g; 153.8 ± 37.1 g) and relative protein (pre: 1.3 ± 0.4 g·kg; post: 1.5 ± 0.3 g·kg) were observed. Furthermore, changes in subjective sleep quality, stress, mood and upper body soreness were observed following the intervention. No changes were observed in body composition, carbohydrate or fat intake. Significant variability in nutrition and body composition changes highlights the importance of applying an individualised approach to nutrition support provision in developmental athletes. Practitioners working within these environments should be aware of the challenges and influences contributing to athletes’ nutrition choices and habits.
Crowdsourcing dictatorship in Thailand
Authors: Sinpeng Aim
Published: September 2022

What explains popular support for military dictatorship? Existing literature on democratic breakdowns focuses on addressing support for democratic collapse but not subsequent authoritarian regime. This article explores pro-dictatorship sentiment before and during the military dictatorship in Thailand. It uses social media data to analyze support for the antidemocratic mobilization of the People’s Democratic Reform Committee (PDRC) and the subsequent military dictatorship, which lasted from 2014 to 2019. It argues that support for military dictatorship prior to and after regime installment was qualitatively different both in sentiment and type of support. Prior to the coup, pro-dictatorship support was unified by antigovernment sentiment, while following the coup pro-regime support was contingent upon policy preferences of different groups. These findings fill a gap in the literature on regime change, which tends to be focused on explaining support for democratic collapse and remains silent on this support in its aftermath. This study may present the first-ever evidence of pro-dictatorship support following a collapse of democracy.
Nursing and Midwifery Students’ Mental Health Status and Intention to Leave During Covid-19 Pandemic
Authors: Haririan Hamidreza , Samadi Parisa , Lalezari Elnaz , Habibzadeh Sajad , Porter Joanne E
Published: September 2022

Introduction

COVID-19 has not only affected the physical health of people but it has also had a major impact on their mental health.

Objective

To investigate the nursing, midwifery, and operating room students’ mental health and intention to leave during COVID-19 pandemic.

Methods

This cross-sectional study was conducted at the nursing and midwifery school of Tabriz, Iran. Over a period of three months (February–May 2021) and through random sampling, 284 students were selected. The research tool consisted of three parts including demographic information, Depression Anxiety Stress scales, and a questionnaire on intention to leave.

Results

More than 20% of the students experienced some degrees of depression, anxiety, and stress. Nearly one-third of participants mentioned a high level of intention to leave. Nursing students had a higher level of a turnover tendency than other students ( p = .004). Male students and who experienced moderate to high level of depression displayed greater intention to leave ( p = .005).

Conclusion

Students suffered from some degrees of stress, anxiety, and depression during the COVID-19, and it strengthened the participants’ intention to leave. Relevant authorities are recommended to improve mental health of the students by providing psychological counseling sessions, reducing their direct contact with patients, and providing personal protective equipment.
Antigen-guided depletion of anti-HLA antibody–producing cells by HLA-Fc fusion proteins
Authors: Webber Ashlee M. , Bradstreet Tara R. , Wang Xiaoli , Guo Hongjie , Nelson Christopher A. , Fremont Daved H. , Edelson Brian T. , Liu Chang
Published: September 2022

Platelet transfusion and transplantation of allogeneic stem cells and solid organs are life-saving therapies. Unwanted alloantibodies to nonself human leukocyte antigens (HLAs) on donor cells increase the immunological barrier to these therapies and are important causes of platelet transfusion refractoriness and graft rejection. Although the specificities of anti-HLA antibodies can be determined at the allelic level, traditional treatments for antibody-mediated rejection nonselectively suppress humoral immunity and are not universally successful. We designed HLA-Fc fusion proteins with a bivalent targeting module derived from extracellular domains of HLA and an Fc effector module from mouse IgG2a. We found that HLA-Fc with A2 (A2Fc) and B7 (B7Fc) antigens lowered HLA-A2− and HLA-B7−specific reactivities, respectively, in sera from HLA-sensitized patients. A2Fc and B7Fc bound to B-cell hybridomas bearing surface immunoglobulins with cognate specificities and triggered antigen-specific and Fc-dependent cytotoxicity in vitro. In immunodeficient mice carrying HLA-A2–specific hybridoma cells, A2Fc treatment lowered circulating anti−HLA-A2 levels, abolished the outgrowth of hybridoma cells, and prolonged survival compared with control groups. In an in vivo anti-HLA-A2−mediated platelet transfusion refractoriness model, A2Fc treatment mitigated refractoriness. These results support HLA-Fc being a novel strategy for antigen-specific humoral suppression to improve transfusion and transplantation outcomes. With the long-term goal of targeting HLA-specific memory B cells for desensitization, further studies of HLA-Fc’s efficacy in immune-competent animal models are warranted.
A conformational transition of the D′D3 domain primes von Willebrand factor for multimerization
Authors: Gruber Sophia , Löf Achim , Hausch Adina , Kutzki Fabian , Jöhr Res , Obser Tobias , König Gesa , Schneppenheim Reinhard , Aponte-Santamaría Camilo , Gräter Frauke , Brehm Maria A. , Benoit Martin , Lipfert Jan
Published: September 2022

Von Willebrand factor (VWF) is a multimeric plasma glycoprotein that is critically involved in hemostasis. Biosynthesis of long VWF concatemers in the endoplasmic reticulum and the trans-Golgi is still not fully understood. We use the single-molecule force spectroscopy technique magnetic tweezers to analyze a previously hypothesized conformational change in the D′D3 domain crucial for VWF multimerization. We find that the interface formed by submodules C8-3, TIL3, and E3 wrapping around VWD3 can open and expose 2 buried cysteines, Cys1099 and Cys1142, that are vital for multimerization. By characterizing the conformational change at varying levels of force, we can quantify the kinetics of the transition and stability of the interface. We find a pronounced destabilization of the interface on lowering the pH from 7.4 to 6.2 and 5.5. This is consistent with initiation of the conformational change that enables VWF multimerization at the D′D3 domain by a decrease in pH in the trans-Golgi network and Weibel-Palade bodies. Furthermore, we find a stabilization of the interface in the presence of coagulation factor VIII, providing evidence for a previously hypothesized binding site in submodule C8-3. Our findings highlight the critical role of the D′D3 domain in VWF biosynthesis and function, and we anticipate our methodology to be applicable to study other, similar conformational changes in VWF and beyond.
Eicosapentaenoic acid loaded silica nanoemulsion attenuates hepatic inflammation through the enhancement of cell membrane components
Authors: Hussein Jihan , El-Bana Mona A. , El-kHayat Zakaria , El-Naggar Mehrez E. , Farrag Abdel Razik , Medhat Dalia
Published: September 2022

Background

Liver inflammation is a multistep process that is linked with cell membrane fatty acids composition. The effectiveness of eicosapentaenoic acid (EPA) undergoes an irreversible change during processing due to their unsaturated nature; so the formation of nanocarrier for EPA is crucial for improving EPA’s bioavailability and pharmacological properties.

Objective

In this study we aimed to evaluate the efficiency of EPA alone or loaded silica nanoemulsion on the management of hepatic inflammation induced by diethyl nitrosamine (DEN) through the enhancement of the cell membrane structure and functions.

Methods

The new formula of EPA was prepared to modify the properties of EPA. Forty-eight male Wistar albino rats were classified into: control, EPA, EPA loaded silica nanoemulsion (EPA–NE), DEN induced hepatic inflammation; DEN induced hepatic inflammation treated with EPA or EPA –NE groups. Plasma tumor necrosis factor alpha (TNF-α), interleukin-1 beta (IL-1β), liver hydroxyproline (Hyp) content, and liver oxidant and anti-oxidants were estimated. Urinary 8- hydroxyguanozine (8- OHdG) and erythrocyte membrane fatty acids fractions were estimated by High-performance liquid chromatography (HPLC). Also, histopathology studies were done to verify our hypothesis.

Results

It was appeared that administration of EPA, in particular EPA loaded silica nanoemulsion, ameliorated the inflammatory response, increased the activity of the anti-oxidants, reduced levels of oxidants, and improved cell membrane structure compared to hepatic inflammation induced by DEN group. Histopathological examination confirmed these results.

Conclusion

EPA and notably EPA loaded silica nanoemulsion strongly recommended as a promising supplement in the management of hepatic inflammation.
Epidemiology of early infections and predictors of mortality after autologous hematopoietic stem-cell transplantation among multiple myeloma, Hodgkin, and non-Hodgkin lymphoma: the first experience from Palestine
Authors: Amer Riad , Salameh Husam , Mosleh Sultan , Abu-Taha Adham , Hamayel Hamza , Enaya Ahmad , Adas Amro , Khursani Ahmad , Wild-Ali Mohamad , Mousa Taghreed , Battat Maher , Daifallah Aiman , Koni Amer , Shawahna Ramzi
Published: September 2022

Background

Autologous hematopoietic stem-cell transplantation (HSCT) is the standard of care in many relapsed and refractory lymphoid malignancy, neuroblastoma, and multiple myeloma (MM). This study was conducted to describe the epidemiology of early infections that occurred within the first 100 days among patients who received HSCT for MM, Hodgkin (HL), and non-Hodgkin lymphoma (NHL) in Palestine.

Methods

This study was conducted in a retrospective cohort design in the only autologous HSCT in Palestine in the period between 2014 and 2021. The medical records of the patients were reviewed to identify and collect demographic, clinical, and microbiological data on bacterial, viral, fungal, and parasitic infections as diagnosed by cultures, polymerase chain reaction, and fluorescent antibody testing.

Results

A total of 145 patients were included in this study (median age = 44.0 [28.0, 53.5] years). Of those, 8 (5.5%) were younger than 18 years, 69 (47.6%) had MM, 53 (36.6%) had HL, and 23 (15.9%) had NHL. The source of fever had no focus in the majority of the cases 82 (56.6%), 12 (8.3%) had bloodstream infections, 8 (5.5%) had colitis, and 7.6 (5.0%) had pneumonia. Patients from whom gram-negative bacteria were isolated stayed in the hospital for longer duration compared to the other patients (median = 21.0 [19.0, 25.0] vs. 18.0 [15.0, 22.0] days, p-value = 0.043, respectively). The cumulative incidence of death in the first 100 days after infusion of stem cells was 3.4%. The cumulative incidence of death in the first 100 days post-transplantation was higher for patients with NHL compared to those with HL and MM (p-value = 0.017). Gram-negative and fungal infections were strong predictors of mortality.

Conclusion

Bacterial gram-positive and gram-negative infections were the most common early infections among patients who underwent autologous HSCT for hematological malignancies (HM) in the only center in Palestine. The findings of this study are informative to healthcare providers and planners of care for patients who are scheduled to receive autologous HSCT for HM.
Apolipoprotein A5 gene polymorphism (rs662799) and cardiovascular disease in end-stage kidney disease patients
Authors: Jacob Jerry , Boczkowska Sylwia , Zaluska Wojciech , Buraczynska Monika
Published: September 2022

Background

Plasma triglyceride (TG) levels are a significant risk factor for cardiovascular disease (CVD). TheAPOA5gene is one of the crucial factors in plasma TG metabolism regulation. The rs662799 polymorphism in theAPOA5gene has been reported to be associated with cardiovascular disease. The goal of this study was to evaluate the potential association of this variant with CVD in patients with end-stage kidney disease. 

Methods

In this case–control study the polymorphism was analyzed using the PCR–RFLP method in 800 consecutive patients with ESKD and 500 healthy controls. The genotype and allele distribution was compared between subgroups of patients with CVD (552) versus those without CVD (248).

Results

The frequency of the minor allele (C) in the healthy individuals was 9% compared to 12% in ESRD group (p = 0.09). The difference between groups was slightly higher for CC homozygote (3.5% versus 1.6%,p = 0.042). The ESKD patient group was analyzed according to the presence or absence of CVD. The significant differences in the polymorphism distribution were revealed in this analysis. The frequency of the C allele in the CVD + subgroup was 14% compared to 6% in CVD- patients (p = 0.001). In the CVD + subgroup the ORs (95% CI) for the C allele and CC genotype were 2.41 (1.61–3.6),p < 0.001 and 3.13 (1.07–9.14),p = 0.036, respectively. This indicates to the association of the variant C allele with cardiovascular disease in ESKD patients. The CC homozygotes have a threefold higher odds of CVD compared to TT homozygotes. The highest frequency of the C allele (18%) was observed in subgroup of patients with diabetic nephropathy, with OR (95% CI) 3.40 (2.13–5.43),p < 0.001.The presence of minor allele (CC and CT genotypes) was significantly associated with increased plasma triglyceride levels (p < 0.001 for both CVD + and CVD- groups).

Conclusion

The present study demonstrated the effect of rs662799 polymorphism on plasma TG levels and its association with the development of cardiovascular disease in ESKD patients.
Trends of key surveillance performance indicators of acute flaccid paralysis: a descriptive analysis, Uganda, 2015–2020
Authors: Amodan Bob Omoda , Kisakye Annet , Okumu Patricia Thiwe , Ahirirwe Sherry Rita , Kadobera Daniel , Driwale Alfred , Ario Alex Riolexus
Published: September 2022

Background

Polio is disease caused by poliovirus which can in turn cause irreversible paralytic disease, presenting as Acute Flaccid Paralysis (AFP). A sensitive AFP surveillance system, in which all reported AFP cases are evaluated, first to determine if they are true AFP cases or not, is key for tracking polio eradication. True AFP cases are then later categorized as polio AFP or non-polio AFP (NPAFP) cases. Sensitivity is defined by meeting an annual NPAFP rate/100,000 population < 15 years of ≥ 4/100,000, and an annual stool adequacy (SA) rate of ≥ 80%. We describe Uganda’s AFP surveillance performance between 2015–2020, based on the WHO-recommended indicators, including; NPAFP and stool adequacy rate.

Methods

We performed a descriptive analysis of national AFP surveillance data, 2015–2020 obtained from ministry of health. We evaluated proportion of reported AFP cases that were true AFP, and changes in NPAFP and stool adequacy (SA) rate over the study period. We evaluated the trends in achieving the targeted NPAFP and SA rates from 2015–2020. We used QGIS to illustrate patterns in NPAFP and SA rates across districts and subregions.

Results

Among 3,605 AFP cases reported and investigated countrywide from 2015–2020, 3,475 (96%) were true AFP cases. All the true AFP cases were non-polio related. District reporting was near-complete (97–100% each year). Overall, the mean NPAFP rate declined from 3.1/100,000 in 2015 to 2.1/100,000 in 2020. Less than 40% of districts met the NPAFP target rate in all years. The proportion of districts achieving the NPAFP target rate of ≥ 4/100,000 significantly declined from 35% in 2015 to 20% in 2020. The mean annual SA rate nationally was 88% from 2015–2020. Only 66% of districts achieved the SA target rate of ≥ 80% in the study period. The proportion of districts with SA rate ≥ 80% significantly increased from 68 to 80% between 2015 and 2020.

Conclusion

Most districts reported AFP cases. However, there was a decline in the NPAFP rate from 2015–2020 and few districts achieved the target rate. The suboptimal AFP surveillance system performance leaves the country at risk of missing ongoing poliovirus transmission. We recommend health worker training on active AFP searches, intensified supportive supervision, increase the number of environmental surveillance sentinel sites to boost AFP surveillance in the country, and periodic review meetings with districts to assess AFP surveillance performance.
An overview of implementing an evidence based program to increase HPV vaccination in HIV community clinics
Authors: Wells Jessica , Klosky James L. , Liu Yuan , Gillespie Theresa Wicklin
Published: September 2022

Background

HPV-related anal cancer occurs in excess rates among people living with HIV (PLWH) and has been increasing in incidence. The HPV vaccine is an effective and safe approach to prevent and reduce the risk of HPV-related disease. Yet, HPV vaccine programs tailored and implemented in the HIV population are lagging for this high-risk group.

Methods

A pre-post intervention study design will be used to tailor, refine, and implement the 4 Pillars™ Practice Transformation Program to increase HPV vaccination among PLWH. Guided by the RE-AIM framework, the CHAMPS study will provide training and motivation to HIV providers and clinic staff to recommend and administer the HPV vaccination within three HIV clinics in Georgia. We plan to enroll 365 HIV participants to receive HPV education, resources, and reminders for HPV vaccination. Sociodemographic, HPV knowledge, and vaccine hesitancy will be assessed as mediators and moderators for HPV vaccination. The primary outcome will be measured as an increase in uptake rate in initiation of the HPV vaccine and vaccine completion (secondary outcome) compared to historical baseline vaccination rate (control).

Discussion

The proposed study is a novel approach to address a serious and preventable public health problem by using an efficacious, evidence-based intervention on a new target population. The findings are anticipated to have a significant impact in the field of improving cancer outcomes in a high-risk and aging HIV population.

Trial registration

NCT05065840; October 4, 2021.
Co-creation using crowdsourcing to promote PrEP adherence in China: study protocol for a stepped-wedge randomized controlled trial
Authors: Sha Yongjie , Li Chunyan , Xiong Yuan , Hazra Aniruddha , Lio Jonathan , Jiang Ivy , Huang Haojie , Kerman Jared , Molina Jannelle , Li Linghua , Liang Ke , Gong Dandan , Li Quanmin , Wu Songjie , Sherer Renslow , Tucker Joseph D. , Tang Weiming
Published: September 2022

Background

Adherent pre-exposure prophylaxis (PrEP) uptake can prevent HIV infections. Despite the high HIV incidence, Chinese key populations have low PrEP uptake and adherence. New interventions are needed to increase PrEP adherence among key populations in China. Co-creation methods are helpful to solicit ideas from the community to solve public health problems. The study protocol aims to describe the design of a stepped-wedge trial and to evaluate the efficacy of co-created interventions to facilitate PrEP adherence among key populations in China.

Methods

The study will develop intervention packages to facilitate PrEP adherence among Chinese key populations using co-creation methods. The study will then evaluate the efficacy of the co-created intervention packages using a stepped-wedge randomized controlled trial. This four-phased closed cohort stepped-wedge design will have four clusters. Each cluster will start intervention at three-month intervals. Seven hundred participants who initiated PrEP will be recruited. Participants will be randomized to the clusters using block randomization. The intervention condition includes receiving co-created interventions in addition to standard of care. The control condition is the standard of care that includes routine clinical assessment every 3 months. All participants will also receive an online follow-up survey every 3 months to record medication adherence and will be encouraged to use a WeChat mini-app for sexual and mental health education throughout the study. The primary outcomes are PrEP adherence and retention in PrEP care throughout the study period. We will examine a hypothesis that a co-created intervention can facilitate PrEP adherence. Generalized linear mixed models will be used for the primary outcome analysis.

Discussion

Developing PrEP adherence interventions in China faces barriers including suboptimal PrEP uptake among key populations, the lack of effective PrEP service delivery models, and insufficient community engagement in PrEP initiatives. Our study design addresses these obstacles by using co-creation to generate social media-based intervention materials and embedding the study design in the local healthcare system. The study outcomes may have implications for policy and intervention practices among CBOs and the medical system to facilitate PrEP adherence among key populations.

Trial registration

The study is registered in Clinical Trial databases in China (ChiCTR2100048981, July 19, 2021) and the US (NCT04754139, February 11, 2021).
Comparative analysis of the biomechanics of anterior cervical discectomy and fusion with multiple segmental plates fixation versus single multilevel plate fixation: a finite element study
Authors: Huang Weibo , Tian Ye , Wang Hongli , Zou Fei , Ma Xiaosheng , Jiang Jianyuan , Li Ruoyu
Published: September 2022

Background

This study aimed to compare the biomechanical differences between anterior cervical discectomy and fusion (ACDF) with multiple-level separate plates and conventional long plates by using finite element analysis.

Methods

The following four finite element models were created to simulate various fixations: (1) C4–6 ACDF with multiple plates, (2) C4–6 ACDF with a single plate, (3) C3–6 ACDF with multiple plates, and (4) C3–6 ACDF with a single plate. The maximum Von-mises stress of the cage and fixation, compressive force of the adjacent intervertebral discs and range of motion (ROM) of different segments in the four models were calculated and analyzed.

Results

For C4–6 ACDF, the maximum Von-mises stress of the cage and fixation was lower in the multiple plate fixation model in all motion states. Similarly, for the C3–6 ACDF models, the peak stress of the C3–4 and C5–6 cages was lower with multiple plates fixation in all motions but the stress of the C4–5 cage in the multiple plates model was slightly higher in flexion, bending and rotation. Besides, applying multiple plates in C3–6 ACDF models resulted in a decreased maximum stress of the fixation under different motions except for bending. In both the C4–6 ACDF and C3–6 ACDF models, the ROM values of the adjacent motion segments were lower in the multiple plates models in extension, bending and rotation. In the C4–6 ACDF models, the peak stress on the adjacent intervertebral discs in the multiple plates models was slightly smaller. In C3–6 ACDF models, the maximum stress on the adjacent intervertebral discs was larger in the single-plate model under flexion, bending and rotation movements.

Conclusion

Multiple plates fixation has a positive effect on increasing stiffness and maintaining the ROM of adjacent segments, indicating lower risk of construct failure and adjacent segment degeneration. Further studies are required to confirm its efficacy in clinical practice.
Three-dimensional morphological analysis of the thoracic pedicle and related radiographic factors in adolescent idiopathic scoliosis
Authors: Sato Tatsuya , Nojiri Hidetoshi , Okuda Takatoshi , Miyagawa Kei , Kobayashi Nozomu , Takahashi Ryosuke , Shimura Arihisa , Tamagawa Shota , Ohara Yukoh , Hara Takeshi , Ishijima Muneaki
Published: September 2022

Background

This study aimed to investigate the laterality of the pedicle morphology at the apical vertebra (AV) level and identify the radiographic factors associated with the laterality ratio of the pedicle morphology at the AV level in patients with adolescent idiopathic scoliosis (AIS).

Methods

Overall, 684 pedicles in 57 AIS patients aged 10–20 years, who underwent preoperative computed tomography (CT) and had Lenke type 1 or 2 with right convex main thoracic curves (MTC), were evaluated. Pedicle diameters of the MTC were assessed. We defined and compared the region containing two vertebrae adjacent to the AV (APEX±1) and the region containing two vertebrae adjacent to the neutral vertebra. We analyzed the pedicle diameter and laterality ratio of APEX±1 and performed multiple linear regression analysis to identify the radiographic factors associated with the laterality of the pedicle diameter.

Results

On the concave side of APEX±1, the pedicles of 15 patients (26.3%) did not accept a 4-mm-diameter pedicle screw (PS), even with 25% cortical bone width expansion. Laterality ratio differences in the pedicle diameters of the cortical bone width in APEX±1 were large in patients with more proximal AV level (p < 0.001) and smaller apical vertebral rotation (AVR) (p = 0.029).

Conclusions

Preoperative planning to accurately select and insert the PS in AIS should be based on the anatomical limitations in APEX±1, AV level, and AVR degree. In APEX±1, the correlation between AVR and the laterality ratio of the pedicle diameter may be useful for pathoetiological interpretation of the AIS deformity.
Prospective cohort study for assessment of integrated care with a triple aim approach: hospital at home as use case
Authors: Herranz Carme , González-Colom Rubèn , Baltaxe Erik , Seijas Nuria , Asenjo Maria , Hoedemakers Maaike , Nicolas David , Coloma Emmanuel , Fernandez Joaquim , Vela Emili , Cano Isaac , Mölken Maureen Rutten-van , Roca Josep , Hernandez Carme
Published: September 2022

Background

Applicability of comprehensive assessment of integrated care services in real world settings is an unmet need. To this end, a Triple Aim evaluation of Hospital at Home (HaH), as use case, was done. As ancillary aim, we explored use of the approach for monitoring the impact of adoption of integrated care at health system level in Catalonia (Spain).

Methods

Prospective cohort study over one year period, 2017–2018, comparing hospital avoidance (HaH-HA) with conventional hospitalization (UC) using propensity score matching. Participants were after the first episode directly admitted to HaH-HA or the corresponding control group. Triple Aim assessment using multiple criteria decision analysis (MCDA) was done. Moreover, applicability of a Triple Aim approach at health system level was explored using registry data.

Results

HaH-HA depicted lower: i) Emergency Room Department (ER) visits (p < .001), ii) Unplanned re-admissions (p = .012); and iii) costs (p < .001) than UC. The weighted aggregation of the standardized values of each of the eight outcomes, weighted by the opinions of the stakeholder groups considered in the MCDA: i) enjoyment of life; ii) resilience; iii) physical functioning; iv) continuity of care; v) psychological wellbeing; (vi) social relationships & participation; (vii) person-centeredness; and (viii) costs, indicated better performance of HaH-HA than UC (p < .05). Actionable factors for Triple Aim assessment of the health system with a population-health approach were identified.

Conclusions

We confirmed health value generation of HaH-HA. The study identified actionable factors to enhance applicability of Triple Aim assessment at health system level for monitoring the impact of adoption of integrated care.

Registration

ClinicalTrials.gov (26/04/2017; NCT03130283).
Availability of services for the diagnosis and treatment of infertility in The Gambia`s public and private health facilities: a cross-sectional survey
Authors: Afferri Anna , Allen Haddijatou , Dierickx Susan , Bittaye Mustapha , Marena Musa , Pacey Allan , Balen Julie
Published: September 2022

Background

Infertility is a long-standing reproductive health issue, which affects both men and women worldwide and it is especially problematic in the Global South. In sub-Saharan Africa, understanding the current availability of diagnostic and treatment services for infertility is important because this could guide health systems to improve access to fertility care for all. Yet, few studies have explicitly started from a health system perspective to grasp the availability and integration of infertility services in sub-Saharan Africa. This quantitative study, the first in The Gambia, West Africa, examines the availability of infertility services in public and private facilities as part of a wider endeavour to improve fertility care policy and practice in the country.

Methods

A cross-sectional survey using Qualtrics was administered to 38 health facilities. The survey was carried out between March and August 2021 and involved closed-ended questions. Data analysis consisted of descriptive statistics and t-tests performed using SPSS version 26.

Results

A total of 25 facilities (66%) offered infertility services, of which 13 (52%) were public and 12 (47%) private. Although the availability of screening tests was similar between health institutions, most diagnostic and treatment services were available only in the private sector. Treatment services included: (i) ovarian stimulation (n = 16, 42%); (ii) reversal of tubal ligation and/or blockage (tuboplasty) (n = 4, 11%); and (iii) intrauterine insemination (n = 3, 8%). Assisted reproductive technologies such as IVF and ICSI were not available in public or private sectors. The Gambian health management information system lacked a dedicated space to capture data on infertility. Reported barriers to integration of infertility services in existing reproductive health services included a lack of specialised training, an absence of national guidance on infertility management, and a shortage of appropriate equipment, supplies, and medication.

Conclusions

The availability of infertility services in The Gambia follows a trajectory that is similar to other SSA countries in which services are mostly obtainable through the private sector. Yet, access to private care is expensive and geographically restricted, which exacerbates inequalities in accessing fertility care for all. Improving the provision of infertility services in the public sector requires systematically capturing data on infertility and investing in the provision of a full-range fertility care package.
Performance of diagnostic assays used to detect Cryptosporidium oocysts in faecal samples of cattle in Kuwait and genotyping of Cryptosporidium species
Authors: Abdou Nadra-Elwgoud M. I. , AlAzemi Maha S. , Al-Sayegh Mohammed T. , Majeed Qais A. H.
Published: September 2022

Backgroud

Cryptosporidium species are zoonotic protozoan parasites responsible for gastroenteritis in various animals and humans. The diagnosis of Cryptosporidium presents many challenges. This research attempted to match the diagnostic efficiency of the modified Ziehl–Neelsen technique (mZN), immunochromatographic assays (IC), and enzyme-linked immunosorbent assay (ELISA) for the detection of Cryptosporidium in faecal samples of cattle in Kuwait. In addition, polymerase chain reaction (PCR) was utilised to determine the predominant species infecting cattle in Kuwait and correlating the detected species with the results of different diagnostic tests used, the presence or absence of clinical signs, and the age group of the infected cattle.

Results

Of 400 analysed faecal samples, Cryptosporidium positive samples were 23%, 15.25%, and 14% using IC, ELISA, and mZN. IC had the highest sensitivity (74.07%), and mZN had the highest specificity (98.29%) using a composite reference standard (CRS) as a gold standard. The rapid IC test results in high false-positive results of cryptosporidiosis, whereas using mZN alone is insufficient to declare a negative faecal sample. Only 74.5% (35/47) of Cryptosporidium-positive samples by the three assays could be amplified by PCR. This study was the first to genotype Cryptosporidium in Kuwait. Cryptosporidium parvum (n = 26) was the dominant species detected from cattle samples, followed by C. andersoni (n = 6), C. bovis (n = 2), and C. raynae (n = 1). The findings showed a statistically relevant relationship between diarrhoea and the detection of Cryptosporidium spp. in faecal samples of cattle (p-value = 0.0003). Pre-weaned calves were the most vulnerable age group to Cryptosporidium spp. infection (p-value = 0.0007).

Conclusion

For screening of Cryptosporidium infection in faecal samples, antigen detection or PCR methods combined with one of the microscopy techniques should be used. Cryptosporidium parvum was the prepoderant Cryptosporidium spp. recovered from cattle samples in Kuwait followed by C. andersoni. Cryptosporidium parvum is a significant risk factor for diarrhoea in pre-weaned calves. However, further study is needed as many other causes of diarrhoea in calves must be ruled out before a diagnosis of Cryptosporidium diarrhoea can be made.