bluuebunny/crossref_metadata_2025 huggingface dataset:
Research on Deformation Mechanism of Cutting Nickel-Based Superalloy Inconel718 Based on Strain Gradient Theory
Authors: Hao ZhaoPeng , Li JiNing , Fan YiHang
Published: March 2021

The traditional material constitutive model can effectively simulate the mechanical properties during the cutting process. However, the scale characteristics contained in materials are not considered in the traditional cutting model, and the inherent scale effect of materials is also ignored. Therefore, the traditional cutting constitutive model cannot effectively reflect the size effect in the cutting process, and then cannot obtain the accurate stress, strain, and temperature. In this present paper, a material constitutive model which can reflect the scale effect is established based on the strain gradient plasticity theory. Through the established model and secondary development of abaqus, the two-dimensional dynamic finite element simulation model of cutting Inconel 718 is established. By comparing the cutting experiment results with the simulation results, the established simulation model can more accurately reflect the effects of temperature, strain gradient effect, equivalent stress, and its scale effect on cutting deformation during the machining process.
Nebulized Micafungin Treatment for
Scopulariopsis
/
Microascus
Tracheobronchitis in Lung Transplant Recipients
Authors: Los-Arcos Ibai , Berastegui Cristina , Martín-Gómez María Teresa , Grau Santiago , Campany-Herrero David , Deu María , Sacanell Judith , Campillo Nuria , Bravo Carles , Len Oscar
Published: March 2021

Scopulariopsis
/
Microascus
isolates cause infections with high mortality in lung transplant recipients. Treatment is challenging due to antimicrobial resistance.
Manogepix, the Active Moiety of the Investigational Agent Fosmanogepix, Demonstrates
In Vitro
Activity against Members of the Fusarium oxysporum and Fusarium solani Species Complexes
Authors: Badali Hamid , Patterson Hoja P. , Sanders Carmita J. , Mermella Barbara , Gibas Connie F. C. , Ibrahim Ashraf S. , Shaw Karen J. , Wiederhold Nathan P.
Published: March 2021

We evaluated the
in vitro
activity of manogepix against
Fusarium oxysporum
and
Fusarium solani
species complex (FOSC and FSSC, respectively) isolates per CLSI document M38 broth microdilution methods. Manogepix demonstrated activity against both FOSC (MEC [minimal effective concentration] range, ≤0.015 to 0.03 μg/ml; MIC
50
range, ≤0.015 to 0.125 μg/ml) and FSSC (MEC, ≤0.015 μg/ml; MIC
50
, ≤0.015 to 0.25 μg/ml).
A Yeast-Based Drug Discovery Platform To Identify Plasmodium falciparum Type II NADH Dehydrogenase Inhibitors
Authors: Cao Yu , Sun Chen , Wen Han , Wang Mengfei , Zhu Pan , Zhong Mengjiao , Li Jian , Chen Xuewei , Tang Yefeng , Wang Jingwen , Zhou Bing
Published: March 2021

Conventional methods utilizing
in vitro
protein activity assay or
in vivo
parasite survival to screen for malaria inhibitors suffer from high experimental background and/or inconvenience. Here, we introduce a yeast-based system to facilitate chemical screening for specific protein or pathway inhibitors.
The Streptococcus pyogenes Signaling Peptide SpoV Regulates Streptolysin O and Enhances Survival in Murine Blood
Authors: Herrera Andrea L. , Callegari Eduardo A. , Chaussee Michael S.
Published: March 2021

GAS secretes signaling peptides that can alter gene expression and impact virulence. We used peptidomics to identify a signaling peptide designated SpoV.
Reassortment with Dominant Chicken H9N2 Influenza Virus Contributed to the Fifth H7N9 Virus Human Epidemic
Authors: Pu Juan , Yin Yanbo , Liu Jiyu , Wang Xinyu , Zhou Yong , Wang Zejiang , Sun Yipeng , Sun Honglei , Li Fangtao , Song Jingwei , Qu Runkang , Gao Weihua , Wang Dongdong , Wang Zhen , Yan Shijie , Chen Mingyue , Zeng Jinfeng , Jiang Zhimin , Sun Haoran , Zong Yanan , Wang Chenxi , Tong Qi , Bi Yuhai , Huang Yinhua , Du Xiangjun , Chang Kin-Chow , Liu Jinhua
Published: March 2021

Avian H9N2 influenza virus, although primarily restricted to chicken populations, is a major threat to human public health by acting as a donor of variant viral genes through reassortment to cocirculating influenza viruses. We established that the high prevalence of evolving H9N2 virus in vaccinated flocks played a key role as a donor of new subclade PB2 and PA genes in the generation of a dominant H7N9 virus genotype (genotype 72 [G72]) with enhanced infectivity in humans during the 2016–2017 N7N9 virus epidemic.
Synthetic DNA Delivery of an Optimized and Engineered Monoclonal Antibody Provides Rapid and Prolonged Protection against Experimental Gonococcal Infection
Authors: Parzych Elizabeth M. , Gulati Sunita , Zheng Bo , Bah Mamadou A. , Elliott Sarah T. C. , Chu Jacqueline D. , Nowak Nancy , Reed George W. , Beurskens Frank J. , Schuurman Janine , Rice Peter A. , Weiner David B. , Ram Sanjay
Published: March 2021

Neisseria gonorrhoeae
has become resistant to most antibiotics in clinical use. Currently, there is no safe and effective vaccine against gonorrhea.
Extent of Cytomegalovirus Replication in the Human Host Depends on Variations of the HLA-E/UL40 Axis
Authors: Vietzen Hannes , Rückert Timo , Hartenberger Svenja , Honsig Claudia , Jaksch Peter , Geleff Silvana , Hammer Quirin , Romagnani Chiara , Segura-Wang Maia , Puchhammer-Stöckl Elisabeth
Published: March 2021

Infection with human cytomegalovirus (HCMV) is associated with substantial morbidity in immunosuppressed patients and after congenital infections. Therefore, development of a vaccine against HCMV is a main public health priority.
Critical ACE2 Determinants of SARS-CoV-2 and Group 2B Coronavirus Infection and Replication
Authors: Adams Lily E. , Dinnon Kenneth H. , Hou Yixuan J. , Sheahan Timothy P. , Heise Mark T. , Baric Ralph S.
Published: March 2021

SARS-CoV-2 (the causative agent of COVID-19) is a major public health threat and one of two related coronaviruses that have caused epidemics in modern history. A method of screening potential infectible hosts for preemergent and future emergent coronaviruses would aid in mounting rapid response and intervention strategies during future emergence events.
Malaria Parasite Schizont Egress Antigen-1 Plays an Essential Role in Nuclear Segregation during Schizogony
Authors: Perrin Abigail J. , Bisson Claudine , Faull Peter A. , Renshaw Matthew J. , Lees Rebecca A. , Fleck Roland A. , Saibil Helen R. , Snijders Ambrosius P. , Baker David A. , Blackman Michael J.
Published: March 2021

Malaria is a deadly infectious disease. Rationally designed novel therapeutics will be essential for its control and eradication.
Central Nervous System (CNS) Viral Seeding by Mature Monocytes and Potential Therapies To Reduce CNS Viral Reservoirs in the cART Era
Authors: León-Rivera Rosiris , Veenstra Mike , Donoso Maribel , Tell Elizabeth , Eugenin Eliseo A. , Morgello Susan , Berman Joan W.
Published: March 2021

We characterized mechanisms of CNS viral reservoir establishment/replenishment using peripheral blood mononuclear cells (PBMC) of PLWH on cART and propose therapeutic targets to reduce/block selective entry of cells harboring HIV (HIV
+
) into the CNS. Using DNA/RNAscope, we show that CD14
+
CD16
+
monocytes with integrated HIV, transcriptionally active, and/or with active viral replication from PBMC of PLWH prescribed cART and virally suppressed, selectively transmigrate across a human BBB model.
A Cyanobacterial Component Required for Pilus Biogenesis Affects the Exoproteome
Authors: Yegorov Yevgeni , Sendersky Eleonora , Zilberman Shaul , Nagar Elad , Waldman Ben-Asher Hiba , Shimoni Eyal , Simkovsky Ryan , Golden Susan S. , LiWang Andy , Schwarz Rakefet
Published: March 2021

Cyanobacteria, environmentally prevalent photosynthetic prokaryotes, contribute ∼25% of global primary production. Cyanobacterial biofilms elicit biofouling, thus leading to substantial economic losses; however, these microbial assemblages can also be beneficial, e.g., in wastewater purification processes and for biofuel production.
Cofactor Specificity of Glucose-6-Phosphate Dehydrogenase Isozymes in Pseudomonas putida Reveals a General Principle Underlying Glycolytic Strategies in Bacteria
Authors: Volke Daniel Christoph , Olavarría Karel , Nikel Pablo Iván
Published: March 2021

Protein families have likely arisen during evolution by gene duplication and divergence followed by neofunctionalization. While this phenomenon is well documented for catabolic activities (typical of environmental bacteria that colonize highly polluted niches), the coexistence of multiple isozymes in central carbon catabolism remains relatively unexplored.
Breast Milk Virome and Bacterial Microbiome Resilience in Kenyan Women Living with HIV
Authors: Maqsood Rabia , Reus Joshua B. , Wu Lily I. , Holland LaRinda A. , Nduati Ruth , Mbori-Ngacha Dorothy , Maleche-Obimbo Elizabeth , Begnel Emily R. , Gantt Soren , Ojee Ednah , Wamalwa Dalton , John-Stewart Grace , Slyker Jennifer , Lehman Dara A. , Lim Efrem S.
Published: March 2021

Breastfeeding plays an important role in seeding the infant gut microbiome and mammary health. Although most studies focus on the diverse breast milk bacterial communities, little is known about the viral communities harbored in breast milk.
Direct Nanopore Sequencing of mRNA Reveals Landscape of Transcript Isoforms in Apicomplexan Parasites
Authors: Lee V. Vern , Judd Louise M. , Jex Aaron R. , Holt Kathryn E. , Tonkin Christopher J. , Ralph Stuart A.
Published: March 2021

We have used a novel nanopore sequencing technology to directly analyze parasite transcriptomes. The very long reads of this technology reveal the full-length genes of the parasites that cause malaria and toxoplasmosis. Gene transcripts must be processed in a process called splicing before they can be translated to protein. Our analysis reveals that these parasites very frequently only partially process their gene products, in a manner that departs dramatically from their human hosts.
Mitochondrion-Dependent Apoptosis Is Essential for Rickettsia parkeri Infection and Replication in Vector Cells
Authors: Wang Xin-Ru , Burkhardt Nicole Y. , Kurtti Timothy J. , Oliver Jonathan D. , Price Lisa D. , Cull Benjamin , Thorpe Cody J. , Thiel Michalina Silva , Munderloh Ulrike G.
Published: March 2021

Rickettsioses, infections caused by the genus
Rickettsia
, are among the oldest known infectious diseases. Ticks are essential arthropod vectors for rickettsiae, and knowledge about the interactions between ticks, their hosts, and pathogens is fundamental for identifying drivers of tick-borne rickettsioses.
Comparison of Transcriptional Responses and Metabolic Alterations in Three Multidrug-Resistant Model Microorganisms, Staphylococcus aureus ATCC BAA-39, Escherichia coli ATCC BAA-196, and Acinetobacter baumannii ATCC BAA-1790, on Exposure to Iodine-Containing Nano-micelle Drug FS-1
Authors: Korotetskiy Ilya S. , Shilov Sergey V. , Kuznetsova Tatyana V. , Ilin Aleksandr I. , Joubert Monique , Taukobong Setshaba , Reva Oleg N.
Published: March 2021

Infections caused by antibiotic-resistant bacteria threaten public health worldwide. Combinatorial therapy in which antibiotics are administered together with supplementary drugs improving susceptibility of pathogens to the regular antibiotics is considered a promising way to overcome this problem.
Tonsillar Microbiota: a Cross-Sectional Study of Patients with Chronic Tonsillitis or Tonsillar Hypertrophy
Authors: Wu Shengru , Hammarstedt-Nordenvall Lalle , Jangard Mattias , Cheng Liqin , Radu Sebastian Alexandru , Angelidou Pia , Zha Yinghua , Hamsten Marica , Engstrand Lars , Du Juan , Ternhag Anders
Published: March 2021

The human microbiota has been shown to be functionally connected to infectious and inflammation-related diseases. So far, only limited studies had been performed on tonsillar microbiota, although tonsils play an essential role in the human immune defense system and encountered numerous microorganisms.
Maternal Emulsifier P80 Intake Induces Gut Dysbiosis in Offspring and Increases Their Susceptibility to Colitis in Adulthood
Authors: Jin Ge , Tang Qiang , Ma Jiaheng , Liu Xiang , Zhou Bingqian , Sun Yue , Pang Xiaoqi , Guo Zixuan , Xie Runxiang , Liu Tianyu , Wang Bangmao , Cao Hailong
Published: March 2021

The main findings of this research showed that maternal P80 intake could disrupt the intestinal barrier, induce gut dysbiosis, and promote colitis susceptibility in adulthood. This study will enhance understanding of the prevention of IBD.
Spontaneous dissection of coeliac and superior mesenteric artery: double whammy
Authors: Lalani Kanhai , Devasia Tom , Paramasivam Ganesh
Published: March 2021

Isolated dissection of one of the mesenteric arteries without concurrent involvement of the aorta is a rare clinical entity and an unusual cause of abdominal pain. It usually involves one artery, most commonly the superior mesenteric artery (SMA) followed by the coeliac artery. We are reporting a rare case where both coeliac and SMA were showing dissection. We are reporting a case of 60-year-old hypertensive male who came with worsening abdominal pain for 5 days; CT scan showed coeliac and SMA dissection without any imaging evidence of intestinal ischaemia. He was successfully managed medically with bowel rest and anticoagulation. Two weeks of follow-up CT scan showed no progression or thrombus formation. For complicated cases, percutaneous transluminal angioplasty of a visceral artery or open surgical exploration or hybrid approach is required. However, for stable uncomplicated cases, medical therapy alone is sufficient.
Reliability of telemedicine for real-time paediatric ophthalmology consultations
Authors: Stewart Carly , Coffey-Sandoval Josephine , Reid Mark W , Ho Tiffany C , Lee Thomas C , Nallasamy Sudha
Published: March 2021

Background/aims

To assess the accuracy of real-time telemedicine to diagnose and manage paediatric eye conditions.

Methods

Design: Prospective, non-inferiority study analysing agreement in diagnoses and management plans between telemedicine and in-person examinations. Setting: Paediatric ophthalmology clinic. Population: Children 0–17 years, English-speaking or Spanish-speaking, able to participate in age-appropriate manner, either previously seen by the optometrist and required ophthalmology referral or newly referred from outside source. Procedures: Paediatric optometrist conducted examinations using digital equipment and streamed live to a paediatric ophthalmologist who recorded diagnoses and management plans, then re-examined patients in-person. Subjects were masked to the fact they would see the ophthalmologist in-person, same-day. Main outcome measures: Discrepancy in management plan or diagnosis between telemedicine and in-person examinations. Non-inferiority threshold was <1.5% for management plan or <15% for diagnosis discrepancies.

Results

210 patients participated in 348 examinations. 131 (62.4%) had strabismus as primary diagnosis. In these patients, excellent and almost perfect agreement was observed for angle measurements (intraclass correlation coefficients=0.98–1.00) and disease categorisation (kappa=0.94–1.00) (p<0.0001 in all cases). No primary diagnoses changed, and no management plans changed following in-person examination. 54/55 patients who consented for surgery at the initial visit did so while masked to receiving an in-person examination. Families felt comfortable with the quality of the telemedicine examination (98.5%) and would participate in another in the future (97.1%).

Conclusion

Paediatric ophthalmic conditions can be reliably diagnosed and managed via telemedicine. Access for underserved populations may be improved by collaboration between ophthalmologists and optometrists using this technology.
Recurrent myocarditis in a patient with active ulcerative colitis: a case report and review of the literature
Authors: Caio Giacomo , Lungaro Lisa , Caputo Fabio , Muccinelli Maria , Marcello Maria Caterina , Zoli Eleonora , Volta Umberto , De Giorgio Roberto , Zoli Giorgio
Published: March 2021

Inflammatory bowel diseases such as ulcerative colitis (UC) may be complicated by several extraintestinal manifestations. These involve joints, skin, eyes and less commonly lungs and heart. Myocarditis may result from the toxic effect of drugs (ie, mesalazine) commonly used for the treatment of UC or due to infections (eg, Coxsackieviruses, enteroviruses, adenovirus). Here, we report a case of a 26-year old man affected by UC and complicated by two episodes of myocarditis. Both episodes occurred during two severe exacerbations of UC. However, in both cases the aetiology of myocarditis remains uncertain being ascribable to extraintestinal manifestation, drug toxicity or both.
Hormonal contraceptive use, bone density and biochemical markers of bone metabolism in British Army recruits
Authors: Coombs Charlotte V , O'Leary T J , Tang J C Y , Fraser W D , Greeves J P
Published: March 2021

Introduction

Hormonal contraceptive use might impair bone health and increase the risk of stress fracture by decreasing endogenous oestrogen production, a central regulator of bone metabolism. This cross-sectional study investigated bone density and biochemical markers of bone metabolism in women taking hormonal contraceptives on entry to basic military training.

Methods

Forty-five female British Army recruits had biochemical markers of bone metabolism, areal bone mineral density (aBMD) and tibial speed of sound (tSOS) measured at the start of basic military training. Participants were compared by their method of hormonal contraception: no hormonal contraception (NONE), combined contraceptive pill (CP) or depot-medroxyprogesterone acetate (DMPA) (20±2.8 years, 1.64±0.63 m, 61.7±6.2 kg).

Results

aBMD was not different between groups (p≥0.204), but tSOS was higher in NONE (3%, p=0.014) when compared with DMPA users. Beta C-terminal telopeptide was higher in NONE (45%, p=0.037) and DMPA users (90%, p=0.003) compared with CP users. Procollagen type 1 N-terminal propeptide was higher in DMPA users compared with NONE (43%, p=0.045) and CP users (127%, p=0.001), and higher in NONE compared with CP users (59%, p=0.014). Bone alkaline phosphatase was higher in DMPA users compared with CP users (56%, p=0.044).

Conclusions

DMPA use was associated with increased bone turnover and decreased cortical bone integrity of the tibia. Lower cortical bone integrity in DMPA users was possibly mediated by increased intracortical remodelling, but trabecular bone was not affected by contraceptive use.
A First-line management team’s strategies for sustaining resilience in a specialised intensive care unit—a qualitative observational study
Authors: Hybinette Karl , Pukk Härenstam Karin , Ekstedt Mirjam
Published: March 2021

Objectives

Acute care units manage high risk patients at the edge of scientifically established treatments and organisational constraints while aiming to balance reliability to standards with the needs of situational adaptation (resilience). First-line managers are central in coordinating clinical care. Any systemic brittleness will be evident only in retrospect through, for example, care quality measures and accident statistics. This challenges us to understand what successful managerial strategies for adaptation are and how they could be improved. The managerial work of balancing reliability and adaptation is only partially understood. This study aims to explore and describe how system resilience is enhanced by naturally occurring coordination performed in situ by a management team under variable circumstances.

Design

An explorative observational study of a tertiary neonatal intensive care unit (NICU) in Sweden. One year of broad preparatory work followed by focused shadowing observations of coordination analysed through inductive–deductive content analysis from a perspective of resilience engineering.

Participants

A team of managers (ie, clinical coordinators, head nurses, senior medical doctors).

Results

The results describe a functional relationship between operational stress and a progression of adjustments in the actual situation, expressed through recurring patterns of adaptation. Managers focused on maintaining coherence in escalating problematic situations by facilitating teamwork through goalsetting, problem-solving and circumventing the technical systems’ limitations.

Conclusions

Coordination supports a coherent goal setting by increased team collaboration and is supported by team members’ abilities to predict the behaviour of each other. Our findings suggest that in design of future research or training for coordination, the focus of assessment and reflection on adaptive managerial responses may lie on situations where the system was ‘stretched’ or ‘needed reorganisation’ and that learning should be about whether the actions were able to achieve short-term goals while preserving the long-term goals.
Direct transfer to angiosuite for patients with severe acute stroke treated with thrombectomy: the multicentre randomised controlled DIRECT ANGIO trial protocol
Authors: Riou-Comte Nolwenn , Zhu François , Cherifi Aboubaker , Richard Sébastien , Nace Lionel , Audibert Gérard , Achit Hamza , Costalat Vincent , Arquizan Caroline , Beaufils Olivier , Consoli Arturo , Lapergue Bertrand , Loeb Thomas , Rouchaud Aymeric , Macian Francisco , Cailloce Dominique , Biondi Alessandra , Moulin Thierry , Desmettre Thibaut , Marnat Gaultier , Sibon Igor , Combes Xavier , Lebedinsky Ariel Pablo , Vuillemet Francis , Kempf Nicolas , Pierot Laurent , Moulin Solene , Lemmel Philippe , Mazighi Mikael , Blanc Raphael , Sabben Candice , Schluck Eric , Bracard Serge , Anxionnat René , Guillemin Francis , Hossu Gabriela , Gory Benjamin
Published: March 2021

Introduction

Mechanical thrombectomy (MT) increases functional independence in patients with acute ischaemic stroke with anterior circulation large vessel occlusion (LVO), and the probability to achieve functional independence decreases by 20% for each 1-hour delay to reperfusion. Therefore, we aim to investigate whether direct angiosuite transfer (DAT) is superior to standard imaging/emergency department-based management in achieving 90-day functional independence in patients presenting with an acute severe neurological deficit likely due to LVO and requiring emergent treatment with MT.

Methods and analysis

DIRECT ANGIO (Effect of DIRECT transfer to ANGIOsuite on functional outcome in patient with severe acute stroke treated with thrombectomy: the randomised DIRECT ANGIO Trial) trial is an investigator-initiated, multicentre, prospective, randomised, open-label, blinded endpoint (PROBE) study. Eligibility requires a patient ≤75 years, pre-stroke modified Rankin Scale (mRS) 0–2, presenting an acute severe neurological deficit and admitted within 5 hours of symptoms onset in an endovascular-capable centre. A total of 208 patients are randomly allocated in a 1:1 ratio to DAT or standard management. The primary outcome is the rate of patients achieving a functional independence, assessed as mRS 0–2 at 90 days. Secondary endpoints include patients presenting confirmed LVO, patients eligible to intravenous thrombolysis alone, patients with intracerebral haemorrhage and stroke-mimics, intrahospital time metrics, early neurological improvement (reduction in National Institutes of Health Stroke Scale by ≥8 points or reaching 0–1 at 24 hours) and mRS overall distribution at 90 days and 12 months. Safety outcomes are death and intracerebral haemorrhage transformation. Medico-economics analyses include health-related quality of life and cost utility assessment.

Ethics and dissemination

The DIRECT ANGIO trial was approved by the ethics committee of Ile de France 1. Study began in April 2020. Results will be published in an international peer-reviewed medical journal.

Trial registration number

NCT03969511.
Predictive value of Modified Early Warning Score (MEWS) and Revised Trauma Score (RTS) for the short-term prognosis of emergency trauma patients: a retrospective study
Authors: Yu Zhejun , Xu Feng , Chen Du
Published: March 2021

Objectives

This study aimed to assess the predictive value of the Modified Early Warning Score (MEWS) and Revised Trauma Score (RTS) for emergency trauma patients who died within 24 hours.

Design

A retrospective, single-centred study.

Setting

This study was conducted at a tertiary hospital in Southern China.

Participants

A total of 1739 patients with acute trauma, aged 16 years or older who presented to the emergency department from 1 November 2016 to 30 November 2019, were included.

Interventions none

None.

Outcome

24-hour mortality was the primary outcome of trauma.

Results

1739 patients were divided into the survival group (1709 patients,98.27%), and the non-survival group (30 patients,1.73%). Crude OR and adjusted OR of MEWS were 1.99, 95% CI (1.73 to 2.29), and 2.00, 95% CI (1.74 to 2.31), p<0.001, respectively. Crude OR and adjusted OR of RTS were 0.62, 95% CI (0.55 to 0.69) and 0.61, 95% CI (0.55 to 0.68), p<0.001, respectively. The area under the curve of MEWS was significantly higher than that of RTS (p=0.005): 0.927, 95% CI (0.914 to 0.939) vs 0.799, 95% CI (0.779 to 0.817).

Conclusions

Both MEWS and RTS were independent predictors of the short-term prognosis in emergency trauma patients, MEWS had better predictive efficacy.
Effect of free distribution of medicines on the process of care for adult patients with type 1 and type 2 diabetes and hypertension: post hoc analysis of randomised controlled trial findings
Authors: Charles Onella , Woods Hannah , Ally Muhamad , Manns Braden , Shah Baiju R , Wang Ri , Persaud Nav
Published: March 2021

Objectives

The Carefully Selected and Easily Accessible at No charge Medicines randomised controlled trial showed that patients receiving free access to medicines had improved diabetes and hypertension outcomes compared with patients who had usual access to medicines. In this study, we aimed to test the impact of providing free access to medicine to people with diabetes and hypertension on process of care indicators.

Design

In this post hoc analysis of randomised controlled trial findings, we identified process of care indicators for the management of diabetes and hypertension using relevant guidelines. The following process of care indicators were identified for diabetes management: encounters with healthcare professionals, blood pressure measurements, self-monitoring of blood glucose, annual eye and foot examination, annual administration of the influenza vaccine, and laboratory testing for glycated haemoglobin (HbA1c), low-density lipoprotein-cholesterol, serum creatinine and urine albumin to creatinine ratio. We identified the following process of care indicators for hypertension: encounters with healthcare professionals, blood pressure measurements, self-measuring of blood pressure, and serum tests for electrolytes, HbA1c, lipids and creatinine. Chart extractions were performed for all patients and the indicators for diabetes and hypertension were recorded. We compared the indicators for patients in each arm of the trial.

Results

The study included 268 primary care patients. Free distribution of medicines may improve self-monitoring behaviours (adjusted rate ratio (aRR) 1.30; 95% CI 0.66 to 2.57) and reduce missed primary care appointments for patients with diabetes (aRR 0.80; 95% CI 0.48 to 1.33) or hypertension (aRR 0.41; 95% CI 0.18 to 0.90). Free distribution may also reduce primary care and consultant appointments and laboratory testing in patients with hypertension.

Conclusions

Improving medicine accessibility for patients with diabetes and hypertension not only improves surrogate health outcomes but also improves the patient experience and may also reduce healthcare costs by encouraging self-monitoring.

Trial registration number

The randomised controlled trial mentioned is clinicaltrials.gov identifier: NCT02744963.
Socioeconomic inequalities and adverse pregnancy outcomes in the UK and Republic of Ireland: a systematic review and meta-analysis
Authors: Thomson Katie , Moffat Malcolm , Arisa Oluwatomi , Jesurasa Amrita , Richmond Catherine , Odeniyi Adefisayo , Bambra Clare , Rankin Judith , Brown Heather , Bishop Julie , Wing Susan , McNaughton Amy , Heslehurst Nicola
Published: March 2021

Objective

There has been an unprecedented rise in infant mortality associated with deprivation in recent years in the United Kingdom (UK) and Republic of Ireland. A healthy pregnancy can have significant impacts on the life chances of children. The objective of this review was to understand the association between individual-level and household-level measures of socioeconomic status and adverse pregnancy outcomes.

Design

Systematic review and meta-analysis.

Data sources

Nine databases were searched (Medline, Embase, Scopus, ASSIA, CINAHL, PsycINFO, BNI, MIDRIS and Google Scholar) for articles published between 1999 and August 2019. Grey literature searches were also assessed.

Study selection criteria

Studies reporting associations between individual-level or household socioeconomic factors on pregnancy outcomes in the UK or Ireland.

Results

Among the 82 353 search results, 53 821 titles were identified and 35 unique studies met the eligibility criteria. Outcomes reported were neonatal, perinatal and maternal mortality, preterm birth, birth weight and mode of delivery. Pooled effect sizes were calculated using random-effects meta-analysis. There were significantly increased odds of women from lower levels of occupation/social classes compared with the highest level having stillbirth (OR 1.40, 95% CI 1.23 to 1.59, I298.62%), neonatal mortality (OR 1.39, 95% CI 1.22 to 1.57, I297.09%), perinatal mortality (OR 1.39, 95% CI 1.23 to 1.57, I298.69%), preterm birth (OR 1.41, 95% CI 1.33 to 1.50, I270.97%) and low birth weight (OR 1.40, 95% CI 1.19 to 1.61, I299.85%). Limitations relate to available data, unmeasured confounders and the small number of studies for some outcomes.

Conclusions

This review identified consistent evidence that lower occupational status, especially manual occupations and unemployment, were significantly associated with increased risk of multiple adverse pregnancy outcomes. Strategies to improve pregnancy outcomes should incorporate approaches that address wider determinants of health to provide women and families with the best chances of having a healthy pregnancy and baby and to decrease pregnancy-related health inequalities in the general population.

PROSPERO registration number

PROSPERO CRD42019140893.
Multicentre prospective cohort study of unmet supportive care needs among patients with breast cancer throughout their cancer treatment trajectory in Penang: a PenBCNeeds Study protocol
Authors: Mohd Shariff Noorsuzana , Azman Nizuwan , Hami Rohayu , Mohd Mujar Noor Mastura , Leong Bin Abdullah Mohammad Farris Iman
Published: March 2021

Introduction

Proper assessment of unmet supportive care needs of patients with breast cancer and its influencing factors at different treatment intervals will improve the rehabilitation of patients with breast cancer. Therefore, this study aims to determine the prevalence of unmet supportive care needs, changes of needs over time and associated factors during the treatment period.

Methods and analysis

This multicentre, prospective cohort study will be conducted in three governmental hospitals and one tertiary cancer institute in Penang, Malaysia. Adult women diagnosed with primary or recurrent tumour, node, metastases stage I–IV breast cancer based on pathological biopsy will be eligible for this study. At least 281 samples are required for this study. Participants will undergo follow-up at three time intervals: T1 at breast cancer diagnosis; T2 at 3 months after diagnosis and T3 at 6 months after diagnosis. Patients will complete a set of questionnaires at each time. The primary outcome of this study includes the changes in supportive care needs over three time points, followed by the secondary outcome examining patients’ characteristics, coping behaviours and positive psychological components as they affect changes in unmet supportive care needs over time.

Ethics and dissemination

The study has received ethics approval from the Medical Research and Ethics Committee, Ministry of Health Malaysia (NMRR-19-268-45809 IIR) and the Human Research Ethics Committee of Universiti Sains Malaysia (USM/JEPeM/17100443). The results of the prospective study will be submitted for publication in a peer-reviewed journal.
Protocol for a multicentre prehospital randomised controlled trial investigating tranexamic acid in severe trauma: the PATCH-Trauma trial
Authors: Mitra Biswadev , Bernard Stephen , Gantner Dashiell , Burns Brian , Reade Michael C , Murray Lynnette , Trapani Tony , Pitt Veronica , McArthur Colin , Forbes Andrew , Maegele Marc , Gruen Russell L
Published: March 2021

Introduction

Haemorrhage causes most preventable prehospital trauma deaths and about a third of in-hospital trauma deaths. Tranexamic acid (TXA), administered soon after hospital arrival in certain trauma systems, is an effective therapy in preventing or managing acute traumatic coagulopathy. However, delayed administration of TXA appears to be ineffective or harmful. The effectiveness of prehospital TXA, incidence of thrombotic complications, benefit versus risk in advanced trauma systems and the mechanism of benefit remain uncertain.

Methods and analysis

The Pre-hospital Anti-fibrinolytics for Traumatic Coagulopathy and Haemorrhage (The PATCH-Trauma study) is comparing TXA, initiated prehospital and continued in hospital over 8 hours, with placebo in patients with severe trauma at risk of acute traumatic coagulopathy. We present the trial protocol and an overview of the statistical analysis plan. There will be 1316 patients recruited by prehospital clinicians in Australia, New Zealand and Germany. The primary outcome will be the eight-level Glasgow Outcome Scale Extended (GOSE) at 6 months after injury, dichotomised to favourable (GOSE 5–8) and unfavourable (GOSE 1–4) outcomes, analysed using an intention-to-treat (ITT) approach. Secondary outcomes will include mortality at hospital discharge and at 6 months, blood product usage, quality of life and the incidence of predefined adverse events.

Ethics and dissemination

The study was approved by The Alfred Hospital Research and Ethics Committee in Victoria and also approved in New South Wales, Queensland, South Australia, Tasmania and the Northern Territory. In New Zealand, Northern A Health and Disability Ethics Committee provided approval. In Germany, Witten/Herdecke University has provided ethics approval. The PATCH-Trauma study aims to provide definitive evidence of the effectiveness of prehospital TXA, when used in conjunction with current advanced trauma care, in improving outcomes after severe injury.

Trial registration number

NCT02187120.
Approaches, enablers, barriers and outcomes of implementing facility-based stillbirth and neonatal death audit in LMICs: a systematic review
Authors: Gondwe Mtisunge Joshua , Mhango John Michael , Desmond Nicola , Aminu Mamuda , Allen Stephen
Published: March 2021

Purpose

To identify approaches, enablers, barriers and outcomes of facility stillbirth and neonatal death audit in low-income and middle-income countries (LMICs).

Data sources

We searched MEDLINE, CINAHL Complete, Academic Search Index, Science Citation Index, Complementary index and Global health electronic databases.

Study selection

Studies were considered eligible when reporting the approaches, enablers, barriers and outcomes of facility-based stillbirth and neonatal death audit in LMICs.

Data extraction

Two authors independently performed the data extraction using predefined templates made before data extraction.

Results of data synthesis

A total of 10 articles from 7 countries were included in the final analysis. Facility or external multidisciplinary teams performed death audits on a weekly or monthly basis. A total of 1018 stillbirths and neonatal deaths were audited. Of 18 audit enablers identified, nine were at the health provider level while 18 of 23 barriers to audit that were identified occurred at the facility level. The facility-level barriers cited by more than one study included: failure to implement change; inadequate training; limited time; increased workload; too many cases and poor documentation. Six studies reported that death audits resulted in structural improvements in physical structure, training, service organisation, supplies and equipment in the wards. Five studies reported that death audits improved the standard of care, with one study showing a significant improvement in measured standards. One study reported a significant reduction in newborn mortality rate of 29.4% (95% CI 0.6% to 2.4%; p=0.0015) and one study a reduction in perinatal mortality of 4.9% (52.8% in 2007 to 47.9% in 2008) before and after perinatal audit implementation.

Conclusion

Stillbirth and neonatal death audit improves facility structures, processes of care and health outcomes in neonatal care. There is a need to enhance enablers and address barriers identified at both health provider and facility levels to improve the audit process.
Psychological health in preschool children with underweight, overweight or obesity: a regional cohort study
Authors: Donkor Hilde Mjell , Toxe Helene , Hurum Jørgen , Bjerknes Robert , Eide Geir Egil , Juliusson Petur , Markestad Trond
Published: March 2021

Objective

To examine if underweight (UW), overweight (OW) or obesity (OB), or body mass index (BMI) expressed as its SD score (BMI SDS), were associated with psychological difficulties in preschool children.

Design

Regional cohort study.

Setting

Oppland County, Norway.

Methods

At the routine school entry health assessment at 5–6 years of age, parents were invited to participate by local public health nurses. The parents completed questionnaires on sociodemographic, health and lifestyle factors of the child and the family, and on the child’s neurocognitive development. They assessed psychological health with the Strengths and Difficulties Questionnaire (SDQ). Public health nurses measured weight and height on all eligible children and reported age, sex, height and weight anonymously for the children who declined to participate.

Participants

We obtained information on 1088 of 1895 (57%) eligible children. The proportion of UW, OW and OB was slightly higher among the children who declined.

Main outcome measures

SDQ subscale and Total Difficulties Scores.

Results

The mean SDQ scores and proportion of scores ≥the 90th percentile had a curvilinear pattern from UW through normal weight (NW), OW and OB with NW as nadir, but the pattern was only significant for the mean Emotional problems, Peer problems and Total SDQ Scales, and for the Total SDQ Score ≥the 90th percentile (TDS90). After adjusting for relevant social, developmental, health and behavioural characteristics, TDS90 was only significantly associated with UW in multiple logistic regression analyses, and only with the lowest quartile of BMI SDS in a linear spline regression analysis.

Conclusions

The study suggests that UW and low BMI, but not OW, OB or higher BMI, are independent risk factors for having psychological symptoms in preschool children.
Public knowledge, preferences and experiences about medical substitute decision-making: a national cross-sectional survey
Authors: Sellars Marcus , Tran Julien , Nolte Linda , White Ben , Sinclair Craig , Fetherstonhaugh Deirdre , Detering Karen
Published: March 2021

Objective

To describe the Australian adult public’s knowledge and experiences regarding substitute decision-making for medical decisions and their preferences for obtaining information about the substitute decision-maker (SDM) role.

Methods

This is a national cross-sectional online survey of the Australian adult public. The survey examined participants’ advance care planning (ACP) awareness and experience, SDM experiences and preferences for obtaining more information about SDM, and participant knowledge about SDM.

Results

Of 1586 people who opened the survey, 1120 (70.6%) were included in the final sample. 13% (n=142) of participants indicated they had acted as an SDM. A median score of two correct responses out of five showed low to moderate knowledge about the SDM role among all participants, with only 33% reporting awareness of SDM laws existing in Australia. While most (59%) participants ranked a health professional as their preferred source of obtaining information about supporting SDMs, few participants who had been an SDM (n=64, 45%) reported obtaining any support in making medical decisions. The median SDM knowledge scores for people who had discussed ACP (3.0 vs 2.0, U=1 45 222, z=6.910, p<0.001), documented their ACP preferences (3.0 vs 2.0, U=71 984, z=4.087, p<0.001) or acted in the SDM role (3.0 vs 2.0, U=56 353, z=−3.694, p<0.001) were significantly higher compared with those who had not.

Conclusions

The Australian public may have low to moderate knowledge about the SDM role and access only minimal support when making challenging medical decisions.
Opioids and driving: education gaps in advanced cancer
Authors: Anil Nagtha , Smallwood Natasha , Dunn Sadie
Published: March 2021

Objectives

Opioids may impair the ability to drive safely, particularly when first prescribed or with dose titration. We investigated whether clinicians evaluate driving status and provide opioid-related driving advice when initiating opioids among people with advanced lung cancer.

Methods

A retrospective medical record review of outpatients with advanced non-small cell lung cancer seen at an Australian tertiary referral centre between 1 January 2015 and 31 December 2019 was undertaken to determine frequency of opioid prescription and documentation of driving status and education regarding driving safety while taking opioids.

Results

Of 1022 patients screened, 205 were commenced on opioid therapy. Forty-seven (23%) patients had driving status documented. According to medical records, education about driving safety while on opioids was provided to two (1%) patients on opioid initiation. Ten (5%) patients received opioid-related driving education at least once at follow-up appointments. The content of the education was infrequently documented, and when documented, focused on opioid side effects impacting driving. Opioid doses were often escalated at follow-up appointments.

Conclusions

According to documentation in medical records, clinicians infrequently assessed driving status on opioid initiation and rarely provided education regarding opioid-related driving risks. Further research and clearer guidance regarding opioids and driving safety in the cancer population are required.
End-stage kidney disease on dialysis: an observational study of modality change from maximum conservative management
Authors: Shrestha Alvin , Burns Aine
Published: March 2021

Objectives

A rising burden from end-stage kidney disease with poor outcomes in the frail, elderly population has seen the emergence of a non-dialytic option, also known as maximum conservative management (MCM). Despite an established MCM programme in our institution, it was anecdotally observed that some MCM patients would end up being dialysed short and long term. We explored treatment modality changes from MCM to renal replacement therapy (RRT), the reasons surrounding the change, and aimed to quantify survival in this cohort of patients.

Methods

44 patients were identified as being MCM, who changed modalities to RRT, from 2000 to 2015, using the Royal Free Hospital Renal Unit’s database. Electronic health records were reviewed retrospectively. Associations with 12-month mortality were explored and Kaplan-Meier method used to predict survival.

Results

The most common modality change was to haemodialysis (81%), with one transplantation, and rest peritoneal dialysis. 28 patients commenced dialysis as unplanned starters, with the most common symptom being fluid overload. One-year survival was associated with increased age (75 vs 83, p=0.004, for alive vs dead) and had lower mean Charlson Comorbidity Index (6.2 vs 7.3, p=0.021). Median survival of 65 months following RRT initiation was predicted by the Kaplan-Meier method.

Conclusions

Patients changed modalities from MCM to RRT due to symptoms, the most common being fluid overload. Despite an unplanned change to RRT, survival appears to be significant at 65 months in this study, indicating clinicians are continuing to offer RRT to patients appropriately.
Blue poo: impact of gut transit time on the gut microbiome using a novel marker
Authors: Asnicar Francesco , Leeming Emily R , Dimidi Eirini , Mazidi Mohsen , Franks Paul W , Al Khatib Haya , Valdes Ana M , Davies Richard , Bakker Elco , Francis Lucy , Chan Andrew , Gibson Rachel , Hadjigeorgiou George , Wolf Jonathan , Spector Timothy D , Segata Nicola , Berry Sarah E
Published: March 2021

Background and aims

Gut transit time is a key modulator of host–microbiome interactions, yet this is often overlooked, partly because reliable methods are typically expensive or burdensome. The aim of this single-arm, single-blinded intervention study is to assess (1) the relationship between gut transit time and the human gut microbiome, and (2) the utility of the ‘blue dye’ method as an inexpensive and scalable technique to measure transit time.

Methods

We assessed interactions between the taxonomic and functional potential profiles of the gut microbiome (profiled via shotgun metagenomic sequencing), gut transit time (measured via the blue dye method), cardiometabolic health and diet in 863 healthy individuals from the PREDICT 1 study.

Results

We found that gut microbiome taxonomic composition can accurately discriminate between gut transit time classes (0.82 area under the receiver operating characteristic curve) and longer gut transit time is linked with specific microbial species such asAkkermansia muciniphila,Bacteroidesspp andAlistipesspp (false discovery rate-adjusted p values <0.01). The blue dye measure of gut transit time had the strongest association with the gut microbiome over typical transit time proxies such as stool consistency and frequency.

Conclusions

Gut transit time, measured via the blue dye method, is a more informative marker of gut microbiome function than traditional measures of stool consistency and frequency. The blue dye method can be applied in large-scale epidemiological studies to advance diet-microbiome-health research. Clinical trial registry websitehttps://clinicaltrials.gov/ct2/show/NCT03479866and trial numberNCT03479866.