bluuebunny/crossref_metadata_2025 huggingface dataset:
Intermolecular vibrational energy transfer enabled by microcavity strong light–matter coupling
Authors: Xiang Bo , Ribeiro Raphael F. , Du Matthew , Chen Liying , Yang Zimo , Wang Jiaxi , Yuen-Zhou Joel , Xiong Wei
Published: May 2020

Atypical vibrational interactions

Vibrational energy transfer (VET) between solute molecules is generally unfavorable in liquids because of weak intermolecular forces. Xiang
et al.
measured the two-dimensional infrared spectrum of a molecular mixture, W(CO)
6
and W(
13
CO)
6
, with saturated concentrations in a binary solvent embedded in an optical microcavity. This experiment showed that the VET between the asymmetric stretch vibrations of two solute molecules is enhanced via polaritonic intermediate states formed by a strong coupling with the cavity mode. The efficiency is modulated by the cavity lifetime, which provides an opportunity to control the VET process in the liquid phase. This could lead to various practical implementations.

Science
, this issue p.
665
Imaging the onset of the resonance regime in low-energy NO-He collisions
Authors: de Jongh Tim , Besemer Matthieu , Shuai Quan , Karman Tijs , van der Avoird Ad , Groenenboom Gerrit C. , van de Meerakker Sebastiaan Y. T.
Published: May 2020

Ultracold molecular collision dynamics

Ultracold collision dynamics are of great importance in understanding the quantum nature of chemical interactions, but achieving the ultracold regime for molecules is challenging. Traditional techniques based on alternative routes to assemble the ultracold atomic constituents are only able to produce a type of ultracold molecules that cannot probe state-selective dynamics. Using Stark deceleration and velocity map–imaging techniques, de Jongh
et al.
achieved the ultracold regime directly for a nitric oxide–helium system and measured the state-to-state cross sections for inelastic scattering with high precision (see the Perspective by Yang and Yang). The observed scattering resonances confirmed high sensitivity to the underlying interaction potential because only the most accurate electronic structure theory could reproduce their structure.

Science
, this issue p.
626
; see also p.
582
Light-mediated strong coupling between a mechanical oscillator and atomic spins 1 meter apart
Authors: Karg Thomas M. , Gouraud Baptiste , Ngai Chun Tat , Schmid Gian-Luca , Hammerer Klemens , Treutlein Philipp
Published: May 2020

Strongly coupled at distance

The development of hybrid quantum systems provides a flexibility that allows for various components to be coupled together, thereby expanding the opportunity to build quantum sensors and devices that can be designed for specific purposes. Key to doing so is being able to strongly couple the different components. Most developments to date have relied on the components being in close proximity, which can hamper design flexibility. Karg
et al.
used a laser to induce strong coupling between a cloud of atoms and an optomechanical membrane. With the components separated by 1 meter, this approach demonstrates a methodology of coupling quantum systems and easing up restrictions on spatial proximity.

Science
, this issue p.
174
A field guide to existential risk
The Precipice: Existential Risk and the Future of Humanity
Toby Ord
Hachette, 2020. 480 pp.
Authors: Jerabek Stepan
Published: May 2020

A pandemic isn't the only peril for which we're unprepared
Ampicillin and Ceftriaxone Solution Stability at Different Temperatures in Outpatient Parenteral Antimicrobial Therapy
Authors: Herrera-Hidalgo L. , López-Cortes L. E. , Luque-Márquez R. , Gálvez-Acebal J. , de Alarcón A. , López-Cortes L. F. , Gutiérrez-Valencia A. , Gil-Navarro M. V.
Published: May 2020

The inclusion of ampicillin-containing regimens in outpatient parenteral antimicrobial therapy programs (OPAT) depends upon solution stability under conditions similar to those experienced in these programs. Lack of this information could hinder the inclusion in OPAT of patients suffering from
Enterococcus faecalis
infective endocarditis treated with ampicillin plus ceftriaxone. The purpose of this study is to determine the stability of ampicillin and ampicillin plus ceftriaxone solutions in a simulated outpatient setting conditions.
Health aid projects have both expanded and constrained the capacity of health facilities to deliver malaria services to under-five children in Malawi
Authors: Dolan Carrie B
Published: May 2020

Objective

This article examines the potential pathways health aid may use to influence the availability of malaria services at a facility level and the utilisation of malaria services for children under five in Malawi.

Methods

This work is grounded in a health services research theoretical model and combines a subnational census of health services available at Malawi health facilities with individual-level data on health service utilisation and the Government of Malawi’s official source of data about health aid allocation at a child-level (n=2171). Logistic and multinomial logistic models were used to assess the relationship between health aid, malaria service readiness and malaria service utilisation. Models were adjusted for predisposing, enabling and need factors and accounted for the complex relationship using a mediation approach.

Results

The evidence presented suggests that health aid translates into increased diagnostic capacity, but not overall or training readiness. Results indicate that increasing aid projects in a region boost its facilities’ diagnostic readiness, increasing each facility’s relative likelihood of having a medium level of diagnostic readiness by 12% (relative risk (RR)=1.118; 95% CI 1.060 to 1.179) and its likelihood of having a high level of readiness by 23% (RR=1.230; 95% CI 1.161 to 1.303), but decreasing its readiness to provide training by 8% (RR=0.925; 95% CI 0.879 to 0.974).

Conclusion

The results of this research highlight the fact that health aid is working to increase malaria diagnostic capacity at a facility level, but that increasing facility readiness to implement the diagnostic tests has been neglected.
Reshaping public hospitals: an agenda for reform in Asia and the Pacific
Authors: Gauld Robin , Asgari-Jirhandeh Nima , Patcharanarumol Walaiporn , Tangcharoensathien Viroj
Published: May 2020

Hospitals in the Asia‐Pacific today face the ‘triple aim’ challenge, proposed by the Institute for Healthcare Improvement, of how to improve quality of care and population health, while at the same time controlling healthcare costs. Yet, pursuing these challenges in combination is presently a remote prospect for many hospitals and, indeed, in a majority of countries in the region. The roles and functions of the public hospital sector within local health systems need redefinition and reform in the context of demographic and epidemiological transitions. Policymakers, managers and health professionals have an obligation to reshape the future of public hospitals. This article outlines actions for how public hospitals can be reshaped from a health system perspective. First, hospitals should be integrated into the fabric of the local health system; they can lead in this through working in alliances with other healthcare facilities, including primary care and private hospitals. Policymakers have a role in facilitating this as it contributes to health improvement of the population. Second, investments in system innovation, management improvement and information systems are required and their impact assessed. Such investments can contribute to cost control and efficiency. Public hospital sector investments should be strategic, efficient and should not bias investment in broader determinants of health. Third, reorienting health workforce competencies and appropriate skills should be central to hospital sector reforms, from policy to frontline services delivery. Creative thinking is needed to build and support flexible care delivery arrangements for services designed to respond to patients ’ and providers’ needs. Pivotal to achievement of each of these three areas of reform is good governance and leadership.
Different suturing techniques in thoracic incision: protocol for a feasibility randomised controlled trial
Authors: Liu Zonghui , Liu Xiangyu , He Lin , Yu Xueyuan , Wang Lu , Wang Rui , He Youcheng , Hao Xiaoyan , Tang Zhishui , Su Yingjun , Shu Maoguo
Published: May 2020

Introduction

Based on the principles of the ideal skin closure technique, we previously described a suture technique (wedge-shaped excision and modified buried vertical mattress suture (WE-MBVMS)) that could provide excellent outcomes for the most demanding surfaces. However, adequate clinical comparative evidence supporting improved outcomes is lacking. Thus, the purpose of this protocol is to establish the feasibility of conducting a fully randomised controlled trial (RCT) comparing the clinical effectiveness of WE-MBVMS with a buried intradermal suture (BIS) in closing thoracic incision.

Methods and analysis

This study is a feasibility RCT of WE-MBVMS and BIS in patients undergoing surgery for costal cartilage harvesting. Seventy-eight participants are expected to participate in the study and will be randomised in a ratio of 1:1 to WE-MBVMS or BIS. Trial feasibility will be assessed by the number of participants assessed for eligibility, recruitment rates, reasons for ineligibility or non-participation, time for interventions, withdrawal and retention at all follow-up points (3, 6 and 12 months), follow-up rates and reasons for withdrawing from the trial. In addition, clinical data regarding the cosmetic results of scars will be collected to inform the sample size for a fully powered RCT.

Ethics and dissemination

This study has been approved by The First Affiliated Hospital of Xi’an Jiaotong University Institutional Review Board (XJTU1AF2017LSK-120). The findings will be published in peer-reviewed journals.

Trial registration number

ChiCTR-INR-17013335; Pre-results.
Study protocol for a cohort study of patients with advanced heart failure in Singapore
Authors: Malhotra Chetna , Foo Renette , Singh Ratna , Ozdemir Semra , Teo Irene , Sim David , Jaufeerally Fazlur , Aung Than , Keong Yeo Khung , Nadkarni Nivedita , Finkelstein Eric Andrew
Published: May 2020

Introductio

Understanding the symptom and health expenditure burden among patients with advanced congestive heart failure (CHF) and their family caregivers is essential to reform policy and practice needed to provide quality care to these patients at affordable prices. The proposed cohort study titled Singapore Cohort of Patients with Advanced Heart Failure aims to describe trajectories of quality of life among patients and their primary informal caregivers, quantify healthcare utilisation and expenditures, assess changes in patient and caregiver awareness of and preferences for knowing diagnostic and prognostic information, awareness and utilisation of palliative care services, preferences for treatments and decision making, perceived quality of care, self-care, caregiver psychological distress and caregiver burden.

Methods

This cohort study will recruit 250 patients with New York Heart Association Classification class III and IV CHF from inpatient wards at two public tertiary healthcare institutions in Singapore. Patients and their primary informal caregiver are being surveyed every 4 months until patients’ death; caregivers are followed until 8 weeks postpatient death. Medical and billing records of patients are obtained and merged with patients’ survey data.

Ethics and dissemination

The study has been approved by an ethics board. Results from the study will be disseminated through publications and presentations targeting researchers, policy makers and clinicians interested in understanding and improving care for patients with advanced CHF.

Trial registration number

NCT03089034.
Predicting intrapartum fetal compromise at term using the cerebroplacental ratio and placental growth factor levels (PROMISE) study: randomised controlled trial protocol
Authors: Sherrell Helen , Clifton Vicky , Kumar Sailesh
Published: May 2020

Introduction

Intrapartum complications are a major contributor to adverse perinatal outcomes, including stillbirth, hypoxic–ischaemic brain injury and subsequent longer term disability. In many cases, hypoxia develops as a gradual process due to the inability of the fetus to tolerate the stress of parturition suggesting reduced fetoplacental reserve before labour commences. The fetal cerebroplacental ratio (CPR) is an independent predictor of intrapartum fetal compromise, poor acid base status at birth and of neonatal unit admission at term. Similarly, circulating maternal levels of placental growth factor (PlGF) are lower in pregnancies complicated by placental dysfunction. This paper outlines the protocol for the PROMISE Study, which aims to determine if the introduction of a prelabour screening test for intrapartum fetal compromise combining the CPR and maternal PlGF level results in a reduction of adverse perinatal outcomes.

Methods and analysis

This is a single-site, non-blinded, individual patient randomised controlled trial of a screening test performed at term, combining the fetal CPR and maternal serum PlGF. Women with a singleton, non-anomalous pregnancy will be recruited after 34 weeks’ gestation and randomised to either receive the screening test or not. Screened pregnancies determined to be at risk will be recommended induction of labour. Demographic, obstetric history and antenatal data will be collected at enrolment, and perinatal outcomes will be recorded after delivery. Relative risks and 95% CIs will be reported for the primary outcome. Regression techniques will be used to examine the influence of prognostic factors on the primary and secondary outcomes.

Ethics and dissemination

This study has been reviewed and approved by the Mater Human Research Ethics Committee (Reference: HREC EC00332) and will follow the principles of Good Clinical Practice. The study results will be disseminated at national and international conferences and published in peer-reviewed journals.

Trial registration number

ACTRN12616001009404; Pre-results.
Quantity of opioids consumed following an emergency department visit for acute pain: a Canadian prospective cohort study
Authors: Daoust Raoul , Paquet Jean , Cournoyer Alexis , Piette Éric , Morris Judy , Gosselin Sophie , Émond Marcel , Lavigne Gilles , Lee Jacques , Chauny Jean-Marc
Published: May 2020

Objectives

Prescription opioid diversion is a significant contributor to the opioid misuse epidemic. We examined the quantity of opioids consumed by emergency department (ED) discharged patients after treatment for an acute pain condition (musculoskeletal, fracture, renal colic, abdominal pain and other), and the percentage of unused opioids available for potential misuse.

Design

Prospective cohort study.

Setting

Tertiary care trauma centre academic hospital.

Participants

A convenience sample of patients ≥18 years who visited the ED for an acute pain condition (≤2 weeks) and were discharged with an opioid prescription. Patients completed a 14-day paper diary of daily pain medication use. To reduce lost to follow-up, participants also responded to standardised phone interview questions about their previous 14-day pain medication use.

Outcomes

Quantity of morphine 5 mg tablets (or equivalent) prescribed, consumed and unused during a 14-day follow-up. Quantity of opioids to adequately supply 80% of patients for 2 weeks and 95% of patients for the first 3 days was also calculated.

Results

Results for 627 patients were analysed (mean age ±SD: 51±16 years, 48% women). Patients consumed a median of seven tablets of morphine 5 mg (32% of the total prescribed opioids). The quantity of opioids to adequately supply 80% of patients for 2 weeks was 20 tablets of morphine 5 mg for musculoskeletal pain, 30 for fracture, 15 for renal colic or abdominal pain and 20 for other pain conditions. The quantity to adequately supply 95% of patients for the first 3 days was 15 tablets of morphine 5 mg.

Conclusions

Patients discharged from the ED with an acute pain condition consumed a median of fewer than 10 tablets of morphine 5 mg (or equivalent). ED physicians should consider prescribing a smaller quantity of opioids and asking the pharmacist to dispense them in portions to minimise unused opioids.

Trial registration number

NCT02799004; Results.
Obstructive sleep apnoea and the risk for coronary heart disease and type 2 diabetes: a longitudinal population-based study in Finland
Authors: Strausz Satu , Havulinna Aki S. , Tuomi Tiinamaija , Bachour Adel , Groop Leif , Mäkitie Antti , Koskinen Seppo , Salomaa Veikko , Palotie Aarno , Ripatti Samuli , Palotie Tuula
Published: May 2020

Objective

To evaluate if obstructive sleep apnoea (OSA) modifies the risk of coronary heart disease, type 2 diabetes (T2D) and diabetic complications in a gender-specific fashion.

Design and setting

A longitudinal population-based study with up to 25-year follow-up data on 36 963 individuals (>500 000 person years) from three population-based cohorts: the FINRISK study, the Health 2000 Cohort Study and the Botnia Study.

Main outcome measures

Incident coronary heart disease, diabetic kidney disease, T2D and all-cause mortality from the Finnish National Hospital Discharge Register and the Finnish National Causes-of-Death Register.

Results

After adjustments for age, sex, region, high-density lipoprotein (HDL) and total cholesterol, current cigarette smoking, body mass index, hypertension, T2D baseline and family history of stroke or myocardial infarction, OSA increased the risk for coronary heart disease (HR=1.36, p=0.0014, 95% CI 1.12 to 1.64), particularly in women (HR=2.01, 95% CI 1.31 to 3.07, p=0.0012). T2D clustered with OSA independently of obesity (HR=1.48, 95% CI 1.26 to 1.73, p=9.11×10−7). The risk of diabetic kidney disease increased 1.75-fold in patients with OSA (95% CI 1.13 to 2.71, p=0.013). OSA increased the risk for coronary heart disease similarly among patients with T2D and in general population (HR=1.36). All-cause mortality was increased by OSA in diabetic individuals (HR=1.35, 95% CI 1.06 to 1.71, p=0.016).

Conclusion

OSA is an independent risk factor for coronary heart disease, T2D and diabetic kidney disease. This effect is more pronounced even in women, who until now have received less attention in diagnosis and treatment of OSA than men.
Which treatment is most effective for patients with patellofemoral pain? A protocol for a living systematic review including network meta-analysis
Authors: Winters Marinus , Holden Sinead , Vicenzino Bill , Welton Nicky J , Caldwell Deborah M , Lura Carolina Bryne , Weir Adam , Rathleff Michael Skovdal
Published: May 2020

Introduction

Patellofemoral pain (PFP) affects 1 in every 14 adults. Many treatments for PFP have been evaluated, but the comparative effectiveness of all available treatments has never been examined. Network meta-analysis is the only design to study the comparative effectiveness of all available treatments in one synthesis. This protocol describes the methods for a systematic review including network meta-analysis to assess which treatment is most likely to be effective for patients with PFP.

Methods and analysis

The primary outcome measures of this network meta-analysis are the global rating of change scale at 6–12 weeks, 13–52 weeks and >52 weeks. The secondary outcome measures are patient-rated pain scales at 6–12 weeks, 13–52 weeks and >52 weeks. Completed published and unpublished randomised controlled trials with full-text reports are eligible for inclusion. We will search Embase, PubMed (including MEDLINE), CENTRAL, Scopus, Web of Science, and CINAHL, SPORTDiscus, OpenGrey, WorldCat, conference Proceedings and multiple trial registers for relevant reports. Two researchers will appraise the study eligibility and perform data extraction. Risk of bias will be assessed with the Cochrane Risk of Bias Tool V.2.0.

Bayesian network meta-analyses will be constructed for global rating of change scale and patient-rated pain. Consistency between direct and indirect comparisons will be assessed. Between study variability will be explored, and a threshold analysis for the credibility of the network meta-analyses’ conclusions will be performed.

Ethics and dissemination

Ethical approval is not required, as this study will be based on published data. The study commenced at 1 February 2018, and its expected completion date is 15 January 2019. Full publication of the work will be sought in an international peer-reviewed journal, as well as translational articles to disseminate the work to clinical practitioners.

PROSPERO registration number

CRD42018079502.
How do general practitioners and pharmacists experience antibiotic use in out-of-hours primary care? An exploratory qualitative interview study to inform a participatory action research project
Authors: Colliers Annelies , Coenen Samuel , Remmen Roy , Philips Hilde , Anthierens Sibyl
Published: May 2020

Rationale

Antibiotics (ABs) are one of the most prescribed medications in out-of-hours (OOH) care in Belgium. Developing a better understanding of why ABs are prescribed in this setting is essential to improve prescribing habits.

Objectives

To assess AB prescribing and dispensing challenges for general practitioners (GPs) and pharmacists in OOH primary care, and to identify context-specific elements that can help the implementation of behaviour change interventions to improve AB prescribing in this setting.

Design

This is an exploratory qualitative study using semistructured interviews. This study is part of a participatory action research project.

Setting and participants

Participants include 17 GPs and 1 manager, who work in a Belgian OOH general practitioners cooperative (GPC), and 5 pharmacists of the area covered by the GPC. The GPC serves a population of more than 187 000 people.

Results

GPs feel the threshold to prescribe AB in OOH care is lower in comparion to office hours. GPs and pharmacists talk about the difference in their professional identity in OOH (they define their task differently, they feel more isolated, insecure, have the need to please and so on), type of patients (unknown patients, vulnerable patients, other ethnicities, demanding patients and so on), workload (they feel time-pressured) and lack of diagnostic tools or follow-up. They are aware of the problem of AB overprescribing, but they do not feel ownership of the problem.

Conclusion

The implementation of behaviour change interventions to improve AB prescribing in OOH primary care has to take these context specifics into account and could involve interprofessional collaboration between GPs and pharmacists.

Trial registration number

NCT03082521; Pre-results.
Protocol for a longitudinal cohort study: determination of risk factors for the development of first venous leg ulcer in people with chronic venous insufficiency, the VEINS (venous insufficiency in South Florida) cohort
Authors: Mervis Joshua S , Kirsner Robert S , Lev-Tov Hadar
Published: May 2020

Introduction

Chronic venous insufficiency (CVI) affects up to one-third of the adult population yet venous leg ulcers (VLU), a significant complication of CVI, only affect 1%–2% of adults in the USA. Why some develop VLU and others do not is unclear. VLU have a significant impact on quality of life and are extremely costly and difficult to treat. Moreover, VLU prevalence is increasing, doubling in the last 20 years. In order to characterise the differences between people with CVI and those who ultimately develop VLU, we aim to set up the unique venous insufficiency in South Florida cohort.

Methods and analysis

Subjects will be recruited from the University of Miami Hospital and Clinic’s vascular laboratory database, which began in July 2011. Any adult age 18–95 who has had venous reflux detected on duplex ultrasound of the lower extremities is included. Approximately 2500 patients are already in the database that meet these criteria, with an estimated 2500 additional potential subjects to be recruited from the vascular laboratory database over the next 5 years. Subjects with a history of VLU prior to the duplex study date will be excluded. Data will be collected via review of the Doppler study report, patient phone interview and review of the electronic medical record. Subjects will be contacted for follow-up every 3 months for at least 5 years until the study endpoint, development of first VLU (fVLU), is reached. In order to estimate the time from reflux documentation to fVLU, Kaplan-Meier survival curves will be constructed. Cox proportional hazard regression models will be constructed to investigate possible risk factors.

Ethics and dissemination

This study is approved by the University of Miami’s Institutional Review Board. We hope to present the results of this study to the scientific community at conferences and in peer-reviewed journals.
Integrating nurses’ experiences with supporting behaviour change for cardiovascular prevention into a self-management internet platform in Finland and the Netherlands: a qualitative study
Authors: Beishuizen Cathrien RL , Akenine Ulrika , Barbera Mariagnese , Rosenberg Anna , Fallah Pour Mandana , Richard Edo , Soininen Hilkka , Mangialasche Francesca , Kivipelto Miia , Pols A Jeannette , Moll van Charante Eric
Published: May 2020

Objectives

Global ageing is linked to an increased burden of cardiovascular disease and dementia, which calls for better prevention strategies. Self-management and eHealth applications are regarded as promising strategies to support prevention. The aim of this study was to explore nurses’ best practices concerning behaviour change guidance for cardiovascular (CV) prevention in order to learn how to optimally integrate them into a coach-supported internet platform for CV self-management.

Design

Qualitative focus group study in Finland and the Netherlands. Discussions were audiotaped and transcribed. Data were thematically analysed following principles of grounded theory.

Setting

Dutch and Finnish primary care settings.

Participants

Six Finnish and seven Dutch primary care nurses with experience in CV prevention.

Results

Similar best practices were found in both countries and comprised of (1) establishing a relationship of trust, (2) managing awareness and expectations and (3) appropriate timing and monitoring of the process of behaviour change. However, the Finnish and Dutch nurses used different approaches for accomplishment of these practices, which was reflected in their recommendations for online support. Both groups emphasised that online support should be combined with human support and integrated into regular care. Finnish nurses had more confidence in patient self-management and remote communication than Dutch nurses, who emphasised the importance of face-to-face contact and preferred to keep control of medical aspects of prevention.

Conclusions

Differences in Dutch and Finnish’s nurses’ practices for supporting CV prevention appear to reflect their local healthcare practices, which should be taken into account when designing internet platforms for health self-management. Including cognitive health as a goal of CV prevention might stimulate motivation for health behaviour change.

Trial registration number

ISRCTN48151589; Pre-results.
Renal hypothermia during partial nephrectomy for patients with renal tumours: a randomised controlled clinical trial protocol
Authors: Breau Rodney H , Cagiannos Ilias , Knoll Greg , Morash Christopher , Cnossen Sonya , Lavallée Luke T , Mallick Ranjeeta , Finelli Antonio , Jewett Michael , Leibovich Bradley C , Cook Jonathan , LeBel Louise , Kapoor Anil , Pouliot Frederic , Izawa Jonathan , Rendon Ricardo , Fergusson Dean A
Published: May 2020

Introduction

Partial nephrectomy is a standard of care for non-metastatic renal tumours when technically feasible. Despite the increased use of partial nephrectomy, intraoperative techniques that lead to optimal renal function after surgery have not been rigorously studied. Clamping of the renal hilum to prevent bleeding during resection causes temporary renal ischaemia. The internal temperature of the kidney may be lowered after the renal hilum is clamped (renal hypothermia) in an attempt to mitigate the effects of ischaemia. Our objective is to determine if renal hypothermia during open partial nephrectomy results in improved postoperative renal function at 12 months following surgery as compared with warm ischaemia (no renal hypothermia).

Methods and analyses

This is a multicentre, randomised, single-blinded controlled trial comparing renal hypothermia versus no hypothermia during open partial nephrectomy. Due to the nature of the intervention, complete blinding of the surgical team is not possible; however, surgeons will be blinded until the time of hilar clamping. Glomerular filtration will be based on plasma clearance of a radionucleotide, and differential renal function will be based on renal scintigraphy. The primary outcome is overall renal function at 12 months measured by the glomerular filtration rate (GFR). Secondary outcomes include change in GFR, GFR of the affected kidney, change in GFR of the affected kidney, serum creatinine, haemoglobin, spot urine albumin to creatinine ratio, quality of life and postoperative complications. Data will be collected at baseline, immediately postoperatively and at 3, 6, 9 and 12 months postoperatively.

Ethics and dissemination

Ethics approval was obtained for all participating study sites. Results of the trial will be submitted for publication in a peer-reviewed journal.

Trial registration number

NCT01529658; Pre-results.
AMBIsome Therapy Induction OptimisatioN (AMBITION): High dose AmBisome for cryptococcal meningitis induction therapy in sub-Saharan Africa: economic evaluation protocol for a randomised controlled trial-based equivalence study
Authors: Ponatshego Ponego Lloyd , Lawrence David Stephen , Youssouf Nabila , Molloy Sile F , Alufandika Melanie , Bango Funeka , Boulware David R , Chawinga Chimwemwe , Dziwani Eltas , Gondwe Ebbie , Hlupeni Admire , Hosseinipour Mina C , Kanyama Cecilia , Meya David B , Mosepele Mosepele , Muthoga Charles , Muzoora Conrad K , Mwandumba Henry , Ndhlovu Chiratidzo E , Rajasingham Radha , Sayed Sumaya , Shamu Shepherd , Tsholo Katlego , Tugume Lillian , Williams Darlisha , Maheswaran Hendramoorthy , Shiri Tinevimbo , Boyer-Chammard Timothée , Loyse Angela , Chen Tao , Wang Duolao , Lortholary Olivier , Lalloo David G , Meintjes Graeme , Jaffar Shabbar , Harrison Thomas S , Jarvis Joseph N , Niessen Louis Wilhelmus
Published: May 2020

Introduction

Cryptococcal meningitis is responsible for around 15% of all HIV-related deaths globally. Conventional treatment courses with amphotericin B require prolonged hospitalisation and are associated with multiple toxicities and poor outcomes. A phase II study has shown that a single high dose of liposomal amphotericin may be comparable to standard treatment. We propose a phase III clinical endpoint trial comparing single, high-dose liposomal amphotericin with the WHO recommended first-line treatment at six sites across five counties. An economic analysis is essential to support wide-scale implementation.

Methods and analysis

Country-specific economic evaluation tools will be developed across the five country settings. Details of patient and household out-of-pocket expenses and any catastrophic healthcare expenditure incurred will be collected via interviews from trial patients. Health service patient costs and related household expenditure in both arms will be compared over the trial period in a probabilistic approach, using Monte Carlo bootstrapping methods. Costing information and number of life-years survived will be used as the input to a decision-analytic model to assess the cost-effectiveness of a single, high-dose liposomal amphotericin to the standard treatment. In addition, these results will be compared with a historical cohort from another clinical trial.

Ethics and dissemination

The AMBIsome Therapy Induction OptimisatioN (AMBITION) trial has been evaluated and approved by the London School of Hygiene and Tropical Medicine, University of Botswana, Malawi National Health Sciences, University of Cape Town, Mulago Hospital and Zimbabwe Medical Research Council research ethics committees. All participants will provide written informed consent or if lacking capacity will have consent provided by a proxy. The findings of this economic analysis, part of the AMBITION trial, will be disseminated through peer-reviewed publications and at international and country-level policy meetings.

Trial registration

ISRCTN72509687; Pre-results.
‘Reducing Delays In Vaccination’ (REDIVAC) trial: a protocol for a randomised controlled trial of a web-based, individually tailored, educational intervention to improve timeliness of infant vaccination
Authors: Dempsey Amanda F , Wagner Nicole , Narwaney Komal , Pyrzanowski Jennifer , Kwan Bethany M , Kraus Courtney , Gleason Kathy , Resnicow Ken , Sevick Carter , Cataldi Jessica , Brewer Sarah E , Glanz Jason M
Published: May 2020

Introduction

Increasing numbers of children are failing to receive many recommended vaccines, which has led to significant outbreaks of vaccine-preventable diseases in the USA and worldwide. A major driver of undervaccination is parental vaccine hesitance. Prior research demonstrates that mothers are the primary decision maker for infant vaccination, and that their vaccination attitudes form primarily during pregnancy and early in their infant’s life.

Methods and analysis

This manuscript describes the protocol for an ongoing three-armed randomised controlled trial done at Kaiser Permanente Colorado (KPCO). The trial aims to test the efficacy of provided tailored, individualised information via the Internet to pregnant and new mothers versus untailored information versus usual care on the timeliness of infant vaccination. The primary outcome to be assessed is vaccination status, which is a dichotomous outcome (up to date vs not) assessed at age 200 days, reflecting the time when infants should have completed the first set of vaccine provided (at age 2, 4 and 6 months). Infants with one or more age-appropriate recommended vaccines at least 30 days delayed are categorised as not up to date whereas all other infants are considered up to date. Secondary outcomes include vaccination status at age 489 days, reflecting receipt of recommended vaccines at age 12–15 months, as well as vaccination attitudes, hesitancy and intention. Vaccination data will be derived from the electronic medical record and the state immunisation registry. Other secondary outcomes will be assessed by online surveys.

Ethics and dissemination

The study activities were approved by the Institutional Review Boards of the University of Colorado, KPCO and the University of Michigan. Results will be disseminated through peer-reviewed manuscripts and conference presentations.

Trial registration number

NCT02665013; Pre-results.
Comparative fertility and pregnancy outcomes after local treatment for cervical intraepithelial neoplasia and stage 1a1 cervical cancer: protocol for a systematic review and network meta-analysis from the CIRCLE group
Authors: Athanasiou Antonios , Veroniki Areti Angeliki , Efthimiou Orestis , Kalliala Ilkka , Naci Huseyin , Bowden Sarah , Paraskevaidi Maria , Martin-Hirsch Pierre , Bennett Philip , Paraskevaidis Evangelos , Salanti Georgia , Kyrgiou Maria
Published: May 2020

Introduction

There are several local treatment methods for cervical intraepithelial neoplasia that remove or ablate a cone-shaped part of the uterine cervix. There is evidence to suggest that these increase the risk of preterm birth (PTB) and that this is higher for techniques that remove larger parts of the cervix, although the data are conflicting. We present a protocol for a systematic review and network meta-analysis (NMA) that will update the evidence and compare all treatments in terms of fertility and pregnancy complications.

Methods and analysis

We will search electronic databases (CENTRAL, MEDLINE, EMBASE) from inception till October 2019, in order to identify randomised controlled trials (RCTs) and cohort studies comparing the fertility and pregnancy outcomes among different excisional and ablative treatment techniques and/or to untreated controls. The primary outcome will be PTB (<37 weeks). Secondary outcomes will include severe or extreme PTB, prelabour rupture of membranes, low birth weight (<2500 g), neonatal intensive care unit admission, perinatal mortality, total pregnancy rates, first and second trimester miscarriage. We will search for published and unpublished studies in electronic databases, trial registries and we will hand-search references of published papers. We will assess the risk of bias in RCTs and cohort studies using tools developed by the Cochrane collaboration. Two investigators will independently assess the eligibility, abstract the data and assess the risk of bias of the identified studies. For each outcome, we will perform a meta-analysis for each treatment comparison and an NMA once the transitivity assumption holds, using the OR for dichotomous data. We will use CINeMA (Confidence in Network meta-analysis) to assess the quality of the evidence for the primary outcome.

Ethics and dissemination

Ethical approval is not required. Results will be disseminated to academic beneficiaries, medical practitioners, patients and the public.

PROSPERO registration number

CRD42018115495
Performance of OncoE6TMCervical Test in detecting cervical precancer lesions in HIV-positive women attending an HIV clinic in Bujumbura, Burundi: a cross-sectional study
Authors: Ndizeye Zacharie , Menon Sonia , Van Geertruyden Jean-Pierre , Sauvaget Catherine , Jacquemyn Y , Bogers John-Paul , Benoy Ina , Vanden Broeck Davy
Published: May 2020

Objective

New rapid and low-cost molecular tests for cervical cancer screening, such as the OncoE6 Cervical Test, are emerging and could be alternatives for low-income and middle-income countries. To this end, we evaluated the clinical performance of the OncoE6 Cervical Test in detecting cervical intraepithelial neoplasia (CIN) among HIV-infected women in Bujumbura, Burundi.

Methods

From June to December 2017, a cross-sectional study was conducted in 680 HIV-positive women at the University Hospital. Women aged 25–65 years who declared having had vaginal intercourse were consecutively recruited, and cervical specimens for OncoE6, liquid-based cytology and human papillomavirus (HPV) genotyping were obtained and visual inspection with acetic acid performed. Thereafter, participants underwent a colposcopic examination. The sensitivity, specificity, and positive and negative predictive values of the different tests were calculated with reference to ‘colposcopic-histological’ diagnoses, and areas under the receiver operating curves of OncoE6 and cytology tests were compared.

Results

The prevalence of CIN was 4.9%, and OncoE6 positivity was 3.1%. OncoE6 sensitivity varied from poor to low with increasing disease severity (42.1%, 95% CI 19.9% to 64.3% at CIN2+ threshold; and 58.3%, 95% CI 30.4% to 86.2% at CIN3+ threshold). OncoE6 had the highest specificity compared with all other tests used together. The performance of the OncoE6 test was significantly lower compared with cytology at atypical squamous cell of undetermined significance (ASCUS+) cut-off (AUC=0.68 vs 0.85, p=0.03) and low-grade squamous intraepithelial lesion (LSIL+) cut-off (AUC=0.68 vs 0.83, p=0.04) for CIN2+ diagnoses. However, the performance of the OncoE6 test was similar to that of cytology at high-grade squamous intraepithelial lesion (HSIL+) cut-off (AUC=0.68 vs 0.76; p=0.30) for CIN2+ diagnoses and was also similar to that of cytology at all cut-offs (ASCUS+, LSIL+ and HSIL+) for CIN3+ diagnoses (p1=0.76, p2=0.95 and p3=0.50, respectively).

Conclusion

The current OncoE6 test proved to be a point-of-care test. However, given its poor performance for CIN2+ diagnoses, we do not recommend it for primary screening. We recommend to enrich it with more oncogenic HPV types, which may improve the performance of the test akin to that of cytology.
Associations between the SHARE frailty phenotype and common frailty characteristics: evidence from a large Danish population study
Authors: Jacobsen Katja Kemp , Jepsen Randi , Lembeck Maurice A , Nilsson Charlotte , Holm Ellen
Published: May 2020

Objectives

Frailty is a major clinical geriatric syndrome associated with serious adverse events including functional disability, falls, hospitalisation, increased morbidity and mortality. The aim of this study was to study associations between a frailty phenotype and frailty characteristics well known from the literature.

Design

Registry-based cross-sectional study.

Setting

The target population consists of inhabitants above the age of 50 living in the Danish municipalities of Lolland and Guldborgsund. Excluded are incapacitated people, inhabitants unable to understand Danish or English and inhabitants without a permanent residence.

Participants

7327 individuals aged 50+ years were included.

Outcome measures

We examined associations between the frailty measurement and factors known to be associated with frailty: sex, age, income insufficiency, education, comorbidity, self-assessed health, morbidity and mortality.

Results

7327 individuals aged 50+ years were included. Of these, 6.5% had ≥3 frailty components (frail), 46.7% had 1–2 components (prefrail) and 46.9% had none (non-frail). Those who were frail were older and more likely female than those who were non-frail or prefrail. There was a stepwise decrease in educational level, and in self-assessed health with increasing frailty status, and a stepwise increase in difficulty in making ends meet, number of hospital contacts and mortality with increasing frailty status, p<0.0001 for each comparison. Compared with individuals who were non-frail, mortality was higher among those who were prefrail (HR: 2.90; 95% CI: 1.30 to 6.43) or frail (HR: 8.21; 95% CI: 3.37 to 20.0).

Conclusions

Based on these findings, we consider the Lolland-Falster Health Study frailty assessment a valid instrument demonstrating the same characteristics as other validated frailty measures concerning associations with sex, age, income insufficiency, education, comorbidity, self-assessed health, morbidity and mortality.

Trial registration number

NCT02482896.
Evaluation of the role of sex as a prognostic factor in critically ill adults with sepsis: systematic review protocol
Authors: Lopez-Alcalde Jesus , Antequera Martín Alba , Stallings Elena , Muriel Alfonso , Fernández-Félix Borja , Solà Ivan , del Campo Rosa , Ponce-Alonso Manuel , Gordo Federico , Fidalgo Pilar , Halperin Ana Verónica , Álvarez-Díaz Noelia , Madrid-Pascual Olaya , Urrutia Gerard , Zamora Javier
Published: May 2020

Introduction

Sepsis is a leading cause of mortality in critically ill patients. Recently, it has been recognised that sex may contribute to a differential risk for developing sepsis and it remains uncertain if the prognosis of sepsis varies between the sexes. The aim of this systematic review is to summarise the available evidence to assess the role of sex as a prognostic factor in patients with sepsis managed in the intensive care unit (ICU).

Methods and analysis

This is a systematic review protocol of prognostic studies of sex in patients with sepsis managed in the ICU. The primary outcomes include all-cause hospital mortality and all-cause hospital mortality during the first 28 days. The secondary outcomes include all-cause hospital mortality during the first 7 days and all-cause mortality at 1 year. We will conduct a search strategy based on the population (sepsis), the prognostic factor (sex), the outcome of interest (mortality) and prognostic study methods. We will search in the following databases up to December 2019: MEDLINE Ovid (from 1976), Embase Elsevier (from 1974), Web of Science and two trial registries. We will impose no language restrictions. Two authors will independently screen titles, abstracts and full-text articles for eligibility of studies, and subsequently extract data. Two authors will independently assess the risk of bias of each study using the Quality in Prognostic Studies (QUIPS) tool. If possible, we will carry out a meta-analysis to provide a pooled prognostic effect estimate for each outcome. We will use the Grading of Recommendations Assessment, Development and Evaluation system to assess the quality of evidence.

Ethics and dissemination

Ethical approval will not be required. Findings from this review will be reported in a peer-reviewed scientific journal. Additionally, the results will be disseminated at conferences and in the mass media.

PROSPERO registration number

CRD42019145054.
The European mistletoe (Viscum albumL.): distribution, host range, biotic interactions, and management worldwide with special emphasis on Ukraine
Authors: Krasylenko Yuliya , Sosnovsky Yevhen , Atamas Natalia , Popov Grigory , Leonenko Volodymyr , Janošíková Kateřina , Sytschak Nadiya , Rydlo Karol , Sytnyk Dmytro
Published: May 2020

The hemiparasitic European mistletoe, Viscum album L. (Viscaceae), displays a rapid and remarkable expansion into natural and urban ecosystems in Ukraine. The monitoring and management of this quickly spreading species is becoming increasingly difficult as new plant species become hosts. Unlike other local mistletoe species, the European mistletoe has a broad distribution and thus requires a countrywide pest status assessment for control. This review outlines the major taxonomic and evolutionary issues pertinent to V. album with an emphasis on the characters used to distinguish its five currently recognized subspecies. The review also provides an updated distribution map and host range for the three V. album subspecies in Ukraine [V. album subsp. album, V. album subsp. abietis (Wiesb.) Janch., and V. album subsp. austriacum (Wiesb.) Vollm.], addressing the current knowledge of their biology and ecology. A significant portion of the paper is devoted to the diversity of organisms associated with V. album, including herbivores, endophytes, and parasites, drawing particular attention to major pollination and dispersal vectors, as well as potential biocontrol agents for this mistletoe species.
Syntheses, theoretical studies, and crystal structures of[Ni(II)SSRRL](PF6)2and[Ni(II)SRSRL](Cl)(PF6)that contains anagostic interactions
Authors: Bainbridge Peyton C. , Luck Rudy L. , Newberry Nick K.
Published: May 2020

The syntheses of two square planar nickel complexes containing the condensation and subsequently reduced products obtained by reacting [Ni(en)3](BF4)2and acetone are reported. The complexes 5,5,7,12,12,14-hexamethyl-1(S),4(S),8(R),11(R)-tetraazacyclotetradecane-nickel(II)[PF6]2and 5,5,7,12,12,14-hexamethyl-1(S),4(R),8(S),11(R)-tetraazacyclotetradecane-nickel(II)[Cl][PF6] labelled as [Ni(II)SSRRL](PF6)2and [Ni(II)SRSRL](Cl)(PF6), respectively, were found to have slightly different solubilities that allowed for their purification. The complexes were characterized by FTIR,1H NMR, and UV–vis spectra. Redox potentials, determined by cyclic voltammetry, established that [Ni(II)SSRRL](PF6)2exhibits a reversible oxidation (E1/2(ox) = 0.85 V) and reduction (E1/2(red) = −1.59 V), whereas [Ni(II)SRSRL](Cl)(PF6) displays an irreversible oxidation (Epa(ox) = 1.37 V) and reversible reduction (E1/2(red) = −1.62 V) relative to the ferrocene couple at 0.0 V. Single crystal X-ray determinations established that one of the compounds, [Ni(II)SSRRL](PF6)2, contained two [Formula: see text] anions, whereas the other compound, [Ni(II)SRSRL](Cl)(PF6), contained one Cl−and one [Formula: see text] anion. In the solid state, compound [Ni(II)SSRRL](PF6)2was held together by H-bonds between H atoms on the Ni containing dication and F atoms in the [Formula: see text] anion. Compound [Ni(II)SRSRL](Cl)(PF6) crystallized in the form of dimers held together by interactions between H atoms attached to N atoms on adjacent cations binding to two Cl−anions in the middle with these dimers held together by further H-bonding to interstitial [Formula: see text] anions. Complex [Ni(II)SRSRL](Cl)(PF6) was found to contain anagostic interactions on the bases of NMR (downfield shift in C–H protons) and structural data (2.3 < d(H-Ni)< 2.9 Å), as well as theoretical calculations.