bluuebunny/crossref_metadata_2025 huggingface dataset:
The value of time in the invigoration of human movements when interacting with a robotic exoskeleton
Authors: Verdel Dorian , Bruneau Olivier , Sahm Guillaume , Vignais Nicolas , Berret Bastien
Published: September 2023

Time and effort are thought to be subjectively balanced during the planning of goal-directed actions, thereby setting the vigor of volitional movements. Theoretical models predicted that the value of time should then amount to high levels of effort. However, the time-effort trade-off has so far only been studied for a narrow range of efforts. To investigate the extent to which humans can invest in a time-saving effort, we used a robotic exoskeleton to substantially vary the energetic cost associated with a certain vigor during reaching movements. In this situation, minimizing the time-effort trade-off should lead to high and low human efforts for upward and downward movements, respectively. Consistently, all participants expended substantial amounts of energy upward and remained essentially inactive by harnessing the work of gravity downward, while saving time in both cases. A common time-effort trade-off may therefore determine the vigor of reaching movements for a wide range of efforts.
Ultrathin membranes to sieve gases
Authors: Yang Ziqi , Zhao Dan
Published: September 2023

Mixed-matrix membranes could enable gas separation for carbon capture
A regional approach to save the Amazon
Authors: Peña-Claros Marielos , Nobre Carlos
Published: September 2023

Early in August this year, a high-profile summit was held in Belém, Brazil, where the eight Amazonian countries discussed the future of the Amazon. The nations recognized that the Amazon is very close to reaching a tipping point for turning into a degraded ecosystem. The result of their discussions was the Belém Declaration, an ambitious plan to protect and conserve the Amazon forests and to support Indigenous Peoples and local communities. Concern arose, however, because they failed to agree on attaining zero deforestation by 2030 and on avoiding new explorations in the Amazon for fossil fuel. The Declaration also lacks specific and measurable indicators. The ministers of Foreign Affairs therefore have a very important role in further refining the agenda and deadlines so that the Belém Declaration can be implemented.
Bacterial respiratory inhibition triggers dispersal of
Pseudomonas aeruginosa
biofilms
Authors: Zemke Anna C. , D'Amico Emily J. , Torres Angela M. , Carreno-Florez Grace P. , Keeley Patrick , DuPont Matt , Kasturiarachi Naomi , Bomberger Jennifer M.
Published: September 2023

Pseudomonas aeruginosa
grows as a biofilm under many environmental conditions, and the bacterium can disperse from biofilms via highly regulated, dynamic processes. However, physiologic triggers of biofilm dispersal remain poorly understood. Based on prior literature describing dispersal triggered by forms of starvation, we tested bacterial respiratory inhibitors for biofilm dispersal in two models resembling chronic airway infections. Our underlying hypothesis was that respiratory inhibitors could serve as a model for the downstream effects of starvation. We used two experimental conditions. In the first condition, biofilms were grown and dispersed from the surface of airway epithelial cells, and the second condition was a model where biofilms were grown on glass in cell culture media supplemented with host-relevant iron sources. In both biofilm models, the respiratory inhibitors potassium cyanide and sodium azide each triggered biofilm dispersal. We hypothesized that cyanide-induced dispersal was due to respiratory inhibition rather than signaling via an alternative mechanism, and, indeed, if respiration was supported by overexpression of cyanide-insensitive oxidase, dispersal was prevented. Dispersal required the activity of the cyclic-di-GMP regulated protease LapG, reinforcing the role of matrix degradation in dispersal. Finally, we examined the roles of individual phosphodiesterases, previously implicated in dispersal to specific triggers, and found signaling to be highly redundant. Combined deletion of the phosphodiesterases
dipA
,
bifA
, and
rbdA
was required to attenuate the dispersal phenotype. In summary, this work adds insight into the physiology of biofilm dispersal under environmental conditions in which bacterial respiration is abruptly limited.

IMPORTANCE

The bacterium
Pseudomonas aeruginosa
grows in biofilm communities that are very difficult to treat in human infections. Growing as a biofilm can protect bacteria from antibiotics and the immune system. Bacteria can leave a biofilm through a process called “dispersal.” Dispersed bacteria seed new growth areas and are more susceptible to killing by antibiotics. The triggers for biofilm dispersal are not well understood, and if we understood dispersal better it might lead to the development of new treatments for infection. In this paper, we find that inhibiting
P. aeurginosa’s
ability to respire (generate energy) can trigger dispersal from a biofilm grown in association with human respiratory epithelial cells in culture. The dispersal process requires a protease which is previously known to degrade the biofilm matrix. These findings give us a better understanding of how the biofilm dispersal process works so that future research can discover better ways of clearing bacteria growing in biofilms.
TamAB is regulated by PhoPQ and functions in outer membrane homeostasis during
Salmonella
pathogenesis
Authors: Ramezanifard Rouhallah , Golubeva Yekaterina A. , Palmer Alexander D. , Slauch James M.
Published: September 2023

Salmonella
survive and replicate in macrophages, which normally kill bacteria by exposing them to a variety of harsh conditions and antimicrobial effectors, many of which target the bacterial cell envelope. The PhoPQ two-component system responds to the phagosome environment and induces factors that protect the outer membrane, allowing adaptation and growth in the macrophage. We show that PhoPQ induces the transcription of the
tamAB
operon both
in vitro
and in macrophages. The TamA protein is structurally similar to BamA, an essential protein in the Bam complex that assembles β-barrel proteins in the outer membrane, while TamB is an AsmA-family protein implicated in lipid transport between the inner and outer membranes. We show that the Bam machinery is stressed
in vitro
under low Mg
2+
, low pH conditions that mimic the phagosome. Not surprisingly, mutations affecting Bam function confer significant virulence defects. Although loss of TamAB alone confers no virulence defect, a
tamAB
deletion confers a synthetic phenotype in
bam
mutant backgrounds in animals and macrophages, and
in vitro
upon treatment with vancomycin or sodium dodecyl sulfate. Mutations affecting YhdP, which functions in partial redundancy with TamB, also confer synthetic phenotypes with
bam
mutations in the animal, but this interaction is not evident
in vitro
. Thus, in the harsh phagocytic environment of the macrophage, the outer membrane Bam machinery is compromised, and the TamAB system, and perhaps other PhoPQ-regulated factors, is induced to compensate. It is most likely that TamAB and other systems assist the Bam complex indirectly by affecting outer membrane properties.

IMPORTANCE

The TamAB system has been implicated in both outer membrane protein localization and phospholipid transport between the inner and outer membranes. We show that the β-barrel protein assembly complex, Bam, is stressed under conditions thought to mimic the macrophage phagosome. TamAB expression is controlled by the PhoPQ two-component system and induced in macrophages. This system somehow compensates for the Bam complex as evidenced by the fact that mutations affecting the two systems confer synthetic phenotypes in animals, macrophages, and
in vitro
in the presence of vancomycin or SDS. This study has implications concerning the role of TamAB in outer membrane homeostasis. It also contributes to our understanding of the systems necessary for
Salmonella
to adapt and reproduce within the macrophage phagosome.
Multicenter performance evaluation of the Alinity m CMV assay for quantifying cytomegalovirus DNA in plasma samples
Authors: Lee Miae , Albert Eliseo , Wessels Els , Kim Soo-Kyung , Chung Hae-Sun , Giménez Estela , Vreeswijk Tom , Claas Eric C. J. , Tai Yan Chin , Reinhardt Birgit , Sasaki Mark M. , Navarro David
Published: September 2023

Monitoring of cytomegalovirus (CMV) viral load is critical for informing treatment decisions in order to prevent the severe health consequences of CMV infection or reactivation of latent CMV in immunocompromised individuals. This first field evaluation examined the analytical and clinical performance of the Alinity m CMV assay. Analytical performance was assessed with a commercially available six-member panel, while the clinical performance evaluation compared the Alinity m CMV assay to the RealTi
m
e CMV assay and a laboratory-developed test (LDT) as the test of record at three large hospital-based clinical laboratories. Precision of the Alinity m CMV assay was demonstrated with total standard deviation (SD) between 0.08 and 0.28 Log IU/mL. A total of 457 plasma specimens were tested on the Alinity m CMV assay and compared to the test of record at each site (
n
= 304 with RealTi
m
e CMV and
n
= 153 with LDT CMV). The Alinity m CMV assay had excellent correlation (correlation coefficient
r
≥0.942) in comparison to the RealTi
m
e CMV or LDT CMV assays. The mean observed bias ranged from −0.03 to 0.34 Log IU/mL. Median onboard turnaround time of Alinity m CMV was less than 3 h. When the CMV assay is run on the Alinity m system, it has the capacity to shorten time to result and, therefore, to therapy.
A head-to-head comparison of three MALDI-TOF mass spectrometry systems with 16S rRNA gene sequencing
Authors: Dichtl Karl , Klugherz Isabel , Greimel Hanna , Luxner Josefa , Köberl Julian , Friedl Simone , Steinmetz Ivo , Leitner Eva
Published: September 2023

Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) has revolutionized diagnostics in culture-based microbiology. Commonly used MALDI-TOF MS systems in clinical microbiology laboratories are MALDI Biotyper (Bruker Daltonics) and Vitek MS (bioMérieux), but recently the new EXS2600 (Zybio) has been launched. This study aimed to evaluate the performance of the three devices by comparing the results to 16S rRNA gene sequencing. A set of 356 previously collected difficult-to-identify bacteria was tested in parallel with the three systems. Only the direct smear method and simple formic acid extraction were applied. Valid results were achieved for 98.6%, 94.4%, and 93.3% of all isolates by MALDI Biotyper, EXS2600, and Vitek MS, respectively. Of all valid results, agreement with sequencing data was achieved in 98.9%, 98.5%, and 99.7% by MALDI Biotyper, EXS2600, and Vitek MS, respectively. Considering only the isolates with valid measurements at the single-species level, misidentification rates were 0%, 2.6%, and 1.1% for MALDI Biotyper, EXS2600, and Vitek MS, respectively. Apart from minor performance differences, our data demonstrate that the three systems provide comparable results and are suitable for use in medical diagnostic laboratories.
The morphogenic protein CopD controls the spatio-temporal dynamics of PBP1a and PBP2b in
Streptococcus pneumoniae
Authors: Lenoir Cassandra , Pelletier Anaïs , Manuse Sylvie , Millat Hugo , Ducret Adrien , Galinier Anne , Doan Thierry , Grangeasse Christophe
Published: September 2023

Penicillin-binding proteins (PBPs) are key to the assembly of peptidoglycan, the major component of the bacterial cell wall. Although several PBP-specific regulatory proteins have been identified in different species, little is known about how the activity of PBPs is controlled and coordinated during the cell cycle. In this study, we characterize the unknown function protein Spr1400 and demonstrate its regulatory function on two PBPs in
Streptococcus pneumoniae
. For that, we use a combination of technics ranging from bacterial genetics and protein biochemistry to microscopy imaging. First, we show that pneumococcal Spr1400 localizes late to the cell division septum. Furthermore, deletion of
spr1400
results in wider cells. Using co-immunoprecipitation and bacterial two hybrid (B2H), we observe that Spr1400 interacts with two PBPs, the class A PBP PBP1a and the class B PBP PBP2b, which are required for cell elongation. Microscale thermophoresis combined with B2H further reveals that these interactions occur through their transmembrane domains. We also show that Spr1400 co-localizes with PBP1a and PBP2b throughout the cell cycle. Strikingly, deletion of
spr1400
alters the dynamics of PBP1a and PBP2b. Indeed, the two PBPs persist longer at the division site and localize later at the division site of daughter cells. Collectively, these data demonstrate that Spr1400, thus named CopD for
c
oordinator
o
f
P
BP1a and 2b
d
ynamics, is a spatio-temporal regulator of PBP1a and PBP2b required for pneumococcal morphogenesis.

IMPORTANCE

Penicillin-binding proteins (PBPs) are essential for proper bacterial cell division and morphogenesis. The genome of
Streptococcus pneumoniae
encodes for two class B PBPs (PBP2x and 2b), which are required for the assembly of the peptidoglycan framework and three class A PBPs (PBP1a, 1b and 2a), which remodel the peptidoglycan mesh during cell division. Therefore, their activities should be finely regulated in space and time to generate the pneumococcal ovoid cell shape. To date, two proteins, CozE and MacP, are known to regulate the function of PBP1a and PBP2a, respectively. In this study, we describe a novel regulator (CopD) that acts on both PBP1a and PBP2b. These findings provide valuable information for understanding bacterial cell division. Furthermore, knowing that ß-lactam antibiotic resistance often arises from PBP mutations, the characterization of such a regulator represents a promising opportunity to develop new strategies to resensitize resistant strains.
VirB, a key transcriptional regulator of
Shigella
virulence, requires a CTP ligand for its regulatory activities
Authors: Gerson Taylor M. , Ott Audrey M. , Karney Monika M. A. , Socea Jillian N. , Ginete Daren R. , Iyer Lakshminarayan M. , Aravind L. , Gary Ronald K. , Wing Helen J.
Published: September 2023

The VirB protein, encoded by the large virulence plasmid of
Shigella
spp., is a key transcriptional regulator of virulence genes. Without
virB
,
Shigella
cells are avirulent. On the virulence plasmid, VirB functions to offset transcriptional silencing mediated by the nucleoid structuring protein, H-NS, which binds and sequesters AT-rich DNA, making it inaccessible for gene expression. Thus, gaining a mechanistic understanding of how VirB counters H-NS-mediated silencing is of considerable interest. VirB is unusual in that it does not resemble classic transcription factors. Instead, its closest relatives are found in the ParB superfamily, where the best-characterized members function in faithful DNA segregation before cell division. Here, we show that VirB is a fast-evolving member of this superfamily and report for the first time that the VirB protein binds a highly unusual ligand, CTP. VirB binds this nucleoside triphosphate preferentially and with specificity. Based on alignments with members of the ParB family, we identify amino acids of VirB likely to bind CTP. Substitutions in these residues disrupt several well-documented activities of VirB, including its anti-silencing activity, its ability to generate a Congo red positive phenotype, and the ability of the VirB protein to form foci in the bacterial cytoplasm when fused to GFP. Although stably produced, our CTP binding mutants do not bind DNA
in vivo
, likely explaining these phenotypes. Thus, this work is the first to show that VirB is a bona fide CTP-binding protein, links
Shigella
virulence phenotypes to the nucleoside triphosphate CTP, and provides novel insight into VirB-CTP-DNA interactions.

IMPORTANCE

Shigella
species cause bacillary dysentery, the second leading cause of diarrheal deaths worldwide. There is a pressing need to identify novel molecular drug targets.
Shigella
virulence phenotypes are controlled by the transcriptional regulator, VirB. We show that VirB belongs to a fast-evolving, plasmid-borne clade of the ParB superfamily, which has diverged from versions with a distinct cellular role—DNA partitioning. We report that, like classic members of the ParB family, VirB binds a highly unusual ligand, CTP. Mutants predicted to be defective in CTP binding are compromised in a variety of virulence attributes controlled by VirB, likely because these mutants cannot engage DNA. This study (i) reveals that VirB binds CTP, (ii) provides a link between VirB-CTP interactions and
Shigella
virulence phenotypes, (iii) provides new insight into VirB-CTP-DNA interactions, and (iv) broadens our understanding of the ParB superfamily, a group of bacterial proteins that play critical roles in many bacteria.
GraS signaling in
Staphylococcus aureus
is regulated by a single D35 residue in the extracellular loop
Authors: Cho Junho , Manna Adhar C. , Snelling Helah S. , Cheung Ambrose L.
Published: September 2023

Bacterial two-component systems are crucial features of bacterial pathogens such as methicillin-resistant
Staphylococcus aureus
to overcome environmental and antimicrobial stresses by activating regulons to interfere with the bactericidal mechanisms. GraRS is a unique subset of two-component systems belonging to the intramembrane-sensing histidine kinase family (IM-HK) and is responsible for resistance to cationic host defense peptides. However, the precise manner by which the short 9-residue extracellular loop of the membrane sensor GraS detects the antimicrobial peptides and transduces the signal is not comprehensively understood. Here, we show that a single point mutation (D35A) in the extracellular loop of GraS blocked activation of GraRS, but this effect was also abrogated with
graS
mutations in the N-terminal transmembrane segments without any accompanying effect on GraS protein expression. Additionally, mutations in H120 and T172 in the dimerization/histidine phosphotransfer (DHp) domain of GraS increased activation without any accompanying enhancement in dimerization, likely due to disruption of the H120-T172 interaction that restricts rotational movements of the DHp helices since swapping H120 and T172 did not alter GraS activation. Notably, the enhancing effects of H120 and T172 mutations were abolished with a D35 mutation, highlighting the pivotal role of D35 in the 9-residue extracellular loop of GraS in GraR phosphorylation. In summary, our study delivers the significance of the D35 in the extracellular loop of GraS and ensuing changes in the N-terminal transmembrane helices as a model to illustrate signaling in the IM-HK subset of two-component regulatory systems.

IMPORTANCE

Methicillin-resistant
Staphylococcus aureus
(MRSA) is a human pathogen capable of infecting skin, blood, internal organs, and artificial medical devices. Generally, personal hygiene and a robust immune system can limit the spread of this pathogen; however, MRSA possesses an assortment of phenotypic tools to survive the hostile host environment including host defense peptides. More specifically,
S. aureus
utilizes two-component systems to sense noxious environmental cues to respond to harmful environmental elements. Our study focused on a two-component system called GraRS that
S. aureus
deploys against host defense peptides. We showed that one single residue in the extracellular loop of GraS and the adjacent membrane segment controlled the activation of GraRS, indicating the importance of a well-tuned-charged residue in the extracellular loop of GraS for sensing activity.
Westward underthrusting of thick North American crust: The dominant thickening process that built the Cordilleran orogenic plateau
Authors: Long Sean P.
Published: September 2023

Quantification of the crustal thickening processes that construct orogenic plateaus is essential for interpreting their genesis. In the North American Cordillera, a 2.75–3.5-km-elevation, 200–250-km-wide plateau was constructed to the west of the Cretaceous–Paleogene Sevier fold-and-thrust belt (SFTB). The SFTB deformed a Mesoproterozoic to Mesozoic sedimentary package that thickened westward from a 2–3-km-thick platform section that was deposited above the ~40-km-thick craton to a 15–25-km-thick continental margin section that was deposited above middle to lower crust that had been significantly thinned during Neoproterozoic rifting. Shortening in the SFTB translated this thick sedimentary package as much as 265 km eastward, which resulted in the relative westward underthrusting of an equivalent length of thick cratonic basement beneath the hinterland region. Measurement of components of thickening with respect to the initial and final crustal thickness above and below the basal thrust décollement demonstrates that thickening accommodated by underthrusting outweighed thickening in the overlying SFTB by a factor of 1.5–3 and was likely the dominant thickening mechanism that constructed the broad hinterland plateau. In eastern Nevada, the reconstructed western edge of the underthrusted craton underlies the western limit of 2.75–3.5 km paleoelevations, which supports this interpretation. This analysis provides an important case study for underthrusting as a first-order thickening process in fold-and-thrust systems that deform sedimentary packages with a high pre-orogenic taper.
Pedal acrometastasis secondary to urothelial carcinoma masquerading as Charcot arthropathy in a patient with diabetes
Authors: Coe Calvin , Chirputkar Kedar , Joseph Leena , Jude Edward B
Published: September 2023

A woman in her 80s with known diabetes mellitus and bladder cancer presented to her general practitioner (GP) with pain and swelling in her left foot following trauma. Initial radiographs were reported as normal, prompting a diagnosis of a simple sprain and conservative management. Three months later, the patient was referred to the orthopaedic team due to progressively increasing pain and swelling. Repeat X-rays revealed lytic lesions in both the talus and navicular bones; MRI confirmed the presence of a lytic and proliferative defect in the mid-foot, which was reported as acute Charcot arthropathy with superimposed infection. This was also considered the most likely diagnosis when imaging was reviewed in two separate multidisciplinary team) meetings. However, biopsy demonstrated that the cause of the presentation was in fact acrometastasis from urothelial carcinoma, an infrequently described entity.
Primary malignant melanoma of the gall bladder masquerading as xanthogranulomatous cholecystitis
Authors: Kumar Kaushlendra , Zaidi Ariba , Husain Nuzhat , Chandra Abhijit
Published: September 2023

Malignant melanoma of the gall bladder is rare. Most cases are metastatic and primary gall bladder melanoma is even more rare. We report a case of primary malignant melanoma of the gall bladder which illustrates the diagnostic challenge posed by this condition. Histopathology and immunohistochemistry play a pivotal role in making a diagnosis and ruling out conditions which mimic it such as xanthogranulomatous cholecystitis and other relatively common epithelial malignancies. We tested for prognostic and predictive markers including BRAF and PD-L1 and immunohistochemistry showed positive staining for BRAF. The tumour cells expressed HMB-45 and were negative for cytokeratin and CD68, favouring a diagnosis of malignant melanoma and excluding the possibility of xanthogranulomatous cholecystitis and carcinoma. On follow-up at 3 months there was no evidence of recurrence of metastasis.
Primary cardiac angiosarcoma presenting with haemoptysis
Authors: Tolentino-de la Mora Abraham , Verdugo-Carrión Zoila Elizabeth , Vázquez-Castro Roger Alexis , Vega-Barrientos Ricardo
Published: September 2023

A male patient in his 30s presented to the emergency room with a 1-week history of dyspnoea that progressed to haemoptysis, having coughed up approximately 200 mL of blood on two occasions. On diagnostic investigation, a mediastinal tumour infiltrating the free wall of the right atrium and multiple pulmonary nodules were discovered. The first suspicion was a neoplasm of pulmonary origin, and a bronchoscopy was performed, histology reported a probable cardiac origin for the neoplasm. A subsequent biopsy confirmed the presence of a primary cardiac angiosarcoma. An extension CT scan revealed brain metastases. The patient received chemotherapy treatment, resulting in a partial response to date. This case is one of the few reported instances of cardiac neoplasm presenting with respiratory symptoms.
The 2022 Summer record-breaking heatwave and health information-seeking behaviours: an infodemiology study in Mainland China
Authors: Li Zhiwei , Fan Yinguang , Su Hong , Xu Zhiwei , Ho Hung Chak , Zheng Hao , Tao Junwen , Zhang Yunquan , Hu Kejia , Hossain Mohammad Zahid , Zhao Qi , Huang Cunrui , Cheng Jian
Published: September 2023

Introduction

Heatwave is a major global health concern. Many countries including China suffered a record-breaking heatwave during the summer of 2022, which may have a significant effect on population health or health information-seeking behaviours but is yet to be examined.

Methods

We derived health information-seeking data from the Baidu search engine (similar to Google search engine). The data included city-specific daily search queries (also referred to Baidu Search Index) for heat-sensitive diseases from 2021 to 2022, including heatstroke, hospital visits, cardiovascular diseases and diabetes, respiratory diseases, mental health and urological diseases. For each city, the record-breaking heatwave days in 2022 were matched to days in the same calendar month in 2021.

Results

The 2022 record-breaking heatwave hit most cities (83.64%) in Mainland China. The average heatwave duration was 13 days and the maximum temperature was 3.60°C higher than that in 2021 (p<0.05). We observed increased population behaviours of seeking information on respiratory diseases (RR=1.014, 95% CI: 1.008 to 1.020), urological diseases (RR=1.011, 95% CI: 1.006 to 1.016) and heatstroke (RR=1.026, 95% CI: 1.016 to 1.036) associated with the heatwave intensity in 2022 (per 1°C increase). The heatwave duration in 2022 (per 1 day increase) was also associated with an increase in seeking information on cardiovascular diseases and diabetes (RR=1.003, 95% CI: 1.002 to 1.004), urological diseases (RR=1.005, 95% CI: 1.002 to 1.008), mental health (RR=1.009, 95% CI: 1.006 to 1.012) and heatstroke (RR=1.038, 95% CI: 1.032 to 1.043). However, there were substantial geographical variations in the effect of the 2022 heatwave intensity and duration on health information-seeking behaviours.

Conclusion

This infodemiology study suggests that the 2022 summer unprecedented heatwave in Mainland China has significantly increased population demand for health-related information, especially for heatstroke, urological diseases and mental health. Population-based research of real-time disease data is urgently needed to estimate the negative health impact of the exceptional heatwave in Mainland China and elsewhere.
Adult mortality trends in Matlab, Bangladesh: an analysis of cause-specific risks
Authors: Ahmed Ali , Nahian Mahin Al , Rahman Md Mahabubur , Alam Nurul , Nahar Quamrun , Streatfield Peter Kim , Haider M Moinuddin , Rahman Mizanur
Published: September 2023

Objective

With socioeconomic development, improvement in preventing and curing infectious diseases, and increased exposure to non-communicable diseases (NCDs) risk factors (eg, overweight/obesity, sedentary lifestyle), the majority of adult deaths in Bangladesh in recent years are due to NCDs. This study examines trends in cause-specific mortality risks using data from the Matlab Health and Demographic Surveillance System (HDSS).

Design, settings and participants

We conducted a follow-up study from 2003 to 2017 using data from Matlab HDSS, which covers a rural population of 0.24 million (in 2018) in Chandpur, Bangladesh. HDSS assessed the causes of all deaths using verbal autopsy and classified the causes using the 10th revision of the International Statistical Classification of Diseases. We examined 19 327 deaths involving 2 279 237 person-years.

Methods

We calculated annual cause-specific mortality rates and estimated adjusted proportional HRs using a Cox proportional hazards model.

Results

All-cause mortality risk declined over the study period among people aged 15 and older, but the risk from stroke increased, and from heart disease and cancers remained unchanged. These causes were more common among middle-aged and older people and thus bore the most burden. Mortality from causes other than NCDs—namely, infectious and respiratory diseases, injuries, endocrine disorders and others—declined yet still constituted over 30% of all deaths. Thus, the overall mortality decline was associated with the decline of causes other than NCDs. Mortality risk sharply increased with age. Men had higher mortality than women from heart disease, cancers and other causes, but not from stroke. Lower household wealth quintile people have higher mortality than higher household wealth quintile people, non-Muslims than Muslims.

Conclusion

Deaths from stroke, heart disease and cancers were either on the rise or remained unchanged, but other causes declined continuously from 2003 to 2017. Immediate strengthening of the preventive and curative healthcare systems for NCDs management is a burning need.
Quality of care from the perspective of people obtaining abortion: a qualitative study in four countries
Authors: Baum Sarah E , Jacobson Laura , Ramirez Ana Maria , Katz Anna , Grosso Belen , Bercu Chiara , Pearson Erin , Gebrehanna Ewenat , Chakraborty Nirali M , Dirisu Osasuyi , Chowdhury Rezwana , Zurbriggen Ruth , Filippa Sofia , Tabassum Tanzila , Gerdts Caitlin
Published: September 2023

Objective

This qualitative study aimed to identify person-centred domains that would contribute to the definition and measurement of abortion quality of care based on the perceptions, experiences and priorities of people seeking abortion.

Methods

We conducted interviews with people seeking abortion aged 15–41 who obtained care in Argentina, Bangladesh, Ethiopia or Nigeria. Participants were recruited from hospitals, clinics, pharmacies, call centres and accompaniment models. We conducted thematic analysis and quantified key domains of quality identified by the participants.

Results

We identified six themes that contributed to high-quality abortion care from the clients’ perspective, with particular focus on interpersonal dynamics. These themes emerged as participants described their abortion experience, reflected on their interactions with providers and defined good and bad care. The six themes included (1) kindness and respect, (2) information exchange, (3) emotional support, (4) attentive care throughout the process, (5) privacy and confidentiality and (6) prepared for and able to cope with pain.

Conclusions

People seeking abortion across multiple country contexts and among various care models have confirmed the importance of interpersonal care in quality. These findings provide guidance on six priority areas which could be used to sharpen the definition of abortion quality, improve measurement, and design interventions to improve quality.
Does the advertisement in Swiss pharmacy windows rest on evidence-based medicine? An observational study
Authors: Känzig Tanja , Potterat Melisa , Corpataux Thibault , Ackermann Simone Daniele , Chaix Edouard , Gibilisco Andrea , Portmann Aurelia , Roberts Judith , Schaller Amandine , Wenger Nicolas , Wolffers Oliver , Beguelin Charles , Genne Daniel
Published: September 2023

Objectives

The aim of the study was to analyse the proportion of evidence-based medication displayed in pharmacies and compare it between the different linguistic regions of the country, at different times of the year to determine the amount of proven effective medications indirectly recommended to the public in different parts of Switzerland.

Design

This is an observational study conducted by medical doctors in the department of internal medicine at the Spitalzentrum Biel, Switzerland.

Setting

The observation took place from July 2019 to May 2020. From a total of 1800 pharmacies in Switzerland, 68 different pharmacies were selected across the 3 main linguistic regions and the medication on display in their windows were examined 4 times a year regarding their efficacy. The displays of medication with or without evidence-based efficacy were described using absolute numbers and proportions and compared between the different linguistic regions at different seasons using χ2.

Participants

There were no human or animal participants involved in this study.

Primary and secondary outcome measures

The primary outcome is the proportion of medication displayed in pharmacy windows with a proven effectiveness in medical literature. The secondary outcome was the variability of the primary outcome over time (seasonal changes), over the different linguistic regions of Switzerland and between chains and privately owned pharmacies.

Results

We examined 970 medications and found that over the whole year, there is a high proportion of non-evidence-based drugs (56,9%) displayed in pharmacies. Swiss German cantons display significantly more non-evidence-based medications in winter. We found no statistical difference for other seasons or between chains and privately owned pharmacies.

Conclusion

Pharmacies in Switzerland tend to display significantly more non-evidence-based drugs, thus indirectly recommending them to the public. In a time of necessary expansion of self-medication by the population, this could incite consumers to buy drugs without proven effectiveness.
Mapping the range of policies relevant to care of small and nutritionally at-risk infants under 6 months and their mothers in Ethiopia: a scoping review protocol
Authors: McGrath Marie , Woldie Mirkuzie , Berhane Melkamu , Abera Mubarek , Hailu Endashaw , Rana Ritu , Lanyero Betty , Grijalva-Eternod Carlos , Abdissa Alemseged , Girma Tsinuel , Kerac Marko , Smythe Tracey
Published: September 2023

Introduction

Evidence gaps limit management of small and/or nutritionally at-risk infants under 6 months and their mothers, who are at higher risk of death, illness, malnutrition and poor growth and development. These infants may be low birth weight, wasted, stunted and/or underweight. An integrated care model to guide their management (MAMI Care Pathway) is being tested in a randomised controlled trial in Ethiopia. Evaluating the extent to which an innovation is consistent with national policies and priorities will aid evidence uptake and plan for scale.

Methods and analysis

This review will evaluate the extent to which the MAMI Care Pathway is consistent with national policies that relate to the care of at-risk infants under 6 months and their mothers in Ethiopia. The objectives are to describe the range and characteristics, concepts, strategic interventions, coherence and alignment of existing policies and identify opportunities and gaps. It will be conducted in accordance with the JBI methodology for scoping reviews (PRISMA-ScR). Eligible documents include infant and maternal health, nutrition, child development, food and social welfare-related policies publicly available in English and Amharic. The protocol was registered on the Open Science Framework Registry on 20 June 2022 (https://osf.io/m4jt6).

Grey literature will be identified through government and agency websites, national and subnational contacts and Google Scholar, and published policies through electronic database searches (MEDLINE, EMBASE and Global and Health Information). The searches will take place between October 2023 and March 2024. A standardised data extraction tool will be used. Descriptive analysis of data will be undertaken. Data will be mapped visually and tabulated. Results will be described in narrative form. National stakeholder discussions will inform conclusions and recommendations.

Ethics and dissemination

Ethical approval is not required as data consist solely of publicly available material. Findings will be used to evidence national and international policy and practice.
Prevalence and impact of chronic dysglycaemia among patients with COVID-19 in Swedish intensive care units: a multicentre, retrospective cohort study
Authors: Balintescu Anca , Rysz Susanne , Hertz Carl , Grip Jonathan , Cronhjort Maria , Oldner Anders , Svensen Christer , Mårtensson Johan
Published: September 2023

Objective

Using glycated haemoglobin A1c (HbA1c) screening, we aimed to determine the prevalence of chronic dysglycaemia among patients with COVID-19 admitted to the intensive care unit (ICU). Additionally, we aimed to explore the association between chronic dysglycaemia and clinical outcomes related to ICU stay.

Design

Multicentre retrospective observational study.

Setting

ICUs in three hospitals in Stockholm, Sweden.

Participants

COVID-19 patients admitted to the ICU between 5 March 2020 and 13 August 2020 with available HbA1c at admission. Chronic dysglycaemia was determined based on previous diabetes history and HbA1c.

Primary and secondary outcomes

Primary outcome was the actual prevalence of chronic dysglycaemia (pre-diabetes, unknown diabetes or known diabetes) among COVID-19 patients. Secondary outcome was the association of chronic dysglycaemia with 90-day mortality, ICU length of stay, duration of invasive mechanical ventilation (IMV) and renal replacement therapy (RRT), accounting for treatment selection bias.

Results

A total of 308 patients with available admission HbA1c were included. Chronic dysglycaemia prevalence assessment was restricted to 206 patients admitted ICUs in which HbA1c was measured on all admitted patients. Chronic dysglycaemia was present in 82.0% (95% CI 76.1% to 87.0%) of patients, with pre-diabetes present in 40.2% (95% CI 33.5% to 47.3%), unknown diabetes in 20.9% (95% CI 15.5% to 27.1%), well-controlled diabetes in 7.8% (95% CI 4.5% to 12.3%) and uncontrolled diabetes in 13.1% (95% CI 8.8% to 18.5%). All patients with available HbA1c were included for the analysis of the relationship between chronic dysglycaemia and secondary outcomes. We found no independent association between chronic dysglycaemia and 90-day mortality, ICU length of stay or duration of IMV. After excluding patients with specific treatment limitations, no association between chronic dysglycaemia and RRT use was observed.

Conclusions

In our cohort of critically ill COVID-19 patients, the prevalence of chronic dysglycaemia was 82%. We found no robust associations between chronic dysglycaemia and clinical outcomes when accounting for treatment limitations.
Transdiagnostic MRI markers of psychopathology following traumatic brain injury: a systematic review and network meta-analysis protocol
Authors: Samiotis Alexia , Hicks Amelia J , Ponsford Jennie , Spitz Gershon
Published: September 2023

Introduction

Psychopathology following traumatic brain injury (TBI) is a common and debilitating consequence that is often associated with reduced functional and psychosocial outcomes. There is a lack of evidence regarding the neural underpinnings of psychopathology following TBI, and whether there may be transdiagnostic neural markers that are shared across traditional psychiatric diagnoses. The aim of this systematic review and meta-analysis is to examine the association of MRI-derived markers of brain structure and function with both transdiagnostic and specific psychopathology following moderate–severe TBI.

Methods and analysis

A systematic literature search of Embase (1974–2022), Ovid MEDLINE (1946–2022) and PsycINFO (1806–2022) will be conducted. Publications in English that investigate MRI correlates of psychopathology characterised by formal diagnoses or symptoms of psychopathology in closed moderate–severe TBI populations over 16 years of age will be included. Publications will be excluded that: (a) evaluate non-MRI neuroimaging techniques (CT, positron emission tomography, magnetoencephalography, electroencephalogram); (b) comprise primarily a paediatric cohort; (c) comprise primarily penetrating TBI. Eligible studies will be assessed against a modified Joanna Briggs Institute Critical Appraisal Instrument and data will be extracted by two independent reviewers. A descriptive analysis of MRI findings will be provided based on qualitative synthesis of data extracted. Quantitative analyses will include a meta-analysis and a network meta-analysis where there are sufficient data available.

Ethics and dissemination

Ethics approval is not required for the present study as there will be no original data collected. We intend to disseminate the results through publication to a high-quality peer-reviewed journal and conference presentations on completion.

PROSPERO registration number

CRD42022358358.
Implications of nicotine vaping products for tobacco control in ASEAN low-income and middle-income countries: in-depth interviews with experts from the region
Authors: Stubbs Thomas , White Victoria , Yong Hua-Hie , Toumbourou John W
Published: September 2023

Objectives

The use of nicotine vaping products (NVPs) has increased in low-income and middle-income countries (LMICs) in the Association of Southeast Asian Nations (ASEAN) region; however, it is uncertain what implications the presence and use of NVPs have for tobacco control.

Design

In-depth interviews were conducted to explore ASEAN tobacco control experts’ (n=11) views on the rise of NVP use in ASEAN LMICs, current NVP policies, the potential harm reduction and smoking cessation utilities of these devices, and what implications they may have for tobacco control. Data were analysed using inductive, reflexive thematic analysis.

Results

Five themes emerged: (1) NVPs threaten tobacco control in ASEAN LMICs; (2) commercial factors influence youth appeal and access: product attributes, marketing, supply chains; (3) opposition to the smoking cessation and harm reduction utilities of NVPs; (4) policies are inconsistent and fragmented in the region; and (5) tobacco industry power and tactics have been used to capture NVP markets.

Conclusions

ASEAN tobacco control experts believe that NVPs pose a threat to youth and non-smokers in LMICs in the region, largely because of tobacco industry NVP marketing activities. They do not support the use of NVPs for smoking cessation or harm reduction and call for more restrictions and consistent policy enforcement across the region to protect young people, while also cautiously recognising that use of NVPs may have some benefits for smokers.
Modelling the transmission of dengue, zika and chikungunya: a scoping review protocol
Authors: Romero-Leiton Jhoana P , Acharya Kamal Raj , Parmley Jane Elizabeth , Arino Julien , Nasri Bouchra
Published: September 2023

Introduction

Aedesmosquitoes are the primary vectors for the spread of viruses like dengue (DENV), zika (ZIKV) and chikungunya (CHIKV), all of which affect humans. Those diseases contribute to global public health issues because of their great dispersion in rural and urban areas. Mathematical and statistical models have become helpful in understanding these diseases’ epidemiological dynamics. However, modelling the complexity of a real phenomenon, such as a viral disease, should consider several factors. This scoping review aims to document, identify and classify the most important factors as well as the modelling strategies for the spread of DENV, ZIKV and CHIKV.

Methods and analysis

We will conduct searches in electronic bibliographic databases such as PubMed, MathSciNet and the Web of Science for full-text peer-reviewed articles written in English, French and Spanish. These articles should use mathematical and statistical modelling frameworks to study dengue, zika and chikungunya, and their cocirculation/coinfection with other diseases, with a publication date between 1 January 2011 and 31 July 2023. Eligible studies should employ deterministic, stochastic or statistical modelling approaches, consider control measures and incorporate parameters’ estimation or considering calibration/validation approaches. We will exclude articles focusing on clinical/laboratory experiments or theoretical articles that do not include any case study. Two reviewers specialised in zoonotic diseases and mathematical/statistical modelling will independently screen and retain relevant studies. Data extraction will be performed using a structured form, and the findings of the study will be summarised through classification and descriptive analysis. Three scoping reviews will be published, each focusing on one disease and its cocirculation/co-infection with other diseases.

Ethics and dissemination

This protocol is exempt from ethics approval because it is carried out on published manuscripts and without the participation of humans and/or animals. The results will be disseminated through peer-reviewed publications and presentations in conferences.
Antimicrobial photodynamic therapy with erythrosine and blue light on dental biofilm bacteria: study protocol for randomised clinical trial
Authors: Gonçalves Marcela Leticia Leal , Sobral Ana Paula Taboada , Gallo Juliana Maria Altavista Sagretti , Gimenez Thais , Ferri Elza Padilha , Ianello Sara , Motta Pamella de Barros , Motta Lara Jansiski , Horliana Anna Carolina Ratto Tempestini , Santos Elaine Marcílio , Bussadori Sandra Kalil
Published: September 2023

Introduction

The objective is to investigate the effect of antimicrobial photodynamic therapy (aPDT) mediated by erythrosine and a blue light-emitting diode (LED) in the reduction of bacteria in dental biofilm.

Methods and analysis

This clinical trial will be conducted with 30 patients who have biofilm, but without the presence of periodontal pockets, and who are being treated at the Dental Clinic of Universidade Metropolitana de Santos. A split-mouth model will be used (n=30), with group 1 control (conventional treatment) and group 2 (conventional treatment and aPDT). The bicarbonate jet will be used to remove dental biofilm in both groups. The treatment will be carried out in one session. aPDT will be performed before cleaning/prophylaxis, only in group 2. Participants will rinse with the photosensitiser erythrosine (diluted to 1 mM) for 1 min of pre-irradiation time, so that the drug can stain all the bacterial biofilm. Then, the D-2000 LED (DMC) will be applied, emitting at a wavelength of ʎ=470 nm, radiant power of 1000 mW, irradiance of 0.532 W/cm2and radiant exposure of 63.8 J/cm2. Irradiation will be performed until the biofilm of the cervical region is illuminated for 2 min/point (4 cm2). The microbiological examination will be performed from samples of supragingival biofilm collected from the gingival sulcus. Collection will be performed in each experimental site before irradiation, immediately after the irradiation procedure and after the prophylaxis. Colony-forming units will be counted and the data will be submitted for statistical analysis for comparison of pretreatment and post-treatment results and between groups (conventional X aPDT).

Ethics and dissemination

This study has been approved by the Ethics Committee of Universidade Metropolitana de Santosunder process number 66984123.0.0000.5509. Results will be published in peer-reviewed journals and will be presented at conferences.

Trial registration number

NCT05805761.