bluuebunny/crossref_metadata_2025 huggingface dataset:
Biomechanical comparison of screw and suture fixation for temporary transarticular tarsocrural immobilization in canine cadavers
Authors: Goffart Laura M. , Reif Ullrich , Hettlich Bianca F. , Kramer Martin
Published: September 2021

Objective

To biomechanically evaluate an ultrahigh–molecular‐weight polyethylene (UWMWPE) suture for temporary tarsocrural immobilization as a potential alternative to the existing surgical method, which uses a 4.5 AO/ASIF calcaneotibial cortical screw.

Study design

Randomized in vitro biomechanical study.

Animals

Pelvic limbs (n = 20) from 10 euthanized adult dogs (average bodyweight of 29.9 kg ± 1.9 kg).

Methods

Tarsocrural joints were immobilized either with a 4.5 AO/ASIF screw or a 1 mm diameter UHMWPE suture. Limbs were loaded with 60 N, 120 N, and 180 N, each for 100 cycles. After cyclic loading, immobilizations were loaded until failure. Load at failure and mode of failure were recorded.

Results

Both immobilization methods remained intact during loading with 60 N, 120 N, and 180 N. Mean and standard deviation (± SD) failure loads were higher for the cortical screw (524.9 N ± 148.7 N) than for the UHMWPE suture (387.8 N ± 105.6 N), P = .0084. The stiffness of both systems was equivalent.

Conclusion

Both techniques were suitable for transarticular tarsocrural immobilization in large‐breed canine cadavers. While load at failure was higher for the screw compared to the suture construct, stiffness of both methods was comparable based on the laboratory settings in this in vitro study.

Clinical significance

Based on the results of this study, both the cortical screw and the UHMWPE suture stabilized the tibiotarsal joint at clinically relevant loads. However, when exposed to high loads, the cortical screw provides increased tibiotarsal stability. Comparative data need to be collected prior to widespread use of UHMWPE sutures in clinical cases.
Nitrate‐rich beetroot juice ingestion reduces skeletal muscle O2 uptake and blood flow during exercise in sedentary men
Authors: Nyberg Michael , Christensen Peter M. , Blackwell Jamie R. , Hostrup Morten , Jones Andrew M. , Bangsbo Jens
Published: September 2021

Dietary nitrate supplementation has been shown to reduce pulmonary O2 uptake during submaximal exercise and enhance exercise performance. However, the effects of nitrate supplementation on local metabolic and haemodynamic regulation in contracting human skeletal muscle remain unclear. To address this, eight healthy young male sedentary subjects were assigned in a randomized, double‐blind, crossover design to receive nitrate‐rich beetroot juice (NO3, 9 mmol) and placebo (PLA) 2.5 h prior to the completion of a double‐step knee‐extensor exercise protocol that included a transition from unloaded to moderate‐intensity exercise (MOD) followed immediately by a transition to intense exercise (HIGH). Compared with PLA, NO3 increased plasma levels of nitrate and nitrite. During MOD, leg and leg blood flow (LBF) were reduced to a similar extent (∼9%–15%) in NO3. During HIGH, leg was reduced by ∼6%–10% and LBF by ∼5%–9% (did not reach significance) in NO3. Leg kinetics was markedly faster in the transition from passive to MOD compared with the transition from MOD to HIGH both in NO3 and PLA with no difference between PLA and NO3. In NO3, a reduction in nitrate and nitrite concentration was detected between arterial and venous samples. No difference in the time to exhaustion was observed between conditions. In conclusion, elevation of plasma nitrate and nitrate reduces leg skeletal muscle and blood flow during exercise. However, nitrate supplementation does not enhance muscle kinetics during exercise, nor does it improve time to exhaustion when exercising with a small muscle mass.

image

Key points

Dietary nitrate supplementation has been shown to reduce systemic O2 uptake during exercise and improve exercise performance.

The effects of nitrate supplementation on local metabolism and blood flow regulation in contracting human skeletal muscle remain unclear.

By using leg exercise engaging a small muscle mass, we show that O2 uptake and blood flow are similarly reduced in contracting skeletal muscle of humans during exercise.

Despite slower kinetics in the transition from moderate to intense exercise, no effects of nitrate supplementation were observed for kinetics and time to exhaustion.

Nitrate and nitrite concentrations are reduced across the exercising leg, suggesting that these ions are extracted from the arterial blood by contracting skeletal muscle.
Effect of Local Thermal Nonequilibrium on the Stability of the Flow in a Vertical Channel Filled With Nanofluid Saturated Porous Medium
Authors: Srinivasacharya D. , Barman Dipak
Published: September 2021

The stability of nanofluid flow in a vertical channel packed with a porous medium is examined for the local thermal nonequilibrium state of the fluid, particle, and solid–matrix phases. The effects of Brownian motion along with thermophoresis are incorporated in the nanofluid model. The Darcy–Brinkman model for the flow in a porous medium and three-field model, each representing the fluid, particle, and solid–matrix phases separately, for the temperature is used. A normal mode analysis is used to obtain the eigenvalue problem for the perturbed state, which is then solved using the Chebyshev spectral collocation technique. The critical Rayleigh number and corresponding wavenumber are presented graphically for the effect of different local thermal nonequilibrium parameters. It is noticed that the influence of local thermal nonequilibrium (LTNE) parameters on convective instability is significant.
Numerical Model for Heat Transfer Processes in Dry Ash Conveyors
Authors: Schmidt Thomas
Published: September 2021

The dry handling of bottom ash from coal-fired power plants has become more and more important in recent years due to a lack of water availability at the location of power plants or for environmental reasons. Hence, it is crucial that a sufficient cooling of the bottom ash can be ensured by the dry cooling air. In this work, a numerical model for the assessment of heat transfer processes in dry ash conveyors is developed and implemented via the software wolframmathematica. The model uses a newly introduced representative geometric quantity for ash particle geometry. In addition to the ash, cooling air is considered as an own phase for which a temperature solution is obtained. A numerical example, considering geometrical and operational data of an existing facility, shows that the main heat transfer between the ash and the cooling air takes place in the ash hopper, where convective heat transfer from ash to cooling air outweighs the effects from coke combustion and radiation from the boiler outlet area. The convective heat transfer in the ash hopper predominantly depends on the geometrical appearance, i.e., size and shape, of the particles, the grain density, as well as on the falling time/velocity. Conservatism of the calculation approach is indicated based on comparison of computed temperatures with measured data and literature values. The derived model can be used in future designs and projections of dry ash handling systems.
Entropy-Based Optimization for Heat Transfer Enhancement in Tubes With Helical Fins
Authors: Pidaparthi Bharath , Li Peiwen , Missoum Samy
Published: September 2021

In this work, a tube with internal helical fins is analyzed and optimized from an entropy generation point of view. Helical fins, in addition to providing heat transfer enhancements, have the potential to level the temperature of the tube under nonuniform circumferential heating. In this work, the geometric parameters of internal helical fins are optimized under two different entropy-based formulations. Specifically, the optimal design solution obtained through the minimization of total entropy is compared with the solutions from the multiobjective optimization of the thermal and viscous entropy contributions when considered as two separate objectives. The latter quantities being associated with heat transfer and pressure drops, it is shown that, from a design optimization point of view, it is important to separate both entropies which are conflicting objectives.
Design of a Surgical Pen-Type Probe for Real-Time Indocyanine Green Fluorescence Emission Diagnosis
Authors: Yoon Ki-Cheol , Kim Kwang Gi , Lee Seung Hoon
Published: September 2021

The advantage of handheld type surgical microscope is that the size of the probe is small and light, and that both the working distance (15–30 cm) and field of view (30 deg) can be adjusted. The shortness working distance will minimize the loss of light source energy. However, the currently developed handheld type surgical microscope is still large, heavy, and uses relatively high energy (600 mW/cm2). To address the aforementioned problems, this study aimed to develop a pen-type surgical fluorescence microscope that is compact, portable, and has an adjustable beam angle and working distance. These features enable real-time diagnosis. The pen-type probe consists of a laser diode, CMOS camera, light source brightness control device, filter, and power switch. The IR-cut filter inside the CMOS camera was removed to facilitate transmission of the fluorescence emission wavelength. In addition, a long-pass filter was attached to the camera so that the external light source was blocked and only the fluorescence emission wavelength was allowed to pass through. The performance of the pen-type probe was tested through a large animal experiment. Indocyanine green (2.5 mg/kg) was injected into a pig's vein. Fluorescence emission of 805-830 nm was achieved by irradiating an external light source (785 nm and 4 mW/cm2), and liver-uptake occurred after 2.4 min. The designed pen-type probe was capable of sufficiently fluorescence expression through low-energy irradiation, and the pen-type probe is small and light and easy to handle by hand because both the pen-based laser device and the camera device are integrated. In addition, it is easy to adjust the working distance and field of view.
An Experimental Investigation of Drilling Performance Improvement Using Reaming While Drilling
Authors: Roohi Abbas , Ashena Rahman , Thonhauser Gerhard , Finkbeiner Thomas , Gerbaud Laurent , Rasouli Vamegh
Published: September 2021

This work investigates the drilling performance by reaming while drilling (RWD) using a dual-body bit and compared it with conventional drilling by a standard drilling bit. The dual-body bit consisted of a 2.45-in. pilot bit located at a short distance ahead of a 2.47 × 3.97-in. reamer. Conducting a series of drilling experiments at a simulation drilling rig with full monitoring sensors, we further studied the drilling performance as a function of the distance between the pilot bit and the reamer. This distance is a greatly important parameter affecting mud diffusion and the resultant change in pore pressure and stress. A method was devised to eliminate the drill-string vibration and its effect on the drilling performance and the energy consumed. The mechanical-specific energy (MSE) calculated for each case was considered as a drilling performance indicator. Using two laboratory experiments as well as analytical thermo-poro-elastic calculations of the Mechanical Specific Energy (MSE), the MSE changes were monitored and recorded. Comparison of this drilling performance indicator was used in both the RWD and the conventional drilling assembly to analyze the effect of RWD. Based on the results, with increasing the distance between the pilot bit and reamer, there is an increase in improvement of drilling performance in terms of MSE reduction. The best drilling performance indicator (MSE reduction of 84%) was observed with the greatest distance between the pilot bit and the reamer of 43.3 cm. The best drilling performance indicator (MSE reduction of 84%) was observed with the distance between the pilot bit and the reamer of 43.3 cm. This is considered a novel finding in reaming while drilling.
Increased Fat Oxidation During Arm Cycling Exercise in Adult Men With Spinal Cord Injury Compared With Noninjured Controls
Authors: Martín-Manjarrés Soraya , Rodríguez-López Carlos , Martín-García María , Vila-Maldonado Sara , Granados Cristina , Mata Esmeralda , Gil-Agudo Ángel , Rodríguez-Gómez Irene , Ara Ignacio
Published: September 2021

People with spinal cord injury (SCI) tend to be more sedentary and increase fat accumulation, which could have a negative influence on metabolic flexibility. The aim of this study was to investigate the capacity to oxidize fat in a homogenous sample of men with thoracic SCI compared with healthy noninjured men during an arm cycling incremental test. Forty-one men, 21 with SCI and 20 noninjured controls, performed an incremental arm cycling test to determine peak fat oxidation (PFO) and the intensity of exercise that elicits PFO (Fatmax). PFO was expressed in absolute values (g/min) and relative to whole-body and upper-body lean mass ([mg·min−1]·kg−1) through three different models (adjusting by cardiorespiratory fitness and fat mass). Gross mechanical efficiency was also calculated. PFO was higher in SCI than in noninjured men (0.27 ± 0.07 vs. 0.17 ± 0.07 g/min; 5.39 ± 1.30 vs. 3.29 ± 1.31 [mg·min−1]·kg−1 whole-body lean mass; 8.28 ± 2.11 vs. 5.08 ± 2.12 [mg·min−1]·kg−1 upper-body lean mass). Fatmax was found at a significantly higher percentage of VO2peak in men with SCI (33.6% ± 8.2% vs. 23.6% ± 6.4%). Differences persisted and even increased in the fully adjustment model and at any intensity. Men with SCI showed significantly higher gross mechanical efficiency at 35 and 65 W than the noninjured group. Men with SCI showed higher fat oxidation when compared with noninjured men at any intensity, even increased after full adjustment for lean mass, fat mass, and cardiorespiratory fitness. These findings suggest that SCI men could improve their metabolic flexibility and muscle mass for greater efficiency, not being affected by their fat accumulation.
A Meta-Analysis of the Effects of Aerobic Exercise on the Basal Level of Endothelial Progenitor Cells in Middle-Aged and Older Adults
Authors: Chen Xiaoke , Sun Xinzheng , Gao Di , Qiu Dan , He Hui
Published: September 2021

Circulatory endothelial progenitor cells (EPCs) play an important role in repairing damaged vascular endothelium and preventing cardiovascular diseases. The decrease in level of circulating EPCs in middle-aged and older adults can lead to an increase in cardiovascular events. Researchers have carried out several studies on the effects of aerobic exercise on circulating EPCs in middle-aged and older adults, but the results vary from one study to another. The aim of this study therefore is to systematically evaluate the effect of aerobic exercise on the basal level of circulating EPCs in middle-aged and older adults by meta-analysis. Randomized controlled trial studies on the effects of aerobic exercise on EPCs were searched for from CNKI, PubMed, EBSCO, Cochrane Library, Web of Science, and Embase databases. The literature was screened according to inclusion and exclusion criteria, research data were extracted, and the literature quality was evaluated by Cochrane scale. Software Review Manager (version 5.3) and Stata (version 15.0) were used for data analysis. A total of nine articles were included in this analysis, including 165 participants (40 healthy adults and 125 patients) who received exercise interventions and 162 participants (40 healthy adults and 122 patients) who served as the control, with an age range from 58 to 70 years. The meta-analysis found that long-term (≥12 weeks) aerobic exercise could improve the level of EPCs in the peripheral circulation (standardized mean differences [SMD] = 0.53, 95% confidence interval [0.30, 0.76], p < .01). The subgroup analysis found that aerobic exercise improved EPCs in healthy people better than in people with cardiovascular disease and that the intervention time needs to be over 12 weeks to have a significant impact. In conclusion, the authors suggest that middle-aged and older adults can improve their EPCs quantity by engaging in moderate-intensity aerobic exercise four to five times per week for no less than 12 weeks to reduce the risk of cardiovascular disease.
Impact of Reduced Sampling Rate on Accelerometer-Based Physical Activity Monitoring and Machine Learning Activity Classification
Authors: Small Scott , Khalid Sara , Dhiman Paula , Chan Shing , Jackson Dan , Doherty Aiden , Price Andrew
Published: September 2021

Purpose: Lowering the sampling rate of accelerometers in physical activity research can dramatically increase study monitoring periods through longer battery life; however, the effect of reduced sampling rate on activity metric validity is poorly documented. We therefore aimed to assess the effect of reduced sampling rate on measuring physical activity both overall and by specific behavior types. Methods: Healthy adults wore sets of two Axivity AX3 accelerometers on the dominant wrist and hip for 24 hr. At each location one accelerometer recorded at 25 Hz and the other at 100 Hz. Overall acceleration magnitude, time in moderate to vigorous activity, and behavioral activities were calculated and processed using both linear and nearest neighbor resampling. Correlation between acceleration magnitude and activity classifications at both sampling rates was calculated and linear regression was performed. Results: Of the 54 total participants, 45 contributed >20 hr of hip wear time and 51 contributed >20 hr of wrist wear time. Strong correlation was observed between 25- and 100-Hz sampling rates in overall activity measurement (r = .97–.99), yet consistently lower activity was observed in data collected at 25 Hz (3.1%–13.9%). Reduced sleep and light activity and increased sedentary time was classified in 25-Hz data by machine learning models. Discrepancies were greater when linear interpolation resampling was used in postprocessing. Conclusions: The 25- and 100-Hz accelerometer data are highly correlated with predictable differences, which can be accounted for in interstudy comparisons. Sampling rate and resampling methods should be consistently reported in physical activity studies, carefully considered in study design, and tailored to the outcome of interest.
Mammalian in vitro gametogenesis
Authors: Saitou Mitinori , Hayashi Katsuhiko
Published: September 2021

Reconstituting reproduction in culture

Research on in vitro gametogenesis (IVG) aims to reconstitute germ cell development, oogenesis and spermatogenesis, in culture. Saitou and Hayashi review some of the recent developments in mammalian IVG. Advances in methods and culture conditions in mice to generate mature oocytes and spermatocytes from pluripotent stem cells have informed similar studies with nonhuman primate and human cells, but differences among species are clear. IVG has great potential for reproductive medicine, including novel diagnosis and modeling of infertility. The realization of human IVG requires further intensive efforts, but as technical hurtles are overcome, careful consideration must be given to the potential application of methods for reproductive purposes. —BAP
A protein network map of head and neck cancer reveals PIK3CA mutant drug sensitivity
Authors: Swaney Danielle L. , Ramms Dana J. , Wang Zhiyong , Park Jisoo , Goto Yusuke , Soucheray Margaret , Bhola Neil , Kim Kyumin , Zheng Fan , Zeng Yan , McGregor Michael , Herrington Kari A. , O’Keefe Rachel , Jin Nan , VanLandingham Nathan K. , Foussard Helene , Von Dollen John , Bouhaddou Mehdi , Jimenez-Morales David , Obernier Kirsten , Kreisberg Jason F. , Kim Minkyu , Johnson Daniel E. , Jura Natalia , Grandis Jennifer R. , Gutkind J. Silvio , Ideker Trey , Krogan Nevan J.
Published: September 2021

Mapping protein interactions driving cancer

Cancer is a genetic disease, and much cancer research is focused on identifying carcinogenic mutations and determining how they relate to disease progression. Three papers demonstrate how mutations are processed through networks of protein interactions to promote cancer (see the Perspective by Cheng and Jackson). Swaney
et al
. focus on head and neck cancer and identify cancer-enriched interactions, demonstrating how point mutant–dependent interactions of PIK3CA, a kinase frequently mutated in human cancers, are predictive of drug response. Kim
et al
. focus on breast cancer and identify two proteins functionally connected to the tumor-suppressor gene BRCA1 and two proteins that regulate PIK3CA. Zheng
et al
. developed a statistical model that identifies protein networks that are under mutation pressure across different cancer types, including a complex bringing together PIK3CA with actomyosin proteins. These papers provide a resource that will be helpful in interpreting cancer genomic data. —VV
Interpretation of cancer mutations using a multiscale map of protein systems
Authors: Zheng Fan , Kelly Marcus R. , Ramms Dana J. , Heintschel Marissa L. , Tao Kai , Tutuncuoglu Beril , Lee John J. , Ono Keiichiro , Foussard Helene , Chen Michael , Herrington Kari A. , Silva Erica , Liu Sophie N. , Chen Jing , Churas Christopher , Wilson Nicholas , Kratz Anton , Pillich Rudolf T. , Patel Devin N. , Park Jisoo , Kuenzi Brent , Yu Michael K. , Licon Katherine , Pratt Dexter , Kreisberg Jason F. , Kim Minkyu , Swaney Danielle L. , Nan Xiaolin , Fraley Stephanie I. , Gutkind J. Silvio , Krogan Nevan J. , Ideker Trey
Published: September 2021

Mapping protein interactions driving cancer

Cancer is a genetic disease, and much cancer research is focused on identifying carcinogenic mutations and determining how they relate to disease progression. Three papers demonstrate how mutations are processed through networks of protein interactions to promote cancer (see the Perspective by Cheng and Jackson). Swaney
et al
. focus on head and neck cancer and identify cancer-enriched interactions, demonstrating how point mutant–dependent interactions of PIK3CA, a kinase frequently mutated in human cancers, are predictive of drug response. Kim
et al
. focus on breast cancer and identify two proteins functionally connected to the tumor-suppressor gene BRCA1 and two proteins that regulate PIK3CA. Zheng
et al
. developed a statistical model that identifies protein networks that are under mutation pressure across different cancer types, including a complex bringing together PIK3CA with actomyosin proteins. These papers provide a resource that will be helpful in interpreting cancer genomic data. —VV
High-strength scalable MXene films through bridging-induced densification
Authors: Wan Sijie , Li Xiang , Chen Ying , Liu Nana , Du Yi , Dou Shixue , Jiang Lei , Cheng Qunfeng
Published: September 2021

Densification via bridging layers

MXenes are a family of layered two-dimensional metal carbides and nitrides with interesting properties that can be lost if voids are formed during synthesis. By using a sequential combination of hydrogen and covalent bonding agents, Wan
et al
. were able to densify the layered structure and remove voids. This procedure leads to improvements in the mechanical strength and toughness, electrical conductivity, and shielding from electromagnetic interference. —MSL
Identifying cancer drivers
Authors: Cheng Ran , Jackson Peter K.
Published: September 2021

Analysis of protein interaction networks can identify previously unknown oncogenic drivers
Time to unfriend Facebook?
Authors: Thorp H. Holden
Published: September 2021

For the past 18 months, communicating the findings of science to the world has hit what sometimes seems like an all-time low. Nevermind the years of failure in convincing much of the public about climate change; the pandemic has revealed shocking ineptness by the scientific establishment at conveying messages about masks, vaccination, or the dangers of consuming horse drugs and aquarium cleaners—even in the face of a rising death toll from COVID-19. One puzzling element of this crisis is how social media has been skillfully exploited by antiscience forces. Given all of this, what is the right move for science communication as it relates to social media? Unfriend Facebook or beat it at its own game?
Learning curve
Authors: Service Robert F.
Published: September 2021

New brain-inspired chips could provide the smarts for autonomous robots and self-driving cars
NIH institutes try new approach to supporting Black scientists
Authors: Kaiser Jocelyn
Published: September 2021

Proponents hope wider use of policy that allows funding of proposals “outside the pay line” will bolster success rates
Ocean scientists confront a critical bottleneck
Authors: Catherman Caroline
Published: September 2021

The world’s only source of essential seawater reference samples could soon close
Early sample tagging and pooling enables simultaneous SARS-CoV-2 detection and variant sequencing
Authors: Chappleboim Alon , Joseph-Strauss Daphna , Rahat Ayelet , Sharkia Israa , Adam Miriam , Kitsberg Daniel , Fialkoff Gavriel , Lotem Matan , Gershon Omer , Schmidtner Anna-Kristina , Oiknine-Djian Esther , Klochendler Agnes , Sadeh Ronen , Dor Yuval , Wolf Dana , Habib Naomi , Friedman Nir
Published: September 2021

A sequencing-based detection and genotyping assay for SARS-CoV-2 is based on early sample pooling using barcoded oligo hybridization.
Practicing Critical Thinking in Undergraduate Microbiology Classes by Presenting News Stories with Data Evidence
Authors: Moisander Pia H.
Published: September 2021

Developing scientific literacy is a key objective in undergraduate biology education. However, finding and accessing important primary research articles and drawing conclusions from original data is often challenging for students.
Development and Validation of a Universal Science Writing Rubric That is Applicable to Diverse Genres of Science Writing
Authors: Pisano Alycia , Crawford Amanda , Huffman Heather , Graham Barbara , Kelp Nicole
Published: September 2021

It is critical for science, technology, engineering, and mathematics (STEM) students to develop competencies in science communication, including science writing. However, it can be difficult for instructors and departments to assess the quality of their students’ science writing.
Toward “Inclusifying” the Underrepresented Minority in STEM Education Research
Authors: Bhatti Haider Ali
Published: September 2021

Research in undergraduate STEM education often requires the collection of student demographic data to assess outcomes related to diversity, equity, and inclusion. Unfortunately, this collection of demographic data continues to be constrained by socially constructed categories of race and ethnicity, leading to problematic panethnic groupings such as “Asian” and “Latinx.” Furthermore, these all-encompassing categories of race and ethnicity exasperate the problematic “underrepresented minority” (URM) label when only specific races and ethnicities are categorized as URMs.
Whole-Genome Sequence and Comparative Analysis of Human Papillomavirus Type 18 Isolated from a Nasopharyngeal Carcinoma from South Africa
Authors: Munsamy Yuri , Seedat Riaz Y. , Sekee Tumelo R. , Bester Phillip A. , van Jaarsveldt Danelle , Burt Felicity J.
Published: September 2021

We report the complete genome sequence of human papillomavirus type 18 isolated from a nasopharyngeal carcinoma in South Africa.
Complete Genome Sequences of Enterovirus D68 Clade A and D Strains in the Philippines
Authors: Okamoto Michiko , Sakamoto Masahiro , Dapat Clyde , Saito Mayuko , Saito-Obata Mariko , Tamaki Raita , Lupisan Socorro P. , Quiambao Beatriz P. , Oshitani Hitoshi
Published: September 2021

Complete genome sequences were determined for 4 clade A and 12 clade D enterovirus D68 strains detected in nasopharyngeal swabs from children with acute respiratory illness in the Philippines. These sequence data will be useful for future epidemiological monitoring, including watching for viral evolution.
Community-engaged medical education: helping to address child health and social inequality
Authors: Parekh Ravi , Maini Arti , Golding Bethany , Kumar Sonia
Published: September 2021

Medical education has a key role in helping to address child health and social inequality. In this paper we describe the rationale for developing a community-engaged approach to education, whereby medical schools partner with local communities. This symbiotic relationship enables medical students to experience authentic learning through working with communities to address local health and social priorities. Case studies of how such approaches have been implemented are described, with key takeaway points for paediatric healthcare professionals wanting to develop community-engaged educational initiatives.
Staged correction of varus knee and lateral thrust in an achondroplastic (ACH) juvenile patient who underwentlimb lengthening with IM nails: tips for proper timing and prioritisation of procedures
Authors: Drakou Androniki , Koutsogewrgopoulou Lukia , Boutzios Georgios , Psifis Markos
Published: September 2021

We present the case of a fifteen-year-old achondroplastic (ACH) woman who requested to have her femurs lengthened by intramedullary nails. She had undergone bilateral tibial lengthening at the age of eleven and presented with a varus deformity of the right lower limb, lateral thrust of the right knee and valgus deformity of the left lower limb. We performed deformity analyses based on mechanical axis measurements, and we came with a staged surgical plan. In ACH adolescences, correction of bony deformity needs to encounter continuous fibula growth dynamics. Lateral knee thrust was corrected by gradual distal translation of the fibula head via an Ilizarov frame and the amount of translation we decided clinically. Tibial lengthening and valgus osteotomy of the distal femur accentuate lateral collateral ligament (LCL) complex laxity. In patients with ACH, tibial lengthening and valgus osteotomy of the distal femur—if needed—should precede LCL complex tightening, and femoral lengthening should follow.
Nudging toward vaccination: a systematic review
Authors: Reñosa Mark Donald C , Landicho Jeniffer , Wachinger Jonas , Dalglish Sarah L , Bärnighausen Kate , Bärnighausen Till , McMahon Shannon A
Published: September 2021

Background

Vaccine hesitancy (VH) and the global decline of vaccine coverage are a major global health threat, and novel approaches for increasing vaccine confidence and uptake are urgently needed. ‘Nudging’, defined as altering the environmental context in which a decision is made or a certain behaviour is enacted, has shown promising results in several health promotion strategies. We present a comprehensive synthesis of evidence regarding the value and impact of nudges to address VH.

Methods

We conducted a systematic review to determine if nudging can mitigate VH and improve vaccine uptake. Our search strategy used Medical Subject Headings (MeSH) and non-MeSH terms to identify articles related to nudging and vaccination in nine research databases. 15 177 titles were extracted and assessed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The final list of included articles was evaluated using the Mixed Methods Appraisal Tool and the Grading of Recommendations, Assessment, Development and Evaluations framework.

Findings

Identified interventions are presented according to a framework for behaviour change, MINDSPACE. Articles (n=48) from 10 primarily high-income countries were included in the review. Nudging-based interventions identified include using reminders and recall, changing the way information is framed and delivered to an intended audience, changing the messenger delivering information, invoking social norms and emotional affect (eg, through storytelling, dramatic narratives and graphical presentations), and offering incentives or changing defaults. The most promising evidence exists for nudges that offer incentives to parents and healthcare workers, that make information more salient or that use trusted messengers to deliver information. The effectiveness of nudging interventions and the direction of the effect varies substantially by context. Evidence for some approaches is mixed, highlighting a need for further research, including how successful interventions can be adapted across settings.

Conclusion

Nudging-based interventions show potential to increase vaccine confidence and uptake, but further evidence is needed for the development of clear recommendations. The ongoing COVID-19 pandemic increases the urgency of undertaking nudging-focused research.

PROSPERO registration number

CRD42020185817.
Realist evaluation of the implementation and impact of the NHS carbon reduction strategy in the UK
Authors: Husain Syed Aleem , Sidhu Manbinder
Published: September 2021

Objectives

To evaluate the extent to which organisational factors facilitate or inhibit the implementation of the National Health Service (NHS) carbon reduction strategy within acute hospital settings.

Setting

A single acute NHS Trust with four satellite sites which serve more than 2 million patients annually in Central England.

Participants

Interviews with a purposive sample of 10 stakeholders, including those who conceptualised the intervention and those who were responsible for its implementation.

Intervention

The NHS is a major carbon emitter and therefore developed the ‘NHS carbon reduction strategy (NHSCRS)’ in 2009. NHS organisations are contractually obliged to develop a local carbon reduction strategy known as a Sustainable Development Management Plan (SDMP) which details carbon reduction measures (CRM), as described in the NHSCRS. However, the organisational context within which the SDMP is implemented is likely to determine the extent of its success. We undertook an adapted realist evaluation cycle to develop refined initial programme theories. Documents were analysed using thematic content analysis. Interview data were analysed using thematic analysis.

Results

CRM were most likely to be implemented if the Trust Board were sufficiently pressured by staff and reputational fears, and the potential impacts of CRM were perceived to align with wider organisational aims. Differences in implementation of CRM across hospital sites were related to logistical factors, accessibility to regional partners and contractual relationships. There were expected carbon, energy and long-term financial savings, with variability in the effectiveness of some CRM post implementation.

Conclusions

Organisational factors, particularly Board leadership and internal implementation pathways, have a significant bearing on whether CRM are implemented or not. However, greater national support and guidance is needed for NHS organisations to effectively reduce their carbon emissions. Further cycles of this evaluation are necessary in multiple case study sites to illuminate the path to a net-zero NHS carbon footprint by 2045.
Left atrial pressure overload and prognosis in elderly patients with heart failure and preserved ejection fraction: a prospective multicenter observational study
Authors: Hoshida Shiro , Tachibana Koichi , Shinoda Yukinori , Minamisaka Tomoko , Yamada Takahisa , Higuchi Yoshiharu , Nakagawa Yusuke , Abe Haruhiko , Fuji Hisakazu , Yasumura Yoshio , Hikoso Shungo , Nakatani Daisaku , Sakata Yasushi
Published: September 2021

Objectives

The severity of diastolic dysfunction is assessed using a combination of several indices of left atrial (LA) volume overload and LA pressure overload. We aimed to clarify which overload is more associated with the prognosis in patients with heart failure and preserved ejection fraction (HFpEF).

Setting

A prospective, multicenter observational registry of collaborating hospitals in Osaka, Japan.

Participants

We enrolled hospitalised patients with HFpEF showing sinus rhythm (men, 79; women, 113). Blood tests and transthoracic echocardiography were performed before discharge. The ratio of diastolic elastance (Ed) to arterial elastance (Ea) was used as a relative index of LA pressure overload.

Primary outcome measures

All-cause mortality and admission for heart failure were evaluated at >1 year after discharge.

Results

In the multivariable Cox regression analysis, Ed/Ea, but not LA volume index, was significantly associated with all-cause mortality or admission for heart failure (HR 2.034, 95% CI 1.059 to 3.907, p=0.032), independent of age, sex, and the serum N-terminal pro-brain natriuretic peptide (NT-proBNP) level. In patients with a higher NT-proBNP level, the effect of higher Ed/Ea on prognosis was prominent (p=0.015).

Conclusions

Ed/Ea, an index of LA pressure overload, was significantly associated with the prognosis in elderly patients with HFpEF showing sinus rhythm.

Trial registration number

UMIN000021831.
Parental and healthcare professional concern in the diagnosis of paediatric sepsis: a protocol for a prospective multicentre observational study
Authors: Sever Zoe , Schlapbach Luregn J , Jessup Melanie , George Shane , Harley Amanda
Published: September 2021

Introduction

Paediatric sepsis is a major contributor to morbidity and mortality worldwide. Assessing concern from parents and healthcare professionals to determine disease severity in a child evaluated for sepsis remains a field requiring further investigation. This study aims to determine the diagnostic accuracy of parental and healthcare professional concern in the diagnosis of children evaluated for sepsis.

Methods and analysis

This prospective multicentre observational study will be conducted over a 24-month period in the paediatric emergency department (ED) at two tertiary Australian hospitals. A cross-sectional survey design will be used to assess the level of concern in parents, nurses and doctors for children presenting to ED and undergoing assessment for sepsis. The primary outcome is a diagnosis of sepsis, defined as suspected infection plus organ dysfunction at time of survey completion. Secondary outcomes include suspected or proven infection and development of organ dysfunction, defined as a Paediatric Sequential Organ Failure Assessment Score >0, within 48 hours of presentation, paediatric intensive care unit admission, confirmed or probable bacterial infection independent of organ dysfunction, and hospital length of stay.

Ethics and dissemination

Ethics approval was obtained from Children’s Health Queensland’s Human Research Ethics Committee (HREC/17/QRCH/85). Findings will be shared with relevant stakeholders and disseminated via conferences and peer-reviewed journals

Trial registration number

WHO Universal Trial Number, U1111-1256-4537; ANZCTR number, ACTRN1262000134092.
Deep brain stimulation for locomotion in incomplete human spinal cord injury (DBS-SCI): protocol of a prospective one-armed multi-centre study
Authors: Stieglitz Lennart H , Hofer Anna-Sophie , Bolliger Marc , Oertel Markus F , Filli Linard , Willi Romina , Cathomen Adrian , Meyer Christian , Schubert Martin , Hubli Michèle , Kessler Thomas M , Baumann Christian R , Imbach Lukas , Krüsi Iris , Prusse Andrea , Schwab Martin E , Regli Luca , Curt Armin
Published: September 2021

Introduction

Spinal cord injury (SCI) is a devastating condition with immediate impact on the individual’s health and quality of life. Major functional recovery reaches a plateau 3–4 months after injury despite intensive rehabilitative training. To enhance training efficacy and improve long-term outcomes, the combination of rehabilitation with electrical modulation of the spinal cord and brain has recently aroused scientific interest with encouraging results. The mesencephalic locomotor region (MLR), an evolutionarily conserved brainstem locomotor command and control centre, is considered a promising target for deep brain stimulation (DBS) in patients with SCI. Experiments showed that MLR-DBS can induce locomotion in rats with spinal white matter destructions of >85%.

Methods and analysis

In this prospective one-armed multi-centre study, we investigate the safety, feasibility, and therapeutic efficacy of MLR-DBS to enable and enhance locomotor training in severely affected, subchronic and chronic American Spinal Injury Association Impairment Scale C patients in order to improve functional recovery. Patients undergo an intensive training programme with MLR-DBS while being regularly followed up until 6 months post-implantation. The acquired data of each timepoint are compared with baseline while the primary endpoint is performance in the 6-minute walking test. The clinical trial protocol was written in accordance with the Standard Protocol Items: Recommendations for Interventional Trials checklist.

Ethics and dissemination

This first in-man study investigates the therapeutic potential of MLR-DBS in SCI patients. One patient has already been implanted with electrodes and underwent MLR stimulation during locomotion. Based on the preliminary results which promise safety and feasibility, recruitment of further patients is currently ongoing. Ethical approval has been obtained from the Ethical Committee of the Canton of Zurich (case number BASEC 2016-01104) and Swissmedic (10000316). Results will be published in peer-reviewed journals and presented at conferences.

Trial registration number

NCT03053791.
Improved diagnostics of infectious diseases in emergency departments: a protocol of a multifaceted multicentre diagnostic study
Authors: Skjøt-Arkil Helene , Heltborg Anne , Lorentzen Morten Hjarnø , Cartuliares Mariana Bichuette , Hertz Mathias Amdi , Graumann Ole , Rosenvinge Flemming S , Petersen Eva Rabing Brix , Østergaard Claus , Laursen Christian B , Skovsted Thor Aage , Posth Stefan , Chen Ming , Mogensen Christian Backer
Published: September 2021

Background

The major obstacle in prescribing an appropriate and targeted antibiotic treatment is insufficient knowledge concerning whether the patient has a bacterial infection, where the focus of infection is and which bacteria are the agents of the infection. A prerequisite for the appropriate use of antibiotics is timely access to accurate diagnostics such as point-of-care (POC) testing.

The study aims to evaluate diagnostic tools and working methods that support a prompt and accurate diagnosis of hospitalised patients suspected of an acute infection. We will focus on the most common acute infections: community-acquired pneumonia (CAP) and acute pyelonephritis (APN). The objectives are to investigate (1) patient characteristics and treatment trajectory of the different acute infections, (2) diagnostic and prognostic accuracy of infection markers, (3) diagnostic accuracy of POC urine flow cytometry on diagnosing and excluding bacteriuria, (4) how effective the addition of POC analysis of sputum to the diagnostic set-up for CAP is on antibiotic prescriptions, (5) diagnostic accuracy of POC ultrasound and ultralow dose (ULD) computerized tomography (CT) on diagnosing CAP, (6) diagnostic accuracy of specialist ultrasound on diagnosing APN, (7) diagnostic accuracy of POC ultrasound in diagnosing hydronephrosis in patients suspected of APN.

Methods and analysis

It is a multifaceted multicentre diagnostic study, including 1000 adults admitted with suspicion of an acute infection. Participants will, within the first 24 hours of admission, undergo additional diagnostic tests including infection markers, POC urine flow cytometry, POC analysis of sputum, POC and specialist ultrasound, and ULDCT. The primary reference standard is an assigned diagnosis determined by a panel of experts.

Ethics, dissemination and registration

Approved by Regional Committees on Health Research Ethics for Southern Denmark, Danish Data Protection Agency and clinicaltrials.gov. Results will be presented in peer-reviewed journals, and positive, negative and inconclusive results will be published.

Trial registration numbers

NCT04661085, NCT04681963, NCT04667195, NCT04652167, NCT04686318, NCT04686292, NCT04651712, NCT04645030, NCT04651244.
Economic evaluations of scaling up strategies of evidence-based health interventions: a systematic review protocol
Authors: Brundisini Francesca , Zomahoun Hervé Tchala Vignon , Légaré France , Rhéault Nathalie , Bernard-Uwizeye Claude , Massougbodji José , Gogovor Amédé , Tchoubi Sébastien , Assan Odilon , Laberge Maude
Published: September 2021

Introduction

Scaling science aims to help roll out evidence-based research results on a wide scale to benefit more individuals. Yet, little is known on how to evaluate economic aspects of scaling up strategies of evidence-based health interventions.

Methods and analysis

Using the Joanna Briggs Institute guidance on systematic reviews, we will conduct a systematic review of characteristics and methods applied in economic evaluations in scaling up strategies. To be eligible for inclusion, studies must include a scaling up strategy of an evidence-based health intervention delivered and received by any individual or organisation in any country and setting. They must report costs and cost-effectiveness outcomes. We will consider full or partial economic evaluations, modelling and methodological studies. We searched peer-reviewed publications in Medline, Web of Science, Embase, Cochrane Library Database, PEDE, EconLIT, INHATA from their inception onwards. We will search grey literature from international organisations, bilateral agencies, non-governmental organisations, consultancy firms websites and region-specific databases. Two independent reviewers will screen the records against the eligibility criteria and extract data using a pretested extraction form. We will extract data on study characteristics, scaling up strategies, economic evaluation methods and their components. We will appraise the methodological quality of included studies using the BMJ Checklist. We will narratively summarise the studies’ descriptive characteristics, methodological strengths/weaknesses and the main drivers of cost-effectiveness outcomes. This study will help identify what are the trade-offs of scaling up evidence-based interventions to allocate resources efficiently.

Ethics and dissemination

No ethics approval is required as no primary data will be collected. The results will be published in a peer-reviewed, international journal and presented at national and international conferences.
Vitamin D supplementation and energy and metabolic homoeostasis in obese and overweight subjects: a protocol for a systematic review
Authors: He Yu , Yang Xiao , Li Min , Zhang Anren , Sun Nianyi
Published: September 2021

Introduction

Obesity and vitamin D deficiency are major public health problems. According to the pathophysiological mechanism of obesity as well as the bidirectional relationship between obesity and vitamin D metabolism and storage, vitamin D supplementation in obese and overweight subjects could have beneficial effects on the energy and metabolic homoeostasis. This review will assess the efficacy of vitamin D supplementation on the energy and metabolic homoeostasis in overweight and obese subjects.

Methods and analysis

In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols, we retrieved the relevant literature from the following electronic bibliographic databases: MEDLINE/PubMed, EMBASE and the Cochrane Central Register of Controlled Trials, from inception to June 2021. A manual search of the reference lists of all the relevant research articles will be performed to identify additional studies. We will include randomised controlled trials (RCTs) published in English that examine the effects of vitamin D supplementation on energy and metabolic homoeostasis in overweight and obese subjects. RCTs with multiple vitamin D groups will also be included. Two reviewers will independently complete the article selection, data extraction and rating. The bias tool from the Cochrane Handbook for Systematic Reviews of Interventions was used to assess the methodological quality of the included studies. A narrative or quantitative synthesis will be performed based on the available data. The planned start and end dates for the study were 1 February 2021 and 1 March 2022.

Ethics and dissemination

Ethical approval will not be required for this review. The results of this review will be disseminated in a peer-reviewed journal.

PROSPERO registration number

CRD42021228981.