bluuebunny/crossref_metadata_2025 huggingface dataset:
Exploring the knowledge, attitudes, practices and lived experiences of frontline health workers in the times of COVID-19 : a qualitative study from Bangladesh
Authors: Tune Samiun Nazrin Bente Kamal , Islam Bushra Zarin , Islam Mir Raihanul , Tasnim Zarin , Ahmed Syed Masud
Published: January 2022

Objective

This study explored Frontline Health Workers’ (FLWs) knowledge, attitude and practice (KAP) on COVID-19 and their lived experiences, in both their personal and work lives, at the early stage of the pandemic in Bangladesh.

Design, setting and participants

This was a qualitative study conducted through telephone interviews in May 2020. A total of 41 FLWs including physicians, nurses, paramedics, community healthcare workers and hospital support staff from 34 public and private facilities of both urban and rural parts of Bangladesh participated in the interview. A purposive sampling technique supplemented by a snowball sampling method was followed to select the participants. The in-depth interviews followed a semi-structured interview guide, and we applied the thematic analysis method for the qualitative data analysis.

Findings

Except physicians, the FLWs did not receive any institutional training on COVID-19, including its prevention and management, in most instances. Also, they had no training in the use of personal protective equipment (PPE). Their common source of knowledge was the different websites or social media platforms. The FLWs were at risk while delivering services because patients were found to hide histories and not maintaining safety rules, including physical distancing. Moreover, inadequate supply of PPE, fear of getting infected, risk to family members and ostracisation by the neighbours were mentioned to be quite common by them. This situation eventually led to the development of mental stress and anxiety; however, they tried to cope up with this dire situation and attend to the call of humanity.

Conclusion

The uncertain work environment during the COVID-19 pandemic simultaneously affected FLWs’ physical and emotional health in Bangladesh. However, they showed professional devotion in overcoming such obstacles and continued to deliver essential services. This could be further facilitated by a quick and targeted training package on COVID-19, and the provision of supplies for delivering services with appropriate safety precautions.
Companionship for women/birthing people using antenatal and intrapartum care in England during COVID-19: a mixed-methods analysis of national and organisational responses and perspectives
Authors: Thomson Gill , Balaam Marie-Claire , Nowland (Harris) Rebecca , Crossland Nicola , Moncrieff Gill , Heys Stephanie , Sarian Arni , Cull Joanne , Topalidou Anastasia , Downe Soo
Published: January 2022

Objectives

To explore stakeholders’ and national organisational perspectives on companionship for women/birthing people using antenatal and intrapartum care in England during COVID-19, as part of the Achieving Safe and Personalised maternity care In Response to Epidemics (ASPIRE) COVID-19 UK study.

Setting

Maternity care provision in England.

Participants

Interviews were held with 26 national governmental, professional and service-user organisation leads (July–December 2020). Other data included public-facing outputs logged from 25 maternity Trusts (September/October 2020) and data extracted from 78 documents from eight key governmental, professional and service-user organisations that informed national maternity care guidance and policy (February–December 2020).

Results

Six themes emerged: ‘Postcode lottery of care’ highlights variations in companionship and visiting practices between trusts/locations, ‘Confusion and stress around ‘rules’’ relates to a lack of and variable information concerning companionship/visiting, ‘Unintended consequences’ concerns the negative impacts of restricted companionship or visiting on women/birthing people and staff, ‘Need for flexibility’ highlights concerns about applying companionship and visiting policies irrespective of need, ‘‘Acceptable’ time for support’ highlights variations in when and if companionship was ‘allowed’ antenatally and intrapartum and ‘Loss of human rights for gain in infection control’ emphasises how a predominant focus on infection control was at a cost to psychological safety and human rights.

Conclusions

Policies concerning companionship and visiting have been inconsistently applied within English maternity services during the COVID-19 pandemic. In some cases, policies were not justified by the level of risk, and were applied indiscriminately regardless of need. There is an urgent need to determine how to sensitively and flexibly balance risks and benefits and optimise outcomes during the current and future crisis situations.
Is acupuncture effective for knee osteoarthritis? A protocol for a systematic review and meta-analysis
Authors: Liu Chuan-Yang , Tu Jian-Feng , Lee Myeong Soo , Qi Ling-Yu , Yu Fang-Ting , Yan Shi-Yan , Li Jin-Ling , Lin Lu-Lu , Hao Xiao-Wan , Su Xin-Tong , Yang Jing-Wen , Wang Li-Qiong
Published: January 2022

Introduction

Knee osteoarthritis (KOA) is one of the leading causes of disability. The effectiveness of acupuncture for treating KOA remains controversial. This protocol describes the method of a systematic review and meta-analysis evaluating the effectiveness and safety of acupuncture for treating KOA.

Methods and analysis

Four English databases (PubMed, Embase, Cochrane Library databases and Web of Science) and four Chinese databases (China National Knowledge Infrastructure, Chinese Biomedical Literature Database, VIP Database for Chinese Technical Periodicals, and Wanfang) will be searched from the database inception to 1 September 2021. All randomised controlled trials related to acupuncture for KOA will be included. Extracted data will include publication details, basic information, demographic data, intervention details and patient outcomes. The primary outcome will be pain intensity. Risk of bias will be assessed using the Cochrane Collaboration’s tool for assessing risk of bias. Article selection, data extraction and risk of bias assessment will be performed in duplicate by two independent reviewers. If the meta-analysis is precluded, we will conduct a descriptive synthesis using a best-evidence synthesis approach. The strength of recommendations and quality of evidence will be assessed using the Grading of Recommendations Assessment Development and Evaluation working group methodology.

Ethics and dissemination

Ethics approval is not required because individual patient data are not included. This protocol was registered in the international Prospective Register of Systematic Reviews on 25 February 2021. The systematic review and meta-analysis will be submitted for publication in a peer-reviewed journal. The findings will also be disseminated through conference presentations.

Trial registration number

CRD42021232177.
Correlates of help-seeking by parents for the socioemotional development of their 3-year-old children: a longitudinal study
Authors: Luo Jie , Raat Hein , Franse Carmen Betsy , Bannink Rienke , Bai Guannan , van Grieken Amy
Published: January 2022

Objectives

Timely parental help-seeking regarding their child’s socioemotional development is associated with a lower rate and lower severity of psychosocial problems in later life. This study aimed to examine the correlates of parental help-seeking for the socio-emotional development of 3-year-old children.

Design

Retrospective cohort study.

Setting

Community-based survey in Rotterdam.

Participants

Of 2305 parents and their 2-year-old children at baseline, 1507 who completed follow-up questionnaires were included in the analyses when children were 3 years old.

Outcome measures

Parental help-seeking regarding their child’s socioemotional development and types of formal and informal help sources (eg, general practitioner, internet) used in the past 12 months were measured. Hierarchical logistic regression models were applied to identify factors correlates of parental help-seeking among 13 predisposing, enabling and need factors according to Andersen’s behavioural model.

Results

In total, 22.6% of parents reported help-seeking in the past 12 months for socioemotional development of their 3-year-old child; 6.8% addressed formal help sources and 17.5% addressed informal help sources. General practitioner (2.7%) and family (12.5%) were the most frequently used formal and informal sources, respectively. In the full model, predisposing factors associated with higher odds of parental help-seeking were child’s other western ethnic background (OR=1.66, 95% CI 1.02 to 2.68) and parental age ≤29 years old (OR=1.71, 95% CI 1.01 to 2.92). No associated factors were found among enabling factors. The need factors associated with higher odds of parental help-seeking were having previous help-seeking (OR=2.52, 95% CI 1.83 to 3.48) and discussing child’s socioemotional development in the well-child visit (OR=2.47, 95% CI 1.73 to 3.53).

Conclusions

Predisposing and need factors were associated with parental help-seeking for socioemotional development of 3-year-old children. The findings can be used to further develop support for parents accessing adequate information, prevention and anticipatory care with regards to the child’s socio-emotional development.
Association of off-the-job training with work performance and work–family conflict among physicians: a cross-sectional study in China
Authors: Wang Xiaoyu , Qin Hua , Zhu Yimei , Wang Zixin , Ye Beizhu , Zhu Xi , Liang Yuan
Published: January 2022

Objectives

To determine whether experiences of off-the-job training in domestic (DT) and overseas study (OS) settings are associated with work performance and work–family conflict in physicians.

Design, setting and participants

We conducted a national cross-sectional survey in 77 public hospitals across seven provinces in China between July 2014 and April 2015. Participants were 3182 physicians.

Exposure

Participants were categorised into four groups: none, DT only, OS only and DT and OS.

Primary outcome measures

Work performance was assessed by work engagement, career attrition and patient-centred care. Work–family conflict was assessed by affecting care for family, feeling guilty towards family and receiving complaints from family.

Results

A total of 25.89% participants had experienced DT only, 8.71% OS only and 8.47% DT and OS. After adjustment for potential confounders, participants who had experiences of DT and OS compared with those with no training were more likely to report positive work performance (pride in work: OR=2.11, 95% CI: 1.43 to 3.10; enjoyment of work: OR=1.67, 95% CI: 1.11 to 2.51; turnover intention: OR=0.54, 95% CI: 0.38 to 0.77; early retirement: OR=0.63, 95% CI: 0.45 to 0.89; and exhaustion: OR=0.66, 95% CI: 0.45 to 0.98) and less work–family conflicts (feeling guilty towards family: OR=0.51, 95% CI: 0.35 to 0.74; and complaints from family: OR=0.66, 95% CI: 0.47 to 0.91). We found no obvious association between DT/OS experience with patient-centred care.

Conclusions

Physicians with DT and OS experiences are more likely to have better work performance and less work–family conflict than those without such experience. Physicians face increasing pressure to pursue continuing education and experience associated distress. Therefore, hospitals and government policy-makers should promote DT and OS.
Problems with evidence assessment in COVID-19 health policy impact evaluation: a systematic review of study design and evidence strength
Authors: Haber Noah A , Clarke-Deelder Emma , Feller Avi , Smith Emily R , Salomon Joshua A. , MacCormack-Gelles Benjamin , Stone Elizabeth M , Bolster-Foucault Clara , Daw Jamie R , Hatfield Laura Anne , Fry Carrie E , Boyer Christopher B , Ben-Michael Eli , Joyce Caroline M , Linas Beth S , Schmid Ian , Au Eric H , Wieten Sarah E , Jarrett Brooke , Axfors Cathrine , Nguyen Van Thu , Griffin Beth Ann , Bilinski Alyssa , Stuart Elizabeth A
Published: January 2022

Introduction

Assessing the impact of COVID-19 policy is critical for informing future policies. However, there are concerns about the overall strength of COVID-19 impact evaluation studies given the circumstances for evaluation and concerns about the publication environment.

Methods

We included studies that were primarily designed to estimate the quantitative impact of one or more implemented COVID-19 policies on direct SARS-CoV-2 and COVID-19 outcomes. After searching PubMed for peer-reviewed articles published on 26 November 2020 or earlier and screening, all studies were reviewed by three reviewers first independently and then to consensus. The review tool was based on previously developed and released review guidance for COVID-19 policy impact evaluation.

Results

After 102 articles were identified as potentially meeting inclusion criteria, we identified 36 published articles that evaluated the quantitative impact of COVID-19 policies on direct COVID-19 outcomes. Nine studies were set aside because the study design was considered inappropriate for COVID-19 policy impact evaluation (n=8 pre/post; n=1 cross-sectional), and 27 articles were given a full consensus assessment. 20/27 met criteria for graphical display of data, 5/27 for functional form, 19/27 for timing between policy implementation and impact, and only 3/27 for concurrent changes to the outcomes. Only 4/27 were rated as overall appropriate. Including the 9 studies set aside, reviewers found that only four of the 36 identified published and peer-reviewed health policy impact evaluation studies passed a set of key design checks for identifying the causal impact of policies on COVID-19 outcomes.

Discussion

The reviewed literature directly evaluating the impact of COVID-19 policies largely failed to meet key design criteria for inference of sufficient rigour to be actionable by policy-makers. More reliable evidence review is needed to both identify and produce policy-actionable evidence, alongside the recognition that actionable evidence is often unlikely to be feasible.
Association of myocardial fibrosis detected by late gadolinium-enhanced MRI with clinical outcomes in patients with diabetes: a systematic review and meta-analysis
Authors: Yang Zhi , Xu Rong , Wang Jia-rong , Xu Hua-yan , Fu Hang , Xie Ling-jun , Yang Meng-xi , Zhang Lu , Wen Ling-yi , Liu Hui , Li Hong , Yang Zhi-gang , Guo Ying-kun
Published: January 2022

Objective

This meta-analysis assessed the associations of myocardial fibrosis detected by late gadolinium-enhanced (LGE)-MRI with the risk of major adverse cardiac and cerebrovascular events (MACCEs) and major adverse cardiac events (MACEs) in patients with diabetes.

Design

Systematic review and meta-analysis reported in accordance with the guidelines of the Meta-analysis of Observational Studies in Epidemiology statement.

Data sources

We searched the Medline, Embase and Cochrane by Ovid databases for studies published up to 27 August 2021.

Eligibility criteria

Prospective or respective cohort studies were included if they reported the HR and 95% CIs for MACCEs/MACEs in patients with either type 1 or 2 diabetes and LGE-MRI-detected myocardial fibrosis compared with patients without LGE-MRI-detected myocardial fibrosis and if the articles were published in the English language.

Data extraction and synthesis

Two review authors independently extracted data and assessed the quality of the included studies. Pooled HRs and 95% CIs were analysed using a random effects model. Heterogeneity was assessed using forest plots and I2 statistics.

Results

Eight studies with 1121 patients with type 1 or type 2 diabetes were included in this meta-analysis, and the follow-up ranged from 17 to 70 months. The presence of myocardial fibrosis detected by LGE-MRI was associated with an increased risk for MACCEs (HR: 2.58; 95% CI 1.42 to 4.71; p=0.002) and MACEs (HR: 5.28; 95% CI 3.20 to 8.70; p<0.001) in patients with diabetes. Subgroup analysis revealed that ischaemic fibrosis detected by LGE was associated with MACCEs (HR 3.80, 95% CI 2.38 to 6.07; p<0.001) in patients with diabetes.

Conclusions

This study demonstrated that ischaemic myocardial fibrosis detected by LGE-MRI was associated with an increased risk of MACCEs/MACEs in patients with diabetes and may be an imaging biomarker for risk stratification. Whether LGE-MRI provides incremental prognostic information with respect to MACCEs/MACEs over risk stratification by conventional cardiovascular risk factors requires further study.
What is known from the existing literature about self-management of pessaries for pelvic organ prolapse? A scoping review protocol
Authors: Dwyer Lucy , Dowding Dawn , Kearney R
Published: January 2022

Introduction

Pelvic organ prolapse (POP) can be managed with a pessary; however, regular follow-up may deter women from pessary management due to the inconvenience of frequent appointments, as well as preventing pessary users from autonomous decision-making. Pessary self-management, whereby the woman removes and inserts her own pessary may be a solution to these issues. However, there remains a number of uncertainties regarding the potential benefits and risks of pessary self-management. This scoping review aims to map available evidence about the subject of pessary self-management for POP to identify knowledge gaps providing the basis for future research.

Methods and analysis

The scoping review will be conducted using the Joanna Briggs Institute scoping review methodology and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. A search of Medline, CINAHL, Embase and PsycInfo will be undertaken to identify relevant articles which meet the eligibility criteria using the search terms ‘pessary’ and ‘self-management’ or ‘self-care’. A hand search of the reference list of non-original research identified during the search but excluded, will be conducted for additional publications which meet the inclusion and exclusion criteria. Data relevant to the topic of pessary self-management will be extracted and critical appraisal of all included publications undertaken.

Ethics and dissemination

No ethical or Health Research Authority approval is required to undertake the scoping review. However, it has been registered with The Open Science Framework (DOI 10.17605/OSF.IO/DNGCP). The findings will inform future research exploring pessary self-management and be disseminated via both a presentation at a national conference and publications in peer reviewed journals.
Use of the ONCO-TreC electronic diary compared with a standard paper diary to improve adherence to oral cancer therapy in patients with solid and haematological tumours: protocol for a randomised controlled trial
Authors: Passardi Alessandro , Serra Patrizia , Caffo Orazio , Masini Carla , Brugugnoli Erika , Vespignani Roberto , Giardino Valeria , Petracci Elisabetta , Bartolini Giulia , Sullo Francesco , Anesi Cecilia , Dianti Marco , Eccher Claudio , Piras Enrico Maria , Gios Lorenzo , Campomori Annalisa , Oberosler Valentina , Forti Stefano
Published: January 2022

Introduction

ONCO-TreC platform consists of a mobile application delivered to patients as electronic diary and a web-based dashboard managed by healthcare professionals. We aim to compare the effectiveness of ONCO-TreC electronic diary with a standard paper diary, in improving adherence to oral cancer therapy in patients with solid and haematological tumours.

Methods and analysis

This is an open label, superiority, randomised controlled trial conducted in two Italian oncology units. Patients will be randomised with a 1:1 ratio to electronic or paper diary. For both groups a counsellor will be responsible for drug and diary delivery. The evaluation period will end after six cycles of therapy. The primary aim is to compare the proportion of non-adherent patients in the two arms. Adherence will be measured through pill count; anyone who takes less than 90% of the total prescribed drug dose will be considered non-adherent. Assuming a percentage of non-adherent patients to oral therapy of 40% in arm B, and a 60% reduction in this percentage in arm A, a sample of 124 patients will provide 80% power to identify an absolute difference greater than 24 percentage points using a bilateral Fisher’s exact test with a significance level of 0.05. Considering a dropout rate of 10%, approximately 136 patients will have to be enrolled. The primary analysis will be performed on the intention-to-treat population. Secondary aims are to describe the reasons for non-adherence, the level of satisfaction of patients and healthcare professionals with the paper and electronic diary, and the impact of non-adherence in terms of healthcare costs.

Ethics and dissemination

Ethical approval was obtained from Romagna Ethics Committee (CEROM), study ID 2108, prot. n. IRST 100.28 of 10/04/2020. Informed consent will be obtained from all study participants. Findings will be disseminated through peer-reviewed journals, conferences and event presentations.

Protocol version

Version 2, 6 April 2021.

Trial registration number

NCT04826458.
Determinants of undernutrition among older adults in South Gondar Zone, Ethiopia: a community-based study
Authors: Yisak Hiwot , Maru Ismael , Abie Misganaw , Arage Getachew , Ewunetei Amien , Azanaw Melkalem Mamuye , Teshome Fentaw
Published: January 2022

Objectives

The objectives of this study were to assess the prevalence and determinants of undernutrition among older adults aged 65 years in the south Gondar Zone, Ethiopia, in 2020.

Design

A community-based cross-sectional study.

Setting

The study was conducted from 1 October to 15 December 2020, in the South Gondar Zone, Ethiopia. Study participants were selected by systematic random sampling. A pretested and structured questionnaire adapted from different literature was used to collect data. Anthropometric measurements were taken following the standard procedure.

Participants

A total of 290 older adults aged greater than or equal to 65 years of age were included in the study.

Data analysis

Descriptive and summary statistics were employed. Multiple logistic regression was fitted to identify determinants of undernutrition. ORs and their 95% CIs were computed to determine the level of significance.

Outcome measures

Undernutrition was assessed by using Body Mass Index and Mini Nutritional Assessment (MNA) tool.

Results

The prevalence of undernutrition was 27.6% (95% CI 22.4 to 32.8), and 2.1% (95% CI 0.7 to 3.8) of the study participants were overweight. Based on the MNA tool, 29.7% (95% CI 24.5 to 35.2) of the study participants were undernourished and 61.7% (95% CI 55.5 to 67.2) were at risk of undernourishment. Rural residence adjusted OR (aOR)=10.3 (95% CI 3.6 to 29.4), inability to read and write aOR=3.5 (95% CI 1.6 to 7.6), decrease in food intake aOR=13.5 (95% CI 6.1 to 29.5) and household monthly income of less than US$35.6 aOR=4.3 (95% CI 1.9 to 9.4) were significantly and independently associated with undernutrition.

Conclusion

The level of undernutrition among older adults in the study area was high, making it an important public health burden. The determinants of undernutrition were a place of residence, educational status, food intake and monthly income.
Optimising treatment expectations in chronic lower back pain through observing others: a study protocol for a randomised clinical trial
Authors: Stuhlreyer Julia , Schwartz Marie , Friedheim Till , Zöllner Christian , Klinger Regine
Published: January 2022

Introduction

Chronic lower back pain (CLBP) is a frequent cause of medical consultations worldwide, and it results in decreased quality of life and disability. Current treatments for CLBP are often not effective, and alternatives are urgently needed. Three promising possibilities have emerged: (1) open-label placebo treatment reduces chronic pain, (2) placebo treatment is as efficacious as opioid treatment with a high correlation between patient expectation and treatment outcome, and (3) observing positive effects in another patient can improve functional capacity. We hypothesise that treatment expectations can be positively influenced through social observation and improve treatment outcome.

Methods and analysis

In our clinical trial, we will randomise patients with CLBP into five groups. Two groups receive either a 3 week course of treatment with an analgesic (ANA) (metamizole/dipyrone) or with open-label placebos (OLP). For one of each group, we will build treatment expectations through observational learning and assess its impact on the treatment. For this purpose, one group each will watch either a positive or a neutral video. The intervention groups will be compared with a control group that will not be given any medication or observational learning. Participants will be recruited via all institutions in the Hamburg metropolitan area that treat patients with CLBP. Patients are eligible for inclusion if they are at least 18 years or older, have CLBP (of at least 3 months duration), and agree to potentially receive an active ANA or an OLP. Patients with pain-related “red flags” will be excluded. The study requires 150 participants (30 participants per group) to assess the differences in the primary outcome, pain intensity. Secondary outcomes include changes in treatment expectations, anxiety, comorbid depression, stress-related neuroendocrine measures, functional and structural connectivity, functional capacity, and ANA consumption. All outcomes and treatment expectations will be measured before and after the intervention and 3 months post-intervention.

Ethics and dissemination

Ethical approval was obtained in January 2020 from the Hamburg Medical Ethics Council (ref number PV7067). Outcomes will be disseminated through publications in peer-reviewed journals and presentations at national and international conference meetings.

Trial registration number

The approved trial protocol was registered at the German Clinical Trials Register (DRKS) and can be found at drks.de (Identifier: DRKS00024418).
Quality improvement methodology can reduce hospitalisation for abscess management
Authors: Dunn Michael , Savoie Kate , Erdem Guliz , Dykes Michael W , Buckingham Don , Spencer Sandra , Besner Gail , Kenney Brian
Published: January 2022

Background

Abscesses are a common reason for ED visits. While many are drained in the ED, some require drainage in the operating room (OR). We observed that a higher percentage of patients at our institution in Columbus, Ohio, were admitted to the hospital with abscesses for incision and drainage (I&D) in the OR than other institutions, including paediatric institutions. Our aim was to decrease hospitalisations for abscess management.

Methods

A multidisciplinary team convened to decrease hospitalisation for patients with abscesses and completed multiple ‘Plan-Do-Study-Act’ cycles, including increasing I&Ds performed in the ED. Other interventions included implementation of a clinical pathway, training of procedure technicians (PT), updating the electronic medical record (EMR), credentialing advanced practice nurses in sedation and individual follow-up with providers for admitted patients. Data were analysed using statistical process control charts. Gross average charges were assessed.

Results

Admissions for I&D decreased from 26.3% to 13.7%. Abscess drainage in the ED improved from 79.3% to 96.5%. Mean length of stay decreased from 19.5 to 11.5 hours for all patients. Patients sedated increased from 3.3% to 18.2%. The number of repeat I&Ds within 30 days decreased from 4.3% to 1.7%.

Conclusion

We decreased hospitalisations for abscess I&D by using quality improvement methodology. The most influential intervention was an initiative to increase I&Ds performed in the ED. Additional interventions included expanded training of PTs, implementation of a clinical pathway, updating the EMR, improving interdepartmental communication and increasing sedation providers.
Nasobiliary drainage: an effective treatment for pruritus in cholestatic liver disease
Authors: Ahmed Wafaa , Jeyaraj Rebecca , Reffitt David , Devlin John , Suddle Abid , Hunt John , Heneghan Michael A , Harrison Phillip , Joshi Deepak
Published: January 2022

Introduction

Nasobiliary drains (NBDs) have been successfully used to manage intrahepatic cholestasis, bile leaks and obstructive cholangitis. It allows external drainage of bile, bypassing the ileum where bile salts are reabsorbed. We assessed the utility of placement with effect on markers of cholestasis and patient symptoms.

Methods

Consecutive patients undergoing NBD over 12 years for the management of pruritus were retrospectively analysed. Recorded variables included patient demographics, procedural characteristics and response to therapy.

Results

Twenty-three patients (14, 61% male) underwent 30 episodes of NBD. The median age was 26 years old (range 2–67 years old). A single procedure was carried out in 20. One patient each had two, three and five episodes of NBD. The most common aetiologies were hereditary cholestatic disease (n=17, 74%) and drug-induced cholestasis (n=5, 22%),

NBD remained in situ for a median of 8 days (range 1–45 days). Significant improvement in bilirubin was seen at 7 days post-NBD (p=0.0324), maintained at day 30 (335 μmol/L vs 302 µmol/L vs 167 µmol/L). There was symptomatic improvement in pruritus in 20 (67%, p=0.0494) episodes. One patient underwent NBD during the first trimester of pregnancy after medical therapy failure with a good symptomatic response. The catheters were well tolerated in 27 (90%) of cases. Mild pancreatitis occurred in 4 (13%) cases.

Conclusion

NBD can be used to provide symptomatic improvement to patients with pruritus associated with cholestasis. It is well tolerated by patients. They can be used in pregnancy where medical management has failed.
Extracellular Vesicles from Pancreatic Cancer Stem Cells Lead an Intratumor Communication Network (EVNet) to fuel tumour progression
Authors: Ruivo Carolina F , Bastos Nuno , Adem Barbara , Batista Ines , Duraes Cecilia , Melo Carlos A , Castaldo Stephanie A , Campos‐Laborie Francisco , Moutinho-Ribeiro Pedro , Morão Barbara , Costa-Pinto Ana , Silva Soraia , Osorio Hugo , Ciordia Sergio , Costa Jose Luis , Goodrich David , Cavadas Bruno , Pereira Luisa , Kouzarides Tony , Macedo Guilherme , Maio Rui , Carneiro Fatima , Cravo Marília , Kalluri Raghu , Machado Jose Carlos , Melo Sonia A
Published: January 2022

Objective

Intratumor heterogeneity drives cancer progression and therapy resistance. However, it has yet to be determined whether and how subpopulations of cancer cells interact and how this interaction affects the tumour.

Design

We have studied the spontaneous flow of extracellular vesicles (EVs) between subpopulations of cancer cells: cancer stem cells (CSC) and non-stem cancer cells (NSCC). To determine the biological significance of the most frequent communication route, we used pancreatic ductal adenocarcinoma (PDAC) orthotopic models, patient-derived xenografts (PDXs) and genetically engineered mouse models (GEMMs).

Results

We demonstrate that PDAC tumours establish an organised communication network between subpopulations of cancer cells using EVs called the EVNet). The EVNet is plastic and reshapes in response to its environment. Communication within the EVNet occurs preferentially from CSC to NSCC. Inhibition of this communication route by impairing Rab27a function in orthotopic xenographs, GEMMs and PDXs is sufficient to hamper tumour growth and phenocopies the inhibition of communication in the whole tumour. Mechanistically, we provide evidence that CSC EVs use agrin protein to promote Yes1 associated transcriptional regulator (YAP) activation via LDL receptor related protein 4 (LRP-4). Ex vivo treatment of PDXs with antiagrin significantly impairs proliferation and decreases the levels of activated YAP.

Patients with high levels of agrin and low inactive YAP show worse disease-free survival. In addition, patients with a higher number of circulating agrin+EVs show a significant increased risk of disease progression.

Conclusion

PDAC tumours establish a cooperation network mediated by EVs that is led by CSC and agrin, which allows tumours to adapt and thrive. Targeting agrin could make targeted therapy possible for patients with PDAC and has a significant impact on CSC that feeds the tumour and is at the centre of therapy resistance.
Effect of stroke etiology on endovascular thrombectomy with or without intravenous alteplase: a subgroup analysis of DIRECT-MT
Authors: Xing Pengfei , Zhang Xiaoxi , Shen Hongjian , Shen Fang , Zhang Lei , Li Zifu , Zhang Yongxin , Hong Bo , Shi Huaizhang , Han Hongxing , Ye Xiaofei , Zhang Yongwei , Yang Pengfei , Liu Jianmin
Published: January 2022

Background

Stroke etiology might influence the clinical outcomes in patients with large vessel occlusion receiving endovascular treatment (EVT) with or without thrombolysis.

Objective

To examine whether stroke etiology resulted in different efficacy and safety in patients treated with EVT-alone or EVT preceded by intravenous alteplase (combined therapy).

Methods

We assessed the efficacy and safety of treatment strategy based on prespecified stroke etiology, cardioembolism (CE), large-artery atherosclerosis (LAA), and undetermined cause (UC) for patients enrolled in the DIRECT-MT trial. The primary outcome was the modified Rankin Scale (mRS) score at 90 days. Multivariate ordinal logistic regression analysis was used to calculate the adjusted common OR for a shift of better mRS score for EVT-alone versus combined therapy. A term was entered to test for interaction.

Results

In this study, 656 patients were grouped into three prespecified stroke etiologic subgroups. The adjusted common ORs for improvement in the 90-day ordinal mRS score with EVT-alone were 1.2 (95% CI 0.8 to 1.8) for CE, 1.6 (95% CI 0.8 to 3.3) for LAA, and 0.8 (95% CI 0.5 to 1.3) for UC. Compared with CE, EVT-alone was more likely to result in an mRS score of 0–1 (pinteraction=0.047) and extended Thrombolysis in Cerebral Infarction ≥2b (pinteraction=0.041) in the LAA group. The differences in mortality and symptomatic intracranial hemorrhage within 90 days were not significant between the subgroups (p＞0.05).

Conclusions

The results did not support the hypothesis that a specific treatment strategy based on stroke etiology should be used for patients with large vessel occlusion (NCT03469206).
Differential price responses for tobacco consumption: implications for tax incidence
Authors: Cruces Guillermo , Falcone Guillermo , Puig Jorge
Published: January 2022

Increasing tobacco taxes is considered the most effective an cost-eﬀective policy to reduce tobacco consumption. However, a common objection to tobacco taxes is that they tend to rely disproportionately on the poorest individuals since less affluent smokers incur proportionately greater expenditures on cigarettes compared with more affluent smokers. Such objections usually assume that all smokers throughout the income distribution react similarly to an increase in tobacco prices. But, if less affluent smokers are more sensitive to price changes (ie, they have a higher demand price elasticity), reductions in tobacco consumption should be higher at the bottom of the income distribution. This paper uses data from Argentina’s Household Expenditure Survey to estimate demand price elasticities for tobacco by income and age groups. Results indicate that less affluent smokers present higher demand price elasticities for cigarettes than more affluent ones. A 10% increase in cigarette prices would decrease consumption by 8.5% (4.4%) for the poorest (richest) smokers. In addition, young people are the most elastic group. These differential elasticities have relevant implications in terms of the distributional incidence of increasing tobacco taxes. As less well-off individuals reduce consumption relatively more, they bear a relatively lower tax burden. Thus, tobacco tax increases may not be regressive as is often believed. As a whole, this paper provides policymakers with relevant arguments for policy discussion and the public debate on common objections to increasing tobacco taxes.
Muscle hypertrophy and strength gains after resistance training with different volume-matched loads: a systematic review and meta-analysis
Authors: Carvalho Leonardo , Junior Roberto Moriggi , Barreira Júlia , Schoenfeld Brad J. , Orazem John , Barroso Renato
Published: January 2022

The purpose of this paper was to conduct a systematic review and meta-analysis of studies that compared muscle hypertrophy and strength gains between resistance training protocols employing very low (VLL < 30% of 1-repetition maximum (RM) or >35RM), low (LL30%–59% of 1RM, or 16–35RM), moderate (ML60%–79% of 1RM, or 8–15RM), and high (HL ≥ 80% of 1RM, or ≤7RM) loads with matched volume loads (sets × repetitions × weight). A pooled analysis of the standardized mean difference for 1RM strength outcomes across the studies showed a benefit favoring HL vs. LL and vs. ML and favoring ML vs. LL. The LL and VLL results showed little difference. A pooled analysis of the standardized mean difference for hypertrophy outcomes across all studies showed no differences between training loads. Our findings indicate that when the volume load is equal between conditions, the highest loads induce superior dynamic strength gains. Alternatively, hypertrophic adaptations were similar irrespective of the load magnitude.

Novelty: Training with higher loads elicits greater gains in 1RM muscle strength when compared to lower loads, even when the volume load is equal between conditions. Muscle hypertrophy is similar irrespective of the magnitude of the load, even when the volume load is equal between conditions.
The importance of B vitamins in enhanced precision nutrition of dairy cows: the case of folates and vitamin B12
Authors: Girard Christiane L. , Duplessis Mélissa
Published: January 2022

Dairy cow diets are generally balanced for energy and major nutrients with B vitamins generally assumed not to be limiting, in spite of their role as coenzymes, essential to many metabolic reactions in protein, carbohydrate, and lipid metabolism. Assuming adequacy of B-vitamin supply may explain some of the discrepancies between the outcomes of metabolic prediction models and measured cow performance. In lactating dairy cow, the amount of B vitamins from the diet and synthesized by the ruminal microbiota is generally sufficient to prevent deficiency symptoms and, as such, is assumed to fulfill requirements. However, reports of beneficial effects of B-vitamin supplementation on dairy cow performance suggest that B-vitamin supply is sometimes lower than its needs, as an insufficient B-vitamin supply decreases metabolic efficiency by driving a shift toward alternative metabolic pathways with greater energy cost. Using information on folates and vitamin B12 illustrated how meeting dairy cow needs for B vitamins should not be overlooked in formulation of rations for lactating dairy cattle. The present review discusses current knowledge and indicates areas presently impeded by the lack of research results, especially the limitations on the ability to estimate B vitamin need and supply.
Quantum-tunneling transitions and exact statistical mechanics of bistable systems with parametrized Dikandé–Kofané double-well potentials
Authors: Nzoupe F. Naha , Dikandé Alain M. , Tchouobiap S. E. Mkam
Published: January 2022

We consider a one-dimensional system of interacting particles (which can be atoms, molecules, ions, etc.), in which particles are subjected to a bistable potential the double-well shape of which is tunable via a shape deformability parameter. Our objective is to examine the impact of shape deformability on the order of transition in quantum tunneling in the bistable system, and on the possible existence of exact solutions to the transfer-integral operator associated with the partition function of the system. The bistable potential is represented by a class composed of three families of parametrized double-well potentials, whose minima and barrier height can be tuned distinctly. It is found that the extra degree of freedom, introduced by the shape deformability parameter, favors a first-order transition in quantum tunneling, in addition to the second-order transition predicted with the $$\phi ^4$$

ϕ
4

model. This first-order transition in quantum tunneling, which is consistent with Chudnovsky’s conjecture of the influence of the shape of the potential barrier on the order of thermally assisted transitions in bistable systems, is shown to occur at a critical value of the shape-deformability parameter which is the same for the three families of parametrized double-well potentials. Concerning the statistical mechanics of the system, the associate partition function is mapped onto a spectral problem by means of the transfer-integral formalism. The condition that the partition function can be exactly integrable, is determined by a criterion enabling exact eigenvalues and eigenfunctions for the transfer-integral operator. Analytical expressions of some of these exact eigenvalues and eigenfunctions are given, and the corresponding ground-state wavefunctions are used to compute the probability density which is relevant for calculations of thermodynamic quantities such as the correlation functions and the correlation lengths.

Graphic Abstract
Transverse-momentum resummation for boson plus jet production at hadron colliders
Authors: Buonocore Luca , Grazzini Massimiliano , Haag Jürg , Rottoli Luca
Published: January 2022

We consider the associated production of a vector or Higgs boson with a jet in hadronic collisions. When the transverse momentum $$q_T$$

q
T

of the boson-jet system is much smaller than its invariant mass Q, the QCD perturbative expansion is affected by large logarithmic terms that must be resummed to all orders. We discuss the all-order resummation structure of the logarithmically enhanced contributions up to next-to-leading logarithmic accuracy. Resummation is performed at the differential level with respect to the kinematical variables of the boson-jet system. Soft-parton radiation produces azimuthal correlations that are fully accounted for in our framework. We present explicit analytical results for the resummation coefficients up to next-to-leading order and next-to-leading logarithmic accuracy, that include the exact dependence on the jet radius.
Impact of $$b \rightarrow s \ell \ell $$ anomalies on rare charm decays in non-universal $$Z'$$ models
Authors: Alok Ashutosh Kumar , Chundawat Neetu Raj Singh , Kumar Dinesh
Published: January 2022

In this work, we study the impact of$$b \rightarrow s \ell \ell $$b→sℓℓ,$$B_s - \bar{B_s}$$Bs-Bs¯mixing and neutrino trident measurements on observables in decays induced by$$c \rightarrow u $$c→utransition in the context of a non-universal$$Z'$$Z′model which generates$$C^{\mathrm{NP}}_{9} <0$$C9NP<0and$$C^{\mathrm{NP}}_9 = - \,C^{\mathrm{NP}}_{10} $$C9NP=-C10NPnew physics scenarios at the tree level. We inspect the effects on$$D^0 \rightarrow \pi ^0 \nu {\bar{\nu }}$$D0→π0νν¯,$$D^+ \rightarrow \pi ^+ \nu {\bar{\nu }}$$D+→π+νν¯and$$B_c \rightarrow B^+ \nu {\bar{\nu }} $$Bc→B+νν¯decays which are induced by the quark level transition$$c \rightarrow u \nu {\bar{\nu }}$$c→uνν¯. The fact that the branching ratios of these decays are negligible in the standard model (SM) and the long distance effects are relatively smaller in comparison to their charged dileptons counterparts, they are considered to provide genuine null-tests of SM. Therefore the observation of these modes at the level of current as well as planned experimental sensitivities would imply unambiguous signature of new physics. Using the constraints on$$Z'$$Z′couplings coming from a combined fit to$$b \rightarrow s \ell \ell $$b→sℓℓ,$$\varDelta M_s$$ΔMsand neutrino trident data, we find that any meaningful enhancement over the SM value is ruled out in the considered framework. The same is true for$$D - {\bar{D}}$$D-D¯mixing observable$$\varDelta M_D$$ΔMDalong with$$D^0 \rightarrow \mu ^+ \mu ^-$$D0→μ+μ-and$$D^+ \rightarrow \pi ^+ \mu ^+ \mu ^-$$D+→π+μ+μ-decay modes which are induced through$$c \rightarrow u \mu ^+ \mu ^-$$c→uμ+μ-transition.
Firing patterns and bifurcation analysis of Purkinje cell dendrite model
Authors: Huang Xiaoshan , Liu Shenquan , Meng Pan , Zang Jie
Published: January 2022

This paper mainly studied firing patterns and related bifurcations in the Purkinje cell dendrite model. Based on the methods of equivalent potentials and time scale analysis, the initial six-dimensional (6D) dendrite model is reduced to a 3D form to facilitate the calculation. We numerically show that the dendrite model could exhibit period-adding bifurcation and four bursting patterns for several vital parameters. Then the bifurcation mechanisms and transition of these four bursting patterns are discussed by phase plane analysis, and two-parameter bifurcation analysis of the fast subsystem, respectively. Moreover, we computed the first Lyapunov coefficient to determine the stability of Hopf bifurcation. Ultimately, we analyzed the codimension-two bifurcation of the whole system and gave a detailed theoretical derivation of the Bogdanov–Takens bifurcation.
[Retracted] Adaptive Enhancement Algorithm of High‐Resolution Satellite Image Based on Feature Fusion
Authors: Wang Ruizhe , Xiao Wang
Published: January 2022

Since the traditional adaptive enhancement algorithm of high‐resolution satellite images has the problems of poor enhancement effect and long enhancement time, an adaptive enhancement algorithm of high‐resolution satellite images based on feature fusion is proposed. The noise removal and quality enhancement areas of high‐resolution satellite images are determined by collecting a priori information. On this basis, the histogram is used to equalize the high‐resolution satellite images, and the local texture features of the images are extracted in combination with the local variance theory. According to the extracted features, the illumination components are estimated by Gaussian low‐pass filtering. The illumination components are fused to complete the adaptive enhancement of high‐resolution satellite images. Simulation results show that the proposed algorithm has a better adaptive enhancement effect, higher image definition, and shorter enhancement time.
Smart Heart Disease Prediction System with IoT and Fog Computing Sectors Enabled by Cascaded Deep Learning Model
Authors: Raju K. Butchi , Dara Suresh , Vidyarthi Ankit , Gupta V. MNSSVKR , Khan Baseem
Published: January 2022

Chronic illnesses like chronic respiratory disease, cancer, heart disease, and diabetes are threats to humans around the world. Among them, heart disease with disparate features or symptoms complicates diagnosis. Because of the emergence of smart wearable gadgets, fog computing and “Internet of Things” (IoT) solutions have become necessary for diagnosis. The proposed model integrates Edge-Fog-Cloud computing for the accurate and fast delivery of outcomes. The hardware components collect data from different patients. The heart feature extraction from signals is done to get significant features. Furthermore, the feature extraction of other attributes is also gathered. All these features are gathered and subjected to the diagnostic system using an Optimized Cascaded Convolution Neural Network (CCNN). Here, the hyperparameters of CCNN are optimized by the Galactic Swarm Optimization (GSO). Through the performance analysis, the precision of the suggested GSO-CCNN is 3.7%, 3.7%, 3.6%, 7.6%, 67.9%, 48.4%, 33%, 10.9%, and 7.6% more advanced than PSO-CCNN, GWO-CCNN, WOA-CCNN, DHOA-CCNN, DNN, RNN, LSTM, CNN, and CCNN, respectively. Thus, the comparative analysis of the suggested system ensures its efficiency over the conventional models.