bluuebunny/crossref_metadata_2025 huggingface dataset:
Torus knot filtered embedded contact homology of the tight contact 3‐sphere
Authors: Nelson Jo , Weiler Morgan
Published: May 2024

Knot filtered embedded contact homology was first introduced by Hutchings in 2015; it has been computed for the standard transverse unknot in irrational ellipsoids by Hutchings and for the Hopf link in lens spaces via a quotient by Weiler. While toric constructions can be used to understand the ECH chain complexes of many contact forms adapted to open books with binding the unknot and Hopf link, they do not readily adapt to general torus knots and links. In this paper, we generalize the definition and invariance of knot filtered embedded contact homology to allow for degenerate knots with rational rotation numbers. We then develop new methods for understanding the embedded contact homology chain complex of positive torus knotted fibrations of the standard tight contact 3‐sphere in terms of their presentation as open books and as Seifert fiber spaces. We provide Morse–Bott methods, using a doubly filtered complex and the energy filtered perturbed Seiberg–Witten Floer theory developed by Hutchings and Taubes, and use them to compute the knot filtered embedded contact homology, for odd and positive.
Homeostasis and evolution in relation to regeneration and repair
Authors: Cano‐Martínez Agustina , Rubio‐Ruiz María Esther , Guarner‐Lans Verónica
Published: May 2024

Homeostasis constitutes a key concept in physiology and refers to self‐regulating processes that maintain internal stability when adjusting to changing external conditions. It diminishes internal entropy constituting a driving force behind evolution. Natural selection might act on homeostatic regulatory mechanisms and control mechanisms including homeodynamics, allostasis, hormesis and homeorhesis, where different stable stationary states are reached. Regeneration is under homeostatic control through hormesis. Damage to tissues initiates a response to restore the impaired equilibrium caused by mild stress using cell proliferation, cell differentiation and cell death to recover structure and function. Repair is a homeorhetic change leading to a new stable stationary state with decreased functionality and fibrotic scarring without reconstruction of the 3‐D pattern. Mechanisms determining entrance of the tissue or organ to regeneration or repair include the balance between innate and adaptive immune cells in relation to cell plasticity and stromal stem cell responses, and redox balance. The regenerative and reparative capacities vary in different species, distinct tissues and organs, and at different stages of development including ageing. Many cell signals and pathways play crucial roles determining regeneration or repair by regulating protein synthesis, cellular growth, inflammation, proliferation, autophagy, lysosomal function, metabolism and metalloproteinase cell signalling. Attempts to favour the entrance of damaged tissues to regeneration in those with low proliferative rates have been made; however, there are evolutionary constraint mechanisms leading to poor proliferation of stem cells in unfavourable environments or tumour development. More research is required to better understand the regulatory processes of these mechanisms.

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Some Results on the Properties of Discrete-Time LTI State-Space Systems
Authors: Kadam Sujay D. , Palanthandalam-Madapusi Harish J.
Published: May 2024

This work brings forward several interesting facts about system properties of linear time-invariant discrete-time systems like output controllability, state controllability and state observability, trackability, and input and state observability. Particularly, the work brings about the inter-relationships between these properties while taking a state-space formulation-based approach to come up with simple facts that are backed up by proofs using preliminary linear algebra.
On Bell's dynamical route to special relativity
Authors: Strauch Frederick W.
Published: May 2024

This paper develops the approach to special relativity put forward by John S. Bell. The classical dynamics of an electron orbiting a nucleus in uniform motion is solved analytically and compared to numerical simulations for an accelerated nucleus. The relativistic phenomena of length contraction and time dilation are shown to result from the electric and magnetic forces on the electron when its motion is analyzed in a single frame of reference. The relevance of these results for understanding the theory of special relativity is discussed.
Lagrange points and regionally conserved quantities
Authors: Edlund Eric M.
Published: May 2024

Lagrange points are the equilibrium points within a restricted three-body system, epitomized by the Trojan asteroids near the L4 and L5 points of the Sun–Jupiter system. They also play a crucial role in some space missions, including the James Webb Space Telescope which is located at the Sun–Earth L2 point. While the existence of five Lagrange points is a well-known feature of the restricted three-body problem, the equations describing the precise location of all five points are not extensively documented. This work presents a derivation of all Lagrange points using polar coordinates and a new normalization scheme that offers a simpler interpretation of solutions compared to prior analyses. A subtle issue concerning the treatment of angular momentum in the potential formulation of this problem is addressed and resolved. The supplementary material to this work contains additional mathematical details and discussion.
Pseudospin-dependent acoustic topological edge and corner states in silica aerogel metamaterials
Authors: Liu Chen , Xiong Wei , Liu Wenjie , Wang Yihe , Zhang Zhiwang , Cheng Ying , Liu Xiaojun
Published: May 2024

Fueled by the concepts of topological insulators, analogous topological acoustics offer an alternative approach to manipulate sound. Theoretical proposals for subwavelength acoustic topological insulators are considered to be ideal effective parameters or utilizeing artificial coiling-space metamaterials. However, the corresponding realization using realistic soft metamaterials remains challenging. In this study, we present the design of an acoustic subwavelength second-order topological insulator using nanoscale porous solid material, silica aerogel, which supports pseudospin-dependent topological edge and corner states simultaneously. Through simulations and experiments, we demonstrate that silica aerogel can function as a soft acoustic metamaterial at the subwavelength scale. By embedding silica aerogel in an air matrix to construct a honeycomb lattice, a double Dirac cone is obtained. A topological phase transition is induced by expanding or contracting the supercell, resulting in band inversion. Additionally, we propose topologically robust acoustic transmission along the one-dimensional edge. Furthermore, we discover that the proposed sonic crystal sustains zero-dimensional corner states, which can efficiently confine energy at subwavelength corners. These findings offer potential for the realization of subwavelength topological acoustic devices using realistic soft metamaterials.
Frequency shift of parametric sound by face-to-face pair of sources in relative motion
Authors: Kotoku Shun , Maeno Reita , Hasegawa Keisuke
Published: May 2024

This paper reports an acoustic phenomenon regarding a parametric sound source (also referred to as a parametric array): a secondary sound wave is generated from the nonlinear interaction of multiple primary sound waves with varied frequency components, particularly when two relatively moving sound sources face each other. It was found that the frequency of the secondary wave fluctuated according to the source movement and provided a theoretical explanation for this phenomenon. It is experimentally demonstrated that this frequency shift was approximately proportional to the velocity of the moving source toward the fixed source and to the driving frequency of the moving source. This phenomenon has much in common with the Doppler's effect, but its unique property is that the frequency shift depends on neither the observation position nor the source velocity toward the observer. These sound generation principles enable measurement of the velocity of slowly moving sound sources while maintaining a low-modulation frequency band and a short measurement time. This phenomenon can potentially be applied to an alternative approach for acoustic noncontact velocimetry of moving objects.
Toward drift-free high-throughput nanoscopy through adaptive intersection maximization
Authors: Ma Hongqiang , Chen Maomao , Nguyen Phuong , Liu Yang
Published: May 2024

Single-molecule localization microscopy (SMLM) often suffers from suboptimal resolution due to imperfect drift correction. Existing marker-free drift correction algorithms often struggle to reliably track high-frequency drift and lack the computational efficiency to manage large, high-throughput localization datasets. We present an adaptive intersection maximization-based method (AIM) that leverages the entire dataset’s information content to minimize drift correction errors, particularly addressing high-frequency drift, thereby enhancing the resolution of existing SMLM systems. We demonstrate that AIM can robustly and efficiently achieve an angstrom-level tracking precision for high-throughput SMLM datasets under various imaging conditions, resulting in an optimal resolution in simulated and biological experimental datasets. We offer AIM as one simple, model-free software for instant resolution enhancement with standard CPU devices.
Unrecoverable lattice rotation governs structural degradation of single-crystalline cathodes
Authors: Huang Weiyuan , Liu Tongchao , Yu Lei , Wang Jing , Zhou Tao , Liu Junxiang , Li Tianyi , Amine Rachid , Xiao Xianghui , Ge Mingyuan , Ma Lu , Ehrlich Steven N. , Holt Martin V. , Wen Jianguo , Amine Khalil
Published: May 2024

Transitioning from polycrystalline to single-crystalline nickel-rich cathodes has garnered considerable attention in both academia and industry, driven by advantages of high tap density and enhanced mechanical properties. However, cathodes with high nickel content (>70%) suffer from substantial capacity degradation, which poses a challenge to their commercial viability. Leveraging multiscale spatial resolution diffraction and imaging techniques, we observe that lattice rotations occur universally in single-crystalline cathodes and play a pivotal role in the structure degradation. These lattice rotations prove unrecoverable and govern the accumulation of adverse lattice distortions over repeated cycles, contributing to structural and mechanical degradation and fast capacity fade. These findings bridge the previous knowledge gap that exists in the mechanistic link between fast performance failure and atomic-scale structure degradation.
Astronomers find long-missing dwarf galaxies—too many of them
Authors: O’Callaghan Jonathan
Published: May 2024

Apparent overabundance means theories of how galaxies took shape in the early universe may need adjusting
Micrococcin cysteine-to-thiazole conversion through transient interactions between the scaffolding protein TclI and the modification enzymes TclJ and TclN
Authors: Calvopina-Chavez Diana G. , Bursey Devan M. , Tseng Yi-Jie , Patil Leena M. , Bewley Kathryn D. , Bennallack Philip R. , McPhie Josh M. , Wagstaff Kimberly B. , Daley Anisha , Miller Susan M. , Moody James D. , Price John C. , Griffitts Joel S.
Published: May 2024

Ribosomally synthesized and post-translationally modified peptides (RiPPs) are a broad group of compounds mediating microbial competition in nature. Azole/azoline heterocycle formation in the peptide backbone is a key step in the biosynthesis of many RiPPs. Heterocycle formation in RiPP precursors is often carried out by a scaffold protein, an ATP-dependent cyclodehydratase, and an FMN-dependent dehydrogenase. It has generally been assumed that the orchestration of these modifications is carried out by a stable complex including the scaffold, cyclodehydratase, and dehydrogenase. The antimicrobial RiPP micrococcin begins as a precursor peptide (TclE) with a 35-amino acid N-terminal leader and a 14-amino acid C-terminal core containing six Cys residues that are converted to thiazoles. The putative scaffold protein (TclI) presumably presents the TclE substrate to a cyclodehydratase (TclJ) and a dehydrogenase (TclN) to accomplish the two-step installation of the six thiazoles. In this study, we identify a minimal TclE leader region required for thiazole formation, demonstrate complex formation between TclI, TclJ, and TclN, and further define regions of these proteins required for complex formation. Our results point to a mechanism of thiazole installation in which TclI associates with the two enzymes in a mutually exclusive fashion, such that each enzyme competes for access to the peptide substrate in a dynamic equilibrium, thus ensuring complete modification of each Cys residue in the TclE core.

IMPORTANCE

Thiopeptides are a family of antimicrobial peptides characterized for having sulfur-containing heterocycles and for being highly post-translationally modified. Numerous thiopeptides have been identified; almost all of which inhibit protein synthesis in gram-positive bacteria. These intrinsic antimicrobial properties make thiopeptides promising candidates for the development of new antibiotics. The thiopeptide micrococcin is synthesized by the ribosome and undergoes several post-translational modifications to acquire its bioactivity. In this study, we identify key interactions within the enzymatic complex that carries out cysteine to thiazole conversion in the biosynthesis of micrococcin.
Functional characterization of a novel flavin reductase from a deep-sea sediment metagenomic library and its application for indirubin production
Authors: Du Jikun , Li Yuanhua , Chen Zhengzhuang , Wang Chang , Huang Yali , Li Li
Published: May 2024

Microbial synthesis is a desirable approach to produce indirubin but suffers from low synthetic efficiency. Insufficient supply of reduced flavins is one major factor limiting synthetic efficiency. To address this, a novel flavin reductase, MoxB, was discovered through screening of the metagenomic library. MoxB showed a strong preference for NADH over NADPH as the electron source for FMN/FAD reduction and exhibited the highest activity at pH 8.0 and 30°C. It displayed remarkable thermostability by maintaining 80% of full activity after incubation at 60°C for 1 h. Furthermore, MoxB showed great organic solvent tolerance and its activity could be significantly increased by bivalent metal ions. In addition, heterologous expression of the
moxB
gene in the indirubin-producing
E. coli
significantly improved indirubin production up to 15.12-fold. This discovery expands the understanding of flavin reductases and provides a promising catalytic tool for microbial indirubin production.

IMPORTANCE

Much effort has been exerted to produce indirubin using engineered
Escherichia coli
, but high-level production has not been achieved so far. Insufficient supply of reduced flavins is one key factor limiting the catalytic efficiency. However, the flavin reductases involved in indirubin biosynthesis have not been hitherto reported. Discovery of the novel flavin reductase MoxB provides a useful tool for enhancing indirubin production by
E. coli
. Overexpression of MoxB in indirubin-producing
E. coli
increased indirubin production by 15.12-fold in comparison to the control strain. Our results document the function of flavin reductase that reduces flavins during indirubin biosynthesis and provide an important foundation for using the flavin reductases to improve indirubin production by engineered microorganisms.
Applying lessons of COVID-19 and other emerging infectious diseases to future outbreaks
Authors: Bloch Evan M. , Sullivan David J. , Casadevall Arturo , Shoham Shmuel , Tobian Aaron A. R. , Gebo Kelly
Published: May 2024

Infectious diseases are emerging and re-emerging far more frequently than many appreciate. In the past two decades alone, there have been numerous outbreaks (e.g., Ebola, chikungunya, Zika, and Mpox) and pandemics (i.e., swine flu and coronavirus disease 2019) with profound effects to public health, the economy, and society at large. Rather than view these in isolation, there are important lessons pertaining to how best to contend with future outbreaks of emerging infectious diseases. Those lessons span definition (i.e., what constitutes a pandemic), through deficiencies in surveillance, data collection and reporting, the execution of research in a rapidly changing environment, the nuances of study design and hierarchy of clinical evidence, triage according to clinical need as supply chains become overwhelmed, and the challenges surrounding forecasting of outbreaks. Understanding those lessons and drawing on both the successes and failures of the past are imperative if we are to overcome the challenges of outbreak/pandemic responsiveness.
A novel clinical metaproteomics workflow enables bioinformatic analysis of host-microbe dynamics in disease
Authors: Do Katherine , Mehta Subina , Wagner Reid , Bhuming Dechen , Rajczewski Andrew T. , Skubitz Amy P. N. , Johnson James E. , Griffin Timothy J. , Jagtap Pratik D.
Published: May 2024

Clinical metaproteomics has the potential to offer insights into the host-microbiome interactions underlying diseases. However, the field faces challenges in characterizing microbial proteins found in clinical samples, usually present at low abundance relative to the host proteins. As a solution, we have developed an integrated workflow coupling mass spectrometry-based analysis with customized bioinformatic identification, quantification, and prioritization of microbial proteins, enabling targeted assay development to investigate host-microbe dynamics in disease. The bioinformatics tools are implemented in the Galaxy ecosystem, offering the development and dissemination of complex bioinformatic workflows. The modular workflow integrates MetaNovo (to generate a reduced protein database), SearchGUI/PeptideShaker and MaxQuant [to generate peptide-spectral matches (PSMs) and quantification], PepQuery2 (to verify the quality of PSMs), Unipept (for taxonomic and functional annotation), and MSstatsTMT (for statistical analysis). We have utilized this workflow in diverse clinical samples, from the characterization of nasopharyngeal swab samples to bronchoalveolar lavage fluid. Here, we demonstrate its effectiveness via analysis of residual fluid from cervical swabs. The complete workflow, including training data and documentation, is available via the Galaxy Training Network, empowering non-expert researchers to utilize these powerful tools in their clinical studies.

IMPORTANCE

Clinical metaproteomics has immense potential to offer functional insights into the microbiome and its contributions to human disease. However, there are numerous challenges in the metaproteomic analysis of clinical samples, including handling of very large protein sequence databases for sensitive and accurate peptide and protein identification from mass spectrometry data, as well as taxonomic and functional annotation of quantified peptides and proteins to enable interpretation of results. To address these challenges, we have developed a novel clinical metaproteomics workflow that provides customized bioinformatic identification, verification, quantification, and taxonomic and functional annotation. This bioinformatic workflow is implemented in the Galaxy ecosystem and has been used to characterize diverse clinical sample types, such as nasopharyngeal swabs and bronchoalveolar lavage fluid. Here, we demonstrate its effectiveness and availability for use by the research community via analysis of residual fluid from cervical swabs.
Human-derived fecal microbiota transplantation alleviates social deficits of the BTBR mouse model of autism through a potential mechanism involving vitamin B
6
metabolism
Authors: Zheng Lifeng , Jiao Yinming , Zhong Haolin , Tan Yan , Yin Yiming , Liu Yanhong , Liu Ding , Wu Manli , Wang Guoyun , Huang Jinqun , Wang Ping , Qin Meirong , Wang Mingbang , Xiao Yang , Lv Tiying , Luo Yangzi , Hu Han , Hou Sheng-Tao , Kui Ling
Published: May 2024

Autism spectrum disorder (ASD) is a heterogeneous neurodevelopmental condition characterized by social communication deficiencies and stereotypic behaviors influenced by hereditary and/or environmental risk factors. There are currently no approved medications for treating the core symptoms of ASD. Human fecal microbiota transplantation (FMT) has emerged as a potential intervention to improve autistic symptoms, but the underlying mechanisms are not fully understood. In this study, we evaluated the effects of human-derived FMT on behavioral and multi-omics profiles of the BTBR mice, an established model for ASD. FMT effectively alleviated the social deficits in the BTBR mice and normalized their distinct plasma metabolic profile, notably reducing the elevated long-chain acylcarnitines. Integrative analysis linked these phenotypic changes to specific
Bacteroides
species and vitamin B
6
metabolism. Indeed, vitamin B
6
supplementation improved the social behaviors in BTBR mice. Collectively, these findings shed new light on the interplay between FMT and vitamin B
6
metabolism and revealed a potential mechanism underlying the therapeutic role of FMT in ASD.

IMPORTANCE

Accumulating evidence supports the beneficial effects of human fecal microbiota transplantation (FMT) on symptoms associated with autism spectrum disorder (ASD). However, the precise mechanism by which FMT induces a shift in the microbiota and leads to symptom improvement remains incompletely understood. This study integrated data from colon-content metagenomics, colon-content metabolomics, and plasma metabolomics to investigate the effects of FMT treatment on the BTBR mouse model for ASD. The analysis linked the amelioration of social deficits following FMT treatment to the restoration of mitochondrial function and the modulation of vitamin B
6
metabolism. Bacterial species and compounds with beneficial roles in vitamin B
6
metabolism and mitochondrial function may further contribute to improving FMT products and designing novel therapies for ASD treatment.
Activation Analysis of the Temperature Dependence of the Dielectric Constant of Ferroelectrics
Authors: Kuzenko D. V.
Published: May 2024

For ferroelectrics lead zirconate titanate and barium titanate, an exponential dependence of the dielectric constant on temperature is shown, provided that the Curie–Weiss law is satisfied. The temperature of equality of ferroelectric dielectric constants for activation processes caused by the interaction of domain walls with point defects, as well as the corresponding activation energies, have been determined.
Short-term treatment of skeletal class III malocclusion by surgery-first approach with SDU protocol
Authors: Buyukcavus Muhammed Hilmi , Findik Yavuz
Published: May 2024

The aim of this case series is to present the successful treatments and long-term results of three adult skeletal class III patients treated with the surgery-first (SF) approach by applying the SDU (Suleyman Demirel University) protocol and to discuss the differences, advantages and disadvantages compared with other methods. Although there were differences in the treatment planning and surgical procedures of the three patients in the case series, the same protocol was followed in all three patients. The desired aesthetic result and functional occlusion were achieved with the SF approach. Significant improvement was observed in the patients’ profile and facial appearance in a short time. The total duration of treatment for all cases was less than a year.
Non-ketotic hyperglycinaemia masquerading as a hypotonic-hyporesponsive episode following vaccination in an infant
Authors: Prasad Arun , Kumar Pradeep , Marithammanahalli Faneesha Giridhar , Kumar Chandramohan
Published: May 2024

Non-ketotic hyperglycinaemia (NKH) is an inborn error of glycine metabolism with autosomal recessive inheritance. A female infant presented to our emergency department with intractable seizures, lethargy and hypotonia, 2 weeks after her routine vaccination. Detailed infective and metabolic workup revealed normal blood sugar, ketone, lactate ammonia, and a high level of glycine in serum and cerebrospinal fluid suggesting NKH. Diagnosis of NKH was further confirmed on genetic analysis forAMTgene mutation. The child showed clinical improvement with oral sodium benzoate. Here, we report the inheritance, pathophysiology, diagnostic approach, genetic confirmation, management and prognosis of a child with NKH.
Uterovaginal prolapse complicated by urogenital myiasis
Authors: Bahadur Anupama , Mundhra Rajlaxmi , Gill Poonam , Mathuria Yogendra
Published: May 2024

Urogenital myiasis is a rare entity that is usually manifested in women belonging to lower socioeconomic status residing in tropical or subtropical nations with poor hygiene or intellectual disability. It is caused by fly larvae capable of penetrating body orifices and healthy or necrotic tissue. The larvae penetrate the skin, forming painful, inflammatory nodules that can form fistula to the internal organs or the skin’s surface. Serous and haemorrhagic exudation, along with crawling larvae, are encountered. Some complications, such as secondary infection and tetanus, have been documented. The prognosis is generally good, and treatment consists of removing the parasitic larvae and thoroughly cleansing the affected area.

We present a case of a postmenopausal woman with parity 3 and live issue 1 in her early 50s from lower socioeconomic status diagnosed with uterovaginal prolapse complicated by myiasis. The patient was managed successfully with systemic antibiotics, manual removal of myiasis and hysterectomy.
Fixation with multiple K-wires and PRP injection as an effective way to manage heel pad avulsion
Authors: Sahoo Samrat Smrutiranjan , Roy Mainak , Dwidmuthe Samir Chandrakant , Tiwari Vivek
Published: May 2024

The treatment of acute heel pad avulsion differs significantly from managing other soft tissue injuries due to its unique soft tissue structure. This case report outlines a scenario involving a male in his 20s who suffered heel pad avulsion without a calcaneal fracture but with an ipsilateral medial malleolus fracture after a twisting injury to the ankle caused by a road traffic accident. Immediate action was taken within 24 hours of the injury, involving thorough debridement of the wound, fixation to the calcaneum using multiple K-wires, primary suturing and internal fixation of the medial malleolus with two cannulated cancellous screws. Postoperative care included PRP (platelet-rich plasma) injections into the wound twice, removal of K-wires after 6 weeks and allowing walking with full weight bearing after 8 weeks. A year later, the wound had completely healed, and the patient was comfortably walking pain-free with full weight-bearing capabilities.
SubconjunctivalDirofilariamasquerading as nodular scleritis
Authors: Sinha Saloni , Tarini Shilpa , Panchal Bhavik , Mishra Dilip K
Published: May 2024

A man in his late 50s presented with a gradually enlarging, painless, reddish mass on the white portion of his left eye for 2 weeks. His best-corrected visual acuity was 20/20 in both eyes. Slit-lamp examination showed a congested, nodular, elevated lesion on the temporal bulbar conjunctiva with two pustule-like elevations. Anterior segment optical coherence tomography showed a subconjunctival solid mass rather than an abscess or a cyst. Scleral deroofing was performed and a long thread-like object resembling a dead worm was identified. The worm was removed intact, and its histopathology confirmed the diagnosis ofDirofilaria. Peripheral blood smear did not show any microfilariae. No recurrences or new lesions were observed during the follow-up examinations at 1 and 5 months post-surgery. This case highlights the importance of considering a parasitic aetiology in cases of nodular or infectious scleritis.
Treatment of congenital melanocytic naevi of nose using multiple flaps in single stage in a paediatric patient and literature review
Authors: Sagar Milind , Tandan Nisha , Kumar Rakesh , Kumar Rajeev
Published: May 2024

A girl in her middle childhood presented to the outpatient department (OPD) with a congenital melanocytic naevi (CMN) of the right nasal alar lobule. Her parents had aesthetic concerns and expressed their desire to get the lesion removed. The full-thickness excision of CMN was performed with the reconstruction of the defect using the nasolabial and dorsal nasal advancement flap with conchal cartilage to shape the contour of the ala.
Clinician and health service interventions to reduce the greenhouse gas emissions generated by healthcare: a systematic review
Authors: Pickles Kristen , Haas Romi , Guppy Michelle , O'Connor Denise A , Pathirana Thanya , Barratt Alexandra , Buchbinder Rachelle
Published: May 2024

Objective

To synthesise the available evidence on the effects of interventions designed to improve the delivery of healthcare that reduces the greenhouse gas (GHG) emissions of healthcare.

Design

Systematic review and structured synthesis.

Search sources

Cochrane Central Register of Controlled Trials, PubMed, Web of Science and Embase from inception to 3 May 2023.

Selection criteria

Randomised, quasi-randomised and non-randomised controlled trials, interrupted time series and controlled or uncontrolled before�after studies that assessed interventions primarily designed to improve the delivery of healthcare that reduces the GHG emissions of healthcare initiated by clinicians or healthcare services within any setting.

Main outcome measures

Primary outcome was GHG emissions. Secondary outcomes were financial costs, effectiveness, harms, patient-relevant outcomes, engagement and acceptability.

Data collection and analysis

Paired authors independently selected studies for inclusion, extracted data, and assessed risk of bias using a modified checklist for observational studies and the certainty of the evidence using Grades of Recommendation, Assessment, Development and Evaluation. Data could not be pooled because of clinical and methodological heterogeneity, so we synthesised results in a structured summary of intervention effects with vote counting based on direction of effect.

Results

21 observational studies were included. Interventions targeted delivery of anaesthesia (12 of 21), waste/recycling (5 of 21), unnecessary test requests (3 of 21) and energy (1 of 21). The primary intervention type was clinician education. Most (20 of 21) studies were judged at unclear or high risk of bias for at least one criterion. Most studies reported effect estimates favouring the intervention (GHG emissions 17 of 18, costs 13 of 15, effectiveness 18 of 20, harms 1 of 1 and staff acceptability 1 of 1 studies), but the evidence is very uncertain for all outcomes (downgraded predominantly for observational study design and risk of bias). No studies reported patient-relevant outcomes other than death or engagement with the intervention.

Conclusions

Interventions designed to improve the delivery of healthcare that reduces GHG emissions may reduce GHG emissions and costs, reduce anaesthesia use, waste and unnecessary testing, be acceptable to staff and have little to no effect on energy use or unintended harms, but the evidence is very uncertain. Rigorous studies that measure GHG emissions using gold-standard life cycle assessment are needed as well as studies in more diverse areas of healthcare. It is also important that future interventions to reduce GHG emissions evaluate the effect on beneficial and harmful patient outcomes.

PROSPERO registration number

CRD42022309428.
Assessment of the methodological, recommendation and reporting quality of global guidelines for neck pain and synthesis of evidence and recommendations: a systematic review protocol
Authors: Li Jiayu , Ou Jiayin , Liu Yang , Shen Chenwei , Chen Xiaoli , Li Ying , Zhao Jiayi , Xu Jing , Zhang Yu , Wang Lin
Published: May 2024

Introduction

Neck pain is a global health problem that can cause severe disability and a huge medical burden. Clinical practice guideline (CPG) is an important basis for clinical diagnosis and treatment. A high-quality CPG plays a significant role in clinical practice. However, the quality of the CPGs for neck pain lacks comprehensive assessment. This protocol aims to evaluate the methodological, recommendation, reporting quality of global CPGs for neck pain and identify key recommendations and gaps that limit evidence-based practice.

Method

CPGs from January 2013 to November 2023 will be identified through a systematic search on 13 scientific databases (PubMed, Cochrane Library, Embase, etc) and 7 online guideline repositories. Six reviewers will independently evaluate the quality of CPGs for neck pain by using the Appraisal of Guidelines for Research and Evaluation, the Appraisal of Guidelines Research and Evaluation-Recommendations Excellence and the Reporting Items for Practice Guidelines in Healthcare tools. Intraclass correlation coefficient will be used to test the consistency of the assessment. We will identify the distribution of evidence and recommendations in each evidence-based CPGs for neck pain and regrade the level of evidence and strength of recommendations by adopting the commonly used Grading of Recommendations, Assessment, Development and Evaluations system. The key recommendations based on high-quality evidence will be summarised. In addition, we will categorise CPGs by different characteristics and conduct a subgroup analysis of the results of assessment.

Ethics and dissemination

No subjects will be involved in this systematic review, so there is no need for ethical approval. The finding of this review will be summarised as a paper for publication in a peer-reviewed journal.

PROSPERO registration number

CRD42023417717.
Prevalence and correlates of paediatric guideline non-adherence for initial empirical care in six low and middle-income settings: a hospital-based cross-sectional study
Authors: Shawon Riffat Ara , Denno Donna , Tickell Kirkby D , Atuhairwe Michael , Bandsma Robert , Mupere Ezekiel , Voskuijl Wieger , Mbale Emmie , Ahmed Tahmeed , Chisti Md Jobayer , Saleem Ali Faisal , Ngari Moses , Diallo Abdoulaye Hama , Berkley James , Walson Judd , Means Arianna Rubin
Published: May 2024

Objectives

This study evaluated the prevalence and correlates of guideline non-adherence for common childhood illnesses in low-resource settings.

Design and setting

We used secondary cross-sectional data from eight healthcare facilities in six Asian and African countries.

Participants

A total of 2796 children aged 2–23 months hospitalised between November 2016 and January 2019 with pneumonia, diarrhoea or severe malnutrition (SM) and without HIV infection were included in this study.

Primary outcome measures

We identified children treated with full, partial or non-adherent initial inpatient care according to site-specific standard-of-care guidelines for pneumonia, diarrhoea and SM within the first 24 hours of admission. Correlates of guideline non-adherence were identified using generalised estimating equations.

Results

Fully adherent care was delivered to 32% of children admitted with diarrhoea, 34% of children with pneumonia and 28% of children with SM when a strict definition of adherence was applied. Non-adherence to recommendations was most common for oxygen and antibiotics for pneumonia; fluid, zinc and antibiotics for diarrhoea; and vitamin A and zinc for SM. Non-adherence varied by site. Pneumonia guideline non-adherence was more likely among patients with severe disease (OR 1.82; 95% CI 1.38, 2.34) compared with non-severe disease. Diarrhoea guideline non-adherence was more likely among lower asset quintile groups (OR 1.16; 95% CI 1.01, 1.35), older children (OR 1.10; 95% CI 1.06, 1.13) and children presenting with wasting (OR 6.44; 95% CI 4.33, 9.57) compared with those with higher assets, younger age and not wasted.

Conclusions

Non-adherence to paediatric guidelines was common and associated with older age, disease severity, and comorbidities, and lower household economic status. These findings highlight opportunities to improve guidelines by adding clarity to specific recommendations.
UPDATE trial: investigating the effects of ultra-processed versus minimally processed diets following UK dietary guidance on health outcomes: a protocol for an 8-week community-based cross-over randomised controlled trial in people with overweight or obesity, followed by a 6-month behavioural intervention
Authors: Dicken Samuel , Makaronidis Janine , van Tulleken Chris , Jassil Friedrich C , Hall Kevin , Brown Adrian Carl , Gandini Wheeler-Kingshott Claudia A.M , Fisher Abigail , Batterham Rachel
Published: May 2024

Introduction

Obesity increases the risk of morbidity and mortality. A major driver has been the increased availability of ultra-processed food (UPF), now the main UK dietary energy source. The UK Eatwell Guide (EWG) provides public guidance for a healthy balanced diet but offers no UPF guidance. Whether a healthy diet can largely consist of UPFs is unclear. No study has assessed whether the health impact of adhering to dietary guidelines depends on food processing. Furthermore, our study will assess the impact of a 6-month behavioural support programme aimed at reducing UPF intake in people with overweight/obesity and high UPF intakes.

Methods and analysis

UPDATE is a 2×2 cross-over randomised controlled trial with a 6-month behavioural intervention. Fifty-five adults aged ≥18, with overweight/obesity (≥25 to <40 kg/m2), and ≥50% of habitual energy intake from UPFs will receive an 8-week UPF diet and an 8-week minimally processed food (MPF) diet delivered to their home, both following EWG recommendations, in a random order, with a 4-week washout period. All food/drink will be provided. Participants will then receive 6 months of behavioural support to reduce UPF intake. The primary outcome is the difference in weight change between UPF and MPF diets from baseline to week 8. Secondary outcomes include changes in diet, waist circumference, body composition, heart rate, blood pressure, cardiometabolic risk factors, appetite regulation, sleep quality, physical activity levels, physical function/strength, well-being and aspects of behaviour change/eating behaviour at 8 weeks between UPF/MPF diets, and at 6-month follow-up. Quantitative assessment of changes in brain MRI functional resting-state connectivity between UPF/MPF diets, and qualitative analysis of the behavioural intervention for feasibility and acceptability will be undertaken.

Ethics and dissemination

Sheffield Research Ethics Committee approved the trial (22/YH/0281). Peer-reviewed journals, conferences, PhD thesis and lay media will report results.

Trial registration number

NCT05627570
Lifetime costs of alcohol consumption in Thailand: protocol for an incidence-based cost-of-illness study using Markov model
Authors: Luangsinsiri Chaisiri , Thavorncharoensap Montarat , Chaikledkaew Usa , Pattanaprateep Oraluck , Sornpaisarn Bundit , Rehm Jürgen
Published: May 2024

Introduction

Several prevalence-based cost-of-illness (COI) studies have been conducted to estimate the economic burden of alcohol consumption borne by a particular society in a given year. Yet there are few studies examining the economic costs incurred by an individual drinker over his/her lifetime. Thus, this study aims to estimate the costs incurred by an individual drinker’s alcohol consumption over his or her lifetime in Thailand.

Methods and analysis

An incidence-based COI approach will be employed. To project individuals’ associated costs over a lifetime, a Markov modelling technique will be used. The following six alcohol-related diseases/conditions will be considered in the model: hypertension, haemorrhagic stroke, liver cirrhosis, liver cancer, alcohol use disorders and road injury. The analysis will cover both direct (ie, direct healthcare cost, costs of property damage due to road traffic accidents) and indirect costs (ie, productivity loss due to premature mortality and hospital-related absenteeism). The human capital approach will be adopted to estimate the cost of productivity loss. All costs will be presented in Thai baht, 2022.

Ethics and dissemination

The Institutional Review Board of Mahidol University, Faculty of Dentistry/Faculty of Pharmacy has confirmed that no ethical approval is required (COE.No.MU-DT/PY-IRB 2021/010.0605). Dissemination of the study findings will be carried out through peer-reviewed publications, conferences and engagement with policy-makers and public health stakeholders.
Financial incentive interventions for smoking cessation among Chinese smokers: study protocol for a cluster randomised controlled trial
Authors: Yang Xiaochen , Galárraga Omar , Cao Wangnan , Lin Haoxiang , Cao Fei , Chang Chun
Published: May 2024

Introduction

There is an urgent issue to relieve the burdens caused by tobacco use through feasible and effective smoking cessation interventions, particularly in a middle-income country with less accessible smoking cessation services and high demand for quitting smoking. Financial incentives have shown effective in changing health behaviours, thus needing to test its portability to a wider implementation and effectiveness of increasing smoking cessation rates.

Methods and analysis

This is a three-arm cluster randomised controlled trial. 462 eligible participants will be assigned to 2 financial incentive groups—rewards or deposits, or the control group. All participants including those in the control group will receive text messages to help quitting smoking developed by the US National Cancer Institute over a 3-month intervention period. In addition to text messages, reward group participants will be rewarded with CNY200 and CNY400 (CNY100 approximately US$15) for sustained smoking abstinence at 1 month and 3 months follow-up assessments; participants in the deposit group will accumulate CNY200 and CNY600 in the deposit accounts after verified smoking abstinence at 1 month and 3 months follow-up assessments, and all the deposits will be given at once right after the 3-month follow-up visit. The primary outcome is biochemically verified smoking abstinence rate sustained for 6 months after enrolment.

Ethics and dissemination

This trial protocol has been approved by the Ethics Committee of Peking University Health Science Centre (date: 23 February 2023; ethical approval number: IRB00001052-22172). Results and findings of this trial will be disseminated in peer-reviewed journals and professional conferences.

Trial registration number

ChiCTR-IOR-2300069631.
Examining the effectiveness of the Gateway conditional caution on health and well-being of young adults committing low-level offences: a randomised controlled trial
Authors: Mitchell Alex , Booth Alison , Morgan Sara , Walker Inna , Chapman Caroline , Barlow-Pay Megan , Cochrane Ann , Filby Emma , Fleming Jenny , Hewitt Catherine , Raftery James , Torgerson David , Weir Lana , Parkes Julie
Published: May 2024

Background

Young adults who commit low-level offences commonly have a range of health and social needs and are significantly over-represented in the criminal justice system. These young adults may need to attend court and potentially receive penalties including imprisonment. Alternative routes exist, which can help address the underlying causes of offending. Some feel more should be done to help young adults entering the criminal justice system. The Gateway programme was a type of out-of-court disposal developed by Hampshire Constabulary, which aimed to address the complex needs of young adults who commit low-level crimes. This study aimed to evaluate the effectiveness and cost-effectiveness of the Gateway programme, issued as a conditional caution, compared with usual process.

Methods

The Gateway study was a pragmatic, parallel-group, superiority randomised controlled trial that recruited young adults who had committed a low-level offence from four sites covering Hampshire and Isle of Wight. The primary outcome was mental health and well-being measured using the Warwick-Edinburgh Mental Well-being Scale. Secondary outcomes were quality of life, alcohol and drug use, and recidivism. Outcomes were measured at 4, 16 and 52 weeks postrandomisation.

Results

Due to issues with retention of participants and low data collection rates, recruitment ended early, with 191 eligible participants randomised (Gateway 109; usual process 82). The primary outcome was obtained for 93 (48.7%) participants at 4 weeks, 93 (48.7%) at 16 weeks and 43 (22.5%) at 1 year. The high attrition rates meant that effectiveness could not be assessed as planned.

Conclusions

Gateway is the first trial in a UK police setting to have a health-related primary outcome requiring individual data collection, rather than focusing solely on recidivism. We demonstrated that it is possible to recruit and randomise from the study population, however follow-up rates were low. Further work is needed to identify ways to facilitate engagement between researchers and vulnerable populations to collect data.

Trial registration number

NCT11888938.
Thunderstorm asthma: a paediatric emergency department experience in London
Authors: Stewart Charles G , Mahesh Ayushi , Mulvenna Claire
Published: May 2024

The aim of this study was to characterise paediatric emergency department presentations during the 2023 thunderstorm asthma (TA) epidemic, characterised by a sudden surge in wheeze presentations, with analysis of environmental factors.

Wheeze presentations totalled 50 (28%) on 12 June and 18 (19%) 13 June. There was no prior asthma in 39 (57%) and no atopic disorders in 30 (44%). There was neither asthma nor atopic disorders in 8 (12%). 44 (65%) were severe or life-threatening. There were no endotracheal intubations and no deaths. High pollen and air pollution warnings were issued.

TA poses a significant, sudden health threat, often in children without asthma. A surge strategy is required.
Association between primary hypothyroidism and metabolic dysfunction-associated steatotic liver disease: an updated meta-analysis
Authors: Mantovani Alessandro , Csermely Alessandro , Bilson Josh , Borella Niccolò , Enrico Scoccia , Pecoraro Barbara , Shtembari Emigela , Morandin Riccardo , Polyzos Stergios A , Valenti Luca , Tilg Herbert , Byrne Christopher D , Targher Giovanni
Published: May 2024

Objective

Epidemiological studies have reported an association between primary hypothyroidism and metabolic dysfunction-associated steatotic liver disease (MASLD). However, the magnitude of the risk and whether this risk changes with the severity of MASLD remains uncertain. We performed a meta-analysis of observational studies to quantify the magnitude of the association between primary hypothyroidism and the risk of MASLD.

Design

We systematically searched PubMed, Scopus and Web of Science from database inception to 31 January 2024, using predefined keywords to identify observational studies in which MASLD was diagnosed by liver biopsy, imaging or International Classification of Diseases codes. A meta-analysis was performed using random-effects modelling.

Results

We identified 24 cross-sectional and 4 longitudinal studies with aggregate data on ~76.5 million individuals. Primary hypothyroidism (defined as levothyroxine replacement treatment, subclinical hypothyroidism or overt hypothyroidism) was associated with an increased risk of prevalent MASLD (n=24 studies; random-effects OR 1.43, 95% CI 1.23 to 1.66; I
2
=89%). Hypothyroidism was also associated with a substantially higher risk of metabolic dysfunction-associated steatohepatitis or advanced fibrosis (n=5 studies; random-effects OR 2.84, 95% CI 2.07 to 3.90; I
2
=0%). Meta-analysis of data from four longitudinal studies showed that there was a marginally non-significant association between hypothyroidism and risk of developing MASLD over a median 4.5-year follow-up (random-effects HR 1.39, 95% CI 0.98 to 1.97; I
2
=85%). Sensitivity analyses did not modify these findings. The funnel plot did not reveal any significant publication bias.

Conclusion

This large and updated meta-analysis provides evidence that primary hypothyroidism is significantly associated with both an increased presence of and histological severity of MASLD.