bluuebunny/crossref_metadata_2025 huggingface dataset:
Systematic evaluation and effect of different treatments (HMT, QESD, OSA) on flow properties of Chenopodium album starch
Authors: Singh Renuka , Singh Sukhcharn , Saxena Dharmesh Chandra
Published: September 2022

This study investigate the changes in the flow properties of Chenopodium album starch (CAS) after modification through quasi‐emulsion solvent diffusion (QESD), octenyl succinic anhydride (OSA), and heat moisture treatment (HMT). The native starch's Carr's index (36.92%) and Hausner ratio (1.55) indicates poor flowability as compared to modified starch that shows fair flowability. The caking strength and cohesion index after modification decreased from 1072.67 to 222.00 g.mm and 15.37 to 8.48 g.mm, respectively. Shear properties assessed at three different pressures (3, 6 and 9 kPa) showed that native CAS was less flowable (COF 22.8 at 6 kPa) than modified (COF 26.9 at 6 kPa), making bulk handling harder. The surface roughness value of the powder as measured by atomic force microscopy was found to be lesser in modified starch (92.49 μm) in comparison to native starch (117.60 μm). Scanning electron microscopy revealed the formation of spherical, smooth oval, and regular shaped starch particles after modification. X‐ray diffraction analysis showed an improvement in crystallinity from 20.01 to 29.86% after modification. Conclusively, QESD treatment significantly improved the flow properties of Chenopodium album starch in comparison of HMT and OSA treatment.

Novelty impact statement

Different treatments (HMT, QESD, and OSA) improved the flow properties by developing regular‐shaped, smooth surface, and larger starch particles with increased crystallinity. The changes in particle size distribution, particle shape, and surface roughness had a substantial impact on all flow parameters throughout a wide range of stress situations. The present research would be valuable in determining the impact of various climatic conditions on material flowability, which is an essential consideration when building processing equipment, hoppers, and silos for the bulk handling of starch.
Efficacy and safety of the innovative cold atmospheric‐pressure plasma technology in the treatment of keloid: A randomized controlled trial
Authors: Suwanchinda Atchima , Nararatwanchai Thamthiwat
Published: September 2022

Background

Keloid (KD) treatment is challenging for both physicians and patients. It can be functional debilitating and psychologically distressing. Available current therapeutics modalities give inconsistently effective results.

Objectives

To evaluate the efficacy and safety of innovative cold atmospheric plasma (CAP) technology in the treatment of keloid.

Methods

This prospective, randomized control trial, the assessor‐blinded trial, includes 18 patients with keloids. The keloid lesion was divided into two halves. One side was randomly treated with CAP technology biweekly on the same treated side for five sessions with a follow‐up 30 days after finishing the final treatment. Another half was left untreated as a control. Efficacy assessment using POSAS, VSS, Patients' satisfaction scale, Antera 3D® skin imaging system. The safety assessment using VAS and adverse effects monitoring was completed.

Results

Objective assessment using Antera 3D® skin imaging system (Miravex, Dublin, Ireland) showed statistically significant improvement (p‐value <0.05) on the treated side compared with the untreated side in all parameters, color, melanin, hemoglobin, texture, except for volume. POSAS, patient, and observer overall opinion score, and patient and observer total score in the summary of all rated characteristics, comparing the treated and untreated areas, showed a statistically significant reduction in all parameters after two treatments (*p‐value <0.05). VSS showed statistically significant improvement after the second treatment and continued to the last follow‐up. Most patients rated satisfaction scales up to 72.2% as moderate improvement, 11.1% as great improvement, 11.1% as slight improvement, and 5.6% as no change. The adverse effect was only a small scab in one patient.

Conclusion

CAP technology could be considered an alternative treatment for keloid offering mild‐to‐moderate improvement with minimal side effects.
Future perspective safe cosmetics: Focused on associated with ISO natural organic index
Authors: Lee Jinkyung , Kwon Ki Han
Published: September 2022

Background

As we enter the era of long COVID, recent studies on the relationship between coronavirus disease‐19 (COVID‐19) and skin are being conducted from various angles. Awareness of the safety of healthy skin is increasing.

Objectives

Therefore, in this study, we empirically analyzed safe cosmetics, natural cosmetics, and organic cosmetics, which have recently become a critical issue.

Methods

Keywords such as ‘long COVID’, ‘COVID‐19 Skin’, ‘ISO Natural Organic Index’, ‘edible’, ‘safe cosmetics’, ‘natural cosmetics’, and ‘organic cosmetics’ were searched and created. This study was conducted using PubMed, Google Scholar, Riss, Scopus, and ResearchGate. Accordingly, a total of 689 papers were studied. This paper was successfully completed using a total of 41 references in this study using PRISMA flow diagram.

Results

In the long COVID era, customers in the beauty and cosmetics market will have to apply ISO natural organic ingredients to the cosmetics and beauty industry, reflecting consumer demand for edible ingredients for safety issues. Therefore, it will be able to provide new strategy and implications for a safer cosmetic market that values health and beauty.

Conclusion

Therefore, in this literature review, interest in skin has increased due to the long corona, and it was determined that changes in the cosmetic market would be necessary by using the ISO natural organic index for the consumer's desire for healthy skin. Therefore, in this article, in the future development of eco‐friendly organic cosmetics, in line with the natural and environment‐friendly changes reminiscent of the efficacy or ingredients of products, it is necessary to develop cosmetics using the ISO natural organic index that meets the needs of consumers and a differentiated strategy.
Vaccination under pessimistic expectations in clinical trials and immunization campaigns
Authors: d'Albis Hippolyte , Etner Johanna , Thuilliez Josselin
Published: September 2022

We provide one of the first formalizations of a vaccination campaign in a decision‐theoretic framework. We analyze a model where an ambiguity‐averse individual must decide how much effort to invest into prevention in the context of a rampant disease. We study how ambiguity aversion affects the effort and the estimation of the vaccine efficacy in clinical trials and immunization campaigns. We find that the behaviors of individuals participating in a clinical trial differ from individuals not participating. Individuals who are more optimistic toward vaccination participate more in trials. Their behaviors and efforts are also affected. As a result, because vaccine efficacy depends on unobserved behaviors and efforts, the biological effect of the vaccine becomes difficult to evaluate. During the scale‐up phase of a vaccination campaign, provided that vaccine efficacy is established, we show that vaccine hesitancy may still be rational.
Shaping EU Attitudes Through Identity Leadership: Investigating Pro‐EU and EU‐Skeptic Identity Narratives
Authors: Hehnen Melissa M. , Fladerer Martin P. , Mols Frank , Frey Dieter
Published: September 2022

The European Union (EU) faces many challenges. Chief among them are (1) the growing electoral appeal of EU‐skeptic parties, (2) the prevalence of negative narratives about the EU, and (3) frequent marginalization of government leaders openly advocating EU membership. It is hence unsurprising that the EU attitude literature focuses heavily on ways in which leaders undermine (rather than bolster) confidence in the EU. The aim of this conceptual article is to fill this void and to shine a spotlight on how leaders seek to restore confidence in the EU. Rather than to merely describe what pro‐EU leaders say in public, we propose a conceptual model that combines older EU attitude research (into “nested” social identities and perceived identity compatibility), with more recent social psychology research (into “identity mobilization” and “identity leadership”). By combining insights from both fields, our framework enables us to gain a deeper understanding of why certain pro‐EU narratives can be expected to “take hold” and instill faith in the EU among the public at large. The discussion focuses on the implications for EU leadership.
Effect of prolonged storage on quality characteristics of recovered plasma: Is there an expiration date?
Authors: Politou Marianna , Kontoteza Ifigeneia Vasiliki , Pouliakis Abraham , Dryllis Georgios , Fortsa Panagiota , Valsami Serena , Stamoulis Konstantinos
Published: September 2022

Background

Although there are guidelines on industrial manufacture of plasma‐derived medicinal products, there are no clear recommendations about plasma intended for fractionation, as there is no expiry time and the effect of prolonged storage on the activity of coagulation factors is unknown.

Study and design methods

A total of 237 units of plasma stored at −30°C in the National Blood Transfusion Centre for 1 year (62 units), 5 years (75 units), and 10 years (100 units) were studied. The effect of storage time was investigated by determining the activity of clotting factors FII, FV, FVII, FVIII, FIX, FX, FXI, FXII, FXIII using coagulometric methods and antithrombin III and fibrinogen with chromogenic assays, using System BCSR > XP (Siemens Healthcare diagnostics Marburg, Germany). Albumin was measured by Medilyzer (BX, Medicon). ABO blood group was recorded and correlated with the levels of FVIII. Comparison of values between one and five, 1 and 10 and 5 and 10 years of storage was performed via the SAS for Windows 9.4 software platform (SAS Institute Inc., NC, U.S.A.).

Results

Albumin, AT III, fibrinogen, FIX, FXI, FXII, and FXIII remain rather stable even after 10 years of storage. Levels of FII, FV, FVII, FVIII, and FX decreased after 5 years of storage.

Discussion

Our study is in agreement with all the previous studies and concludes that there is a putative usability of recovered plasma and some of its coagulation factors after many years of storage at the recommended temperature.
A cross‐species validation of single‐beat metrics of cardiac contractility
Authors: Ahmadian Mehdi , Williams Alexandra M. , Mannozzi Joseph , Konecny Filip , Hoiland Ryan L. , Wainman Liisa , Erskine Erin , Duffy Jennifer , Manouchehri Neda , So Kitty , Tauh Keerit , Sala‐Mercado Javier A. , Shortt Katelyn , Fisk Shera , Kim Kyoung‐Tae , Streijger Femke , Foster Glen E. , Kwon Brian K. , O'Leary Donal S. , West Christopher R.
Published: September 2022

The assessment of left ventricular (LV) contractility in animal models is useful in various experimental paradigms, yet obtaining such measures is inherently challenging and surgically invasive. In a cross‐species study using small and large animals, we comprehensively tested the agreement and validity of multiple single‐beat surrogate metrics of LV contractility against the field‐standard metrics derived from inferior vena cava occlusion (IVCO). Fifty‐six rats, 27 minipigs and 11 conscious dogs underwent LV and arterial catheterization and were assessed for a range of single‐beat metrics of LV contractility. All single‐beat metrics were tested for the various underlying assumptions required to be considered a valid metric of cardiac contractility, including load‐independency, sensitivity to inotropic stimulation, and ability to diagnose contractile dysfunction in cardiac disease. Of all examined single‐beat metrics, only LV maximal pressure normalized to end‐diastolic volume (EDV), end‐systolic pressure normalized to EDV, and the maximal rate of rise of the LV pressure normalized to EDV showed a moderate‐to‐excellent agreement with their IVCO‐derived reference measure and met all the underlying assumptions required to be considered as a valid cardiac contractile metric in both rodents and large‐animal models. Our findings demonstrate that single‐beat metrics can be used as a valid, reliable method to quantify cardiac contractile function in basic/preclinical experiments utilizing small‐ and large‐animal models

image

Key points

Validating and comparing indices of cardiac contractility that avoid caval occlusion would offer considerable advantages for the field of cardiovascular physiology.

We comprehensively test the underlying assumptions of multiple single‐beat indices of cardiac contractility in rodents and translate these findings to pigs and conscious dogs.

We show that when performing caval occlusion is unfeasible, single‐beat metrics can be utilized to accurately quantify cardiac inotropic function in basic and preclinical research employing various small and large animal species.

We report that maximal left‐ventricular (LV)‐pressure normalized to end‐diastolic volume (EDV), LV end‐systolic pressure normalized to EDV and the maximal rate of rise of the LV pressure waveform normalized to EDV are the best three single‐beat metrics to measure cardiac inotropic function in both small‐ and large‐animal models.
A Hybrid, Runtime Coupled Incompressible CFD-CAA Method for Analysis of Thermoacoustic Instabilities
Authors: Reinhardt Hanna , Alanyalıoğlu Çetin , Fischer André , Lahiri Claus , Hasse Christian
Published: September 2022

Thermoacoustic instabilities in gas turbine engines are of increasing interest for design of future low-emission technology combustors. Numerical methods used to predict thermoacoustic instabilities often employ either fully compressible resource-intense computational fluid dynamics (CFD) simulations, or two-step approaches where source terms extracted from CFD simulations are supplied to subsequent computational aeroacoustics (CAA) simulations. This work demonstrates an analysis of self-excited thermoacoustic instabilities using a hybrid method based on runtime coupling of incompressible CFD and CAA simulations. A prior implementation for the computation of combustion noise through one-way coupling of CFD and CAA solvers has been extended to a two-way coupling that allows acoustics to influence the flow field. The resulting hybrid method couples acoustic and convective physical phenomena by using mean flow field quantities and the thermoacoustic energy source term obtained from the solution of the Navier–Stokes equations in the low Mach number limit as an input for the acoustic perturbation equations (APEs). The fluctuating acoustic quantities pressure and velocity obtained from the solution of the APE are in turn included in the solution of the low Mach number Navier–Stokes equations, influencing the convective dynamics of the flow field. The suitability of the present implementation to capture thermoacoustic feedback is demonstrated through analysis of the well-known self-excited instability observed in a Rijke tube. The results are presented and discussed in comparison with a fully compressible reference solution.
Experimentally Validated Design of an Anode Recirculation Blower for Polymer-Electrolyte-Membrane Fuel Cells Under Variable Fluid Composition
Authors: Nachtigal Philipp , Kentschke Thorge , Seume Joerg R.
Published: September 2022

This paper focuses on the design, construction, and the experimental testing of an anode recirculation blower (ARB) based on a turbocompressor for PEM-FCs. The blower presented consists of a high-speed centrifugal compressor, driven by a so-called media-gap motor. Additionally, it includes a droplet separator to eliminate liquid water from the anode loop. The aerodynamic design is based on one-dimensional-correlations and three-dimensional-numerical CFD simulations. Different gas compositions of hydrogen, nitrogen, and water vapor are considered in the design, depending on the operating points of a PEM-FC. The gas composition has a significant influence on the achievable pressure ratio at constant compressor speeds, depending mainly on the specific heat capacity of the gas. Performance maps for different gas compositions are calculated using CFD for the designed ARB. A prototype is built and tested. The results validate the CFD predictions and show that the operating range of a PEM fuel cell can be covered with the present blower. In addition, it could be shown that an enthalpy-based approach using common characteristic numbers of turbomachines, allows converting performance maps—acquired with different gas compositions—into one another. This allows the performance map prediction for different gas compositions based on existing performance maps. This approach is illustrated by numerical and experimental results.
Dynamic Versus Quasi-Static Analysis of Crack Propagation in Soft Materials
Authors: Abu-Qbeitah Suhib , Jabareen Mahmood , Volokh Konstantin Y.
Published: September 2022

Cracks usually propagate dynamically that makes them so dangerous. However, most crack simulations are based on quasi-static analyses because they are simpler than the dynamic ones. Is it correct to use quasi-static analyses instead of the dynamic ones? Will the quasi-static and dynamic simulations provide similar results? We try to answer these questions in the present work. We compare results of quasi-static and dynamic simulations of crack propagation in aneurysm material. We use the material-sink (MS) approach, which is based on the notion of the diffused bond breakage. The latter feature implies a local loss of material and, consequently, decrease of mass density, which, in its turn, means that both stiffness and inertia go down in the damaged zone. The cancellation of inertia is an important feature of the MS approach in contrast to more formal regularization theories as phase field, gradient damage, and other nonlocal formulations. The MS approach is implemented within commercial finite-element software abaqus. A reduced mixed finite-element formulation is adopted to circumvent the volumetric locking and an implicit staggered solution algorithm is developed via the user-defined element subroutine UEL. Considered examples show that the onset of crack instability under static loads is followed by the dynamic rather than quasi-static crack propagation. Moreover, dynamic and quasi-static simulations, generally, provide different results.
Intelligent Detection and Classification of Surface Defects on Cold-Rolled Galvanized Steel Strips Using a Data-Driven Faulty Model With Attention Mechanism
Authors: Chen Hao , Nie Zhenguo , Xu Qingfeng , Fei Jianghua , Yang Kang , Li Yaguan , Lin Hongbin , Fan Wenhui , Liu Xin-Jun
Published: September 2022

In the production of cold-rolled galvanized steel strips used for stamping car body parts, the in-situ and real-time defect detection is crucial for quality control, in which various types of defects inevitably occur. It is challenging to improve the accuracy of defect detection and classification by appropriate means to assist the manual screening process better. Defects under actual production conditions are often not prominent enough in defect characteristics, and there may be a significant similarity between different defect categories. To eliminate this weakness, we propose a data-driven deep learning approach named steel surface faulty detection attention net (SSFDANet) that uses images of the galvanized steel surfaces as input to identify whether the product is qualified and automatic classification of defect types instantaneously. This method can shorten product inspection time and improve the production line automation efficiency. In addition, the attention mechanism is utilized to enhance the performance of SSFDANet. Compared with the baseline ResNet, SSFDANet achieves a noticeable improvement in classification accuracy on test data. The well-trained model can successfully show an improved performance than the baseline models on the multiple types of faulty. Enhanced by SSFDANet with high classification accuracy, the defect rate of products is significantly reduced, and the production speed of the production line is significantly improved. Future prospective studies that are inspired by this article are also discussed.
A Review of Cuspidal Serial and Parallel Manipulators
Authors: Wenger Philippe , Chablat Damien
Published: September 2022

Cuspidal robots can move from one inverse or direct kinematic solution to another without ever passing through a singularity. These robots have remained unknown because almost all industrial robots do not have this feature. However, in fact, industrial robots are the exceptions. Some robots appeared recently in the industrial market can be shown to be cuspidal, but, surprisingly, almost nobody knows it and robot users meet difficulties in planning trajectories with these robots. This article proposes a review on the fundamental and application aspects of cuspidal robots. It addresses the important issues raised by these robots for the design and planning of trajectories. The identification of all cuspidal robots is still an open issue. This article recalls in details the case of serial robots with three joints, but it also addresses robots with more complex architectures such as 6-revolute-jointed robot and parallel robots. We hope that this article will help disseminate more wide knowledge on cuspidal robots.
Sequential sensor selection for the localization of acoustic sources by sparse Bayesian learning
Authors: Courcoux-Caro Milan , Vanwynsberghe Charles , Herzet Cédric , Baussard Alexandre
Published: September 2022

This paper deals with the design of sensor arrays in the context involving the localization of a few acoustic sources. Sparse approximation is known to be effective to find the source locations, but it depends on different array characteristics, such as the number of sensors and the array geometry. The present paper tackles this array design problem under the form of a sequential sensor selection procedure. The proposed method alternates between two steps. One step involves a source localization estimator, given a current set of measurement points, to obtain the estimation variance. Then, the other step selects the new point where a future measurement will maximally decrease the variance from the previous step. As such, the procedure can be applied online. Both numerical and experimental studies are conducted in an indoor nearfield configuration. Results show that the proposed approach performs better than offline state-of-the-art methods, and the presented empirical study reveals a better robustness to the model mismatches originating from the room reflections.
Draft Genome of a Member of the Family
Chromobacteriaceae
Isolated from Anopheles Mosquitoes in West Africa
Authors: Stephens Keenan , Gnambani Edounou Jacques , Bilgo Etienne , Diabate Abdoulaye , Soby Scott
Published: September 2022

Chromobacterium
sp. strain IRSSSOUMB001 with potent insecticidal activity was isolated from
Anopheles gambiae
s.l. in Burkina Faso. The draft genome is 5,090,822 bp and encodes predicted genes for hydrogen cyanide production, haemolysin, a T3SS, and
yopE
, which are potential virulence factors against mosquitoes.
Genome Sequence and Annotation of Bacteriophage Tokki Isolated on Arthrobacter globiformis B-2979
Authors: Aguilera Marti Alicia , Bullock Nicholas D. , Everett Samuel B. , Bates Tonya C. , Wisner Ellen M.
Published: September 2022

Arthrobacter
phage Tokki is a siphovirus isolated from soil in River Falls, Wisconsin. The genome contains 57,652-bp encoding 98 proteins, of which 23 were assigned a function. Tokki’s genome structure and content is typical of other AU2 subcluster phages, except for the lack of an identifiable acetyltransferase.
ESBL Escherichia coli Isolates Have Enhanced Gut Colonization Capacity Compared to Non-ESBL Strains in Neonatal Mice
Authors: Kremer Aspen , Whitmer Grant , Diaz Alondra , Sajwani Alima , Navarro Alexis , Arshad Mehreen
Published: September 2022

Antimicrobial resistance is a global public health emergency. Infants, especially preterm infants and those in the neonatal intensive care unit, immunocompromised hosts, and those with chronic illnesses are at highest risk of adverse outcomes from invasive infections with antimicrobial-resistant strains.
Structural Basis of Peptide-Based Antimicrobial Inhibition of a Resistance-Nodulation-Cell Division Multidrug Efflux Pump
Authors: Lyu Meinan , Ayala Julio C. , Chirakos Isabella , Su Chih-Chia , Shafer William M. , Yu Edward W.
Published: September 2022

RND efflux pumps can export numerous antimicrobials that enter Gram-negative bacteria, and their action can reduce the efficacy of antibiotics and provide decreased susceptibility to various host antimicrobials. Here, we identified a
c
ationic
a
ntibiotic-
s
ensitizing
p
eptide (CASP) that binds within the periplasmic cleft of an RND transporter protein (MtrD) produced by
Neisseria gonorrhoeae
.
Recurrent biventricular takotsubo cardiomyopathy with fatal outcome
Authors: Osman Abdul-Fatawu , Khor Si Yuan , Abdelazeem Basel , Barham Waseem
Published: September 2022

A woman in her 60s presented initially with nausea, vomiting and abdominal pain. She rapidly progressed to respiratory failure requiring intubation. ECG demonstrated no significant ST segment changes. Troponin I and brain natriuretic peptide were elevated. Chest CT angiography demonstrated small non-occlusive segmental pulmonary emboli. Transthoracic echocardiogram findings suggested biventricular takotsubo cardiomyopathy (TCM) with left ventricular ejection fraction of less than 20%. She improved with aggressive management and was discharged on carvedilol, lisinopril, atorvastatin and apixaban. Follow-up echocardiogram revealed complete resolution of the left and right ventricular wall motion abnormalities at 9 weeks. She had symptoms recurrence after 7 months from the initial presentation. Repeated echocardiogram was consistent with biventricular TCM recurrence. Despite aggressive medical therapy, multiorgan failure developed and patient care was later transitioned to palliative care.
Therapeutic effects of exercise interventions for patients with chronic kidney disease: an umbrella review of systematic reviews and meta-analyses
Authors: Zhang Fan , Bai Yan , Zhao Xing , Huang Liuyan , Wang Weiqiong , Zhou Wenqin , Zhang Huachun
Published: September 2022

Objective

To conduct an overview of meta-analyses evaluating the impact of exercise interventions on improving health outcomes in patients with chronic kidney disease (CKD).

Design

An umbrella review of systematic review and meta-analyses of intervention trials was performed.

Data sources

PubMed, Web of Science, Embase and the Cochrane Database of Systematic Reviews were searched from inception to 9 March 2021 for relevant articles.

Eligibility criteria for selecting studies

Eligible meta-analyses compared the effects of usual care with and without exercise in patients with CKD. Health outcomes included those related to cardiovascular risk factors, physical fitness, dialysis-related symptoms, dialysis adequacy and health-related quality of life. Systematic reviews and meta-analyses that included fewer than 3 RCTs or fewer than 100 participants were excluded from the analysis.

Results

A total of 31 eligible systematic reviews and meta-analyses were included that assessed 120 outcomes. For physical fitness, there was a moderate effect size for cardiorespiratory fitness, muscle strength and body composition and small effect size for muscle endurance. The effect sizes for cardiovascular risk factors, dialysis-related symptoms and health-related quality of life outcomes were small. According to the Grading of Recommendations Assessment, Development and Evaluation framework, most outcomes were low or very low quality.

Conclusion

Exercise appears to be a safe way to affect concomitant cardiovascular risk factors, such as blood pressure, improve physical fitness and health-related quality of life and reduce dialysis-related symptoms in patients with CKD.

PROSPERO registration number

CRD42020223591.
Acceptability of text messages and knowledge change for cervical cancer screening: a Tanzanian mixed methods study
Authors: Løkke Kristian Foldager , Rasch Vibeke , Mwaiselage Julius , Gammeltoft Tine , Linde Ditte Søndergaard
Published: September 2022

Objectives

To investigate the acceptability of a text message intervention and evaluate if text messages could increase knowledge of cervical cancer and screening.

Design

This study was a substudy of a randomised controlled trial that used a mixed methods research design combining a quantitative questionnaire dataset and qualitative interview data. A before and after assessment was made of questionnaire responses. Acceptability was measured on a 6-point Likert scale and knowledge was measured through 16 binary true/false knowledge questions concerning cervical cancer and screening. Qualitative data were coded using a combined inductive–deductive approach.

Setting

Ocean Road Cancer Institute in Dar es Salaam as well as Kilimanjaro Christian Medical Center and Mawenzi Regional hospital in the Kilimanjaro Region in Tanzania.

Participants

Human papillomavirus (HPV) positive women who had been randomised to the intervention group and received educative and reminder messages. Qualitative interviews were conducted with a subgroup of women in the intervention group.

Interventions

15 one-way educative and reminder text messages.

Results

A total of 115 women in the intervention group responded to both the baseline and follow-up questionnaire. Overall, women found it highly acceptable to receive text messages, and there was a trend towards acceptability rising between baseline and follow-up (mean: 0.22; 95% CI 0.00 to 0.44; p=0.05; t-statics=1.96). A significant increase in acceptability was found among the lowest educated and those who had not previously been screened. The qualitative interviews showed that the underlying reasons for the high acceptability rate were that the women felt someone cared for them and that the text messages were for their own benefits. The text messages did not improve the women’s knowledge on cervical cancer and screening.

Conclusions

Educative and reminder text messages are highly acceptable among HPV-positive Tanzanian women; however, they do not increase the women’s knowledge of cervical cancer and screening.

Trial registration number

clingov (NCT02509702).
Protocol for community-driven selection of strategies to implement evidence-based practices to reduce opioid overdoses in the HEALing Communities Study: a trial to evaluate a community-engaged intervention in Kentucky, Massachusetts, New York and Ohio
Authors: Young April M , Brown Jennifer L , Hunt Timothy , Sprague Martinez Linda S , Chandler Redonna , Oga Emmanuel , Winhusen T John , Baker Trevor , Battaglia Tracy , Bowers-Sword Rachel , Button Amy , Fallin-Bennett Amanda , Fanucchi Laura , Freeman Patricia , Glasgow LaShawn M , Gulley Jennifer , Kendell Charles , Lofwall Michelle , Lyons Michael S , Quinn Maria , Rapkin Bruce David , Surratt Hilary L , Walsh Sharon L
Published: September 2022

Introduction

Opioid-involved overdose deaths continue to surge in many communities, despite numerous evidence-based practices (EBPs) that exist to prevent them. The HEALing Communities Study (HCS) was launched to develop and test an intervention (ie, Communities That HEAL (CTH)) that supports communities in expanding uptake of EBPs to reduce opioid-involved overdose deaths. This paper describes a protocol for a process foundational to the CTH intervention through which community coalitions select strategies to implement EBPs locally.

Methods and analysis

The CTH is being implemented in 67 communities (randomised to receive the intervention) in four states in partnership with coalitions (one per community). Coalitions must select at least five strategies, including one to implement each of the following EBPs: (a) overdose education and naloxone distribution; expanded (b) access to medications for opioid use disorder (MOUD), (c) linkage to MOUD, (d) retention in MOUD and (e) safer opioid prescribing/dispensing. Facilitated by decision aid tools, the community action planning process includes (1) data-driven goal setting, (2) discussion and prioritisation of EBP strategies, (3) selection of EBP strategies and (4) identification of next steps. Following review of epidemiologic data and information on existing local services, coalitions set goals and discuss, score and/or rank EBP strategies based on feasibility, appropriateness within the community context and potential impact on reducing opioid-involved overdose deaths with a focus on three key sectors (healthcare, behavioural health and criminal justice) and high-risk/vulnerable populations. Coalitions then select EBP strategies through consensus or majority vote and, subsequently, suggest or choose agencies with which to partner for implementation.

Ethics and dissemination

The HCS protocol was approved by a central Institutional Review Board (Advarra). Results of the action planning process will be disseminated in academic conferences and peer-reviewed journals, online and print media, and in meetings with community stakeholders.

Trial registration number

NCT04111939.
Embedded point of care randomisation for evaluating comparative effectiveness questions: PROSPECTOR-critical care feasibility study protocol
Authors: Wilson Matthew G , Asselbergs Folkert W , Miguel Ruben , Brealey David , Harris Steve K
Published: September 2022

Introduction

Many routinely administered treatments lack evidence as to their effectiveness. When treatments lack evidence, patients receive varying care based on the preferences of clinicians. Standard randomised controlled trials are unsuited to comparisons of different routine treatment strategies, and there remains little economic incentive for change.

Integrating clinical trial infrastructure into electronic health record systems offers the potential for routine treatment comparisons at scale, through reduced trial costs. To date, embedded trials have automated data collection, participant identification and eligibility screening, but randomisation and consent remain manual and therefore costly tasks.

This study will investigate the feasibility of using computer prompts to allow flexible randomisation at the point of clinical decision making. It will compare the effectiveness of two prompt designs through the lens of a candidate research question—comparing liberal or restrictive magnesium supplementation practices for critical care patients. It will also explore the acceptability of two consent models for conducting comparative effectiveness research.

Methods and analysis

We will conduct a single centre, mixed-methods feasibility study, aiming to recruit 50 patients undergoing elective surgery requiring postoperative critical care admission. Participants will be randomised to either ‘Nudge’ or ‘Preference’ designs of electronic point-of-care randomisation prompt, and liberal or restrictive magnesium supplementation.

We will judge feasibility through a combination of study outcomes. The primary outcome will be the proportion of prompts displayed resulting in successful randomisation events (compliance with the allocated magnesium strategy). Secondary outcomes will evaluate the acceptability of both prompt designs to clinicians and ascertain the acceptability of pre-emptive and opt-out consent models to patients.

Ethics and dissemination

This study was approved by Riverside Research Ethics Committee (Ref: 21/LO/0785) and will be published on completion.

Trial registration number

NCT05149820.
Implementation of the Afya conditional cash transfer intervention to retain women in the continuum of care: a mixed-methods process evaluation
Authors: Dickin Sarah , Vanhuyse Fedra , Stirrup Oliver , Liera Carla , Copas Andrew , Odhiambo Aloyce , Palmer Tom , Haghparast-Bidgoli Hassan , Batura Neha , Mwaki Alex , Skordis Jolene
Published: September 2022

Objectives

We report the results of a mixed-methods process evaluation that aimed to provide insight on the Afya conditional cash transfer (CCT) intervention fidelity and acceptability.

Intervention, setting and participants

The Afya CCT intervention aimed to retain women in the continuum of maternal healthcare including antenatal care (ANC), delivery at facility and postnatal care (PNC) in Siaya County, Kenya. The cash transfers were delivered using an electronic card reader system at health facilities. It was evaluated in a trial that randomised 48 health facilities to intervention or control, and which found modest increases in attendance for ANC and immunisation appointments, but little effect on delivery at facility and PNC visits.

Design

A mixed-methods process evaluation was conducted. We used the Afya electronic portal with recorded visits and payments, and reports on use of the electronic card reader system from each healthcare facility to assess fidelity. Focus group interviews with participants (N=5) and one-on-one interviews with participants (N=10) and healthcare staff (N=15) were conducted to assess the acceptability of the intervention. Data analyses were conducted using descriptive statistics and qualitative content analysis, as appropriate.

Results

Delivery of the Afya CCT intervention was negatively affected by problems with the electronic card reader system and a decrease in adherence to its use over the intervention period by healthcare staff, resulting in low implementation fidelity. Acceptability of cash transfers in the form of mobile transfers was high for participants. Initially, the intervention was acceptable to healthcare staff, especially with respect to improvements in attaining facility targets for ANC visits. However, acceptability was negatively affected by significant delays linked to the card reader system.

Conclusions

The findings highlight operational challenges in delivering the Afya CCT intervention using the Afya electronic card reader system, and the need for greater technology readiness before further scale-up.

Trial registration number

NCT03021070.
Service delivery models for enhancing linkage to and retention in HIV care services for adolescent girls and young women and adolescent boys and young men: a protocol for an overview of systematic reviews
Authors: Jonas Kim , Zani Babalwa , Ramraj Trisha , Chirinda Witness , Jama Ngcwalisa , Basera Wisdom , McClinton Appollis Tracy , Pass Desiree , Govindasamy Darshini , Mukumbang Ferdinand C , Mathews Catherine , Nicol Edward
Published: September 2022

Introduction

Recent advances in the HIV care continuum have shown that an individual diagnosed with HIV should be initiated on antiretroviral therapy as soon as possible regardless of the CD4 count levels and retained in HIV care services. Studies have reported large losses in the HIV continuum of care, before and after the era of universal test and treat. Several systematic reviews have reported on the strategies for improving linkage to and retention in HIV treatment and care. The purpose of this overview of systematic reviews is to identify HIV care interventions or service delivery models (SDMs) and synthesise evidence on the effects of these to link adolescent girls and young women (AGYW) and adolescent boys and young men (ABYM) to care and retain them in care. We also aim to highlight gaps in the evidence on interventions and SDMs to improve linkage and retention in HIV care of AGYW and ABYM.

Methods and analysis

An electronic search of four online databases: PubMed, Cochrane Database of Systematic Reviews, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Web of Science will be performed to identify systematic reviews on the effects of linkage to and retention in HIV care interventions or SDMs for AGYW aged 15–24 years and ABYM aged 15–35 years. Our findings on the effects of interventions and SDMs will be interpreted considering the intervention and or SDMs’ effectiveness by the time period, setting and population of interest. Two or more authors will independently screen articles for inclusion using a priori criteria.

Ethics and dissemination

Ethics approval is not required for this study as only published secondary data will be used. Our findings will be disseminated through peer-reviewed publication, conference abstracts and through presentations to stakeholders and other community fora. The findings from this overview of systematic reviews will inform mixed-methods operations research on HIV intervention programming and delivery of HIV care services for AGYW and ABYM in South Africa.

PROSPERO registration number

CRD42020177933.
ALK inhibitors in ALK-rearranged non-small cell lung cancer with and without brain metastases: systematic review and network meta-analysis
Authors: Jiang Jun , Zhao Cong , Zhang Fang , Liu Zhenhua , Zhou Kaiyuan , Ren Xinling , Wan Yi
Published: September 2022

Objectives

To systematically evaluate the efficacy and safety of anaplastic lymphoma kinase (ALK) inhibitors in ALK-rearranged positive non-small cell lung cancer (NSCLC) with brain metastases, and update the overall survival (OS) outcomes of the second-generation and third-generation ALK (ALK-2ndG/3rdG) inhibitors versus first-generation (ALK-1stG) inhibitors.

Design

The study is in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis guidelines. Randomised controlled trials (RCTs) published up to 3 November 2021 were retrieved from PubMed, EMBASE, Cochrane Library and ClinicalTrials.gov.

Setting

RCTs from any country and healthcare setting.

Participants

Patients with advanced ALK-positive NSCLC with or without brain metastases.

Interventions and comparisons

The interventions were ALK-2ndG/3rdG; the control arm was ALK-1stG or crizotinib.

Primary and secondary outcome measures

Primary outcomes included median progression-free survival and median OS. Secondary outcomes included systemic objective response rate, intracranial response rate and rate of grade ≥3 adverse events (AEs).

Results

A total of 12 RCTs involving 3156 patients were analysed. Compared with ALK-1stG (crizotinib), ALK-2ndG (alectinib, brigatinib, ceritinib and ensartinib) significantly improved the OS (HR: 0.72, 95% CI: 0.57 to 0.90, p=0.004) and intracranial response of patients with any brain metastases, especially with measurable (diameter ≥10 mm) brain metastases. Network meta-analysis demonstrated that ALK-3rdG (lorlatinib) had superior efficacy for patients with brain lesions, but performed a distinct side-effect profile. Moreover, alectinib showed superior efficacy and lower toxicity in ALK-positive NSCLC.

Conclusion

Treatment with ALK-2ndG inhibitors significantly improved OS compared with crizotinib, and alectinib has less severe AEs than any other ALK inhibitors with moderate-high efficacy. The limited OS follow-up and inadequate sample sizes might contribute to having no statistically significant difference in OS of lorlatinib versus crizotinib. More high-quality and longer follow-up RCTs are warranted to prove our findings.

PROSPERO registration number

CRD42021292245.
Prevention of vasoplegia with CytoSorb in heart failure patients undergoing cardiac surgery (CytoSorb-HF trial): protocol for a randomised controlled trial
Authors: Papazisi Olga , Bruggemans Eline F , Berendsen Remco R , Hugo Juan D V , Lindeman Jan H N , Beeres Saskia L M A , Arbous M Sesmu , van den Hout Wilbert B , Mertens Bart J A , Ince Can , Klautz Robert J M , Palmen Meindert
Published: September 2022

Introduction

Vasoplegia is a common complication after cardiac surgery and is associated with poor prognosis. It is characterised by refractory hypotension despite normal or even increased cardiac output. The pathophysiology is complex and includes the systemic inflammatory response caused by cardiopulmonary bypass (CPB) and surgical trauma. Patients with end-stage heart failure (HF) are at increased risk for developing vasoplegia. The CytoSorb adsorber is a relatively new haemoadsorption device which can remove circulating inflammatory mediators in a concentration based manner. The CytoSorb-HF trial aims to evaluate the efficacy of CytoSorb haemoadsorption in limiting the systemic inflammatory response and preventing postoperative vasoplegia in HF patients undergoing cardiac surgery with CPB.

Methods and analysis

This is an investigator-initiated, single-centre, randomised, controlled clinical trial. In total 36 HF patients undergoing elective cardiac surgery with an expected CPB duration of more than 120 min will be randomised to receive CytoSorb haemoadsorption along with standard surgical treatment or standard surgical treatment alone. The primary endpoint is the change in systemic vascular resistance index with phenylephrine challenge after CPB. Secondary endpoints include inflammatory markers, sublingual microcirculation parameters and 30-day clinical indices. In addition, we will assess the cost-effectiveness of using the CytoSorb adsorber. Vascular reactivity in response to phenylephrine challenge will be assessed after induction, after CPB and on postoperative day 1. At the same time points, and before induction and on postoperative day 4 (5 time points in total), blood samples will be collected and the sublingual microcirculation will be recorded. Study participants will be followed up until day 30.

Ethics and dissemination

The trial protocol was approved by the Medical Ethical Committee of Leiden The Hague Delft (METC LDD, registration number P20.039). The results of the trial will be published in peer-reviewed medical journals and through scientific conferences.

Trial registration number

NCT04812717.
Effect of stress management based on cognitive–behavioural therapy on nurses as a universal prevention in the workplace: a systematic review and meta-analysis protocol
Authors: Kuribayashi Kazuto , Takano Ayumi , Inagaki Akiko , Imamura Kotaro , Kawakami Norito
Published: September 2022

Introduction

The mental health status of nurses affects not only their well-being but also the organisational outcomes and the quality of patient care. Hence, stress management strategies are critical as a universal prevention measure that address an entire population and are not directed at a specific risk group to maintain nurses’ mental health in the workplace. No systematic review or meta-analysis has been conducted to evaluate the effect of cognitive–behavioural therapy (CBT) that specifically focuses on universal prevention. Therefore, the aim of this study is to examine the effectiveness that is reported in published randomised controlled trial (RCT) studies.

Methods and analysis

This systematic review and meta-analysis will analyse published studies selected from electronic databases (ie, Cochrane Central Register of Controlled Trials, PubMed, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, PsycARTICLES, Web of Science and the Japan Medical Abstracts Society). The inclusion criteria for studies are that they (1) were conducted to assess the effect of CBT on the mental health of nurses as a universal prevention, (2) used an RCT design and (3) provided sufficient results (sample sizes, means and SD) to estimate the pooled effect sizes with 95% CIs. Studies will be excluded if they only targeted nurses who had been screened as being at high risk in terms of their mental health and indicated that they required the prevention. The methodological quality of the included studies will be assessed using the Cochrane Collaboration’s risk of bias tool.

Ethics and dissemination

Ethical approval is not required because this study is based on information obtained from previous studies. The results and findings of this study will be submitted for publication in a peer-reviewed international scientific journal. Results from this study will be helpful when implementing CBT strategies for nurses as a universal preventative measure in the workplace and for managing stress-related outcomes.

PROSPERO registration number

CRD42020152837.