bluuebunny/crossref_metadata_2025 huggingface dataset:
Health outcomes of unpaid caregivers in low‐ and middle‐income countries: A systematic review and meta‐analysis
Authors: Magaña Irene , Martínez Pablo , Loyola María‐Soledad
Published: August 2020

Aims and objectives

To explore differences in health outcomes between unpaid caregivers and noncaregivers living in low‐ and middle‐income countries (LMICs).

Background

Previous meta‐analyses found worse health outcomes for unpaid caregivers in high‐income nations. However, no meta‐analysis has considered unpaid caregivers from LMICs. A systematic integration of this topic may contribute to nursing care for unpaid caregivers in LMICs.

Design

Systematic review and meta‐analysis of observational studies.

Methods

Following PRISMA statement, studies were searched for using the CINAHL, PubMed and SciELO databases, limited to publications until 31 December 2019. Random‐ and fixed‐effects meta‐analyses were used for data synthesis.

Results

Fourteen studies from Africa, Asia and South America were included. Unpaid caregivers of people with ill‐health were more anxious and depressed than noncaregivers. Studies conducted in Asia and South America reported poorer health outcomes for unpaid caregivers than noncaregivers, whereas the trend for African studies was the opposite. Unpaid caregivers of healthy individuals may have better health status than noncaregivers, particularly those caring between 1–14 hr per week. Of the six studies which examined gender differences, two studies informed worse health outcomes for women, one presented the opposite effect, and three found no differences.

Conclusions

Individual, social, cultural and systemic factors play an important role in the health outcomes of unpaid caregivers in LMICs. More evidence is needed from LMICs. As unpaid caregivers are predominantly female, urgent attention to the health outcomes of female unpaid caregivers is required.

Relevance to clinical practice

The management of mental health problems, particularly anxiety and depression, should be an integral part of nursing care for unpaid caregivers living in LMICs. To further promote the health of unpaid caregivers in developing countries, stakeholders should consider launching educational campaigns that assist caregivers in finding ways to meet their cultural obligations while also reinforcing caregiver self‐care.
Income inequality and technological progress: The effect of R&D incentives, integration, and spillovers
Authors: Osório António , Pinto Alberto
Published: August 2020

Recent years witnessed an increase in income inequality. Several explanations have been put forward. In the present paper, we consider a series of technologically related events that have been crucial for the increased income inequality, that is, public R&D incentives, increasing horizontal integration and spillover effects. We found that public R&D incentives and the increasing horizontal integration have biased the income distribution towards the top income group. In particular, the high‐skilled workers involved in the R&D process have benefited enormously from this process. Similarly, capital owners have seen an increase in their profits, because of the reduction in product market competition and technological improvements in the production process. We found the effect of knowledge spillovers to be less clear‐cut. We conclude discussing the implications of our results and suggesting possible solutions to the increasing income inequality. We call for the creation of supranational institutions, and for stricter legislation on competition and antitrust policy.
Population pharmacokinetics of micafungin over repeated doses in critically ill patients: a need for a loading dose?
Authors: Kapralos Iasonas , Mainas Efstratios , Neroutsos Efthymios , Apostolidi Stella , Siopi Maria , Apostolopoulou Olympia , Dimopoulos George , Sambatakou Helen , Valsami Georgia , Meletiadis Joseph , Dokoumetzidis Aristides
Published: August 2020

Objectives

To study the population pharmacokinetics of micafungin in critically ill patients, evaluate and optimize dosage regimens.

Methods

An HPLC–fluorescence bioassay for micafungin was developed, fully validated and applied to a pharmacokinetic study conducted in 14 ICU patients. Dense blood sampling was performed from days 1 to 7. A population pharmacokinetic model accounting for interindividual (IIV) and interoccasion variability (IOV) of the PK parameters was developed. Simulations were performed to estimate the probability of target attainment (PTA) for several dosing regimens.

Key findings

A two-compartment pharmacokinetic model best described the data, with population clearance CL = 1.31 L/h and central volume V1 = 14.2 L. The relatively high IOV observed (45% for CL, 27% for V1) sets limits for the dose individualization in this population. The low PTA on the first day of treatment suggests the need of a loading dose. PTA and CFR estimates show that the current micafungin dosage may be insufficient for the treatment of borderline susceptible Candida strains.

Conclusions

A loading dose of up to 300 mg of micafungin is needed for the treatment of invasive candidiasis in ICU patients while a maintenance dose of up to 200 mg can be considered in empirical antifungal treatment.
A network meta‐analysis of different positive airway pressure interventions in obesity hypoventilation syndrome
Authors: Iftikhar Imran H. , Greer Meredith , Wigger Gregory W. , Collop Nancy A.
Published: August 2020

Continuous positive airway pressure (CPAP) and different types of non‐invasive ventilation (NIV) have been studied in obesity hypoventilation syndrome such as bi‐level PAP with back‐up rate (BPAP‐BUR), BPAP without BUR, and the new hybrid devices that target a pre‐set volume by adjustment of pressure support (VT‐PS). Although several studies have compared one PAP intervention with the other, none has compared all four in a head‐to‐head design, which formed the basis of this network meta‐analysis. PubMed and Web of Science were searched for potentially includable randomised active comparator trials. Changes in partial pressure of carbon dioxide (PaCO2) and Epworth Sleepiness Score (ESS) were the primary outcomes of interest. Network meta‐analysis was done in R program using the ‘frequentist’ framework. A total of seven trials were included. Only VT‐PS and BPAP‐BUR showed statistically significant reductions in PaCO2 compared to control, with no significant inter‐PAP differences except for the comparison between VT‐PS and CPAP. Only VT‐PS showed a statistically significant improvement in ESS as compared to control, with no other significant inter‐PAP differences. P‐score ranking (based on effect size and standard errors) and Hasse diagram ranked VT‐PS and BPAP as superior to other PAPs for both primary outcomes. There were no significant differences between the different PAP interventions for hospital or emergency department admissions. The results of this network meta‐analysis suggest superiority of VT‐PS and BPAP over other PAP interventions at least for daytime hypercapnia and subjective daytime somnolence.
A local limit theorem for linear random fields
Authors: Fortune Timothy , Peligrad Magda , Sang Hailin
Published: August 2020

In this article, we establish a local limit theorem for linear fields of random variables constructed from i.i.d. innovations each with finite second moment. When the coefficients are absolutely summable we do not restrict the region of summation. However, when the coefficients are only square‐summable we add the variables on unions of rectangle and we impose regularity conditions on the coefficients depending on the number of rectangles considered. Our results are new also for the dimension 1, that is, for linear sequences of random variables. The examples include the fractionally integrated processes for which the results of a simulation study is also included.
Toward a theory of myth
Authors: Mills Jon
Published: August 2020

Why do we need a theory of myth? Because no systematic theory exists, let alone a consensus. What I am particularly interested in addressing are not specific theories of myth, or specific myths themselves, but rather what constitutes a good theory. In particular, throughout our investigation I hope to illuminate what a proper theory of myth would be expected to offer in terms of its descriptive and explanatory power, coherency, generality, meaningfulness, and functional utility. Here I offer a theoretic typology of myth by exploring the origin, signification, symbolic structure, and essence of myth in terms of its source, force, form, object, and teleology derived from archaic ontology. Through my analysis of an explanandum and an explanans, I argue that both interpretation and explanation are acts of explication that signify the ontological significance, truth, and psychic reality of myth in both individuals and social collectives.
Clinical response to 2 protocols of aerosolized gentamicin in 46 dogs withBordetella bronchisepticainfection (2012‐2018)
Authors: Morgane Canonne Aude , Roels Elodie , Menard Maud , Desquilbet Loïc , Billen Frédéric , Clercx Cécile
Published: August 2020

Background

Bordetella bronchiseptica(Bb) infection commonly causes respiratory disease in dogs. Gentamicin delivered by aerosol maximizes local drug delivery without systemic absorption but clinical response to protocols remains undetermined.

Objectives

To compare the clinical response to 2 protocols of aerosolized delivery of gentamicin in bordetellosis.

Animals

Forty‐six dogs withBbinfection confirmed by culture or quantitative polymerase chain reaction on bronchoalveolar lavage.

Methods

Retrospective study. Administration of aerosolized gentamicin for ≥10 minutes q12h for ≥3 weeks using 4 mg/kg diluted with saline (group 1) or undiluted 5% solution (group 2). Clinical response firstly assessed after 3‐4 weeks and treatment pursued by 3‐weeks increments if cure not reached. Cure defined as absence of cough persisting at least a week after treatment interruption.

Results

Demographic data were similar between both groups. Clinical cure at 3‐4 weeks was more frequently observed with the use of undiluted solution (19/33 vs 3/13 dogs,P= .03) in association with a shorter median duration of treatment (4 vs 6 weeks,P= .01). Dogs from group 2 having less than 1000 cells/μL in lavage were also more likely to be cured at 3‐4 weeks than dogs with more than 1000 cells/μL [9/9 vs 10/19,P= .006] and median duration of treatment in that subgroup of animals was reduced (3 vs 5 weeks,P= .02).

Conclusion and Clinical Importance

Aerosolized delivery of gentamicin seems effective for inducing clinical cure inBbinfection. Clinical response appears better using undiluted 5% solution, particularly in the subgroup of dogs having less than 1000 cells/μL in lavage.
Contact and Commitment to Development: Evidence from quasi‐random missionary assignments
Authors: Crawfurd Lee
Published: August 2020

Public support for global development in rich countries is critical for sustaining effective government and individual action. But the causes of public support are not well understood. Does spending time living in a developing country play a role in generating individual commitment to development? Addressing this question is fraught with selection bias, as individuals are rarely exogenously assigned to spend time in different countries. In this paper I address this question using a natural experiment – the quasi‐random assignment of missionaries from the Church of Jesus Christ of Latter‐day Saints to two‐year missions in different world regions. I provide the first causal estimates of the effect of travel to a developing country on attitudes to global development. Data comes from a new survey gathered through mission alumni Facebook groups. Missionaries assigned to low‐income and middle‐income world regions (Africa, Asia, Latin America, and Caribbean) have similar prior characteristics to those assigned to high‐income Europe. Those assigned to Africa self‐report greater interest in global development and greater charitable attitudes and behaviours. However, they also express stronger opposition to immigration from poor countries, and are less likely to be involved in political campaigns to address global development. Spending time in lower income countries may lead to greater support for charity but less support for political change.
A competing risk nomogram for predicting cancer‐specific death of patients with buccal mucosa cancer
Authors: Jiang Qingkun , Xue Danfeng , Xin Yuqi , Qiu Jiaxuan
Published: August 2020

Objectives

Our aim was to develop and validate a competing risk nomogram to determine the probability of cancer‐specific death in buccal mucosa cancer (BMC) patients.

Materials and Methods

We examined the records of BMC patients in the Surveillance, Epidemiology, and End Results (SEER) Program and First Affiliated Hospital of Nanchang University (China). We adopted the cumulative incidence function and Fine–Gray proportional hazards model based on univariate and multivariate analyses by R‐software to identify the risk factors associated with cancer‐specific death. Subsequently, a nomogram was developed and validated to predict the 3‐ and 5‐year probability of cancer‐specific death.

Results

In 1,286 BMC patients identified from SEER database, cumulative incidences of cancer‐specific death after diagnosis were 33.4% and 35.5% for 3 and 5 years, respectively. In the training cohort (n = 902) from SEER database, the Fine–Gray model indicated that age, Tumor Node Metastasis (TNM) stages, grade, surgery, and histological type were independent risk factors associated with cancer‐specific death, based on which a prognostic nomogram was developed. In the internal validation cohort from SEER database (n = 384) and the external validation cohort from our medical center (n = 174), the nomogram was well calibrated and showed remarkable prediction performance.

Conclusion

The nomogram created herein may prove to be a good assistant tool for assessing the prognosis of BMC patients.
The implementation of low‐flow anesthesia at a tertiary pediatric center: A quality improvement initiative
Authors: Glenski Todd A. , Levine Laura
Published: August 2020

Introduction

Anesthesia machines have evolved over the years to excel in delivering low‐flow anesthesia (<1 L fresh gas flow) in a closed‐circuit system, with the obvious benefits being decreased costs and reduced emissions of greenhouse gases. At a pediatric hospital that provides over 25 000 anesthetics a year, a quality improvement project was initiated with the aim of decreasing the amount of sevoflurane used per anesthetic by 20% over the course of a year.

Methods

Three Plan‐Do‐Study‐Act cycles involving gathering comparative data, departmental education, improvement updates on our huddle board, and intraoperative confirmation rounds were completed. The bottles of sevoflurane used and the total number of anesthetics performed were collected each month. To account for the fluctuation of anesthetic cases per month, a metric of “Anesthetics Performed per Bottle of Sevoflurane Used” was created.

Results

Compared to a prior twelve‐month period, the Anesthetics Performed per Bottle of Sevoflurane Used were higher with a mean increase of 25%. The bottles of sevoflurane used per month was lower with a mean decrease of 20%. The carbon footprint of our sevoflurane use was also decreased and extrapolated over a year, and the decrease was equivalent to 70 000 miles driven, over 3,200 gallons of gasoline consumed, or over 31000 pounds of coal burned.

Conclusion

A QI initiative aimed at changing the practice of delivering at least 2L fresh gas flow to delivering a low‐flow anesthetic has been a successful value‐added enhancement to our pediatric anesthesia practice.
Bipolar Pulsed Radiofrequency for Trigeminal Neuralgia: A Report of Two Cases
Authors: Silva Victor , Day Miles , Santiago Margarita
Published: August 2020

Background

Trigeminal neuralgia (TN) is the most common cause of facial pain, leading to significant disability and impacting a patient's quality of life. Percutaneous procedures like continuous radiofrequency, pulsed radiofrequency (PRF), and combined continuous and pulsed radiofrequency have been studied in past years comparing different voltages in order to find more effective therapies with fewer complications (eg, numbness and masseter muscle weakness). With regard to young patients, there is still insufficient evidence on the most appropriate procedure in this patient population. PRF does not cause thermal damage. The mechanism of action involves delivering an electrical field to targeted nerves or tissues, modulating pain. We propose that bipolar pulsed radiofrequency (2 parallel cannulas) in the trigeminal ganglion produce a denser and larger field resulting in more effective controlled pain.

Case Presentation

We present 2 cases of 40‐ and 48‐year‐old men with severe V2 to V3 TN who underwent bipolar PRF. We performed bipolar PRF on the trigeminal ganglion through the foramen ovale using two 22‐gauge 100‐mm cannulas with 10‐mm active tips. Parameters used were voltage of 85 V, pulse width of 20 milliseconds, and total duration time of 6 minutes. Both patients reported complete relief of pain after the procedure, and at 2‐year follow‐up they were pain free and experienced a better quality of life. No complications were reported.

Conclusion

Bipolar PRF could be a non‐neurodestructive option for young people with TN and deserves further investigation as a treatment option.
Intravesical monitoring of intra‐abdominal pressure after renal transplantation in children: A safety and feasibility study
Authors: Wagner Jula , Herden Uta , Fischer Lutz , Schild Raphael , Vettorazzi Eik , Herrmann Jochen , Ebenebe Chinedu Ulrich , Singer Dominique , Deindl Philipp
Published: August 2020

IAH after RTX can threaten graft viability. This study aimed to assess the feasibility and safety of longitudinal IAP measurements as an IAH screening method in children after RTX. A cohort of eight children with a mean ± SD [range] age 9.6 ± 6.2 [2‐17] years who underwent RTX and 18 control patients were evaluated between May 2017 and February 2018. We compared longitudinal IAP measurements using a Foley manometer to other clinical monitoring data. In total, 29 IAP measurements were performed in RTX patients and 121 in controls. The mean post‐operative IAP was 7.4 ± 4.3 [1‐16] mm Hg following RTX and 8.1 ± 3.7 [1‐19] mm Hg in controls. We noted IAH in 9 (31%) of 29 IAP measurements after RTX and in 41 (34%) of 121 IAP measurements in controls. No graft dysfunction occurred in RTX patients despite elevated IAP values. The mean ± SD [range] time expenditure for IAP measurement was 2.1 ± 0.4 [0.6‐3.2] minutes. No severe complications occurred during the IAP measurements. Analysis of longitudinal IAP measurements demonstrated that IAP measurement is safe and feasible in children recovering from renal transplantation in the PICU.
Introducing Change in Public Service Organizations under Austerity: The Complex Case of the Governance of the Defence in the United Kingdom
Authors: Solar Carlos
Published: August 2020

Introducing, managing, and sustaining change in public service organizations is challenging for policy makers to implement and for scholars to theorize. In 2010, the U.K. Government introduced policy changes to help bring down the national deficit. The executive's planned reforms aimed to deliver a so‐called battle‐winning military force, a smaller and more professional Ministry of Defence, and an affordable overall defence organization. The article borrows from theories of management and public policy to help enlighten our understanding of change under New Public Management and governance approaches. The article's central claim is that the U.K. Government sought to correct cost‐efficiency processes in public service organizations trying to reshape organizational and managerial structures dependent on many internal and external pressures. The article examines the executive's purpose in developing a need for change and the ways to implement it. I question whether the U.K. Government's prescriptive and hierarchical approach to organizational change in public administration is sustainable in the long term.

Related Articles

Ariely, Gal. 2011. “Why People (Dis)Like the Public Service: Citizen Perception of the Public Service and the NPM Doctrine.” Politics & Policy 39 (6): 997‐1019. https://doi.org/10.1111/j.1747-1346.2011.00329.x

Burau, Viola, and Carole Clavier. 2018. “Understanding Gaps in the Coexistence between Different Modes of Governance: A Case Study of Public Health in Schools in a Multilevel System.” Politics & Policy 46 (4): 604‐629. https://doi.org/10.1111/polp.12269

Monza, Sabina, and Eva Anduiza. 2016. “The Visibility of the EU in the National Public Spheres in Times of Crisis and Austerity.” Politics & Policy 44 (3): 499‐524. https://doi.org/10.1111/polp.12163
Role of sex‐biased miRNAs in teleosts – a review
Authors: Bhat Rayees Ahmad , Priyam Manisha , Foysal Md Javed , Gupta Sanjay Kumar , Sundaray Jitendra Kumar
Published: August 2020

MicroRNAs (miRNAs) are small non‐coding RNAs that control the expression of genes by targeting specific mRNAs. Data related to miRNAs are limited for fish species, with only 16 out of the 30 000 fish species enlisted in miRBase. In the present review, we have summarized the recent findings on the implication of miRNAs in the teleost reproduction with an emphasis on commercially important candidates. The information related to various miRNAs and their roles during different developmental stages of gonads in nine important species has been compiled. We have focused on the trend of sexual dimorphism in the gonadal miRNA repertoire of teleost species. Species‐specific variability is observed in the expression pattern of gonadal miRNAs in both male and female fish. It is noteworthy that our summarization of teleost miRNAs in reproduction has highlighted the gaps in functional information on the identified miRNAs (both conserved and novel). It is only after functional validation of the miRNA targets, one can use these findings to enhance reproductive health and production of the commercial teleost species to boost overall aquaculture sector.
Can individuals’ beliefs help us understand nonadherence to malaria test results? Evidence from rural Kenya
Authors: Maffioli Elisa Maria , Prudhomme O’Meara Wendy , Turner Elizabeth L. , Mohanan Manoj
Published: August 2020

In malaria‐endemic countries about a quarter of test‐negative individuals take antimalarials (artemisinin‐based combination therapies [ACTs]). ACT overuse depletes scarce resources for subsidies and contributes to parasite resistance. As part of an experiment in Kenya that provided subsidies for rapid diagnostic test and/or for ACTs conditionally on being positive, we studied the association between beliefs on malaria status (prior and posterior the intervention) and decisions to get tested and to purchase ACTs. We find that prior beliefs do not explain the decision of getting tested (conditional on the price) and nonadherence to a negative test. However, test‐negative individuals who purchase ACTs report higher posterior beliefs than those who do not, consistent with a framework in which the formers revise beliefs upward, while the latters do not change or revise downward. We also do not find evidence that prior beliefs on ACT effectiveness and trust in test results play any major role in explaining testing or treatment behavior. Further research is needed to improve adherence to malaria‐negative test results.
Education, gender, and generational change: The transformation of dowry in village Nepal
Authors: Fuller Sascha
Published: August 2020

In a small Bahun village in Gorkha district, West Nepal, in only one generation, there has been a huge shift to educating young women and including them in modernity. Ideologies of ‘gender equality’ in education that are promoted in development programs and discourse, and in Maoist rhetoric, have been powerful drivers behind this. In this paper I highlight the gender and generational dynamics of the changing relationship of women to education in Nepal. I argue that the move to educating women is not a simple one, nor is it necessarily a development success story. The importance placed on educating the younger generation, including women, is also very much tied to local Bahun culture, marriage values and status. Bahun villagers of Ludigaun place great importance on both education and marriage. When combined, I argue, education has in fact become dowry. While there have been transformations in education and other modernising processes, as well as in dowry practices, in this paper I show that they have come to maintain traditional hierarchies and to support the status making of the educated Bahun man.
Identification of a novel DI*02(2558T) allele associated with weakened expression of DI2 antigen
Authors: Wen Jizhi , van den Akker Emile , Luo Guangping , Jia Shuangshuang , Wei Ling , Wang Zhen , van der Schoot C. Ellen , Ji Yanli
Published: August 2020

Background

The distribution of DI1/DI2 antigens of the Diego blood group system is polymorphic in Mongoloid populations and the corresponding alloantibodies are clinically significant. Here a novel DI variant was found by donor screening, and the effect of the novel and previously reported mutations on expression of DI1/DI2 antigens and Band 3 protein was explored.

Study Design and Methods

DNA samples of 1150 Chinese donors were collected. DI*01/DI*02 genotyping was determined by Sanger sequencing. For the carrier of novel allele, the expression of Band 3 and DI1/DI2 antigens on red blood cells (RBCs) was detected by Western blot and flow cytometry, respectively. in vitro expression studies were conducted by transfecting the mutant (including the novel and three reported DI*02(2534T), DI*02(2358_2359insCAC), and DI*02(2572T) alleles) or wild‐type DI*02 constructs into HEK 293T cells, the expression of Band 3 and DI1/DI2 antigens was analyzed.

Results

A novel heterozygous mutation (c.2558C>T, p.Thr853Met), which is located near the DI1/DI2 polymorphism site (c.2561T>C), was identified in a donor with DI:‐1,2 phenotype. Reduced expression of DI2 antigen was observed on the RBCs, while weakened expression of Band 3 and absence of DI2 antigen were detected in cells transfected with the mutant DI*02(2558T) construct. In addition, absent or decreased expression of Band 3 and DI2 antigen was also detected in cells transfected with three reported mutant constructs.

Conclusion

The novel DI*02(2558T) allele and three previously described DI mutations can affect the expression of Band 3 protein and/or DI2 antigen and/or interfere with DI*01/DI*02 genotyping result.
Corneoconjunctival transposition with and without ACell®for deep corneal ulcer repair in 18 dogs
Authors: Keenan Alessandra V. , Boveland Shannon D. , Rodriguez Galarza Roxanne , Moore Phillip A.
Published: August 2020

Objective

To document a case series using corneoconjunctival transposition (CCT) surgery with and without bioscaffolding matrix (ACell®) to repair deep corneal ulcers and perforations in dogs.

Animals studied

Eighteen dogs of various breeds that presented with deep or perforating corneal ulcers.

Procedures

Corneoconjunctival transposition grafts with or without ACell®were sutured using a simple interrupted 8‐0 or 9‐0 polyglactin 910 pattern.

Results

A total of eighteen dogs (19 eyes) were diagnosed with deep corneal ulcers (n = 7) and perforating corneal ulcers (n = 12). A CCT was performed in all eyes, with ten of them additionally receiving an ACell®graft. The majority of lesions were located axially in 14/19 (81%) eyes. Grafts were harvested from dorsal (n = 8), temporal (n = 5), ventral (n = 4), or nasal (n = 2) quadrants. Brachycephalic breeds (13/18) were over‐represented. Keratoconjunctivitis sicca was present in 10/19 eyes (52.6%). Bacterial isolates were cultured from 8/19 eyes. Post‐operative therapy included topical antibiotics, plasma, cycloplegics, oral antibiotics, and oral nonsteroidal anti‐inflammatory drugs. CCT integration with and without ACell®occurred at a median of 20 days (range 7‐38 days) post‐operatively with no significant difference between groups. Median follow‐up time was 188 days. Short‐term post‐operative complications included granulation tissue formation (19/19), corneal edema (4/19), graft retraction (4/19), and anterior synechia (1/19). Long‐term complications in 14 eyes with follow‐up >30 days included superficial corneal pigmentation (6/14) and epithelial inclusion cysts (5/14). Two eyes were nonvisual at last follow‐up due to cataract formation.

Conclusions

Corneoconjunctival transposition with ACell®can be utilized for corneal ulcer repair in dogs.
College Students’ Development of Badminton Skills and Tactical Competencies Following Play Practice
Authors: Liu Hairui , Wang Wei , Zhang Chunhe , Hastie Peter A.
Published: August 2020

Purpose: The purpose of this study was to examine the effects of Play Practice (PP) instruction on badminton performance in college students. Method: A total of 66 students from the United States and China participated in units following either the principles of PP or skill-focused instruction. A nonequivalent control/comparison group experimental design with premeasure and postmeasure was used in this study. Separate analyses of variance with repeated measures (Time × Group) were conducted to examine the effects of PP and skill-focused instruction for each of the four dependent variables: (a) forehand clear, (b) wall volley, (c) game performance, and (d) tactical understanding. Results: Both PP and skill-focused instruction conditions were effective in improving participants’ skills from pretest to posttest. However, PP was also effective in improving participants’ game performance. Conclusion: PP effectively developed both fundamental skills and tactical aspects of badminton without diminishing the transfer effect from practice to games.
The ecological and evolutionary consequences of systemic racism in urban environments
Authors: Schell Christopher J. , Dyson Karen , Fuentes Tracy L. , Des Roches Simone , Harris Nyeema C. , Miller Danica Sterud , Woelfle-Erskine Cleo A. , Lambert Max R.
Published: August 2020

Imprints of racism

Cities create challenging environments for many nonhuman species, and the presence of nonhumans in cities influences the health and well-being of the humans with which they share the environment. Distinct urban conditions are created by landscape modification, but the history of this transformation is not equal across urban environments. Schell
et al.
review how systematic racist practices such as residential segregation, enacted in part through redlining, have led to an unequal distribution of “nature” within cities. These inequities continue to play out in both the ecological processes of cities and the welfare of their residents.

Science
, this issue p.
eaay4497
Knowledge transfer for large-scale vaccine manufacturing
Authors: Price W. Nicholson , Rai Arti K. , Minssen Timo
Published: August 2020

Massive, rapid production will require firms to share know-how not just about what to make but how to make it
Differential Effects of Heated Perfusate on Morphology, Viability, and Dissemination of Staphylococcus epidermidis Biofilms
Authors: Beckwith Joanne K. , VanEpps J. Scott , Solomon Michael J.
Published: August 2020

Bacterial biofilms are a leading cause of medical device infections.Staphylococcus epidermidisis commonly responsible for these types of infections. With increasing occurrences of antibacterial resistance, there has been a new push to explore treatment options that augment traditional antibiotic therapies. Here, we show how thermal treatment can be applied to both degrade bacterial biofilms on substrates and impede the proliferation of cells that detach from them. Understanding the response of both surface-adhered and dispersed bacterial cells under thermal stress conditions is a foundational step toward the development of anin situtreatment/remediation method for biofilm growth in medical devices; such an application could use oscillatory flow of heated fluid in a catheter as an adjuvant to antibiotic treatment. The work furthermore provides new insight into the viability of disseminated biofilm material.
Mask versus nasal prong leak and intermittent hypoxia during continuous positive airway pressure in very preterm infants
Authors: Poets Christian F , Lim Kathleen , Marshall Andrew , Jackson Hamish , Gale Timothy J , Dargaville Peter A
Published: August 2020

Background

Nasal continuous positive airway pressure (NCPAP) can be applied via binasal prongs or nasal masks; both may be associated with air leak and intermittent hypoxia. We investigated whether the latter is more frequent with nasal masks or prongs.

Methods

Continuous 24 hours recordings of inspired oxygen fraction (FiO2), pulse rate, respiratory rate, pulse oximeter saturation (SpO2) and CPAP level were made in preterm infants with respiratory insufficiency (n=20) managed on CPAP in the NICU at the Royal Hobart Hospital. As part of routine care, nasal interfaces were alternated 4-hourly between mask and prongs. In each recording, the first two segments containing at least 3 hours of artefact-free signal for each interface were selected. Recordings were analysed for episodes with hypoxaemia (SpO2 <80% for ≥10 s) and bradycardia (pulse rate <80/min for ≥4 s) and for episodes of pressure loss at the nasal interface. Data were compared using Wilcoxon-matched pairs test and are reported as median (IQR).

Results

Infants had a gestational age at birth of 26 (25-27) weeks and postnatal age of 17 (14–24) days. There was no difference in %time with interface leak between prong and mask (0.9 (0–8)% vs 1.1 (0–18)%, p=0.82), %time with SpO2 <80% (0.15 (0–1.2)% vs 0.06 (0–0.8)%, p=0.74) or heart rate <80/min (0.03 (0–0.2)% vs 0 (0–0.2)%, p=0.64). Three infants had interface leak for >10% of the time with prongs and 5 with the mask.

Conclusion

Both interfaces resulted in a similarly stable provision of positive airway pressure, and there was also no difference in the occurrence of intermittent hypoxia.
Size at birth, growth trajectory in early life, and cardiovascular and metabolic risks in early adulthood: EPICure study
Authors: Ni Yanyan , Beckmann Joanne , Hurst John R , Morris Joan K , Marlow Neil
Published: August 2020

Objective

To investigate whether size at birth and growth trajectories in infancy and childhood are associated with determinants of cardiovascular and metabolic risks in young adults born extremely preterm (EP, <26 weeks of gestation).

Methods

We used longitudinal data from the EPICure study of 129 EP survivors up to 19 years in the UK and Ireland in 1995. Determinants of cardiovascular and metabolic risks at 19 years included the presence of metabolic syndrome, body mass index (BMI) and systolic blood pressure (SBP). Predictors were birth weight for gestation and gain in weight z-scores in the following periods: birth–postmenstrual age of 40 weeks (term), infancy (term–2.5 years), early childhood (2.5–6.0 years) and late childhood (6–11 years).

Results

Metabolic syndrome was present in 8.7% of EP participants at 19 years. Compared with subjects without metabolic syndrome, those with metabolic syndrome tended to have a smaller size at birth (difference in means: −0.55 SD, 95% CI −1.10 to 0.01, p=0.053) and a greater increase in weight z-scores from term to 2.5 years (difference in means: 1.00 SD, 95% CI −0.17 to 2.17, p=0.094). BMI at 19 years was positively related to growth from 2.5 to 6.0 years (
β
: 1.03, 95% CI 0.31 to 1.75, p=0.006); an inverse association with birthweight z-scores was found in the lower socioeconomic status group (
β
: −1.79, 95% CI −3.41 to –0.17, p=0.031). Central SBP was positively related to growth from 2.5 to 6.0 years (
β
: 1.75, 95% CI 0.48 to 3.02, p=0.007).

Conclusion

Size at EP birth and increased catch-up in weight from 2.5 to 6.0 years were associated with BMI and central SBP in early adulthood.
Exploratory cost-effectiveness model of electromagnetic navigation bronchoscopy (ENB) compared with CT-guided biopsy (TTNA) for diagnosis of malignant indeterminate peripheral pulmonary nodules
Authors: Rickets William , Lau Kelvin Kar Wing , Pollit Vicki , Mealing Stuart , Leonard Catherine , Mallender Philip , Chaudhuri Nilanjan , Shah Pallav L , Naidu Umamamaheswar Babu
Published: August 2020

Introduction

Lung cancer is accountable for 35 000 deaths annually, and prognosis is improved when the cancer is diagnosed early. CT-guided biopsy (transthoracic needle aspiration, TTNA) and electromagnetic navigation bronchoscopy (ENB) can be used to investigate indeterminate pulmonary nodules if the patient is unfit for surgery. However, there is a paucity of clinical and health economic evidence that directly compares ENB with TTNA in this population group. This cost-effectiveness study aimed to explore potential scenarios whereby ENB may be considered cost-effective when compared with TTNA.

Methods

A cohort decision analytic model was developed using a UK National Health Service perspective. ENB was assumed to have equal sensitivity to TTNA at 82%. Lifetime costs and quality-adjusted life-year (QALY) gain were calculated to estimate the net monetary benefit at a £20 000 per QALY threshold. Sensitivity analyses were used to explore scenarios where ENB could be considered a cost-effective intervention.

Results

Under the assumption that ENB has equal efficacy to TTNA, ENB was found to be dominant (less costly and more effective) when compared with TTNA, due to having a reduced risk and cost of adverse events. This conclusion was most sensitive to changes in the cost of intervention, estimates of effectiveness and adverse event rates.

Discussion

ENB is expected to be cost-effective when the likelihood of an accurate diagnosis is equal to (or better than) TTNA, which may occur in certain subgroups of patients in whom TTNA is unlikely to accurately diagnose malignancy or when an experienced practitioner achieves a high accuracy with ENB.
Survey of trainee attitudes to skill development and simulation training in
trauma and orthopaedics
Authors: Jassim Shivan S , Varma Sundeep K , Ramachandran Manoj , Akhtar Kashif S N
Published: August 2020

Background

Simulation training in surgery is widespread and allows surgeons to
practise novel operative techniques and acquaint themselves with unfamiliar
surgical procedures. The use of box or virtual reality simulators in many
surgical specialities is established; however, its use within trauma and
orthopaedics (T&O) in the UK and the attitudes of trainee towards it are
not known. The aim of this study is to explore the experiences and opinions of
T&O trainees towards simulation training.

Methods

An electronic survey consisting of 11 questions on the experiences of
simulation training and attitudes towards it was sent to all T&O speciality
trainees in London.

Results

Fewer than 10% of the responders had used or had ready access to
simulators to prepare for unfamiliar operations, with almost 90% preferring to
read about them in a journal or watch them on an online video site. Over half
had only seen simulators on courses or been aware of them. Over 75% of the
responders believed that simulators should be available for trainees, but most
did not feel that they should be used as part of formal assessments.

Conclusions

Methods for preparing for new operations have expanded over the past
20 years, yet the use of simulator machines is not widespread. Many trainees
believe current machines are not widely available nor realistic enough to be
useful, with most preferring online videos and operative technique books for
preparing for an unfamiliar operation.
Mass eradication ofHelicobacter pylorito reduce gastric cancer incidence and mortality: a long-term cohort study on Matsu Islands
Authors: Chiang Tsung-Hsien , Chang Wei-Jung , Chen Sam Li-Sheng , Yen Amy Ming-Fang , Fann Jean Ching-Yuan , Chiu Sherry Yueh-Hsia , Chen Yi-Ru , Chuang Shu-Ling , Shieh Chun-Fu , Liu Cheng-Ying , Chiu Han-Mo , Chiang Hung , Shun Chia-Tung , Lin Ming-Wei , Wu Ming-Shiang , Lin Jaw-Town , Chan Chang-Chuan , Graham David Y , Chen Hsiu-Hsi , Lee Yi-Chia
Published: August 2020

Objective

Although mass eradication ofHelicobacter pylorihas been proposed as a means to eliminate gastric cancer, its long-term effects remain unclear.

Design

Mass eradication ofH. pyloriinfection was launched in 2004 and continued until 2018 for a high-risk Taiwanese population aged 30 years or older dwelling on Matsu Islands with prevalentH. pyloriinfection. Test positives for the13C-urea breath test underwent eradication therapy. We evaluated the effectiveness of the mass eradication in reducing two main outcomes, incidence and mortality rates of gastric cancer, until the end of 2016 and 2018, respectively.

Results

After six rounds of mass screening and eradication, the coverage rate reached 85.5% (6512/7616). The referral rate for treatment was 93.5% (4286/4584). The prevalence rates ofH. pylorifell from 64.2% to 15.0% with reinfection rates of less than 1% per person-year. The presence and severity of atrophic gastritis and intestinal metaplasia also decreased with time. Compared with the historical control period from 1995 to 2003, the effectiveness in reducing gastric cancer incidence and mortality during the chemoprevention period was 53% (95% CI 30% to 69%, p<0.001) and 25% (95% CI −14% to 51%, p=0.18), respectively. No significant changes were noted in the incidence rates of other digestive tract cancers or the antibiotic resistance rate ofH. pylori.

Conclusion

Population-based eradication ofH. pylorihas significantly reduced gastric cancer incidence with no increase in the likelihood of adverse consequences. A significant reduction in mortality is likely to be achieved with a longer follow-up period.

Trial registration number

NCT00155389
Continuous PENG block for hip fracture: a case series
Authors: Del Buono Romualdo , Padua Eleonora , Pascarella Giuseppe , Soare Corina Gabriela , Barbara Enrico
Published: August 2020

Introduction

The pericapsular nerve group (PENG) block is a novel regional technique indicated for analgesia for hip joint pain. We administered PENG blocks and performed catheter insertion for continuous infusions in patients with femur fractures on hospital admission. In this case series, we describe our initial experience of pain management in 10 patients with continuous infusion and its associated adverse events.

Case series

The PENG block was administered with an introducer needle. The catheter was then inserted 3 cm beyond the needle tip. In three patients, blood aspiration through the catheter occurred. In each patient, the catheter was repositioned 0.5–1.0 cm more medially. No blood aspiration or visible hematoma occurred subsequently. The presence of any vascular structure deep to the iliopsoas muscle was excluded postoperatively based on a Doppler color flow scan.

Discussion

Overall, eight patients had femoral neck fractures, and two patients had intertrochanteric fractures. All 10 patients reported good pain relief. The median (IQR) Numerical Rating Scale (NRS) score decreased from 7 (6–7) before the block to 2 (2–2.75) 20 min after PENG catheter placement. The median (IQR) NRS score after 12, 24 and 48 hours were 2 (2–3), 2 (2–3), and 2 (0.25–2), respectively. Patients underwent surgery 24–48 hours following catheter placement. Catheters were removed by an Acute Pain Service nurse 72 hours postinsertion. We want to highlight the potential for intravascular catheter placement in this anatomical region. Further studies are required to confirm if this is a technical error or an associated complication of continuous PENG blocks.
Association between asthma, corticosteroids and allostatic load biomarkers: a cross-sectional study
Authors: Barry Luke Evan , O’Neill Ciaran , Heaney Liam G
Published: August 2020

Background

Allostatic load, a measure of early ageing or ‘wear and tear’ from adapting to environmental challenges, has been suggested as a framework with which to understand the stress-related disruption of multiple biological systems which may be linked to asthma. Considering the socioeconomic context is also critical given asthma and allostatic overload are more common in lower socioeconomic groups.

Aims

Estimate the relationship between allostatic load and its constituent biomarkers, asthma and corticosteroid prescribing while controlling for socioeconomic status.

Methods

Data from Understanding Society (a nationally representative survey of UK community-dwelling adults) waves 1–3 (2009–2012) allowed the identification of a sex-specific risk profile across 12 biomarkers used to construct an Allostatic Load Index for a sample of 9816 adults. Regression analyses were used to examine the association of asthma status and corticosteroid prescriptions with allostatic load and its constituent biomarkers while controlling for socioeconomic status (n=9805).

Results

Subjects with currently treated asthma and no corticosteroid prescription have an allostatic load 1.21 times higher than those without asthma (p<0.001). Asthmatic subjects in receipt of inhaled corticosteroids had an allostatic load, approximately 1.12 times higher than those without asthma (p<0.001). This association persisted in sensitivity analyses and appeared to be driven by an association with specific biomarkers (dehydroepiandrosterone-sulfate, waist-to-height ratio and C-reactive protein).

Conclusion

Early ageing, in the form of a higher allostatic load, was present even in the mildest asthma group not receiving inhaled corticosteroids. Allostatic load is helpful in understanding the increased all-cause mortality and multimorbidity observed in asthma.
Night-to-night variability of respiratory events in obstructive sleep apnoea: a systematic review and meta-analysis
Authors: Roeder Maurice , Bradicich Matteo , Schwarz Esther Irene , Thiel Sira , Gaisl Thomas , Held Ulrike , Kohler Malcolm
Published: August 2020

Background

It is current practice to use a single diagnostic sleep study in the diagnostic workup of obstructive sleep apnoea (OSA). However, a relevant night-to-night variability (NtNV) of respiratory events has been reported.

Methods

We evaluated the NtNV of respiratory events in adults with suspected or already diagnosed OSA who underwent more than one diagnostic sleep study. Data sources were PubMed, Cochrane and Embase up to 23 January 2019. Random-effects models were used for evidence synthesis. For moderator analysis, mixed-effects regression analysis was performed. The study was registered with PROSPERO (CRD42019135277).

Results

Of 2143 identified papers, 24 studies, comprising 3250 participants, were included. The mean Apnoea-Hypopnoea Index (AHI) difference between the first and second night was −1.70/hour (95% CI −3.61 to 0.02). REM time differences (first to second night) were significantly positive associated with differences in mean AHI (β coefficient 0.262 (95% CI 0.096 to 0.428). On average, 41% (95% CI 27% to 57%) of all participants showed changes of respiratory events >10/hour from night to night. Furthermore, 49% (95% CI 32% to 65%) of participants changed OSA severity class (severity thresholds at 5/hour, 15/hour and 30/hour) at least once in sequential sleep studies. Depending on the diagnostic threshold (5/hour, 10/hour or 15/hour), on average 12% (95% CI 9% to 15%), 12% (95% CI 8% to 19%) and 10% (95% CI 8% to 13%) of patients would have been missed during the first night due to single night testing.

Conclusion

While there was no significant difference between mean AHI in two sequential study nights on a group level, there was a remarkable intraindividual NtNV of respiratory events, leading to misdiagnosis and misclassification of patients with suspected OSA.