bluuebunny/crossref_metadata_2025 huggingface dataset:
Toxicity and response to ipilimumab and nivolumab in older patients with metastatic melanoma: A multicentre retrospective analysis
Authors: Pathmanathan Shivanshan , Babu Hari , Dzienis Marcin , Azer Mary , Eastgate Melissa
Published: September 2022

Combination immunotherapy with nivolumab and ipilimumab is an effective therapy in the treatment of metastatic melanoma, however, its benefit in older patients is unclear. A multicentre retrospective study was performed to compare the efficacy and toxicity of combination immunotherapy in metastatic melanoma in patients ≥65 years versus <65 years, and complications of steroids used to manage toxicity. One hundred and thirty‐nine patients were included with 52 patients ≥65 years (median age: 70; range: 65–83) and 87 patients <65 years (median age: 52; range: 22–64). Median overall survival was similar in patients ≥65 years versus <65 years (14.9 vs. 17.3 months p = .58). Median progression‐free survival was also similar in both groups (7.1 vs. 6.9 months p = .79), as was overall response rate (48.1% vs. 44.8% p = .73). Age was not associated with a difference in overall survival on multivariate analysis. There was similar rates of Grade 3 or higher adverse events in patients ≥65 years versus <65 years (50% vs. 49% p = 1.0) and discontinuation rates secondary to toxicity (55.8% vs. 56% p = 1.0). Median duration of steroids used to treat adverse events was similar (11 vs. 12 weeks p = .46). Complications of steroids requiring inpatient admission was numerically higher in the older patients (41.3% vs. 20.4% p = .07). Patients ≥65 years received similar benefit from combination immunotherapy in comparison to their younger counterparts with similar toxicity.
Forecasting future range shifts of Xylella fastidiosa under climate change
Authors: Godefroid Martin , Cruaud Astrid , Streito Jean‐Claude , Rasplus Jean‐Yves , Rossi Jean‐Pierre
Published: September 2022

Xylella fastidiosa (Xf) is a vector‐borne plant bacterium native to the Americas, which causes severe diseases to agricultural crops, ornamental plants and forest trees. The bacterium is becoming a source of worldwide health plant concern and disease outbreaks associated with Xf have occurred outside of its native range (in Europe, Asia and the Middle East). Several studies have estimated risks associated with Xf outbreaks in invaded regions under current climate conditions, but future climate change has been seldom addressed. In the present study, we calibrated correlative models of bioclimatic species distribution to forecast the potential range and severity of two economically important Xf‐related diseases (Pierce's disease and the bacterial leaf scorch of shade trees) by the period 2040–2060. Models predict that conditions could become highly favourable for Pierce's disease in economically important wine‐producing regions of the world, highlighting the need to design control strategies. Similarly, models suggest that risk of bacterial leaf scorch of shade trees might increase in temperate regions where it is still apparently absent. However, we note that substantial uncertainty in predictions arises from high levels of correlation among climatic variables in the calibration data set. The inherent lack of knowledge concerning whether the distribution of Xf‐related diseases is at climatic equilibrium or not in Europe may also influence our predictions. The models provide valuable information to identify regions where increased surveillance efforts should be made and where control strategies are required.
Seed positioning in extruded pellets: does it matter?
Authors: Brown Vanessa S. , Ritchie Alison L. , Stevens Jason C. , Hanks Taylah D. , Hobbs Richard J. , Erickson Todd E.
Published: September 2022

Extruded pellets containing activated carbon (AC) can be used to sow native seeds while simultaneously applying herbicide to control invasive species. Incorporating AC in pellets has been demonstrated to protect native seeds; however, there may be unintended detrimental impacts to seedling emergence. We aimed to optimize seed position within pellets to maximize emergence and survival of the perennial shrub Jacksonia furcellata. Seeds were positioned at 2 mm (top), 6 mm (middle), and 12 mm (bottom) within pellets (with or without AC), sown on or below the soil surface, and compared to non‐pelleted seeds sown under the soil surface in the equivalent positions (2, 6, and 12 mm depth). Trays were treated with a pre‐emergent herbicide (Simazine) or left unsprayed. Emergence (without herbicide) was significantly higher from seeds positioned at the bottom of pellets without AC sown on the soil surface (70%), compared to non‐pelleted seeds sown at the bottom (12 mm below the soil surface; 57%). However, emergence was inhibited when seeds were positioned in the middle (6 mm) of pellets with AC (32%). When treated with Simazine, survival was highest from seeds positioned at the bottom of pellets with AC (60%), compared to pellets without AC (15%) and non‐pelleted seeds sown at the bottom (12 mm below the soil surface; 15%). Jacksonia furcellata seeds positioned at the bottom of pellets, sown on the soil surface, shows promise to minimize negative impacts to emergence, and maximize herbicide protection. Further testing with additional species is required to refine pellet production (e.g. recipe, extrusion, and shape) for optimal emergence.
Asymptotic approximation of the likelihood of stationary determinantal point processes
Authors: Poinas Arnaud , Lavancier Frédéric
Published: September 2022

Continuous determinantal point processes (DPPs) are a class of repulsive point processes on with many statistical applications. Although an explicit expression of their density is known, it is too complicated to be used directly for maximum likelihood estimation. In the stationary case, an approximation using Fourier series has been suggested, but it is limited to rectangular observation windows and no theoretical results support it. In this contribution, we investigate a different way to approximate the likelihood by looking at its asymptotic behavior when the observation window grows toward . This new approximation is not limited to rectangular windows, is faster to compute than the previous one, does not require any tuning parameter, and some theoretical justifications are provided. It moreover provides an explicit formula for estimating the asymptotic variance of the associated estimator. The performances are assessed in a simulation study on standard parametric models on and compare favorably to common alternative estimation methods for continuous DPPs.
Intersectional oppression: A reflexive dialogue between Muslim academics and their experiences of Islamophobia and exclusion in UK Higher Education
Authors: Mahmud Arif , Islam Maisha
Published: September 2022

Islamophobia has seen a disturbing rise in British and international contexts; however, we see limited attention being afforded to this in the context of Higher Education (HE), particularly the impacts of this through the lens of staff members. HE continues to frame itself as a post‐racial, secular, progressive, and inclusive space, yet is perpetually opposed due to its surreptitious and violent incidences of racism, classism, sexism and ableism. We discuss here, using liberatory‐based and autoethnographic methodologies, Muslim staff members' experiences and insights of Islamophobia in UK HE institutions (HEIs)—a severely underrepresented group and largely invisible issue in the academy. We highlight the need to expose, challenge, question, and destabilise the continuous victimisation of Muslims within these spaces and beyond. We unpick issues related to intersectionality and different levels of exclusion by exploring the sense of belonging felt by Muslim staff; specific challenges and episodes of Islamophobia faced; and ways the sector can dismantle Islamophobia and begin developing practices to genuinely support anti‐Muslim, anti‐racist inclusion and social justice.
Who deserves what and why during the COVID‐19 pandemic: Applying the CARIN principles of deservingness to the American welfare state
Authors: Crabtree David I. , Wehde Wesley W.
Published: September 2022

How does the public decide who is deserving of welfare benefits? To shed light on this question, we investigate whether the CARIN principles of deservingness—specifically the ideas of control, attitude, reciprocity, identity, and need—impact the public's perception of American welfare target groups. We draw contrast between traditional welfare programs and pandemic‐related programs to gain a more comparative understanding of the principles' effects as well as to determine what role the pandemic may play in shaping welfare perceptions. We report that positive, deserving social constructions exist for recipients of both traditional and pandemic‐related welfare programs, and we find evidence that the distinction between traditional and pandemic‐related programs is important for deservingness perceptions in the US. Overall, these results suggest the importance of the CARIN criteria in an American context.
Mega‐sized pericentromeric blocks of simple telomeric repeats and their variants reveal patterns of chromosome evolution in ancient Cycadales genomes
Authors: Vozárová Radka , Wang Wencai , Lunerová Jana , Shao Fengqing , Pellicer Jaume , Leitch Ilia J. , Leitch Andrew R. , Kovařík Aleš
Published: September 2022

Simple telomeric repeats composed of six to seven iterating nucleotide units are important sequences typically found at the ends of chromosomes. Here we analyzed their abundance and homogeneity in 42 gymnosperm (29 newly sequenced), 29 angiosperm (one newly sequenced), and eight bryophytes using bioinformatics, conventional cytogenetic and molecular biology approaches to explore their diversity across land plants. We found more than 10 000‐fold variation in the amounts of telomeric repeats among the investigated taxa. Repeat abundance was positively correlated with increasing intragenomic sequence heterogeneity and occurrence at non‐telomeric positions, but there was no correlation with genome size. The highest abundance/heterogeneity was found in the gymnosperm genus Cycas (Cycadaceae), in which megabase‐sized blocks of telomeric repeats (i.e., billions of copies) were identified. Fluorescent in situ hybridization experiments using variant‐specific probes revealed canonical Arabidopsis‐type telomeric TTTAGGG repeats at chromosome ends, while pericentromeric blocks comprised at least four major telomeric variants with decreasing abundance: TTTAGGG>TTCAGGG >TTTAAGG>TTCAAGG. Such a diversity of repeats was not found in the sister cycad family Zamiaceae or in any other species analyzed. Using immunocytochemistry, we showed that the pericentromeric blocks of telomeric repeats overlapped with histone H3 serine 10 phosphorylation signals. We show that species of Cycas have amplified their telomeric repeats in centromeric and telomeric positions on telocentric chromosomes to extraordinary high levels. The ancestral chromosome number reconstruction suggests their occurrence is unlikely to be the product of ancient Robertsonian chromosome fusions. We speculate as to how the observed chromosome dynamics may be associated with the diversification of cycads.
MRI characteristics of canine prostatic neoplasia
Authors: Yang Nicole S. , Johnson Eric G. , Palm Carrie A. , Burton Jenna H. , Rebhun Robert B. , Kent Michael S. , Culp William T.N.
Published: September 2022

Magnetic resonance imaging (MRI) has been used to evaluate dogs with suspected prostatic neoplasia, however, published studies describing MRI characteristics of canine prostatic neoplasia are currently lacking. The aims of the current retrospective case series study were to describe MRI findings of the pelvic region in dogs with a histopathologic or cytologic diagnosis of prostatic neoplasia. Retrospective analysis of these images was then performed by a board‐certified veterinary radiologist for shared imaging characteristics. The most consistent characteristics were heterogeneous hyperintensity of the tumor on T2‐weighted images (10/10) and short tau inversion recovery images (10/10), prostatic capsular margin distortion by the tumor (10/10), cavitations (10/10), complete effacement of the prostatic architecture (9/10), neurovascular bundle (NVB) compression or invasion (9/10), heterogeneous isointensity of the tumor on T1‐weighted images (9/10), and strong contrast enhancement of the tumor (8/10). Additional features included an overlying pattern of distorted radiating striations (7/10), regional lymphadenomegaly (5/10), mineralization within the mass (5/10), urinary bladder trigone involvement (6/10), and post‐prostatic urethral involvement (7/10). These findings supported the use of MRI as an adjunct imaging modality for diagnosis and therapeutic planning of prostatic neoplasia and including prostatic neoplasia as a likely differential diagnosis for dogs with these MRI characteristics.
CT measures of osseous cervicothoracic intervertebral foramina are repeatable and associated with CT measures of adjacent articular processes in horses
Authors: Rovel Tibor , Duchateau Luc , Saunders Jimmy , Vandenberghe Filip , Vanderperren Katrien
Published: September 2022

Narrowing of the equine cervicothoracic intervertebral foramina (IF) has the potential to cause forelimb lameness and/or neck pain although limited information is available on CT of the IF. The aims of this retrospective, analytical study were to describe a protocol for quantifying CT cervicothoracic IF size; evaluate the repeatability of IF size measures; test associations between IF size and adjacent articular process (AP) size, ventral extent, and anatomic location; and determine the proportion of IF with narrowing. Computed tomographic images were acquired in 20 Warmblood horses that presented with forelimb lameness and/or neck pain. All IF between C5 and T2 (n = 160) were evaluated. IF cross‐sectional area (CSA), APCSA, and AP ventral extent were measured. The repeatability of IFCSA measurement was calculated. Possible associations between IFCSA and: APCSA, ventral extent, side, or location were assessed. IF narrowing was defined as more than 50% of reduction in IF height when compared with its widest part(s). The repeatability of IFCSA measurement was excellent. There was a significant association between IFCSA and: APCSA (P < 0.001; R2 = 0.859; slope = −0.106), ventral extent (P = 0.022; R2 = 0.161; slope = −0.0617), and location (P < 0.001; higher values between C7 and T2). The association between IFCSA and ventral extent was small. Narrowing was identified in 61 (38.1%) IF. Maximum degree of narrowing was most common at the cranial (26.3%) and middle (68.8%) third of the IF. Narrowing was not identified at T1‐T2. In conclusion, CT cervicothoracic IF size can be measured with excellent repeatability, and associations were found between IF size and: AP size, ventral extent, and location.
Reducing zoonotic avian influenza transmission at household poultry slaughter using a behaviour change tool for limited literacy audiences
Authors: Clark Andrew A. , Eid Samah , Hassan Mohamed K. , Carter Kip , Swayne David E.
Published: September 2022

Human infections in Egypt with highly pathogenic avian influenza (HPAI) likely due to airborne transmission of HPAI virus (HPAIV) during home slaughter of poultry predominately affect women and children, who are the primary caregivers of household poultry. This study developed a safe contained poultry slaughter procedure to reduce airborne HPAIV and zoonotic infections and simultaneously created an educational outreach tool for teaching the modified procedure. The tool designed for limited literacy audiences used two illustrated posters and handouts for teaching the safe contained poultry slaughter procedure. The posters were developed with advice of animal health professionals and then refined by target audience women's focus groups. These women's focus groups proved to be the critical step for assuring the understanding, acceptance, effectiveness and accuracy of the outreach tool. The safe contained poultry slaughter procedure was designed to be low or no cost, sustainable by using a universal implement found in village households and designed as a minor variation of standard poultry halal slaughter. It was crafted to be culturally appropriate and religiously acceptable.
Physics based model of an AlGaN/GaN vacuum field effect transistor
Authors: Hernandez N. , Cahay M. , Ludwick J. , Back T. , Hall H. , O’Mara J.
Published: September 2022

A vacuum field effect transistor (VacFET) is proposed that consists of a modification of a conventional AlGaN/GaN high electron mobility transistor to include a nanogap near the gate on either the source (cathode) or drain (anode) side of the device. The current flowing through the two-dimensional electron gas (2DEG) under the gate is obtained using a charge-control model, which is forced to be equal to the tunneling current across the nanogap. The latter is modeled using a modified version of Simmons tunneling theory of a metal–insulator–metal junction to include the effect of barrier lowering across the nanogap. When compared to other recently fabricated VacFETs, the proposed device has potential for much higher emission current densities and transconductance levels, of the order of several hundreds of mA/mm and tens of mS/mm, respectively. For similar material parameters and physical dimensions, the proposed VacFET has a turn-on voltage that depends on the location of the nanogap on either the source or drain side of the gate. It is shown that the current–voltage characteristics of VacFETs with a nanogap either on the drain or source side of the gate are highly sensitive to their physical parameters and biasing conditions, making them a very strong candidate for chemical or gas sensing applications. This is due to the sensitivity of the tunneling current to the effective barrier height and field enhancement factor of the nanogap.
“I Hear the Music and My Spirits Lift!” Pleasure and Ballroom Dancing for Community-Dwelling Older Adults
Authors: Chipperfield Sarah R. , Bissell Paul
Published: September 2022

Physical activity for older adults is recommended to encourage the maintenance of functional autonomy and improve mental health. Ballroom dancing involves aerobic, strength, and balance work and is an inherently a social activity. This 12-month qualitative study considered the influence of ballroom dancing on health and well-being in community-dwelling older adults. It explores an underreported aspect of physical activity, which may incentivize older people to participate, that is, pleasure. Qualitative data were managed and analyzed using the Framework Analysis approach. Semistructured interviews were conducted with 26 older adult ballroom dancers. Five typologies of pleasure were identified. In addition to “sensual pleasure,” “pleasure of habitual action,” and “pleasure of immersion,” as suggested by Phoenix and Orr, the “pleasure of practice” and “pleasure of community” were also identified. Ballroom dancing produces a strong sense of embodied pleasure for older adults and should be promoted by health and exercise professionals for community-dwelling older adults.
Evaluating the Dual-Target Aptima HIV-1 Quant Dx Assay: Comparison between Viral Loads Measured with
pol
and
LTR
Targets in the Same Samples
Authors: Sberna Giuseppe , Sarti Silvia , Cicalini Stefania , Antinori Andrea , Garbuglia Anna Rosa , Amendola Alessandra
Published: September 2022

The last generation dual-target platforms for quantification of HIV-1 RNA return a single value of viral load (VL) derived from a combined reading of two HIV-1 genome targets. By using a modified version of Aptima software, providing both the VL results obtained from
pol
and
LTR
amplification separately, we observed discordant VL results in some samples from HIV-1-infected patients on antiretroviral therapy.
Metachronous parathyroid adenoma characterised by recurrent nephrolithiasis
Authors: Turner Kiera Brigh , Wideroff Jonathan , Brickman Lawrence
Published: September 2022

Hyperparathyroidism is often diagnosed after identifying hypercalcaemia through routine testing in asymptomatic patients; however, many patients experience severe and painful symptoms related to their diagnosis, including nephrolithiasis and bone pain with osteoporosis. Double adenomata are an uncommon cause of hyperparathyroidism, and they occasionally occur metachronously with recurrent symptoms years apart. This case report examines a woman in her 60s with a history of parathyroid adenoma 9 years earlier who presented with recurrent nephrolithiasis. She was found to have a recurrence of primary hyperparathyroidism after more than a year of recurrent urinary tract infections, nephrolithiasis and bacteraemia. A neck exploration revealed a metachronous parathyroid adenoma, which was removed with complete resolution of symptoms. Her case demonstrates the importance of evaluating patients with nephrolithiasis for hyperparathyroidism and communicating abnormal laboratory results with the patient in a hospital setting. It also provides the opportunity to examine the rare diagnosis of a metachronous parathyroid adenoma.
Case of anterior glottic web with bilateral vocal cord cancers
Authors: Kusunoki Takeshi , Wada Ryo
Published: September 2022

We experienced a case of anterior glottic web with bilateral vocal cord cancers. The laryngoscopic findings showed milky tumour lesions on bilateral vocal cords and a web-like formation with an adhesion in the anterior commissure. In this case, we performed laryngomicrosurgery to remove the bilateral vocal cord tumours and the anterior glottic web. This case was diagnosed as bilateral glottic carcinoma (laryngeal carcinoma TNM classification: pT1bN0M0) with an anterior glottic web. Therefore, this patient underwent radiation therapy (66 Gy). At present, one and a half years have passed since the end of radiotherapy. There is no recurrence of the glottic cancer or web. The airway at the glottis was patent. It has been reported that cutting-off the anterior glottic web could easily lead to readhesion. Accordingly, we continued to follow-up to determine whether there was a recurrence of readhesion of the anterior glottic web or glottic cancer.
Testicular yolk sac tumour metastasis to the L2 vertebra
Authors: Murray Gisela , De Jesus Orlando , Correa-Rivas Maria , Cheverez-Ocasio Jorge I
Published: September 2022

The role of surgery for metastases to the vertebra from yolk sac tumours has not been established. The main treatment for disseminated disease is chemotherapy. We present a man in his 30s with a left orchiectomy for a testicular mixed germ cell tumour with a prominent yolk sac component who, 12 months later, developed an asymptomatic metastasis to the L2 vertebra unresponsive to chemotherapy and radiotherapy. The patient underwent resection of the L2 vertebral body, leaving a small residual tumour anterior to the vertebra attached to the great vessels. Pathology confirmed the diagnosis of a metastatic testicular yolk sac tumour in the vertebra. The postoperative MRI 6 months later demonstrated significant expansion of the tumour at the soft tissues anterior to the expandable titanium cage encasing the great vessels and extending to the paraspinal areas. Additional salvage surgery was not recommended because of the advanced stage of the tumour.
Impact of a physician-led exercise programme on quality of life, muscle mass and clinical response in inflammatory bowel disease patients during induction with disease-modifying therapy: a study protocol
Authors: Mc Gettigan Neasa , Hanley Marion , Skelly Fiona , Dowling Jennifer , Dunne Ruth , Morrin Martina M , McCaffrey Noel , O'Toole Aoibhlinn , Boland Karen
Published: September 2022

Introduction

Biologic and small-molecule therapies have revolutionised the treatment of moderate-to-severe inflammatory bowel disease (IBD). A significant proportion of patients experience early or delayed treatment failure. Patients with IBD with greater visceral obesity are less likely to respond to biologics. Sarcopenia has been identified as a predictor of disease severity and need for rescue therapy in acute severe ulcerative colitis. The aim of this study is to assess the feasibility of a physician-derived exercise programme in patients with IBD commencing biologic or small-molecule therapy in addition to the effect on physical fitness, body composition and objective measures of quality of life, fatigue scores and disease activity.

Methods and analysis

This is a randomised controlled feasibility study comparing the effects of a physician-derived exercise programme and standard medical care (biologic/small-molecule therapy) with standard care alone in patients with moderate to severe IBD. Patients with IBD in the intervention group will undergo a structured exercise programme for 20 weeks. Both IBD groups will carry out body composition, disease activity and quality-of-life assessments at baseline, week 12 and week 26. The primary objective is to assess the feasibility of the physician-derived exercise programme in patients with IBD commencing disease-modifying therapies. Secondary endpoints include a change in cardiorespiratory fitness, disease activity/inflammation, fatigue, health-related quality of life outcomes and body composition between the two IBD groups. Exploratory endpoints include validation of anterior thigh ultrasound for sarcopenia screening, assessment of proinflammatory cytokines and markers of immunometabolism.

Ethics and dissemination

This study has received ethical approval from the Beaumont Hospital Ethics committee on 22 October 2021 (reference number 21/21). Data generated or analysed during this study will be published as an article and supplementary appendix in relevant medical journals. The data will also be presented at national and international conferences.

Trial registration number

NCT05174754.
Co-creating an arts-based eye health education strategy in Zanzibar: process, outcomes and lessons learnt
Authors: Chan Ving Fai , Belluigi Dina , Yong Ai Chee , Mulewa Damaris , Poonsamy-Govender Pirindhavellie , Graham Christine , Mashayo Eden , Graham Ronnie , Price-Sanchez Carlos , Omar Fatma
Published: September 2022

Introduction

Published examples of health programme co-creation are scarce and we found none in the field of eye care. We described the outcomes and lessons learnt from the ZANZIbar Arts for Children’s Eyesight (ZANZI-ACE) eye health programme co-creation process.

Methods

We used a 2.5-day stakeholder workshop (number of participants=34) to develop the ZANZI-ACE intervention, which aimed to use music performances in eye health education to improve child eye health service uptake in Zanzibar. A Zanzibar-wide music competition was then launched to encourage local participation, followed by a judging session to select three pieces as the ZANZI-ACE eye health programme intervention materials.

Results

The barriers to the improved uptake of child eye health services raised by the participants were mainly cultural and social. Sensitising parents, teachers, children and community members with proper eye health knowledge was the key to addressing these barriers. The goal of sensitisation is to improve children’s vision so that they can achieve their fullest potential. Music and song ranked highest among the proposed art forms, so three music pieces were chosen as the ZANZI-ACE eye health programme intervention materials. A detailed ZANZI-ACE implementation strategy, a theory of change and key performance outcomes indicators were developed.

Conclusion

The co-creation process and outcomes of the ZANZI-ACE eye health programme show that engaging a diverse group of stakeholders is critical to developing locally relevant health programmes. The lessons learnt from the process will prove useful to researchers who aspire to design innovative health programmes.
Academic health science centre models across the developing countries and lessons for implementation in Indonesia: a scoping review
Authors: Bismantara Haryo , Ahern Susannah , Teede Helena J , Liew Danny
Published: September 2022

Objective

To describe models of academic health science centres (AHSCs) across developing countries, in order to inform AHSC development in Indonesia.

Design

Scoping review with systematic methods.

Data sources

Ovid MEDLINE, ProQuest Central, Wiley online library, Scopus and Web of Sciences were searched for relevant publications from 1 January 2015 to 1 December 2020. ‘Grey literature' was hand searched by targeted website searches, Google searches, as well as personal communication held with stakeholders in Indonesia specifically. Relevant articles regarding AHSCs in developing countries are included. The review would be synthesised to focus on the purpose, structure and core activities of AHSCs. Strategies for success were also considered.

Results

Twenty-six recognised AHSCs in developing countries were identified, located in Asia (n=13), Europe (n=1), South America (n=7) and Africa (n=5). Innovation, health system improvement and enhancement in academic capacity were the common visions. Most centres are functionally integrated and university-led. Most AHSCs include community health services to complement primary stakeholders such as academic institutions and hospitals. Limited information was identified regarding patient and public involvement and workforce capacity building. Five AHSCs have been piloted in Indonesia since 2018, integrating universities, academic hospitals and provincial health offices. However, information regarding their core activities and successes is limited.

Conclusions

The review suggests that limited published data are available on AHSC models in developing countries, but they still provide important insight into AHSC development in Indonesia. Innovation and health systems strengthening are the common visions. Functional integration with university leadership is the most common model of governance. Other than universities and hospitals, community health centres, research centres and regional health offices are common partners. There is a little description of community engagement and workforce capacity building.
Systematic evidence map of evidence addressing the top 10 priority research questions for hyperemesis gravidarum
Authors: Dean Caitlin Rosa , Nijsten Kelly , Spijker René , O'Hara Margaret , Roseboom Tessa J , Painter Rebecca C
Published: September 2022

Objective

Knowledge gaps regarding hyperemesis gravidarum (HG) are substantial. We aimed to systematically identify and map recent evidence addressing the top 10 priority questions for HG, as published in 2021 in a James Lind Alliance Priority Setting Partnership.

Design

Systematic evidence map.

Methods

We searched MEDLINE and EMBASE on 12 January 2021 and CINAHL on 22 February 2021 with search terms hyperemesis gravidarum, pernicious vomiting in pregnancy and their synonyms. Results were limited to 2009 onwards. Two reviewers independently screened titles and abstracts to assess whether the studies addressed a top 10 priority questions for HG. Differences were discussed until consensus was reached. Publications were allocated to one or more top 10 research questions. Study design was noted, as was patient or public involvement. Two reviewers extracted data synchronously and both cross-checked 10%. Extracted data were imported into EPPI-Reviewer software to create an evidence map.

Outcome measures

The number and design of studies in the search yield, displayed per the published 10 priority questions.

Results

Searches returned 4338 results for screening; 406 publications were included in the evidence map. 136 publications addressed multiple questions. Numerous studies address the immediate and long-term outcomes or possible markers for HG (question 8 and 9, respectively 164 and 82 studies). Very few studies seek a possible cure for HG (question 1, 8 studies), preventative treatment (question 4, 2 studies) or how to achieve nutritional requirements of pregnancy (question 10, 17 studies). Case reports/series were most numerous with 125 (30.7%) included. Few qualitative studies (9, 2.2%) were identified. 25 (6.1%) systematic reviews addressed eight questions, or aspects of them. 31 (7.6%) studies included patient involvement.

Conclusions

There are significant gaps and overlap in the current HG literature addressing priority questions. Researchers and funders should direct their efforts at addressing the gaps in the top 10 questions.
Eid-al-Fitr festivity and Ramadan fasting attitude among individuals with diabetes from Saudi Arabia and Pakistan: a cross-sectional study
Authors: Gazzaz Zohair J , Baig Mukhtiar , Kanpurwala Muhammad Adnan , Jamil Tahir , Mojaddidi Moaz A , Murad Manal A
Published: September 2022

Objectives

The present study aimed to assess the attitude of Saudi and Pakistani individuals with diabetes regarding Eid-al-Fitr festivities, exploring diabetes care during the month of Ramadan and these individuals’ dietary patterns on Eid day.

Design

Cross-sectional study.

Setting

Jeddah (Saudi Arabia) and Karachi (Pakistan).

Participants

Of the total 405 subjects, 204 individuals with diabetes from Saudi Arabia (SA) and 201 from Pakistan (Pak) were enrolled.

Data collection and analysis

This survey-based study was carried out in SA and Pak after Eid-al-Fitr 2020. An online questionnaire was circulated via various social media platforms. The data analyses were performed using SPSS V.26.

Results

There were 80 subjects with type 1 diabetes mellitus (DM) and 325 subjects with type 2 DM. Among our study subjects, 73 were on insulin, 260 were on oral antidiabetics (OADs) and 72 were taking both OADs and insulin. Two-thirds of the participants, 276 (68%) visited their physicians before Ramadan. Many participants (175, 43.2%) broke their fast a day or more because of diabetes. Many participants consumed sugary food on Eid day. The use of chocolates, sugary foods and fresh juices on Eid-al-Fitr was higher in Saudi subjects than in Pakistani ones (p<0.001). Saudi subjects with diabetes adhered more strictly to medications during Ramadan than Pakistani subjects (p=0.01). Saudi participants were more compliant with monitoring DM during Eid-al-Fitr compared with Pakistani subjects. Many participants in both groups felt stressed or depressed and stated that their Eid celebrations were restrictive because of their DM conditions.

Conclusions

Most Saudi and Pakistani participants enjoyed Eid celebrations by abstaining from dietary restrictions. The sugar consumption attitude during Eid day was not up to the mark. Many subjects broke their fasts for a day or more because of diabetes. Saudis were more vigilant in monitoring DM than Pakistanis during Eid-al-Fitr. Individuals with diabetes should consult their physicians before Ramadan for checkups and counselling.
Randomised controlled pilot and feasibility study of multimodal agility-based exercise training (MAT) versus strength and endurance training (SET) to improve multiple sclerosis-related fatigue and fatigability during inpatient rehabilitation (ReFEx): study protocol
Authors: Wolf Florian , Nielsen Jörn , Saliger Jochen , Hennecken Eva , Eschweiler Mareike , Folkerts Ann-Kristin , Karbe Hans , Zimmer Philipp
Published: September 2022

Introduction

Subjective fatigue and objectively assessed fatigability are common symptoms in persons with multiple sclerosis (pwMS). Recent work has suggested a positive effect of balance and motor control training (BMCT) in reducing fatigue. It is unclear whether this effect can also be attained during inpatient rehabilitation. Multimodal agility-based exercise training (MAT) has been developed as a framework that incorporates BMCT with added agility components but has not been applied to pwMS. Therefore, this study will evaluate the feasibility of a randomised controlled trial comparing MAT against strength and endurance training (SET) for the improvement of MS-related fatigue and fatigability in a German neurological rehabilitation centre.

Methods and analysis

A total of 24 pwMS (Expanded Disability Status Scale ≤5.0, Fatigue Scale for Motor and Cognitive Functions ≥53) will be randomly assigned to either SET or land and water-based MAT for 4–6 weeks during inpatient rehabilitation. Assessments of subjective fatigue, motor and cognitive fatigability, cognitive and cardiorespiratory performance, and balance confidence will be performed at admission and discharge. Subjective fatigue will also be assessed at 1, 4 and 12 weeks after discharge. Feasibility outcomes will include patients’ acceptance of study procedures and interventions, recruitment rate, retention rate, time needed to complete baseline assessments, intervention adherence and fidelity. All quantitative outcomes will be reported descriptively. A total of 12 pwMS (6 per group) will be interviewed to gain insights into participants’ experiences during study participation.

Ethics and dissemination

Ethical approval has been obtained from the Ethics Committee of the University of Bonn (reference number: 543/20). Dissemination of findings is planned via peer-reviewed journals, conferences and media releases.

Trial registration number

DRKS00023943.
Prefabricated contoured foot orthoses to reduce pain and increase physical activity in people with hip osteoarthritis: protocol for a randomised feasibility trial
Authors: King Matthew G , Kemp Joanne L , Hon Ryan , Pizzari Tania , Wong Justin , Menz Hylton , Taylor Nicholas F , Harms Anton , McClelland Jodie A , Semciw Adam Ivan
Published: September 2022

Introduction

The aim of this randomised feasibility trial is to determine the feasibility of conducting an adequately powered randomised controlled trial (RCT) investigating the efficacy of prefabricated contoured foot orthoses in people with hip osteoarthritis (OA). The secondary aims of the trial are to compare the effect of prefabricated contoured foot orthoses to a flat shoe insert comparator on outcomes of hip-related pain, physical activity and quality of life. We hypothesise that the demand, implementation, acceptability and practicality of foot orthoses as a treatment option for people with hip OA will be deemed feasible, informing the development of an adequately powered RCT to evaluate the efficacy and long term outcomes.

Methods and analysis

We will recruit 28 people with hip OA who will be randomised to receive either prefabricated contoured foot orthoses or flat shoe inserts to use for a 6-week period. Both groups will receive standardised education on hip OA and physical activity. The study’s primary outcome is the feasibility domains of demand, implementation, acceptability and practicality. The secondary outcomes include the change in Hip Osteoarthritis Outcome Score-12, Patient Health Questionnaire-9, Brief Fear of Movement Scale for OA, Physical activity accelerometry and the Physical Activity Questionnaire-short form. Descriptive statistics will be used to describe feasibility outcomes with limited efficacy analysis used for the secondary outcomes. Linear mixed models will be used to analyse between-group differences at 6 weeks, with baseline values used as covariates, treatment allocation as a fixed factor and participant as a random factor.

Ethics and dissemination

This trial has been approved by the La Trobe University Human Research Ethics Committee (HEC20427), St. Vincent’s Hospital Melbourne, Human Research Ethics Committee (HREC 266/20) and Northern Health Research Governance (NH-2021-292862). The results will be disseminated via a peer-reviewed journal and presented at international conferences.

Trial registration number

NCT05138380.
Increasing access to essential medicines through partnership: experience in developing and delivering chlorhexidine gel for newborn cord care
Authors: DeAngelis Elena , Clarke Andrew , Gibson Rachel , Karrar Karrar , Williams Pauline
Published: September 2022

Sustainable access to essential medicines in low-income and middle-income countries requires innovative cross-sectoral collaboration throughout the lifecycle of a medicine. Partnerships are essential to address the systemic challenges of global health and health inequity. Pharmaceutical companies, funders, governments, international non-governmental organisations (I-NGOs) and other key stakeholders can leverage, through effective partnership working, their unique expertise to help drive innovation and share learnings and risks. Here, we reflect on one approach taken in the development and supply of chlorhexidine digluconate 7.1% w/w gel (equivalent to 4% w/w chlorhexidine) for neonatal cord care. We describe and analyse the steps taken by GSK to increase access to chlorhexidine gel, including partnering with the I-NGO Save the Children in Western Kenya. Learning points gained along the journey are shared, together with subsequent steps taken to increase access, with the aim of making recommendations that may be applicable to similar enterprises in the future.
Independent reporting in oral and maxillofacial pathology
Authors: Gorania Riddhi , Hunter Keith , Hall Gillian , Brierley Daniel J
Published: September 2022

Aims

To understand the current practice, extent of use and barriers related to independent reporting (IR) in oral and maxillofacial pathology (OMFP) training in the UK.

Methods

A questionnaire was created containing questions about the experiences and opinions surrounding IR in OMFP. The target participants were (1) consultants in OMFP who had been involved in training OMFP trainees in the last 5 years and (2) current OMFP trainees. The questionnaire was delivered via Google Forms and disseminated using a link in an invitation email sent to the participants.

Results

A total of 13 consultant responses (response rate of 81%) and 12 trainee responses (response rate of 92%) were received. Of these, three consultants and five trainees were using IR at the time of the study. Several themes emerged highlighting the perceived benefits and concerns regarding IR.

Conclusions

This study suggests that there is a disparity in the way IR is used in OMFP training across the UK. There was shared concern between consultants and trainees regarding the lack of clear guidance and subsequent fear of litigation. These are issues that need to be addressed if trainees are to have a similar experience across the country and be prepared for independent practice on completion of training.
Perceived discrimination at work: examining social, health and work-related factors as determinants among breast cancer survivors – evidence from the prospective CANTO cohort
Authors: Ruiz De Azua Garazi , Vaz-Luis Ines , Bovagnet Thomas , Di Meglio Antonio , Havas Julie , Caumette Elsa , Martin Elise , Pistilli Barbara , Coutant Charles , Cottu Paul , Rouanet Philippe , Arnaud Antoine , Arsene Olivier , Ibrahim Mahmoud , Wassermann Johanna , Rouzier Roman , Martin Anne-Laure , Everhard Sibille , Dumas Agnes , Menvielle Gwenn
Published: September 2022

Background

We assessed the prevalence of self-reported perceived discrimination in the workplace after the end of treatment among breast cancer (BC) survivors and studied its association with social, health-related and work-related factors.

Methods

We used data from a French prospective cohort (CANcer TOxicities) including women diagnosed with stage I–III BC. Our analysis included 2130 women who were employed, <57 years old at BC diagnosis and were working 2 years afterwards. We assessed the association between social, health-related and work-related factors and perceived discrimination in the workplace using logistic regression models.

Results

Overall, 26% of women reported perceived discrimination in the workplace after the end of treatment. Women working for a small company, in the public sector or with better overall health status were less likely to report perceived discrimination. Women who benefited from easing dispositions at their workplace, who did not feel supported by their colleagues and those who returned to work because of fear of job loss were more likely to report perceived discrimination.

Conclusions

One in four BC survivors perceives discrimination in the workplace. Health and work-related factors are associated with increased likelihood of reporting perceived discrimination.

Trial registration number

NCT01993498.
Defining capabilities in deployed UK military prehospital emergency care
Authors: Thompson Michael , Jefferson O , James T , Waller B , Reed R , Slade H , Swift K , Pynn H J
Published: September 2022

The UK military prehospital emergency care (PHEC) operational clinical capability framework must be updated in order that it retains its use as a valid operational planning tool. Specific requirements include accurately defining the PHEC levels and the ‘Medical Emergency Response Team’ (MERT), while reinforcing PHEC as a specialist area of clinical practice that requires an assured set of competencies at all levels and mandatory clinical currency for vocational providers.

A military PHEC review panel was convened by the Defence Consultant Advisor (DCA) for PHEC. Each PHEC level was reviewed and all issues which had, or could have arisen from the existing framework were discussed until agreement between the six members of this panel was established.

An updated military PHEC framework has been produced by DCA PHEC, which defines the minimum requirements for each operational PHEC level. These definitions cover all PHEC providers, irrespective of professional background. The mandatory requirement for appropriate clinical exposure for vocational and specialist providers is emphasised. An updated definition of MERT has been agreed.

This update provides clarity to the continually evolving domain of UK military PHEC. It sets out the PHEC provider requirements in order to be considered operationally deployable in a PHEC role. There are implications for training, manning and recruitment to meet these requirements, but the processes required to address these are already underway and well described elsewhere.
Association of fluid-attenuated inversion recovery vascular hyperintensity with ischaemic events in internal carotid artery or middle cerebral artery occlusion
Authors: Lyu Jinhao , Hu Jianxing , Wang Xinrui , Bian Xiangbing , Wei Mengting , Wang Liuxian , Duan Qi , Lan Yina , Zhang Dekang , Wang Xueyang , Zhang Tingyang , Tian Chenglin , Lou Xin
Published: September 2022

Background and purpose

Individuals with intracranial artery occlusion have high rates of ischaemic events and recurrence. It has been challenging to identify patients who had high-risk stroke using a simple, valid and non-invasive screening approach. This study aimed to investigate whether fluid-attenuated inversion recovery (FLAIR) vascular hyperintensity (FVH), a specific imaging sign on the FLAIR sequence, could be a predictor of ischaemic events in a population with internal carotid artery (ICA) or middle cerebral artery (MCA) occlusion.

Methods

We retrospectively analysed 147 patients (mean 60.43±12.83 years) with 149 lesions, including 37 asymptomatic and 112 symptomatic cases of ICA or MCA occlusion. Symptomatic occlusion was considered if ischaemic events were present in the relevant territory within 90 days. FVH Alberta Stroke Program Early Computed Tomography Score (FVH-ASPECTS: 0–7, with 0 indicating absence of FVH and 7 suggesting prominent FVH) and collateral circulation grade were assessed for each participant. Multivariable logistic regression analysis was performed to detect independent markers associated with symptomatic status.

Results

A lower FVH-ASPECTS was associated with a more favourable collateral circulation grade (rho=−0.464, p<0.0001). The FVH-ASPECTS was significantly lower in the asymptomatic occlusion group than in the symptomatic occlusion group (p<0.0001). FVH-ASPECTS (Odd ratio, 2.973; 95% confidence interval, 1.849 to 4.781; p<0.0001) was independently associated with symptomatic status after adjustment for age, sex, lesion location and collateral circulation grade in the multivariate logistic regression. The area under the curve was 0.861 for the use of FVH-ASPECTS to identify symptomatic occlusion.

Conclusions

The ability to discriminate symptomatic from asymptomatic occlusion suggests that FVH may be a predictor of stroke. As a simple imaging sign, FVH may serve as a surrogate for haemodynamic impairments and can be used to identify high-risk stroke cases early in ICA or MCA occlusion.