bluuebunny/crossref_metadata_2025 huggingface dataset:
Anesthesia management of neonates and infants requiring intraoperative neurophysiological monitoring: A concise review
Authors: Nakahari Hirofumi , Wilton Niall C. T. , Kojima Taiki
Published: April 2023

Intraoperative neurophysiological monitoring is currently used to prevent intraoperative spinal cord and nerve injuries during neonatal and infant surgeries. However, its use is associated with some issues in these young children. The developing nervous system of infants and neonates requires higher stimulation voltage than adults to ensure adequate signals, thereby necessitating reduced anesthesia dose to avoid suppressing motor and somatosensory‐evoked potentials. Excessive dose reduction, however, increases the risk of unexpected body movement when used without neuromuscular blocking drugs. Most recent guidelines for older children and adults recommend total intravenous anesthesia with propofol and remifentanil. However, the measurement of anesthetic depth is less well understood in infants and neonates. Size factors and physiological maturation cause pharmacokinetics differences compared with adults. These issues make neurophysiological monitoring in this young population a challenge for anesthesiologists. Furthermore, monitoring errors such as false‐negative results immediately affect the prognosis of motor and bladder‐rectal functions in patients. Therefore, anesthesiologists need to be familiar with the effects of anesthetics and age‐specific neurophysiological monitoring challenges. This review provides an update regarding available anesthetic options and their target concentration in neonates and infants requiring intraoperative neurophysiological monitoring.
Posterior femoral cutaneous nerve impingement post marathon: A case report
Authors: Sheplay Kirk A. , Sheplay Anthony W.
Published: April 2023

Introduction

Posterior femoral cutaneous nerve (PFCN) neuropathy is an uncommon, potentially under‐recognized cause of low back, buttock, perineal, and posterior and lateral thigh pain and numbness. Most PFCN injuries are caused by intramuscular injections; however, this is the first reported case of a PFCN injury of hamstring pathology due to tendonitis caused by long‐distance running.

Case Report

A middle‐aged man presented with right lower buttock pain, which started 2 weeks after running a marathon. The pain was located medial and superior to the ischia tuberosity and extended distally to the right scrotum with no testicular pain. The pain progressed such that he was unable to sit down for over a year. An initial MRI showed right hamstring tendonitis. Consults with sports medicine and hip orthopedics provided no clear diagnosis. He failed to improve with NSAIDs, physical therapy, massage, PRP injection, two Ganglion of Impar Nerve blocks, and trial of Pregabalin. The diagnosis was confirmed with temporary relief following a PFCN block. He was then advised to have the nerve resected because of the failure of nonsurgical treatment.

Discussion

After excluding the more common etiologies of buttock pain and sitting intolerance, practitioners should consider the rarer condition of the impingement of the PFCN in runners.
The executive lawmaking agenda: Political parties, prime ministers, and policy change in Australia
Authors: Gibbons Andrew , Evans Rhonda
Published: April 2023

In Westminster systems, governments enjoy a privileged position in the lawmaking process that they can use to deliver on their campaign promises and achieve their policy goals. What policy areas do governments seek to affect through lawmaking? How stable is the executive lawmaking agenda? How responsive is that agenda to changes triggered by elections or by transitions in prime minister? This study uses a dataset of 3982 Australian bills introduced between 2000 and 2017 to answer these questions. While it finds considerable stability in the policy content of executive lawmaking agendas, the analysis also indicates that Australia's executive lawmaking agenda is more responsive to changes in prime minister than to changes in the party in power. As the first application of the comparative policy agendas approaches to government bills in Australia, this article offers new insights into executive lawmaking priorities during an especially turbulent period in Australian politics.
Argumentative Representation and Democracy: A Critique of Alexy's Defense of Judicial Review of Legislation
Authors: Buriticá‐Arango Esteban , Gaviria‐Mira Julián
Published: April 2023

Robert Alexy has argued that the democratic objection to judicial review of legislation can be successfully addressed by assuming that judges exercise a special form of argumentative representation. In this article we argue that Alexy does not explain (as he should) under what circumstances judicial review tends to produce better decisions than parliamentary procedure, nor does he explain how judicial review can have a greater intrinsic value than parliamentary procedure. Subsequently, we argue that the intrinsic value of argumentative representation depends on the promotion of citizen deliberation, whereas its instrumental value depends on judges being committed to the rights of discrete and insular minorities in the face of hostile majorities.
Externalities in the wildland–urban interface: Private decisions, collective action, and results from wildfire simulation models for California
Authors: Kunreuther Howard , Demidov Artem , Pauly Mark , Turcic Matija , Wilson Michael
Published: April 2023

Property damage from wildfires occurs from spread into built‐up areas, the wildland–urban interface. Fire spread occurs as embers from one burning structure ignite neighboring ones—but mitigation reduces the chances that fire spreads. In this study, we use a simulation model with realistic parameters for a neighborhood in California to illustrate patterns of marginal benefit from mitigation. We extend existing models of fire spread in two novel ways. We show how to describe the no‐regulation equilibrium and social optimal levels of mitigation by incorporating data on a key factor, the distribution of house values in the community. We incorporate insurance in the model and show that it improves homeowner decision‐making and insurance premium regulation. The fire spread simulations show that under plausible parameter values, there is a pattern in which mitigation's marginal benefit is low at low levels of community mitigation, rises to a maximum, and then falls quickly to a low level. We argue that the maximum marginal benefit is a guide to achieving optimal mitigation in a community. Owner mitigation decisions will depend on the distribution of house values in the neighborhood and other factors. In an illustration, we use the distribution of house values in a California community to illustrate the mitigation owners will choose under independent (Nash) investment decisions, and the efficiency‐improving actions involving regulations or insurance premium subsidies that can lead to the social optimum.
Is fear of hypoglycemia a major barrier to an active lifestyle in children and adolescents with type 1 diabetes? The Diactive‐1 Study
Authors: Huerta‐Uribe Nidia , Chueca‐Guindulain María J. , Berrade‐Zubiri Sara , Burillo‐Sánchez Elisabet , Izquierdo Mikel , García‐Hermoso Antonio
Published: April 2023

Studies on fear of hypoglycemia as a barrier to physical activity among youth with type 1 diabetes (T1D) have been limited and controversial, most of which used self‐reported assessment. The aim of the study was to evaluate the relationship between fear of hypoglycemia and physical activity and glycemic metrics in children and adolescents with T1D. Seventy‐four participants (6–18 years of age; 44.6% females) with T1D were included in the study. Physical activity was assessed through accelerometry on nine consecutive days, and blood glucose metrics were simultaneously tracked using continuous glucose monitoring (time‐in‐range and hypoglycemic events). A closed question was used to evaluate the avoidance of physical activity due to fear of hypoglycemia. Fifteen participants (20%) reported avoiding physical activity due to fear of hypoglycemia. The group reporting no fear of hypoglycemia showed lower total physical activity (−35.33 min/day, 95% confidence interval [CI] (−77.57 to −1.47)) and light physical activity (−29.81 min/day, 95% CI −64.01 to −2.75) and higher sedentary time (77.95 min/day, 95% CI 26.46–136.87) per day compared with those with fear of hypoglycemia. No difference was found between those patients with fear of hypoglycemia in terms of meeting the recommendations of glycated hemoglobin, glucose coefficient of variation, and time‐in‐range when compared to those with no fear of hypoglycemia. In conclusion, children and adolescents with fear of hypoglycemia were more active, less sedentary, and had similar glycemic metrics to those without fear. Our results therefore suggest that fear of hypoglycemia may be less of a barrier to an active lifestyle than previously believed.
Does economic state matter for leverage adjustments? An India–China comparison
Authors: Bajaj Yukti , Kashiramka Smita , Singh Shveta
Published: April 2023

We examine the impact of the economic state on capital structure dynamics of Indian and Chinese listed firms using a 10‐year sample period. The empirical analysis is based on the standard partial adjustment mechanism. The economic state (in the base model) is categorised into a good and bad state based on the gross domestic product growth rate. Using system generalised method of moments estimation, our findings suggest that the capital structure speed of adjustment is pro‐cyclical for Indian firms, i.e., they exhibit faster adjustments during a good state of the economy than the bad state. In contrast, the speed is countercyclical in the context of Chinese firms, i.e., they exhibit slower adjustments during a good state of the economy and vice versa. Furthermore, consistent with the existing literature, Indian firms do faster rebalancing than the Chinese ones. Our findings are robust across alternate measures of leverage as well as the economic state.
Efficacy and rates of diquat for reducing invasive knotweeds and potential for sequential use with imazapyr
Authors: Kuehne Lauren , Heimer David
Published: April 2023

Invasive knotweeds (Reynoutria spp.) pose an ongoing challenge for weed management programs worldwide, requiring years of persistent treatment. In this study, we tested efficacy of diquat applied as foliar spray early in the growing season for short‐term suppression, and for potential to boost long‐term control when applied sequentially with a mid‐season treatment of imazapyr. We evaluated responses of knotweeds (R. japonica, R. × bohemica, and R. sachelinensis) treated with one of three diquat concentrations (0.25%, 0.50%, or 1.0%, v/v), using multiple metrics to capture changes in aboveground plant density and abundance. Canopy cover and biomass were significantly reduced by all diquat concentrations and resembled pre‐treatment conditions at 8WAT, reflecting the shift toward reduced stem heights in treated compared with untreated plots. Stem counts at 8WAT, however, did not differ in response to diquat treatments. Sequentially applied early‐season diquat and mid‐season imazapyr treatments reduced canopy cover (66%–82%), biomass (65%–91%), and stem density (57%–79%) when evaluated 1 year after treatment; reductions were greatest in plots treated with medium and high diquat concentrations, suggesting that diquat treatments may have an additive effect. Overall, our study establishes rates of diquat to reduce biomass of invasive knotweed, and supports additional testing to assess improvement in long‐term control when used sequentially with a systemic herbicide.
Weed control in a pesticide‐free farming system with mineral fertilisers
Authors: Saile Marcus , Spaeth Michael , Schwarz Jürgen , Bahrs Enno , Claß‐Mahler Ingrid , Gerhards Roland
Published: April 2023

Negative impacts of pesticides on the environment and human health, the risk of pesticide residues in the food chain, and the problems with herbicide‐resistant weed biotypes support the need for alternative cropping systems. The objective of this study was to investigate weed populations, weed management and crop yield in a pesticide‐free cropping system with the use of mineral fertilisers. Conventional‐, organic‐ and mineral‐ecological cropping systems (MECS) with 6‐year crop rotations including winter wheat, maize, winter triticale or winter rye, soyabean or spring pea, and spring barley were established in a randomised complete strip plot design with four repetitions. Experiments were conducted at four locations in Germany. Preventive and sensor‐guided mechanical weed management strategies were applied in all crops in the organic system and in MECS. Herbicide were applied in the conventional farming system. Weed densities, weed species composition, weed control efficacy (WCE) and crop yield were analysed over 2 years in 2020 and 2021. Conventional farming had the highest WCE and 1–7 weeds m−2 (2.7% weed coverage) after herbicide application. In the organic cropping system and MECS, up to 27 weeds m−2 were counted after camera‐guided weed hoeing. Weed coverage in MECS (9.7%) was higher than in the organic cropping system with 7.7%. Crop yield in MECS was equal to the conventional farming system and 20% higher yield than in the organic farming system. MECS represents a promising new and productive cropping practice if an effective integrated weed management strategy is applied.
Barriers and facilitators to the adoption and use of assistive technology for adults with an intellectual disability who live in supported accommodation: a mixed methods systematic review protocol
Authors: Morris Benjamin , Warren Alison , Bradwell Hannah , Noonan Miriam
Published: April 2023

Objective:

This review will identify the barriers and facilitators of assistive technology adoption and use in adults with intellectual disabilities living in supported accommodation. This will inform the development of an assistive technology adoption framework for these settings.

Introduction:

Assistive technology has the potential to increase the independence and well-being of people with intellectual disabilities; however, it is often not adopted. Generic models of technology adoption exist, and a recent systematic review has explored factors influencing access to assistive technology by people with intellectual disabilities. However, no review has presented a framework of adoption or use of technology specifically for people with intellectual disabilities living in supported accommodation.

Inclusion criteria:

This review will include qualitative, quantitative, and mixed method studies as well as gray literature published from 1989 to 2023 on the barriers and facilitators of technology adoption and use by adults with intellectual disabilities living in supported accommodation. Systematic reviews and theses will be excluded.

Methods:

The review will be conducted in accordance with the JBI methodology for mixed methods systematic reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Databases to be searched will include PubMed, Scopus, Web of Science Core Collection, CINAHL, IEEE Xplore, and SocINDEX. Two independent reviewers will screen titles and abstracts for relevance and quality. Data will be extracted by 1 reviewer and validated by a second independently. Data analysis will use a convergent integrated approach, with quantitative data “qualitized” using thematic analysis to allow comparison. All data will be mapped onto an existing framework of technological adoption via framework synthesis.

Systematic review registration number:

353732
DETERMINATION OF INDICATORS OF THE DETERIORATION OF THE EPIDEMIOLOGICAL AND EPIZOOTOLOGICAL SITUATIONS
Authors: Sikhayeva N.S. , Zakarya K.D. , Adilova A.A. , Zhubanova G.S. , Zharmuhambetova D.T. , Abeldinova A.S. , Abdybekova A.M. , Rsaliev A.S.
Published: April 2023

Major outbreaks of infectious diseases have demonstrated the need for new approaches to biosecurity, which include efficient planning and implementation of infection prevention and control measures. This work is not possible without the early determination of relevant indicators.
The purpose of the work is the analysis of indicators in determining the deterioration of the epidemiological and epizootological situation.
Results. The methodological approaches to the collection of information, the definition of indicators and their evaluation were analyzed. The analysis of the role of indicators in assessing the epidemiological and epizootological situation in terms of diseases was carried out. The main indicators of the deterioration of the epidemiological and epizootological situation for such diseases as coronavirus infection, anthrax, brucellosis, and plague have been identified.
Conclusion. The following three general indicators assessing the deterioration of the epidemiological situation were identified: an increase in the incidence, a decrease in the coverage of preventive vaccinations, and the ignition of dormant foci of diseases. To assess the epizootic situation, additional indicators were identified, such as an increase in the incidence in animal population and changes in natural, climatic and soil conditions. Indicators of deterioration of the epidemiological situation may vary depending on the specific disease and its mode of transmission.
THE INFLUENCE OF PHYSICAL FACTORS ON THE GROWTH OF BACTERIA-ANTAGONIST BACILLUS SUBTILIS BIM B-760 D
Authors: Kuptsov V.N. , Shmyga E.Y. , Kolomiets E.I. , Nagorny R.K. , Plavsky V.U.
Published: April 2023

The influence of electric current and electromagnetic radiation on the growth and antimicrobial activity of bacteria B. subtilis BIM B-760 D - the basis of the biopesticide "Bactaven C" was studied. It was determined that the use of inoculum treated with an alternating current of 16 mA and frequency 17 Hz has enabled to obtain a 2-day culture of B. subtilis BIM B-760 D with a titer of CFU and spores 2.4 – 2.7 times higher compared to the variant without electrical stimulation. Exposure of the seed material for 30 minutes in the electromagnetic field of a Tesla transformer (frequency 490 kHz) with a multi–needle electrode promoted 1.9 – 2.0 times increase in the titer of spores, CFU and 12 % higher antifungal activity by 48 h of culture.
The Path to Translating Focus of Attention Research into Canadian Physiotherapy, Part 2: Physiotherapist Interviews Reveal Impacting Factors and Barriers to Focus of Attention Use
Authors: Hussien Julia , Gignac Lauren , Shearer Lauren , Ste-Marie Diane M.
Published: April 2023

Although researchers have highlighted the benefits of adopting an external focus of attention for rehabilitation, studies have consistently revealed low external focus use by physiotherapists. Consequently, the purpose of this research was to explore factors influencing physiotherapists’ focus of attention use and to gain insight into the barriers, and potential solutions, related to effective external focus use. Eight physiotherapists, working with musculoskeletal rehabilitation clients, first completed the Therapists’ Perceptions of Motor Learning Principles Questionnaire and then participated in virtual one-on-one interviews. The interviews followed a semistructured interview guide and were analyzed using a total quality framework approach to qualitative content analysis. Data showed that physiotherapists’ focus of attention use was influenced by physiotherapist, client, and task characteristics/experiences, as well as focus of attention statement provision strategies. Furthermore, the main barriers discussed related to educational experiences, reinforcement of internal focus of attention statement use and aspects related to research. Solutions presented to these barriers included the incorporation of focus of attention content into both the Canadian physiotherapy curriculum and continued education. Overall, these results advance our knowledge of factors underlying physiotherapists’ focus of attention use and barriers that must be overcome to successfully translate the focus of attention research into physiotherapy.
The Path to Translating Focus of Attention Research Into Canadian Physiotherapy, Part 3: Designing a Workshop Through Consultation With Physiotherapists and Focus of Attention Researchers
Authors: Hussien Julia , Gignac Lauren , Shearer Lauren , Ste-Marie Diane M.
Published: April 2023

Although researchers have consistently demonstrated the potential benefit of an external focus of attention for rehabilitation, research has shown that this finding has yet to be translated into Canadian physiotherapy. Further, specific barriers to external focus use have been reported by Canadian physiotherapists, and as a solution toward increasing physiotherapists’ use of external focus, these same physiotherapists recommended the development of an educational workshop on focus of attention. Considering this, described herein is the process of developing such a workshop, which involved (a) gathering input from physiotherapists concerning content and format via one-on-one interviews and (b) engaging in discussion about content with focus of attention researchers. Analysis of the interview data featured key content for the workshop, the types of activities to include, and a recommended sequencing for the activities: specifically, sharing didactic information on focus of attention research, then providing instruction and demonstration of external focus use, and finally, finishing with opportunities for generating and delivering external focus statements. This input, along with that of the researchers, led to the development of a two-component focus of attention workshop, which includes an asynchronous component, featuring seven self-directed learning modules and a synchronous component, which consists of a virtual group session.
Mechanical nonreciprocity in a uniform composite material
Authors: Wang Xiang , Li Zhihao , Wang Shuxu , Sano Koki , Sun Zhifang , Shao Zhenhua , Takeishi Asuka , Matsubara Seishiro , Okumura Dai , Sakai Nobuyuki , Sasaki Takayoshi , Aida Takuzo , Ishida Yasuhiro
Published: April 2023

Mechanical nonreciprocity, or the asymmetric transmission of mechanical quantities between two points in space, is crucial for developing systems that can guide, damp, and control mechanical energy. We report a uniform composite hydrogel that displays substantial mechanical nonreciprocity, owing to direction-dependent buckling of embedded nanofillers. This material exhibits an elastic modulus more than 60 times higher when sheared in one direction compared with the opposite direction. Consequently, it can transform symmetric vibrations into asymmetric ones that are applicable for mass transport and energy harvest. Furthermore, it exhibits an asymmetric deformation when subjected to local interactions, which can induce directional motion of various objects, including macroscopic objects and even small living creatures. This material could promote the development of nonreciprocal systems for practical applications such as energy conversion and biological manipulation.
A magnified compact galaxy at redshift 9.51 with strong nebular emission lines
Authors: Williams Hayley , Kelly Patrick L. , Chen Wenlei , Brammer Gabriel , Zitrin Adi , Treu Tommaso , Scarlata Claudia , Koekemoer Anton M. , Oguri Masamune , Lin Yu-Heng , Diego Jose M. , Nonino Mario , Hjorth Jens , Langeroodi Danial , Broadhurst Tom , Rogers Noah , Perez-Fournon Ismael , Foley Ryan J. , Jha Saurabh , Filippenko Alexei V. , Strolger Lou , Pierel Justin , Poidevin Frederick , Yang Lilan
Published: April 2023

Ultraviolet light from early galaxies is thought to have ionized gas in the intergalactic medium. However, there are few observational constraints on this epoch because of the faintness of those galaxies and the redshift of their optical light into the infrared. We report the observation, in JWST imaging, of a distant galaxy that is magnified by gravitational lensing. JWST spectroscopy of the galaxy, at rest-frame optical wavelengths, detects strong nebular emission lines that are attributable to oxygen and hydrogen. The measured redshift is
z
= 9.51 ± 0.01, corresponding to 510 million years after the Big Bang. The galaxy has a radius of

16.2

−
7.2

+
4.6

parsecs, which is substantially more compact than galaxies with equivalent luminosity at
z
~ 6 to 8, leading to a high star formation rate surface density.
Marking time
Authors: Price Michael
Published: April 2023

Radiocarbon timestamps left in ancient tree rings by cosmic ray bombardments can date historical events with unprecedented precision
UK science during rapid change
Authors: Thorp H. Holden
Published: April 2023

When Ottoline Leyser was appointed as the chief executive of UK Research and Innovation (UKRI) in 2020, she acquired a front-row seat for some extraordinary events in United Kingdom and European politics. She took charge of UKRI—which was forged from multiple agencies to unify government-funded research in all fields—after Brexit and during a time of bold moves in the reorganization of science in the UK, continuous turnover in the UK government, and formidable challenges in coordinating with European science. She sat down with me for a candid talk about these matters and a refreshing willingness to explain the issues.
In Miami, a modern clash over a 2000-year-old settlement
Authors: Malakoff David
Published: April 2023

High-rises planned for “extraordinary” Native American site
Transcriptional Mechanisms of Thermal Acclimation in
Prochlorococcus
Authors: Alonso-Sáez Laura , Palacio Antonio S. , Cabello Ana M. , Robaina-Estévez Semidán , González José M. , Garczarek Laurence , López-Urrutia Ángel
Published: April 2023

Prochlorococcus
is a major marine primary producer with a global impact on atmospheric CO
2
fixation. This cyanobacterium is widely distributed across the temperate ocean, but virtually absent at latitudes above 40° for yet unknown reasons.
Complete Genome Sequence of
Desulfomicrobium
sp. Strain ZS1 from Zodletone Spring in Oklahoma, USA
Authors: Mulay Sayali A. , Alexander William G. , Hahn C. Ryan , Klingeman Dawn M. , Elshahed Mostafa S. , Youssef Noha H. , Podar Mircea
Published: April 2023

Desulfomicrobium
sp. strain ZS1 is an obligate anaerobic, sulfate-reducing member of the
Desulfobacterota
from Zodletone Spring, an anoxic sulfide-rich spring in southwestern Oklahoma. Its complete genome was sequenced using a combination of Illumina and Oxford Nanopore platforms and encodes 3,364 proteins and 81 RNAs on a single chromosome.
Prevalence, Associated Factors, and Appropriateness of Empirical Treatment of Trichomoniasis, Bacterial Vaginosis, and Vulvovaginal Candidiasis among Women with Vaginitis
Authors: Huang Sung-Hsi , Hsu Heng-Cheng , Lee Tai-Fen , Fan Hui-Min , Tseng Chi-Wei , Chen I-Hui , Shen Hung , Lee Chia-Yi , Tai Hui-Ting , Hsu Hong-Ming , Hung Chien-Ching
Published: April 2023

Vaginal complaints are widespread among women and are associated with emotional, physical, and economic burdens with challenges in their diagnosis and management. In this survey, we identified that 40% of vaginitis in Taiwan was caused by either trichomoniasis, bacterial vaginosis, vulvovaginal candidiasis, or a combination of these infections.
Endomyocardial biopsy-proven hydroxychloroquine-induced cardiomyopathy in a patient with rheumatoid arthritis
Authors: Malhotra Anureet , Pathak Mihir Abhijit , Dalia Tarun , Vidic Andrija
Published: April 2023

Hydroxychloroquine is a disease-modifying antirheumatic drug used for various rheumatological conditions. Its long-term use is well-known to have toxic effects on cardiac muscle cells. We present a biopsy-proven case of hydroxychloroquine-induced cardiotoxicity with detailed histopathological and imaging findings. The patient was referred to our heart failure clinic for concerns of reduction in left ventricular ejection fraction despite being on guideline-directed medical therapy. She had been diagnosed with rheumatoid arthritis, pulmonary hypertension and then subsequently heart failure with reduced ejection fraction 5 years ago. The evaluation included right heart catheterisation, cardiac MRI and endomyocardial biopsy. Light and electron microscopy showed myocyte hypertrophy and vacuolar change, abnormal mitochondria, myeloid bodies and curvilinear bodies. These findings were specific for hydroxychloroquine-induced cardiomyopathy. This case highlights the importance of clinical monitoring, early suspicion and consideration of drug-induced toxicities as a culprit for heart failure.
Perspectives of healthcare workers on the challenges with obstetric referrals in rural communities in Ghana: a descriptive phenomenology study
Authors: Dzomeku Veronica Millicent , Mensah Adwoa Bemah Boamah , Nakua Emmanuel Kweku , Agbadi Pascal , Okyere Joshua , Kumah Alex , Munukpa Jacob , Ofosu Anthony Adofo , Lockhart Nancy , Lori Jody R
Published: April 2023

Objective

We explored and document healthcare workers’ (HCWs’) perspectives on the challenges encountered during obstetric referrals.

Design

The study adopted a qualitative research approach and a descriptive phenomenology design. HCWs permanently working in 16 rural healthcare facilities in the Sene East and West Districts composed of the target population for this study. Using a purposive sampling technique, participants were recruited and enrolled in in-depth individual interviews (n=25) and focused group discussions (n=12). Data were analysed thematically using QSR NVivo V.12.

Setting

Sixteen rural healthcare facilities in the Sene East and West Districts, Ghana.

Participants

Healthcare workers.

Results

Areas related to patient as well as institutional level issues challenged the referral processes. At the patients’ level, financial constraints, fears associated with referral and patients’ non-compliance with referrals were identified as challenges that delayed the referral process. With regard to institutional challenges, the following emerged: referral transportation challenges, poor attitudes of service providers, low staff strength and healthcare bureaucracies.

Conclusion

We conclude that in order for obstetric referrals in rural Ghana to be effective and timely, there is the need to raise more awareness about the need for patients to comply with referral directives, through health education messages and campaigns. Given our findings on the delays associated with long deliberations, the study recommends the training of more cadre of healthcare providers to facilitate obstetric referral processes. Such an intervention would help to improve the current low staff strength. Also, there is a need to improve ambulatory services in rural communities to counteract the challenges that poor transportation system poses on obstetric referrals.
Unmasking hidden disparities: a comparative observational study examining the impact of different rurality classifications for health research in Aotearoa New Zealand
Authors: Whitehead Jesse , Davie Gabrielle , de Graaf Brandon , Crengle Sue , Lawrenson Ross , Miller Rory , Nixon Garry
Published: April 2023

Objectives

Examine the impact of two generic—urban–rural experimental profile (UREP) and urban accessibility (UA)—and one purposely built—geographic classification for health (GCH)—rurality classification systems on the identification of rural–urban health disparities in Aotearoa New Zealand (NZ).

Design

A comparative observational study.

Setting

NZ; the most recent 5 years of available data on mortality events (2013–2017), hospitalisations and non-admitted hospital patient events (both 2015–2019).

Participants

Numerator data included deaths (n=156 521), hospitalisations (n=13 020 042) and selected non-admitted patient events (n=44 596 471) for the total NZ population during the study period. Annual denominators, by 5-year age group, sex, ethnicity (Māori, non-Māori) and rurality, were estimated from Census 2013 and Census 2018.

Primary and secondary outcome measures

Primary measures were the unadjusted rural incidence rates for 17 health outcome and service utilisation indicators, using each rurality classification. Secondary measures were the age-sex-adjusted rural and urban incidence rate ratios (IRRs) for the same indicators and rurality classifications.

Results

Total population rural rates of all indicators examined were substantially higher using the GCH compared with the UREP, and for all except paediatric hospitalisations when the UA was applied. All-cause rural mortality rates using the GCH, UA and UREP were 82, 67 and 50 per 10 000 person-years, respectively. Rural–urban all-cause mortality IRRs were higher using the GCH (1.21, 95% CI 1.19 to 1.22), compared with the UA (0.92, 95% CI 0.91 to 0.94) and UREP (0.67, 95% CI 0.66 to 0.68). Age-sex-adjusted rural and urban IRRs were also higher using the GCH than the UREP for all outcomes, and higher than the UA for 13 of the 17 outcomes. A similar pattern was observed for Māori with higher rural rates for all outcomes using the GCH compared with the UREP, and 11 of the 17 outcomes using the UA. For Māori, rural–urban all-cause mortality IRRs for Māori were higher using the GCH (1.34, 95% CI 1.29 to 1.38), compared with the UA (1.23, 95% CI 1.19 to 1.27) and UREP (1.15, 95% CI 1.10 to 1.19).

Conclusions

Substantial variation in rural health outcome and service utilisation rates were identified with different classifications. Rural rates using the GCH are substantially higher than the UREP. Generic classifications substantially underestimated rural–urban mortality IRRs for the total and Māori populations.
Leflunomide treatment for patients hospitalised with COVID-19: DEFEAT-COVID randomised controlled trial
Authors: Kralj-Hans Ines , Li Kuo , Wesek Adrian , Lamorgese Alexia , Omar Fatima , Ranasinghe Kapila , McGee Megan , Brack Kieran , Li Shiliang , Aggarwal Ritesh , Bulle Ajay , Kodre Aparna , Sharma Shashank , Fluck David , John Isaac , Sharma Pankaj , Belsey Jonathan D , Li Ling , Seshasai Sreenivasa Rao Kondapally , Li Hong Lin , Marczin Nandor , Chen Zhong
Published: April 2023

Objective

To evaluate the clinical efficacy and safety of leflunomide (L) added to the standard-of-care (SOC) treatment in COVID-19 patients hospitalised with moderate/critical clinical symptoms.

Design

Prospective, open-label, multicentre, stratified, randomised clinical trial.

Setting

Five hospitals in UK and India, from September 2020 to May 2021.

Participants

Adults with PCR confirmed COVID-19 infection with moderate/critical symptoms within 15 days of onset.

Intervention

Leflunomide 100 mg/day (3 days) followed by 10–20 mg/day (7 days) added to standard care.

Primary outcomes

The time to clinical improvement (TTCI) defined as two-point reduction on a clinical status scale or live discharge prior to 28 days; safety profile measured by the incidence of adverse events (AEs) within 28 days.

Results

Eligible patients (n=214; age 56.3±14.9 years; 33% female) were randomised to SOC+L (n=104) and SOC group (n=110), stratified according to their clinical risk profile. TTCI was 7 vs 8 days in SOC+L vs SOC group (HR 1.317; 95% CI 0.980 to 1.768; p=0.070). Incidence of serious AEs was similar between the groups and none was attributed to leflunomide. In sensitivity analyses, excluding 10 patients not fulfilling the inclusion criteria and 3 who withdrew consent before leflunomide treatment, TTCI was 7 vs 8 days (HR 1.416, 95% CI 1.041 to 1.935; p=0.028), indicating a trend in favour of the intervention group. All-cause mortality rate was similar between groups, 9/104 vs 10/110. Duration of oxygen dependence was shorter in the SOC+L group being a median 6 days (IQR 4–8) compared with 7 days (IQR 5–10) in SOC group (p=0.047).

Conclusion

Leflunomide, added to the SOC treatment for COVID-19, was safe and well tolerated but had no major impact on clinical outcomes. It may shorten the time of oxygen dependence by 1 day and thereby improve TTCI/hospital discharge in moderately affected COVID-19 patients.

Trial registration numbers

EudraCT Number: 2020-002952-18,NCT05007678.
Smoking patterns and the intention to quit in German patients with cancer: study protocol for a cross-sectional observational study
Authors: Bokemeyer Frederike , Lebherz Lisa , Schulz Holger , Bokemeyer Carsten , Gali Kathleen , Bleich Christiane
Published: April 2023

Introduction

Patients who continue to smoke cigarettes after a cancer diagnosis can experience poorer treatment tolerance and outcomes than those who quit immediately. Identifying risk factors specific to patients with cancer who smoke, as well as their smoking behaviours (eg, frequency of use, types of tobacco products), dependency level and quit intentions, is necessary to better inform patients and encourage quitting smoking after a cancer diagnosis. This study aims to examine the occurrence of smoking in patients with cancer treated at specialised oncology departments and outpatient clinics based within the metropolitan region of Hamburg, Germany, and presents an analysis of their smoking patterns. This understanding is the first step in developing an adequate smoking cessation intervention and shall contribute to a sustainable improvement in the treatment results, long-term survival and quality of life of patients with cancer.

Methods and analysis

A questionnaire will be administered to patients with cancer (N=865) aged 18 years and above in the catchment area of Hamburg, Germany. Data acquisition includes sociodemographic, medical and psychosocial data as well as information on current smoking patterns. To identify the associations between smoking patterns and sociodemographic characteristics, disease-related variables, and psychological risk factors, descriptive statistics and multiple logistic as well as multinomial regressions will be performed.

Ethics and dissemination

This study was registered at Open Science Framework (https://doi.org/10.17605/OSF.IO/PGBY8). It was approved by the ethics committee of the local psychological Ethic committee at the centre of psychosocial medicine Hamburg, Germany (LPEK) (tracking number: LPEK-0212). The study will be carried out in accordance with the Code of Ethics of the Declaration of Helsinki. The results will be published in peer-reviewed scientific journals.
Factors influencing the choice-of-care pathway and survival in the fetus with hypoplastic left heart syndrome in New Zealand: a population-based cohort study
Authors: Soszyn Natalie , Cloete Elza , Sadler Lynn , de Laat Monique W M , Crengle Sue , Bloomfield Frank , Finucane Kirsten , Gentles Thomas L
Published: April 2023

Objectives

To better understand the relative influence of fetal and maternal factors in determining the choice-of-care pathway (CCP) and outcome in the fetus with hypoplastic left heart syndrome (HLHS).

Design

A retrospective, population-based study of fetuses with HLHS from a national dataset with near-complete case ascertainment from 20 weeks’ gestation. Fetal cardiac and non-cardiac factors were recorded from the patient record and maternal factors from the national maternity dataset. The primary endpoint was a prenatal decision for active treatment after birth (intention-to-treat). Factors associated with a delayed diagnosis (≥24 weeks’ gestation) were also reviewed. Secondary endpoints included proceeding to surgical treatment, and 30-day postoperative mortality in liveborns with an intention-to-treat.

Setting

New Zealand population-wide.

Participants

Fetuses with a prenatal diagnosis of HLHS between 2006 and 2015.

Results

Of 105 fetuses, the CCP was intention-to-treat in 43 (41%), and pregnancy termination or comfort care in 62 (59%). Factors associated with intention-to-treat by multivariable analysis included a delay in diagnosis (OR: 7.8, 95% CI: 3.0 to 20.6, p<0.001) and domicile in the maternal fetal medicine (MFM) region with the most widely dispersed population (OR: 5.3, 95% CI: 1.4 to 20.3, p=0.02). Delay in diagnosis was associated with Māori maternal ethnicity compared with European (OR: 12.9, 95% CI: 3.1 to 54, p<0.001) and greater distance from the MFM centre (OR: 3.1, 95% CI: 1.2 to 8.2, p=0.02). In those with a prenatal intention-to-treat, a decision not to proceed to surgery was associated with maternal ethnicity other than European (p=0.005) and the presence of major non-cardiac anomalies (p=0.01). Thirty-day postoperative mortality occurred in 5/32 (16%) and was more frequent when there were major non-cardiac anomalies (p=0.02).

Conclusions

Factors associated with the prenatal CCP relate to healthcare access. Anatomic characteristics impact treatment decisions after birth and early postoperative mortality. The association of ethnicity with delayed prenatal diagnosis and postnatal decision-making suggests systemic inequity and requires further investigation.
Hand-Arm Bimanual Intensive Therapy Including Lower Extremities (HABIT-ILE) in adults with chronic stroke: protocol of a randomised controlled trial
Authors: Ebner-Karestinos Daniela , Gathy Estelle , Carton de Tournai Astrid , Herman Enimie , Araneda Rodrigo , Dricot Laurence , Macq Benoît , Vandermeeren Yves , Bleyenheuft Yannick
Published: April 2023

Introduction

Stroke causes multiple deficits including motor, sensitive and cognitive impairments, affecting also individual’s social participation and independence in activities of daily living (ADL) impacting their quality of life. It has been widely recommended to use goal-oriented interventions with a high amount of task-specific repetitions. These interventions are generally focused only on the upper or lower extremities separately, despite the impairments are observed at the whole-body level and ADL are both frequently bimanual and may require moving around. This highlights the need for interventions targeting both upper and lower extremities. This protocol presents the first adaptation of Hand-Arm Bimanual Intensive Therapy Including Lower Extremities (HABIT-ILE) for adults with acquired hemiparesis.

Methods and analysis

This randomised controlled trial will include 48 adults with chronic stroke, aged ≥40 years. This study will compare the effect of 50 hours of HABIT-ILE against usual motor activity and regular rehabilitation. HABIT-ILE will be provided in a 2-week, adult’s day-camp setting, promoting functional tasks and structured activities. These tasks will continuously progress by increasing their difficulty. Assessed at baseline, 3 weeks after and at 3 months, the primary outcome will be the adults-assisting-hand-assessment stroke; secondary outcomes include behavioural assessments for hand strength and dexterity, a motor learning robotic medical device for quality of bimanual motor control, walking endurance, questionnaires of ADL, stroke impact on participation and self-determined patient-relevant goals, besides neuroimaging measures.

Ethics and dissemination

This study has full ethical approval from theComité d’éthique Hospitalo-Facultaire/Université catholique de Louvain, Brussels (reference number: 2013/01MAR/069) and the local medical Ethical Committee of the CHU UCL Namur-site Godinne. Recommendations of the ethical board and the Belgian law of 7 May 2004, concerning human experiments will be followed. Participants will sign a written informed consent ahead of participation. Findings will be published in peer-reviewed journals and conference presentations.

Trial registration number

NCT04664673.
Long-term consequences of neonatal encephalopathy in the hypothermia era: protocol for a follow-up cohort study at 9 years of age
Authors: Brossard-Racine Marie , Rampakakis Emmanouille , Tardif Christine Lucas , Gilbert Guillaume , White Angela , Luu Thuy Mai , Gallagher Anne , Pinchefsky Elana , Montreuil Tina , Simard Marie-Noelle , Wintermark Pia
Published: April 2023

Introduction

Therapeutic hypothermia (TH) became the standard of care treatment for neonates with moderate and severe neonatal encephalopathy (NE) in most industrialized countries about 10 years ago. Although TH is effective in reducing mortality and the incidence of severe developmental disabilities, the recent literature converges in reporting frequent cognitive and behavioural difficulties at school entry in children with NE-TH. Although these challenges are deemed minor compared with cerebral palsy and intellectual disability, their impacts on a child’s self-determination and family’s well-being are quite significant. Therefore, the nature and extent of these difficulties need to be comprehensively described so that appropriate care can be offered.

Methods and analysis

The current study will be the largest follow-up study of neonates with NE treated with TH to characterize their developmental outcomes and associated brain structural profiles at 9 years of age. Specifically, we will compare executive function, attention, social cognition, behaviour, anxiety, self-esteem, peer problems, brain volume, cortical features, white matter microstructure and myelination between children with NE-TH and matched peers without NE. Associations of perinatal risk factors and structural brain integrity with cognitive, behavioural and psycho-emotional deficits will be evaluated to inform about the potential aggravating and protective factors associated with function.

Ethics and dissemination

This study is supported by the Canadian Institute of Health Research (202203PJT-480065-CHI-CFAC-168509), and received approval from the Pediatric Ethical Review Board of the McGill University Health Center (MP-37-2023-9320). The study findings will be disseminated in scientific journals and conferences and presented to parental associations and healthcare providers to inform best practices.

Trial registration number

NCT05756296.
Doctors Improving Referrals project: a referrals toolkit for junior doctors
Authors: Thorley Emma V , Doshi Akash , Turner Benedict R H
Published: April 2023

Every day in hospitals around the world, millions of interspecialty referrals are made to obtain advice on the optimal care and management of patients. In the UK, the brunt of this work is undertaken by junior doctors with less clinical experience than the specialist colleagues to which they refer. A survey of 283 junior doctors revealed that colleagues were underconfident when making referrals and struggled to know which specialty to contact, how to reach the specialty and what clinical information to include in the referral. More concerningly, 10% of those surveyed had experienced bullying or belittling behaviours and verbal aggression from colleagues when referring.

The aim of this project was to design and implement a referrals toolkit for junior doctors to improve confidence making referrals and time to interspecialty advice, to improve patient care. Process mapping to understand the constituents of good referrals was combined with a failure modes and effects analysis describing how referrals fail to identify areas for intervention.

A specialty referrals guide with all specialty contact information was created at the trust, demonstrating an increase in junior doctor median confidence from 3/5 (n=20) to 5/5 (n=23) (p<0.001); 65% found it quicker to refer with the guide and 81% found an improved time to discharge. A referrals cheat sheet was also created, containing specialty-specific information to be included when making a referral. This has been downloaded over 23 000 times from around the globe. Of survey respondents (n=43), 74% noted improved confidence in making referrals, 26% noted faster time to specialty advice and 19% found a positive impact on patient discharges. Overall, the referrals toolkit has been beneficial for both junior doctors and the patients for which they care and has been accessed by over 50% of new foundation doctors in 2021 and 2022.