bluuebunny/crossref_metadata_2025 huggingface dataset:
Worldviews and Conflict Analysis
Authors: Sheikh Mona Kanwal
Published: August 2022

This article lays out an argument for relocating worldview analysis from the margins of conflict analysis to its center. While we may understand worldviews as an integral part of most escalated conflicts—which may seem to be about something else as well (e.g., energy, borders, economic grievances)—worldviews conflict can also be described as a particular form of conflict. This duality is important to recognize for the further development of the field of conflict analysis. The article also lays out the relevance of worldview analysis to conflict analysis, and how it can enhance our understanding of escalatory conflict dynamics.
Macroscopic diagnostic clue for parkinsonism
Authors: Yoshida Mari , Akagi Akio , Miyahara Hiroaki , Riku Yuichi , Ando Takashi , Ikeda Toshimasa , Yabata Hiroyuki , Moriyoshi Hideyuki , Koizumi Ryuichi , Iwasaki Yasushi
Published: August 2022

The neuropathological background of parkinsonism includes various neurodegenerative disorders, including Lewy body disease (LBD), multiple system atrophy (MSA), progressive supranuclear palsy (PSP), and corticobasal degeneration (CBD). The pathological diagnostic procedure begins by assessing the macroscopic findings to evaluate the degenerative lesions in brains with the naked eye. Usually, degenerative lesions show variable atrophy and brownish discoloration in accordance with disease‐specific profiles. These macroscopic appearances support neuropathologists in identifying the relevant regions for microscopic examination. The neuropathological diagnosis of parkinsonism is based on regional distribution and fundamental proteinopathies in neurons and glia cells. LBD and MSA are synucleinopathies, and PSP and CBD are tauopathies. Among them, glial‐predominant proteinopathy (MSA, PSP, and CBD) may play a significant role in volume reduction. Therefore, macroscopic inspection provides the appropriate direction for assessment. The disease duration, the severity of lesions, and mixed pathologies make the validation of macroscopic observations more complicated. In this review, we outline the macroscopic diagnostic clues in LBD, MSA, PSP, and CBD that could help with pathological refinement.
Unrecognized role of claudin‐10b in basolateral membrane infoldings of the thick ascending limb
Authors: Quintanova Catarina , Himmerkus Nina , Svendsen Samuel L. , von Schwerdtner Otto , Merkel Cosima , Pinckert Lennart , Mutig Kerim , Breiderhoff Tilman , Müller Dominik , Günzel Dorothee , Bleich Markus
Published: August 2022

Claudin‐10b is an important component of the tight junction in the thick ascending limb (TAL) of Henle's loop and allows paracellular sodium transport. In immunofluorescence stainings, claudin‐10b–positive cells exhibited extensive extra staining of basolateral, column‐like structures. The precise localization and function have so far remained elusive. In isolated cortical TAL segments from C57BL/6J mice, kidney‐specific claudin‐10 knockout mice (cKO), and respective litter mates (WT), we investigated the localization and protein expression and function by fluorescence microscopy and electrophysiological measurements. Ultrastructural analysis of TAL in kidney sections was performed by electron microscopy. Claudin‐10b colocalized with the basolateral Na+‐K+ ATPase and the Cl– channel subunit barttin, but the lack of claudin‐10b did not influence the localization or abundance of these proteins. However, the accessibility of the basolateral infolded extracellular space to ouabain or fluorescein was increased by basolateral Ca2+ removal and in the absence of claudin‐10b. Ultrastructural analysis by electron microscopy revealed a widening of basolateral membrane infoldings in cKO in comparison to WT. We hypothesize that claudin‐10b shapes neighboring membrane invaginations by trans interaction to stabilize and facilitate high‐flux salt transport in a water‐tight epithelium.
Exploration of incompatible crosses in plants for novel and useful variations
Authors: Kurella B.R.S. Visarada , Jacob Jinu , Meena Kanti , Cheruku Deepika , Mulpuri Sujatha
Published: August 2022

Crop improvement through pre‐breeding utilizes elite lines, germplasm and species of compatible gene pools, but crossing and characterizing the derivatives between incompatible species, especially distant genera or species, is realized to introduce de novo variations that are heritable, stable and especially economically contributing. This is a novel approach to introduce large‐scale de novo variations in crops that can be applied to widening of the genetic base. It helps to introduce heritable and agronomical variations that can be evolved in a short time for use in trait specific breeding programmes. In crosses between incompatible species many times F1 are delusive appearing like maternal parent. But large variations in F2 are observed due to genetic changes that include partial or complete elimination of the genome from the paternal parent, reshuffling of the maternal genome leading to several changes that are translated to phenotype. Genome, transcriptome and epigenetic reprogramming is responsible for the above genetic changes. Crossing two distant species can be used as an additional tool in plant breeding.
Evaluation of Detector Position and Light Fluence Distribution Using an Infrared Navigation System during Pleural Photodynamic Therapy†
Authors: Sun Hongjing , Kim Michele M. , Ong Yi Hong , Dimoft Andreea , Singhal Sunil , Busch Theresa M. , Cengel Keith A. , Zhu Timothy C.
Published: August 2022

Photodynamic therapy (PDT) has been used to treat malignant pleural mesothelioma. Current practice involves delivering light to a prescribed light fluence with a point source, monitored by eight isotropic detectors inside the pleural cavity. An infrared (IR) navigation system was used to track the location of the point source throughout the treatment. The recorded data were used to reconstruct the pleural cavity and calculate the light fluence to the whole cavity. An automatic algorithm was developed recently to calculate the detector positions based on recorded data within an hour. This algorithm was applied to patient case studies and the calculated results were compared to the measured positions, with an average difference of 2.5 cm. Calculated light fluence at calculated positions were compared to measured values. The differences between the calculated and measured light fluence were within 14% for all cases, with a fixed scattering constant and a dual correction method. Fluence‐surface histogram (FSH) was calculated for photofrin‐mediated PDT to be able to cover 80% of pleural surface area to 50 J cm−2(83.3% of 60 J cm−2). The study demonstrates that it will be possible to eliminate the manual measurement of the detector positions, reducing the patient's time under anesthesia.
Care coordination for healthcare referrals under a shared‐savings program
Authors: Bravo Fernanda , Levi Retsef , Perakis Georgia , Romero Gonzalo
Published: August 2022

Accountable care organizations (ACOs) are responsible for the quality and cost of care of specified patient populations, including the cost of referrals. Motivated by this environment, we study care coordination for healthcare referrals. We consider an ACO that refers an uncertain number of patients from its attributed population to a preferred external provider for specialized health services. ACOs are typically paid under the Medicare Shared Savings Program (MSSP). Under the MSSP, the payer sets a spending benchmark for the beneficiary population during a fixed time period and shares any gains (losses) relative to it with the ACO. During the billing period, all services delivered to the attributed population by the ACO and external providers continue to be reimbursed under fee‐for‐service. Gains (losses) are determined at the end of the period by comparing the actual spending, which includes all care expenses (regular visits, referrals, and failed treatments) incurred by the payer in the period to the predefined benchmark. In this environment, the ACO and external providers—the latter not compensated under the MSSP—lack incentives to invest enough in care coordination initiatives. We study financial incentive mechanisms between the ACO and its preferred external provider to achieve integrated care coordination in referral markets under the MSSP. We show that traditional fee‐for‐service and capitation agreements do not provide sufficient incentives for care coordination in referral markets. However, a risk‐ and cost‐sharing mechanism can induce integrated care coordination efforts while satisfying the ACO and provider's participation constraints. We characterize a family of such mechanisms and numerically study the variability of the ACO and the external provider's profit. We demonstrate that this type of agreement can be used not only to induce integrated care coordination but can also result in a Pareto improvement in profit variability. We also illustrate the impact of the different MSSP risk tracks parameters on the performance of this care coordination mechanism, including their effect on the quality of care and the payer's mean spending.
Mitigating the financial risk behind emission cap compliance: A case in maritime transportation
Authors: Sun Qinghe , Chen Li , Chou Mabel C. , Meng Qiang
Published: August 2022

The enforcement of ever‐stringent regulatory requirements capping emission limits is challenging the traditional operations of various transportation sectors. In maritime transportation, the recent regulation tightening fuel sulfur limits to 0.50%, known as the “IMO 2020,” has been enforced. There is a flurry of activities by ocean carriers to equip their vessels to comply with this regulation. Although the technical conditions are clear, investment decisions are hard to make due to inevitable uncertainties in the current transition period, especially on the impact of fuel prices in the long run. In this study, we consider an ocean carrier's technology investment decisions. Each compliance solution is subject to uncertain operating costs with a partially characterized probability distribution that may deviate from current expected norms. The carrier chooses a portfolio of compliance solutions for its entire fleet that would best adhere to two decision criteria characterized by a net present value (NPV) target in investment and a capacity utilization rate target in fleet deployment. To find optimal decisions that will perform well in the uncertain transition period, we introduce a tractable mathematical model, termed the ambiguous robustness optimization model, to minimize the financial riskiness index associated with the risk of expected NPV not meeting a specified target. We further propose a solution scheme through mixed‐integer second‐order cone programming approximation that can be efficiently solved by off‐the‐shelf solvers. We show that this decision support system performs well in numerical experiments constructed using real data on the Asia‐North America West Coast shipping network.
Liberalization for services foreign direct investment and product mix adjustment: Evidence from Chinese exporting firms
Authors: Bai Zhuoran , Meng Shuang , Miao Zhuang , Zhang Yan
Published: August 2022

This article is the first to explore how manufacturing firms adjust their export product mix in response to services liberalization. We focus on the liberalization of services foreign direct investment (FDI) in destination (importing) countries. Our analysis of detailed customs transaction data from China, finds a promotion effect of services FDI liberalization on export diversification of manufactured goods, which is mainly revealed by an increase in export value, variation in the number of product varieties, the dispersion ratio across exported products, and a decrease in the export skewness ratio. However, this diversification‐promotion effect is only found in developing countries, but not present in developed countries. Our study suggests that services liberalization incurred in importing countries play an important role in promoting export scale and diversification.
Varieties of Tatar Esotericism in Post‐Soviet Russia
Authors: KEFELI AGNÈS
Published: August 2022

After the collapse of the USSR, intellectuals from traditionally Soviet Muslim ethnicities began the complicated process of rethinking their religious identities, political philosophies, and worldviews. Although Western scholars often present this process as an unproblematic “return to Islam,” the newly religious thinkers of the 1990s and 2000s engaged the rich philosophical universe of their time, incorporating, rejecting, and transforming elements of Russian and Western esotericism in their efforts to formulate answers for the contemporary world. This article focuses on the Tatars (the largest ethnic minority in Russia), whose writers sought not only to recover religion but to remake it in a form suitable for their post‐Soviet society.
Identification of the novel HLA‐C*14:02:38 allele in a Chinese individual
Authors: Feng Zhi‐Hui , Jiao Shu‐Xian , Chen Peng , Pang Shutao
Published: August 2022

HLA‐C*14:02:38 differs from HLA‐C*14:02:01:01 by one nucleotide at position 288 in exon 2.
Androgens in postmenopausal women
Authors: Vigneswaran Kugajeevan , Hamoda Haitham
Published: August 2022

Key content

Androgen therapy can improve sexual wellbeing, libido and sexual arousal in postmenopausal women through its effect on the central nervous system.

Testosterone levels gradually decline throughout a woman’s lifespan and testosterone therapy may be useful for menopausal women with sexual dysfunction, in whom estrogen therapy alone has been ineffective.

Learning objectives

To understand the physiology and the potential impact of changes in testosterone levels in postmenopausal women.

To be aware of the potential role of androgen therapy in postmenopausal women with low sexual desire causing distress.

To review the available evidence behind the use of androgen therapy for female sexual dysfunction in the menopause.

Ethical issues

More women are spending a greater proportion of their lives in the postmenopausal period, so it is important to gain a greater understanding of the role of testosterone replacement after the menopause in improving sexual dysfunction.

Off‐label use of testosterone gels and creams is common; when prescribing these, clinicians must inform women of the potential benefits and risks as well as the fact that long‐term safety data is still lacking.
The OsWRKY63–OsWRKY76–OsDREB1B module regulates chilling tolerance in rice
Authors: Zhang Mingxing , Zhao Ranran , Huang Kai , Huang Shuangzhan , Wang Haitao , Wei Zhiqi , Li Zhao , Bian Mingdi , Jiang Wenzhu , Wu Tao , Du Xinglin
Published: August 2022

Rice (Oryza sativa) is sensitive to low temperatures, which affects the yield and quality of rice. Therefore, uncovering the molecular mechanisms behind chilling tolerance is a critical task for improving cold tolerance in rice cultivars. Here, we report that OsWRKY63, a WRKY transcription factor with an unknown function, negatively regulates chilling tolerance in rice. OsWRKY63‐overexpressing rice lines are more sensitive to cold stress. Conversely, OsWRKY63‐knockout mutants generated using a CRISPR/Cas9 genome editing approach exhibited increased chilling tolerance. OsWRKY63 was expressed in all rice tissues, and OsWRKY63 expression was induced under cold stress, dehydration stress, high salinity stress, and ABA treatment. OsWRKY63 localized in the nucleus plays a role as a transcription repressor and downregulates many cold stress‐related genes and reactive oxygen species scavenging‐related genes. Molecular, biochemical, and genetic assays showed that OsWRKY76 is a direct target gene of OsWRKY63 and that its expression is suppressed by OsWRKY63. OsWRKY76‐knockout lines had dramatically decreased cold tolerance, and the cold‐induced expression of five OsDREB1 genes was repressed. OsWRKY76 interacted with OsbHLH148, transactivating the expression of OsDREB1B to enhance chilling tolerance in rice. Thus, our study suggests that OsWRKY63 negatively regulates chilling tolerance through the OsWRKY63–OsWRKY76–OsDREB1B transcriptional regulatory cascade in rice.
Health care providers’ experiences caring for women living with obesity during pregnancy, birth, and postpartum: a qualitative systematic review protocol
Authors: Smith Helen , Macdonald Danielle , Ross-White Amanda , Grant Shannan , Snelgrove-Clarke Erna
Published: August 2022

Objective:

This review will examine qualitative evidence about the experiences of health care providers who provide care to women living with obesity during the perinatal period to support evidence-informed approaches to care.

Introduction:

As the number of women living with obesity increases, health care providers are interacting more with this population during pregnancy, birth, and postpartum. Qualitative studies about this topic show that health care providers often face challenges that prevent the provision of quality care. A qualitative systematic review of the experiences of health care providers caring for women living with obesity throughout the perinatal period is important to identify and address current gaps in the delivery of perinatal health care services.

Inclusion criteria:

All studies with settings where licensed health care providers care for women living with obesity during pregnancy, birth, and postpartum will be considered. Studies published in English from 1995 onward will be included. The review will consider both mixed methods and qualitative studies such as phenomenology, grounded theory, and participatory action research.

Methods:

The following databases will be searched: CINAHL, Embase, PsycINFO, MEDLINE, and Sociological Abstracts (ProQuest). The ProQuest Digital Dissertations database will be searched for unpublished studies. Two independent reviewers will assess each study. Conflicts will be resolved through discussion. Data will be extracted by 2 trained independent reviewers. JBI resources for meta-aggregation will be used and data will be categorized and synthesized accordingly.
A Comprehensive 4E Study on the Performance of Bifacial Solar Module Installed on Different Ground Surface Colors: An Experimental Study on a Specific Site
Authors: Muthu Vimala , Ramadas Geetha
Published: August 2022

Solar energy will be the most sought-after source for generating electricity shortly because of its availability in abundance and pollution-free nature. Bifacial photovoltaic (PV) technology increases the power output through the albedo effect. However, the major drawback of PV-based power is that the efficiency is very low at less than 25%. The study focuses on the impact of surface color to explore the possibilities of enhancing the efficiency of solar modules considering the different terrace surfaces available in the residential region. The proposed work is one such attempt where the study is mainly focused on the impact of the surface properties on the extraction of electricity from the solar module without adopting the active techniques. A detailed study on different colors like black, green, and white is carried out. The study observed that the white surface improves the albedo effect toward the rear surface of the module, thereby improving the energy production factor (EPF) and higher life cycle conversion efficiency (LCE). It is observed that there is a 4.8% increase in the average efficiency when using white as ground cover as compared to normal reference ground. The comparative study is also carried out for various lifetime periods (T) like 10, 15, and 20 years. Calculated the exergetic cost by considering operating periods like 15, 20, 25, and 30 years with 2%, 5%, and 10% interest rates, and it is observed that after 30 years of operation at a 2% interest rate, energetic cost reached its highest value.
Physical Education Teachers’ Experiences of Nurturing a Community of Practice Online
Authors: Ferreira Heidi J. , Gonçalves Luiza , Parker Melissa
Published: August 2022

Purpose: Drawing on the concept of community of practice, the purpose of this study was to explore Brazilian physical education teachers’ experiences of nurturing a community of practice online during the COVID-19 pandemic. Method: This was an action research project, and the participants were 13 high school physical education teachers (one of them acted as teacher-facilitator), one critical friend, and one meta-critical friend. Data sources included teachers’ online meetings, critical friend conversations, interviews, and the facilitator’s reflexive journal. Results: Inductive analysis resulted in four themes: finding emotional and pedagogical support, building a teachers-only space, creating an online group dynamic, and negotiating to research their own practice. The findings are discussed in relation to the characteristics of community of practices and online continuing professional development. Conclusion: Key aspects for future online collaborative continuing professional development are highlighted: (a) teachers-only; (b) by teachers, for teachers; and (c) combination of tools.
The APP intracellular domain promotes
LRRK2
expression to enable feed-forward neurodegenerative mechanisms in Parkinson’s disease
Authors: Zhang Zhi-Wei , Tu Haitao , Jiang Mei , Vanan Sarivin , Chia Sook Yoong , Jang Se-Eun , Saw Wuan-Ting , Ong Zhi-Wei , Ma Dong-Rui , Zhou Zhi-Dong , Xu Jie , Guo Kai-Hua , Yu Wei-Ping , Ling Shuo-Chien , Margolin Richard A. , Chain Daniel G. , Zeng Li , Tan Eng-King
Published: August 2022

Gain-of-function mutations in the leucine-rich repeat kinase 2 (
LRRK2
) gene are common in familial forms of Parkinson’s disease (PD), which is characterized by progressive neurodegeneration that impairs motor and cognitive function. We previously demonstrated that LRRK2-mediated phosphorylation of β-amyloid precursor protein (APP) triggers the production and nuclear translocation of the APP intracellular domain (AICD). Here, we connected LRRK2 to AICD in a feed-forward cycle that enhanced LRRK2-mediated neurotoxicity. In cooperation with the transcription factor FOXO3a, AICD promoted
LRRK2
expression, thus increasing the abundance of LRRK2 that promotes AICD activation.
APP
deficiency in LRRK2
G2019S
mice suppressed
LRRK2
expression, LRRK2-mediated mitochondrial dysfunction, α-synuclein accumulation, and tyrosine hydroxylase (TH) loss in the brain, phenotypes associated with toxicity and loss of dopaminergic neurons in PD. Conversely, AICD overexpression increased
LRRK2
expression and LRRK2-mediated neurotoxicity in LRRK2
G2019S
mice. In LRRK2
G2019S
mice or cultured dopaminergic neurons from LRRK2
G2019S
patients, treatment with itanapraced reduced
LRRK2
expression and was neuroprotective. Itanapraced showed similar effects in a neurotoxin-induced PD mouse model, suggesting that inhibiting the AICD may also have therapeutic benefits in idiopathic PD. Our findings reveal a therapeutically targetable, feed-forward mechanism through which AICD promotes LRRK2-mediated neurotoxicity in PD.
Frizzled does not get bent out of shape by Wnt
Authors: Angers Stephane
Published: August 2022

Ligands of the Wnt family activate the Frizzled-LRP5/6 receptor complex to initiate intracellular signaling. In this issue of
Science Signaling
, Mahoney
et al.
reveal a Wnt-stimulated positive feedback loop that involves local production of the lipid phosphatidylinositol(4,5)bisphosphate [PI(4,5)P
2
], which promotes Dishevelled recruitment and additional PI(4,5)P
2
production, to facilitate LRP5/6 phosphorylation.
Innate depression
Authors: Ferrarelli Leslie K.
Published: August 2022

Restoring AHI1 in macrophages may improve antiviral immunity in patients with depression.
Contribution of TagA-Like Glycosyltransferases to the Assembly of the Secondary Cell Wall Polysaccharide in Bacillus anthracis
Authors: Tomatsidou Anastasia , Krunic Maria , Missiakas Dominique
Published: August 2022

Glycosyltransferases (GTs) catalyze the transfer of sugar moieties from activated donor molecules to acceptor molecules to form glycosidic bonds using a retaining or inverting mechanism. Based on the structural relatedness of their catalytic and carbohydrate-binding modules, GTs have been grouped into 115 families in the Carbohydrate-Active EnZyme (CAZy) database.
Automatic oxygen control for reducing extremes of oxygen saturation: a randomised controlled trial
Authors: Nair Vrinda , Kannan Loganathan Prakash , Lal Mithilesh Kumar , Pringleton Helen , Bachman Thomas Edward , Brodlie Malcolm , Dixon Paul
Published: August 2022

Objective

The objective of this study was to evaluate the efficacy of the automatic oxygen control (A-Fio2) in reducing the percentage of time spent in severe hypoxaemia (Spo2<80%) in preterm infants for the time period on invasive ventilation and/or nasal continuous positive airway pressure (NCPAP) delivered by AVEA ventilator.

Design

A parallel arm randomised controlled trial.

Setting

A level-III neonatal intensive care unit.

Patients

Preterm infants (<33 weeks birth gestation) who received invasive ventilation or NCPAP in the first 72 hours of age.

Interventions

A-Fio2vs manual (M-Fio2) oxygen control.

Outcomes

The primary outcome of the study was percentage of time spent in severe hypoxaemia (Spo2<80%).

Results

44 infants were randomised to either A-Fio2or M-Fio2arm and continued in the study for the period of respiratory support (invasive ventilation and/or NCPAP). The total number of study days in A-Fio2 and M-Fio2arm were 194 and 204 days, respectively. The percentage of time spent in Spo2<80% was significantly lower with A-Fio2compared with M-Fio2(median of 0.1% (IQR: 0.07–0.7) vs 0.6% (0.2–2); p=0.03). The number of prolonged episodes (>60 s) of Spo2<80% per day was also significantly lower in A-Fio2(0.3 (0.0–2) vs 2 (0.6–6); p=0.02).

Conclusion

A-Fio2was associated with statistically significant reduction in the percentage of time spent in severe hypoxaemia when compared with M-Fio2in preterm infants receiving respiratory support.

Trial registration number

NCT04223258.
Unravelling the role of the mandatory use of face covering masks for the control of SARS-CoV-2 in schools: a quasi-experimental study nested in a population-based cohort in Catalonia (Spain)
Authors: Coma Ermengol , Català Martí , Méndez-Boo Leonardo , Alonso Sergio , Hermosilla Eduardo , Alvarez-Lacalle Enric , Pino David , Medina Manuel , Asso Laia , Gatell Anna , Bassat Quique , Mas Ariadna , Soriano-Arandes Antoni , Fina Avilés Francesc , Prats Clara
Published: August 2022

Objective

To assess the effectiveness of mandatory use of face covering masks (FCMs) in schools during the first term of the 2021–2022 academic year.

Design

A retrospective population-based study.

Setting

Schools in Catalonia (Spain).

Population

599 314 children aged 3–11 years attending preschool (3–5 years, without FCM mandate) and primary education (6–11 years, with FCM mandate).

Study period

From 13 September to 22 December 2021 (before Omicron variant).

Interventions

A quasi-experimental comparison between children in the last grade of preschool (5 years old), as a control group, and children in year 1 of primary education (6 years old), as an interventional group.

Main outcome measures

Incidence of SARS-CoV-2, secondary attack rates (SARs) and effective reproductive number (R*).

Results

SARS-CoV-2 incidence was significantly lower in preschool than in primary education, and an increasing trend with age was observed. Six-year-old children showed higher incidence than 5 year olds (3.54% vs 3.1%; OR 1.15 (95% CI 1.08 to 1.22)) and slightly lower but not statistically significant SAR (4.36% vs 4.59%; incidence risk ratio 0.96 (95% CI 0.82 to 1.11)) and R* (0.9 vs 0.93; OR 0.96 (95% CI 0.87 to 1.09)). Results remained consistent using a regression discontinuity design and linear regression extrapolation approaches.

Conclusions

We found no significant differences in SARS-CoV-2 transmission due to FCM mandates in Catalonian schools. Instead, age was the most important factor in explaining the transmission risk for children attending school.
Cardiac complications from multisystem inflammatory syndrome associated with prior COVID-19 infection
Authors: Patel Krishna , Mehta Rahul , Betz Yaqub M , Man Louise M
Published: August 2022

Multisystem inflammatory syndrome in adults (MIS-A) is a systemic inflammatory condition that presents roughly 4–6 weeks after initial COVID-19 infection. Patients typically present with persistent fevers, widespread rash, abdominal pain, vomiting and diarrhoea, and new-onset neurological symptoms. Cardiac dysfunction is a prominent feature of COVID-19 sequelae due to the abundance of ACE2 receptors on cardiac tissue. Delayed diagnosis due to the novelty of MIS-A can lead to cardiac complications like heart failure and shock, which could result in chronic cardiac disease. Avoidance of complications and chronic illness is possible with prompt corticosteroid therapy. Despite patient recovery to baseline level of function, surveillance of cardiac function to screen for chronic cardiac disease in the follow-up period is recommended. We present a case of MIS-A in a young man, compare his presentation with other similar cases and discuss implications of delayed diagnosis.
Streptococcus gallolyticus-related spinal epidural abscess
Authors: Agrawal Vineet , Viswanathan Stalin , Selvaraj Jayachandran , Pillai Vivekanandan
Published: August 2022

Spinal epidural abscess (SEA) is a surgical emergency if it causes paraplegia.Staphylococcus aureusand streptococci are the most common causes.Streptococcus gallolyticushas been reported to cause SEA only on three occasions earlier—all were associated with endocarditis or colonic malignancy. We report an older woman with diabetic ketoacidosis who presented with poorly localised back pain, fever and altered sensorium. Her lumbar puncture revealed frank pus, and MRI showed an SEA. She could not be weaned from mechanical ventilation post-surgical decompression, and she succumbed to ventilator-associated pneumonia. A triad of fever, back pain and neurological deficit should lead one to consider intraspinal suppuration. This report is the firstS. gallolyticus-related SEA from India and the first in literature that was not associated with either endocarditis or colonic malignancy.
Physical activity and risk of infection, severity and mortality of COVID-19: a systematic review and non-linear dose–response meta-analysis of data from 1 853 610 adults
Authors: Ezzatvar Yasmin , Ramírez-Vélez Robinson , Izquierdo Mikel , Garcia-Hermoso Antonio
Published: August 2022

Objective

To quantify the association between physical activity and risk of SARS-CoV-2 infection, COVID-19-associated hospitalisation, severe illness and death due to COVID-19 in adults.

Design

A systematic review and meta-analysis.

Data sources

Three databases were systematically searched through March 2022.

Eligibility criteria for selecting studies

Peer-reviewed articles reporting the association between regular physical activity and at least one COVID-19 outcome in adults were included. Risk estimates (ORs, relative risk (RR) ratios or HRs) were extracted and pooled using a random-effects inverse-variance model.

Results

Sixteen studies were included (n=1 853 610). Overall, those who engaged in regular physical activity had a lower risk of infection (RR=0.89; 95% CI 0.84 to 0.95; I
2
=0%), hospitalisation (RR=0.64; 95% CI 0.54 to 0.76; I
2
=48.01%), severe COVID-19 illness (RR=0.66; 95% CI 0.58 to 0.77; I
2
=50.93%) and COVID-19-related death (RR=0.57; 95% CI 0.46 to 0.71; I
2
=26.63%) as compared with their inactive peers. The results indicated a non-linear dose–response relationship between physical activity presented in metabolic equivalent of task (MET)-min per week and severe COVID-19 illness and death (p for non-linearity <0.001) with a flattening of the dose–response curve at around 500 MET-min per week.

Conclusions

Regular physical activity seems to be related to a lower likelihood of adverse COVID-19 outcomes. Our findings highlight the protective effects of engaging in sufficient physical activity as a public health strategy, with potential benefits to reduce the risk of severe COVID-19. Given the heterogeneity and risk of publication bias, further studies with standardised methodology and outcome reporting are now needed.

PROSPERO registration number

CRD42022313629.
Bibliometric analysis of sub-Saharan African and US authorship in publications about sub-Saharan Africa funded by the Fogarty International Center, 2008–2020
Authors: Akudinobi Ezinne A , Kilmarx Peter H
Published: August 2022

Background

Authorship and author order have been used as one measure to characterise equity in research partnerships. First and last (senior) authorships often denote scientific merit as well as potential for research career advancement. A previous analysis found that only about 20%–25% of publications about Africa with coauthors from top-ranking US universities had a first or last author from the topic country. In this bibliometric analysis, we evaluated authorship of publications about sub-Saharan Africa (SSA) funded by the Fogarty International Center (FIC) of the US National Institutes of Health, an institution with a mission of training and capacity building in low-income and middle-income countries.

Methods

We analysed publications from PubMed and Web of Science that were funded by FIC, about SSA, and published between 2008 and 2020. Relative citation ratio (RCR) data from iCite were used to compare group citation impact measures using the Wilcoxon rank sum test.

Results

A total of 3446 publications met the inclusion criteria, with annual number increasing from 114 in 2008 to 352 in 2020. SSA-affiliated first authors increased from 53 (47%) in 2008 to 224 (63%) in 2020. SSA-affiliated last authors increased from 32 (28%) to 166 (47%). For both first and last authorships, the median RCR value of publications with SSA-affiliated authors was lower than for US-affiliated authors (first authors: 0.84 vs 0.95, p=0.0021; last authors: 0.88 vs 0.91, p=0.010).

Conclusion

The increase in first and last authorships by SSA-affiliated authors of publications about SSA suggests increasing equity in research activities funded by FIC. Further investigation and actions are needed to establish how authorship reflects other aspects of equity, the implication of the lower RCR in papers with SSA-affiliated first and last authors and what policies and practices are needed to further promote equity in global health research.
Health, financial and environmental impacts of unnecessary vitamin D testing: a triple bottom line assessment adapted for healthcare
Authors: Breth-Petersen Matilde , Bell Katy , Pickles Kristen , McGain Forbes , McAlister Scott , Barratt Alexandra
Published: August 2022

Objective

To undertake an assessment of the health, financial and environmental impacts of a well-recognised example of low-value care; inappropriate vitamin D testing.

Design

Combination of systematic literature search, analysis of routinely collected healthcare data and environmental analysis.

Setting

Australian healthcare system.

Participants

Population of Australia.

Outcome measures

We took a sustainability approach, measuring the health, financial and environmental impacts of a specific healthcare activity. Unnecessary vitamin D testing rates were estimated from best available published literature; by definition, these provide no gain in health outcomes (in contrast to appropriate/necessary tests). Australian population-based test numbers and healthcare costs were obtained from Medicare for vitamin D pathology services. Carbon emissions in kg CO2e were estimated using data from our previous study of the carbon footprint of common pathology tests. We distinguished between tests ordered as the primary test and those ordered as an add-on to other tests, as many may be done in conjunction with other tests. We conducted base case (8% being the primary reason for the blood test) and sensitivity (12% primary test) analyses.

Results

There were a total of 4 457 657 Medicare-funded vitamin D tests in 2020, on average one test for every six Australians, an 11.8% increase from the mean 2018–2019 total. From our literature review, 76.5% of Australia’s vitamin D tests provide no net health benefit, equating to 3 410 108 unnecessary tests in 2020. Total costs of unnecessary tests to Medicare amounted to >$A87 000 000. The 2020 carbon footprint of unnecessary vitamin D tests was 28 576 kg (base case) and 42 012 kg (sensitivity) CO2e, equivalent to driving ~160 000–230 000 km in a standard passenger car.

Conclusions

Unnecessary vitamin D testing contributes to avoidable CO2e emissions and healthcare costs. While the footprint of this example is relatively small, the potential to realise environmental cobenefits by reducing low-value care more broadly is significant.
Nursing, frailty, functional decline and models of care in relation to older people receiving long-term care: a scoping review protocol
Authors: Flyum Ida Røed , Gjevjon Edith Roth , Josse-Eklund Anna , Lærum-Onsager Ellisiv , Borglin Gunilla
Published: August 2022

Introduction

Older people receiving healthcare in long-term care contexts (eg, home healthcare, sheltered housing and nursing home contexts) are especially vulnerable to developing frailty and functional decline. Considering the negative effects associated with these conditions and the possibility of preventing them from progressing, it is vital that nurses possess a broad knowledge base related to them. Particularly as prevention related to these conditions lies well within their remit. Such knowledge could guide the development of effective models of care, ensuring continuity and, hence, quality of care. Our objective will be to review published literature on existing models of care targeting frailty and/or functional decline and how these conditions are described by older people themselves, significant others and nurses in relation to long-term care.

Methods and analysis

The scoping review will be conducted in accordance with Arksey and O’Malley’s methodological framework. Recent methodological developments will be considered. PubMed, CINAHL and PsycINFO will be searched. Eligibility criteria will be peer-reviewed papers and written in English. All types of study designs will be eligible and included papers will be quality and ethically assessed. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-Protocol checklist for protocols and the PRISMA for Scoping Reviews checklist were followed in this paper.

Ethics and dissemination

As the study outlined in this protocol is a scoping review, no ethics approval was needed for this protocol nor for the upcoming study. The findings will be published in an open-access, peer-reviewed journal. Additionally, the findings will guide a research project following the Medical Research Council’s framework for developing and evaluating complex interventions. Thus, supporting us in developing a model of care related to the detection and prevention of frailty and/or functional decline among older people in a long-term care context.
Mixed-methods investigation of barriers and needs in mental healthcare of adults with autism and recommendations for future care (BarrierfreeASD): study protocol
Authors: David Nicole , Dückert Sophia , Gewohn Petia , König Hannah , Rahlff Pascal , Erik Frank , Vogeley Kai , Schöttle Daniel , Konnopka Alexander , Schulz Holger , Peth Judith
Published: August 2022

Introduction

Autism refers to an early-onset neurodevelopmental condition with characteristic impairments and difficulties in practical living skills, which persist across the lifespan such that adults with autism often require substantial support and comprehensive care. Yet, mental health and other services are frequently unavailable for adults with autism despite considerable need for mental healthcare and individual, familial and socioeconomic burdens. This study will (1) examine current needs, barriers and burdens related to ineffective healthcare of adults with autism in Germany, (2) develop specific recommendations for a need-oriented mental healthcare model and (3) evaluate its future implementation.

Methods and analysis

A mixed-methods design with three phases will be conducted. In phase 1, current mental healthcare for adults with autism will be assessed at three levels (individual, structural and professional) and from three perspectives (adults with autism, relatives and healthcare providers) using (1) focus groups/interviews (qualitative data) and (2) large-scale online surveys (quantitative data). Furthermore, service utilisation and related costs will be estimated. In phase 2, recommendations for a future healthcare model will be derived based on phase 1, considering the heterogeneous and complex needs within the autism spectrum and specifying indications for recommended services. In phase 3, these will again be evaluated by the three stakeholder groups using mixed-methods and analysed regarding feasibility of implementation and cost-effectiveness. Our study will, thus, contribute to a better translation of recommendations into practice to reduce disability, burden and costs related to ineffective healthcare and improve mental health outcomes for adults with autism and those who support them.

Ethics and dissemination

This study was approved by the Local Psychological Ethics Commission of the Center for Psychosocial Medicine at the University Medical Center Hamburg-Eppendorf (LPEK-0227). Findings will be disseminated via scientific meetings and peer-reviewed journals. Cooperating partners and associations will be informed about the study’s course and findings by regular newsletters and meetings.

Trial registration number

This study protocol was preregistered at the Open Science Framework (osf.io/5x8pg).
PP18 The BICeP study: results of a before and after study of a text-message intervention designed to increase confidence and willingness to perform CPR
Authors: Farquharson Barbara , Dixon Diane , Clegg Gareth , Williams Brian , Ramsay Pam , Macinnes Lisa
Published: August 2022

Background

Prompt bystander cardiopulmonary resuscitation (CPR) is the single most important factor determining survival from OHCA, increasing the likelihood of survival up to 4-fold. Much is invested in training lay-people to be competent but many don’t attempt CPR when they encounter OHCA reducing potential for emergency services interventions to be successful.

Aim

To develop a behaviour-change text-messaging intervention to increase proportion of lay-people who will initiate CPR in the event of OHCA.

Methods

Working with lay-people and expert advisory group we developed a series of 35 text messages comprising 14 behaviour change techniques designed to increase intentions to perform CPR. We recruited 20 lay people to a before and after pilot study to evaluate the acceptability of the messages and explore participant responses to them. Intention to perform CPR was assessed in relation to 4 varied scenarios before and after the intervention.

Results

Twenty lay-people (6F, 14M; aged 20-84) participated in the study. Seventeen received the complete intervention over 4-6 weeks, two received 20+messages and one a single message before opting out. Fifteen participants provided follow-up data. Intentions to initiate CPR in CPR scenarios were greater after the intervention than before with all but one participant maintaining or increasing their original (high) intentions. Increases in psychological predictors of intention: attitudes (pre:57.5 post:63.0), perceived behavioural control(pre:50.0 post:58.0), self-efficacy (pre:74.5 post:81.0) and self-assessed competence (pre:19.5 post:20.5) were observed following the intervention. Qualitative data suggested the intervention was positively received and viewed as helpful in improving confidence by reinforcing and building on messages from training though additional options for delivery format and pace should be considered.

Conclusions

A behaviour-change text-message intervention delivered after CPR training is acceptable, easily scalable and may help improve rates of lay CPR initiation. Full scale evaluation of effectiveness is planned.
PP19 Advances in community paramedicine in response to COVID-19
Authors: Batt Alan M , Hultink Amber , Lanos Chelsea , Tierney Barbara , Grenier Mathieu , Heffern Julia
Published: August 2022

Background

Already well situated in the community, paramedics work collaboratively with other community partners to ensure patients receive the services that they require and the high quality in-home and in-community care they deserve. The ongoing COVID-19 pandemic has highlighted the prevalence of social inequities in Canada, particularly in already marginalized groups, and the importance of social connectedness and caregiver wellbeing solutions. We sought to explore innovations in community paramedicine programs across Canada in response to COVID-19.

Methods

We conducted a scoping literature review of community paramedicine publications since 2020, with a focus on Canadian context, and undertook semi-structured interviews with key informants to capture innovations that may not be well represented in the literature.

Results

A total of 22 studies, combined with 26 grey literature sources were identified through the literature search. We interviewed ten stakeholders from diverse community care and community paramedicine settings across Canada to further explore each element of the conceptual framework. A conceptual framework (Figure 1) was developed to categorize the literature and findings into themes, namely: leveraging technology (e.g., virtual consultations, remote monitoring); responding to COVID-19 (e.g., mass testing and vaccination); addressing social needs (e.g., home visits, helping patients with groceries); caring for vulnerable populations (e.g., providing palliative care at home). These innovations were united in the idea of collaborating with other health care professionals and agencies, while facilitating care and case management coordination.

Conclusions

The COVID-19 pandemic has highlighted the essential collaborative care role community paramedicine programs can provide to patients in their homes or communities. Community paramedicine programs have evolved to meet the needs of their communities. These programs have demonstrated their ability to support public health measures, provide home and community-based care, and most importantly, collaborate with other health care professionals in coordinating and providing care to Canadians regardless of social circumstances.