bluuebunny/crossref_metadata_2025 huggingface dataset:
Isolation, molecular characterization of indigenous Metarhizium anisopliae (Metchnikoff) isolate, using ITS-5.8s rDNA region, and its efficacy against the Helicoverpa armigera (Hubner) (Lepidoptera: Noctuidae)
Authors: Shanker Ravi , Prajapati Malyaj R. , Singh Reetesh Pratap , Singh Rajendra , Singh Jitender , Kumar Pankaj
Published: March 2023

Background

As a biological control agent, entomopathogenic fungus (EPF) can give an alternative to high-risk pesticides. Metarhizium anisopliae is one of the most promising pest controls EPF in the worldwide.

Result

On fungi-specific selective media, the EPF isolate SVPUAT was isolated from Western Uttar Pradesh, India. The isolate was identified as M. anisopliae (GenBank accession no. OP962431) after molecular screening utilizing PCR amplification with the internal transcribed spacer (ITS) region primer. In a contact toxicity experiment, the isolate SVPUAT was tested against the 4th instar larvae of Helicoverpa armigera (Hubner) at concentrations ranging from 103 to 1010 spores ml−1. The lethal time LT50 and LT90 values for the 4th instar larvae of H. armigera injected with 1 × 1010 spores ml−1 were 3.46 and 5.54 days, respectively.

Conclusions

The present M. anisopliae isolate SVPUAT was identified using the ITS-5.8s rDNA region from GenBank and has showed significant pathogenicity to H. armigera. More research is needed to prove the efficacy against various pests of economic important as a legitimate choice for an integrated pest management program.
Trends and innovations in the formulation of plant-based foods
Authors: Tachie Christabel , Nwachukwu Ifeanyi D. , Aryee Alberta N. A.
Published: March 2023

Globally, the production, distribution, sale and consumption of plant-based foods (PBFs) are on the increase due to heightened consumer awareness, a growing demand for clean label products, widespread efforts to promote and embrace sustainable practices, and ethical concerns over animal-derived counterparts. This has led to the exploration of several strategies by researchers and the food industry to develop alternative milk, cheese, meat, and egg products from various plant-based sources using technologies such as precision fermentation (PF), scaffolding, extrusion, and muscle fibre simulation. This work explores current alternative protein sources and PBFs, production trends, innovations in formulation, nutritional quality, as well as challenges restricting full utilization and other limitations. However, PBFs have several limitations which constrain their acceptance, including the beany flavour of legumes, concerns about genetically modified foods, cost, nutritional inadequacies associated micronutrient deficiencies, absence of safety regulations, and the addition of ingredients that are contrary to their intended health-promoting purpose. The review concludes that investing in the development of PBFs now, has the potential to facilitate a rapid shift to large scale consumption of sustainable and healthy diets in the near future.

Graphical Abstract
Improving diagnosis and treatment of knee osteoarthritis in persons with type 2 diabetes: development of a complex intervention
Authors: King Lauren K. , Ivers Noah M. , Waugh Esther J. , MacKay Crystal , Stanaitis Ian , Krystia Owen , Stretton Jane , Wong Sim , Weisman Alanna , Bardai Zahra , Ross Susan , Brady Shawn , Shloush Marlee , Stier Tara , Gakhal Natasha , Agarwal Payal , Parsons Janet , Lipscombe Lorraine , Hawker Gillian A.
Published: March 2023

Background

Symptomatic knee osteoarthritis (OA) commonly co-occurs in people with type 2 diabetes (T2DM) and increases the risk for diabetes complications, yet uptake of evidence-based treatment is low. We combined theory, stakeholder involvement and existing evidence to develop a multifaceted intervention to improve OA care in persons with T2DM. This was done in partnership with Arthritis Society Canada to leverage the existing infrastructure and provincial funding for community arthritis care.

Methods

Each step was informed by a User Advisory Panel of stakeholder representatives, including persons with lived experience. First, we identified the target groups and behaviours through consulting stakeholders and current literature. Second, we interviewed persons living with T2DM and knee OA (n = 18), health professionals (HPs) who treat people with T2DM (n = 18) and arthritis therapists (ATs,n = 18) to identify the determinants of seeking and engaging in OA care (patients), assessing and treating OA (HPs) and considering T2DM in OA treatment (ATs), using the Theoretical Domains Framework (TDF). We mapped the content to behavioural change techniques (BCTs) to identify the potential intervention components. Third, we conducted stakeholder meetings to ascertain the acceptability and feasibility of intervention components, including content and modes of delivery. Fourth, we selected intervention components informed by prior steps and constructed a programme theory to inform the implementation of the intervention and its evaluation.

Results

We identified the barriers and enablers to target behaviours across a number of TDF domains. All stakeholders identified insufficient access to resources to support OA care in people with T2DM. Core intervention components, incorporating a range of BCTs at the patient, HP and AT level, sought to identify persons with knee OA within T2DM care and refer to Arthritis Society Canada for delivery of evidence-based longitudinal OA management. Diverse stakeholder input throughout development allowed the co-creation of an intervention that appears feasible and acceptable to target users.

Conclusions

We integrated theory, evidence and stakeholder involvement to develop a multifaceted intervention to increase the identification of knee OA in persons with T2DM within diabetes care and improve the uptake and engagement in evidence-based OA management. Our partnership with Arthritis Society Canada supports future spread, scalability and sustainability. We will formally assess the intervention feasibility in a randomized pilot trial.
Underutilized wild edible fungi and their undervalued ecosystem services in Africa
Authors: Sileshi Gudeta W. , Tibuhwa Donatha D. , Mlambo Alec
Published: March 2023

Background

Edible fungi including wild mushrooms have been largely neglected and underutilized in Africa. Not only is the number of edible species unknown, but the critical role they play in human food and nutrition and the ecosystem services they provide have remained poorly understood and undervalued.

Methods

We reviewed the literature with the objective of providing a synthesis of knowledge on (1) the diversity of wild edible fungi of Africa with emphasis on mushrooms; (2) the ecosystem services provided by wild edible fungi; (3) anthropogenic threats to their diversity and utilization; and (4) opportunities for their conservation and cultivation.

Results

We identified a total of 480 species of wild edible mushrooms in 126 genera belonging to 60 fungal families across Africa. A total of, 249 species were mycorrhizal, 28 species were termitophilic and 203 species were saprophytic or parasitic. Wild edible mushrooms provide food that is high in digestible proteins, antioxidants and fibre but low in fats. They are also sources of income for rural populations. Almost all species play a role in nutrient recycling and hence the productivity of forests and agroecosystems. However, deforestation and land degradation are threatening the mushroom diversity in some regions of Africa.

Conclusion

The African continent is endowed with a tremendous diversity of neglected and underutilized edible wild mushrooms providing nutritious food for humans and playing a key role in the structure and functioning of native forests and woodlands. Deforestation and the loss of habitat are the greatest threats to edible wild species in Africa. The loss of indigenous knowledge can also potentially limit dietary choices and market opportunities. Therefore, we recommend national forestry research and development programs and international frameworks such as Reducing Emissions from Deforestation and Degradation (REDD +) to invest in the conservation, cultivation and valorisation of wild edible mushrooms to achieve sustainable forest management and the welfare of local communities.
The potential harms of sedentary behaviour on cardiometabolic health are mitigated in highly active adults: a compositional data analysis
Authors: Franssen Wouter M. A. , Jermei Jarne , Savelberg Hans H. C. M. , Eijnde Bert O.
Published: March 2023

Background

Insufficient physical activity and sedentary behaviour (SB) are important factors that determine cardiometabolic health and the development of non-communicable diseases. The aim of this study was to investigate the modifying effects of moderate-to-vigorous physical activity (MVPA) on the association between SB and cardiometabolic health within highly active adults.

Methods

In a cross-sectional design, 61 (male/female: 41/20) highly trained adults (age: 33.6 ± 10.7 years; BMI: 22.4 ± 2.3 kg/m2) performed a maximal cardiopulmonary exercise test from which indicators for peak performance were determined. Physical activity and SB were assessed using the activPAL3™ accelerometer. In addition, anthropometrics, blood pressure, plasma lipids and insulin sensitivity were assessed. These cross-sectional associations between a daily movement behaviour composition and cardiometabolic health parameters were investigated using a compositional data analysis approach.

Results

Participants spent 600 ± 86 min/day in SB and engaged in almost 1.5 h per day of MVPA. No association was found between SB and cardiometabolic health related variables, whereas MVPA (β = 8.07 ± 2.18; r2 = 0.544; p < 0.001) was only significantly associated with oxygen uptake, relative to all other remaining behaviours.

Conclusion

No associations were found between the time spent in SB and cardiometabolic health related outcomes, possibly due to the high amount of time spent in MVPA within highly active adults.

Trial registration: The present study was registered on the 14th of January 2022 at clinicaltrials.gov (NCT04711928).
Understanding the urgent and emergency care navigation work undertaken by people with cancer and their informal caregivers: a conceptually framed scoping review
Authors: Defty John , Wagland Richard , Richardson Alison
Published: March 2023

Background

People with cancer frequently use urgent and emergency care. Reviews of research have focussed on the incidence and predictors of service use in this population, rather than how people make decisions about which service to access. Understanding what factors influence these choices will inform ways in which we might enable people with cancer to effectively access services.

Aims

(1) Describe research undertaken about choices made by people with cancer about routes to access urgent and emergency care; (2) characterise decisions made by patients and informal caregivers to use certain services, with specific reference to work involved in navigating access; and (3) identify research priorities.

Methods

Scoping review of qualitative and mixed methods studies. Electronic database searches (AMED, CINAHL, Embase, MEDLINE, PsycInfo) and ‘berrypicking’ identified 18 papers. Study, participant, and service characteristics were mapped, and Turnbull et al.’s Model of Urgent Care Help-seeking informed a directed qualitative content analysis.

Results

Studies have involved people with advanced cancer to the relative exclusion of people with curable disease, receiving anticancer treatment, and who are multi-morbid. Six subcategories of navigation work were identified: (1) making decisions with, and seeking help from, specialists, (2) seeking safety, (3) positioning to access desired treatment, (4) negotiating tortuous pathways to help, (5) making decisions in collaboration with caregivers, and (6) managing isolation from services and social networks.

Conclusion

There are significant knowledge gaps and a need for more research, particularly studies of how different patient groups prepare for potential deterioration and make sense of systems of urgent and emergency care.
The Impact of Context on Students’ Framing and Reasoning about Fluid Dynamics
Authors: Slominski Tara , Christensen Warren M , Buncher John B , Momsen Jennifer
Published: March 2023

The notorious difficulty of human anatomy and physiology (HA&P) may stem, in part, from the nature of the discipline itself. This idea was tested by manipulating item context to reveal patterns in students’ reasoning about fluid dynamics, a crosscutting phenomenon. Distinct differences were found in how students reasoned in HA&P versus non-HA&P contexts.
Two Cases of Thyroiditis in Adolescents Following COVID-19 Vaccinations
Authors: Chimatapu Sri Nikhita , Ferber Christopher J , Thambundit Apisadaporn , Okawa Erin R
Published: March 2023

With the onset of the COVID-19 pandemic and the development of widespread vaccination strategies, there have been case reports in the adult literature suggesting an increase in thyroiditis after COVID-19 vaccination. We herein describe 2 children who presented with thyroiditis after COVID-19 vaccination. Two children who received Pfizer-BioNTech COVID-19 messenger RNA vaccines later developed symptoms of thyroid hyperactivity, had positive thyroid-stimulating immunoglobulin (TSI) levels and received treatment directed toward Graves disease. Our case series is the first to demonstrate Graves disease after COVID-19 vaccination in the pediatric population. Given this possibility, it is important for pediatricians to be watchful for symptoms of thyroiditis post vaccination to prevent treatment delays.
Between Faith and Works
Authors: Vaucanson Bastian Felter
Published: March 2023

This article elucidates François Fénelon's (1651–1715) conception of monarchical charity by connecting it with earlier conceptions of charity, especially that of François de Sales (1567–1622). It discusses three topoi of devotional literature that it presents as addressing the tension between faith and works: the value of obedience, the notion of the ignorant saint, and the notion of a spiritual elite. It then argues that Sales gives considerable weight to charitable actions performed out of obedience to God, often against one's own inclination and without regard for self-interest. On the premise that Fénelon's princely ideal should not be separated from the concerns of his spiritual writings, the article argues that Fénelon saw a ruler who sacrifices his pleasures and self-interest to his care for his people as an embodiment of the Salesian conception of charity.
Amanitine poisoning - cases, management, therapy results
Authors: Kubicka Magdalena , Wilk Joanna , Dębiec Paweł , Cholewa Krystian , Makarewicz Magdalena , Szymańska Adrianna
Published: March 2023

Mushroom poisoning continues to be a serious clinical problem. The most serious are intoxications with mushrooms containing cytotropic toxins with predominant injury of liver, kidneys and heart. The toxic properties of the phalloides are mainly due to α-amanitin, which is an inhibitor of RNA polymerase II. The clinical course of poisoning can be divided for 4 periods. The asymptomatic period usually lasts 6-24 hours after mushroom consumption. Then the period of the gastrointestinal disorder lasting on average 12-24 hours. The second latency period with apparent improvement of the patient's general condition lasting 12-24 hours is subjected to the stage, during which biochemical markers of hepatocyte activity appear. After a few days (usually on the 4-5th day) from poisoning, kidney function may occur (oliguria or anuria), and circulatory system disorders may also occur. Death usually occurs between 4-16 days after poisoning. The treatment of poisoning with amanita phalloides includes a number of procedures, including rapid removal of toxins, blocking the penetration of amatoxins into the hepatic cell, compensation of systemic metabolic disorders, and extracorporeal support of liver function.
The rationing of nursing care phenomenon in the light of scientific reports – definitions, system solutions, assessment methods – PART I
Authors: Milecka Dorota , Homętowska Henryka , Manulik Stanisław
Published: March 2023

Rationing of nursing care is a widespread and growing phenomenon whose causes are multifaceted and whose consequences are serious. Nursing rationing is defined as withholding or failing to perform necessary nursing tasks due to insufficient time, staffing, and/or inadequate skills. Nursing rationing is also defined as omission, delay, or failure to complete, which qualifies as an error of omission. Unfinished nursing care has many negative consequences for patients, nurses, and organizations. The presented series of three papers aims to show many important aspects related to care rationing. This first part of the series of rationing of nursing care phenomenon will address definitions and concepts of rationing of nursing care, rationing of nursing care in the context of health care rationing, rationing of care versus omission of care or medical error, methods for assessing the rationing and the quality of nursing care, and main reasons for rationing of nursing care.
Gladys Peake Guevara: veinte años de liderazgo de la enfermería chilena de la segunda mitad del siglo XX
Authors: Castillo Lucia
Published: March 2023

Introducción: La historia de la salud posee numerosos hitos protagonizados por mujeres anónimas conformando un vacío historiográfico de aquellas figuras femeninas que han aportado a las políticas sanitarias.

Objetivo: Relevar la figura de Gladys Peake como destacada enfermera chilena y latinoamericana contribuyendo a la construcción de un cuerpo epistemológico profesional de mujeres.

Métodologia: Histórico-biográfico a partir de la revisión de fuentes primarias documentales y relatos de fuentes secundarias sometidos a análisis temático y analizados bajo los supuestos teóricos de la interseccionalidad.

Resultados: Emergieron tres categorías de análisis: Gladys Peake como articuladora de la profesionalización de la enfermería chilena, como Sub-Jefa del Sub-departamento de Enfermería y su accionar durante el quiebre institucional durante la dictadura de Augusto Pinochet.

Conclusiones: Gladys Peake fue una líder que se posicionó como referente de la enfermería nacional, y en su gestión, reprodujo las prácticas propias de un momento de plena crisis institucional en pro del desarrollo de la enfermería chilena. Sin embargo, supo sobreponer su identidad profesional por sobre su ideología, dando cuenta del potencial político de las mujeres enfermeras.
Electronic cigarettes for smoking cessation in pregnancy: a nation–wide mixed methods study
Authors: Broadfield Amy , Ayre Helen , Ahmadi Keivan
Published: March 2023

Background/Aims

The use of electronic cigarettes for smoking cessation during pregnancy is supported by Public Health England and the Royal College of Midwives. However, their long-term effects remain largely unknown. The aim of this study was to explore midwives’ knowledge of and attitudes to electronic cigarette use in pregnancy, and whether this affected their recommendation for their use in smoking cessation.

Methods

An online survey was distributed to 122 qualified midwives in England. Participants were scored on their knowledge of and attitude to electronic cigarettes and their use in pregnancy. The study was cross-sectional and responses were subjected to analytical and descriptive statistical analysis.

Results

There was a significant indirect association between knowledge and attitude, where an increase in knowledge was associated with a more negative attitude (P≤0.001). There was a significant association between attitude, knowledge and personal practice. Categories identified from qualitative data were ‘not enough or no training/information/resources provided’ and ‘not enough research has been done’.

Conclusions

Midwives’ practice in supporting electronic cigarette use as a smoking cessation strategy is influenced by their knowledge and attitude, as well as by challenges in implementing recommendations in practice. This highlights the perceived need for more research on the potential risks and benefits, as well as more resources.
Pre-registration midwifery
Authors: Davies Emma , Morgan Davie
Published: March 2023

Emma Davies and Davie Morgan from Health Education and Improvement Wales discuss the successful recommissioning of Bangor University's pre-registration midwifery programme
Being prepared
Authors: Anastasi Emma
Published: March 2023

Emma Anastasi outlines the key dos and don’ts to make an interview count!
Social media: a hard nut to crack!
Authors: Gill Pamela
Published: March 2023

Pamela Gill offers a guide on getting your social media organised and off the ground.
The social media maze
Authors: Brown Clementine Rees
Published: March 2023

Clementine Rees Brown discusses the perks and pitfalls of a social media career with Anna Middleton.
Oral cancer and tobacco cessation: what’s your role?
Authors: Wake Charlotte
Published: March 2023

Charlotte Wake outlines how to aid patients in smoking cessation and patients oral care.

Aim

To increase knowledge of tobacco use, its effects on oral cancer and how we can help our patients to stop their tobacco use.

Objectives

To have a better understanding of the different types of tobacco To have knowledge of the five A‘s’ of tobacco cessation To know where we can gain information to refer patients to local smoking cessation clinics This article meets GDC development outcomes B,C,D
Broaching a difficult discussion
Authors: Brown Alison
Published: March 2023

Alison Brown breaks down how to approach speaking about oral cancer with patients.
March 2023 Medical Image of the Month: Spontaneous Pneumomediastinum as a Complication of Marijuana Smoking Due to Müller's Maneuvers
Authors:   Doctors Medical Center of Modesto and Emanuel Medical Center, Modesto and Turlock, CA USA, Mahmoud Mohammad
Published: March 2023

No abstract available. Article truncated after 150 words. A 35-year-old woman with a medical history notable for celiac disease, ulcerative colitis, and bipolar disorder presents to the Emergency Department for evaluation of a strange sensation in the chest and neck associated with nausea and vomiting for one day. The patient also reports persistent nausea and markedly decreased oral intake for the last four days. She reported no concomitant symptoms such as shortness of breath, wheezing, fever, or chills. She denies diarrhea or constipation. Socially, she admits to smoking marijuana daily, and alcohol occasionally. Vital sign shows blood pressure 147/97 mmHg, pulse 92 BPM, temperature 37.3°C, SpO2 96% breathing ambient air. She appears nontoxic and well-nourished, and the lungs are clear to auscultation bilaterally without any wheezes, rales, or rhonchi. The heart examination reveals a regular rate and rhythm, with normal S1 and S2 heart sounds and no murmurs, rubs, or gallops. The abdomen is soft, non-tender, and not …
Femtosecond laser inscribed fiber Bragg gratings based on precise spatial apodization
Authors: Ioannou Andreas , Kalli Kyriacos
Published: March 2023

Plane-by-plane femtosecond laser fabricated apodized fiber Bragg gratings (FBG) are demonstrated for the first time, to the best of our knowledge. The method reported in this work provides a fully customizable and controlled inscription that can realize any desired apodized profile. By using this flexibility, we experimentally demonstrate four different apodization profiles (Gaussian, Hamming, New, Nuttall). These profiles were chosen to evaluate their performance with regard to the sidelobe suppression ratio (SLSR). Usually, a higher reflectivity of a grating fabricated with a femtosecond laser will result in a greater difficulty to achieve a controlled apodization profile due to the nature of the material modification. Therefore, the goal of this work is to fabricate high-reflectivity FBGs without sacrificing the SLSR and provide a direct comparison with apodized low-reflectivity FBGs. In our weak apodized FBGs, we also consider the background noise introduced during the femtosecond (fs)-laser inscription process which is fundamental when multiplexing FBGs within a narrow wavelength window.
Exploiting non-orthogonal eigenmodes in a non-Hermitian optical system to realize sub-100 MHz magneto-optical filters.
Authors: Logue Fraser , Briscoe Jack , Pizzey Danielle , Wrathmall Steven , Hughes Ifan
Published: March 2023

Non-Hermitian physics is responsible for many of the counter-intuitive effects observed in optics research opening up new possibilities in sensing, polarization control and measurement. A hallmark of non-Hermitian matrices is the possibility of non-orthogonal eigenvectors resulting in coupling between modes. The advantages of propagation mode coupling have been little explored in magneto-optical filters and other devices based on birefringence. Magneto-optical filters select for ultra-narrow transmission regions by passing light through an atomic medium in the presence of a magnetic field. Passive filter designs have traditionally been limited by Doppler broadening of thermal vapors. Even for filter designs incorporating a pump laser, transmissions are typically less than 15% for sub-Doppler features. Here we exploit our understanding of non-Hermitian physics to induce non-orthogonal propagation modes in a vapor and realize better magneto-optical filters. We construct two new filter designs with ENBWs and maximum transmissions of 181 MHz, 42 % and 140 MHz, 17% which are the highest figure of merit and first sub-100 MHz FWHM passive filters recorded respectively. This work opens up a range of new filter applications including metrological devices for use outside a lab setting and commends filtering as a new candidate for deeper exploration of non-Hermitian physics such as exceptional points of degeneracy.
Climate change and security research: Conflict, securitisation and human agency
Authors: Arnall Alex
Published: March 2023

Climate change has increasingly been understood as a security problem by researchers, policymakers and media commentators. This paper reviews two strands of work that have been central to the development of this understanding–namely 1) the links between global heating and violent conflict and 2) the securitisation of climate change–before outlining an agency-oriented perspective on the climate-security nexus. While providing sophisticated analyses of the connections between climate change and security, both the conflict and securitisation strands have encountered several epistemological challenges. I argue that the climate security concept can be revitalised in a progressive manner if a more dynamic, relational approach to understanding security is taken. Such an approach recognises people’s everyday capacities in managing their own safety as well as the security challenges involved in responding to a continually evolving threat such as climate change.
To use or not to use: Exploring factors influencing the uptake of modern contraceptives in urban informal settlements of Mumbai
Authors: Bahuguna Manjula , Das Sushmita , Shende Sushma , Manjrekar Shreya , Pantvaidya Shanti , Fernandez Armida , Jayaraman Anuja
Published: March 2023

Rapid urbanization and a high unmet need for family planning in urban informal settlements point to the significance of identifying gaps that exist in the path of voluntary uptake of contraceptives. We undertook this study to better understand the perspectives related to family planning among women living in informal settlements of Mumbai. We used a mixed-methods approach, including a cross-sectional survey with 1407 married women of reproductive age and face-to-face in-depth interviews with 22 women, both users and non-users of modern contraceptives. 1070 (76%) of the participants were using modern contraceptives and women’s age, education, parity, socioeconomic status and exposure to family planning interventions were the main determinants of contraceptive use. Poor contraceptive awareness before marriage coupled with social norms of early childbearing and completing family resulted in unplanned and less spaced pregnancies even among current users. In such cases, women either continued with the pregnancy or opted for abortion which sometimes could be unsafe. The decision to use contraceptives was taken in most cases after achieving the desired family size and was also influenced by belief in traditional methods, fear of side effects, spousal/family awareness and counselling by frontline workers. We recommend strengthening of sexual and reproductive health component of adolescent health programs. It is pertinent to inform women about their reproductive rights and most importantly empower them to practice these rights. This can be achieved by increasing women’s age at marriage and continued promotion of formal education. Widespread misconceptions related to the side effects of modern methods need to be mitigated via counselling. Referral, follow-up, and suggestions on available choices of contraceptives should be given in case women face any side effects from the use of contraceptives. At the same time, improving spousal awareness and communication regarding family planning will allow couples to make informed decisions. Finally, roping in role models in the community will create an environment conducive to operationalizing rights-based family planning.
Antiretroviral treatment failure and associated factors among people living with HIV on therapy in Homa Bay, Kenya: A retrospective study
Authors: Masaba Rose , Woelk Godfrey , Siamba Stephen , Ndimbii James , Ouma Millicent , Khaoya Jacob , Kipchirchir Abraham , Ochanda Boniface , Okomo Gordon
Published: March 2023

Despite large numbers of patients accessing antiretroviral treatment (ART) in Kenya, few studies have explored factors associated with virologic failure in Western Kenya, specifically. We undertook a study in Homa Bay County, Kenya to assess the extent of virologic treatment failure and factors associated with it. This was an observational retrospective study conducted from September 2020 to January 2021. Data were abstracted from the records of patients who had been on ART for at least six months at the time of data collection after systematic sampling stratified by age group at ART initiation (0–14 and 15+ years), using probability proportion to the numbers of patients attending the facility. Confirmed viral treatment failure was defined as viral load ≥1000 copies/ml based on two consecutive viral load measurements after at least three months of enhanced adherence counseling. Data were analyzed using descriptive statistics and Cox regression modeling. Of the 2,007 patients sampled, 160 (8.0%) had confirmed virologic treatment failure. Significantly higher virologic treatment failure rates were identified among male patients 78/830 (9.4%) and children 115/782 (14.7%). Factors associated with virologic treatment failure (VTF), were age 0–14 years, adjusted hazard ratio (AHR) 4.42, (95% Confidence Interval [CI], 3.12, 6.32), experience of treatment side effects AHD: 2.43, (95% CI, 1.76, 3.37), attending level 2/3 health facility, AHR: 1.87, (95% CI: 1.29, 2,72), and history of opportunistic infections (OIs), AHR: 1.81, (95% CI, 1.76, 3.37). Children, attendees of level 2/3 health facilities, patients with a history of OIs, and those experiencing treatment side-effects are at risk of VTF. Increased focus on children and adolescents on screening for drug resistance, administration of and adherence to medication, and on effective information and education on side-effects is critical. Additionally, there is need for increased training and support for health care workers at primary level care facilities.
Investigation of in-phase bilateral exercise effects on corticospinal plasticity in relapsing remitting multiple sclerosis: A registered report single-case concurrent multiple baseline design across five subjects
Authors: Sokratous Dimitris , Charalambous Charalambos C. , Papanicolaou Eleni Zamba , Michailidou Kyriaki , Konstantinou Nikos
Published: March 2023

Relapsing-remitting Multiple Sclerosis is the most common demyelinating neurodegenerative disease and is characterized by periods of relapses and generation of various motor symptoms. These symptoms are associated with the corticospinal tract integrity, which is quantified by means of corticospinal plasticity which can be probed via transcranial magnetic stimulation and assessed with corticospinal excitability measures. Several factors, such as exercise and interlimb coordination, can influence corticospinal plasticity. Previous work in healthy and in chronic stroke survivors showed that the greatest improvement in corticospinal plasticity occurred during in-phase bilateral exercises of the upper limbs. During in-phase bilateral movement, both upper limbs are moving simultaneously, activating the same muscle groups and triggering the same brain region respectively. Altered corticospinal plasticity due to bilateral cortical lesions is common in MS, yet, the impact of these type of exercises in this cohort is unclear. The aim of this concurrent multiple baseline design study is to investigate the effects of in-phase bilateral exercises on corticospinal plasticity and on clinical measures using transcranial magnetic stimulation and standardized clinical assessment in five people with relapsing-remitting MS. The intervention protocol will last for 12 consecutive weeks (30–60 minutes /session x 3 sessions/week) and include in-phase bilateral movements of the upper limbs, adapted to different sports activities and to functional training. To define functional relation between the intervention and the results on corticospinal plasticity (central motor conduction time, resting motor threshold, motor evoked potential amplitude and latency) and on clinical measures (balance, gait, bilateral hand dexterity and strength, cognitive function), we will perform a visual analysis and if there is a potential sizeable effect, we will perform statistical analysis. A possible effect from our study, will introduce a proof-of-concept for this type of exercise that will be effective during disease progression.

Trial registration: ClinicalTrials.gov NCT05367947.
Performance of bedside tools for predicting infection-related mortality and administrative data for sepsis surveillance: An observational cohort study
Authors: Bateson Meghan , Marwick Charis A. , Staines Harry J. , Patton Andrea , Stewart Elaine , Rooney Kevin D.
Published: March 2023

Background

Measuring sepsis incidence and associated mortality at scale using administrative data is hampered by variation in diagnostic coding. This study aimed first to compare how well bedside severity scores predict 30-day mortality in hospitalised patients with infection, then to assess the ability of combinations of administrative data items to identify patients with sepsis.

Methods

This retrospective case note review examined 958 adult hospital admissions between October 2015 and March 2016. Admissions with blood culture sampling were matched 1:1 to admissions without a blood culture. Case note review data were linked to discharge coding and mortality. For patients with infection the performance characteristics of Sequential Organ Failure Assessment (SOFA), National Early Warning System (NEWS), quick SOFA (qSOFA), and Systemic Inflammatory Response Syndrome (SIRS) were calculated for predicting 30-day mortality. Next, the performance characteristics of administrative data (blood cultures and discharge codes) for identifying patients with sepsis, defined as SOFA ≥2 because of infection, were calculated.

Results

Infection was documented in 630 (65.8%) admissions and 347 (55.1%) patients with infection had sepsis. NEWS (Area Under the Receiver Operating Characteristic, AUROC 0.78 95%CI 0.72–0.83) and SOFA (AUROC 0.77, 95%CI 0.72–0.83), performed similarly well for prediction of 30-day mortality. Having an infection and/or sepsis International Classification of Diseases, Tenth Revision (ICD-10) code (AUROC 0.68, 95%CI 0.64–0.71) performed as well in identifying patients with sepsis as having at least one of: an infection code; sepsis code, or; blood culture (AUROC 0.68, 95%CI 0.65–0.71), Sepsis codes (AUROC 0.53, 95%CI 0.49–0.57) and positive blood cultures (AUROC 0.52, 95%CI 0.49–0.56) performed least well.

Conclusions

SOFA and NEWS best predicted 30-day mortality in patients with infection. Sepsis ICD-10 codes lack sensitivity. For health systems without suitable electronic health records, blood culture sampling has potential utility as a clinical component of a proxy marker for sepsis surveillance.
Machine learning for the identification of respiratory viral attachment machinery from sequences data
Authors: Walker Kenji C. , Shwarts Maïa , Demidikin Stepan , Chakravarty Arijit , Joseph-McCarthy Diane
Published: March 2023

At the outset of an emergent viral respiratory pandemic, sequence data is among the first molecular information available. As viral attachment machinery is a key target for therapeutic and prophylactic interventions, rapid identification of viral “spike” proteins from sequence can significantly accelerate the development of medical countermeasures. For six families of respiratory viruses, covering the vast majority of airborne and droplet-transmitted diseases, host cell entry is mediated by the binding of viral surface glycoproteins that interact with a host cell receptor. In this report it is shown that sequence data for an unknown virus belonging to one of the six families above provides sufficient information to identify the protein(s) responsible for viral attachment. Random forest models that take as input a set of respiratory viral sequences can classify the protein as “spike” vs. non-spike based on predicted secondary structure elements alone (with 97.3% correctly classified) or in combination with N-glycosylation related features (with 97.0% correctly classified). Models were validated through 10-fold cross-validation, bootstrapping on a class-balanced set, and an out-of-sample extra-familial validation set. Surprisingly, we showed that secondary structural elements and N-glycosylation features were sufficient for model generation. The ability to rapidly identify viral attachment machinery directly from sequence data holds the potential to accelerate the design of medical countermeasures for future pandemics. Furthermore, this approach may be extendable for the identification of other potential viral targets and for viral sequence annotation in general in the future.
Quality evaluation of the Azithromycin tablets commonly marketed in Adama, and Modjo towns, Oromia Regional State, Ethiopia
Authors: Mekasha Yesuneh Tefera , Chali Belachew Umeta , Feissa Anbessa Bekele , Godena Gemmechu Hasen , Hassen Hassen Kebede , Wega Sultan Suleman
Published: March 2023

Background

Azithromycin is a therapeutically” relevant macrolide antibiotic registered on the Essential Medicines List of the World Health Organization. The fact that medicine is selected as an essential drug doesn’t mean that it is of good quality. Hence, a continuous quality evaluation of the drug should be mandated to verify that the right medication is available on the market.

Objective

To evaluate the quality of Azithromycin Tablets commonly marketed in Adama, and Modjo town, Oromia Regional State, Ethiopia.

Methods

All six brands were subjected to in-vitro quality control tests, which were carried out according to procedures described in the manufacturer’s method, the United States Pharmacopeia, and the WHO inspection tool. All quality control parameters were compared by one-way ANOVA. Statistically, significant difference was considered when P<0.05. The in-vitro dissolution profiles of the brands were also compared statistically using the post-hoc Dunnett test, model-independent and model-dependent approaches.

Results

All of the evaluated brands agreed with WHO visual inspection criteria. All of the tablets achieved the thickness, and diameter test requirements of the manufacturer’s specification (±5%). All brands passed the hardness, friability, weight variation, disintegration, identity, and assay tests as stipulated by USP. The dissolution rate was more than 80% in 30 minutes, which was within the USP specification. The model-independent parameters have confirmed that only two brands (2/6) were deemed better brands for interchangeability. Weibull and Korsemeyer’s Peppas model were the best release models.

Conclusion

All of the evaluated brands passed the quality specification. The model dependent approaches revealed that drug release data fit well to the Weibull, and Korsemeyer’s Peppas release models. However, the model-independent parameters have confirmed that only two brands were deemed better brands (2/6) for interchangeability. Due to the dynamic nature of low-quality medications, the Ethiopian Food, and Drug Authority should keep an eye on marketed products to guarantee their quality, especially for drugs like azithromycin for which non-bioequivalence data from the study has revealed a clinical concern.
System network analysis of Rosmarinus officinalis transcriptome and metabolome—Key genes in biosynthesis of secondary metabolites
Authors: Moghadam Ali , Foroozan Eisa , Tahmasebi Ahmad , Taghizadeh Mohammad Sadegh , Bolhassani Mohammad , Jafari Morteza
Published: March 2023

Medicinal plants contain valuable compounds that have attracted worldwide interest for their use in the production of natural drugs. The presence of compounds such as rosmarinic acid, carnosic acid, and carnosol in Rosmarinus officinalis has made it a plant with unique therapeutic effects. The identification and regulation of the biosynthetic pathways and genes will enable the large-scale production of these compounds. Hence, we studied the correlation between the genes involved in biosynthesis of the secondary metabolites in R. officinalis using proteomics and metabolomics data by WGCNA. We identified three modules as having the highest potential for the metabolite engineering. Moreover, the hub genes highly connected to particular modules, TFs, PKs, and transporters were identified. The TFs of MYB, C3H, HB, and C2H2 were the most likely candidates associated with the target metabolic pathways. The results indicated that the hub genes including Copalyl diphosphate synthase (CDS), Phenylalanine ammonia lyase (PAL), Cineole synthase (CIN), Rosmarinic acid synthase (RAS), Tyrosine aminotransferase (TAT), Cinnamate 4-hydroxylase (C4H), and MYB58 are responsible for biosynthesis of important secondary metabolites. Thus, we confirmed these results using qRT-PCR after treating R. officinalis seedlings with methyl jasmonate. These candidate genes may be employed for genetic and metabolic engineering research to increase R. officinalis metabolite production.
Provision and delivery of survivorship care for adult patients with haematological malignancies: A scoping review protocol
Authors: Baldwin Zoe-Anne V. , Busby Steph , Allsup David , Cohen Judith , Bamidele Olufikayo
Published: March 2023

Introduction

Haematological malignancies are a heterogenous group of blood and lymphatic cancers. Survivorship care is a similarly diverse term concerning patients’ health and wellbeing from diagnosis to end of life. Survivorship care for patients with haematological malignancies has traditionally been consultant-led and secondary care-based, although shifts away from this model have been occurring, largely via nurse-led clinics and interventions with some remote monitoring. However, there remains a lack of evidence regarding which model is most appropriate. Although previous reviews exist, patient populations, methodologies, and conclusions are varied, and further high-quality research and evaluation has been recommended.

Aims

The aim of the scoping review this protocol describes is to summarise current evidence on the provision and delivery of survivorship care for adult patients diagnosed with a haematological malignancy, and to identify existing gaps to inform future research.

Methodology

A scoping review will be carried out utilising Arksey and O’Malley’s guidelines as its methodological framework. Studies published in the English language from December 2007 to the present will be searched on bibliographic databases, including Medline, CINAHL, PsycInfo, Web of Science, and Scopus. Papers’ titles, abstracts, and full text will predominantly be screened by one reviewer with a second reviewer blind screening a proportion. Data will be extracted using a customised table developed in collaboration with the review team, and presented in tabular and narrative format, arranged thematically. Studies included will contain data regarding adult (25+) patients diagnosed with any haematological malignancy in combination with aspects related to survivorship care. The survivorship care elements could be delivered by any provider within any setting, but should be delivered pre- or post-treatment, or to patients on a watchful waiting pathway.

Registration

The scoping review protocol has been registered on the Open Science Framework (OSF) repository Registries (https://osf.io/rtfvq; DOI: 10.17605/OSF.IO/RTFVQ).
A review of ultrasound for the diagnosis of acute appendicitis in adults
Authors: Pather Vijay , Gosal Preet
Published: March 2023

Acute appendicitis is one of the most common surgical emergencies globally, with a lifetime incidence of 8.6% in men and 6.7% in women. While acute appendicitis should be managed promptly to reduce the morbidity associated with perforated appendicitis, morbidity from negative appendicectomy is similar to morbidity from uncomplicated appendicitis. Computer tomography is widely used to aid in the diagnosis of acute appendicitis, however, is costly, often has a slow turn around time, and is associated with exposure to ionising radiation. In contrast, ultrasound is cheap, widely available, requires minimal patient preparation, and does not require exposure to ionising radiation. Ultrasonography is becoming increasingly used for adult patients in emergency settings. The literature has estimated the sensitivity of ultrasound for acute appendicitis in adult patients as between 39-96.4%. The sensitivity and specificity of ultrasound for the diagnosis of acute appendicitis is significantly increased when the appendix is visualised. In cases of a non visualised appendix, indirect ultrasound signs can improve the sensitivity to 93.9% and specificity to 85.7%. The variation in sensitivity and specificity for ultrasound in the diagnosis of acute appendicitis in adults may be due to multiple factors. Ultrasonographer experience, a retrocaecal appendix and obesity have all been described. Given the availability, cost and potential to reduce the rate of negative appendicectomy, ultrasound should be considered as the first line imaging modality for adult patients presenting with suspected AA.