bluuebunny/crossref_metadata_2025 huggingface dataset:
Use of suction electrodes for measurement of intrinsic tongue muscular endurance during lingual pressure generation
Authors: Ita Reiko , Magara Jin , Ochiai Yuto , Tsujimura Takanori , Inoue Makoto
Published: October 2023

Background

Lingual pressure (LP) generation is cooperatively controlled not only by the intrinsic tongue (I‐ton) muscles but also by hyoid muscle activation. However, the measurement of endurance and fatigue properties of I‐ton muscles is difficult due to the instability of electrodes.

Objective

The purpose of this study was to apply suction electrodes to measure electromyograms (EMGs) of I‐ton muscle and to evaluate integrated EMG amplitude (iEMG) and mean power frequency (MPF) of EMG in the I‐ton and hyoid muscles performing continuous LP.

Methods

Twenty healthy adult volunteers (10 males, 10 females, mean age 28.8 years) were instructed to perform 10‐s LP generation tasks at 25%, 50%, 75% and 100% of maximum LP in randomised order with visual feedback. During each task, EMGs of the I‐ton, suprahyoid (S‐hyo), infrahyoid (I‐hyo) and masseter (Mass) muscles were simultaneously recorded. The iEMG and MPF of EMG burst during 10‐s LP tasks were compared. The recording period was divided into three substages to analyse temporal changes with the Friedman test.

Results

During the 10‐s task, the iEMG significantly increased as the LP strength increased (p < .001). There was no time‐dependent change in the I‐ton iEMG; however, the MPF of the I‐ton EMG burst decreased in all tasks (p < .05). The S‐hyo and I‐hyo iEMGs gradually increased, especially with strong LP (p < .01).

Conclusion

While I‐ton muscles may easily fatigue during 10‐s LP generation, S‐hyo and I‐hyo muscles may help compensate for the weakened I‐ton muscle activity by increasing their activity to maintain LP.
Gender influences on caring, dignity and well‐being in older person care: A systematic literature review and thematic synthesis
Authors: Xiarchi Lamprini M. , Nässén Kristina , Palmér Lina , Cowdell Fiona , Lindberg Elisabeth
Published: October 2023

Globally, healthcare has become dominated by women nurses. Gender is also known to impact the way people are cared for in various healthcare systems. Considering gender from the perspective of how lived bodies are positioned through the structural relations of institutions and processes, this systematic review aims to explore the meaning of gender in the caring relationship between the nurse and the older person through a synthesis of available empirical data published from 1993 to 2022. CINAHL, PUBMED, EMBASE and Web of Science were searched from the beginning of each database's temporal range, and PRISMA guidelines were used for the screening, reviewing and selection processes of available records. A thematic synthesis of the available data resulted in three analytical themes: (i)vulnerability of the gendered body, (ii)norms and values related to gender and sexualityand (iii)balancing closeness and distance in the nurse‐patient relationship. These themes are intertwined and represent different aspects of gender meaning in the nurse–patient relationship. This research shows that gender, through its influence on the gendered body, its relationship with power dynamics in the caring process, and its intersection with dimensions of identity, has a significant meaning for the experienced vulnerability in the nurse–patient relationship. This has implications for the well‐being and sense of dignity of the older person as well as the nurse.
The analysis of Puccinia triticina field populations in Canada between 2018 and 2020 using restriction site‐associated DNA genotyping‐by‐sequencing
Authors: Wang Xiben , Reimer Elisa , Bakkeren Guus , McNabb Winnie , McCallum Brent
Published: October 2023

Puccinia triticina, the causal agent of wheat leaf rust, is a dynamic pathogen causing significant yield losses worldwide. In this study, we analysed the virulence and genetic structure of 98 P. triticina isolates collected in Canada between 2018 and 2020. Isolates from Manitoba and Saskatchewan were found to be highly related for virulence, as were isolates from Quebec and Ontario. Isolates from Alberta had a virulence profile more similar to those from Manitoba and Saskatchewan than to Ontario and Quebec. To study the genetic structure of P. triticina populations, we used the restriction site‐associated DNA (RAD) genotyping‐by‐sequencing method to identify single‐nucleotide polymorphisms (SNPs). The Puccinia DNA sequences were aligned against the reference genome of P. triticina race BBBD and 1898 SNPs were identified. The phylogenetic analysis using SNP markers grouped these P. triticina into three genetic clades. The separation of P. triticina into three genetic clades was also supported by principal component analysis. Isolates from Clade 1 and Clade 2 were found throughout Canada, whereas Clade 3 isolates were only found in Ontario and Quebec. There were differences in virulence profiles among P. triticina isolates from the three genetic clades and a general correlation between virulence phenotypes and SNP genotypes was observed. These results indicate that the SNPs derived from RAD genotyping‐by‐sequencing could be useful in tracking the genetic and virulence dynamics of this pathogen in Canadian wheat.
Corporate income taxation and multinational production
Authors: Shen Yang
Published: October 2023

Through the lens of a quantitative general equilibrium model of international trade and multinational production, this paper studies corporate tax competition and cooperation among asymmetric countries. The model theoretically supports the empirical regularities that corporate income taxation influences multinational firms' location and production decisions. Calibrating the model to three asymmetric countries for a hypothetical tax competition, I find that race to the bottom occurs in the Nash equilibrium. Furthermore, counterfactual analysis of the global minimum corporate tax shows welfare reduction compared to the equilibrium of tax competition but welfare improvement compared to the current tax regime.
I'm with you, baby: Using parental embodied mentalizing in a pilot study to capture change following the circle of security parenting intervention
Authors: Shai Dana , Boris Neil , Brandtzæg Ida , Torsteinson Stig , Spencer Rose , Haugaard Karin , Smith‐Nielsen Johanne
Published: October 2023

Supported by a large body of work demonstrating the impact of infant attachment representations on subsequent development, numerous therapeutic programs have been developed to promote secure attachment, with increasing focus on parental mentalizing. Nonetheless, empirical evidence supporting their effectiveness has yet to be fully established. The current pilot study (N = 24) was designed to evaluate whether and to what extent parents' shifts in parental mentalizing following a brief attachment‐based group intervention, namely circle of security parenting (COSP; Cooper, Hoffman & Powell, 2009) can be captured using the parental embodied mentalizing instrument (PEM; Shai & Belsky, 2017). Compared to a waiting list–control group, this small‐scale study examined whether community‐based low‐risk mothers of infants aged 5–48 months show an increase in their observed PEM capacities following the intervention. Secondary self‐reported outcome variables parental stress, feeling of competence, and self‐compassion. Findings show that PEM ratings improved significantly over time in the COSP group, but not in the control group. Intervention group mother–infant dyads also presented significantly longer embodied interactions communication post intervention compared to the control group. No effects of the COSP on parental stress, competence, or self‐compassion were found. Despite the small sample size, these results tentatively suggest that COSP can improve embodied mentalizing abilities.
Impact of Installation on the Performance of an Aero-Engine Exhaust at Wind-Milling Flow Conditions
Authors: Goulos Ioannis , MacManus David , Rebassa Josep Hueso , Tejero Fernando , Au Andy , Sheaf Christopher
Published: October 2023

This paper presents a numerical investigation of the effect of wing integration on the aerodynamic behavior of a typical large civil aero-engine exhaust system at wind-milling flow conditions. The work is based on the dual stream jet propulsion (DSJP) test rig, as will be tested within the transonic wind tunnel (TWT) located at the aircraft research association (ARA) in the UK. The DSJP rig was designed to measure the impact of the installed pressure field due to the effect of the wing on the aerodynamic performance of separate-jet exhausts. The rig is equipped with the dual separate flow reference nozzle (DSFRN), installed under a swept wing. Computational fluid dynamic simulations were carried out for representative ranges of fan and core nozzle pressure ratios (CNPR) for “engine-out” wind-milling scenarios at end of runway (EOR) takeoff, diversion, and cruise conditions. Analyses were done for both isolated and installed configurations to quantify the impact of the installed pressure field on the fan and core nozzle discharge coefficients. The impact of fan and core nozzle pressure ratios, as well as freestream Mach number and high-lift surfaces on the installed suppression effect, was also evaluated. It is shown that the installed pressure field can reduce the fan nozzle discharge coefficient by up to 16%, relative to the isolated configuration for EOR wind-milling conditions. The results were used to inform the design and setup of the experimental activity which is planned for 2023.
Control of
glnA
(glutamine synthetase) expression by urea in non-pathogenic and uropathogenic
Escherichia coli
Authors: Urs Karthik , Zimmern Philippe E. , Reitzer Larry
Published: October 2023

Previous transcriptomic studies have shown that
glnA
, which codes for glutamine synthetase (GS), is induced during growth of uropathogenic
E. coli
in urine. GS is at the intersection of carbon and nitrogen metabolism and is, not surprisingly, highly regulated. The
glnALG
operon specifies GS and two regulators of the nitrogen-regulated (Ntr) response, which scavenges nitrogenous compounds during nitrogen limitation. Transcription of
glnA
initiates from the cAMP receptor protein (Crp)-dependent
glnAp1
and the GlnG-dependent
glnAp2
promoters which respond to carbon and nitrogen limitation, respectively. High
glnA
expression is most often associated with nitrogen limitation, and its expression in urine could suggest nitrogen limitation, despite a high concentration of ammonia which suppresses
glnA
expression. To understand the basis for this expression, we compared growth of a non-pathogenic and a uropathogenic strain of
E. coli
in minimal media and a urine-like medium in wild-type,
ΔglnG
and
Δcrp
strains and assessed
glnA
expression with transcriptional and translational fusions, quantitative reverse transcription PCR, direct enzymatic assay, and Western blots. Our results showed that urea induced expression from the Crp-dependent
glnAp1
promoter which produced a transcript that was not translated, inhibited expression from the Ntr
glnAp2
promoter, and did not induce other Ntr genes, i.e., high
glnA
transcription can occur without induction of the Ntr response. We conclude that urea induces
glnA
expression in
E. coli
that is independent of the regulators of the Ntr response.

IMPORTANCE

The bacteria that cause urinary tract infections often become resistant to antibiotic treatment, and genes expressed during an infection could suggest non-antibiotic targets. During growth in urine,
glnA
(specifying glutamine synthetase) expression is high, but our results show that urea induces
glnA
expression independent of the regulation that responds to nitrogen limitation. Although our results suggest that
glnA
is an unlikely target for therapy because of variation in urinary components between individuals, our analysis of
glnA
expression in urine-like environments has revealed previously undescribed layers of regulation. In other words, regulatory mechanisms that are discovered in a laboratory environment do not necessarily operate in the same way in nature.
The expression and function of HSV ICP47 and its promoter in mice
Authors: Velusamy Thilaga , Singh Navneet , Croft Sarah , Smith Stewart , Tscharke David C.
Published: October 2023

Herpes simplex virus (HSV) protein immediate early-infected cell protein (ICP)47 inhibits the transporter associated with antigen presentation, thereby concealing infected cells from the CD8
+
T-cell response in humans. By contrast, in mouse cells, ICP47 was found to be ineffective
in vitro
, despite some evidence for a role of this protein
in vivo
, specifically in the nervous system. Recent evidence suggests that the promoter that drives ICP47 might be active in the establishment of latency and during latency, leading to the possibility that a role might be found in protecting neurons that are latently infected with HSV from T-cell attack. Here, we explored this idea by studying a set of recombinant HSVs that were null for ICP47 protein and/or express Cre recombinase from ICP47 promoters, for use in a Cre-marking mouse model. Using these viruses, we found that contrary to previous studies, the activity of ICP47 in mouse cells is efficient enough to detectably reduce antigen presentation, albeit at levels much lower than in human cells. However,
in vivo
, we found no evidence of ICP47 influencing HSV pathogenesis or latency in a model where the virus does not spread beyond the peripheral nervous system. Finally, we show that the ability of the ICP47 promoter to drive protein expression during HSV latency is dependent on the location that it is placed in a recombinant virus genome and that such expression is undetectable from its native locus.

IMPORTANCE

Immune evasion and latency are key mechanisms that underlie the success of herpesviruses. In each case, interactions between viral and host proteins are required and due to co-evolution, not all mechanisms are preserved across host species, even if infection is possible. This is highlighted by the herpes simplex virus (HSV) protein immediate early-infected cell protein (ICP)47, which inhibits the detection of infected cells by killer T cells and acts with high efficiency in humans, but poorly, if at all in mouse cells. Here, we show that ICP47 retains modest but detectable function in mouse cells, but in an
in vivo
model we found no role during acute infection or latency. We also explored the activity of the ICP47 promoter, finding that it could be active during latency, but this was dependent on genome location. These results are important to interpret HSV pathogenesis work done in mice.
A diagnostic stewardship approach to prevent unnecessary testing of an enteric bacterial molecular panel
Authors: Campodónico Victoria L. , Hanlon Ann , Mikula Michael W. , Miller Jo-Anne , Gherna Michael , Carroll Karen C. , Simner Patricia J.
Published: October 2023

After stool culture was replaced by an enteric bacterial panel (EBP) at the Johns Hopkins Hospital (JHH), many EBPs were ordered >3 days after admission (EBP >3 days) with low yield. To reduce unnecessary testing, a hard stop for ordering EBP >3 days was established with the option to override the restriction. The present study retrospectively evaluates the usefulness of overriding that restriction. A retrospective chart review was performed on all patients with an EBP >3 days at the JHH from November 2021 to October 2022. The override provided only one new diagnosis of
Salmonella
infection in a patient who developed diarrhea within 3 days of admission but was not tested by EBP until day 5. There were no positive EBPs >3 days in patients without diarrhea or who developed diarrhea >3 days after admission (diarrhea >3 days). Most patients with requests to override the restriction were also tested for
Clostridioides difficile
. All patients positive for
C. difficile
received treatment and their
C. difficile
positive test resulted
>
1 day before the EBP was run. There were no differences in yield in patients
>
65 years of age with significant comorbidities or associated with neutropenia, leukocytosis, human immunodeficiency virus status, or lactoferrin positivity. There were no positive tests in patients receiving stool softeners within the previous 48 hours of testing. Overriding the hard stop should not be approved in patients without diarrhea or with diarrhea >3 days, who received stool softeners within the previous 48 hours or have not been tested for more common causes of hospital-acquired diarrhea.

IMPORTANCE

Testing for enteric bacterial pathogens in patients hospitalized for more than 3 days is almost always inappropriate. Our study validates the utility of the 3-day rule and the use of clinical decision support tools to decrease unnecessary testing of enteropathogenic bacteria other than
C. difficile
. Overriding the restriction was very low yield. Our study highlights the importance of diagnostic stewardship and further refines the criteria for allowing providers to override the restriction while monitoring the impact of the interventions.
Anatomy of the Band Structure of the Newest Apparent Near-Ambient Superconductor LuH3 – xNx
Authors: Pavlov N. S. , Shein I. R. , Pervakov K. S. , Pudalov V. M. , Nekrasov I. A.
Published: October 2023

Recently it was claimed that nitrogen-doped lutetium hydride exhibited a near-ambient superconducting transition with a temperature of 294 K at a pressure of only 10 kbar, this pressure being several orders of magnitude lower than previously demonstrated for hydrides under pressure. In this paper, we investigate within DFT + U the electronic structure of both parent lutetium hydride LuH3 and nitrogen doped lutetium hydride LuH2.75N0.25. We calculated corresponding bands, density of states and Fermi surfaces with and without spin-orbit coupling (SOC). It is shown that in the stoichiometric system the Lu-5$$d$$ states cross the Fermi level while the H-$$1s$$ states make almost no contribution at the Fermi level. However, with nitrogen doping, the N‑$$2p$$ states enter the Fermi level in large quantities and bring together a significant contribution from the H‑$$1s$$ states. The presence of N-$$2p$$ and H-$$1s$$ states at the Fermi level in a doped compound can facilitate the emergence of superconductivity. Surprisingly, SOC splits quite significantly (0.1–0.25 eV) nitrogen bands in LuH2.75N0.25 just below the Fermi level. For instance, nitrogen doping almost doubles the value of DOS at the Fermi level. Simple BCS analysis shows that the nitrogen doping of LuH3 can provide $${{T}_{c}}$$ more than 100 K and even increase it with further hole doping.
Abnormal clinical presentation and surgical outcome of an intraventricular cavernoma of the third ventricle
Authors: Maupin Callen M , Herrmann Amanda A , Kashyap Bhavani , Rosenbloom Michael H
Published: October 2023

We present a unique case of a man presenting with progressive short-term memory deficits over 10+ years who was found to have a large intraventricular cavernoma in the anterior wall of the third ventricle with invasion of medial limbic structures. Identifying intraventricular cavernomas early is crucial to prevent substantial growth and to increase the chance of successful patient outcomes.
Pyopericardium presenting as pericardial tamponade in a patient with common variable immunodeficiency disorder
Authors: Windels An , Neri Inês , Conceição Catarina , Osório Joana
Published: October 2023

A male patient in his 20s with a medical history of common variable immunodeficiency disorder, non-compliant with therapy, presented to the emergency department with respiratory distress and severe hypoxaemia. Chest radiography demonstrated extensive bilateral infiltrates and an increased cardiothoracic ratio.Streptococcus pneumoniaeurine antigen test was positive. ECG demonstrated diffuse ST-segment elevation. An arterial line was placed and demonstrated pulsus paradoxus. Transthoracic echocardiography revealed an extensive pericardial effusion, with echocardiographic signs of cardiac tamponade. Emergency subxiphoid pericardiocentesis was performed with an initial drainage of 750 mL of purulent fluid consistent with pyopericardium. Immediate haemodynamic improvement was observed. The patient required a second pericardiocentesis for drainage of a relapsing pericardial effusion. The course was complicated by effusive-constrictive pericarditis requiring anterior interphrenic pericardiectomy. Treatment with intravenous immunoglobulin and antibiotics led to a complete recovery.
Bivalvular infective endocarditis complicated by perivalvular abscess and aorto-right atrium fistula
Authors: Yousaf Amman , Ahmad Soban , Ahsan Muhammad Zorais , Ahsan Muhammad Junaid
Published: October 2023

Infective endocarditis caused byPseudomonas aeruginosain patients without a history of intravenous drug abuse and endovascular procedures is rare. We present a middle-aged man with fever, chills, night sweats and dyspnoea for 2 weeks. Physical examination and blood cultures were drawn, and the patient was empirically started on antibiotics. Unfortunately, the patient experienced progressive clinical deterioration requiring endotracheal intubation and vasopressor support. Transthoracic echocardiogram followed by transesophageal echocardiogram was performed that showed bicuspid aortic valve, severe aortic regurgitation, membranous ventricular septal defect, vegetations on aortic and tricuspid valves, dilated aortic root, and a fistula between the aorta and right atrium. The patient underwent emergent aortic valve and aortic root replacement along with tricuspid commissuroplasty and ventricular septal defect (VSD) closure. Later, intraoperative tissue cultures grewP. aeruginosa, and antipseudomonal antibiotic coverage was added. This case highlights thatP. aeruginosa endocarditiscan occur without risk factors and can lead to fatal cardiovascular complications.
Are maternal vaccines effective and safe for mothers and infants? A systematic review and meta-analysis of randomised controlled trials
Authors: de Bruin Odette , Phijffer Emily , Ahmadizar Fariba , van der Maas Nicoline , Wildenbeest Joanne , Sturkenboom Miriam , Bont Louis , Bloemenkamp Kitty
Published: October 2023

Introduction

Maternal vaccination is a promising strategy to reduce the burden of vaccine-preventable diseases for mothers and infants. We aimed to provide an up-to-date overview of the efficacy and safety of all available maternal vaccines.

Methods

We searched PubMed, Embase, CENTRAL and ClinicalTrials.gov on 1 February 2022, for phase III and IV randomised controlled trials (RCTs) that compared maternal vaccination against any pathogen with placebo or no vaccination. Primary outcomes were laboratory-confirmed or clinically confirmed disease in mothers and infants. Secondary safety outcomes included intrauterine growth restriction, stillbirth, maternal death, preterm birth, congenital malformations and infant death. Random effects meta-analysis were used to calculate pooled risk ratio’s (RR). Quality appraisal was performed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE).

Results

Six RCTs on four maternal vaccines, influenza, tetanus, diphtheria and pertussis (Tdap), pneumococcal and respiratory syncytial virus (RSV) were eligible. The overall risk of bias and certainty of evidence varied from low to high. Maternal influenza vaccination significantly reduced the number of laboratory-confirmed influenza cases (RR 0.58, 95% CI 0.42 to 0.79, event rate 57 vs 98, 2 RCTs, n=6003, I2=0%), and clinically confirmed influenza cases in mothers (RR 0.88, 95% CI 0.78 to 0.99, event rate 418 vs 472, 2 RCTs, n=6003, I2=0%), and laboratory-confirmed influenza in infants (RR 0.66, 95% CI 0.52 to 0.85, event rate 98 vs 148, 2 RCTs, n=5883, I2=0%), although this was not significant for clinically confirmed influenza in infants (RR 0.99, 95% CI 0.94 to 1.05, event rate 1371 vs 1378, 2 RCTs, n=5883, I2=0%). No efficacy data were available on maternal Tdap vaccination. Maternal pneumococcal vaccination did not reduce laboratory-confirmed and clinically confirmed middle ear disease (RR 0.49, 95% CI 0.24 to 1.02, event rate 9 vs 18, 1 RCT, n=133 and RR 0.88 95% CI 0.69 to 1.12, event rate 42 vs 47, 1 RCT, n=133, respectively), and clinically confirmed lower-respiratory tract infection (LRTI) (RR 1.08, 95% CI 0.82 to 1.43, event rate 18 vs 34, 1 RCT, n=70) in infants. Maternal RSV vaccination did not reduce laboratory-confirmed RSV LRTI in infants (RR 0.75, 95% CI 0.56 to 1.01, event rate 103 vs 71, 1 RCT, n=4527). There was no evidence of a significant effect of any of the maternal vaccines on the reported safety outcomes.

Conclusions

The few RCTs with low event rates suggest that, depending on the type of maternal vaccine, the vaccine might effectively prevent disease and within its size does not show safety concerns in mothers and infants.

PROSPERO registration number

CRD42021235115.
Geospatial patterns of progress towards UNAIDS ‘95-95-95’ targets and community vulnerability in Zambia: insights from population-based HIV impact assessments
Authors: Cuadros Diego F , Chowdhury Tuhin , Milali Masabho , Citron Daniel T , Nyimbili Sulani , Vlahakis Natalie , Savory Theodora , Mulenga Lloyd , Sivile Suilanji , Zyambo Khozya Davie , Bershteyn Anna
Published: October 2023

Introduction

In sub-Saharan Africa, HIV/AIDS remains a leading cause of death. The UNAIDS established the ‘95-95-95’ targets to improve HIV care continuum outcomes. Using geospatial data from the Zambia Population-based HIV Impact Assessment (ZAMPHIA), this study aims to investigate geospatial patterns in the ‘95-95-95’ indicators and individual-level determinants that impede HIV care continuum in vulnerable communities, providing insights into the factors associated with gaps.

Methods

This study used data from the 2016 ZAMPHIA to investigate the geospatial distribution and individual-level determinants of engagement across the HIV care continuum in Zambia. Gaussian kernel interpolation and optimised hotspot analysis were used to identify geospatial patterns in the HIV care continuum, while geospatial k-means clustering was used to partition areas into clusters. The study also assessed healthcare availability, access and social determinants of healthcare utilisation. Multiple logistic regression models were used to examine the association between selected sociodemographic and behavioural covariates and the three main outcomes of study.

Results

Varied progress towards the ‘95-95-95’ targets were observed in different regions of Zambia. Each ‘95’ displayed a unique geographical pattern, independent of HIV prevalence, resulting in four distinct geographical clusters. Factors associated with gaps in the ‘95s’ include younger age, male sex, and low wealth, with younger individuals having higher odds of not being on antiretroviral therapy and having detectable viral loads.

Conclusions

Our study revealed significant spatial heterogeneity in the HIV care continuum in Zambia, with different regions exhibiting unique geographical patterns and levels of performance in the ‘95-95-95’ targets, highlighting the need for geospatial tailored interventions to address the specific needs of different subnational regions. These findings underscore the importance of addressing differential regional gaps in HIV diagnosis, enhancing community-level factors and developing innovative strategies to improve local HIV care continuum outcomes.
NISCAHN: a phase II trial of nivolumab in patients with salivary gland carcinoma (Unicancer ORL-08)
Authors: Fayette Jérôme , Even Caroline , Digue Laurence , Geoffrois Lionnel , Rolland Fréderic , Cupissol Didier , Guigay Joel , Le Tourneau Christophe , Dillies Anne Françoise , Zanetta Sylvie , Bozec Laurence , Borel Christian , Couchon-Thaunat Sophie , Costes-Martineau Valérie , Sudaka-Bahadoran Anne , Jallut Isabelle , Garic Florence , Lardy-Cleaud Audrey , Chabaud Sylvie
Published: October 2023

Objective

Salivary gland cancers (SGC) are rare cancers with currently no standard treatment for recurrent/metastatic disease. Based on checkpoint inhibitors benefit in a broad range of tumours, NIvolumab in Salivary gland CArcinoma of the Head and Neck (NISCAHN) evaluated nivolumab efficacy in SGC.

Methods and analysis

In this phase II single-stage Fleming design, patients with SGC with a progressive disease progression within 6 months prior to entering the study, were divided into ACC (adenoid cytic carcinoma) and non-ACC. All received nivolumab for a maximum of 12 months. The primary endpoint was the non-progression rate at 6 months (NPR6m) according to Response Evaluation Criteria in Solid Tumors V.1.1. Secondary endpoints included progression-free survival (PFS), overall survival (OS), overall response rate (ORR), tumour growth rate, safety and quality of life (health-related quality of life).

Results

46 patients with ACC and 52 patients without ACC were enrolled over 1 year. Median follow-up was respectively 29.2 months and 16.9 months for patients with ACC and non-ACC. In the ACC cohort, with 15/45 patients non-progressive at 6 months, the primary endpoint was met (33.3%; 95% CI 21.8 to NE). Nivolumab failed to demonstrate efficacy in the non-ACC cohort (NPR6m: 14.0%; 7/50 patients). ORR, PFS and OS were 8.7% (95% CI 2.4 to 20.8), 5.3 (95% CI 3.2 to 5.6) and 17.2 months (95% CI 12.5-NE) in the ACC cohort, and 3.8% (95% CI 0.5 to 13.2), 1.8 (95% CI 1.7 to 3.5) and 11.5 months (95% CI 7.5 to 14.8) in the non-ACC cohort. Nivolumab safety profile was consistent with previous reports.

Conclusion

Nivolumab has limited efficacy in SGC. Differential results were observed in the two cohorts. The primary endpoint was met in the ACC cohort and no new safety signals were identified.

Trial registration number

EudraCT number: 2016-001794-32/NCT03132038.
Use of immersive virtual reality for stress reduction during botulinum toxin injection for spasticity (RVTOX): a study protocol of a randomised control trial
Authors: Bougeard Marie , Hauret Isabelle , Pelletier-Visa Mathilde , Plan-Paquet Anne , Givron Pascale , Badin Marin , Pereira Bruno , Lanhers Charlotte , Coudeyre Emmanuel
Published: October 2023

Introduction

Botulinum toxin injection is a common way to help reduce spasticity in the body caused by central neurological damage such as cerebral stroke, multiple sclerosis or traumatic brain injury. The pain felt during the injection causes most patients to experience significant stress for further injections, the level of which is variable between patients.

Immersive virtual reality is a digital technique that simulates the three-dimensional spatial and sound environment around a person said to be immersed in this virtualised world. The effectiveness of virtual reality comes from the intensity of this multisensory immersion, known as the feeling of presence (ie, subjective experience of being in one place or one environment, even when you are physically in another one).

Only one research article in paediatrics has shown that immersive reality technique has a positive impact on the level of pain and agitation suffered during botulinum toxin injections. The purpose of this study is therefore to evaluate with sufficient assurance the following research hypothesis: virtual reality can help adults cope with the stress and pain of botulinum toxin treatment injection.

Methods and analysis

The research hypothesis will be tested using a randomised stepped-wedge method versus a non-invasive technique (headset with virtual reality session) to its control (headset with no image nor audio).

The design leads to considering the injection as a statistical unit as all participants will undergo the standard condition, the control technique and virtual reality technique.

Ethics and dissemination

Patients will be fully and fairly informed in terms of their understanding of the objectives and constraints of the study and the possible risks involved. They will also be entitled to refuse the study and/or withdraw, and this refusal will have no impact on their follow-up as part of their pathology. Dissemination of the results of this study will be through peer-reviewed publications, and national and international conferences.

Ethics were approved by the Comité de Protection des Personnes Nord-Ouest in January 2022.

Trial registration number

NCT05364203.
Investigating mortality and morbidity associated with UrINary incontinence during Older Womens Secondary Care Admissions and exploring nurses experiences of delivering related care (U-INconti): a mixed methods research protocol
Authors: Iles-Smith Heather , McMillan Isobel May , Evans-Cheung Trina , Haas Eckersley Ruth , Russell Margaret , Wood Julie , McCarthy Robyn Emelda , Rosson Lyndsey , Doxford-Hook Liz , Fu Yu , McGowan Linda
Published: October 2023

Introduction

Urinary incontinence (UI) is associated with increasing age and is more frequently experienced by women. Despite 40% prevalence in the community, little is known about the prevalence/incidence of UI in older women during hospital admission. UI during hospital admissions, within this group, has also been under-researched in terms of its relationship to specific clinical conditions and mortality rates. Given that UI has serious implications for both patient care and women’s general health and well-being on discharge, this protocol describes a planned research project which aims to determine mortality, morbidity, prevalence and incidence of UI in older women (≥55 years) during hospital admission to inform nursing practice. Additionally, it aims to explore the experience of nurses who deliver women’s care.

Methods and analysis

This is an explanatory mixed-methods study consisting of two phases: (1) retrospecitive analysis of electronic patient care records (EPCR) to determine prevalence/incidence of UI, clinical conditions most likely associated with UI and any associations between UI and death, (2) nurse interviews to explore views, knowledge and perceptions of performing the nursing assessment and providing care for older women (≥55 years) with UI during admission. EPCR will be gained from a National Health Service (NHS) teaching hospital. Nurse interviews will be conducted with nurses from an alternative but similar-sized NHS hospital.

Ethics and dissemination

Ethical approval is provided by the University of Salford Ethics Committee and regulatory approval by the NHS Health Research Authority (Integrated Research Application System project ID: 303118). Local NHS trust approval to access electronic care records for the purposes of analysis of anonymised data has been provided by one of the two collaborating NHS hospitals. Findings will be disseminated through open-access geriatric or urogynaecology journals and presented to relevant stakeholders at local, national and international meetings including scientific meetings such as the UK Continence Society and International Continence Society.
What do healthcare providers think of the quality of uterotonics? A mixed-methods systematic review
Authors: Torloni Maria Regina , Betran Ana Pilar , Vazquez Corona Martha , Bohren Meghan , Widmer Mariana
Published: October 2023

Objectives

To synthesise evidence on the perceptions of healthcare providers (HCPs) about the quality of oxytocin and misoprostol available in their settings, and their actions as a result of these perceptions.

Design

Mixed-methods systematic review.

Eligibility criteria

We included quantitative and qualitative studies reporting HCPs’ perceptions about oxytocin or misoprostol quality.

Data sources

We searched CINAHL, Cochrane Library, Ebscohost, Embase, PubMed, Global Index Medicus, Portal regional BVS, PsycNET, Scopus and Web of Science from inception to 31 March 2022 and grey literature.

Risk of bias

We used the Center for Evidence-Based Management critical appraisal tool for surveys. For qualitative studies, we used the Critical Appraisal Skills Programme tool.

Data extraction and synthesis

Two independent reviewers performed study selection, data extraction and quality assessment. We conducted separate quantitative and qualitative syntheses and integrated the evidence into a narrative synthesis (convergent segregated review design).

Results

We included five (three quantitative and two qualitative) studies, of moderate or high quality, conducted in low-income and middle-income countries (LMICs). In the three quantitative studies (N=7065 participants), 8.2–21.3% of HCPs had experienced problems due to known/suspected low-quality oxytocin and 3.3% due to low-quality misoprostol. In the two qualitative studies, perception of oxytocin quality varied. In quantitative studies, when confronted with suspected/known low-quality oxytocin, 29–78% of HCPs would inform a supervisor, 62% would document this in writing, 45–54% would change to another drug and 5–37% would double the dose of oxytocin. Qualitative evidence suggests that many HCPs do not formally report suspected low-quality oxytocin or misoprostol, and use higher doses or additional uterotonics.

Conclusions

A proportion of HCPs from LMICs perceive oxytocin to be of low quality. There is very limited evidence on their perceptions about misoprostol. Many HCPs do not report suspected low-quality uterotonics but change to another medicine or double the dose of oxytocin.

PROSPERO registration number

CRD42022323812.
Representativeness of a mobile phone-based coverage evaluation survey following mass drug administration for soil-transmitted helminths: a comparison of participation between two cross-sectional surveys
Authors: Ramesh Rohan Michael , Oswald William E , Israel Gideon John , Aruldas Kumudha , Galagan Sean , Legge Hugo , Puthupalayam Kaliappan Saravanakumar , Walson Judd , Halliday Katherine E , Ajjampur Sitara S R
Published: October 2023

Objectives

With increasing mobile phone subscriptions, phone-based surveys are gaining popularity with public health programmes. Despite advantages, systematic exclusion of participants may limit representativeness. Similar to control programmes for neglected tropical diseases (NTDs), the DeWorm3 trial of biannual community-wide mass drug administration (MDA) for elimination of soil-transmitted helminth infection used in-person coverage evaluation surveys to measure the proportion of the at-risk population treated during MDA. Due to lockdown during the COVID-19 pandemic, a phone-based coverage evaluation survey was necessary, providing an opportunity for the current study to compare representativeness and implementation (including non-response) of these two survey modes.

Design

Comparison of two cross-sectional surveys.

Setting

The DeWorm3 trial site in Tamil Nadu, India, includes Timiri, a rural subsite, and Jawadhu Hills, a hilly, hard-to-reach subsite inhabited predominantly by a tribal population.

Participants

In the phone-based and in-person coverage evaluation surveys, all individuals residing in 2000 randomly selected households (50 in each of the 40 trial clusters) were eligible to participate. Here, we characterise household participation.

Results

Of 2000 households, 1780 (89.0%) participated during the in-person survey. Of 2000 households selected for the phone survey, 346 (17.3%) could not be contacted as they had not provided a telephone number during the census and 1144 (57.2%) participated. Smaller households, households with lower socioeconomic status and those with older, women or less educated household-heads were under-represented in the phone-based survey compared with censused households. Regression analysis revealed non-response in the phone-based survey was higher among households from the poorest socioeconomic quintile (prevalence ratio (PR) 2.3, 95% CI 2.0 to 2.7) and lower when heads of households had completed secondary school or higher education (PR 0.7, 95% CI 0.6 to 0.8).

Conclusions

Our findings suggest phone-based surveys under-represent households likely to be at higher risk of NTDs and in-person surveys are more appropriate for measuring MDA coverage within programmatic settings.

Trial registration number

NCT03014167.
Use of CT, ED presentation and hospitalisations 12 months before and after a diagnosis of cancer in Western Australia: a population-based retrospective cohort study
Authors: Ha Ninh Thi , Kamarova Sviatlana , Youens David , Ho Chau , Bulsara Max K , Doust Jenny , Mcrobbie Donald , O’Leary Peter , Wright Cameron , Trevithick Richard , Moorin Rachael
Published: October 2023

Objective

To examine the use of CT, emergency department (ED)-presentation and hospitalisation and in 12 months before and after a diagnosis of cancer.

Design

Population-based retrospective cohort study.

Setting

West Australian linked administrative records at individual level.

Participants

104 009 adults newly diagnosed with cancer in 2004–2014.

Main outcome measures

CT use, ED presentations, hospitalisations.

Results

As compared with the rates in the 12th month before diagnosis, the rate of CT scans started to increase from 2 months before diagnosis with an increase in both ED presentations and hospitalisation from 1 month before the diagnosis. These rates peaked in the month of diagnosis for CT scans (477 (95% CI 471 to 482) per 1000 patients), and for hospitalisations (910 (95% CI 902 to 919) per 1000 patients), and the month prior to diagnosis for ED (181 (95% CI 178 to 184) per 1000 patients) then rapidly reduced after diagnosis but remained high for the next 12 months. While the patterns of the health services used were similar between 2004 and 2014, the rate of the health services used during after diagnosis was higher in 2014 versus 2004 except for CT use in patients with lymphohaematopoietic cancer with a significant reduction.

Conclusion

Our results showed an increase in demand for health services from 2 months before diagnosis of cancer. Increasing use of health services during and post cancer diagnosis may warrant further investigation to identify factors driving this change.
Critically examining health complexity experienced by urban Indigenous peoples in Canada by exploring the factors that allow health complexity to persist: a qualitative study of Indigenous patients in Calgary, Alberta
Authors: Sehgal Anika , Scott Sara , Murry Adam , Henderson Rita , Barnabe Cheryl , Crowshoe Lynden (Lindsay)
Published: October 2023

Objectives

This study aims to identify and critically examine the components of health complexity, and explore the factors that allow it to exist, among urban Indigenous peoples in Canada.

Design

Qualitative exploration with relational conversations.

Setting

Calgary, Alberta, Canada.

Participants

A total of nine urban Indigenous patients were recruited from a multidisciplinary primary healthcare clinic that serves First Nations, Métis and Inuit peoples. Recruitment and data collection took place between September and November 2021.

Results

Thematic analysis revealed three main themes, namely: sources of health complexity, psychological responses to adversity, and resilience, strengths, and protective factors. Key sources of health complexity arose from material resource disparities and adverse interpersonal interactions within the healthcare environment, which manifest into psychological distress while strengths and resilience emerged as protective factors.

Conclusion

The healthcare system remains inapt to address complexity among urban Indigenous peoples in Canada. Healthcare violence experienced by Indigenous peoples only further perpetuates health complexity. Future clinical tools to collect information about health complexity among urban Indigenous patients should include questions about the factors defined in this study.
Safety and efficacy of enhanced recovery after surgery among patients undergoing percutaneous nephrolithotomy: protocol for a systematic review and meta-analysis
Authors: Liu Liang , Yue Xiao , Xiao Yu , Wang Qiang
Published: October 2023

Introduction

Enhanced recovery after surgery is widely used in the perioperative period in the field of urology; however, it lacks comprehensive and systematic evidence supporting its efficacy and safety after percutaneous nephrolithotomy. This meta-analysis aimed to assess the safety and efficacy of enhanced recovery after percutaneous nephrolithotomy.

Methods and analysis

Relevant databases, including PubMed, Web of Science, Embase, The Cochrane Library, China Knowledge Resource Integrated Database, Wanfang Database, Chinese Biomedical Document Service System, and Chinese Science and Technology Journal Database, will be searched from their inception to 19 September 2022. Two researchers will independently screen the literature, extract data and evaluate the included studies. The Grading of Recommendations, Assessment, Development, and Evaluation will be used to assess the degree of certainty of the evidence. Based on the Cochrane Handbook V.5.1.0, the risk of bias assessment of the included randomised controlled trials will be assessed. Based on their randomisation method, allocation generation, concealment, blinding and follow-up, we will assess randomised controlled trials. Random-effects and fixed-effects models and subgroup analyses will be used for meta-analysis. RevMan V.5.4.1 will be used for data collection and meta-analysis.

Ethics and dissemination

Due to the nature of this systematic review, ethics approval is not required for this study. We will publish the results of this review in a peer-reviewed journal.

PROSPERO registration number

CRD42023411520.
MyCOACH (COnnected Advice for Cognitive Health): a digitally delivered multidomain intervention for cognitive decline and risk of dementia in adults with mild cognitive impairment or subjective cognitive decline–study protocol for a randomised controlled trial
Authors: Amos Jessica G , Zheng Lidan , Eramudugolla Ranmalee , Parekh Dinaz , Huque Md Hamidul , Delbaere Kim , Lautenschlager Nicola , Anstey Kaarin J
Published: October 2023

Introduction

Digital health interventions are cost-effective and easily accessible, but there is currently a lack of effective online options for dementia prevention especially for people at risk due to mild cognitive impairment (MCI) or subjective cognitive decline (SCD).

Methods and analysis

MyCOACH (COnnected Advice for Cognitive Health) is a tailored online dementia risk reduction programme for adults aged ≥65 living with MCI or SCD. The MyCOACH trial aims to evaluate the programme’s effectiveness in reducing dementia risk compared with an active control over a 64-week period (N=326). Eligible participants are randomly allocated to one of two intervention arms for 12 weeks: (1) the MyCOACH intervention programme or (2) email bulletins with general healthy ageing information (active control). The MyCOACH intervention programme provides participants with information about memory impairments and dementia, memory strategies and different lifestyle factors associated with brain ageing as well as practical support including goal setting, motivational interviewing, brain training, dietary and exercise consultations, and a 26-week post-intervention booster session. Follow-up assessments are conducted for all participants at 13, 39 and 65 weeks from baseline, with the primary outcome being exposure to dementia risk factors measured using the Australian National University-Alzheimer’s Disease Risk Index. Secondary measures include cognitive function, quality of life, functional impairment, motivation to change behaviour, self-efficacy, morale and dementia literacy.

Ethics and dissemination

Ethical approval was obtained from the University of New South Wales Human Research Ethics Committee (HC210012, 19 February 2021). The results of the study will be disseminated in peer-reviewed journals and research conferences.

Trial registration number

ACTRN12621000977875.