bluuebunny/crossref_metadata_2025 huggingface dataset:
Identification of potential canine mammary tumour cell biomarkers using proteomic approach: Differences in protein profiles among tumour and normal mammary epithelial cells by two‐dimensional electrophoresis‐based mass spectrometry
Authors: Fhaikrue Itsarapan , Srisawat Wanwisa , Nambooppha Boondarika , Pringproa Kidsadagon , Thongtharb Atigan , Prachasilchai Worapat , Sthitmatee Nattawooti
Published: May 2020

Canine mammary tumours (CMTs) are regarded as invasive with a high rate of recurrent and metastasis in intact female dogs. Tumour diagnosis, therefore, is an important step in predicting and monitoring tumour progression. This study was designed to identify protein expression on CMTs by employing a proteomic approach. The primary cell culture from benign mixed tumour, simple carcinoma, complex carcinoma and normal mammary gland were established, and two‐dimensional electrophoresis (2DE) was subsequently performed. The different spots on each sample type were collected for identification using liquid chromatography‐tandem mass spectrometry (LC‐MS/MS). The results indicated that cytokeratin 5 (CK5) and transketolase (TKT) were identified in benign mixed tumour cells and complex carcinoma cells. In contrast, cytokeratin 18 (CK18) and pyruvate kinase PKM were identified in simple carcinoma cells. Moreover, alpha‐2‐HS‐glycoprotein tumour antigen was identified specifically in complex carcinoma cells. In addition, ATP‐dependent 6‐phosphofructokinase platelet type and elongation factor 2 proteins were observed in benign cells. In conclusion, all expressed proteins in this study have been recognized for acting as their expression that differs from healthy mammary epithelial cells. Expectantly, this study identified the expressed proteins that might be useful in further diagnostic biomarker studies on CMTs.
Translanguaging and ‘Culigion’ features of Saudi English
Authors: Elyas Tariq , Alzahrani Muhannad , Widodo Handoyo Puji
Published: May 2020

In Saudi Arabia and other Middle Eastern contexts, English has played an increasingly important role in such different areas as business, politics, popular culture, tourism, economics, education, and religion. Mahboob and Elyas (2014) argue that the social status of English is ideologically replete with economic, social, political, and religious overtones intertwined within the fabric of Saudi society. This has encouraged Mahboob and Elyas (2014) to propose an emerging Expanding Circle variety called ‘Saudi English’. The present study sheds some light on four main issues: (1) English post 9/11 in Saudi Arabia; (2) English in the light of Saudi Vision 2030; (3) the impact of religion, culture, and language on Saudi English; and (4) translanguaging features of Saudi English in contemporary Saudi Arabia. It also examines our findings against the Saudi English's literature in an effort to link this phenomenon of English as a lingua franca and find Englishes that are exclusively related to the Saudi context.
Assessment of Domestic Policies Guiding the Fair and Equitable Sharing of Benefits From Utilization of Genetic Resources and Traditional Knowledge
Authors: Arjjumend Hasrat , Koutouki Konstantia
Published: May 2020

The objective of the Nagoya Protocol guides Parties to regulate illegitimate access and utilization of biological resources or associated traditional knowledge, and also directs Parties to share with fairness, equity and justice the monetary or non-monetary benefits arising out of utilization of genetic resources. In a nod to the United Nations Declaration on Rights of Indigenous People, the Nagoya Protocol binds the Parties to create access and benefit sharing (ABS) laws, policies or administrative measures as envisaged in Articles 5.2 and 5.5 of the Protocol, and obliges the States to allow for benefits to flow to Indigenous peoples and local communities (ILCs). Present paper is based on an opinion survey of academic/research institutions, civil society organizations and concerned individuals apart from competent national authorities of Asian countries. Review of secondary information, especially domestic ABS laws of relevant countries, and participant observation were other means of legal and policy analysis. The findings of this paper illustrate that the accrued benefits from the utilization of genetic resources or traditional knowledge are not adequately realized by Indigenous people or local communities. State sovereignty occupies dominance when justice and equity principles are considered in benefit sharing mechanism. It leads to the infringement of Indigenous rights and conservation objectives. Discrepancies in domestic ABS laws and in the frameworks for their implementation could be addressed by ensuring the participation of ILCs in domestic ABS rulemaking, decision-making processes, and the participatory execution of ABS mechanisms at all levels. The resulting gains in efficiency in the ABS process could then better achieve the goal of conserving and sustainably using biodiversity, while also ensuring respect for the rights of Indigenous people.
Splenic responses to a series of repeated maximal static and dynamic apnoeas with whole‐body immersion in water
Authors: Elia Antonis , Barlow Matthew. J. , Wilson Oliver J. , O'Hara John P.
Published: May 2020

New Findings

What is the central question of this study?

Splenic contractions occur in response to apnoea‐induced hypoxia with and without face immersion in water. However, the splenic responses to a series of static or dynamic apnoeas with whole‐body water immersion in non‐divers and elite breath‐hold divers are unknown.

What is the main finding and its importance?

Static and dynamic apnoeas were equally effective in stimulating splenic contractions across non‐divers and elite breath‐hold divers. These findings demonstrate that the magnitude of the splenic response is largely dictated by the degree of the hypoxemic stress encountered during voluntary apnoeic epochs.

Splenic contractions occur in response to apnoea‐induced hypoxia with and without facial water immersion. However, the splenic responses to a series of static (STA) or dynamic (DYN) apnoeas with whole‐body water immersion in non‐divers (NDs) and elite breath‐hold divers (EBHDs) are unknown. EBHD (n = 8), ND (n = 10) and control participants (n = 8) were recruited. EBHD and ND performed a series of five maximal DYN or STA on separate occasions. Control performed a static eupnoeic (STE) protocol to control against any effects of water immersion and diurnal variation on splenic volume and haematology. Heart rate (HR) and peripheral oxygen saturation (SpO2) were monitored for 30 s after each apnoea. Pre‐ and post‐apnoeic splenic volumes were quantified ultrasonically, and blood samples were drawn for haematology. For EBHD and ND end‐apnoeic HR was higher (P < 0.001) and SpO2 was lower in DYN (P = 0.024) versus STA. EBHD attained lower end‐apnoeic SpO2 during DYN and STA than NDs (P < 0.001). Splenic contractions occurred following DYN (EBHD, −47 ± 6%; ND, −37 ± 4%; P < 0.001) and STA (EBHD, −26 ± 4%; ND, −26 ± 8%; P < 0.01). DYN‐associated splenic contractions were greater than STA in EBHD only (P = 0.042). Haemoglobin concentrations were higher following DYN only (EBHD, +5 ± 8g/L  , +4 ± 2%; ND, +8 ± 3 g/L , +4.9 ± 3%; P = 0.019). Haematocrit remained unchanged after each protocol. There were no between group differences in post‐apnoeic splenic volume or haematology. In both groups, splenic contractions occurred in response to STA and DYN when combined with whole‐body immersion. DYN apnoeas, were effective at increasing haemoglobin concentrations but not STA apnoeas. Thus, the magnitude of the splenic response relates to the hypoxemic stress encountered during apnoeic epochs.
Una revisión temática de las expectativas de los pacientes frente a las conductas del médico
Authors: Marroquín Arturo , Gómez-Restrepo Carlos , Botero-Bermúdez Mónica
Published: May 2020

Introducción:  Actualmente, la medicina enfatiza en una atención centrada en el paciente. No solo la naturaleza de la profesión demanda perpetuar estas intenciones, sino que, inmersos en un sistema de salud en crisis, la satisfacción del paciente como marcador de la calidad de la atención puede traducirse en mejores desenlaces en salud y por ende en ahorros enormes a largo plazo. Objetivo: En este orden de ideas nos propusimos realizar una revisión temática con búsqueda sistemática de la literatura sobre las expectativas del paciente frente al comportamiento del médico durante la atención. Métodos y materiales: Se realizó una búsqueda en las bases de datos Pubmed, Lilacs y Embase con términos específicos y libres. Resultados: Se filtraron 46 artículos para realizar la revisión según criterios de inclusión previamente establecidos. De acuerdo con la información, se crearon 4 dimensiones alrededor del constructo de las expectativas; Confianza, respeto (autonomía), empatía y comunicación. Se extrajo posteriormente la información tanto cuantitativa como cualitativa. Conclusiones: Aunque pareciera existir numerosas investigaciones al respecto, también existe divergencia. Aunque la mayoría de las veces, los individuos parecieran concordar frente a las dimensiones encontradas, s, diferentes grupos culturales y de diferentes características discrepan frente a las expectativas. Teniendo en cuenta esta heterogeneidad, investigación local es requerida para aproximarse a las expectativas de la población colombiana.
Accelerometer-Assessed Prolonged Sitting During Work and Leisure Time and Associations With Age, Body Mass Index, and Health: A Cross-Sectional Study
Authors: Mechlenburg Inger , Tjur Marianne , Overgaard Kristian
Published: May 2020

Background: High levels of sitting may have a negative impact on health. The aim of this study was to examine how sitting time varies between work and leisure time and to identify parameters associated with overall sitting time and prolonged sitting. Methods: In a total of 189 persons ≥18 years randomly selected from the Danish Civil Registration System, sitting time was monitored with an accelerometer-based sensor mounted at the mid-thigh. Moreover, participants completed a questionnaire including data on demographics, work schedule, and general health. Data were processed using a custom built algorithm. Overall sitting was parametrized as mean % of time spent sitting and prolonged sitting as s (periods exceeding 30 minutes). Results: During working hours, the mean overall sitting time (49.2%) was significantly lower than during leisure time on both working days (60.6%, p < .0001) and on days off work (58.9%, p < .0001). For men, prolonged sitting was positively associated with age, while corresponding associations were negative among female participants (p = .01). Body mass index (BMI) increased by 0.06 kg/m2 for every % increase in prolonged sitting (p = .005). The odds ratio of reporting poor health was 1.05 for every % increase in overall sitting during leisure time on workdays (p = .005). Conclusions: Overall sitting time varies between work and leisure time. Prolonged sitting is positively associated with age for men and with BMI for both men and women.
Inconsistent sexual signaling degrades optimal mating decisions in animals
Authors: Tanner Jessie C. , Bee Mark A.
Published: May 2020

Inconsistent signaling alters the landscape of sexual selection by shielding low-quality males from selection.
Nanoscale optical pulse limiter enabled by refractory metallic quantum wells
Authors: Qian Haoliang , Li Shilong , Li Yingmin , Chen Ching-Fu , Chen Wenfan , Bopp Steven Edward , Lee Yeon-Ui , Xiong Wei , Liu Zhaowei
Published: May 2020

Sub–100-nm metallic quantum well heterostructures are able to restrict optical pulses with the intensity up to 400 GW/cm
2
.
Yu-Shiba-Rusinov bands in ferromagnetic superconducting diamond
Authors: Zhang Gufei , Samuely Tomas , Iwahara Naoya , Kačmarčík Jozef , Wang Changan , May Paul W. , Jochum Johanna K. , Onufriienko Oleksandr , Szabó Pavol , Zhou Shengqiang , Samuely Peter , Moshchalkov Victor V. , Chibotaru Liviu F. , Rubahn Horst-Günter
Published: May 2020

Ferromagnetic superconducting nanodiamond films show Yu-Shiba-Rusinov bands with an extraordinarily large spatial extent.
Designing exceptional gas-separation polymer membranes using machine learning
Authors: Barnett J. Wesley , Bilchak Connor R. , Wang Yiwen , Benicewicz Brian C. , Murdock Laura A. , Bereau Tristan , Kumar Sanat K.
Published: May 2020

Designing advanced membrane materials with machine-assisted learning.
Inferring change points in the spread of COVID-19 reveals the effectiveness of interventions
Authors: Dehning Jonas , Zierenberg Johannes , Spitzner F. Paul , Wibral Michael , Neto Joao Pinheiro , Wilczek Michael , Priesemann Viola
Published: May 2020

Keeping the lid on infection spread

From February to April 2020, many countries introduced variations on social distancing measures to slow the ravages of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Publicly available data show that Germany has been particularly successful in minimizing death rates. Dehning
et al.
quantified three governmental interventions introduced to control the outbreak. The authors predicted that the third governmental intervention—a strict contact ban since 22 March—switched incidence from growth to decay. They emphasize that relaxation of controls must be done carefully, not only because there is a 2-week lag between a measure being enacted and the effect on case reports but also because the three measures used in Germany only just kept virus spread below the growth threshold.

Science
, this issue p.
eabb9789
A Rapidly Evolving Polybasic Motif Modulates Bacterial Detection by Guanylate Binding Proteins
Authors: Kohler Kristin M. , Kutsch Miriam , Piro Anthony S. , Wallace Graham D. , Coers Jörn , Barber Matthew F.
Published: May 2020

Many infectious diseases are caused by microbes that enter and survive within host cells. Guanylate binding proteins (GBPs) are a group of immune proteins which recognize and inhibit a variety of intracellular pathogenic microbes. We discovered that a short sequence within GBPs required for the detection of bacteria, the polybasic motif (PBM), has been rapidly evolving between primate species. By swapping PBMs between primate GBP1 genes, we were able to show that specific sequences can both reduce and improve the ability of GBP1 to target intracellular bacteria. We also show that the ability to envelop bacteria has independently evolved in GBP2 of South American monkeys. Taking the results together, this report illustrates how primate GBPs have adapted to defend against infectious pathogens.
Coevolution of Eukaryote-like Vps4 and ESCRT-III Subunits in the Asgard Archaea
Authors: Lu Zhongyi , Fu Ting , Li Tianyi , Liu Yang , Zhang Siyu , Li Jinquan , Dai Junbiao , Koonin Eugene V. , Li Guohui , Chu Huiying , Li Meng
Published: May 2020

The discovery of Asgard archaea has changed the existing ideas on the origins of eukaryotes. Researchers propose that eukaryotic cells evolved from Asgard archaea. This hypothesis partly stems from the presence of multiple eukaryotic signature proteins in Asgard archaea, including homologs of ESCRT proteins that are essential components of the endomembrane system in eukaryotes. However, structural and functional features of Asgard ESCRT remain unknown. Our study provides evidence that Asgard ESCRT is functionally comparable to the eukaryotic counterparts, suggesting that despite the apparent absence of endomembranes in archaea, eukaryotic ESCRT was inherited from an Asgard archaeal ancestor, alongside the emergence of endomembrane system during eukaryogenesis.
Persistent Legionnaires’ Disease and Associated Antibiotic Treatment Engender a Highly Disturbed Pulmonary Microbiome Enriched in Opportunistic Microorganisms
Authors: Pérez-Cobas Ana Elena , Ginevra Christophe , Rusniok Christophe , Jarraud Sophie , Buchrieser Carmen
Published: May 2020

The composition and dynamics of the lung microbiome during pneumonia are not known, although the lung microbiome might influence the severity and outcome of this infectious disease, similar to what was shown for the microbiome at other body sites. Here we report the findings of a comprehensive analysis of the lung microbiome composition of three patients with long-term pneumonia due to
L. pneumophila
and its evolution during antibiotic treatment. This work adds to our understanding of how the microbiome changes during disease and antibiotic treatment and points to microorganisms and their interactions that might be beneficial. In addition to bacteria and fungi, our analyses included archaea and eukaryotes (protozoa), showing that both are present in the pulmonary microbiota and that they might also play a role in the response to the microbiome disturbance.
A Chemical Counterpunch: Chromobacterium violaceum ATCC 31532 Produces Violacein in Response to Translation-Inhibiting Antibiotics
Authors: Lozano Gabriel L. , Guan Changhui , Cao Yanzhuan , Borlee Bradley R. , Broderick Nichole A. , Stabb Eric V. , Handelsman Jo
Published: May 2020

Secondary metabolites play important roles in microbial communities, but their natural functions are often unknown and may be more complex than appreciated. While compounds with antibiotic activity are often assumed to underlie microbial competition, they may alternatively act as signal molecules. In either scenario, microorganisms might evolve responses to sublethal concentrations of these metabolites, either to protect themselves from inhibition or to change certain behaviors in response to the local abundance of another species. Here, we report that violacein production by
C. violaceum
ATCC 31532 is induced in response to hygromycin A from
Streptomyces
sp. 2AW, and we show that this response is dependent on inhibition of translational polypeptide elongation and a previously uncharacterized two-component regulatory system. The breadth of the transcriptional response beyond violacein induction suggests a surprisingly complex metabolite-mediated microbe-microbe interaction and supports the hypothesis that antibiotics evolved as signal molecules. These novel insights will inform predictive models of soil community dynamics and the unintended effects of clinical antibiotic administration.
Persistence of Grenvillian dominance in Laurentian detrital zircon age systematics explained by sedimentary recycling: Evidence from detrital zircon double dating and detrital monazite textures and geochronology
Authors: Zotto S.C. , Moecher D.P. , Niemi N.A. , Thigpen J.R. , Samson S.D.
Published: May 2020

Grenvillian ages dominate Neoproterozoic to Paleozoic detrital zircon (DZ) populations across eastern Laurentia and persist through the present. The persistence of this dominance is inferred to result from recycling of DZ grains ultimately sourced from exceptionally Zr-rich and zircon-fertile Grenvillian granitoids. Pennsylvanian arenites of the Appalachian Basin (eastern United States) exhibit DZ U-Pb age distributions that are nearly identical to those of Neoproterozoic to Cambrian strata, and contain detrital diagenetic monazite grains formed via metamorphism or diagenesis of sedimentary rocks in the source region. Detrital zircon (U-Th)/He ages are mostly 475–300 Ma, yielding lag times [Δt = U-Pb age − (U-Th)/He age] of 500–1000 m.y. and 1200–2400 m.y. for Grenvillian and Paleoproterozoic to Archean DZ grains, respectively. Detrital monazite Th-Pb ages are comparable to (U-Th)/He cooling ages, reflecting formation of monazite during Paleozoic regional metamorphism of Neoproterozoic to Cambrian strata that reset the (U-Th)/He systematics of Grenvillian DZ grains within those metasediments. These results are either consistent with or prove recycling. Incorporation of other geological constraints permits definition of at least three (and potentially five) recycling events and their timing following initial post-Grenvillian exhumation and erosion (the “great Grenvillian sedimentation episode”). Recycling events include dispersal of post-Grenvillian sediment during deposition of Neoproterozoic to Cambrian strata (formation of the “Great Unconformity”: cycle 1), subsequent erosion of metamorphosed Neoproterozoic to Cambrian strata generating detritus for the Pennsylvanian arenites sampled here (cycle 2), and modern erosion of those arenites (cycle 3). Pancontinental river systems facilitated dispersal of sediment of ultimate Grenvillian age during or after each cycle.
Supplemental Material: Ordo-Silurian assemblage in the Indochina interior: Geochronological, elemental, and Sr-Nd-Pb-Hf-O isotopic constraints of early Paleozoic granitoids in South Laos
Authors: Wang Yuejun
Published: May 2020

Table S1: Zircon U-Pb dating results for the early Paleozoic granitoids in South Laos of the Indochina interior; Table S2: Zircon Hf-O isotopic analytical results for the early Paleozoic granitoids in South Laos of the Indochina interior.
Supplemental Material: Cyclostratigraphic calibration of the Eifelian Stage (Middle Devonian, Appalachian Basin, Western New York, USA)
Authors: Pas Damien
Published: May 2020

ICP-OES dataset, Matlad and R scripts.
Supplemental Material: Biomarker evidence of algal-microbial community changes linked to redox and salinity variation, Upper Devonian Chattanooga Shale (Tennessee, USA)
Authors: Song Yi , Xie Shucheng
Published: May 2020

Table S1: original data of all proxies in this paper and concentration of each element and compound; Figure S2: Mass chromatograms of selected sample showing the distribution of (a) n-alkanes, (b) C27-C29 steranes and diasteranes (m/z 217), (c) Terpane m/z 191 fingerprint, (d) aryl isoprenoids (m/z 133 or 134).
Primary care faecal calprotectin testing in children with suspected inflammatory bowel disease: a diagnostic accuracy study
Authors: Walker Gareth J , Chanchlani Neil , Thomas Amanda , Lin Simeng , Moore Lucy , Heerasing Neel M , Hendy Peter , Abdelrahim Mohamed , Mole Sean , Perry Mandy H , Mcdonald Timothy J , Bewshea Claire M , Hart James W , Russell Richard K , Ahmad Tariq , Goodhand James R , Kennedy Nicholas A
Published: May 2020

Objective

To determine the diagnostic accuracy of calprotectin to diagnose inflammatory bowel disease (IBD) in children in whom general practitioners (GPs) suspected IBD.

Design

Prospective observational cohort study of a new calprotectin-based primary care referral pathway.

Setting

48 GP practices and gastroenterology secondary care services at the Royal Devon and Exeter NHS Foundation Trust in the South-West of England, UK.

Patients

195 children aged between 4 and 18 years referred on the pathway between January 2014 and August 2017 for investigation of gastrointestinal symptoms were included.

Interventions

Primary-care-driven faecal calprotectin testing. Primary and secondary care records over 12 months from the point of calprotectin testing were used as the reference standard.

Main outcome measures

Diagnostic accuracy of calprotectin testing to detect IBD.

Results

7% (13/195) tested patients were diagnosed with IBD. Using our prespecified cut-off of 100 µg/g, calprotectin had a diagnostic accuracy of 91% (95% CI 86% to 95%) with a sensitivity for distinguishing IBD from non-IBD of 100% (95% CI 75% to 100%), a specificity of 91% (95% CI 85% to 94%), a positive predictive value of 43% (95% CI 25% to 63%) and a negative predictive value of 100% (95% CI 98% to 100%). Calprotectin testing had no effect on the time to diagnosis, but a negative test contributed to saved referrals and was associated with fewer diagnostic tests in secondary care.

Conclusions

Calprotectin testing of children with suspected IBD in primary care accurately distinguishes IBD from a functional gut disorder, reduces secondary care referrals and associated diagnostic healthcare utilisation.
Insulin enhances renal glucose excretion: relation to insulin sensitivity and sodium-glucose cotransport
Authors: Ferrannini Ele , Pereira-Moreira Ricardo , Seghieri Marta , Rebelos Eleni , Souza Aglécio L , Chueire Valeria B , Arvia Caterina , Muscelli Elza
Published: May 2020

Introduction

Insulin regulates renal glucose production and utilization; both these fluxes are increased in type 2 diabetes (T2D). Whether insulin also controls urinary glucose excretion is not known.

Methods

We applied the pancreatic clamp technique in 12 healthy subjects and 13 T2D subjects. Each participant received a somatostatin infusion and a variable glucose infusion to achieve (within 1 hour) and maintain glycemia at 22 mmol/L for 3 hours; next, a constant insulin infusion (240 pmol/min/kg) was added for another 3 hours. Urine was collected separately in each period for glucose and creatinine determination.

Results

During saline, glucose excretion was lower in T2D than controls in absolute terms (0.49 (0.32) vs 0.69 (0.18) mmol/min, median (IQR), p=0.01) and as a fraction of filtered glucose (16.2 (6.4) vs 19.9 (7.5)%, p<0.001). With insulin, whole-body glucose disposal rose more in controls than T2D (183 (48) vs 101 (48) µmol/kgFFM/min, p<0.0003). Insulin stimulated absolute and fractional glucose excretion in controls (p<0.01) but not in T2D. Sodium excretion paralleled glucose excretion. In the pooled data, fractional glucose excretion was directly related to whole-body glucose disposal and to fractional sodium excretion (r=0.52 and 0.54, both p<0.01). In another group of healthy controls, empagliflozin was administered before starting the pancreatic clamp to block sodium-glucose cotransporter 2 (SGLT2). Under these conditions, insulin still enhanced both glucose and sodium excretion.

Conclusions

Acute exogenous insulin infusion jointly stimulates renal glucose and sodium excretion, indicating that the effect may be mediated by SGLTs. This action is resistant in patients with diabetes, accounting for their increased retention of glucose and sodium, and is not abolished by partial SGLT2 inhibition by empagliflozin.
Does women’s mobile phone ownership matter for health? Evidence from 15 countries
Authors: LeFevre Amnesty E , Shah Neha , Bashingwa Jean Juste Harrisson , George Asha S , Mohan Diwakar
Published: May 2020

Mobile phones have the potential to increase access to health information, improve patient–provider communication, and influence the content and quality of health services received. Evidence on the gender gap in ownership of mobile phones is limited, and efforts to link phone ownership among women to care-seeking and practices for reproductive maternal newborn and child health (RMNCH) have yet to be made. This analysis aims to assess household and women’s access to phones and its effects on RMNCH health outcomes in 15 countries for which Demographic and Health Surveys data on phone ownership are available. Multilevel logistic regression models were used to explore factors associated with women’s phone ownership, along with the association of phone ownership to a wide range of RMNCH indicators. Study findings suggest that (1) gender gaps in mobile phone ownership vary, but they can be substantial, with less than half of women owning mobile phones in several countries; (2) the gender gap in phone ownership is larger for rural and poorer women; (3) women’s phone ownership is generally associated with better RMNCH indicators; (4) among women phone owners, utilisation of RMNCH care-seeking and practices differs based on their income status; and (5) more could be done to unleash the potential of mobile phones on women’s health if data gaps and varied metrics are addressed. Findings reinforce the notion that without addressing the gender gap in phone ownership, digital health programmes may be at risk of worsening existing health inequities.
Beyond HOSPEX: what is the additional training value of military hospital exercises (HOSPEX)?
Authors: Gimzewska Madelaine , Hunter K , Al Azzawi S , Boreham A
Published: May 2020

Background

The use of simulation in clinical environments is a frequently used adjunct to training individuals and teams. The military uses clinical simulation to train large numbers of personnel, standardise patient pathways and sustain specific skills to ensure medical personnel are prepared to deploy in their clinical roles.

Methods

As part of a North Atlantic Treaty Organization (NATO) exercise, 256 Field Hospital (Reserves) deployed a team of clinicians to simulate a role 2 basic field hospital. This hospital exercise (HOSPEX) involved training, and a 4-day real-time exercise with casualty simulation. A retrospective survey of all clinical personnel was conducted to analyse the utility of the exercise on their understanding of their job role, the workings of the field hospital and their confidence in deploying on operations.

Results

39 personnel were surveyed, with questions graded on a modified Likert scale. 41% had previous operational experience in their current job role. A significantly higher proportion of respondents graded their understanding of their job role, and the field hospital overall, as good or excellent having completed the exercise (p<0.01), and 90% felt more confident in fulfilling their operational role postexercise. 90% of respondents had previous experience of simulation, and 94% of these rated the military simulation as being more beneficial than civilian equivalents.

Discussion

With a shift towards simulation in medical training, opportunities have arisen within HOSPEX to develop additional skills for teams and individuals. Simulation is especially important in personnel who have not had previous operational experience, who may deploy on first time operations in senior clinical and leadership roles.

Conclusion

HOSPEXs are perceived as being extremely useful by clinical personnel preparing for future operational deployment. HOSPEX simulation has prepared the military for varied operations since its inception, and the paradigm has potential for extension into civilian training for high intensity medical responses.
Effectiveness of psychological, psychoeducational and psychosocial interventions to prevent postpartum depression in adolescent and adult mothers: study protocol for a systematic review and meta-analysis of randomised controlled trials
Authors: Martín-Gómez Carmen , Moreno-Peral Patricia , Bellón Juan A , Conejo Cerón Sonia , Campos-Paino Henar , Gómez-Gómez Irene , Rigabert Alina , Benítez Isabel , Motrico Emma
Published: May 2020

Introduction

The prevalence of postpartum depression (PPD) is 17%, and the incidence is 12% worldwide. Adverse consequences for mothers and babies have been associated with this disease. To assess the effectiveness of psychological, psychoeducational and psychosocial interventions in preventing PPD, a systematic review and meta-analysis (SR/MA) will be conducted.

Methods and analysis

A SR/MA will be performed following the indications of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies will be identified through MEDLINE (Ovid and PubMed), PsycINFO, Web of Science, Scopus, CINAHL, Cochrane Central Register of Controlled Trials, OpenGrey, Australian New Zealand Clinical Trial Registry, ClinicalTrials.gov and evidencebasedtherapy.org from inception until 31 January 2020. Bridging searches will be also conducted until the review is completed. The selection criteria will be as follows: (1) subjects will be pregnant females or females who have given birth in the last 12 months and who were non-depressive at baseline; (2) psychological, psychoeducational and psychosocial interventions; (3) comparator will be usual care, attention control, waiting list or no intervention; (4) outcomes will be specific results on PPD; and (5) the design of the studies will be randomised controlled trials. No restrictions regarding the year of publication, the setting of the intervention or the language of publication will be considered. Pooled standardised mean differences and 95% CIs will be calculated. The risk of bias of the studies will be assessed through the Cochrane Collaboration risk of bias tool. Heterogeneity between the studies will be determined by the I2 and Cochran’s Q statistics. Sensitivity and subgroup analyses will also be performed. Publication bias will be checked with funnel plots and Egger’s test. Heterogeneity will be explored by random-effects meta-regression analysis.

Ethics and dissemination

The ethical assessment was not required. The results will be presented at conferences and disseminated through publications.

PROSPERO registration number

CRD42018109981.
Efficacy and safety of xuezhikang once per day versus two times per day in patients with mild to moderate hypercholesterolaemia (APEX study): a protocol for a multicentre, prospective randomised controlled, open-label, non-inferiority study
Authors: Wu Zexuan , Wu Dexi , Jiang Jingzhou , Chen Ailan , Zheng Dong-Dan , Li Jianhao , Dong Yugang , Chen Yili
Published: May 2020

Introduction

Reduction in low-density lipoprotein cholesterol (LDL-C) improves clinical outcomes in patients with coronary artery disease. However, rates of lipid-lowering medication adherence are far from ideal. Reducing dosage frequency from multiple dosing to once-daily dosing may improve patients’ medication adherence. Xuezhikang (XZK), an extract of Chinese red yeast rice, contains a family of naturally occurring statins and is traditionally prescribed as 600 mg two times per day. A comParative Efficacy study of XZK (APEX study) is designed to test the hypothesis that XZK prescribed 1200 mg once per day (OD group) is non-inferior to 600 mg two times per day (TD group) in patients with hypercholesterolaemia.

Methods and analysis

The APEX study is a multicentre, prospective randomised controlled, open-label, non-inferiority study. We plan to recruit 316 patients aged ≥18 years with a diagnosis of mild to moderate hypercholesterolaemia for primary prevention. Patients will be randomised (1:1) to OD group and TD group. The OD group take XZK 1200 mg once per day after dinner while TD group take a traditional dose of 600 mg, two times per day after meals. Participants will have an 8-week medication period and be followed up at weeks 0, 4 and 8. The primary end point is the mean percentage change from baseline to week 8 in serum LDL-C. Secondary end points are safety and lipid-lowering effect on other lipoproteins and compliance. Data analyses will be on the intention-to-treat principle using non-inferiority analysis.

Ethics and dissemination

The research had been approved by the Clinical Research and Laboratory Animal Ethics Committee of the First Affiliated Hospital, Sun Yat-sen University ((2017)286). The results will be reported through peer-reviewed journals, seminars and conference presentations.

Trial registration number

ChiCTR-IIR-17013660.
The comparative effectiveness of physical exercise interventions in individuals with chronic non-specific neck pain: protocol for a network meta-analysis
Authors: de Zoete Rutger MJ , McAuley James H , Armfield Nigel R , Sterling Michele
Published: May 2020

Introduction

Neck pain is a global burdensome problem, with a large proportion of neck pain cases becoming chronic. Although physical exercise is a commonly prescribed treatment, the evidence on the effectiveness of isolated exercise interventions remains limited. Traditional pairwise randomised controlled trials (RCTs) and meta-analyses are limited in only comparing two interventions. This protocol describes the design of a network meta-analysis, which enables a comparative investigation of all physical exercise interventions for which RCTs are available. We aim to systematically compare the effectiveness of different types of physical exercise in people with chronic non-specific neck pain.

Methods and analysis

Nine electronic databases (AMED, CINAHL, Cochrane Central Register of Controlled Trials, Embase, MEDLINE, Physiotherapy Evidence Database, PsycINFO, Scopus and SPORTDiscus) were searched for RCTs from inception to 12 March 2019. Titles and abstract firstly, and full-text papers secondly, will be screened by two reviewers. Data will be extracted by two reviewers. The primary outcome measure is effectiveness of the intervention. Methodological quality of included studies will be assessed by two reviewers using the PEDro scale. The overall quality of evidence will be assessed with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework, which has been adapted for network meta-analyses. The available evidence will be summarised using a network diagram. A contribution matrix will be presented to allow assessment of direct and indirect evidence. Forest plots will be constructed to visualise effects of all included exercise interventions. Pairwise effect sizes will be calculated by including all evidence available in the network. Effect measures for treatments that have not been compared in a pairwise RCT can be compared indirectly by contrasting effect sizes of comparisons with a common comparator.

Ethics and dissemination

This work synthesises evidence from previously published studies and does not require ethics review or approval. A manuscript describing the findings will be submitted for publication in a peer-reviewed scientific journal.

PROSPERO registration number

CRD42019126523.
Availability and prices of medicines for non-communicable diseases at health facilities and retail drug outlets in Kenya: a cross-sectional survey in eight counties
Authors: Ashigbie Paul G , Rockers Peter C , Laing Richard O , Cabral Howard J , Onyango Monica A , Buleti John Paul Likalamu , Wirtz Veronika J
Published: May 2020

Objectives

The objective of this study was to determine the availability and prices of medicines for non-communicable diseases (NCDs) in health facilities and private for-profit drug outlets in Kenya.

Design

Cross-sectional study.

Methods

All public and non-profit health facilities in eight counties (Embu, Kakamega, Kwale, Makueni, Narok, Nyeri, Samburu and West Pokot) that purchased medicines from the Mission for Essential Drugs and Supplies, a major wholesaler, were surveyed in September 2016. For each health facility, one nearby private for-profit drug outlet was also surveyed. Data on availability and price were analysed for 24 NCD and 8 acute medicine formulations. Availability was analysed separately for medicines in the national Essential Medicines List (EML) and those in the Standard Treatment Guidelines (STGs). Median price ratios were estimated using the International Medical Products Price Guide as a reference.

Results

59 public and 78 non-profit facilities and 135 drug outlets were surveyed. Availability of NCD medicines was highest in private for-profit drug outlets (61.7% and 29.3% for medicines on the EML and STGs, respectively). Availability of STG medicines increased with increasing level of care of facilities: 16.1% at dispensaries to 31.7% at secondary referral facilities. The mean proportion of availability for NCD medicines listed in the STGs (0.25) was significantly lower than for acute medicines (0.61), p<0.0001. The proportion of public facilities giving medicines for free (0.47) was significantly higher than the proportion of private non-profit facilities giving medicines for free (0.09) (p<0.0001). The mean price ratio of NCD medicines was significantly higher than for acute medicines in non-profit facilities (4.1 vs 2.0, respectively; p=0.0076), and in private for-profit drug outlets (3.5 vs 1.7; p=0.0013).

Conclusion

Patients with NCDs in Kenya appear to have limited access to medicines. Increasing access should be a focus of efforts to achieve universal health coverage.
Characteristics of patients seeking outpatient smoking cessation treatment before and after the implementation of a smoke-free law in Valencia (Spain): a cross-sectional study
Authors: Wang Yang , Guadalupe-Fernández Víctor , Salamanca Ludwing Florez , Saiz Patricia Guillem , Saiz Javier Guillem , Sánchez Carmen Saiz
Published: May 2020

Objective

Explore potential changes in the characteristics of patients requesting smoking cessation treatment at an outpatient setting in Spain before and after Law 42/2010 was enacted.

Design

This is a cross-sectional study with convenience sampling. The information was obtained from the medical records of patients receiving smoking cessation treatment from January 2008 to December 2014.

Setting

Hospital Clinico Universitario de Valencia.

Participants

423 patients who sought smoking cessation treatment 36 months before or 48 months after the enactment of the law.

Results

After the enactment of a comprehensive smoke-free law in Spain, the patients seeking smoking cessation treatment were older (p=0.003), had lower values of exhaled CO (p<0.0001), lower number of previous attempts to quit (p=0.027) and more history of medical problems related to smoking (p=0.002).

Conclusion

Our findings support the idea that society–nation level interventions could have an impact at the individual level, reflected by the change of patients’ characteristics. It seems that the Law 42/2010 mobilised certain group of patients to seek treatment.
Place, poverty and prescriptions: a cross-sectional study using Area Deprivation Index to assess opioid use and drug-poisoning mortality in the USA from 2012 to 2017
Authors: Kurani Shaheen , McCoy Rozalina Grubina , Inselman Jonathan , Jeffery Molly Moore , Chawla Sagar , Finney Rutten Lila J , Giblon Rachel , Shah Nilay D
Published: May 2020

Objective

To identify the relationships between county-level area deprivation and patterns of both opioid prescriptions and drug-poisoning mortality.

Design, setting and participants

For this retrospective cross-sectional study, we used the IQVIA Xponent data to capture opioid prescriptions and Centres for Disease Control and Prevention National Vital Statistics System to assess drug-poisoning mortality. The Area Deprivation Index (ADI) is a composite measure of social determinants of health comprised of 17 US census indicators, spanning four socioeconomic domains. For all US counties with available opioid prescription (2712 counties) and drug-poisoning mortality (3133 counties) data between 2012 and 2017, we used negative binomial regression to examine the association between quintiles of county-level ADI and the rates of opioid prescriptions and drug-poisoning mortality adjusted for year, age, race and sex.

Primary outcome measures

County-level opioid prescription fills and drug-poisoning mortality.

Results

Between 2012 and 2017, overall rates of opioid prescriptions decreased from 96.6 to 72.2 per 100 people, while the rates of drug-poisoning mortality increased from 14.3 to 22.8 per 100 000 people. Opioid prescription and drug-poisoning mortality rates were consistently higher with greater levels of deprivation. The risk of filling an opioid prescription was 72% higher, and the risk of drug-poisoning mortality was 36% higher, for most deprived compared with the least deprived counties (both p<0.001).

Discussion

Counties with greater area-level deprivation have higher rates of filled opioid prescriptions and drug-poisoning mortality. Although opioid prescription rates declined across all ADI quintiles, the rates of drug-poisoning mortality continued to rise proportionately in each ADI quintile. This underscores the need for individualised and targeted interventions that consider the deprivation of communities where people live.
Study protocol and pilot results of an observational cohort study evaluating effect of red blood cell transfusion on oxygenation and mitochondrial oxygen tension in critically ill patients with anaemia: the INsufficient Oxygenation in the Intensive Care Unit (INOX ICU-2) study
Authors: Baysan Meryem , Arbous Mendi S , Mik Egbert G , Juffermans Nicole P , van der Bom Johanna G
Published: May 2020

Introduction

The recently developed protoporphyrin IX-triple state lifetime technique measures mitochondrial oxygenation tension (mitoPO2) in vivo at the bedside. MitoPO2might be an early indicator of oxygen disbalance in cells of critically ill patients and therefore may support clinical decisions regarding red blood cell (RBC) transfusion. We aim to investigate the effect of RBC transfusion and the associated changes in haemoglobin concentration on mitoPO2and other physiological measures of tissue oxygenation and oxygen balance in critically ill patients with anaemia. We present the protocol and pilot results for this study.

Methods and analysis

We perform a prospective multicentre observational study in three mixed intensive care units in the Netherlands with critically ill patients with anaemia in whom an RBC transfusion is planned. The skin of the anterior chest wall of the patients is primed with a 5-aminolevulinic acid patch for 4 hours for induction of mitochondrial protoporphyrin-IX to enable measurements of mitoPO2, which is done with the COMET monitoring device. At multiple predefined moments, before and after RBC transfusion, we assess mitoPO2and other physiological parameters of oxygen balance and tissue oxygenation. Descriptive statistics will be used to describe the data. A linear mixed-effect model will be used to study the association between RBC transfusion and mitoPO2and other traditional parameters of oxygenation, oxygen delivery and oxygen balance. Missing data will be imputed using multiple imputation methods.

Ethics and dissemination

The institutional ethics committee of each participating centre approved the study (reference P16.303), which will be conducted according to the 1964 Helsinki declaration and its later amendments. The results will be submitted for publication in peer-reviewed journals and presented at scientific conferences.

Trial registration number

NCT03092297.
Study protocol for a multicentre longitudinal mixed methods study to explore the Outcomes of ChildrEn and fAmilies in the first year after paediatric Intensive Care: the OCEANIC study
Authors: Manning Joseph C , Latour Jos M. , Curley Martha A.Q. , Draper Elizabeth S. , Jilani Tahseen , Quinlan Philip R , Watson R. Scott , Rennick Janet E. , Colville Gillian , Pinto Neethi , Latif Asam , Popejoy Emma , Coad Jane
Published: May 2020

Introduction

Annually in the UK, 20 000 children become very ill or injured and need specialist care within a paediatric intensive care unit (PICU). Most children survive. However, some children and their families may experience problems after they have left the PICU including physical, functional and/or emotional problems. It is unknown which children and families experience such problems, when these occur or what causes them. The aim of this mixed-method longitudinal cohort study is to understand the physical, functional, emotional and social impact of children surviving PICU (aged: 1 month–17 years), their parents and siblings, during the first year after a PICU admission.

Methods and analysis

A quantitative study involving 300 child survivors of PICU; 300 parents; and 150–300 siblings will collect data (using self-completion questionnaires) at baseline, PICU discharge, 1, 3, 6 and 12 months post-PICU discharge. Questionnaires will comprise validated and reliable instruments. Demographic data, PICU admission and treatment data, health-related quality of life, functional status, strengths and difficulties behaviour and post-traumatic stress symptoms will be collected from the child. Parent and sibling data will be collected on the impact of paediatric health conditions on the family’s functioning capabilities, levels of anxiety and social impact of the child’s PICU admission. Data will be analysed using descriptive and inferential statistics. Concurrently, an embedded qualitative study involving semistructured interviews with 24 enrolled families at 3 months and 9 months post-PICU discharge will be undertaken. Framework analysis will be used to analyse the qualitative data.

Ethics and dissemination

The study has received ethical approval from the National Health Services Research Ethics Committee (Ref: 19/WM/0290) and full governance clearance. This will be the first UK study to comprehensively investigate physical, functional, emotional and social consequences of PICU survival in the first-year postdischarge.

Clinical Trials Registration Number:ISRCTN28072812[Pre-results]