bluuebunny/crossref_metadata_2025 huggingface dataset:
Predation by Euseius scutalis (Acari: Phytoseiidae) on Tetranychus urticae and Eutetranychus orientalis (Acari: Tetranychidae): effect of prey density and developmental stage
Authors: Stathakis Theodoros I. , Kapaxidi Eleftheria V. , Papadoulis Georgios Th. , Papanikolaou Nikos E.
Published: October 2021

Predation ability is a key component determining the suppression of agricultural pests by natural enemies. The aim of this study is to evaluate the effect of prey density and developmental stage on the predation of Euseius scutalis (Acari: Phytoseiidae) on the two-spotted spider mite, Tetranychus urticae (Acari: Tetranychidae) and the oriental red mite, Eutetranychus orientalis (Acari: Tetranychidae). For this purpose, laboratory functional response experiments were conducted using female adults of E. scutalis. Results indicated that the predator causes an inverse density dependent mortality to larvae, nymphs and adults of the two-spotted spider mite, as well as the oriental red mite. The random predator equation was used to fit the data. E. scutalis handling time increased significantly with T. urticae and E. orientalis developmental stage. The maximum number of T. urticae prey consumed was 48.3 larvae, 28.5 nymphs and 11.0 adults, where the corresponding values for E. orientalis were 48.8, 32.2 and 18.2 larvae, nymphs and adults, respectively. Estimated handling times and attack rates of E. scutalis on larvae, nymphs and adults of T. urticae were 0.4970 h and 0.1058 h-1, 0.8435 h and 0.1395 h-1, and 2.1834 h and 0.0835 h-1, respectively. The corresponding values on larvae, nymphs and adults of E. orientalis were 0.4920 h and 0.1166 h-1, 0.7452 h and 0.1361 h-1, and 1.3186 h and 0.0597 h-1, respectively. The results of this study may be indicative of the predation ability of adults of E. scutalis on these notorious pests, providing a basis for determining release rates appropriate for various pest densities.
Review of the genus Transeius Сhant & McMurtry (Acari: Phytoseiidae) of Russia
Authors: Khaustov Vladimir A. , Joharchi Omid , Doker Ismail
Published: October 2021

Surveys were carried out to assess Phytoseiidae (Acari: Mesostigmata) diversity in various habitats and ecosystems during the last two years in Russia. This study aimed to provide a review of the Russian species belonging to the genus Transeius Chant & McMurtry (Acari: Phytoseiidae) mostly based on the materials collected in this study as well as previous records. As a result, T. avetianae (Arutunjan & Ohandjanian) and T. proximus (Kolodochka) are reported for the first time in Russia. In addition, Transeius kornosorae Döker & Khaustov sp. nov. is described based on females. Furthermore, an identification key is provided for Russian species of the genus.
Analysis of Six
tonB
Gene Homologs in Bacteroides fragilis Revealed That
tonB3
is Essential for Survival in Experimental Intestinal Colonization and Intra-Abdominal Infection
Authors: Parker Anita C. , Seals Nathaniel L. , Baccanale Cecile L. , Rocha Edson R.
Published: October 2021

The opportunistic, anaerobic pathogen and commensal of the human large intestinal tract,
Bacteroides fragilis
strain 638R, contains six predicted TonB proteins, termed TonB1-6, four ExbBs orthologs, ExbB1-4, and five ExbDs orthologs, ExbD1-5. The inner membrane TonB/ExbB/ExbD complex harvests energy from the proton motive force (Δp), and the TonB C-terminal domain interacts with and transduces energy to outer membrane TonB-dependent transporters (TBDTs).
Trained Innate Immunity Induced by Vaccination with Low-Virulence
Candida
Species Mediates Protection against Several Forms of Fungal Sepsis via Ly6G
+
Gr-1
+
Leukocytes
Authors: Lilly Elizabeth A. , Bender Breah E. , Esher Righi Shannon , Fidel Paul L. , Noverr Mairi C.
Published: October 2021

Trained innate immunity (TII) is induced following immunization with live attenuated microbes and represents a clinically important strategy to enhance innate defenses. TII was initially demonstrated following intravenous inoculation with low-virulence
Candida albicans
, with protection against a subsequent lethal
C. albicans
intravenous bloodstream infection (BSI) mediated by monocytes with enhanced cytokine responses.
Cytokinin Inhibits Fungal Development and Virulence by Targeting the Cytoskeleton and Cellular Trafficking
Authors: Gupta Rupali , Anand Gautam , Pizarro Lorena , Laor Bar-Yosef Dana , Kovetz Neta , Sela Noa , Yehuda Tal , Gazit Ehud , Bar Maya
Published: October 2021

Cytokinins (CKs), important plant growth/developmental hormones, have previously been associated with host disease resistance. Here, we demonstrate that CK directly inhibits the growth, development, and virulence of
B. cinerea
(
Bc
) and many additional phytopathogenic fungi.
A Previously Undescribed Highly Prevalent Phage Identified in a Danish Enteric Virome Catalog
Authors: Van Espen Lore , Bak Emilie Glad , Beller Leen , Close Lila , Deboutte Ward , Juel Helene Bæk , Nielsen Trine , Sinar Deniz , De Coninck Lander , Frithioff-Bøjsøe Christine , Fonvig Cilius Esmann , Jacobsen Suganya , Kjærgaard Maria , Thiele Maja , Fullam Anthony , Kuhn Michael , Holm Jens-Christian , Bork Peer , Krag Aleksander , Hansen Torben , Arumugam Manimozhiyan , Matthijnssens Jelle
Published: October 2021

Through generation of the DEVoC, we added numerous previously uncharacterized viral genomes and genes to the ever-increasing worldwide pool of human gut viromes. The DEVoC, the largest human gut virome catalog generated from consistently processed fecal samples, facilitated the analysis of the 91 healthy Danish gut viromes.
Bilateral iliopsoas abscess presenting with abdominal wall cellulitis and left-sided empyema thoracis: a rare presentation
Authors: Suresh Chilaka , Shaikh Oseen Hajilal , Naik Mude Naveen , Kumbhar Uday Shamrao
Published: October 2021

Iliopsoas abscess is common in immunocompromised patients and rarely presents with empyema thoracis. We present a 26-year-old male with no comorbidities who presented with a 3-day history of abdominal pain, fever and dyspnoea. There was no history of tuberculosis or recent contact with a tuberculous patient. On examination, the patient had facial dysmorphism and abdominal wall cellulitis extending bilaterally from flank to the inguinoscrotal region. Chest X-ray showed a left pleural effusion. Ultrasonography and contrast-enhanced CT also showed bilateral iliopsoas abscess with a left massive pleural empyema. The patient underwent bilateral abscess open drainage, thoracostomy for left empyema thoracis and intravenous antibiotic therapy. The patient had an uneventful course postoperatively and was discharged.
Left ventricular apical mass after myocardial infarction—not always a thrombus: a diagnostic dilemma
Authors: Balasubramaniyan Jayanty Venkata , Arul Judah Nijas , Rathinasamy Jebaraj , Periyasamy Thangavel
Published: October 2021

Myxomas arising from the left ventricle (LV) are extremely rare and can be easily mistaken for a thrombus. We report a case of a 35-year-old man who presented with an acute cerebrovascular accident, having had a prior history of an anterior wall myocardial infarction 2 years back with an echocardiographic evaluation showing mild LV systolic dysfunction. His present prothrombotic workup revealed hyperhomocystinaemia and elevated levels of factor VIII. Present echocardiography revealed a mass arising from a scarred LV wall. Considering the possibility of a thrombus, he was initially started on parenteral anticoagulation. Unfortunately, consequent echocardiogram evaluation showed no reduction in size of the LV mass hence surgical removal was done. Histopathological evaluation unveiled the mass to be a myxoma.
Complicated and persistent severe COVID-19 pneumonia in a recipient of allogeneic haematopoietic stem cell transplant
Authors: Lazzari Lorenzo , Oltolini Chiara , Ciceri Fabio , Giglio Fabio
Published: October 2021

We describe the case of a 45-year-old man affected by T-cell acute lymphoblastic leukaemia and diagnosed with COVID-19 early after an allogeneic haematopoietic stem cell transplant. The infectious disease was characterised by a severe and prolonged course, further complicated by a spontaneous pneumomediastinum and pneumopericardium. We successfully treated this patient with the antiviral drug remdesivir associated with two courses of COVID-19 convalescent plasma. This case report represents a good example of the typical clinical course of COVID-19 in severely immunosuppressed patients and gives evidence that in this population only a prompt treatment directed towards viral clearance can face the absence of a valid immune reactivity.
Vaccine nationalism and internationalism: perspectives of COVID-19 vaccine trial participants in the United Kingdom
Authors: Vanderslott Samantha , Emary Katherine , te Water Naude Rebecca , English Marcus , Thomas Tonia , Patrick-Smith Maia , Henry John , Douglas Naomi , Moore Maria , Stuart Arabella , Hodgson Susanne H , Pollard Andrew J
Published: October 2021

Background

Vaccine nationalism has become a key topic of discussion during the development, testing, and rollout of COVID-19 vaccines. Media attention has highlighted the ways that global, coordinated access to vaccines has been limited during the pandemic. It has also exposed how some countries have secured vaccine supply, through bilateral purchase agreements and the way pharmaceutical companies have priced, negotiated, and delivered these supplies. Much of the focus of this debate has been on the vaccine supply ‘winners’ and ‘losers’, but the voices of public opinion have been more limited.

Methods

We explore the concepts of vaccine nationalism and internationalism from the perspective of vaccine trial participants, using an empirical perspectives study that involved interviews with phase I/II COVID-19 vaccine trial participants in Oxford, UK. We surveyed and interviewed participants between September and October 2020 about their views, motivations and experiences in taking part in the trial.

Results

First, we show how trial participants describe national and international ideas about vaccination as intertwined and challenge claims that these positions are mutually exclusive or oppositional. Second, we analyse these viewpoints further to show that vaccine nationalism is closely connected with national pride and metaphors of a country’s scientific achievements. Participants held a global outlook and were highly supportive of the prioritisation of vaccines by global need, but many were also pessimistic that such a solution could be possible.

Conclusion

Trial participants constitute an informed public group, with situated public expertise that the global community could draw on as an expert opinion. We argue that vaccine nationalism is strongly attached to national character and, therefore, it is more difficult for ownership of a vaccine to be thought of as international.
Social and economic costs of gambling problems and related harm among UK military veterans
Authors: Harris Shaun , Pockett R D , Dighton G , Wood K , Armour C , Fossey M , Hogan L , Kitchiner N , Larcombe J , Rogers R D , Dymond S
Published: October 2021

Introduction

Military veterans are at heightened risk of problem gambling. Little is known about the costs of problem gambling and related harm among United Kingdom (UK) Armed Forces (AF) veterans. We investigated the social and economic costs of gambling among a large sample of veterans through differences in healthcare and social service resource use compared with age-matched and gender-matched non-veterans from the UK AF Veterans’ Health and Gambling Study.

Methods

An online survey measured sociodemographic characteristics, gambling experience and problem severity, mental health and healthcare resource utilisation. Healthcare provider, personal social service and societal costs were estimated as total adjusted mean costs and utility, with cost-consequence analysis of a single timepoint.

Results

Veterans in our sample had higher healthcare, social service and societal costs and lower utility. Veterans had greater contacts with the criminal justice system, received more social service benefits, had more lost work hours and greater accrued debt. A cost difference of £590 (95% CI −£1016 to −£163) was evident between veterans with scores indicating problem gambling and those reporting no problems. Costs varied by problem gambling status.

Conclusions

Our sample of UK AF veterans has higher healthcare, social service and societal costs than non-veterans. Veterans experiencing problem gambling are more costly but have no reduction in quality of life.
Multilevel factors influencing contraceptive use and childbearing among adolescent girls in Bara district of Nepal: a qualitative study using the socioecological model
Authors: Sekine Kazutaka , Khadka Nirajan , Carandang Rogie Royce , Ong Ken Ing Cherng , Tamang Anand , Jimba Masamine
Published: October 2021

Objectives

This study aimed to identify the multilevel factors that influence contraceptive use and childbearing decisions in Nepal and examine relationships among these factors.

Design

The study drew on qualitative data collected through in-depth interviews (IDIs) and key informant interviews (KIIs) and triangulated results.

Setting

An urban municipality and a rural municipality in Bara district, Nepal.

Participants

We recruited a total of 60 participants (e.g., 20 married adolescent girls aged 15–19, 20 husbands, 20 mothers-in-law) for IDIs and 10 (e.g., four healthcare providers, three health coordinators, three female community health volunteers) for KIIs.

Results

Married adolescent girls faced a range of barriers that are inter-related across different levels. Patriarchal norms and power imbalances between spouses limited their decision-making power regarding contraception. Social pressures to give birth soon after marriage drove the fear of infertility, abandonment and the stigmatisation of childless married couples, which leads to lack of women’s autonomy in making decisions about family planning. Mothers-in-law and religion exerted considerable influence over couples’ decisions regarding contraception. Limited access to information about the benefits and methods of family planning contributed to fear of the side effects of contraceptives and low awareness about the risks involved in adolescent pregnancy.

Conclusions

The convergent results from triangulation confirm that the decision to postpone childbearing is not merely the personal choice of an individual or a couple, highlighting the importance of targeting families and communities. The study underscores the need to challenge restrictive sociocultural norms so that adolescent girls become empowered to exercise greater control over contraceptive use.
Trends in gender of authors of original research in oncology among major medical journals: a retrospective bibliometric study
Authors: Lee Shing Fung , Redondo Sánchez Daniel , Sánchez María‑José , Gelaye Bizu , Chiang Chi Leung , Wong Irene Oi Ling , Cheung Denise Shuk Ting , Luque Fernandez Miguel Angel
Published: October 2021

Objective

We evaluated the temporal trend in gender ratios of first and last authors in the field of oncological research published in major general medical and oncology journals and examined the gender pattern in coauthorship.

Design

We conducted a retrospective study in PubMed using the R package RISmed. We retrieved original research articles published in four general medical journals and six oncology specialty journals. These journals were selected based on their impact factors and popularity among oncologists. We identified the names of first and last authors from 1 January 2002 to 31 December 2019. The gender of the authors was identified and validated using the Gender API database (https://gender-api.com/).

Primary and secondary outcome measures

The percentages of first and last authors by gender and the gender ratios (male to female) and temporal trends in gender ratios of first and last authors were determined.

Results

We identified 34 624 research articles, in which 32 452 had the gender of both first and last authors identified. Among these 11 650 (33.6%) had women as the first author and 7908 (22.8%) as the last author, respectively. The proportion of female first and last authors increased from 26.6% and 16.2% in 2002, to 32.9% and 27.5% in 2019, respectively. However, the gender ratio (male to female) of first and last authors decreased by 1.5% and 2.6% per year, respectively, which were statistically significant (first author: incidence rate ratio (IRR) 0.98, 95% CI 0.97 to 1.00; last author: IRR 0.97, 95% CI 0.96 to 0.99). Male first and last authorship was the most common combination. Male–female and female–female pairs increased by 2.0% and 5.0%, respectively (IRR 1.02, 95% CI 1.01 to 1.03 and IRR 1.05, 95% CI 1.04 to 1.06, respectively).

Conclusions

The continued under-representation of women means that more efforts to address parity for advancement of women in academic oncology are needed.
Efficacy of left ventricular unloading strategies during venoarterial extracorporeal membrane oxygenation in patients with cardiogenic shock: a protocol for a systematic review and Bayesian network meta-analysis
Authors: Zhang Pengbin , Wei Shilin , Zhai Kerong , Huang Jian , Cheng Xingdong , Tao Zhenze , Gao Bingren , Liu Debin , Li Yongnan
Published: October 2021

Introduction

Venoarterial extracorporeal membrane oxygenation (VA-ECMO) has been widely used for patients with refractory cardiogenic shock. A common side effect of this technic is the resultant increase in left ventricular (LV) afterload which could potentially aggravate myocardial ischaemia, delay ventricular recovery and increase the risk of pulmonary congestion. Several LV unloading strategies have been proposed and implemented to mitigate these complications. However, it is still indistinct that which one is the best choice for clinical application. This Bayesian network meta-analysis (NMA) aims to compare the efficacy of different LV unloading strategies during VA-ECMO.

Methods and analysis

PubMed, Embase, the Cochrane Library and the International Clinical Trials Registry Platform will be explored from their inception to 31 December 2020. Random controlled trials and cohort studies that compared different LV unloading strategies during VA-ECMO will be included in this study. The primary outcome will be in-hospital mortality. The secondary outcomes will include neurological complications, haemolysis, bleeding, limb ischaemia, renal failure, gastrointestinal complications, sepsis, duration of mechanical ventilation, length of intensive care unit and hospital stays. Pairwise and NMA will respectively be conducted using Stata (V.16, StataCorp) and Aggregate Data Drug Information System (V.1.16.5), and the cumulative probability will be used to rank the included LV unloading strategies. The risk of bias will be conducted using the Cochrane Collaboration’s tool or Newcastle-Ottawa Quality Assessment Scale according to their study design. Subgroup analysis, sensitivity analysis and publication bias assessment will be performed. The Grading of Recommendations Assessment, Development and Evaluation will be conducted to explore the quality of evidence.

Ethics and dissemination

Either ethics approval or patient consent is not necessary, because this study will be based on literature. The results will be disseminated through peer-reviewed publications and conference presentations.

PROSPERO registration number

CRD42020165093.
Minimal versus specialist equipment in the delivery of pulmonary rehabilitation: protocol for a non-inferiority randomised controlled trial
Authors: Nolan Claire M , Walsh Jessica A , Patel Suhani , Barker Ruth E , Polgar Oliver , Maddocks Matthew , Gao Wei , Wilson Rebecca , Fiorentino Francesca , Man William
Published: October 2021

Introduction

Pulmonary rehabilitation (PR), an exercise and education programme for people with chronic lung disease, aims to improve exercise capacity, breathlessness and quality of life. Most evidence to support PR is from trials that use specialist exercise equipment, for example, treadmills (PR-gym). However, a significant proportion of programmes do not have access to specialist equipment with training completed with minimal exercise equipment (PR-min). There is a paucity of robust literature examining the efficacy of supervised, centre-based PR-min. We aim to determine whether an 8-week supervised, centre-based PR-min programme is non-inferior to a standard 8-week supervised, centre-based PR-gym programme in terms of exercise capacity and health outcomes for patients with chronic lung disease.

Methods and analysis

Parallel, two-group, assessor-blinded and statistician-blinded, non-inferiority randomised trial. 436 participants will be randomised using minimisation at the individual level with a 1:1 allocation to PR-min (intervention) or PR-gym (control). Assessment will take place pre-PR (visit 1), post-PR (visit 2) and 12 months following visit 1 (visit 3). Exercise capacity (incremental shuttle walk test), dyspnoea (Chronic Respiratory Questionnaire (CRQ)-Dyspnoea), health-related quality of life (CRQ), frailty (Short Physical Performance Battery), muscle strength (isometric quadriceps maximum voluntary contraction), patient satisfaction (Global Rating of Change Questionnaire), health economic as well as safety and trial process data will be measured. The primary outcome is change in exercise capacity between visit 1 and visit 2. Two sample t-tests on an intention to treat basis will be used to estimate the difference in mean primary and secondary outcomes between patients randomised to PR-gym and PR-min.

Ethics and dissemination

London-Camden and Kings Cross Research Ethics Committee and Health Research Authority have approved the study (18/LO/0315). Results will be submitted for publication in peer-reviewed journals, presented at international conferences, disseminated through social media, patient and public routes and directly shared with stakeholders.

Trial registration number

ISRCTN16196765.
Retrospective analysis of characteristics associated with higher-value radiotherapy episodes of care for bone metastases in Medicare fee-for-service beneficiaries
Authors: Marshall Deborah , Aldridge Melissa D , Dharmarajan Kavita
Published: October 2021

Objectives

The Centers for Medicare & Medicaid Services’ newly enacted Radiation Oncology Model (‘RO Model’) was designed to test the cost-saving potential of prospective episode-based payments for radiation treatment for 17 cancer diagnoses by encouraging high-value care and more efficient care delivery. For bone metastases, evidence supports the use of higher-value, shorter courses of radiation (≤10 fractions). Our goal was to determine the prevalence of short radiation courses (≤10 fractions) for bone metastases and the setting, treatment and patient characteristics associated with such courses and their expenditures.

Design

Using the RO Model episode file, we evaluated receipt of ≤10 fractions of radiotherapy for bone metastases and expenditures by treatment setting for Medicare fee-for-service beneficiaries during calendar years 2015–2017.

Using unadjusted and adjusted regression models, we determined predictors of receipt of ≤10 fractions and expenditures. Multivariable models adjusted for treatment and patient characteristics.

Results

There were 48 810 episodes for bone metastases during the period. A majority of episodes for ≤10 fractions occurred in hospital-outpatient settings (62.8% (N=22 715)). After adjusting for treatment and patient factors, hospital-outpatient treatment setting remained a significant predictor of receiving ≤10 fractions (adjusted OR 2.03 (95% CI 1.95, 2.12; p<0.001) vs free-standing). The greatest adjusted contributors to total expenditures were number of fractions (US$−3424 (95% CI US$−3412 to US$−3435) for ≤10 fractions vs >10; p<0.001) and treatment type (including US$7716 (95% CI US$7424 to US$8018) for intensity modulated radiation therapy vs conventional external beam; p<0.001).

Conclusions

A measurable performance gap exists for delivery of higher-value bone metastases radiotherapy under an episode-based model, associated with increased expenditures. The RO Model may succeed in improving the value of bone metastases radiation. Increasing the capacity of free-standing centres to implement palliative-focused services may improve the ability of these practices to succeed under the RO Model.
Role and utility of COVID-19 laboratory testing in low-income and middle-income countries: protocol for rapid evidence synthesis
Authors: Ouma Ojiambo Kevin , Ephraim Kisangala , Loyce Nakalembe , Namisango Eve , Nalugoda Fred , Ndagire Regina , Wangi Rachel Nante , Kawala Brenda Allen , Katairo Thomas , Okullo Allen Eva , Apunyo Robert , Semakula Daniel , Luwambo Ash , Kinengyere Alison Annet , Sewankambo Nelson , Balinda Sheila N , Ocan Moses , Obuku Ekwaro A
Published: October 2021

Introduction

Accurate and affordable laboratory testing is key to timely diagnosis and appropriate management of patients with COVID-19. New laboratory test protocols are released into the market under emergency use authorisation with limited evidence on diagnostic test accuracy. As such, robust evidence on the diagnostic accuracy and the costs of available tests is urgently needed to inform policy and practice especially in resource-limited settings. We aim to determine the diagnostic test accuracy, cost-effectiveness and utility of laboratory test strategies for COVID-19 in low-income and middle-income countries.

Methods and analysis

This will be a multistaged, protocol-driven systematic review conducted in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for diagnostic test accuracy studies. We will search for relevant literature in at least six public health databases, including PubMed, Google Scholar, MEDLINE, Scopus, Web of Science and the WHO Global Index Medicus. In addition, we will search Cochrane Library, COVID-END and grey literature databases to identify additional relevant articles before double-screening and abstraction of data. We will conduct a structured narrative and quantitative synthesis of the results guided by the Fryback and Thornbury framework for assessing a diagnostic test. The primary outcome is COVID-19 diagnostic test accuracy. Using the GRADE approach specific to diagnostic accuracy tests, we will appraise the overall quality of evidence and report the results following the original PRISMA statement. The protocol is registered with the International Prospective Register of Systematic Reviews (PROSPERO;https://www.crd.york.ac.uk/prospero/).

Ethics and dissemination

Ethical review was done by the School of Biomedical Sciences Research Ethics Committee and the Uganda National Council for Science and Technology. The published article will be accessible to policy and decision makers. The findings of this review will guide clinical practice and policy decisions and highlight areas for future research.

PROSPERO registration numberCRD42020209528.
Intranasal insulin for treatment of delirium in older hospitalised patients: study protocol for a randomised controlled trial
Authors: Nitchingham Anita , Milne Andrew , Toson Barbara , Tuch Bernard , Agar Meera , Close Jacqueline , Caplan Gideon
Published: October 2021

Introduction

Delirium is one of the most common conditions diagnosed in hospitalised older people and is associated with numerous adverse outcomes, yet there are no proven pharmacological treatments. Recent research has identified cerebral glucose hypometabolism as a pathophysiological mechanism offering a therapeutic target in delirium. Insulin, delivered via the intranasal route, acts directly on the central nervous system and has been shown to enhance cerebral metabolism and improve cognition in patients with mild cognitive impairment and dementia. This trial will determine whether intranasal insulin can reduce the duration of delirium in older hospitalised patients.

Methods and analysis

This is a prospective randomised, placebo-controlled, double-blind study with 6 months follow-up. One hundred patients aged 65 years or older presenting to hospital with delirium admitted under geriatric medicine will be recruited. Participants will be randomised to intranasal insulin detemir or placebo administered twice daily until delirium resolves, defined as Confusion Assessment Method (CAM) negative for 2 days, or discharge from hospital. The primary outcome measure will be duration of delirium using the CAM. Secondary outcome measures will include length of hospital stay, severity of delirium, adherence to treatment, hospital complications, new admission to nursing home, mortality, use of antipsychotic medications during hospital stay and cognitive and physical function at 6 months postdischarge.

Ethics and dissemination

This trial has been approved by the South Eastern Sydney Human Research and Ethics Committee. Dissemination plans include submission to a peer-reviewed journal for publication and presentation at scientific conferences.

Trial registration number

ACTRN12618000318280.
Longitudinal study on the effect of surgical weight loss on beat-to-beat blood pressure variability in patients undergoing bariatric surgery: a study protocol
Authors: Fares Souha , Bakkar Nour-Mounira Z , Alami Ramzi , Lakkis Issam , Badr Kamal
Published: October 2021

Introduction

Alterations in linear and non-linear parameters of beat-to-beat blood pressure variability (BPV) have been shown to predict disease prognosis and distinguish between risk categories in various pathological conditions, independently of average blood pressure levels. Obesity places subjects at elevated risk of vascular diseases, including hypertension, resulting in serious cardiac, respiratory and cerebral events. However, little is known about the status of vascular dynamics in obese and morbidly obese adults.

Methods and analysis

In this present quasi-experimental longitudinal study, changes in beat-to-beat BPV, using continuous, non-invasive blood pressure monitoring, in obese subjects undergoing bariatric surgery are characterised. The capacity of linear and non-linear measures of BPV to detect differences between hypertensive, prehypertensive and normotensive obese subjects prebariatric and postbariatric surgery are tested. Additionally, potential correlations between beat-to-beat BPV and age, body mass index, gender and comorbidities will be investigated. In parallel, the impact of the unsteady fluctuations of beat-to-beat blood pressure on the dynamic stresses imparted by blood flow on blood vessel walls will be explored. We expect to find altered BPV profiles in hypertensive and prehypertensive subjects as compared with normotensive subjects. We also expect to see differential normalisation in BPV profiles between hypertensive, prehypertensive and normotensive subjects over time.

Ethics and dissemination

The study has been approved by the Institutional Review Board at the American University of Beirut (IRB ID: BIO-2018-0040). Study results will be made available to the public through publications in peer-reviewed journals and conference papers and/or presentations.
Characteristics of frequently attending children in hospital emergency departments: a systematic review
Authors: Greenfield Geva , Okoli Olivia , Quezada-Yamamoto Harumi , Blair Mitch , Saxena Sonia , Majeed Azeem , Hayhoe Benedict
Published: October 2021

Objective

To summarise the literature on frequent attendances to hospital emergency departments (EDs) and describe sociodemographic and clinical characteristics of children who attend EDs frequently.

Setting

Hospital EDs.

Participants

Children <21 years, attending hospital EDs frequently.

Primary outcome measures

Outcomes measures were defined separately in each study, and were predominantly the number of ED attendances per year.

Results

We included 21 studies representing 6 513 627 children. Between 0.3% and 75% of all paediatric ED users were frequent users. Most studies defined four or more visits per year as a ‘frequent ED’ usage. Children who were frequent ED users were more likely to be less than 5 years old. In the USA, patients with public insurance were more likely to be frequent attenders. Frequent ED users more likely to be frequent users of primary care and have long-term conditions; the most common diagnoses were infections and gastroenteritis.

Conclusions

The review included a wide range of information across various health systems, however, children who were frequent ED users have some universal characteristics in common. Policies to reduce frequent attendance might usefully focus on preschool children and supporting primary care in responding to primary care oriented conditions.
Financing of surgery and anaesthesia in sub-Saharan Africa: a scoping review
Authors: Ifeanyichi Martilord , Aune Ellis , Shrime Mark , Gajewski Jakub , Pittalis Chiara , Kachimba John , Borgstein Eric , Brugha Ruairi , Baltussen Rob , Bijlmakers Leon
Published: October 2021

Objective

This study aimed to provide an overview of current knowledge and situational analysis of financing of surgery and anaesthesia across sub-Saharan Africa (SSA).

Setting

Surgical and anaesthesia services across all levels of care—primary, secondary and tertiary.

Design

We performed a scoping review of scientific databases (PubMed, EMBASE, Global Health and African Index Medicus), grey literature and websites of development organisations. Screening and data extraction were conducted by two independent reviewers and abstracted data were summarised using thematic narrative synthesis per the financing domains: mobilisation, pooling and purchasing.

Results

The search resulted in 5533 unique articles among which 149 met the inclusion criteria: 132 were related to mobilisation, 17 to pooling and 5 to purchasing. Neglect of surgery in national health priorities is widespread in SSA, and no report was found on national level surgical expenditures or budgetary allocations. Financial protection mechanisms are weak or non-existent; poor patients often forego care or face financial catastrophes in seeking care, even in the context of universal public financing (free care) initiatives.

Conclusion

Financing of surgical and anaesthesia care in SSA is as poor as it is underinvestigated, calling for increased national prioritisation and tracking of surgical funding. Improving availability, accessibility and affordability of surgical and anaesthesia care require comprehensive and inclusive policy formulations.
Multicentric study to evaluate the effectiveness of Thermalytix as compared with standard screening modalities in subjects who show possible symptoms of suspected breast cancer
Authors: Singh Akshita , Bhat Venkatraman , Sudhakar S , Namachivayam ArunKumar , Gangadharan Charitha , Pulchan Candice , Sigamani Alben
Published: October 2021

Introduction

Machine learning in computer-assisted diagnostics improves sensitivity of image analysis and reduces time and effort for interpretation. Compared to standard mammograms, a thermal scan is easily scalable and is a safer screening tool. We evaluate the performance of Thermalytix (an automated thermographic screening algorithm) compared with other standard breast cancer screening modalities.

Methods

A prospective multicentre study was conducted to assess the non-inferiority of sensitivity of Thermalytix (test device) to that of standard modalities in detecting malignancy in subjects who show possible symptoms of suspected breast cancer. Standard screening modalities and Thermalytix were obtained and interpreted independently in a blinded fashion. A receiver operating characteristic (ROC) curve was constructed to identify the best cut-off point, non-inferiority margin of ≥10% to demonstrate the non-inferiority.

Results

We recruited 258 symptomatic women who first underwent a thermal scan, followed by mammogram and/or ultrasound. At Youden’s Index of ROC curve, the test device had a sensitivity of 82.5% (95% CI 73.2 to 91.9) and specificity of 80.5% (95% CI 75.0 to 86.1) as compared with diagnostic mammogram, which had sensitivity of 92% (95% CI 80.7 to 97.8) and specificity of 45.9% (95% CI 34.3 to 57.9) when BI-RADS 3 (Breast Imaging-Reporting and Data System) was considered as test-positive. The overall area under the curve (AUC) was 0.845. For women aged <45 years, the test device had a sensitivity and specificity of 87.0% (95% CI 66.4 to 97.2) and 80.6% (95% CI 72.9 to 86.9), respectively. For women aged ≥45 years, the sensitivity and specificity were 80.5% (95% CI 65.1 to 91.2) and 86.5% (95% CI 78.0 to 92.6, respectively).

Conclusion

We evaluated Thermalytix, a new AI-based modality for detecting breast cancer. The high AUC in both women under 45 years and above 45 years shows the potential of Thermalytix to be a supplemental diagnostic modality for all ages. Further evaluation on larger sample size is needed.

Trial registration number

CTRI/2017/10/0 10 115;
Gender differences in snowboarding accidents in Austria: a 2005–2018 registry analysis
Authors: Rugg Christopher Duane , Malzacher Till , Ausserer Julia , Rederlechner Andrea , Paal Peter , Ströhle Mathias
Published: October 2021

Objectives

To elucidate gender differences in snowboarding accidents.

Design

Retrospective registry analysis within the Austrian National Registry of Mountain Accidents.

Setting

Snowboard-related emergencies between November 2005 and October 2018.

Participants

All injured snowboarders with documented injury severity and gender (3536 men; 2155 women).

Primary and secondary outcome measures

Gender-specific analysis of emergency characteristics and injury patterns.

Results

Over time, the number of mild, severe and fatal injuries per season decreased in men but not in women. Accidents most frequently were interindividual collisions (>80%) and occurred when heading downhill on a slope. Men more often suffered injuries to the shoulder (15.1% vs 9.2%) and chest (6.8% vs 4.4%), were involved in accidents caused by falling (12.9% vs 9.6%) or obstacle impact (4.3% vs 1.5%), while on slopes with higher difficulty levels (red: 42.6% vs 39.9%; black: 4.2% vs 2.5%), while snowboarding in a park (4.8% vs 2.1%) and under the influence of alcohol (1.6% vs 0.5%). Women more often sustained injuries to the back (10.2% vs 13.1%) and pelvis (2.9% vs 4.2%), on easier slopes (blue: 46.1% vs 52.4%) and while standing or sitting (11.0% vs 15.8%). Mild injuries were more frequent in women (48.6% vs 56.4%), severe and fatal injuries in men (36.0% vs 29.7% and 0.9% vs 0.4%). Male gender, age and the use of a helmet were risk factors for the combined outcome of severe or fatal injuries (OR (99% CI): 1.22 (1.00 to 1.48), 1.02 (1.02 to 1.03) and 1.31 (1.05 to 1.63)). When wearing a helmet, the relative risk (RR) for severe injuries increased while that for mild injuries decreased in male snowboarders only (RR (95% CI): 1.21 (1.09 to 1.34) and 0.88 (0.83 to 0.95)).

Conclusions

Snowboard injuries are proportionally increasing in women and the observed injury patterns and emergency characteristics differ substantially from those of men. Further gender-specific research in snowboard-related injuries should be encouraged.

Trial registration number

NCT03755050.
Advancing mechanisms of implementation to accelerate sustainable evidence-based practice integration: protocol for generating a research agenda
Authors: Lewis Cara C , Powell Byron J , Brewer Stephanie K , Nguyen Ann M , Schriger Simone H , Vejnoska Sarah F , Walsh-Bailey Callie , Aarons Gregory A , Beidas Rinad S , Lyon Aaron R , Weiner Bryan , Williams Nathaniel , Mittman Brian
Published: October 2021

Introduction

Mechanisms explainhowimplementation strategies work. Implementation research requires careful operationalisation and empirical study of the causal pathway(s) by which strategies effect change, and factors that may amplify or weaken their effects. Understanding mechanisms is critically important to replicate findings, learn from negative studies or adapt an implementation strategy developed in one setting to another. Without understanding implementation mechanisms, it is difficult to design strategies to produce expected effects across contexts, which may have disproportionate effects on settings in which priority populations receive care. This manuscript outlines the protocol for an Agency for Healthcare Research and Quality-funded initiative to: (1) establish priorities for an agenda to guide research on implementation mechanisms in health and public health, and (2) disseminate the agenda to research, policy and practice audiences.

Methods and analysis

A network of scientific experts will convene in ‘Deep Dive’ meetings across 3 years. A research agenda will be generated through analysis and synthesis of information from six sources: (1) systematic reviews, (2) network members’ approaches to studying mechanisms, (3) new proposals presented in implementation proposal feedback sessions, (4) working group sessions conducted in a leading implementation research training institute, (5) breakout sessions at the Society for Implementation Research Collaboration’s (SIRC) 2019 conference and (6) SIRC conference abstracts. Two members will extract mechanism-relevant text segments from each data source and a third member will generate statements as an input for concept mapping. Concept mapping will generate unique clusters of challenges, and the network will engage in a nominal group process to identify priorities for the research agenda.

Ethics and dissemination

This initiative will yield an actionable research agenda to guide research to identify and test mechanisms of change for implementation strategies. The agenda will be disseminated via multiple channels to solicit feedback and promote rigorous research on implementation mechanisms.
Cross-sectional study of parental knowledge, behaviour and anxiety in management of paediatric fever among German parents
Authors: Hamideh Kerdar Sara , Himbert Christina , Martin David D , Jenetzky Ekkehart
Published: October 2021

Objectives

Fever is a common symptom among children. Parental lack of knowledge about fever could cause anxiety and lead to unnecessary measures to subside fever. There is little evidence about German parents’ knowledge and their fever management.

Design

A cross-sectional study using a paper-based questionnaire.

Setting

16 kindergartens in Saarbrücken and Saarlouis regional association accepted to participate in the study. Parents from these kindergartens were requested during the pickup time to answer the questionnaire.

Participants

481 German parents participated in the study, 394 of them were women. Inclusion criteria were good understanding of German and being a parent of at least one child below the age of 7 years.

Primary and secondary outcome measures

Knowledge and behaviour of parents on paediatric fever management and the factors influencing fever anxiety.

Results

The older the parents were, the more anxiety they reported. Their definition of fever had a wide range of 30°C–41°C (mean 38.46, SD=0.67) and almost 90% (mean 3.05, SD=2.03) of participants reported fever as useful, whereby they felt more confident the more they found fever useful. 69% of parents felt calm when their child has fever (mean 4.47, SD=2.27). In case of fever, 55% of parents administer paracetamol, 72% ibuprofen and 32% of them would alternate between the two. Paracetamol and ibuprofen are used more by more anxious parents. In explorative factor analysis, reasons to reduce temperature were summarised in three main factors: damage prevention, illness control and well-being protection, whereby the first two were positively related to parental anxiety.

Conclusions

Both knowledge as well as level of confidence/anxiety vary largely. Taking antipyretics is related to higher level of anxiety, indicating the need for further education. Fever anxiety depends on multiple factors, which have to be further investigated.
Facilitators and barriers to implementation of Alberta family integrated care (FICare) in level II neonatal intensive care units: a qualitative process evaluation substudy of a multicentre cluster-randomised controlled trial using the consolidated framework for implementation research
Authors: Zanoni Pilar , Scime Natalie V , Benzies Karen , McNeil Deborah A , Mrklas Kelly
Published: October 2021

Objective

To evaluate the barriers and facilitators to implementing Alberta Family Integrated Care (AB-FICare [2019 Benzies]), a model of care for integrating parents into level II neonatal intensive care units (NICUs) care teams, from the perspective of healthcare providers (HCP) and hospital administrators.

Design

Qualitative process evaluation substudy.

Setting

Ten level II NICUs in six cities across Alberta, Canada.

Participants

HCP and hospital administrators (n=32) who were involved in the cluster-randomised controlled trial of AB-FICare in level II NICUs.

Methods

Post-implementation semi-structured interviews were conducted via phone or in-person. The Consolidated Framework for Implementation Research was used to develop interview guides, code transcripts and analyse data.

Results

Key facilitators to implementation of AB-FICare included (1) a receptiveimplementation climate,(2)compatibilityof the intervention with individual and organisational practices, (3)available resourcesandaccess to knowledge and informationfor HCP and hospital administrators, (4) engagement ofkey stakeholdersacross the organisation, (5) engagement of and outcomes forintervention participants,and (6)reflecting and evaluatingon implementation progress and patient and family outcomes. Barriers were (1)design quality and packagingof the intervention, (2)relative priorityof AB-FICare in relation to other initiatives, and (3)learning climatewithin the organisation. Mixed influences on implementation depending on contextual factors were coded to eight constructs:intervention source, cost, peer pressure, external policy and incentives, staff needs and resources, structural characteristics, organisational incentives and rewards,andknowledge, beliefs and attitudes.

Conclusions

The characteristics of an organisation and the implementation process had largely positive influences, which can be leveraged for implementation of AB-FICare in the NICU. We recommend site-specific consultations to mitigate barriers and assess how swing factors might impact implementation given the local context, with the goal that strategies can be put in place to manage their influence on implementation.

Trial registration number

NCT02879799.