bluuebunny/crossref_metadata_2025 huggingface dataset:
A note on the coupled and dual energy release rates for VCCT
Authors: Farkash Elad , Banks‐Sills Leslie
Published: August 2021

The coupled energy release rate may be used with the virtual crack closure technique (VCCT) method to determine the stress intensity factors of interface cracks. Different equations were presented over the years using this parameter. In recent papers, a new approach was presented by the authors. This approach includes two additional energy release rates, called here, the dual energy release rates. Here, the coupled and dual energy release rates are explored and well established. This leads to a new and more suitable equation for calculating the mode mixity or phase angle. In addition, a geometrical interpretation between the energy release rates for both homogeneous and interface crack problems is found. A problem of an interface crack between two linear elastic, isotropic, and homogeneous materials in an infinite body is presented. This problem emphasizes the advantage of the new equation, and the geometrical relation between the energy release rates is illustrated.
New nurses apply only basic source evaluation criteria but realize their skills are lacking: More sophisticated approaches to teaching evaluation skills are required
Authors: Schvaneveldt Nena , Diekema Anne R. , Hopkins Elizabeth (Betsy) S. , Patterson Brandon
Published: August 2021

Background

While information evaluation is an essential component of evidence based practice, it remains unclear how nurses perceive their own source evaluation skills and what evaluation criteria they typically apply.

Objectives

This study aims to determine nurses’ self‐reported confidence in their evaluation skills and their actual source evaluation ability. The findings will guide information literacy instruction.

Methods

A questionnaire asked recently graduated nurses from four institutions in the Intermountain West (USA) to rate their confidence in evaluating information and to provide examples of evaluation criteria they typically applied. The quality of these criteria was rated by nursing librarians, then compared with reported confidence in evaluation, years employed as a nurse and highest degree level.

Results

While nurses’ self‐reported confidence levels about source evaluation largely matched their ability, their evaluation criteria showed a low level of sophistication and did not match the recommended criteria by professional organizations. Graduate education, not years of work experience, was predictive of the quality of criteria used by nurses, suggesting the importance of more instruction on source evaluation for nursing students.

Conclusions

Nursing educators, including librarians, need to teach evaluation skills at the undergraduate level. Further investigation into building evaluation skills in nurses is warranted.
Scalp application of the antioxidant piroctone olamine reduces hair shedding in an 8‐week randomized, double‐blind, placebo‐controlled clinical study
Authors: Davis Michael G. , Piliang Melissa P. , Bergfeld Wilma F. , Caterino Tamara L. , Fisher Brian K. , Sacha Jarek P. , Carr Greg J. , Moulton Laura T. , Whittenbarger Deborah J. , Punyani Supriya , Schwartz James R.
Published: August 2021

Objective

Increasing scalp hair fullness is a global unmet consumer need. An approach to decrease hair shedding by reducing scalp stratum corneum oxidation via a combination of antioxidant and barrier‐enhancing technologies has been previously demonstrated. The purpose of this study was to test the effectiveness of the individual antioxidant piroctone olamine in two different product forms (shampoo or leave‐on product) for activity to improve hair retention.

Methods

Female subjects with self‐perceived hair thinning participated in an 8‐week, double‐blind, placebo‐controlled, randomized clinical study to evaluate either a piroctone olamine (PO) containing shampoo or a PO containing leave on treatment, each relative to their corresponding placebo formulation Too many periods. Results for phototrichograms, TEWL, and biomarker analysis of scalp condition for the shampoo treatments are discussed. Phototrichogram results are shared for the assessment of the leave on treatment.

Results

Statistically significant increases in hair amount were observed by phototrichogram after use of both PO‐containing products versus placebo formulations. The PO shampoo treatment also significantly decreased oxidative stress on the hair and scalp, and improved scalp condition as assessed by TEWL and scalp biomarker values.

Conclusion

These results illustrate the effectiveness of a cosmetic antioxidant to improve scalp condition thereby improving hair retention. The observed improvements in scalp condition are consistent with previous reports with other antioxidant technologies and suggest that the hair retention effect was achieved by preventing oxidative damage to the scalp.
Acne and diet: a review
Authors: Conforti Claudio , Agozzino Marina , Emendato Giovanni , Fai Annatonia , Fichera Federica , Marangi Giovanni F. , Neagu Nicoleta , Pellacani Giovanni , Persichetti Paolo , Segreto Francesco , Zalaudek Iris , Dianzani Caterina
Published: August 2021

Acne is one of the most frequent dermatological afflictions especially for people in their first 30 years of age. Several studies have shown that nutrition is one of the key factors involved in acne pathogenesis. Data show that a high glycemic index diet may be a trigger in acne pathogenesis, while patients with a low glycemic index diet have fewer acne lesions. Milk and chocolate are also involved in the exacerbation of acne. However, foods rich in omega‐3 fatty acids suppress the production of inflammatory cytokines with therapeutic effect. Additionally, docosapentaenoic acid and γ‐linolenic acid have demonstrated improved acne lesions. The aim of this review was to summarize current knowledge on the association between acne and diet with special attention to the most frequently discussed factors involved in its pathogenesis: milk, chocolate, omega‐3 fatty acids, hyperglycemia, hyperinsulinism, and IGF‐1.
Medical Oncology Care Plan: a tool for improving the provision of clinical information to patients
Authors: Vaitiekunas Laurence , Coomer Keegan , Turner Cassie , Brown Amy , Sabesan Sabe
Published: August 2021

Improving clinical communication between patient and clinician through the provision of written information empowers patients to make informed decisions, underpinning patient‐centred care and leading to greater health outcomes. The Townsville Cancer Centre has formulated a holistic care plan template for each patient as a tool to enhance this communication. Using questionnaire‐based and qualitative surveys, understanding of the patient's cancer and perspectives of clinicians were examined. The results demonstrate that patients generally have a firm knowledge base of their disease with the predominant finding being that patients wish to be more informed with written information about their diagnosis and alternatives for treatment. While initially time consuming, completion of care plans had many benefits for clinicians; they prompted them to collect holistic information, engage in discussions to capture patient goals and document details about prognosis, treatment options and management of side‐effects. Medical oncology care plans provide a sustainable method to provide clinicians a practical template to gather vital information and encourage patients to participate in the decision‐making process for healthcare.
Does the Gender Mix Influence Collective Bargaining on Gender Equality? Evidence from France
Authors: Bruno Anne‐Sophie , Greenan Nathalie , Tanguy Jeremy
Published: August 2021

Gender equality at work has become in recent years a priority for governments. In France, collective bargaining is the main lever to achieve progress on gender equality issues. In a two‐tier bargaining framework, industries and firms are required by law to negotiate on the reduction of gender inequalities. Using firm‐level survey data on labor relations issues combined with administrative data, this paper seeks to better understand the dynamics of collective bargaining on gender equality at the firm level by questioning the role played by the gender mix. We find that gender diversity favors gender equality bargaining at the firm level. Underrepresentation and overrepresentation of women reduce the probability of firms negotiating an agreement on gender equality. The introduction of sanctions in the recent period has prompted low‐feminized firms to negotiate more on gender equality but had little impact on highly feminized firms.
No room for males in caves: Female‐biased sex ratio in subterranean amphipods of the genus Niphargus
Authors: Premate Ester , Borko Špela , Kralj‐Fišer Simona , Jennions Michael , Fišer Žiga , Balázs Gergely , Bíró Anna , Bračko Gregor , Copilaş‐Ciocianu Denis , Hrga Nuša , Herczeg Gábor , Rexhepi Behare , Zagmajster Maja , Zakšek Valerija , Fromhage Lutz , Fišer Cene
Published: August 2021

Sex allocation theory predicts that the proportion of daughters to sons will evolve in response to ecological conditions that determine the costs and benefits of producing each sex. All else being equal, the adult sex ratio (ASR) should also vary with ecological conditions. Many studies of subterranean species reported female‐biased ASR, but no systematic study has yet been conducted. We test the hypothesis that the ASR becomes more female‐biased with increased isolation from the surface. We compiled a data set of ASRs of 35 species in the subterranean amphipod Niphargus, each living in one of three distinct habitats (surface‐subterranean boundary, cave streams, phreatic lakes) representing an environmental gradient of increased isolation underground. The ASR was female‐biased in 27 of 35 species; the bias was statistically significant in 12 species. We found a significant difference in the ASR among habitats after correction for phylogeny. It is most weakly female‐biased at the surface‐subterranean boundary and most strongly female‐biased in phreatic lakes. Additional modelling suggests that the ASR has evolved towards a single value for both surface‐subterranean boundary and cave stream‐dwelling species, and another value for 9 of 11 phreatic lake dwellers. We suggest that a history of inbreeding in subterranean populations might lower inbreeding depression such that kin selection favours mating with siblings. This could select for a female‐biased offspring sex ratio due to local mate competition among brothers. The observed patterns in sex ratios in subterranean species make them a group worthy of more attention from those interested in sex allocation theory.
Understanding factors that influence the decision to be vaccinated against influenza and pertussis in pregnancy: A qualitative study
Authors: Arreciado Marañón Antonia , Fernández‐Cano María Isabel , Montero‐Pons Laura , Feijoo‐Cid Maria , Reyes‐Lacalle Azahara , Cabedo‐Ferreiro Rosa Maria , Manresa‐Domínguez Josep Maria , Falguera‐Puig Gemma
Published: August 2021

Aims and Objectives

To identify how pregnant women perceive pertussis and influenza and the factors that influence their decision to be vaccinated.

Background

Suffering from influenza during pregnancy increases complications in the pregnant woman, foetus and newborn. Pertussis in children under six months of age causes severe complications. Maternal vaccination against influenza and pertussis is effective and safe. However, vaccination rates are insufficient.

Design

We conducted a qualitative descriptive study, using semi‐structured interviews. This research adheres to the COREQ guidelines and checklist.

Methods

We carried out 18 semi‐structured face‐to‐face interviews with pregnant women, using intentional sampling and thematic analysis.

Results

We identified an overarching theme, ‘factors that influenced participants’ decision to be vaccinated or not’, which was composed of four subthemes that were in turn made up of 12 categories. The factors that influenced participants’ decision to be vaccinated against influenza and pertussis were related to their knowledge of and their perception of risk for these diseases. Participants perceived the risk of pertussis to be greater, and they focused their concern on the newborn. The recommendations and convictions of nurse‐midwives were the most important factors encouraging vaccination. Participants trusted their nurse‐midwives and most reported that they would have been vaccinated if their midwife had recommended it. Other factors were linked to lack of information, fear and concerns about economic interests.

Conclusions

The convictions and actions of the nurse‐midwife in recommending vaccination to pregnant women are decisive. Strategies to improve vaccination rates should be directed to helping health professionals understand how their practice affects the final decision of pregnant women.

Relevance to clinical practice

Understanding the factors that limit vaccination rates among pregnant women provides valuable information to nurse‐midwives that can help to improve vaccination strategies and practices. Increased maternal vaccination rates would reduce morbidity and mortality among pregnant women and newborns.
Validation of a novel diagnostic tool for decreased tongue pressure
Authors: Imamura Yoshiki , Chebib Najla , Ohta Midori , Maria Schulte‐Eickhoff Regina , Mekki Mustapha , Schimmel Martin , Arakawa Itsuka , Graf Christophe , Sato Yuji , Müller Frauke
Published: August 2021

Introduction

Reduced tongue pressure may render eating and swallowing difficult. The purpose of this study was to investigate whether the tongue training device can also be used as a diagnostic device and whether its sensitivity and specificity are equal to the numerical tongue pressure measuring device.

Material and Methods

The target group is patients aged 70 years and over who are hospitalised for rehabilitation. Tongue pressure was measured by both, a tongue pressure measuring instrument and a tongue training tool. The diagnosis of the reduced tongue pressure was made with the tongue pressure measuring instrument and set the verified with the novel tongue training tool.

Results

Sixty‐two participants were included in the study. Forty‐five were classified by the tongue pressure measuring device and 53 by the tongue training device as ‘low tongue pressure’. Spearman correlation confirmed a positive correlation between the tongue pressure measuring device and the tongue training device rs = 0.800, p = 0.01 level (2‐tailed). The tongue training device test identified sensitivity was 100%, and its specificity was 52.9%. The AUC of the ROC curve is 0.901.

Conclusion

The tongue training device seems a simple, safe and readily available alternative to the tongue pressure measuring device for the diagnosis of low tongue pressure, with an excellent sensitivity and very good specificity.
Outcomes and complications of anal sacculectomy for non‐neoplastic anal sac disease in cats: 8 cases (2006–2019)
Authors: Jimeno Sandoval J. C. , Charlesworth T. , Anderson D.
Published: August 2021

Objectives

To describe the features of non‐neoplastic anal sac disease in cats, the surgical procedure, complications, surgical outcome and prognosis compared to well‐established data for anal sacculectomy in canine patients.

Materials and Methods

A retrospective review of medical records of cats undergoing anal sacculectomy for non‐neoplastic disease between 2006 and 2019.

Results

Eight cats were included in the study of which four of eight developed minor and self‐limiting complications including defaecatory complications in three cases and superficial corneal ulceration in one case. No cat developed permanent faecal incontinence. No long‐term postoperative complication was recorded. Median surgical time was 35 minutes (range, 20 to 42). Median hospitalisation time was 1.5 days (range, 1 to 4). The incidence of short‐term minor complications is higher than previously reported in dogs, although this might be in agreement with a reported higher incidence in dogs smaller than 15 kg.

Clinical Significance

Anal sacculectomy for non‐neoplastic anal sac disease is a safe procedure in cats with relatively high rate of short‐term but self‐limiting, minor, postoperative complications.
A HU‐like protein is required for full virulence in Xanthomonas campestris pv. campestris
Authors: Su Qian , Wang Xin‐Xin , Leng Ming , Qi Yan‐Hua , Pang Fu‐Yuan , Tang Ji‐Liang , Lu Guang‐Tao
Published: August 2021

Bacteria harbour several abundant small DNA‐binding proteins known as nucleoid‐associated proteins (NAPs) that contribute to the structure of the bacterial nucleoid as well as to gene regulation. Although the function of NAPs as global transcriptional regulators has been comprehensively studied in the model organism Escherichia coli, their regulatory functions in other bacteria remain relatively poorly understood. Xanthomonas campestris pv. campestris (Xcc) is a gram‐negative bacterium that causes black rot disease in almost all members of the crucifer family. In previous work, we demonstrated that a Fis homologue protein, which we named Fis‐like protein (Flp), contributes to the regulation of virulence, type III secretion, and a series of other phenotypes in Xcc. Here we have examined the role of XC_1355, which is predicted to encode a DNA‐binding protein belonging to the HU family herein named HU‐like protein (Hlp). We show that mutation of XC_1355 in Xcc reduces the virulence, extracellular polysaccharide production, and cell motility, but has no effect on the production of extracellular enzymes and induction of the hypersensitive response. These data together with transcriptome analysis indicate that hlp is a previously uncharacterized gene involved in virulence that has partially overlapping and complementary functions with flp in Xcc, although the two regulators have opposite effects on the expression of genes involved in type III secretion. The findings add to our understanding of the complex regulatory pathways that act to regulate virulence in Xcc.
Aboveground herbivory causes belowground changes in twelve oak Quercus species: a phylogenetic analysis of root biomass and non‐structural carbohydrate storage
Authors: Perkovich Cynthia , Ward David
Published: August 2021

Plant ecosystem structure is understood to be a result of complex multitrophic interactions. Most multitrophic studies focus on plant aboveground adaptations to aboveground herbivore pressures, neglecting belowground adaptations in response to aboveground damage. Differential investment in root structures may allow plants to compensate for tissue loss or damage due to herbivores. Furthermore, phylogeny may constrain a plant's ability to adapt belowground. We examined the belowground responses of 12 species of oak Quercus to varying locations and intensities of simulated herbivore damage. We first established that oak belowground traits responded to aboveground herbivory by measuring patterns of investment in coarse versus fine root structures and re‐allocation of non‐structural carbohydrates (NSC) to root storage. We then tested whether phylogeny could explain variations in investment patterns using phylogenetic independent contrasts. Plant adaptations to aboveground herbivory included allocating biomass and carbon reserves to root structures, depending on the location and intensity of herbivore damage. NSC re‐allocation to root storage was observed when oak species experienced any type of damage, but damage to lateral tissues caused a greater re‐allocation than apical damage or control treatments. We found that most belowground responses to aboveground herbivory are species‐specific and may be adapted for environmental conditions or type of herbivory. Some responses to herbivore damage, such as changes in fine‐root mass and root sugar concentrations, were phylogenetically constrained. Phylogenetic constraints generally occur when there is severe damage at the apical meristem. Plants may adapt to aboveground tissue loss due to varying herbivore pressures (i.e. varying location and intensity of damage) by differentially investing in root types and NSC re‐allocation to root storage. Understanding linkages between and phylogenetic constraints of plant belowground responses to aboveground herbivory will improve our understanding of the ecological processes involved in multitrophic interactions.
Identifying key factors for transplantation success in the restoration of kelp (Ecklonia radiata) beds
Authors: Graham Tristan D. J. , Morris Rebecca L. , Strain Elisabeth M. A. , Swearer Stephen E.
Published: August 2021

Kelp beds are a defining feature of temperate reefs worldwide, playing a fundamental role as ecosystem engineers and primary producers. Overgrazing by the native sea urchin Heliocidaris erythrogramma has driven a phase shift from kelp beds of Ecklonia radiata to barrens across much of Port Phillip Bay, Victoria. Here, we present the results of a transplant experiment, which took juvenile E. radiata sporophytes from a source reef and attached them with silicon tubing to basalt tiles. Following an initial localized cull, we monitored the development and survival of individual E. radiata to investigate the drivers of loss during transplantation, including disturbance (control vs. procedural control), receiving environment (kelp canopy vs. no canopy), and translocation site (within vs. between reefs). We also investigated the role of holdfast reattachment and developmental stage on kelp survival. Sixty‐nine percent of the kelp transplants survived over the 17 weeks, with no increased loss resulting from transplantation to a reef 41 km away. We observed high survival of transplants in the absence of ongoing urchin exclusion. Furthermore, the provision of a canopy is not necessary and may result in adverse impacts on survival and development of juvenile sporophyte transplants presumably through competition for light. Individuals at the collection location (controls) were unlikely to survive to maturity suggesting their removal for transplanting is likely to have minimal impact on the kelp population of the donor reef. The methods used could be feasibly upscaled for rehabilitating or restoring kelp beds both in Port Phillip Bay and elsewhere.
Evaluating the Preparedness of Indian States against COVID‐19 Pandemic Risk: A Fuzzy Multi‐criteria Decision‐Making Approach
Authors: Choudhury Sudipa , Majumdar Abhijit , Saha Apu Kumar , Majumdar Prasenjit
Published: August 2021

The preparedness of Indian states and union territories (UTs) against the COVID‐19 pandemic has been evaluated. Ten parameters related to demographic, socioeconomic, and healthcare aspects have been considered and the performances of 27 states and three UTs have been evaluated applying the Fuzzy Analytic Hierarchy Process. Opinions of medical experts have been considered to ascertain the relative importance of decision criteria as well as subcriteria. The scores of various states and UTs in each of the decision subcriteria have been calculated by using the secondary data collected from authentic sources. It is found that Kerala and Bihar are the best prepared and worst prepared states, respectively, to combat COVID‐19 pandemic. Karnataka, Goa, and Tamil Nadu have very good preparedness whereas Chhattisgarh, Jharkhand, and Bihar have very poor preparedness. Maharashtra, the most affected state in India, has average preparedness. As around 650 million people are vulnerable due to the poor and very poor preparedness of their states, the country needs to make region specific mitigation strategies to combat the COVID‐19 pandemic and the preparedness map will be helpful in that direction.
COVID‐19 in Rural America: Impacts of Politics and Disadvantage*
Authors: Albrecht Don E.
Published: August 2021

Early in the COVID‐19 pandemic, people living in cities were much more likely than rural residents to become infected with and die from the virus. Beginning in the summer of 2020, however, the proportional increase in virus spread became much greater in rural areas. By March 2021, per capita cases and deaths were greater in nonmetro than in metro areas. Multi‐variate regression analysis found that political views were the most important variable explaining per capita COVID‐19 cases, while measures of disadvantage were the best predictors of COVID‐19 deaths. Counties with high proportions of Trump voters had higher per capita cases, and in nonmetro areas, these counties had higher death rates. Overall, the best predictor of COVID‐19 death rates is low levels of educational attainment, high poverty rates, and high minority populations.
A REVIEW OF INTER CELL INTERFERENCE MANAGEMENT IN REGULAR AND IRREGULAR GEOMETRY CELLULAR NETWORKS
Authors: Ullah Rahat , Ullah Fahim , Khalid Zubair , Safdar Hashim
Published: August 2021

This paper reviews the inter-cell interference (ICI) mitigation approaches in the OFDMA based multicellular networks with more emphasis on the frequency reused based ICI coordination schemes in the downlink systems. The geometry of the network severely affects the Signal to Interference and Noise Ratio (SINR); therefore, the wireless cellular systems are strongly dependent on the spatial BSs configuration and topology of a network. ICI mitigation techniques for both regular and irregular geometry networks are analyzed and a qualitative comparison along with the future research directions are presented.
IN VITRO CYTOTOXIC EVALUATION AND APOPTOTIC EFFECTS OF DILLAPIOLE ON HUMAN NASAL SQUAMOUS CELL CARCINOMA
Authors: Ruslan Nur Batrisyia , Mohd Amin Indah , Abdul Hamid Hasani Narimah , Ahmad Vivi Noryati , Aris Farizan , Khor Goot Heah
Published: August 2021

Dillapiole is one of the major compounds in Peperomia pellucida. Dillapiole exerts cytotoxicity effect on several cancer cells such as breast and colon with a minimal effect on normal cells. However, its effect on cancers in head and neck region remains ambiguous. Therefore, in the current study, the cytotoxicity effect of dillapiole on human nasal squamous cell carcinoma, RPMI 2650 and the underlying mechanism were investigated. Normal human gingival fibroblast, HGnF cells was used as comparison. Cisplatin and untreated cells were used as positive and negative controls, respectively. Cell cytotoxicity was determined using WST-1 assay; and validated by trypan blue exclusion assays. Cell death mechanism was determined using Annexin V-FITC detection kit and analyzed by flow cytometer. The cytotoxic effect of dillapiole on RPMI 2650 cells was shown significantly increased with the increasing amount of dillapiole from 25.93 ± 6.39 % to 83.87 ± 8.43 % (p<0.05, n=3) with the respective IC50 and IC75 of 46 µM and 125 µM. None of both IC50 and IC75 were obtained for HGnF cells up to 150 µM. Loss of normal shape, cytoplasm shrinkage and reduction in cell volume were detected in RPMI 2650 cells after dillapiole treatment at respective IC50 (46 µM) and IC75 (125 µM), indicating apoptosis. These findings indicate that dillapiole cytotoxicity effect is more selective towards RPMI 2650 compared to HGnF cells and the mechanism of death was through the induction of apoptosis.
Effect of Tip Vortex Reduction on Air-Cooled Condenser Axial Flow Fan Performance: An Experimental Investigation
Authors: Pretorius Johannes P. , Erasmus Johan A.
Published: August 2021

Large diameter axial flow fans are used in air-cooled condenser (ACC) systems of modern power stations. Efficiency improvements on these fans can significantly reduce the ACC power consumption and increase the net sent-out power to the grid. This study targets fan performance enhancement through blade tip vortex reduction. Experimental investigations are performed on a representative ACC scale fan, where tests consider the effects of tip clearance and two new tip endplate designs on fan performance. Test results confirm the findings of previous studies, showing the negative effect of increasing tip clearance on performance. Despite testing limitations, results from tests incorporating endplates show that fan static pressure coefficient and efficiency increase over large ranges of flow coefficient compared to the datum fan. These outcomes agree with observations from literature and warrants further exploration. Future work is recommended to provide confirmation on the presented trends.
Increased Trunk Kinetics Observed During Dose-Specific Trunk Lean Gait Modification
Authors: Eddo Oladipo , Vaz João R. , Ludwick Jaime , Lindsey Bryndan , Martin Joel , Caswell Shane , Cortes Nelson
Published: August 2021

Trunk modification is associated with knee abduction moment reduction in both healthy groups and individuals with knee osteoarthritis. Ambulatory-related changes in trunk kinematics have been implicated in increased trunk moment. The purpose of this study was to investigate the effect of dose-specific lateral trunk lean on trunk kinetics during ipsilateral and contralateral stance phases. Nineteen healthy participants completed 10 baseline walking trials, followed by 10 trials employing lateral trunk lean. Trunk modification magnitudes were determined based on the average baseline trunk angle. Five trials of both small and large trunk modification magnitudes were completed. Visual real-time biofeedback was projected as a line graph displaying the trunk angle during stance, and a highlighted bandwidth was designated the target range. A 1-factor repeated-measures analysis of variance or Friedman test was used to assess differences between the conditions (P < .05) in trunk dependent measures. Trunk kinetics displayed significant increases, even during modest modifications to the trunk angle. The participants experienced increased peak frontal plane trunk moment and angular impulse during ipsilateral stance. The observed increase in the peak lateral joint reaction force is suggestive of a compromised loading environment at the spine. Implementing trunk modification might result in unintended secondary changes along the kinetic chain, but further investigation is required.
Thrombin-Derived C-Terminal Peptide Reduces
Candida
-Induced Inflammation and Infection
In Vitro
and
In Vivo
Authors: Dahlman Anna , Puthia Manoj , Petrlova Jitka , Schmidtchen Artur , Petruk Ganna
Published: August 2021

Infections due to the opportunistic fungus
Candida
have been on the rise in the last decades, especially in immunocompromised individuals and hospital settings. Unfortunately, the treatments available today are limited.
Lipopolysaccharide Preconditioning Augments Phagocytosis of Malaria-Parasitized Red Blood Cells by Bone Marrow-Derived Macrophages in the Liver, Thereby Increasing the Murine Survival after Plasmodium yoelii Infection
Authors: Ono Takeshi , Yamaguchi Yoko , Nakashima Hiroyuki , Nakashima Masahiro , Ishikiriyama Takuya , Seki Shuhji , Kinoshita Manabu
Published: August 2021

Malaria remains a grave concern for humans, as effective medical countermeasures forPlasmodiuminfection have yet to be developed. Phagocytic clearance of parasitized red blood cells (pRBCs) by macrophages is an important front-line innate host defense againstPlasmodiuminfection.
c-di-AMP Is Essential for the Virulence of
Enterococcus faecalis
Authors: Kundra Shivani , Lam Ling Ning , Kajfasz Jessica K. , Casella Leila G. , Andersen Marissa J. , Abranches Jacqueline , Flores-Mireles Ana L. , Lemos José A.
Published: August 2021

Second messenger nucleotides are produced by bacteria in response to environmental stimuli and play a major role in the regulation of processes associated with bacterial fitness, including but not limited to osmoregulation, envelope homeostasis, central metabolism, and biofilm formation. In this study, we uncovered the biological significance of c-di-AMP in the opportunistic pathogen
Enterococcus faecalis
by isolating and characterizing strains lacking genes responsible for c-di-AMP synthesis (
cdaA
) and degradation (
dhhP
and
gdpP
).
Embracing excellence in healthcare: the role of positive feedback
Authors: Plunkett Adrian
Published: August 2021

Embracing failure for the purpose of learning is a key trait in successful teams. Failure, however, is not the only source of learning. The majority of interventions in healthcare are successful, yet our prevailing efforts to extract learning intelligence tend to focus almost exclusively on failures, such as harm and errors. By considering the learning potential across the whole landscape of work from success to failure, we can widen the range of learning opportunities. The key steps to learn from excellence are first to recognise excellence, which can be highly subjective, and second to provide positive feedback. Positive feedback enhances learning through a number of routes, including increasing self-efficacy and intrinsic motivation. It may also help to improve relationships within teams and to offset negativity associated with blame cultures.
Commercial use of evidence in public health policy: a critical assessment of food industry submissions to global-level consultations on non-communicable disease prevention
Authors: Lauber Kathrin , McGee Darragh , Gilmore Anna B
Published: August 2021

Background

Ultra-processed food industry (UPFI) actors have consistently opposed statutory regulation in health policy debates, including at the WHO. They do so most commonly with claims that regulatory policies do not work, will have negative consequences or that alternatives such as self-regulation work well or better. Underlying this are often assertions that industry is aligned with principles of evidence-based policymaking. In this study, we interrogate if this holds true by exploring the extent and quality of the evidence UPFI respondents employed to support claims around regulatory policy, and how they did this.

Methods

First, we identified all submissions from organisations who overtly represent UPFI companies to consultations held by the WHO on non-communicable disease policy between 2016 and 2018. Second, we extracted all relevant factual claims made in these submissions and noted if any evidence was referenced in support. Third, we assessed the quality of evidence using independence from UPFI, nature, and publication route as indicators. Lastly, where peer-reviewed research was cited, we examined if the claims made could be justified by the source cited.

Results

Across 26 included consultation responses, factual claims around regulation were made in 18, although only 10 referenced any evidence at all. Of all 114 claims made, 39 pieces of identifiable evidence were cited in support of 56 claims. Of the 39 distinct pieces of evidence, two-thirds were industry-funded or industry-linked, with only 16 externally peer-reviewed. Over half of industry-funded or industry-linked academic articles failed to declare a conflict of interest (COI). Overall, of only six claims which drew on peer-reviewedandindependent research, none appropriately represented the source.

Discussion

UPFI respondents made far-reaching claims which were rarely supported by high-quality, independent evidence. This indicates that there may be few, if any, benefits from consulting actors with such a clear COI.
Using health management information system data: case study and verification of institutional deliveries in Ethiopia
Authors: Arsenault Catherine , Yakob Bereket , Kassa Munir , Dinsa Girmaye , Verguet Stéphane
Published: August 2021

Health management information systems (HMIS) are a crucial source of timely health statistics and have the potential to improve reporting in low-income countries. However, concerns about data quality have hampered their widespread adoption in research and policy decisions. This article presents results from a data verification study undertaken to gain insights into the quality of HMIS data in Ethiopia. We also provide recommendations for working with HMIS data for research and policy translation. We linked the HMIS to the 2016 Emergency Obstetric and Newborn Care Assessment, a national census of all health facilities that provided maternal and newborn health services in Ethiopia. We compared the number of visits for deliveries and caesarean sections (C-sections) reported in the HMIS in 2015 (January–December) to those found in source documents (paper-based labour and delivery and operating theatre registers) in 2425 facilities across Ethiopia. We found that two-thirds of facilities had ‘good’ HMIS reporting for deliveries (defined as reporting within 10% of source documents) and half had ‘very good’ reporting (within 5% of source documents). Results were similar for reporting on C-section deliveries. We found that good reporting was more common in urban areas (OR: 1.30, 95% CI 1.06 to 1.59), public facilities (OR: 2.95, 95% CI 1.38 to 6.29) and in hospitals compared with health centres (OR: 1.71, 95% CI 1.13 to 2.61). Facilities in the Somali and Afar regions had the lowest odds of good reporting compared with Addis Ababa and were more likely to over-report deliveries in the HMIS. Further work remains to address remaining discrepancies in the Ethiopian HMIS. Nonetheless, our findings corroborate previous data verification exercises in Ethiopia and support greater use and uptake of HMIS data for research and policy decisions (particularly, greater use of HMIS data elements (eg, absolute number of services provided each month) rather than coverage indicators). Increased use of these data, combined with feedback mechanisms, is necessary to maintain data quality.
Review of study reporting guidelines for clinical studies using artificial intelligence in healthcare
Authors: Shelmerdine Susan Cheng , Arthurs Owen J , Denniston Alastair , Sebire Neil J
Published: August 2021

High-quality research is essential in guiding evidence-based care, and should be reported in a way that is reproducible, transparent and where appropriate, provide sufficient detail for inclusion in future meta-analyses. Reporting guidelines for various study designs have been widely used for clinical (and preclinical) studies, consisting of checklists with a minimum set of points for inclusion. With the recent rise in volume of research using artificial intelligence (AI), additional factors need to be evaluated, which do not neatly conform to traditional reporting guidelines (eg, details relating to technical algorithm development). In this review, reporting guidelines are highlighted to promote awareness of essential content required for studies evaluating AI interventions in healthcare. These include published and in progress extensions to well-known reporting guidelines such as Standard Protocol Items: Recommendations for Interventional Trials-AI (study protocols), Consolidated Standards of Reporting Trials-AI (randomised controlled trials), Standards for Reporting of Diagnostic Accuracy Studies-AI (diagnostic accuracy studies) and Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis-AI (prediction model studies). Additionally there are a number of guidelines that consider AI for health interventions more generally (eg, Checklist for Artificial Intelligence in Medical Imaging (CLAIM), minimum information (MI)-CLAIM, MI for Medical AI Reporting) or address a specific element such as the ‘learning curve’ (Developmental and Exploratory Clinical Investigation of Decision-AI) . Economic evaluation of AI health interventions is not currently addressed, and may benefit from extension to an existing guideline. In the face of a rapid influx of studies of AI health interventions, reporting guidelines help ensure that investigators and those appraising studies consider both the well-recognised elements of good study design and reporting, while also adequately addressing new challenges posed by AI-specific elements.
Effects of flexi-bar training on muscle strength and physical performance in older people with dynapenia: the protocol of a randomised controlled trial
Authors: Wei Ning , Wang Xinxin , Chen Ling , Lyu Mengyu
Published: August 2021

Introduction

Dynapenia is a new term that is used to describe the age-related loss of muscle strength. Flexi-bar training is a safe and feasible device for older people with dynapenia. This study will investigate the effects of a 12-week flexi-bar training programme on muscle strength and physical function in older people with dynapenia.

Methods and analysis

A total of 114 participants (aged more than 65 years) with age-related muscle loss will participate in a 12-week flexi-bar training programme. The participants will be randomly divided into three groups, namely, flexi-bar, placebo and control, with equal number of participants in each group. The assessments will be conducted at preintervention, postintervention and 12 weeks after training completion. The primary outcome is timed-up-and-go test. The secondary outcomes are five-repetition sit-to-stand test, 10-metre walking test, handgrip strength, as well as the serum albumin and haemoglobin levels.

Ethics and dissemination

The procedures of this study were reviewed and approved by the Human Ethics Review Board of Wuhan Brain Hospital (General Hospital of the Yangtze River Shipping) on 29 September 2020 (#L20200013). The findings of this study will be published in peer-reviewed journals and presented at conferences. The trial was registered on 6 November 2020.

Trial registration number

ISRCTN14316668.
Rates of turnover among general practitioners: a retrospective study of all English general practices between 2007 and 2019
Authors: Parisi Rosa , Lau Yiu-Shing , Bower Peter , Checkland Kath , Rubery Jill , Sutton Matt , Giles Sally J , Esmail Aneez , Spooner Sharon , Kontopantelis Evangelos
Published: August 2021

Objective

To quantify general practitioners’ (GPs’) turnover in England between 2007 and 2019, describe trends over time, regional differences and associations with social deprivation or other practice characteristics.

Design

A retrospective study of annual cross-sectional data.

Setting

All general practices in England (8085 in 2007, 6598 in 2019).

Methods

We calculated turnover rates, defined as the proportion of GPs leaving a practice. Rates and their median, 25th and 75th percentiles were calculated by year and region. The proportion of practices with persistent high turnover (>10%) over consecutive years were also calculated. A negative binomial regression model assessed the association between turnover and social deprivation or other practice characteristics.

Results

Turnover rates increased over time. The 75th percentile in 2009 was 11%, but increased to 14% in 2019. The highest turnover rate was observed in 2013–2014, corresponding to the 75th percentile of 18.2%. Over time, regions experienced increases in turnover rates, although it varied across English regions. The proportion of practices with high (10% to 40%) turnover within a year almost doubled from 14% in 2009 to 27% in 2019. A rise in the number of practices with persistent high turnover (>10%) for at least three consecutive years was also observed, from 2.7% (2.3%–3.1%) in 2007 to 6.3% (5.7%–6.9%) in 2017. The statistical analyses revealed that practice-area deprivation was moderately associated with turnover rate, with practices in the most deprived area having higher turnover rates compared with practices in the least deprived areas (incidence rate ratios 1.09; 95% CI 1.06 to 1.13).

Conclusions

GP turnover has increased in the last decade nationally, with regional variability. Greater attention to GP turnover is needed, in the most deprived areas in particular, where GPs often need to deal with more complex health needs. There is a large cost associated with GP turnover and practices with very high persistent turnover need to be further researched, and the causes behind this identified, to allow support strategies and policies to be developed.
The 20 most important questions for novices of full-endoscopic spinal surgery in China: a mixed-method study protocol
Authors: Liu Can , Chu Hong Ling , Li Geng , He Jiao Yang , Ma Yun Long , Du Chuan Chao , Hai Bao , Zhu Bin
Published: August 2021

Introduction

The full-endoscopic spinal surgery (FESS) procedure is widely accepted and welcomed in China. With the continuous development of minimally invasive surgery, the further expansion of indications and the greater diversity of techniques, spinal endoscopic surgery currently accounts for more than 10% of spinal surgery in China, ranking among the top in the world. However, the admission system and standardised training system for spinal endoscopic surgery are not perfect, which presents a challenge and disadvantage for novices.

Methods and analysis

Exploratory mixed methods are applied for designing this study. First, we will collect questions from novices by allowing them to openly list their concerns to those who have completed FESS. These qualitative questions will be categorised using NVivo software. To produce the qualitative results, a questionnaire for the sequential two-round Delphi approach will be developed to identify the 20 most important questions from novices. This study is planned to be started at April 2021, and completed at March 2022.

Ethics and dissemination

The Research Ethics Committee of Peking University Third Hospital provided a waiver for this Delphi protocol. We expect that the findings will be published in a clinical journal and presented at conferences. Furthermore, we hope that the results can contribute to answering the questions raised by novices of spinal endoscopy in the form of books and to improving the training system for spinal endoscopy surgery.
Low myocardial energetic efficiency is associated with increased mortality in aortic stenosis
Authors: Bahlmann Edda , Einarsen Eigir , Cramariuc Dana , Midtbø Helga , Mancusi Costantino , Rossebø Anne , Willems Stephan , Gerdts Eva
Published: August 2021

Objectives

In hypertension, low myocardial energetic efficiency (MEEi) has been documented as an integrated marker of metabolic and left ventricular (LV) myocardial dysfunction. We tested the predictive performance of MEEi in initially asymptomatic aortic stenosis (AS) patients free from diabetes and known cardiovascular disease.

Methods

Data from 1703 patients with mostly moderate AS enrolled in the Simvastatin and Ezetimibe in Aortic Stenosis study followed for 4.3 years was used. MEE was calculated from Doppler stroke volume/([heart rate/60]) and indexed to LV mass (MEEi). The threshold value for MEEi associated with increased mortality was identified in generalised additive model with smoothing splines. Covariables of MEEi were identified in logistic regression analysis. Outcome was assessed in Cox regression analysis and reported as HR and 95% CI.

Results

MEEi <0.34 mL/s per gram was associated with increased cardiovascular mortality (n=80) (HR 2.53 (95% CI 1.50 to 4.28)) and all-cause mortality (n=155) (HR 1.74 (95% CI 1.20 to 2.52)) (both p<0.01). The association was independent of confounders of low MEEI (<0.34 mL/s per gram) identified in multivariable logistic regression analysis, including more severe AS, higher body mass index, lower LV midwall shortening and ejection fraction and presence of hypertension. Comparison of the Cox models with and without MEEi among the covariables demonstrated that MEEi significantly improved the prognostic yield (both p<0.01).

Conclusions

In patients with initially asymptomatic AS, low MEEi was associated with clustering of cardiometabolic risk factors, lower LV myocardial function and subsequent increased mortality during 4.3 years follow-up, independent of known prognosticators.

Trial registration number

NCT00092677.