bluuebunny/crossref_metadata_2025 huggingface dataset:
Wake‐up call: 4 out of 5 older hospitalised patients have nocturnal lower urinary tract symptoms
Authors: Nguyen Huong Xuan Thi , Penukonda Samhita , Stephen Shiny , Whishaw David M. , Bower Wendy F.
Published: October 2021

Objective

Nocturnal lower urinary tract symptoms (nLUTS) increase with age, frailty and comorbid systemic illness and affect many older people. The aim of this study was to describe the prevalence of nLUTS in a hospital aged‐care sub‐acute environment.

Methods

Prospective clinical audit based on semi‐structured bedside interviews of older adult patients admitted to a tertiary hospital aged rehabilitation ward over a 7‐month period.

Results

A total of 147 eligible patients were included in this clinical audit. The prevalence of nLUTS was 80% (76% nocturia; 54% nocturnal urgency; 32% nocturnal enuresis; 51% nocturnal incontinence). The incidence of any nLUTs was 37%. Half the sample reported daytime incontinence, which always co‐existed with at least one nLUTS.

Conclusion

Nocturnal lower urinary tract symptoms are a problem for four out of five older hospitalised patients. This highlights the need to screen for nLUTS early in the hospital admission and for implementation of a multidisciplinary team intervention to decrease morbidity and improve quality of life in this vulnerable population.
Immunopathogenesis and management of polymorphic light eruption
Authors: Kadurina Miroslava , Kazandjieva Jana , Bocheva Georgeta
Published: October 2021

Polymorphic light eruption (PLE) is the most common immunologically mediated photodermatosis, demonstrating many abnormalities caused by critical failure of ultraviolet (UV)‐induced immunosuppression. The unique expression of antimicrobial peptides in PLE, which is most likely determined by alteration of microbiome components upon UV exposure, implicates their possible triggering role and pathogenic significance in the eruption. The review aims to clarify current knowledge regarding the immunological disturbances correlated with PLE that serve a base for better understanding of molecular pathogenesis of the disease and the development of new therapeutic strategies. Preventive treatment with broad‐spectrum suncreens and sunscreens containing DNA repair enzymes, as well as natural photohardening with graduate exposure to sunlight in early spring could be sufficient in milder cases. Antioxidants and topical calcipotriol are promising approach for adjuvant prevention. Phototherapy, mainly with narrow band UVB rays, is more appropriate method in severe cases of the disease. The established treatment options for PLE include local and systemic glucocorticoids, systemic nonsedative antihistamines for itch relief, and rarely, immunosuppressive drugs in the refractory cases. Like medical photohardening, afamelanotide has the potential of photoprotection by inducing a melanization of the skin. Afamelanotide is believed to be a possible new treatment option for very severe and refractory cases of PLE. Targeting the main pruritogenic cytokine, IL‐31, opens a new road for the development of novel therapeutic approaches to combat moderate and severe itching in cases of PLE with intense pruritus.
Evaporative silicification in floating microbial mats: patterns of oxygen production and preservation potential in silica‐undersaturated streams, El Tatio, Chile
Authors: Wilmeth Dylan T. , Myers Kimberly D. , Lalonde Stefan V. , Mänd Kaarel , Konhauser Kurt O. , Grandin Prisca , van Zuilen Mark A.
Published: October 2021

Microbial mats floating within multiple hydrothermally sourced streams in El Tatio, Chile, frequently exhibit brittle siliceous crusts (~1 mm thick) above the air–water interface. The partially silicified mats contain a diverse assemblage of microbial clades and metabolisms, including cyanobacteria performing oxygenic photosynthesis. Surficial crusts are composed of several amorphous silica layers containing well‐preserved filaments (most likely cyanobacteria) and other cellular textures overlying EPS‐rich unsilicified mats. Environmental logs, silica crust distribution, and microbial preservation patterns provide evidence for crust formation via repeated cycles of evaporation and silica precipitation. Within the mats, in situ microelectrode profiling reveals that daytime oxygen concentrations and pH values are diminished beneath silica crusts compared with adjacent unencrusted communities, indicating localized inhibition of oxygenic photosynthesis due to light attenuation. As a result, aqueous conditions under encrusted mats have a higher saturation state with regard to amorphous silica compared with adjacent, more active mats where high pH increases silica solubility, likely forming a modest feedback loop between diminished photosynthesis and crust precipitation. However, no fully lithified sinters are associated with floating encrusted mats in El Tatio streams, as both subaqueous and subaerial silica precipitation are limited by undersaturated, low‐SiO2 (<150 ppm) stream waters. By contrast, well‐cemented sinters can form by evaporation in silica‐undersaturated solutions above 200 ppm SiO2. Floating mats in El Tatio therefore represent a specific sinter preservation window, where evaporation in silica‐undersaturated microbial mats produces crusts, which preserve cells and affect mat chemistry, but low‐silica concentrations prevent the formation of lasting sinter deposits. Patterns of silica precipitation in El Tatio microbial communities show that the preservation potential of silicifying mats in the rock record is strongly dependent on aqueous silica concentrations.
Application of sputtered ceramic TiC/a:C thin films with different structures by changing the deposition parameters
Authors: Balázsi Katalin , Balázsi Csaba
Published: October 2021

Titanium carbide‐based thin films have been produced by DC magnetron sputtering. It was demonstrated that the same technology with changing of the deposition parameters, such as deposition temperature or power of Ti target, resulted in the preparation of TiC/a:C thin films with various structures. The structure of thin films and volume fraction of amorphous and crystal phases were precisely tailored by the control of deposition parameters. These ceramic nanocomposite TiC/a:C thin films according to their various structures, hence, their different mechanical, tribological, or wetting parameters can be used in wide range of applications.
Longitudinal associations between early child weight gain, parent feeding, child self‐regulation, and later child body mass index
Authors: Perez Marisol , Winstone Laura K. , Curci Sarah G. , Hernández Juan C. , Somers Jennifer A. , Luecken Linda J.
Published: October 2021

Background

Few longitudinal studies have examined associations of child weight trajectories, maternal demandingness and responsiveness during feeding, and child self‐regulation.

Objective

We examined if child weight‐for‐length trajectories from 6 weeks to 2 years of age were associated with maternal demandingness and responsiveness at child age 3 years old, and if maternal feeding dimensions predicted child BMI trajectories from 4.5 to 7.5 years among Mexican American children from low‐income families. Child self‐regulation was evaluated as a potential mechanism linking maternal feeding with child BMI.

Method

Child (N = 322) weight and length/height were assessed at 10 timepoints from 6 weeks through 7.5 years. Mothers completed the Caregiver Feeding Style Questionnaire when the child was 3 years of age.

Results

A steeper slope of weight‐for‐length z scores from 6 weeks to 2 years (indicating more rapid weight gain) was associated with less maternal demands during feeding at 3 years. More maternal demandingness at child age 3 years predicted lower child BMI at 4.5 years, but not trajectories from 4.5 to 7 years. Child self‐regulation was not associated with child BMI from 4.5 to 7.5 years.

Conclusion

The findings highlight how the relationship between mothers and children during feeding can be bidirectional and potentially influenced by the developmental stage.
What should be the future focus of mental health nursing? Exploring the perspectives of mental health nurses, consumers, and allied health staff
Authors: Wand Timothy , Glover Suzanne , Paul Diane
Published: October 2021

The landscape of mental health care and service delivery is changing, as is our understanding of the underlying causes for mental distress. It is now apparent that biogenic explanations have been overstated and instead experiences of trauma and adversity constitute the main contributor to people’s experiences of mental health challenges. The shortcomings of treatments traditionally used in mental health care are also evident, and with a contemporary focus on person‐centred care, the utility of diagnostic labels has been called into question. Taking all this into consideration, this study sought to explore, what should be the future focus of mental health nursing? Three separate focus groups were conducted. One with a sample of senior clinical mental health nurses, one with a sample of consumer representatives and another with allied health professionals. The common theme across all three focus groups was the centrality of the therapeutic role of mental health nurses (MHNs). Consumers and allied health participants, in particular, advocated for a de‐emphasis on medications, psychiatric diagnoses, and custodial practices. The MHNs role in health promotion, working collaboratively with consumers, being hopeful, understanding the individual perspective, and appreciating the social determinants of mental health were all highlighted in framing the future focus of MHN practice.
The social protection of platform workers in Romania: Meeting the growing demand for affordable and adequate coverage?
Authors: Roşioru Felicia
Published: October 2021

In a changing world of work, platform workers struggle to gain adequate protection, and effective access to the benefits provided by the social security system form a part of this. Social security benefits in Romania are particular in that access is based on a person having a professional income, regardless of the legal status of the worker (subordinate or self‐employed). As a rule, all workers are covered in the event of illness and changing family circumstances as well as for pensions. In contrast, coverage for self‐employed workers for unemployment benefits, work injury and occupational disease benefits, paid leave in the event of illness, protection against the risks related to pregnancy or to care for a sick child is voluntary. Given the diffusion of platform work, the article addresses the specific situation of platform workers in Romania, formally covered by the social security system, but who face obstacles related to eligibility criteria, administrative formalities, the risk of the automatic termination of work and intermittent work patterns.
Making recovery meaningful for people with intellectual disabilities
Authors: Trustam Emma , Chapman Philippa , Shanahan Paul
Published: October 2021

Background

A recovery approach within mental health services has gained momentum. Its meaning for adults with intellectual disabilities recovering from mental health disorders is less understood. Peoples' experiences of recovery were explored to help inform recovery‐focused recommendations for clinical practise.

Method

A qualitative design using interpretative phenomenological analysis was applied. Nine interviews with people with intellectual disabilities who had experienced mental health disorders were conducted.

Results

Two themes that emerged focusing on entry to service and the recovery experience. Subthemes for entry to service included unfair treatment, valuing information and managing expectations. The recovery experience subthemes were therapeutic alliance, self‐management, emotional development, autonomy, connectedness, positive identity and a belief in recovery.

Conclusions

Hearing peoples' experiences directly allowed the current themes to emerge in the context of living with lifelong disabilities. This article adds to the sparse literature and highlights considerations for recovery‐based interventions for people with intellectual disabilities.
Association of increased levels of omentin‐1 and carotid intima‐media thickness with early signs of cardiovascular risk in patients with polycystic ovary syndrome: A prospective case control study
Authors: Alanya Tosun Şebnem , Gurbuz Tugba , Cebi Aysegul , Tosun Alptekin , Gokmen Oya , Usta Murat
Published: October 2021

Aim

Omentin‐1, an adipokine primarily secreted from visceral adipose tissue, regulates metabolic homeostasis, whereas carotid intima‐media thickness (CIMT) is a valid marker for early diagnosis of atherosclerosis. We aimed to investigate whether polycystic ovary syndrome (PCOS) is related to levels of omentin‐1 and CIMT and demonstrate the association with cardiovascular risk.

Methods

A prospective case–control study was performed on 47 PCOS patients and 35 healthy subjects. Hormonal and metabolic parameters, levels of serum omentin‐1, and CIMT were evaluated in the two groups.

Results

The right, left, total CIMT, and levels of serum omentin‐1 were significantly higher in the PCOS group than in the healthy controls (p = 0.015, p = 0.009, p = 0.021, and p = 0.002, respectively). Using multiple linear and backward elimination regression analyses, serum omentin‐1 was found to be independently associated with age and Ln‐transformed homeostasis model assessment of insulin resistance, and cardiovascular parameters were independently associated with body mass index (BMI). In the PCOS group, the means of right, left, and total CIMT were significantly higher in the subgroup with BMI levels ≥25 kg/m2 compared to the subgroup with BMI levels <25 kg/m2 (p < 0.001 for all comparisons).

Conclusion

A significant increase in CIMT is associated with cardiovascular risk in patients with PCOS. Levels of serum omentin‐1 were found to be significantly higher in early PCOS cases at a younger age, acting as a protective acute‐phase reactant.
Knowledge Acquisition of Self-Organizing Systems With Deep Multiagent Reinforcement Learning
Authors: Ji Hao , Jin Yan
Published: October 2021

Self-organizing systems (SOS) can perform complex tasks in unforeseen situations with adaptability. Previous work has introduced field-based approaches and rule-based social structuring for individual agents to not only comprehend the task situations but also take advantage of the social rule-based agent relations to accomplish their tasks without a centralized controller. Although the task fields and social rules can be predefined for relatively simple task situations, when the task complexity increases and the task environment changes, having a priori knowledge about these fields and the rules may not be feasible. In this paper, a multiagent reinforcement learning (RL) based model is proposed as a design approach to solving the rule generation problem with complex SOS tasks. A deep multiagent reinforcement learning algorithm was devised as a mechanism to train SOS agents for knowledge acquisition of the task field and social rules. Learning stability, functional differentiation, and robustness properties of this learning approach were investigated with respect to the changing team sizes and task variations. Through computer simulation studies of a box-pushing problem, the results have shown that there is an optimal range of the number of agents that achieves good learning stability; agents in a team learn to differentiate from other agents with changing team sizes and box dimensions; the robustness of the learned knowledge shows to be stronger to the external noises than with changing task constraints.
Determination of the Inverse Kinematics Branches of Solution Based on Joint Coordinates for Universal Robots-Like Serial Robot Architecture
Authors: Schreiber Louis-Thomas , Gosselin Clément
Published: October 2021

This paper introduces a classification of the inverse kinematics solutions (or robot postures) of six degrees-of-freedom serial robots with a geometry based on or similar to Universal Robots’ arms. The solution of the inverse kinematics problem is first presented briefly, and the equations required to classify the robot postures(branches) based on the joint coordinates are then introduced.
Experimental Study on the Heat Transfer Performance of a Stainless-Steel Heat Pipe With Sintered Fiber Wick
Authors: Mo Haijun , Zhao Hang , Wang Xiaowu , Cao Rui , Wan Zhenping , Tao Sulian
Published: October 2021

A kind of stainless-steel heat pipe with sintered fiber wick is investigated with the aim to improve the heat dissipation when it is used in spent fuel pools in nuclear power plants. The effects of test angle, porosity, and the filling rate on the heat transfer performance of the heat pipe are studied. At a test angle of 90 deg, the permeability plays an important role in the power limit since gravity can provide the necessary driving force. Larger porosity involves poor heat conductivity although it results in better permeability. When the test angle is zero, gravity is no longer the driving force. In this case, the evaporation section can still avoid dry burning because part of the evaporation section is dipped in deionized water. Therefore, permeability and filling ratio are two important factors influencing the power limit. Filling rate determines the vapor-flowing space. When the test angle is smaller than zero, gravity becomes a resistance force. Then, the lag tension and the filling rate exert the greatest influence on the performance of the heat pipe. Smaller porosity corresponds to a smaller contact angle.
“You Kick Like A Girl!” The Effects of Gender Stereotypes on Motor Skill Learning in Young Adolescents
Authors: Mousavi Seyyed Mohammadreza , Gray Laura , Beik Sahar , Deshayes Maxime
Published: October 2021

This study investigated the effect of gender stereotypes on (a) a soccer learning task based on accuracy (i.e., shooting on different size targets) among young adolescents and (b) the strategy used to score as many points as possible. After performing 10 baseline trials, 45 young adolescents were randomly divided into three groups: positive stereotype, negative stereotype, and control. Then, they performed five blocks of 10 trials and two retention tests, 1 and 3 days after the stereotype manipulation to assess the relatively permanent consequences of stereotype effects. Results showed that when the negative stereotype was induced, participants performed worse during the acquisition phase and the first retention test. The positive stereotype only had a positive effect on performance during the second retention test. These findings provide the first evidence of the effect of gender stereotypes on motor learning tasks requiring accuracy among young adolescents.
Erratum: Research and Politics
Authors: Goldschmidt Richard B.
Published: October 2021

My attention has been drawn by correspondents to two incorrect statements in my article "Research and Politics" (
Science
, March 4, 1949). First, it was stated that Vavilov died in a concentration camp. This should have read "died in exile in a remote region of the USSR," since the details are unknown. Second, I said that Kammerer committed suicide after going to Russia. Actually, he did so while still in Vienna, at the moment when he was finally to move to Moscow.
Erratum: Neomycin, a New Antibiotic Active against Streptomycin-Resistant Bacteria, including Tuberculosis Organisms
Authors: Waksman Selman A.
Published: October 2021

I would like to call your attention to an error that crept into the paper on neomycin by Waksman and Lechevalier (
Science
, March 25). On page 307, right column, lines 1, 8, and 9, the letter μ should read
u
, or
unit
.
Correction
Authors: Gardner Eugene
Published: October 2021

In our article "Mesons Produced by the Cyclotron" (Gardner, E.
et al. Science
, 1950, 111, 191) there is a typographical error on page 196 in the table near the top of the page. The first entry in the right-hand column reads 28.8 and should read 26.8.
Erratum: Pantothenic Acid in Copper Deficiency in Rats
Authors: Singer Leon , Davis George K.
Published: October 2021

In our paper "Pantothenic Acid in Copper Deficiency in Rats" (
Science
, 1950, 111, 472), in the last sentence of the second paragraph on page 473, the daily administered dose mentioned should be "0.1 μg of copper" and not "1.1 μg" as printed.
Rewarding Properties of Intracranial Stimulation
Authors: Brodie David A. , Moreno Oscar M. , Malis Jerry L. , Boren John J.
Published: October 2021

Monkeys can be trained to press a lever to obtain intracranial brain stimulation on a large fixed-ratio schedule as well as on a continuous reinforcement schedule. A long extinction curve appears to be indicative of a future high fixed-ratio performance.
Mayaro Virus Isolated from a Trinidadian Mosquito,
Mansonia venezuelensis
Authors: Aitken T. H. G. , Downs W. G. , Anderson C. R. , Spence L. , Casals J.
Published: October 2021

A strain of Mayaro virus has been isolated in Trinidad from the mosquito
Mansonia venezuelensis
. This is the first record of isolation of this agent from naturally infected mosquitoes, caught in the wild.
Stimulus Generalization of Conditioned Suppression
Authors: Fleshler Morton , Hoffman Howard S.
Published: October 2021

A tone ending in unavoidable electric shock was periodically presented to pigeons while they pecked a key for food. When pecking was completely disrupted by tone, shock was disconnected, and the training tone and tones having new frequencies were presented. Initially the gradient of generalization was broad; as testing proceeded, however, the gradient narrowed severely.
Deoxyribonucleic Acid Mediates Sensitization of Penicillin-Resistant
Staphylococcus
Authors: Nathanson R. B.
Published: October 2021

An extract, which contained deoxyribonucleic acid, from a penicillin-sensitive hospital strain of
Staphylococcus aureus
conferred the property of sensitivity upon a penicillin-resistant strain of the same species, with the phage type of the sensitized
S. aureus
remaining unchanged after transformation.
Irrigation and Nitrogen Effects on Sweet Corn Row Numbers at Various Growth Stages
Authors: Schreiber Henry A. , Stanberry Chauncy O. , Tucker Henry
Published: October 2021

Kernel rows per ear of a hybrid of
Zea mays L.
were found to be affected by environmental conditions during the first 7 weeks after planting. Increased row numbers were evident on harvested ears if as little as 25 pounds per acre of nitrogen fertilizer was added at planting.
Pogonophora in the Western Atlantic Ocean
Authors: Bayer Frederick M.
Published: October 2021

The occurrence of pogonophoran worms of the genus
Siboglinum
off the east coast of Florida is reported. Their presence in association with pennatulids is noted, and compared with a similar instance in the Bering Sea. This association is probably due to similar ecological requirements.
Detrital Mineral Grains in Tektites
Authors: Barnes Virgil E.
Published: October 2021

Abundant detrital crystalline mineral grains have been found in layered Muong Nong-type indochinite tektites from Nong Sapong, northeastern Thailand. These grains are an integral part of some tektite layers, and their presence furnishes strong presumptive evidence that indochinites, as well as other tektite groups in which layered specimens occur, formed from surficial earth materials.
Parameters of the Plasma Affecting the Radiation of Pulsar 1
Authors: Tanenbaum B. S. , Zeissig G. A. , Drake F. D.
Published: October 2021

Analysis of the relation between time delay and frequency for pulses from Pulsar 1 shows that the dispersive region of the ray path must exceed 300 astronomical units and have an average electron number density less than 8000 per cubic centimeter and average magnetic field strength less than 2 × 10
-3
gauss. These requirements almost guarantee that the observed dispersion takes place in the interstellar medium.
A Low-Threshold Test Ban Is Feasible
Authors: Feiveson Harold A. , Paine Christopher E. , von Hippel Frank
Published: October 2021

At present, nuclear explosions are limited by treaty to underground testing with yields of no more than 150 kilotons, and recently there have been renewed calls for further test restrictions. As part of these discussions, the U.S. Congress is considering bills that would legislate new limits to testing, whereas the Reagan Administration opposes such constraints. The editors of
Science
have asked two groups of participants in the debate to present their arguments for or against new limits to testing. Feiveson, Paine, and von Hippel argue for a treaty of indefinite duration between the United States and the Soviet Union, which includes the following provisions: (i) a ban on all testing outside a designated site having known seismic properties; (ii) verification by means of on-site inspection and in-country seismic monitoring; (iii) unlimited testing below 1 kiloton at the special site; and (iv) an average of one test per year with a yield of up to 15 kilotons for ensuring reliability of the nuclear stockpile. Miller, Brown, and Nordyke argue that a lowering of the present 150-kiloton threshold would be undesirable, and that new test bans would divert attention from a comprehensive approach to negotiated reductions in the nuclear and conventional arsenals of the United States and the Soviet Union.
Gene Ties Arthropods Together
Authors: Roush Wade
Published: October 2021

Boston—Scientists have argued that insects, which have unbranched limbs, and crustaceans—with branched ones—are two very distinct groups. New developmental evidence, however, points to a much closer relationship. Limb branching in both groups is a second-order phenomenon, scientists report, affected by a single gene, called Distal-less (
Dll
). It shouldn't be used to separate the groups, but to bring them together (see Report on p.
1363
).
Sexing Fossils: A Boy Named Lucy?
Authors: Shreeve James
Published: October 2021

A controversial new analysis of its pelvis indicates that “Lucy,” the most famous human ancestor of all, was really a male. This gender-bender is also a species-splitter: If correct, the analysis implies that Lucy's 3-million-year-old species,
Australopithecus afarensis,
was actually two separate species.
Clementine 2 to Size Up an Asteroid
Authors: Weisman Jonathan
Published: October 2021

Oakland, California—Last year, a compact, sophisticated military spacecraft called Clementine wowed the planetary science community by mapping the moon at a total cost of $100 million. Next year's defense budget includes the first funding for Clementine's successor, which will continue in this vein of low-budget, high-stakes space exploration. Clementine 2 is set to rendezvous with as many as 3 nearby asteroids in 1998 to study their composition and structure—information that might someday be crucial to deflecting an asteroid on a collision course with Earth.
How ambitious are oil and gas companies’ climate goals?
Authors: Dietz Simon , Gardiner Dan , Jahn Valentin , Noels Jolien
Published: October 2021

Despite many claims, the sector is not on track
Tackling the pandemic with (biased) data
Authors: Pagel Christina , Yates Christian A.
Published: October 2021

Data are crucial for understanding and addressing the pandemic, but there are pitfalls
Active mechanisorption driven by pumping cassettes
Authors: Feng Liang , Qiu Yunyan , Guo Qing-Hui , Chen Zhijie , Seale James S. W. , He Kun , Wu Huang , Feng Yuanning , Farha Omar K. , Astumian R. Dean , Stoddart J. Fraser
Published: October 2021

Pumping macrocycles onto surfaces

Numerous chemical processes, ranging from water purification to catalysis, involve sorption of small molecules onto surfaces. Typically, spontaneous attractive interactions favor the binding event. Feng
et al
. report a mechanisorption process that requires redox manipulations to pump macrocycles from bulk solution onto axles immobilized on a metal-organic framework. The resulting rotaxanes store energy through nonequilibrium charge concentration in their mechanical bonds. Ultimately, the technique could also prove useful for actively partitioning compounds with particular functionality between surface and bulk environments. —JSY
Impact of neurodegenerative diseases on human adult hippocampal neurogenesis
Authors: Terreros-Roncal J. , Moreno-Jiménez E. P. , Flor-García M. , Rodríguez-Moreno C. B. , Trinchero M. F. , Cafini F. , Rábano A. , Llorens-Martín M.
Published: October 2021

Disease and hippocampal dysfunction

Impaired function of the brain’s hippocampus can underpin psychiatric symptoms and cognitive impairment. Looking at postmortem brain samples from patients affected by any of several neurodegenerative disorders, Terreros-Roncal
et al
. investigated whether adult neurogenesis was disrupted (see the Perspective by Gage). Indeed, functions of the neurogenic niche shifted and the cells produced were abnormal in shape and differentiation. The neuronal plasticity characteristic of the hippocampus may make it especially susceptible to the ravages of neurodegenerative disease. —PJH
Why is Kangaroo Mother Care not yet scaled in the UK? A systematic review and realist synthesis of a frugal innovation for newborn care
Authors: Stefani Giulietta , Skopec Mark , Battersby Cheryl , Harris Matthew
Published: October 2021

Objective

Kangaroo Mother Care (KMC) is a frugal innovation improving newborn health at a reduced cost compared with incubator use. KMC is widely recommended; however, in the UK, poor evidence exists on KMC, and its implementation remains inconsistent.

Design

This Systematic Review and Realist Synthesis explores the barriers and facilitators in the implementation of KMC in the UK.

Data source

OVID databases, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus and Google Scholar were searched.

Eligibility criteria

Studies were UK based, in maternity/neonatal units, for full-term/preterm children. First screening included studies on (1) KMC, Kangaroo Care (KC) or skin-to-skin contact (SSC) or (2) Baby Friendly Initiative, Small Wonders Change Program or family-centred care if in relation to KMC/KC/SSC. Full texts were reviewed for evidence regarding KMC/KC/SSC implementation.

Results

The paucity of KMC research in the UK did not permit a realist review. However, expanded review of available published studies on KC and SSC, used as a proxy to understand KMC implementation, demonstrated that the main barriers are the lack of training, knowledge, confidence and clear guidelines.

Conclusion

The lack of KMC implementation research in the UK stands in contrast to the already well-proven benefits of KMC for stable babies in low-income contexts and highlights the need for further research, especially in sick and small newborn population. Implementation of, and research into, KC/SSC is inconsistent and of low quality. Improvements are needed to enhance staff training and parental support, and to develop guidelines to properly implement KC/SSC. It should be used as an opportunity to emphasise the focus on KMC as a potential cost-effective alternative to reduce the need for incubator use in the UK.
Recruiters’ perspectives and experiences of trial recruitment processes: a qualitative evidence synthesis protocol
Authors: Farrar Nicola , Elliott Daisy , Jepson Marcus , Houghton Catherine , Young Bridget , Donovan Jenny , Rooshenas Leila
Published: October 2021

Introduction

Recruitment to randomised trials (RCTs) is often challenging. Reviews of interventions to improve recruitment have highlighted a paucity of effective interventions aimed at recruiters and the need for further research in this area. Understanding the perspectives and experiences of those involved in RCT recruitment can help to identify barriers and facilitators to recruitment, and subsequently inform future interventions to support recruitment. This protocol describes methods for a proposed qualitative evidence synthesis (QES) of recruiters’ perspectives and experiences relating to RCT recruitment.

Methods and analysis

The proposed review will synthesise studies reporting clinical and non-clinical recruiters’ perspectives and experiences of recruiting to RCTs. The following databases will be searched: Ovid MEDLINE, CINAHL, EMBASE, PsycInfo, Cochrane Central Register of Controlled Trials, ORRCA and Web of Science. A thematic synthesis approach to analysing the data will be used. An assessment of methodological limitations of each study will be performed using the Critical Appraisal Skills Programme tool. Assessing the confidence in the review findings will be evaluated using the GRADE Confidence in Evidence from Reviews of Qualitative research (GRADE-CERQual) tool.

Ethics and dissemination

The proposed QES will not require ethical approval as it includes only published literature. The results of the synthesis will be published in a peer-reviewed journal and publicised using social media. The results will be considered alongside other work addressing factors affecting recruitment in order to inform future development and refinement of recruitment interventions.

PROSPERO registration number

CRD42020141297.
Gut microbiome, enteric infections and child growth across a rural–urban gradient: protocol for the ECoMiD prospective cohort study
Authors: Lee Gwenyth O , Eisenberg Joseph N S , Uruchima Jessica , Vasco Gabriela , Smith Shanon M , Van Engen Amanda , Victor Courtney , Reynolds Elise , MacKay Rebecca , Jesser Kelsey J , Castro Nancy , Calvopiña Manuel , Konstantinidis Konstantinos T , Cevallos William , Trueba Gabriel , Levy Karen
Published: October 2021

Introduction

The functional consequences of the bacterial gut microbiome for child health are not well understood. Characteristics of the early child gut microbiome may influence the course of enteric infections, and enteric infections may change the composition of the gut microbiome, all of which may have long-term implications for child growth and development.

Methods and analysis

We are conducting a community-based birth cohort study to examine interactions between gut microbiome conditions and enteric infections, and how environmental conditions affect the development of the gut microbiome. We will follow 360 newborns from 3 sites along a rural–urban gradient in northern coastal Ecuador, characterising enteric infections and gut microbial communities in the children every 3 to 6 months over their first 2 years of life. We will use longitudinal regression models to assess the correlation between environmental conditions and gut microbiome diversity and presence of specific taxa, controlling for factors that are known to be associated with the gut microbiome, such as diet. From 6 to 12 months of age, we will collect weekly stool samples to compare microbiome conditions in diarrhoea stools versus stools from healthy children prior to, during and after acute enteric infections, using principal-coordinate analysis and other multivariate statistical methods.

Ethics and dissemination

Ethics approvals have been obtained from Emory University and the Universidad San Francisco de Quito institutional review boards. The findings will be disseminated through conference presentations and peer-reviewed journals.
Paediatric tuberculosis preventive treatment preferences among HIV-positive children, caregivers and healthcare providers in Eswatini: a discrete choice experiment
Authors: Hirsch-Moverman Yael , Strauss Michael , George Gavin , Mutiti Anthony , Mafukidze Arnold , Shongwe Siphesihle , Dube Gloria Sisi , El Sadr Wafaa M , Mantell Joanne E , Howard Andrea A
Published: October 2021

Objective

Isoniazid preventive therapy initiation and completion rates are suboptimal among children. Shorter tuberculosis (TB) preventive treatment (TPT) regimens have demonstrated safety and efficacy in children and may improve adherence but are not widely used in high TB burden countries. Understanding preferences regarding TPT regimens’ characteristics and service delivery models is key to designing services to improve TPT initiation and completion rates. We examined paediatric TPT preferences in Eswatini, a high TB burden country.

Design

We conducted a sequential mixed-methods study utilising qualitative methods to inform the design of a discrete choice experiment (DCE) among HIV-positive children, caregivers and healthcare providers (HCP). Drug regimen and service delivery characteristics included pill size and formulation, dosing frequency, medication taste, treatment duration and visit frequency, visit cost, clinic wait time, and clinic operating hours. An unlabelled, binary choice design was used; data were analysed using fixed and mixed effects logistic regression models, with stratified models for children, caregivers and HCP.

Setting

The study was conducted in 20 healthcare facilities providing TB/HIV care in Manzini, Eswatini, from November 2018 to December 2019.

Participants

Ninety-one stakeholders completed in-depth interviews to inform the DCE design; 150 children 10–14 years, 150 caregivers and 150 HCP completed the DCE.

Results

Despite some heterogeneity, the results were fairly consistent among participants, with palatability of medications viewed as the most important TPT attribute; fewer and smaller pills were also preferred. Additionally, shorter waiting times and cost of visit were found to be significant drivers of choices.

Conclusion

Palatable medication, smaller/fewer pills, low visit costs and shorter clinic wait times are important factors when designing TPT services for children and should be considered as new paediatric TPT regimens in Eswatini are rolled out. More research is needed to determine the extent to which preferences drive TPT initiation, adherence and completion rates.
How can we strengthen mental health services in Swedish youth clinics? A health policy and systems study protocol
Authors: Richter Sundberg Linda , Christianson Monica , Wiklund Maria , Hurtig Anna-Karin , Goicolea Isabel
Published: October 2021

Introduction

Strengthening first-line mental healthcare services for youth remains a priority for the Swedish government. The government is currently investigating how different sectors involved can be strengthened, but evidence is scarce. Youth clinics play a key role in these discussions, being one of the most trusted services for youth. However, analysis of organisational functions and coordination with other services is important to strengthen youth clinics’ role in first-line mental healthcare. This study investigates these challenges and aims to analyse the integration of mental healthcare within youth clinics to identify strategies to strengthen first-line mental healthcare for youth in Sweden.

Methods and analysis

This study adopts a health policy and systems approach. In the first phase, a formative realist evaluation is conducted to ascertain what works in terms of integrating mental healthcare services within youth clinics, for what type of youth subpopulations and under what circumstances. National-level stakeholders will be interviewed to elicit the programme theory that explains how the intervention is supposed to work. The programme theory will then be tested in three–five cases. The cases will be comprised of youth clinics and their stakeholders. Quantitative and qualitative information will be gathered, including via visual methodologies and questionnaires. The second phase includes a concept mapping study, engaging stakeholders and young people to build consensus on strategies to strengthen the integration of mental healthcare into youth clinics.

Ethics and dissemination

The Swedish Ethical Review Authority has approved the study (2019-02910 and 2020-04720). The results will be published in open-access peer-reviewed journals and presented at scientific conferences.
Total hip arthroplasty versus progressive resistance training in patients with severe hip osteoarthritis: protocol for a multicentre, parallel-group, randomised controlled superiority trial
Authors: Frydendal Thomas , Christensen Robin , Mechlenburg Inger , Mikkelsen Lone Ramer , Overgaard Søren , Ingwersen Kim Gordon
Published: October 2021

Introduction

Hip osteoarthritis (OA) is the leading cause for total hip arthroplasty (THA). Although, being considered as the surgery of the century up to 23% of the patients report long-term pain, and deficits in physical function and muscle strength may persist after THA. Progressive resistance training (PRT) appears to improve multiple outcomes moderately in patients with hip OA. Current treatment selection is based on low-level evidence as no randomised controlled trials have compared THA to non-surgical treatment. The primary aim of this trial is to investigate whether THA followed by standard care is superior to 12 weeks of supervised PRT followed by 12 weeks of optional unsupervised PRT for improving hip pain and function in patients with severe hip OA.

Methods and analysis

This is a protocol for a multicentre, parallel-group, assessor-blinded, randomised controlled superiority trial conducted at four hospitals across three healthcare regions in Denmark. 120 patients aged ≥50 years with clinical and radiographic hip OA found eligible for THA by an orthopaedic surgeon will be randomised to THA followed by standard care, or 12 weeks of PRT (allocation 1:1). The primary outcome will be change in patient-reported hip pain and function, measured using the Oxford Hip Score, from baseline to 6 months after initiating the treatment. Key secondary outcomes will be change in the Hip disability and Osteoarthritis Outcome Score subscales, University of California Los Angeles Activity Score, 40 m fast-paced walk test, 30 s chair stand test and occurrence of serious adverse events. Patients declining participation in the trial will be invited into a prospective observational cohort study.

Ethics and dissemination

The trial has been approved by The Regional Committees on Health Research Ethics for Southern Denmark (Project-ID: S-20180158). All results will be presented in peer-reviewed scientific journals and international conferences.

Trial registration number

ClinicalTrials.gov (NCT04070027).
Multicentre, longitudinal, observational cohort study to examine the relationship between neutrophil function and sepsis in adults and children with severe thermal injuries: a protocol for the Scientific Investigation of the Biological Pathways Following Thermal Injury-2 (SIFTI-2) study
Authors: Hazeldine Jon , McGee Kirsty C , Al-Tarrah Khaled , Hassouna Tarek , Patel Krupali , Imran Rizwana , Bishop Jonathan R B , Bamford Amy , Barnes David , Wilson Yvonne , Harrison Paul , Lord Janet M , Moiemen Naiem S
Published: October 2021

Introduction

Burn-induced changes in the phenotype and function of neutrophils, cells which provide front-line protection against rapidly dividing bacterial infections, are emerging as potential biomarkers for the early prediction of sepsis. In a longitudinal study of adult burns patients, we recently demonstrated that a combined measurement of neutrophil phagocytic capacity, immature granulocyte (IG) count and plasma cell-free DNA (cfDNA) levels on the day of injury gave good discriminatory power for the prediction of later sepsis development. However, limited by a small sample size, single-centre design and focus on adult burns patients, these biomarkers require prospective validation in a larger patient cohort. The Scientific Investigation of the Biological Pathways Following Thermal Injury-2 study aims to prospectively validate neutrophil phagocytic activity, IG count and plasma cfDNA levels as early prognostic biomarkers of sepsis in thermally injured adult and paediatric patients.

Methods and analysis

This multicentre, longitudinal, observational cohort study will enrol 245 paediatric and adult patients with moderate to severe burns within 24 hours of injury. Blood samples will be obtained at 19 postinjury time points (days 1–14, day 28, months 3, 6, 12 and 24) and analysed for neutrophil phagocytic activity, IG count and cfDNA levels. Patients will be screened daily for sepsis using the 2007 American Burn Association diagnostic criteria for sepsis. In addition, daily multiple organ dysfunction syndrome and Sequential Organ Failure Assessment Scores will be recorded relationships between neutrophil phagocytic activity, IG count and plasma cfDNA levels on day 1 of injury and the development of sepsis will be examined using logistic regression models.

Ethics and dissemination

This study received ethics approval from the West Midlands, Coventry and Warwickshire Research Ethics Committee (REC reference:16/WM/0217). Findings will be presented at national and international conferences, and submitted for publication in peer-reviewed journals.

Trial registration number

NCT04693442.
Exploring the meaning, role and experiences of a patient-led social innovation for people affected by cancer: a new collaborative care model complementing traditional cancer rehabilitation in Sweden
Authors: Smith Frida , Hellström Andreas , Gunnarsdóttir Katrín Ásta , Genell Anna , Eriksson Erik , Mannefred Carina , Björk-Eriksson Thomas , Vaughn Lisa
Published: October 2021

Objective

Kraftens Hus is the first support centre in Sweden designed by and for people affected by cancer, including patients, family, friends, staff members and local community representatives (collectively ‘stakeholders’). The purpose of this study was to explore the meaning, role and experiences of Kraftens Hus stakeholders using a patient and public involved methodology.

Methods

To understand and map the experiences of visitors to Kraftens Hus, we applied concept mapping (CM), a mixed methods approach where data are collected and analysed in four structured steps designed to capture the diverse perspectives of multiple stakeholders. Qualitative interviews with relevant stakeholders supplemented the CM findings.

Results

The final concept map contained six clusters of ideas. Within the clusters, there was a recurring theme that cancer-affected people value accessible and long-term psychosocial support (PSS). The intended emotional, social and practical needs identified in a previous design process seem to have been addressed and appreciated by Kraftens Hus visitors.

Conclusion

Kraftens Hus is an example of a new patient-led social innovation based on a life-event perspective and integration of resources from different sectors in society. By focusing on life, not the disease, the care continuum expands, and long-term PSS is provided alongside cancer treatment. The evaluation confirms that PSS should focus on health and well-being in the broadest sense.
Alcoholic Psychoses
Authors: Marjot David H.
Published: October 2021

The study of alcoholic psychoses in Servicemen shows the clinical picture to be more varied than is usually believed and that they have much in common with other drug states.

The ‘pharmacological’ and ‘withdrawal’ theories of alcoholic psychoses receive clinical support. The brevity of the binge which can produce physical dependence is not widely recognised.

Alcoholic psychoses not only conform to the classic organic reaction types, but may also resemble schizophrenia.
Problems of Communication and Ear Protection in the Royal Marines
Authors: Forrest M. R. , Coles R. R. A.
Published: October 2021

A simple modification to the V.51R-type plug has enabled ease of communication to be combined with adequate protection against high-intensity noises, notably of gunfire origin. These Gundefenders were developed and tested in the laboratory by means of hard-walled artificial ears, cadaver ears, pure-tone and speech audiometric threshold shifts. Their performance was proved by means of series of TTS studies and communication trials. It is believed that these earplugs should now replace conventional earplugs for usage in all gunfire noise exposure situations in which the latter are normally used.
Preventive Medicine in the Nuclear Submarine Programme
Authors: Lambert R. J. W.
Published: October 2021

Some of the new tasks imposed on the medical branch by the advent of the nuclear submarine are described. Control of the environment becomes a major part of the medical officer’s duties and, in particular, atmospheric toxicology requires a sophisticated approach. A submarine community forms a useful model for certain lines of research, and some of these are indicated.