bluuebunny/crossref_metadata_2025 huggingface dataset:
Role of flagellar hydrogen bonding in Salmonella motility and flagellar polymorphic transition
Authors: Wang Chu , Lunelli Michele , Zschieschang Erik , Bosse Jens Bernhard , Thuenauer Roland , Kolbe Michael
Published: August 2019

Bacterial flagellar filaments are assembled by tens of thousands flagellin subunits, forming 11 helically arranged protofilaments. Each protofilament can take either of the two bistable forms L‐type or R‐type, having slightly different conformations and inter‐protofilaments interactions. By mixing different ratios of L‐type and R‐type protofilaments, flagella adopt multiple filament polymorphs and promote bacterial motility. In this study, we investigated the hydrogen bonding networks at the flagellin crystal packing interface in Salmonella enterica serovar typhimurium (S. typhimurium) by site‐directed mutagenesis of each hydrogen bonded residue. We identified three flagellin mutants D108A, N133A and D152A that were non‐motile despite their fully assembled flagella. Mutants D108A and D152A trapped their flagellar filament into inflexible right‐handed polymorphs, which resemble the previously predicted 3L/8R and 4L/7R helical forms in Calladine’s model but have never been reported in vivo. Mutant N133A produces floppy flagella that transform flagellar polymorphs in a disordered manner, preventing the formation of flagellar bundles. Further, we found that the hydrogen bonding interactions around these residues are conserved and coupled to flagellin L/R transition. Therefore, we demonstrate that the hydrogen bonding networks formed around flagellin residues D108, N133 and D152 greatly contribute to flagellar bending, flexibility, polymorphisms and bacterial motility.
Quantifying spatial and temporal variation of North Pacific fin whale (Balaenoptera physalus) acoustic behavior
Authors: Archer Frederick I. , Rankin Shannon , Stafford Kathleen M. , Castellote Manuel , Delarue Julien
Published: August 2019

In order to help develop hypotheses of connectivity among North Pacific fin whales, we examine recordings from 10 regions collected in the spring and fall. We develop a Random Forest model to classify fin whale note types that avoids manual note classification errors. We also present a method that objectively quantifies the note and pattern composition of recordings. We find that fin whale recordings near Hawaii have distinctive patterns, similar to those found in other regions in the central North Pacific, suggesting potential migration pathways. Our results are consistent with previous studies that suggest there may be two different populations utilizing the Chukchi Sea and central Aleutians in the fall and mix to some degree in the southern Bering Sea. Conversely, we found little difference between spring and fall recordings in the eastern Gulf of Alaska, suggesting some residency of whales in this region. This is likely due to fine scale similarities of calls among the inshore regions of British Columbia, while offshore areas are being utilized by whales traveling from various distant areas. This study shows how our novel approach to characterize recordings is an objective and informative way to standardize spatial and temporal comparisons of fin whale recordings.
Temporal and spatial spread of Hypoderma actaeon infection in roe deer from peninsular Spain determined by an indirect enzyme‐linked immunosorbent assay
Authors: Panadero R. , López C. M. , Remesar S. , Cabanelas E. , Varas G. , Markina F. , Díaz P. , García‐Dios D. , Prieto A. , Fernández G. , Díez‐Baños P. , Morrondo P.
Published: August 2019

The host switching of Hypoderma actaeon (Diptera: Oestridae), a specific parasite of red deer (Cervus elaphus), towards roe deer (Capreolus capreolus) has been recently reported in Spain. To provide information about the temporal and spatial spreading of H. actaeon infection in roe deer, 244 serum samples from animals hunted in Spain between 2013 and 2018 were analysed by an indirect enzyme‐linked immunosorbent assay. The overall seropositivity was 13.9%. Seropositivity was higher in continental (27.7%) and mountainous (12%) areas from central Spain, followed by southern‐Mediterranean (11.2%) and northern‐oceanic regions (3.5%). Differences were significant between central‐continental and northern‐oceanic regions (P = 0.003). No differences were found according to the sex and age of roe deer (P > 0.05). In 2013, all seropositive animals were concentrated in two distant areas in central and southern Spain, suggesting that the host switch could have occurred independently in both regions. Changes in the pattern of distribution of red deer and roe deer could have favoured the spreading of this myiasis towards roe deer, indicating that roe deer may become infested by H. actaeon in areas where both cervids coexist at high densities.
Trichophyton mentagrophytes and T interdigitale genotypes are associated with particular geographic areas and clinical manifestations
Authors: Taghipour Simin , Pchelin Ivan M. , Zarei Mahmoudabadi Ali , Ansari Saham , Katiraee Farzad , Rafiei Abdollah , Shokohi Tahereh , Abastabar Mahdi , Taraskina Anastasia E. , Kermani Firoozeh , Diba Kambiz , Nouripour‐Sisakht Sadegh , Najafzadeh Mohammad Javad , Pakshir Keyvan , Zomorodian Kamiar , Ahmadikia Kazem , Rezaei‐Matehkolaei Ali
Published: August 2019

The fungi Trichophyton mentagrophytes and T interdigitale account for significant amount of dermatophytosis cases worldwide. These two dermatophytes form a species complex and have a number of ribosomal internal transcribed spacer (ITS) region genotypes, allowing simultaneous species identification and strain typing. Our aim was to describe the geographic distribution of T mentagrophytes/T interdigitale ITS region genotypes and find an association between the genotypes and clinical presentations of respective infections. We performed rDNA ITS region sequencing in 397 Iranian T mentagrophytes/T interdigitale isolates and analysed all available in GenBank entries with sequences of this kind. For the study, 515 clinical annotations were available. Statistical analysis was performed by chi‐squared test and Spearman rank correlation analysis. A total of 971 sequences belonged to genotypes with at least 10 geographic annotations and were classified on the basis of exclusive occurrence in a particular region or high relative contribution to a regional sample. We discerned Asian and Oceanian (“KU496915” Type V, “KT192500” Type VIII, “KU315316”), European (“FM986750” Type III, “MF926358” Type III*, “KT285210” Type VI) and cosmopolitan (“FM986691” Type I, “JX122216” Type II, “KP132819” Type II* and “AF170453” Type XXIV) genotypes. There was statistically significant difference in the ITS genotype distribution between different affected body sites. Trichophyton mentagrophytes “KT192500” Type VIII correlated with tinea cruris, T mentagrophytes “KU496915” Type V correlated with tinea corporis, T interdigitale “JX122216” Type II correlated with tinea pedis and onychomycosis. Trichophyton mentagrophytes and T interdigitale genotypes can be associated with distinct geographic locations and particular clinical presentations.
Diagnostic performance of immunohistochemistry for the aspergillosis and mucormycosis
Authors: Choi Sungim , Song Joon Seon , Kim Ji Yeun , Cha Hye Hee , Yun Ji Hyppun , Park Jung Wan , Jung Kyung Hwa , Jo Kyeong Min , Jung Jiwon , Kim Min Jae , Chong Yong Pil , Park Young Soo , Lee Sang‐Oh , Choi Sang‐Ho , Kim Yang Soo , Woo Jun Hee , Kim Sung‐Han
Published: August 2019

Objective

To investigate the accuracy of immunohistochemistry (IHC) tests for distinguishing between mucormycosis and aspergillosis and compare the clinical characteristics of mucormycosis patients according to galactomannan (GM) results.

Methods

We evaluated diagnostic performance of IHC test with tissue sections of patients with culture‐proven invasive fungal infection. In addition, we conducted PCR assay with tissue sections of mucormycosis patients with positive GM results to evaluate the possibility of co‐infection.

Results

In culture‐proven mucormycosis (n = 13) and aspergillosis (n = 20), the sensitivity and specificity of IHC test were both 100% for mucormycosis and 85% and 100%, respectively, for aspergillosis. Among the 53 patients who met the modified criteria for proven mucormycosis and had GM assay results, 24 (45%) were positive. Compared with those with negative GM results (n = 29), mucormycosis patients with positive GM results had significantly higher incidence of gastrointestinal tract infections (6/24 [25%] vs 0/29 [0%], P = .006) and were more likely to be histomorphologically diagnosed as aspergillosis (7/24 [29%] vs 2/29 [7%], P = .06). PCR assay amplified both Aspergillus‐ and Mucorales‐specific DNA in 6 of these 24 cases.

Conclusions

Immunohistochemistry tests seem useful for compensating for the limitations of histomorphologic diagnosis in distinguishing between mucormycosis and aspergillosis. Some proven mucormycosis patients with positive GM results had histopathology consistent with aspergillosis and gastrointestinal mucormycosis. In addition, about one quarter of these patients revealed the evidence of co‐infection with aspergillosis by PCR assay.
On elucidation of the role of mitochondria dysfunction and oxidative stress in multiple sclerosis
Authors: Tobore Tobore Onojighofia
Published: August 2019

Multiple sclerosis (MS) is a complex human neurodegenerative dysimmune disease of the central nervous system (CNS) which is characterized by chronic inflammation, demyelination, loss of blood‐brain barrier (BBB) integrity, neuronal loss, reactive astrogliosis, and oligodendrocyte depletion. It can result in physical disability and severe neurological and cognitive deficits. Research indicates that MS prevalence has significantly increased in many regions around the world since 1990. The specific elements that trigger MS remain unknown. In this paper, the critical role played by mitochondria dysfunction and oxidative stress in MS pathogenesis, progression, and clinical symptoms are elucidated. Their interactions with the key factors in the disease, as well as treatment strategies, are discussed.
Multiple and interpersonal trauma are risk factors for both post‐traumatic stress disorder and borderline personality disorder: A systematic review on the traumatic backgrounds and clinical characteristics of comorbid post‐traumatic stress disorder/borderline personality disorder groups versus single‐disorder groups
Authors: Jowett Sally , Karatzias Thanos , Albert Idit
Published: August 2019

Background

Both borderline personality disorder (BPD) and post‐traumatic stress disorder (PTSD) are associated with exposure to traumatic events and are highly comorbid. No review to date has addressed the clinical presentations and traumatic backgrounds associated with these disorders although this work is essential for the development of effective interventions.

Objectives

To systematically explore similarities and differences in traumatic history and clinical presentation in comorbid BPD and PTSD as compared to PTSD or BPD alone.

Method

The Web of Science, Cochrane Library, PsycINFO, MEDLINE, and PILOTS databases were searched systematically. Eligible studies included adult populations, compared comorbid BPD/PTSD to a single disorder, and published in English.

Results

A total of 10,147 cases across 33 studies were included: 2,057 comorbid BPD/PTSD, 2,648 BPD only, and 5,442 PTSD only. The comorbid group overall reported greater exposure to multiple and interpersonal trauma and elevated emotion dysregulation compared to both single‐disorder groups. In terms of methodological quality, most papers achieved a Fair rating with improvements required in minimizing bias through recruiting adequate and representative samples, and reporting on traumatic exposure.

Conclusion

Multiple and interpersonal trauma might have a unique role in the development of comorbid BPD/PTSD features, particularly so for emotion dysregulation. Future research is required to unravel the unique characteristics of interpersonal trauma that can generate BPD and PTSD symptoms.

Practitioner points

Practitioners should routinely assess for interpersonal trauma considering its impact.

Tackling emotion regulation difficulties might promote recovery from both PTSD and BPD symptoms.

Presence of self ‐injury might be used to discriminate between PTSD and BPD and offer suitable interventions.
Learning with Projection Effects in Service Operations Systems
Authors: He Qiao‐Chu , Chen Ying‐Ju , Righter Rhonda
Published: August 2019

In this paper, we study customers’ learning behaviors in service operations systems, when the customers hold incorrect beliefs about the population distribution (“projection effects”). We propose a basic model wherein the customers are heterogeneous in both delay sensitivity and awareness of service quality, which explains “rational hesitations”: The uninformed and patient customers obfuscate the quality signaled by the queue length for the uninformed and impatient customers, who wait and join when the queue becomes longer. Ironically, with such bounded rationality, the customers who are more averse to waiting will react more sensitively to the observed long queue, which leads to an overestimation of the service quality and waiting in the long queue. Such bounded rationality also impedes effective learning by inducing decision errors, which, among other consequences, reduces the social welfare due to a blind “buying frenzy” even if the service quality is low.
Inventory Management under Storage and Order Restrictions
Authors: Sharma Shrutivandana , Abouee‐Mehrizi Hossein , Sartor Giorgio
Published: August 2019

Inventory management in most practical settings faces challenges due to various restrictions on storage and replenishment of products. These restrictions may be posed by budget availability, different production/supply schedules for different products, and limited storage space shared by a number of products—very common in retail, food, and the pharmaceutical industry. Motivated by this, we investigate in this study how simultaneous restrictions on shared storage capacity and product‐specific order capacities impact optimal replenishments in a multi‐product system. We formulate the inventory replenishment problem as a multi‐period stochastic dynamic program, where products face stochastic demand with general distributions and excess demand is lost or fulfilled by emergency orders. We first fully characterize the optimal replenishment policy for two‐product systems, and provide a methodology to compute optimal replenishment quantities, which can be described as a dynamic priority‐based replenishment rule. Our results show that for each product, the optimal replenishment priority as well as quantity depends on the inventory levels of both products and all available capacities. More interestingly, the results show that capacity restrictions can flip the stocking priorities of products. Based on the optimal policy for two‐product systems, we develop a heuristic for multi‐product systems whose complexity scales linearly with the number of products. Under moderate storage capacities, our heuristic significantly outperforms the naive heuristics that ignore dynamic priority assignment, and closely captures the benefits of the optimal policy for systems with large number of products.
Influence of a bovine respiratory disease vaccine with a temperature‐sensitive modified live or killed infectious bovine rhinotracheitis component on oestrous cycle parameters and anti‐Müllerian hormone concentration in nulliparous heifers
Authors: Widener Caitlin Lark , Graves William M. , Alward Kayla J. , Bohlen Jillian F.
Published: August 2019

The objective of this study was to examine the impact of a bovine respiratory disease complex (BRDC) vaccine with a temperature‐sensitive modified live vaccine (MLV) infectious bovine rhinotracheitis (IBR) component on oestrous cycle parameters and the follicular pool. Twenty‐four Holstein heifers (12.4 ± 0.5 months) previously calfhood vaccinated with an IBR MLV component were enrolled in two replicates (Spring; n = 10 and Fall; n = 14) and were blocked by pre‐vaccination bovine viral diarrhoea (BVD) serum neutralizing (SN) titres. Upon enrolment, heifers were oestrous synchronized with sampling beginning at detected oestrus. At their second heat, heifers were vaccinated with a BRDC calfhood vaccine with a MLV (MLV; n = 12) or killed (K; n = 12) IBR component and sampled for two additional cycles. Serum samples for oestrogen (E2) and progesterone (P4) as well as ultrasound data of ovarian structures were collected every other day. Serum samples for anti‐Müllerian hormone (AMH) were collected at oestrus and mid‐cycle for each cycle, and serum for titres was collected prior to and following vaccination. Data were analysed with the PROC MIXED and GLM procedures of SAS. There was no difference in pre‐ or post‐vaccination titres between MLV and K heifers (p > .5). Vaccination had no impact on P4 concentrations, P4 area under the curve, luteal tissue area, peak E2 production or oestrous cycle length (p > .05). Cycle number did impact AMH concentration (p < .05). In MLV heifers, AMH concentration was highest in cycle 1 (p < .05) while cycles 2 and 3 did not differ (p > .05). This was also true for the K heifers in the Fall replicate (p < .05). Within cycle 2, AMH concentrations were numerically lower between vaccine types (K = 308.22 ± 33.3 pg/ml, MLV = 181.13 ± 32.9 pg/ml; p > .05). Although no differences were seen in overall cycle parameters, differences in AMH concentrations may indicate a reduction of the follicular pool following vaccination and requires further investigation.
Significance of the chemistry and morphology of diagenetic siderite in clastic rocks of the Mesozoic Scotian Basin
Authors: Pe‐Piper Georgia , Piper David J. W.
Published: August 2019

Siderite (FeCO3) is a widespread minor diagenetic mineral in clastic sedimentary basins. Although eodiagenetic authigenesis of siderite is well‐known, siderite formed during burial diagenesis shows habits and chemical compositions that are poorly understood. This study tests the hypothesis that diagenetic siderite cements in sandstones in the Scotian Basin, offshore eastern Canada, show systematic variability in chemistry and habit that is a response to recrystallization and changing composition of basinal fluids. Mineral textures were determined from backscattered electron images, and chemistry mostly from electron microprobe analyses. Five chemical types of siderite are identified using k‐means cluster analysis, based on the amount of substitution of Ca, Mg and Mn for Fe. Eodiagenetic microcrystalline coated grains, concretions and intraclasts in sandstones are principally Fe‐rich siderite and locally have recrystallised to blocky equant crystals. Mesodiagenetic Mg‐rich siderite partly replaced these equant crystals and also framework mica and K‐feldspar grains, showing textural evidence for coupled dissolution–reprecipitation. Slender Mg‐rich siderite rhombs (lozenges, bladed or wheat‐seed siderite) have precipitated before and after the formation of quartz overgrowths in geochemical microenvironments. Magnesium substitution reflects Mg‐rich formation waters resulting from smectite to illite conversion. Equivalent Ca‐rich siderite occurs where sandstones overlie a Jurassic carbonate bank. Late Mn‐rich siderite has complex textures resembling those of Mississippi‐Valley type ores, with spheroidal rims, a honeycomb‐like mesh and concentric infill around secondary pores. It also occurs in veins or replacing intraclasts, post‐dating late ferroan‐calcite cements in sandstones that show strong dissolution by hot basinal brines. The Ca, Mg and Mn content of diagenetic siderite, coupled with textural evidence for recrystallization, can thus be used to track changes in ambient formation fluids. Siderite habits and chemistry described from the Scotian Basin are found in many clastic basins, suggesting that the observed recrystallization textures and variation in chemical type are of broad application.
AtHB23 participates in the gene regulatory network controlling root branching, and reveals differences between secondary and tertiary roots
Authors: Perotti María F. , Ribone Pamela A. , Cabello Julieta V. , Ariel Federico D. , Chan Raquel L.
Published: August 2019

In Arabidopsis, lateral root (LR) development is mainly controlled by several known auxin‐regulated transcription factors (TFs). Here, we show that AtHB23 (a homeodomain‐leucine zipper I TF) participates in this intricate network. Our study of the expression pattern of AtHB23 revealed that it is transcriptionally activated in the early stages of secondary LR primordium (LRP). We found that AtHB23 directly limits the expression of LBD16, a key factor in LR initiation, and also directly induces the auxin transporter gene LAX3. We propose that this HD‐Zip I mediates the regulation of LAX3 by ARF7/19. Furthermore, AtHB23 plays distinct roles during the formation of secondary and tertiary roots, exhibiting differential expression patterns. ATHB23 is expressed throughout the tertiary root primordium, whereas it is restricted to early stages in secondary primordia, likely later repressing LBD16 in tertiary LR development and further inhibiting root emergence. Our results suggest that different genetic programs govern the formation of LRP from the main or secondary roots, thereby shaping the global dynamic architecture of the root system.
Antimicrobial resistance genes present in the faecal microbiota of free‐living Galapagos tortoises (Chelonoidis porteri)
Authors: Nieto‐Claudin Ainoa , Esperón Fernando , Blake Stephen , Deem Sharon L.
Published: August 2019

Antimicrobial resistance (AMR), encoded by plasmid‐mediated AMR genes (ARGs), is an increasing global public health threat. Wildlife play a fundamental role as sentinels, reservoirs and potential vectors of ARGs. For the first time in Galapagos, we have identified and quantified the presence of ARGs in free‐living giant tortoises (Chelonoidis porteri). We performed ARG analyses by quantitative PCR of faeces collected from the cloaca of 30 tortoises widely distributed across Santa Cruz Island. Validated samples (n = 28) were analysed by a panel of up to 21 different ARGs and all 28 tortoise samples were positive to one or more genes encoding resistance. Thirteen of 21 tested ARGs were present in at least one sample, and 10 tortoises (35.7%) had a multi‐resistant pattern. We recommend additional research so we may more fully understand resistance patterns across taxa and geographical locations throughout the Galapagos archipelago, and the implications of ARGs for the health of wildlife, domestic animals, and humans. In this study, we found 100% of sampled giant tortoises had ARGs present in their faeces, suggesting a large‐scale distribution of these genes within the archipelago.
Intravenous magnesium sulfate to attenuate hemodynamic changes in laparoscopic surgery: a systematic review protocol
Authors: Nygard Brian , Brickey Doug , Greenwood Jennifer
Published: August 2019

Objective:

The objective of this systematic review is to determine the efficacy of intravenous magnesium sulfate when used to attenuate hemodynamic fluctuations associated with the creation of pneumoperitoneum in adults undergoing laparoscopic surgery.

Introduction:

Laparoscopic surgery has gained popularity as a result of improved patient outcomes postoperatively, but pneumoperitoneum alters the patient's physiology and hemodynamic profile during the intraoperative period. Magnesium sulfate is a non-opioid agent known for its ability to blunt the physiologic sympathetic response associated with exposure to noxious stimuli. Magnesium sulfate may be efficacious in combating undesirable hemodynamic changes associated with pneumoperitoneum.

Inclusion criteria:

Studies that included participants 18 years or older undergoing any laparoscopic surgery using pneumoperitoneum with CO2 insufflation will be considered. Studies will be excluded if patients were being treated for pheochromocytoma. Studies can employ any intravenous dosing strategy of magnesium sulfate, administered at any point in the perioperative period for the purpose of blunting the sympathetic response to creation of a pneumoperitoneum.

Methods:

A systematic search of MEDLINE, CINAHL, Cochrane Library, Google Scholar, Trip Database, MedNar, Grey Literature Report and ProQuest Dissertations and Theses will be conducted to identify both published and unpublished studies on the topic of interest. The search will be limited to studies written in English and performed on humans. Studies will be selected for review based on inclusion criteria and will be appraised by two reviewers using a standardized appraisal tool.

Systematic review registration number:

PROSPERO CRD42019139991.
Roles of three distinct neurogenic motor patterns during pellet propulsion in guinea‐pig distal colon
Authors: Costa Marcello , Keightley Lauren J. , Wiklendt Lukasz , Hibberd Timothy J. , Arkwright John W. , Omari Taher , Wattchow David A. , Zagorodnyuk Vladimir , Brookes Simon J. H. , Dinning Phil G. , Spencer Nick J.
Published: August 2019

Key points

Enteric neural circuits enable isolated preparations of guinea‐pig distal colon to propel solid and fluid contents by a self‐sustaining neuromechanical loop process.

In addition there are at least three neural mechanisms which are not directly involved in propulsion: cyclic motor complexes, transient neural events and distal colon migrating motor complexes.

In excised guinea‐pig colon we simultaneously recorded high resolution manometry, video‐imaging of colonic wall movements and electrophysiological recordings from smooth muscle, which enabled us to identify mechanisms that underlie the propulsion of colonic content.

The results show that the intermittent propulsion during emptying of the multiple natural faecal pellets is due to the intermittent activation of cyclic motor complexes and this is facilitated by transient neural events.

Loss or dysfunction of these activities is likely to underlie disordered gastrointestinal transit.

It is well known that there are different patterns of electrical activity in smooth muscle cells along different regions of the gastrointestinal tract. These different patterns can be generated by myogenic and/or neurogenic mechanisms. However, what patterns of electrical activity underlie the propulsion of natural faecal content remains unknown, particularly along the large intestine, where large quantities of water are reabsorbed and semi‐solid faeces form. In this study, we developed a novel approach which enables for the first time the simultaneous recording of high resolution intraluminal manometry, electrophysiology from the smooth muscle, and spatio‐temporal video imaging of colonic wall movements. Using this approach we were able to reveal the nature of enteric neuromuscular transmission and patterns of motor activity responsible for the movement of content. Three distinct neurogenic patterns of electrical activity were recorded even in the absence of propulsive movement. These were the cyclic motor complexes (CMCs), the transient neural events (TNEs) and the slowly propagating distal colonic migrating motor complexes (DCMMCs). We present evidence that the initiation of pellet propulsion is due to a cyclic motor complex (CMC) occurring oral to the pellet. Furthermore, we discovered that the intermittent propulsion of natural faecal pellets is generated by intermittent activation of CMCs; and this propulsion is facilitated by hexamethonium‐sensitive TNEs. However, TNEs were not required for propulsion. The findings reveal the patterns of electrical activity that underlie propulsion of natural colonic content and demonstrate that propulsion is generated by a complex interplay between distinct enteric neural circuits.
Global health competencies in UK postgraduate medical training: a scoping review and curricular content analysis
Authors: Al-Shakarchi Nader , Obolensky Lucy , Walpole Sarah , Hemingway Harry , Banerjee Amitava
Published: August 2019

Objective

To assess global health (GH) training in all postgraduate medical education in the UK.

Design

Mixed methodology: scoping review and curricular content analysis using two GH competency frameworks.

Setting and participants

A scoping review (until December 2017) was used to develop a framework of GH competencies for doctors. National postgraduate medical training curricula were analysed against this and a prior framework for GH competencies. The number of core competencies addressed and/or appearing in each programme was recorded.

Outcomes

The scoping review identified eight relevant publications. A 16-competency framework was developed and, with a prior 5-competency framework, used to analyse each of 71 postgraduate medical curricula. Curricula were examined by a team of researchers and relevant learning outcomes were coded as one of the 5 or 16 core competencies. The number of core competencies in each programme was recorded.

Results

Using the 5-competency and 16-competency frameworks, 23 and 20, respectively, out of 71 programmes contained no global health competencies, most notably the Foundation Programme (equivalent to internship), a compulsory programme for UK medical graduates. Of a possible 16 competencies, the mean number across all 71 programmes was 1.73 (95% CI 1.42 to 2.04) and the highest number were in paediatrics and infectious diseases, each with five competencies. Of the 16 core competencies, global burden of disease and socioeconomic determinants of health were the two most cited with 47 and 35 citations, respectively. 8/16 competencies were not cited in any curriculum.

Conclusions

Equity of care and the challenges of practising in an increasingly globalised world necessitate GH competencies for all doctors. Across the whole of postgraduate training, the majority of UK doctors are receiving minimal or no training in GH. Our GH competency framework can be used to map and plan integration across postgraduate programmes.
Guidance from key organisations on exploring, confirming and interpreting subgroup effects of medical treatments: a scoping review
Authors: Wijn Stan R W , Rovers Maroeska M , Le Ly H , Belias Michail , Hoogland Jeroen , IntHout Joanna , Debray Thomas , Reitsma Johannes B
Published: August 2019

Objectives

With the increasing interest in personalised medicine, the use of subgroup analyses is likely to increase. Subgroup analyses are challenging and often misused, possibly leading to false interpretations of the effect. It remains unclear to what extent key organisations warn for such pitfalls and translate current methodological research to detect these effects into research guidelines. The aim of this scoping review is to determine and evaluate the current guidance used by organisations for exploring, confirming and interpreting subgroup effects.

Design

Scoping review.

Eligibility criteria

We identified four types of key stakeholder organisations: industry, health technology assessment organisations (HTA), academic/non-profit research organisations and regulatory bodies. After literature search and expert consultation, we identified international and national organisations of each type. For each organisation that was identified, we searched for official research guidance documents and contacted the organisation for additional guidance.

Results

Twenty-seven (45%) of the 60 organisations that we included had relevant research guidance documents. We observed large differences between organisation types: 18% (n=2) of the industry organisations, 64% (n=9) of the HTA organisations, 38% (n=8) of academic/non-profit research organisations and 57% (n=8) of regulatory bodies provided guidance documents. The majority of the documents (n=33, 63%) mentioned one or more challenges in subgroup analyses, such as false positive findings or ecological bias with variations across the organisation types. Statistical recommendations were less common (n=19, 37%) and often limited to a formal test of interaction.

Conclusions

Almost half of the organisations included in this scoping review provided guidance on subgroup effect research in their guidelines. However, there were large differences between organisations in the amount and level of detail of their guidance. Effort is required to translate and integrate research findings on subgroup analysis to practical guidelines for decision making and to reduce the differences between organisations and organisation types.
Systematic reviews and meta-analyses comparing mortality in restrictive and liberal haemoglobin thresholds for red cell transfusion: protocol for an overview of systematic reviews
Authors: Trentino Kevin M , Farmer Shannon L , Sanfilippo Frank M , Leahy Michael F , Isbister James , Mayberry Rhonda , Hofmann Axel , Murray Kevin
Published: August 2019

Introduction

There has been a significant increase in the number of systematic reviews and meta-analyses of randomised controlled trials investigating thresholds for red blood cell transfusion. To systematically collate, appraise and synthesise the results of these systematic reviews and meta-analyses, we will conduct an overview of systematic reviews.

Methods and analysis

This is a protocol for an overview of systematic reviews. We will search five databases: MEDLINE, Embase, Web of Science Core Collection, PubMed (for prepublication, in process and non-Medline records) and Google Scholar. We will consider systematic reviews and meta-analyses of randomised controlled trials evaluating the effect of haemoglobin thresholds for red blood cell transfusion on mortality. Two authors will independently screen titles and abstracts retrieved in the literature search and select studies meeting the eligibility criteria for full-text review. We will extract data onto a predefined form designed to summarise the key characteristics of each review. We will assess the methodological quality of included reviews and the quality of evidence in included reviews.

Ethics and dissemination

Formal ethics approval is not required for this overview as we will only analyse published literature. The findings of this study will be presented at relevant conferences and submitted for peer-review publication. The results are likely to be used by clinicians, policy makers and developers of clinical guidelines and will inform suggestions for future systematic reviews and randomised controlled trials.

PROSPERO registration number

CRD42019120503.
Frailty Levels In Geriatric Hospital paTients (FLIGHT)—the prevalence of frailty among geriatric populations within hospital ward settings: a systematic review protocol
Authors: Doody Paul , Aunger Justin , Asamane Evans , Greig Carolyn A , Lord Janet , Whittaker Anna
Published: August 2019

Introduction

Frailty is a common and clinically significant condition in geriatric populations, associated with adverse health outcomes such as hospitalisation, disability and mortality. Although there are systematic reviews/meta-analyses assessing the prevalence of frailty in community-dwelling older adults, nursing home residents, and cancer and general surgery patients, there are none assessing the overall prevalence of frailty in geriatric hospital inpatients.

Methods and analysis

This review will systematically search and analyse the prevalence of frailty within geriatric hospital inpatients within the literature. A search will be employed on the platforms of Ovid, Web of Science and databases of Cumulative Index to Nursing and Allied Health Literature (CINAHL) Plus, SCOPUS and the Cochrane Library. Any observational or experimental study design which utilises a validated operational definition of frailty, reports the prevalence of frailty, has a minimum age ≥65 years, attempts to assess the whole ward/clinical population and occurs in hospital inpatients, will be included. Title and abstract and full-text screenings will be conducted by three reviewers. Methodological quality of eligible studies will be assessed using the Joanna Briggs Institute critical appraisal tool. Data extraction will be performed by two reviewers. If sufficient data are available, a meta-analysis synthesising pooled estimates of the prevalence of frailty and pre-frailty, as well as the prevalence of frailty stratified by age, sex, operational frailty definition, prevalent morbidities, ward type and location, among older hospitalised inpatients will be conducted. Clinical heterogeneity will be assessed by two reviewers. Statistical heterogeneity will be assessed through a Cochran Q test, and an I2test performed to assess its magnitude.

Ethics and dissemination

Ethical approval was not required as primary data will not be collected. Findings will be disseminated through publication in peer reviewed open access scientific journals, public engagement events, conference presentations and social media.

PROSPERO registration number

79202.
Developing and testing a matrix to achieveready-everyday nursing standards(RENS): an observational study protocol
Authors: Ratsch Angela , Sewell Fiona , Pennington Adrian
Published: August 2019

Introduction

The Australian Council on Healthcare Standards (ACHS) set criteria for the delivery of healthcare services in Australia. While a voluntary process, continual accreditation with ACHS is an expectation of, and for, Australian healthcare providers. Juxtapositioned with the ACHS, the Nursing and Midwifery Board of Australia (NMBA) set the mandatory practice requirements of, and for, Australian nurses. Despite these overarching quality and governance directives, a regional Queensland Hospital and Health Service (HHS) demonstrated deficits in the quality of nursing care. Accordingly, a HHS project was commissioned with the aim of producing a quantum shift in the quality of nursing services such that the service wasready-everydayfor accreditation assessment, and nursing practice exemplified the NMBA standards.

Several barriers to achieving the aim were identified and it was considered that the implementation of critical system changes would structurally and operationally support the achievement of the aim. The system changes are pivoted around an interactive matrix that links nursing care services to the array of nursing professional and practice standards and provides real-time quantitative output measures. This paper outlines the protocol that will be used to establish, implement and evaluate the matrix.

Methods and analysis

A participatory action research design with a modified Delphi methodology will be used for the development the matrix. The organisational change management around the matrix implementation will be informed by Kotter’s model and supported by the use of the McKinsey 7S. The matrix implementation phase will be conducted using a modifiedPromoting Action on Research Implementation in Health Servicesmodel. Quantitative and qualitative data will be collected over a 12 month pre-test/post-test design to measure the statistical significance of the matrix in supporting compliance with nursing standards and the achievement of quality nursing care. Quantitative data from quality of care assessments will be analysed using descriptive and comparative statistics. Qualitative data from staff surveys will be analysed by content analysis of the major themes (n~200).

Ethics and dissemination

The project has ethics approval from a Queensland Health Human Research Ethics Committee. Results will be reported to participants and other stakeholders at seminars and conferences and through peer-reviewed publications.
Improving physical healthcare provided to psychiatric inpatients at an acute mental health trust
Authors: Hassan Shahnaz , Byravan Swetha , Al-Zubaidi Hussain
Published: August 2019

Psychiatric patients are at high risk of developing physical health complications. This is due to various factors including medications prescribed, life style choices and diagnostic overshadowing. Admission to a psychiatric unit provides a prime opportunity to review a patient’s physical healthcare. We noticed prior to the commencement of this project that this opportunity was not always being used in the inpatient unit, with one in four patients at baseline data collection having no physical health checks. This is despite clear guidance laid out in the trust policy ‘Physical Examination of Service Users during Admission to Hospital’. We aimed to improve compliance with these checks to 100%. A number of prior audits in this area had failed to sustain improvement. Therefore, we proposed a quality improvement approach involving a series of plan do study act cycles, in order to test and review processes prior to implementation. The first cycle involved simplification of the paper-based documentation used for physical health checks, which resulted in minimal improvement by 5%. The second cycle involved combining this documentation with the history taking proforma resulting in an overall improvement in compliance to 90%. We learnt that a move away from the more widely used audit towards a more holistic approach of quality improvement allowed an informed continuum of change to take place which likely led to sustained improvement. Post implementation data collected at 1 month revealed compliance remained at 90%. Our initial 100% target was perhaps unrealistic, as there are also longstanding underlying cultural issues around physical healthcare in psychiatric patients that are complex to address and beyond the scope of this project.
The value of Facebook in nation-wide hospital quality assessment: a national mixed-methods study in Norway
Authors: Bjertnaes Oyvind , Iversen Hilde Hestad , Skyrud Katrine Damgaard , Danielsen Kirsten
Published: August 2019

Objectives

The objective was to assess the possibility of using a combination of official and unofficial Facebook ratings and comments as a basis for nation-wide hospital quality assessments in Norway.

Methods

All hospitals from a national cross-sectional patient experience survey in 2015 were matched with corresponding Facebook ratings. Facebook ratings were correlated with both case-mix adjusted and unadjusted patient-reported experience scores, with separate analysis for hospitals with official site ratings and hospitals with unofficial site ratings. Facebook ratings were also correlated with patient-reported incident scores, hospital size, 30-day mortality and 30-day readmission. Facebook comments from 20 randomly selected hospitals were analysed, contrasting the content and sentiments of official versus unofficial Facebook pages.

Results

Facebook ratings were significantly correlated with most patient-reported indicators, with the highest correlations relating to unadjusted scores for organisation (0.60, p<0.000) and nursing services (0.57, p<0.000). Facebook ratings were significantly correlated with hospital size (−0.40, p=0.003) and 30-day mortality (0.31, p=0.040). Sentiment analysis showed that 84.7% of the comments from unofficial Facebook sites included neutral comments that did not give any specific description of experiences of the quality of care at the hospital. Content analysis identified common themes on official and unofficial Facebook pages.

Conclusions

Facebook ratings were associated with patient-reported indicators, hospital size, and 30-day mortality. Qualitative comments from official Facebook are more relevant for hospital evaluation than unofficial sites. More research is needed on using Facebook ratings as a standalone indicator of patient experiences in national quality measurement, and such ratings should be reported together with research-based patient experience indicators and with explicit criteria for the inclusion of unofficial sites.
Say what? Patients have poor immediate memory of major risks of interscalene block disclosed during the informed consent discussion
Authors: Bai Johnny Wei , Abdallah Faraj W , Cohn Melanie , Ladowski Stephanie , Madhusudan Poorna , Brull Richard
Published: August 2019

Background

Poor memory of disclosed risks can undermine informed consent and create medicolegal challenges. The extent to which patients remember the risks of peripheral nerve blockade following the informed consent discussion is unknown. This prospective cohort study evaluated patients’ immediate memory of risks related to interscalene block (ISB) that were disclosed during the preoperative informed consent discussion.

Methods

Using a standardized script, patients scheduled for arthroscopic shoulder surgery were informed of the risks of ISB by an anesthesiologist in the preoperative assessment clinic. Immediately thereafter, consenting participants were asked to identify the risks of ISB from a printed list of nine true risks (four major and five minor) and nine ‘distractor’ items, which were unrelated adverse events and not disclosed. The primary outcome was the proportion of participants who remembered all four true major risks includinglong-term nerve damage, seizure, life-threatening event, and damage to the covering of the lung.

Results

Among 125 participants, only 26 (21%) remembered all four major risks of ISB. The mean number of major risks remembered was 2±1 out of 4. Fifteen (12%) participants remembered all nine true risks. The mean number of true risks remembered was 6±2 out of 9. Multivariable analysis revealed that participants’ self-rated assessment of their memory was not associated with actual recall.

Conclusion

Patients have poor immediate memory of the major risks related to ISB disclosed during the informed consent discussion. Under the present study conditions, the validity of the informed consent process for patients undergoing ISB may be undermined.
Seasonal variability and individual consistency in gray seal (Halichoerus grypus) isotopic niches
Authors: Hernandez K.M. , Bogomolni A.L. , Moxley J.H. , Waring G.T. , DiGiovanni R.A. , Hammill M.O. , Johnston D.W. , Sette L. , Polito M.J.
Published: August 2019

Although it is often assumed that individuals in generalist populations are equivalent, recent research indicates that individual dietary specialization can be common in marine predators. Gray seals (Halichoerus grypus (Fabricius, 1791)) were considered locally extinct in United States waters by 1958 but have since recolonized the region. Although considered generalists, less is known about gray seal foraging ecology in the United States. To address this, we used carbon and nitrogen stable isotope analyses to investigate the foraging niches of adult gray seals in Massachusetts, USA. We examined skin, fur, and blood components to investigate seasonal variability and individual consistency in foraging niches, and serially sampled vibrissae to quantify the degree of individual foraging specialization in this population. Our results suggest that seals shift from coastal foraging habitats before molt to offshore habitats after molt, with a coincident shift from higher to lower trophic-level prey. Adult gray seals also exhibited individual consistency in foraging niches independent of population-level shifts and reflect a generalist population composed of individual foraging specialists. These findings serve as a baseline for subsequent research on gray seals in United States waters that could help to determine the mechanisms which promote individual specialization in this population.
Application of Deng’s similarity-based analytic hierarchy process approach in parametric optimization of the electrical discharge machining process of SDK11 die steel
Authors: Van Duc-Nguyen , Van Bong-Pham , Huu Phan-Nguyen
Published: August 2019

This study presents a hybrid Taguchi – analytic hierarchy process (AHP) – Deng’s similarity-based method for the multi-objective optimization of the electrical discharge machining process of SKD11. Among many parameters, the four most important parameters including current, voltage, pulse-on time, and pulse-off time are considered as control factors. The four quality characteristics including material removal rate, tool wear rate, surface roughness, hardness of machined surface, and white layer thickness were considered for simultaneous optimization. The hybrid Taguchi – AHP – Deng’s similarity-based multi-objective optimization was compared with several other methods to evaluate the effectiveness of this hybrid technique. The results show that the Taguchi – AHP – Deng’s similarity-based method is a good alternative to solve multi-objective optimization problems.