bluuebunny/crossref_metadata_2025 huggingface dataset:
Structural Breaks in U.S. Macroeconomic Time Series: A Bayesian Model Averaging Approach
Authors: CHECK ADAM , PIGER JEREMY
Published: May 2021

We investigate the evidence for structural breaks in autoregressive models of U.S. macroeconomic time series. There is substantial model uncertainty associated with such models, including uncertainty related to lag selection, the number of structural breaks, and the specific parameters that break. We develop a feasible approach to Bayesian model averaging, where the model space encompasses these sources of uncertainty. We find pervasive evidence for breaks in variance parameters, and for price inflation series, we find strong evidence of changes in persistence. We also find evidence for reductions in trend growth rates of production series. For most series, there is substantial model uncertainty, calling into question the common practice of basing inference on one selected structural break model.
Primary culture of adult cortical neurons from reptile Gekko japonicus
Authors: He Bingqiang , Sun Chunshuai , Li Hui , Yang Ting , Song Honghua , Wang Yongjun , Wang Yingjie
Published: May 2021

Adult neurons of several reptiles still retain the ability of axonal regeneration in contrast to the low intrinsic regenerative capacity of those in the central nervous system (CNS) in mammals. This feature of the reptilian neurons has provided a perfect model for elucidating the regenerative mechanism lost in the mammalian counterparts. However, little information is available on the primary culture method of adult reptilian neurons, which greatly limits their valuable applications. In the present study, we introduced a simple and easy method for the isolation, culture, and identification of neurons from the cerebral cortex using the adult geckos. The cultured cells were further identified by immunofluorescence using antibodies against neuron‐specific markers β‐Ⅲ‐tubulin and NeuN. The cortical neurons from adult gecko displayed spindle‐shaped, bipolar, or multipolar morphology with a plump soma. This primary culture method for adult reptilian neurons will be beneficial for comparative studies of neuronal biology in various vertebrates.
Non‐shivering thermogenesis in four species of African mole‐rats differing in their sociality
Authors: Luna F. , Okrouhlík J. , McKechnie A. E. , Bennett N. C. , Šumbera R.
Published: May 2021

Many mammalian species are adapted to living in burrows for most of their lives. Inhabiting such thermally stable environments may influence the variation on the species thermogenic capacity, particularly non‐shivering thermogenesis (NST). African mole‐rats (Bathyergidae) are subterranean rodents occurring in fynbos, grassland and wooded savannas across sub‐Saharan Africa that vary in the complexity of their social systems, ranging from strictly solitary to highly social species. The presence and magnitude of NST are well known in social bathyergids, but no such data exist for their solitary counterparts. In this study, we quantified NST in three solitary mole‐rat species represented by three distinct genera together with one social species. Our results showed that NST in all species is functional. Maximum metabolic rate after norepinephrine injection was equivalent to 269% of resting values in the social giant mole‐ratFukomys mechowiiand 166%, 282% and 157% in the three solitary species: the silvery mole‐ratHeliophobius argenteocinereus, the Cape mole‐ratGeorychus capensisand the Cape dune mole‐ratBathyergus suillus, respectively. To test our prediction that NST capacity is higher in solitary bathyergids, we combined our data with those available for other members of this family. In contrast to our prediction, NST did not differ between social and solitary bathyergids. Body mass, as the main factor, and minimum air temperature (Tmin), accounts for more than 80% of NST variation in bathyergid mole‐rats.
ALK‐rearranged histiocytosis: Report of two cases with involvement of the central nervous system
Authors: Rossi Sabrina , Gessi Marco , Barresi Sabina , Tamburrini Gianpiero , Giovannoni Isabella , Ruggiero Antonio , Colafati Giovanna Stefania , Frassanito Paolo , Carboni Alessia , Alexandre Andrea , Cacchione Antonella , Trombatore Pietro , Diomedi‐Camassei Francesca , Gaspari Stefania , Gianno Francesca , Marras Carlo Efisio , Cecinati Valerio , Carai Andrea , Mastronuzzi Angela , Alaggio Rita
Published: May 2021

Aims

Histiocytoses are a heterogeneous group of localized or disseminated diseases. Clinical presentation and patients' outcome vary greatly, ranging from mild to life‐threatening disorders. Rare cases of systemic or localized histiocytosis harboring ALK rearrangement have been reported.

Methods

Two cases of CNS histiocytosis were thoroughly investigated by implementing multiple molecular tests, i.e. FISH, RT‐qPCR, NGS analysis.

Results

In a 10‐month old girl (patient #1), MRI showed two left hemispheric lesions and a right fronto‐mesial lesion histologically consisting of a moderately cellular infiltrative proliferation, composed by CD68(PGM1)+/CD163+ spindle cells. ALK 5’/3’‐imbalance and a KIF5B(exon 24)‐ALK(exon 20) fusion were documented by RT‐qPCR and NGS analysis, respectively. A subsequent CT scan showed multiple hepatic and pulmonary lesions. The patient was started on chemotherapy (vinblastine) associated to an ALK‐inhibitor (Alectinib) with remarkable response. In a 11‐year‐old girl (patient #2), MRI showed a right frontal 1.5 cm lesion. Neuropathological examination revealed a histiocytic proliferation composed by medium sized CD68(PGM1)+/HLA‐DR+ cells, showing moderate ALK1 positivity. ALK rearrangement and a KIF5B(exon 24)‐ALK(exon 20) fusion were demonstrated also in this case. Subsequent CT, 18F‐FDG‐PET and MRI scans showed the presence of a single right femoral lesion, proved to be a fibrous cortical defect.

Conclusions

In ALK‐histiocytoses, CNS involvement may occur as part of a systemic disease or, rarely, as its only primary disease localization, which could remain otherwise asymptomatic. The diagnosis often relies on neuropathological examination of brain biopsy, which may pose a diagnostic challenge due to the variable histopathological features. An integrated histological and molecular approach in such cases is recommended.
The left dorsal stream causally mediates the tone labeling in absolute pitch
Authors: Rogenmoser Lars , Arnicane Andra , Jäncke Lutz , Elmer Stefan
Published: May 2021

Absolute pitch (AP) refers to the ability to effortlessly identify given pitches without any reference. Correlative evidence suggests that the left posterior dorsolateral prefrontal cortex (DLPFC) is responsible for the process underlying pitch labeling in AP. Here, we measured the sight‐reading performance of right‐handed AP possessors and matched controls under cathodal and sham transcranial direct current stimulation of the left DLPFC. The participants were instructed to report notations as accurately and as fast as possible by playing with their right hand on a piano. The notations were simultaneously presented with distracting auditory stimuli that either matched or mismatched them in different semitone degrees. Unlike the controls, AP possessors revealed an interference effect in that they responded slower in mismatching conditions than in the matching one. Under cathodal stimulation, this interference effect disappeared. These findings confirm that the pitch‐labeling process underlying AP occurs automatically and is largely nonsuppressible when triggered by tone exposure. The improvement of the AP possessors’ sight‐reading performances in response to the suppression of the left DLPFC using cathodal stimulation confirms a causal relationship between this brain structure and pitch labeling.
Multi‐modal Neuroelectrophysiological Monitoring in the Treatment of Thoracic Tuberculosis with Debridement and Bone Grafting and Posterior Pedicle Screw Fixation via Costal Transverse Process Approach
Authors: Zhang Chen‐wei , Shi Shi‐yuan , Tao Xiao , Hu Jin‐ping , Cao Tian‐yi , Fei Jun
Published: May 2021

Objective

To explore the value of multi‐mode neuroelectrophysiological monitoring (MIOM) in evaluating spinal cord and nerve root function in the treatment of thoracic tuberculosis via costal transverse process approach.

Methods

From December 2017 to September 2019, a retrospective study of thoracic tuberculosis patients in our hospital was conducted. This study included 25 patients (14 men and 11 women). The average age of patients at the time of surgery was 63.3 years (range, 20–83 years). All patients (three cases with the destruction of a single vertebral body, 13 cases with the destruction of two vertebral bodies, and nine cases with the destruction of three or more vertebral bodies) underwent costal transverse process approach with debridement and bone grafting and internal fixation combined with intraoperative multimodal neuroelectrophysiological monitoring. During the operation, somatosensory evoked potential (SEP), transcranial electrical stimulation motor evoked potential (TES‐MEP), and spontaneous electromyography (EMG) were used to monitor progress. ESR, visual analogue scale (VAS), Cobb angle, and Oswestry disability index (ODI) were statistically analyzed to evaluate the treatment effects and patient satisfaction.

Results

All 25 patients were successfully monitored. The follow‐up time ranged from 12 to 21 months, with an average of 15.3 months. SEP waveform abnormalities occurred in five patients during the operation, the incidence rate was 28%. Of these five patients, three patients changed their instruments and postures, and adjusted the flushing water flow in time; one patient received pressure therapy in time; the operation was suspended for 10 min for one patient. There were seven cases with abnormal TES‐MEP waveform, the incidence rate was 28%. Among these seven cases, five cases adjusted the nail path during the operation and adjusted the nail position in time. One case adjusted the inclination angle of the operating table in time; one case completed the contralateral nail stick correction in time; five of them had abnormal TES‐MEP waveforms, and EMG burst potential was also detected, the incidence rate was 20%. After prompt treatment, the abnormal waveforms of all patients returned to normal; no abnormal waveforms, recurrence of tuberculosis, loosening of internal fixation, nerve and spinal cord dysfunction, etc. The VAS score, erythrocyte sedimentation rate (ESR), Cobb angle, and ODI scores of the patients 1 year after operation were significantly improved compared with 1 week after operation (P < 0.05).

Conclusion

Multi‐mode intraoperative electrophysiological detection combined with costal transverse process approach for the treatment of thoracic tuberculosis could avoid intraoperative nerve and blood vessel damage, reduce surgical risk, improve surgical efficiency, and ensure curative effect.
Language‐centered approach to care improvement in a pediatric dermatology clinic
Authors: Blundell Andrew R. , Moustafa Danna , Bartenstein Diana W. , Smith Gideon P. , Hawryluk Elena B.
Published: May 2021

Language‐congruent care can improve clinical outcomes. As a quality improvement initiative supported by the Department of Dermatology at Massachusetts General Hospital, the American Academy of Dermatology, and the Society for Pediatric Dermatology, our group established monthly pediatric dermatology “Spanish clinics” that scheduled Spanish‐speaking patients on the same day and utilized a dedicated, live interpreter who stayed with the clinical team throughout the clinic. Patients reported high satisfaction scores, averaging 9.8 out of 10, and 90.5% of patients preferred this model to traditional appointments. Our participating physician found “Spanish clinics” allowed for more efficient care not only in the monthly pilot clinics, but in all clinics occurring during the time period.
Emotional content overrides spatial attention
Authors: Bekhtereva Valeria , Craddock Matt , Müller Matthias M.
Published: May 2021

Spatial attention is our capacity to attend to or ignore particular regions of our spatial environment. However, some classes of stimuli may be able to override our efforts to ignore them. Here we assessed the relationship between involuntary attentional capture with emotional images and spatial attention at early stages of perceptual processing. Multiple scenes of unpleasant and neutral content were displayed in rapid serial visual presentation (RSVP) streams that elicited the steady‐state visual evoked potential (SSVEP), a neural marker of selective attention at early visual areas. In a spatial cueing task, participants were cued to covertly attend to RSVP streams presented at 4 and 6 Hz presentation rates in the left and right visual hemifields. The task was to detect square targets occasionally displayed within the image streams, responding only to those appearing on the cued side. The RSVP streams were always neutral pictures in one visual hemifield but would unpredictably switch from neutral to aversive content in the other visual hemifield. We found that SSVEP amplitude was consistently modulated by a change in emotional valence of image streams, regardless of whether the change in content occurred in the attended or unattended spatial location, reflecting an automatic sensory amplification for affective stimuli. The present data provide further evidence in support that emotional images can attract visual processing resources independently of spatial attention allocation, and are consistent with sustained sensory facilitation of early visual areas through re‐entrant feedback projections from higher‐order cortical areas involved in the extraction of affective information.
Inoculum origin and soil legacy can shape plant–soil feedback outcomes for tropical grassland restoration
Authors: Wolfsdorf Gabriel , Abrahão Anna , D'Angioli André M. , de Sá Dechoum Michele , Meirelles Sérgio T. , F. L. Pecoral Luísa , Rowland Lucy , da Silveira Verona Larissa , B. Schmidt Isabel , B. Sampaio Alexandre , S. Oliveira Rafael
Published: May 2021

Restoration techniques tailored to grasslands are needed to improve the effectiveness of restoration in tropical landscapes. In this study, we investigated the joint effects of plant–soil legacies and soil inocula in native and invaded Cerrado grasslands to evaluate whether different microbial origins affect plant–soil feedbacks and the likelihood of restoration. Using two grass species, we measured aboveground biomass, and several plant traits over two growth cycles. Species responded differently to inocula and legacies. The legacy of the invasiveUrochloa eminiiand invaded soil inocula positively affected mycorrhizal colonization. The legacy ofDiectomis fastigiata, a commonly used species in Cerrado restoration, resulted in a negative self‐feedback potentially limiting its effectiveness for restoration. The success of the invasive species was in part due to its broad ecological niche and its ability to cope with a broad range of soil conditions. Our research suggests soil inocula and legacies could be used to aid restoration efforts in the tropics, allowing restoration practitioners to stimulate the growth of species targeting functional traits for a given ecosystem.
Genetic rescue reduces mate limitation in a threatened, clonal, and self‐incompatible plant species
Authors: Gavin‐Smyth Nora , Kramer Andrea T. , Urbina‐Casanova Rafael , Vitt Pati , Fant Jeremie B.
Published: May 2021

Mate limitation is a restoration issue in self‐incompatible plant species and can easily go undetected in clonal species when seed set is not directly measured. Populations experiencing mate limitation have low‐to‐no seed production, and therefore are not demographically viable. The only way to overcome mate limitation in an existing population is genetic rescue, while efforts to restore populations where mate limitation may be an issue should consider mixing source populations. While the merits and challenges of genetic rescue and mixing source populations have been widely debated in the literature, very few long‐term examples are available to inform restoration actions. We hypothesized that remnant populations are experiencing mate limitation, while mixed‐source populations are not. We tested mate limitation using three treatments: (1) open pollination; (2) controlled crosses within populations; and (3) controlled crosses between nearby populations (genetic rescue). We compared seed set and offspring fitness among cross treatments and by population type. We confirmed that remnant populations are experiencing mate limitation: seed set averaged only 13% with no genetic augmentation, while the genetic rescue treatment increased seed set by an average of 96%. However, for mixed‐source populations, no differences were found for seed set with genetic rescue treatment. Offspring fitness did not significantly differ by cross treatment or population status. Results support local genetic rescue and mixed‐sourcing as restoration tools for clonal, self‐incompatible species.
Latitude of seed source impacts flowering phenology and fitness in translocated plant populations
Authors: Rushing Naomi S. , Flint Shelby A. , Shaw Ruth G.
Published: May 2021

Seed sourcing strategies have received considerable attention in the restoration literature and are a key component of effective management for restoration and conservation of natural areas. Research and discussion tend to focus on optimal distances and environmental similarities between seed sources and planting sites. However, given the increasing calls for assisted gene flow and assisted migration, greater consideration of translocating populations in specific directions across climatic gradients is warranted. To the extent that local adaptation proceeds primarily in response to climatic conditions, assisted gene flow across climatic gradients is likely to promote species persistence in the face of climate change. However, if species are adapted to other abiotic and biotic factors, translocating populations across climatic gradients may have unintended and potentially maladaptive consequences. Here, we used extensive collections of seed materials from across the state of Minnesota, a field planting that established common conditions at a location that was near the southern extreme of all the source locations, and subsequent aster modeling of fitness data to examine the overall fitness consequences of translocating populations across the landscape. We found that populations from cooler, northern sources tended to have higher fitness than those from warmer, more southern locations. In addition, populations from more northern locations tended to have earlier flowering phenology relative to populations from more southern sources, perhaps conferring a fitness advantage. Taken together, our results suggest that latitude of origin may be an important factor to take into consideration during seed source selection for restoration work, and that the direction of the effects can be at odds with expectations based on climatic considerations.
Longitudinal Strength, Power, and Push-Start Performance Changes in a Skeleton Athlete: Case Study
Authors: Mosey Tim J. , Mitchell Lachlan J.G.
Published: May 2021

Objectives: The purpose of this study was to document the longitudinal strength and power characteristic changes and race performance changes of a skeleton athlete. Method: Longitudinal strength and power changes were assessed with strength and power diagnostic testing over a 9-year period. Trends over 9 years for relative strength were analyzed using a linear model. Push-start time was recorded across multiple tracks. Trends over 9 years for start performance at each track were assessed using a mixed-effects linear model to account for the impact of different tracks. Lower-body strength and power changes were assessed via a 1-repetition-maximum squat and a body-weight countermovement jump. The relationship between strength and power changes was assessed over time. The relationship between strength changes and start performance was determined by assessing the fixed effect of relative strength changes on push-start time. Results: Relative lower-body strength ranged from 1.6 kg per body weight to 1.9 kg per body weight and showed a significant mean improvement of 0.05 kg per body weight per year (R2 = .71, P < .01). A negative correlation (R2 = .79) between relative strength changes and push-start performance across multiple tracks was found. The mixed-effects model indicated that push-start time improved significantly year to year (0.02 s; P < .001; R2 = .74) when controlling for the effect of track. Conclusions: The longitudinal analysis of push-start time and the associations with changes in strength suggest that training this quality can have a positive effect on push-start performance.
Physical Fitness of Rural Polish School Youth: Trends Between 1986 and 2016
Authors: Bartkowiak Sylwia , Konarski Jan M. , Strzelczyk Ryszard , Janowski Jarosław , Karpowicz Małgorzata , Malina Robert M.
Published: May 2021

Background: The objective of the study was to evaluate secular changes in the physical fitness of rural school youth, 7–15 years, in west-central Poland between 1986 and 2016.Methods: The fitness of cross-sectional samples of school youth resident in the same 10 communities was evaluated in 4 decennial surveys: 1986—1417 boys/1326 girls; 1996—979 boys/947 girls; 2006—871 boys/843 girls; and 2016—1189 boys/1105 girls. Five tests evaluated speed (5-m run), agility (figure 8 run), explosive power (vertical jump), flexibility (stand and reach), and cardiovascular fitness (modified Harvard step test). Age- and sex-specific descriptive statistics were calculated by survey, while differences among surveys were compared in 3 broad age groups (7–9, 10–12, and 13–15 y) using analysis of variance with age and age squared as covariates.Results: Speed and flexibility declined, while the jump and step test index changed variably across surveys. Although agility improved across surveys, the major improvement occurred between 1986 and 1996.Conclusions: Performances of rural school youth on 5 tests of physical fitness changed significantly, but, variably, between 1986 and 2016. The results were generally consistent with other studies of Polish school youth that spanned a similar interval.
Real-time imaging of Na
+
reversible intercalation in “Janus” graphene stacks for battery applications
Authors: Sun Jinhua , Sadd Matthew , Edenborg Philip , Grönbeck Henrik , Thiesen Peter H. , Xia Zhenyuan , Quintano Vanesa , Qiu Ren , Matic Aleksandar , Palermo Vincenzo
Published: May 2021

Janus graphene stacks as artificial graphite allow the reversible intercalation of sodium ions.
Membrane-confined liquid-liquid phase separation toward artificial organelles
Authors: Mu Wenjing , Ji Zhen , Zhou Musen , Wu Jianzhong , Lin Yiyang , Qiao Yan
Published: May 2021

A synthetic protocell with subcompartments was designed to mimic cellular signal processing.
Tissue-engineered vascular microphysiological platform to study immune modulation of xenograft rejection
Authors: Kim Tae Hee , Yan Ji-Jing , Jang Joon Young , Lee Gwang-Min , Lee Sun-Kyung , Kim Beom Seok , Chung Justin J. , Kim Soo Hyun , Jung Youngmee , Yang Jaeseok
Published: May 2021

Tissue-engineered vascular microphysiological platform is applicable for evaluating immune modulation of xenograft rejection.
Molecular mechanisms of metabotropic GABA
B
receptor function
Authors: Shaye Hamidreza , Stauch Benjamin , Gati Cornelius , Cherezov Vadim
Published: May 2021

This review outlines the current understanding of the structure and activation mechanism of the metabotropic GABA
B
receptors.
Complete Genome Sequences of Ralstonia solanacearum Strains Isolated from Zingiberaceae Plants in Japan
Authors: Iiyama Kazuhiro , Kodama Sawa , Kusakabe Honoka , Sakai Yoriko , Horita Mitsuo , Yano Kazutaka , Kyaw Htet Wai Wai , Tsuchiya Kenichi , Furuya Naruto
Published: May 2021

Here, we report the complete genome sequences of three
Ralstonia solanacearum
strains isolated from Zingiberaceae plants in Japan. The total genome sizes of these strains ranged from 5.87 to 6.05 Mb. Strains MAFF 211472, MAFF 211479, and MAFF 311693 each carried one chromosome and one megaplasmid. MAFF 311693 contained an additional 71.9-kb plasmid.
Supplemental Material: Reorienting the West African craton in Paleoproterozoic–Mesoproterozoic supercontinent Nuna
Authors: Gong Zheng , al. et
Published: May 2021

Detailed geochronological, paleomagnetic, and rock magnetic results.
Monitoring, reporting and regulating medicine quality: tensions between theory and practice in Tanzania
Authors: Hamill Heather , David-Barrett Elizabeth , Mwanga Joseph Rogathe , Mshana Gerry , Hampshire Kate
Published: May 2021

In 2012, the WHO launched its Global Surveillance and Monitoring System (GSMS) for substandard and falsified medicines, with the aim of improving the quality of reporting and using the data to inform post-market surveillance and build regulatory capacity. However, from a regulatory governance perspective, its effectiveness depends on the willingness and ability of actors ‘on the ground’ to identify, report and investigate possible infringements and to enforce penalties. This paper presents findings from 27 interviews with representatives of agencies charged with regulating pharmaceutical markets and 4 interviews with pharmaceutical industry representatives in Tanzania. Their experiences provide important insights into how the theorised mechanism between reporting and a reduction in undesirable behaviours can play out in a low-income context, revealing hidden assumptions about regulator behaviour and motivations. A combination of chronic under-resourcing, information gaps and enforcement challenges conspires to limit the efforts of local regulators to achieve the GSMS goals, shedding new light on the relationship between apparent ‘misconduct’ and structural constraints.
Implementing pharmaceutical track-and-trace systems: a realist review
Authors: Kootstra Joeke , Kleinhout-Vliek Tineke
Published: May 2021

Introduction

One way to prevent falsified medical products from entering the regulated pharmaceutical supply chain is to implement a pharmaceutical track-and-trace system (PTTS). Such systems in the most extensive versions generally mandate a scan at every point of contact with the medical product: from the point of entry to dispensation. There have been several attempts to implement such systems; for example, a ‘full’ PTTS in Turkey and the more pared-down version offered by the European Union’s Falsified Medicines Directive and Delegated Act. This study aims to identify facilitators and barriers to implementing (elements of) a PTTS, with the Turkish system used as a benchmark.

Methods

We conducted a ‘realist’ review, which synthesises literature and aims to establish how a specific technology works, for whom, under which circumstances. We searched Embase, Medline Ovid, Web of Science, Cochrane Central and Google Scholar databases, yielding 2,790 scholarly articles. We selected 21 for review.

Results

Implementation of PTTS elements has been attempted in different compositions in several primarily high-income and middle-income countries. Factors that affected implementation included stakeholders like the government and supply chain actors, the coordination between them, and their awareness, knowledge, and skills, as well as regulation and legislation, monetary investments, and technical and digital requirements.

Conclusion

The interplay between contextual factors is crucial for successful PTTS implementation. Specifically, the findings indicate that aligning the incentives for all actors and allowing for adjustments in a continuous implementation process will likely facilitate implementation.
Elusive quality: the challenges and ethical dilemmas faced by international non-governmental organisations in sourcing quality assured medical products
Authors: Enright Katherine
Published: May 2021

Although medical products that are of sound quality are fundamental to the delivery of healthcare, so too is their availability, affordability, accessibility and acceptability. However, achieving all of these aims consistently and simultaneously may be unfeasible due to a host of barriers—no matter the country. If uncertainty, constraints and conflicting priorities also threaten their delivery, not only does the situation becomes yet more challenging, the morally just course of action becomes yet more opaque. While global health organisations, supply chains and projects are heterogenous, international non-governmental organisations (iNGOs) responding to humanitarian crises or delivering development assistance in low-income and middle-income countries are undoubtedly prone to this issue. In a novel framing of the problem of substandard and falsified medicines, this article explores some ethical dilemmas that, directly or indirectly, could result in the quality of medical products in iNGO health projects to be compromised. Drawing on a broad literature base and years of experience as a senior humanitarian pharmacist, the author reflects on the barriers, culture and system that contributes to the existence and persistence of substandard and falsified medical products in global assistance projects. The paper offers an in-depth examination of pressures that may arise in four key areas (capacity, supply chain, bureaucracy and quality assurance) and postulates on the myriad ways in which this may alter the attitudes, behaviours and decision-making of iNGOs in a manner that disincentivises the prioritisation of medical product quality. This paper does not seek to excoriate the aid sector, but rather to lend a new perspective: that such predicaments are overlooked, real-world ethical dilemmas in urgent need of greater openness, research, debate and guidance, for the benefit of moral decision-making and patient care.
Unmet need for primary healthcare and associated individual and household-level factors in Kenya: results from a national survey
Authors: Otieno Peter O , Kiroro Francis , Runyenje Cynthia , Kamau Pauline
Published: May 2021

Objective

To determine the prevalence of unmet need for primary healthcare and associated individual and household-level factors in Kenya.

Design

The data for this study are drawn from the 2016 Kenya Integrated Household Budget Survey (KIHBS). A multistage sampling technique involving a systematic selection of clusters at the national level and final selection of households was used.

Setting

This study was conducted in Kenya. The KIHBS is a nationally representative survey on a wide range of indicators to assess the progress made in improving the living standards of the population at the national level.

Participants

A total of 9447 households comprising 15 539 household members who reported a sickness or injury over the 4 weeks preceding this survey were included in this study. The study respondents comprised of the household heads.

Primary outcome measure

The primary outcome of this study is unmet need for primary healthcare defined as an unexpressed demand for primary healthcare following a reported sickness or injury over the 4 weeks preceding this survey.

Results

About one in every five study participants experienced an unexpressed demand for primary care. The odds of having unmet need for primary healthcare were 68% higher among participants without health insurance coverage compared with those with health insurance (adjusted OR 1.68; p<0.001; 95% CI 1.34 to 2.09) and 45% higher among households headed by single or unmarried persons compared with the those who were in a marital union (adjusted OR 1.45; p<0.05; 95% CI 1.06 to 1.98).

Conclusions

Our findings show that there is still a considerable unexpressed demand for primary care services despite widespread implementation of Universal Health Coverage (UHC) in Kenya, with households without a health insurance cover bearing the highest burden. Therefore, the design of UHC reforms in Kenya should focus on embedding social health protection to escalate the demand for primary healthcare services.
Association between vitamin D supplementation or serum vitamin D level and susceptibility to SARS-CoV-2 infection or COVID-19 including clinical course, morbidity and mortality outcomes? A systematic review
Authors: Grove Amy , Osokogu Osemeke , Al-Khudairy Lena , Mehrabian Amin , Zanganeh Mandana , Brown Anna , Court Rachel , Taylor-Phillips Sian , Uthman Olalekan A , McCarthy Noel , Kumar Sudhesh , Clarke Aileen
Published: May 2021

Objective

To systemically review and critically appraise published studies of the association between vitamin D supplementation or serum vitamin D level and susceptibility to SARS-CoV-2 infection or COVID-19, including clinical course, morbidity and mortality outcomes.

Design

Systematic review.

Data sources

MEDLINE (OVID), Embase (OVID), Cochrane Central Register of Controlled Trials, MedRxiv and BioRxiv preprint databases. COVID-19 databases of the WHO, Cochrane, CEBM Oxford and Bern University up to 10 June 2020.

Study selection

Studies that assessed vitamin D supplementation and/or low serum vitamin D in patients acutely ill with, or at risk of, severe betacoronavirus infection (SARS-CoV, MERS-CoV, SARS-CoV-2).

Data extraction

Two authors independently extracted data using a predefined data extraction form and assessed risk of bias using the Downs and Black Quality Assessment Checklist.

Results

Searches elicited 449 papers, 59 studies were eligible full-text assessment and 4 met the eligibility criteria of this review. The four studies were narratively synthesised and included (1) a cross-sectional study (n=107) suggesting an inverse association between serum vitamin D and SARS-CoV-2; (2) a retrospective cohort study (348 598 participants, 449 cases) in which univariable analysis showed that vitamin D protects against COVID-19; (3) an ecological country level study demonstrating a negative correlation between vitamin D and COVID-19 case numbers and mortality; and (4) a case–control survey (n=1486) showing cases with confirmed/probable COVID-19 reported lower vitamin D supplementation. All studies were at high/unclear risk of bias.

Conclusion

There is no robust evidence of a negative association between vitamin D and COVID-19. No relevant randomised controlled trials were identified and there is no robust peer-reviewed published evidence of association between vitamin D levels and severity of symptoms or mortality due to COVID-19. Guideline producers should acknowledge that benefits of vitamin D supplementation in COVID-19 are as yet unproven despite increasing interest.
Association between early bronchiolitis and the development of childhood asthma: a meta-analysis
Authors: Wang Guizuo , Han Dong , Jiang Zhengdong , Li Manxiang , Yang Shumei , Liu Lu
Published: May 2021

Objective

Early life bronchiolitis has been hypothesised to be associated with the subsequent risk of persistent wheezing or asthma. However, the link remains controversial. The objective of our study was to evaluate the association between bronchiolitis before 2 years of age and the late-onset wheezing/asthma.

Design

Systematic review and meta-analysis.

Methods

PubMed, Embase and Web of Science databases were systematically searched for studies published between 1955 and January 2020. Meanwhile, we also checked through the reference lists of relevant articles to see whether these references included reports of other studies that might be eligible for the review. Cohort and case–control studies assessing the association between early-life bronchiolitis and late-onset wheezing/asthma were included in this meta-analysis. Data were extracted by two independent reviewers. Results were pooled using a random-effects model or fixed-effects model according to the heterogeneity among studies.

Results

32 original articles with 292 844 participants, which met the criteria, were included in this meta-analysis. Bronchiolitis before 2 years of age was associated with an increased risk of subsequent wheezing/asthma (relative risk=2.46, 95% CI 2.14 to 2.82, p<0.001). After categorising studies into different groups based on age at the end of follow-up, geographical region and study quality, the association still remained significant.

Conclusions

The meta-analysis indicates an association between bronchiolitis before 2 years of age and the wheezing/asthma in later life. Well-designed and highly standardised prospective studies that better address bias due to potential confounding factors are needed to validate the risk identified in our meta-analysis.

PROSPERO registration number

CRD42018089453.
Identifying factors associated with overweight and obesity among intermediate school students aged 12–15 years in school settings: mixed-methodology protocol
Authors: Almutairi Naif Saleh , Burns Sharyn , Portsmouth Linda
Published: May 2021

Introduction

Childhood obesity is a public health concern globally. In Arab countries, the prevalence of overweight and obesity has increased significantly over the last three decades. The level of childhood overweight and obesity in the Kingdom of Saudi Arabia (KSA) is high and continues to increase. This study will explore factors associated with overweight and obesity among adolescents and identify barriers and enablers to the implementation of comprehensive school-based obesity prevention interventions.

Methods and analysis

Socioecological model will inform this mixed-methods study. The study will include three phases: (1) a scoping review of the literature; (2) the development of a student survey instrument and (3) a mixed-method study comprising a cross-sectional survey targeting students aged 12–15 years with the collection of the students’ height and weight measurements; one-on-one interviews with physical education teachers and school principals; and the administration of school climate audits using the Health Promoting School framework. Reliability and validity of the survey instrument will be examined during survey development. Descriptive, inferential and thematic analysis will be employed using appropriate statistical software.

Ethics and dissemination

Ethical approval has been granted from the Curtin University of Human Research Ethics Committee (HR2020-0337) and from the KSA Ministry of Education (4181827686). School principals will provide permission to conduct the study in individual schools. Individual consent/assent will be obtained from students and their parents, and teachers. Study findings will be disseminated via peer-review publications, reports and conferences.
COVID-19 prevention practices in urban setting during early introduction of the disease: results from community survey in SNNP Region, Ethiopia
Authors: Endriyas Misganu , Kawza Aknaw , Alano Abraham , Hussen Mamush , Shibru Endashaw
Published: May 2021

Objective

To assess community practices related to COVID-19 prevention and its associated factors during the early introduction of the disease to the study area.

Setting and participants

A community-based cross-sectional study was conducted in Southern Nations, Nationalities and People’s Region, Ethiopia. Ten zonal towns with high population density and mobility and 1239 participants were included in the study.

Outcome measure

A semistructured questionnaire was uploaded to SurveyCTO data collection system with security patterns. Mask usage was assessed by observation, while social distancing and handwashing were assessed by interview. Data were collected by health professionals who have Bachelor of Science degree and above and analysed using SPSS V.25. Descriptive statistics and binary logistic regression were performed.

Results

From 1239 individuals, about half, 657 (53%), of respondents were women and about two-thirds, 795 (64.2%), were married. Nearly 9 out of 10 (90.3%) and about 8 out of 10 (82.0%) respondents reported that they frequently wash hands with soap and/or use sanitiser and keep social distancing as means to prevent COVID-19, respectively. Less than three-fifths (57.8%) of respondents wore masks during the interview. In summary, about half (48.9%) of respondents were practising the three recommended methods (social distancing, handwashing and wearing masks). Sex, educational status, family size and overall knowledge about COVID-19 were associated with practising COVID-19 prevention measures.

Conclusion

COVID-19 prevention practice was low as only about half of participants were practising social distancing, handwashing and wearing masks. Although awareness creation has been implemented through different forms of media, it should be strengthened in different local languages. Concerned government bodies should strictly follow using masks in public gatherings.
Effecting a national implementation project through distributed leadership in the West Midlands: rising to the spread challenge
Authors: Gillies James , Morton Victoria A Hodgetts , Jasim Simone , Fox Caroline , Broggio Penny , Pillay Thillagavathie
Published: May 2021

We describe the utility and impact of a distributed leadership model to implement a National Health Service (NHS) England Academic Health Sciences national quality improvement programme, in the West Midlands. This model was adopted to address the inherent difficulties of implementing change in practice in a large geographical region with a diverse population of health service personnel. We report on the inclusion of a senior trainee as part of the implementation team, supported by a multidisciplinary clinical consultant team, with equal agency in decision making, acting as mentors and activators in the background.
Use of the ReSVinet Scale for parents and healthcare workers in a paediatric emergency service: a prospective study
Authors: Camacho-Cruz Jhon , Briñez Shirley , Alvarez Jorge , Leal Victoria , Villamizar Gómez Licet , Vasquez-Hoyos Pablo
Published: May 2021

Introduction

Most scales for acute respiratory infection (ARI) are limited to healthcare worker (HCW) use for clinical decision-making. The Respiratory Syncytial Virus network (ReSVinet) Scale offers a version for parents that could potentially help as an early warning system.

Objective

To determine whether or not the ReSVinet Scale for ARI in infants can be reliably used by HCWs and parents in an emergency service.

Methods

A prospective study was done of infants with ARI who were admitted to a paediatric emergency room to assess the ReSVinet Scale when used by faculty (paediatric doctor-professors), residents (doctors doing their first specialty in paediatrics) and parents. Spearman’s correlation and a weighted kappa coefficient were used to measure interobserver agreement. Internal consistency was also tested by Cronbach’s alpha test.

Results

Overall, 188 patients, 58% male, were enrolled. A Spearman’s correlation of 0.92 for faculty and resident scoring and 0.64 for faculty or resident and parent scoring was found. The weighted kappa coefficients were 0.78 for faculty versus residents, 0.41 for faculty versus parents, and 0.41 for residents versus parents. Cronbach’s alpha test was 0.67 for faculty, 0.62 for residents and 0.69 for parents.

Conclusion

There was good correlation in the ReSVinet scores between health professionals when used in the paediatric emergency area. Agreement between parents and health professionals was found to be more variable. Future studies should focus on finding ways to improve its reliability when used by parents before the scale is used in the emergency room.
Dengue virus infection induces inflammation and oxidative stress on the heart
Authors: Kangussu Lucas Miranda , Costa Vivian Vasconcelos , Olivon Vania Claudia , Queiroz-Junior Celso Martins , Gondim Antônio Nei Santana , Melo Marcos Barrouin , Reis Daniela , Nóbrega Natália , Araújo Natália , Rachid Milene Alvarenga , Souza Renan Pedra de , Tirapelli Carlos Renato , Santos Robson Augusto Souza dos , Cruz Jader dos Santos , Teixeira Mauro Martins , Souza Danielle da Glória de , Bonaventura Daniella
Published: May 2021

Objective

Dengue fever is one of the most important arboviral diseases in the world, and its severe forms are characterised by a broad spectrum of systemic and cardiovascular hallmarks. However, much remains to be elucidated regarding the pathogenesis triggered by Dengue virus (DENV) in the heart. Herein, we evaluated the cardiac outcomes unleashed by DENV infection and the possible mechanisms associated with these effects.

Methods

A model of an adapted DENV-3 strain was used to infect male BALB/c mice to assess haemodynamic measurements and the functional, electrophysiological, inflammatory and oxidative parameters in the heart.

Results

DENV-3 infection resulted in increased systemic inflammation and vascular permeability with consequent reduction of systolic blood pressure and increase in heart rate. These changes were accompanied by a decrease in the cardiac output and stroke volume, with a reduction trend in the left ventricular end-systolic and end-diastolic diameters and volumes. Also, there was a reduction trend in the calcium current density in the ventricular cardiomyocytes of DENV-3 infected mice. Indeed, DENV-3 infection led to leucocyte infiltration and production of inflammatory mediators in the heart, causing pericarditis and myocarditis. Moreover, increased reactive oxygen species generation and lipoperoxidation were also verified in the cardiac tissue of DENV-3 infected mice.

Conclusions

DENV-3 infection induced a marked cardiac dysfunction, which may be associated with inflammation, oxidative stress and electrophysiological changes in the heart. These findings provide new cardiac insights into the mechanisms involved in the pathogenesis triggered by DENV, contributing to the research of new therapeutic targets for clinical practice.