bluuebunny/crossref_metadata_2025 huggingface dataset:
The Rubber Hand Illusion: Top-down attention modulates embodiment
Authors: Thériault Rémi , Landry Mathieu , Raz Amir
Published: January 2022

The Rubber Hand Illusion (RHI) creates distortions of body ownership through multimodal integration of somatosensory and visual inputs. This illusion largely rests on bottom-up (automatic multisensory and perceptual integration) mechanisms. However, the relative contribution from top-down factors, such as controlled processes involving attentional regulation, remains unclear. Following previous work that highlights the putative influence of higher-order cognition in the RHI, we aimed to further examine how modulations of working memory load and task instructions—two conditions engaging top-down cognitive processes—influence the experience of the RHI, as indexed by a number of psychometric dimensions. Relying on exploratory factor analysis for assessing this phenomenology within the RHI, our results confirm the influence of higher-order, top-down mental processes. Whereas task instruction strongly modulated embodiment of the rubber hand, cognitive load altered the affective dimension of the RHI. Our findings corroborate that top-down processes shape the phenomenology of the RHI and herald new ways to improve experimental control over the RHI.
Smouldering multiple sclerosis: the ‘real MS’
Authors: Giovannoni Gavin , Popescu Veronica , Wuerfel Jens , Hellwig Kerstin , Iacobaeus Ellen , Jensen Michael B. , García-Domínguez José Manuel , Sousa Livia , De Rossi Nicola , Hupperts Raymond , Fenu Giuseppe , Bodini Benedetta , Kuusisto Hanna-Maija , Stankoff Bruno , Lycke Jan , Airas Laura , Granziera Cristina , Scalfari Antonio
Published: January 2022

Using a philosophical approach or deductive reasoning, we challenge the dominant clinico-radiological worldview that defines multiple sclerosis (MS) as a focal inflammatory disease of the central nervous system (CNS). We provide a range of evidence to argue that the ‘real MS’ is in fact driven primarily by a smouldering pathological disease process. In natural history studies and clinical trials, relapses and focal activity revealed by magnetic resonance imaging (MRI) in MS patients on placebo or on disease-modifying therapies (DMTs) were found to be poor predictors of long-term disease evolution and were dissociated from disability outcomes. In addition, the progressive accumulation of disability in MS can occur independently of relapse activity from early in the disease course. This scenario is underpinned by a more diffuse smouldering pathological process that may affect the entire CNS. Many putative pathological drivers of smouldering MS can be potentially modified by specific therapeutic strategies, an approach that may have major implications for the management of MS patients. We hypothesise that therapeutically targeting a state of ‘no evident inflammatory disease activity’ (NEIDA) cannot sufficiently prevent disability accumulation in MS, meaning that treatment should also focus on other brain and spinal cord pathological processes contributing to the slow loss of neurological function. This should also be complemented with a holistic approach to the management of other systemic disease processes that have been shown to worsen MS outcomes.
Survival status and predictors of mortality among HIV-positive children initiated antiretroviral therapy in Bahir Dar town public health facilities Amhara region, Ethiopia, 2020
Authors: Chekole Bogale , Belachew Amare , Geddif Azeb , Amsalu Eden , Tigabu Agimasie
Published: January 2022

Background:

Although there is a presence of governmental and non-governmental organizations running to provide quality HIV care services to reduce HIV-related mortality, there is rapid disease progression and death among children in developing countries including Ethiopia. Thus, this study was aimed to assess the mortality predictors of children living with HIV at Bahir Dar town public health facilities.

Method:

A facility-based retrospective follow-up study was conducted among 588 children who were enrolled in the HIV care clinic from 1 September 2010 to 30 August 2019. Data were entered into the Epi-Data entry 3.1 and then exported to STATA version 14 for analysis. Multiple imputation models were employed to handle missing data using the multivariate imputation Chained Equations technique. The Kaplan–Meier survival curve and log-rank test were used to estimate and compare the survival time of categorical variables.

Result:

About 27 (4.6%) (95% confidence interval: 2.9–6.5) deaths were observed from the 30,062.3 person-months follow-up period, and the overall incidence density rate of 0.9 per 1000 child-months (95% confidence interval: 0.6–1.3). Advanced WHO clinical stage (adjusted hazard ratio = 3.18; 95% confidence interval: 1.07–9.43), hemoglobin level less than 8 g/dL (adjusted hazard ratio = 3.54; 95% confidence interval: 1.27–8.85), children having a weight for age of <−2z (adjusted hazard ratio = 2.81; 95% confidence interval: 1.19–6.6), children with poor adherence (adjusted hazard ratio = 3.91; 95% confidence interval: 1.41–10.8), and starting the treatment beyond 1 week of being eligible (adjusted hazard ratio = 3.22; 95% confidence interval: 1.21–8.53) were predictors of HIV-related mortality among children initiated antiretroviral therapy.

Conclusion:

The hazard of mortality was higher among HIV-infected children in the early period of initiation. Enhancing antiretroviral therapy drug adherence, monitoring Hgb level, and timely initiation of antiretroviral therapy reduce HIV-related mortality.
The early impact of the global lockdown on post-secondary students and staff: A global, descriptive study
Authors: Nowrouzi-Kia Behdin , Osipenko Leeza , Eftekhar Parvin , Othman Nasih , Alotaibi Sultan , Schuster Alexandra M , Sun Suh Hae , Duncan Andrea
Published: January 2022

Objectives:

The aim of this study was to gain a preliminary, broad-level understanding of how the first lockdown impacted post-secondary students, faculty, and staff worldwide.

Methods:

The data were obtained via a global online cross-sectional questionnaire survey using a mixed-method design and disseminated to university students, faculty, and staff from April to November 2020. The data were categorized in four themes/categories: (1) social life and relationships, (2) access to services, (3) health experiences, and (4) impact on mental health well-being.

Results:

The survey included 27,804 participants from 121 countries and 6 continents. The majority of participants were from Europe (73.6%), female (59.2%), under 30 years of age (64.0%), living in large urban areas (61.3%), %), and from middle-income families (66.7%). Approximately 28.4% of respondents reported that the lockdown negatively impacted their social life, while 21.2% reported the lockdown had a positive impact. A total of 39.2% reported having issues accessing products or services, including essentials, such as groceries, or medical services. In addition, respondents reported an increase in stress and anxiety levels and a decrease in quality of life during the first 2 weeks of the lockdown.

Conclusions:

The COVID-19 pandemic and lockdown measures had an evident impact on the lives of post-secondary students, faculty, and staff. Further research is required to inform and improve policies to support these populations at both institutional and national levels.
Lessons Learned From VHA’s Rapid Implementation of Virtual Whole Health Peer-Led Groups During the COVID-19 Pandemic: Staff Perspectives
Authors: Anderson Ekaterina , Dvorin Kelly , Etingen Bella , Barker Anna M. , Rai Zenith , Herbst Abigail , Mozer Reagan , Kingston Rodger P. , Bokhour Barbara
Published: January 2022

Background

Committed to implementing a person-centered, holistic (Whole Health) system of care, the Veterans Health Administration (VHA) developed a peer-led, group-based, multi-session “Taking Charge of My Life and Health” (TCMLH) program wherein Veterans reflect on values, set health and well-being-related goals, and provide mutual support. Prior work has demonstrated the positive impact of these groups. After face-to-face TCMLH groups were disrupted by the COVID-19 pandemic, VHA facilities rapidly implemented virtual (video-based) TCMLH groups.

Objective

We sought to understand staff perspectives on the feasibility, challenges, and advantages of conducting TCMLH groups virtually.

Methods

We completed semi-structured telephone interviews with 35 staff members involved in the implementation of virtual TCMLH groups across 12 VHA facilities and conducted rapid qualitative analysis of the interview transcripts.

Results

Holding TCMLH groups virtually was viewed as feasible. Factors that promoted the implementation included use of standardized technology platforms amenable to delivery of group-based curriculum, availability of technical support, and adjustments in facilitator delivery style. The key drawbacks of the virtual format included difficulty maintaining engagement and barriers to relationship-building among participants. The perceived advantages of the virtual format included the positive influence of being in the home environment on Veterans’ reflection, motivation, and self-disclosure, the greater convenience and accessibility of the virtual format, and the virtual group’s role as an antidote to isolation during the COVID-19 pandemic.

Conclusion

Faced with the disruption caused by the COVID-19 pandemic, VHA pivoted by rapidly implementing virtual TCMLH groups. Staff members involved in implementation noted that delivering TCMLH virtually was feasible and highlighted both challenges and advantages of the virtual format. A virtual group-based program in which participants set and pursue personally meaningful goals related to health and well-being in a supportive environment of their peers is a promising innovation that can be replicated in other health systems.
Peri-Operative Outcomes Comparison of General Anaesthesia and Brachial Plexus Block for Open Reduction Internal Fixation of Metacarpal Fractures
Authors: Budden Curtis , Donaldson Elsa Kaley , Tredget Edward , Tsui Ban C. H.
Published: January 2022

Introduction:

Brachial plexus blockade (BPB) is a procedure of growing popularity amongst surgeons and anaesthesiologists involved with upper limb surgery. The safety and benefit in hand surgery is unclear.

Methods:

A retrospective chart review was performed examining all operative hand cases over a 2-year period. All cases of metacarpal open reduction internal fixation (ORIF) were included. Cases were excluded if paediatric patient, additional procedures performed, and/or a decreased LOC. Parametric statistical tests were performed.

Results:

In total, 54 cases with general anaesthesia (GA) and 48 cases with BPB were identified for the study (n = 102). The average total time from operating theatre to discharge was 245 ± 72 minutes in GA group and 195 ± 54 minutes in BPB ( P < .001). Of those who had a GA, 47/54 patients required analgesia post-operatively versus 12/48 in the BPB ( P < .001). Of all, 25/52 and 5/48 patients required anti-emetics post-operatively in the GA and BPB groups, respectively ( P < .001). Need for any parenteral medication post-operatively was also significantly different ( P < .001).

Conclusion:

This is the first study to specifically examine anaesthetic techniques for ORIF of hand fractures; adding to the body of literature establishing BPB as a safe and efficient method of anaesthesia.
Quantifying the Effects of Motivation on Listening Effort: A Systematic Review and Meta-Analysis
Authors: Carolan Peter J , Heinrich Antje , Munro Kevin J , Millman Rebecca E
Published: January 2022

Motivation influences the amount of listening effort (LE) exerted or experienced under challenging conditions, such as in high-noise environments. This systematic review and meta-analysis is the first to quantify the effects of motivation on LE. The review was pre-registered in PROSPERO, and performed in accordance with PRISMA guidelines. Eligible studies examined the influence of motivation or individual traits (related to motivation) on LE in adults. Motivational factors, coded as independent variables, included financial reward, evaluative threat, perceived competence, feedback, and individual traits. LE outcomes were categorized as subjective, behavioral, or physiological. The quality of evidence was assessed using an adaptation of the Cochrane Collaboration Risk of Bias Tool. Nested random-effects meta-analyses were performed to quantify and compare the influence of motivational factors across LE outcomes. After assessing 3,532 records, 48 studies met the inclusion criteria and 43 were included in the meta-analyses. Risk of bias was high, for example, many studies lacked sample size justification. Motivational factors had a small-to-medium effect (mean Cohen's d = 0.34, range: 0.11–0.72) on LE. When LE outcomes were considered collectively, an external manipulation of motivation (perceived competence) produced a larger mean effect size compared with individual traits. Some combinations of motivational factors and LE outcomes produced more robust effects than others, for example, evaluative threat and subjective LE outcomes. Although wide prediction intervals and high risk of bias mean that significant positive effects cannot be guaranteed, these findings provide useful guidance on the selection of motivational factors and LE outcomes for future research.
Usability and Acceptability of the QuestLeukemia Mobile Application: A Pilot Study for An Educational and Psychological Intervention for Children with Chronic Illnesses
Authors: Meyer Rachel , Wang Kira , Yearley Alexander , Grob Sydney , Zeitlin Jacob , Bloomfeld Jack , You Melissa , Lee Diane , Bonner Melanie , Shah Nirmish , Page Kristin
Published: January 2022

It is widely accepted that educational interventions benefit children with chronic diseases (disease awareness and autonomy) or those undergoing medical procedures (decreased anxiety and improved satisfaction). Hematopoietic cell transplantation (HCT) is an intensive procedure to treat life-threatening diseases but is associated with multiple adverse medical experiences. QuestLeukemia (QuestED, Durham, NC) is a mobile app designed to educate pediatric patients preparing for HCT through age-appropriate videos and quizzes. Here we describe the results of the initial pilot study assessing acceptability and feasibility of QuestLeukemia app. Eligible participants were selected from a convenience sample (inpatient HCT unit and outpatient clinic). Participants spent 30–60 min using the app then completed a survey assessing the app for usability, accessibility, and user satisfaction. Participants identified the app as a useful tool for gaining disease-related knowledge and reported greater autonomy over their disease process. On average, patients indicated that the app was easy to use ( M = 4.93), enjoyable ( M = 4.79), and comprehensive ( M = 4.71). Parents followed similar trends of satisfaction with the app. Pediatric HCT providers likewise reported that the app was easy to use ( M = 4.22), enjoyable ( M = 4.85), and educationally comprehensive ( M = 4.77). The QuestLeukemia mobile application prototype provides an easy, enjoyable, and educational tool for pediatric patients undergoing HCT. This application was well received by patients, parents, and providers. These findings will be used to design future iterations of the game in clinical care.
1L NER1006 can improve rates of adequate and high-quality bowel cleansing in the right colon: a post hoc analysis of two randomised clinical trials
Authors: Manning Jonathan , Halonen Juha , Cheriyamkunnel Sandra Jose , Álvarez-González Marco Antonio
Published: January 2022

Background

The right colon is difficult to cleanse compared with other colon segments. This post hoc analysis of two randomised clinical trials (MORA and NOCT) examined whether 1L polyethylene glycol (PEG) NER1006 and two mid-volume alternatives could improve adequate and high-quality cleansing in the right colon among patients with complete cleansing assessments.

Methods

Patients received NER1006 (N2D), 2L PEG plus ascorbate (2LPEG) or oral sulphate solution (OSS) as a 2-day evening/morning split-dosing regimen or NER1006 as a same-day morning-only dosing regimen (N1D). Patients had full segmental scoring assigned by treatment-blinded central readers using the Harefield Cleansing Scale. The right colon adequate (score ≥ 2) and high-quality (score ≥ 3) cleansing success of NER1006 (N2D and N1D) versus 2LPEG and OSS was analysed individually and as pooled groups (N2D vs. 2LPEG/OSS). We assessed the comparative right colon cleansing rates of the N2D versus 2LPEG/OSS in overweight males. We also performed a multivariable regression analysis to examine factors affecting cleansing in the right colon.

Results

A total of 1307 patients were included. Pooled N2D showed significantly improved rates of adequate-level cleansing in the right colon compared with 2LPEG (97.5% [504/517] vs. 94.6% [246/260]; p = 0.020) and OSS (97.5% [504/517] vs. 93.8% [244/260]; p = 0.006). In MORA, the rate of adequate right colon cleansing did not significantly differ between N1D and 2LPEG (95.2% [257/270] vs. 94.6% [246/260]; p = 0.383). The rate of right colon high-quality cleansing was significantly improved with N2D or N1D vs. 2LPEG (p < 0.001 for both), and was numerically higher with N2D versus OSS (p = 0.11). In overweight males, NER1006 delivered numerically higher adequate (p = 0.398) and superior high-quality (p = 0.024) cleansing rates versus 2LPEG/OSS. Multivariable regression analysis showed NER1006 was associated with adequate and high-quality cleansing (p = 0.031 and p < 0.001), while time between preparation and colonoscopy was negatively associated (p = 0.034 and p = 0.006).

Conclusions

NER1006 delivered improved rates of adequate and high-quality right colon cleansing compared with 2LPEG and OSS. The increased rate of high-quality cleansing with NER1006 versus its comparators was also seen in overweight males.
Living conditions, lifestyle habits and health among adults before and after the COVID-19 pandemic outbreak in Sweden - results from a cross-sectional population-based study
Authors: Molarius Anu , Persson Carina
Published: January 2022

Background

Studies on the public health consequences of COVID-19 pandemic showing data based on robust methods are scarce. The aim of this study was to investigate mental and physical health as well as living conditions and lifestyle habits in the general population before and after the COVID-19 outbreak in Sweden.

Methods

The study is based on 2273 persons 16-84 years who responded to the national public health survey in February-May 2020 in Värmland county (overall response rate 45%). The differences between early respondents (before the outbreak, n = 1711) and late respondents (after the outbreak, n = 562) were studied using multivariate logistic regression, adjusting for background characteristics: age, gender, educational level, and country of birth. The same analyses were also completed in the corresponding survey carried out in February-June 2018.

Results

Statistically significant differences between the groups were obtained for economic difficulties and worry about losing one’s job, which were more common among late respondents, and for sleeping difficulties, which were more common among early respondents after adjusting for background characteristics. There were no differences in other living conditions nor in lifestyle factors. Prevalence of good self-rated health, high blood pressure, aches in shoulders or neck, anxiety or worry and stress did not differ between the groups. In 2018, the only statistically significant difference between early and late respondents concerned economic difficulties.

Conclusions

Very few differences in living conditions, lifestyle factors and health were observed in the study population before and after the COVID-19 outbreak. The results suggest that, in addition to a possible decrease in sleeping difficulties, the prevalence of being worried about losing one’s job increased among the employed after the outbreak.
Obstetrics and gynecology resident perception of virtual fellowship interviews
Authors: Ding Jia Jennifer , Has Phinnara , Hampton B. Star , Burrell Dayna
Published: January 2022

Background

Travel restrictions amidst the COVID-19 pandemic reshaped interviewing for fellowships into a predominantly virtual process. How this impacts Obstetrics and Gynecology (OB/GYN) resident approaches to fellowship application and Match navigation is largely unknown.

Methods

We performed a cross-sectional survey study of fourth year OB/GYN residents in the United States who participated in at least one virtual fellowship interview in 2020. We collected information regarding demographics, application strategy, perceived strengths and weaknesses of virtual interviews, and confidence with rank list creation. Descriptive statistics were used for categorical variables and responses pre- and post-Match were compared using Fisher’s exact test.

Results

Seventy-five out of an estimated 490 applicants (~ 15% response rate) completed the survey. Of the respondents, 65.3% felt they interviewed at more programs virtually than they would anticipate completing in person, but perceived less confidence in having the necessary information (n = 45, 60%) or understanding the culture of programs (n = 59, 78.7%) to create a rank list. Cost savings were the main benefit of virtual interviews (n = 50, 66.7%), and inability to get a true “feel” for a program was the biggest limitation (n = 43, 57.3%). A majority (46.7%) advocate for a future hybrid interview process.

Conclusions

OB/GYN residents pursuing fellowship reported interviewing at more programs during the virtual season, but had less confidence with rank list creation. Cost savings benefits are weighed against difficulty getting a “feel” for programs virtually. Most would advocate for a future hybrid interview process.
Twenty years of traditional and complementary medicine regulation and its impact in Malaysia: achievements and policy lessons
Authors: Park Ji-Eun , Yi Junhyeok , Kwon Ohmin
Published: January 2022

Background

Many countries are trying to integrate traditional and complementary medicine (T&CM) into their health care systems. However, it is not easy to integrate T&CM within a given health care system. This study aims to draw policy outcomes and lessons from the case of Malaysia, which has been making efforts for over 20 years to integrate various types of T&CM into the national health care system (NHS).

Methods

Documents were searched in major databases and websites using words such as Malaysia and T&CM, and additional documents were secured using snowballing techniques. Data were classified and organized according to the World Health Organization health systems framework.

Results

Malaysia has focused on managing the safety and quality of T&CM, and to that end it has been institutionalized by enacting specialized laws rather than by applying existing medical law directly. Malaysia was able to institutionalize T&CM by adopting a step-by-step approach that considered the appropriateness of administrative policies and measures.

Conclusions

Malaysia's experiences in implementing its T&CM policies will raise practical implications for countries struggling to integrate their existing T&CM into the NHS and utilize it for universal health coverage.
The attitude and acceptability towards medical promotional tools and their influence on physicians’ prescribing practices in Jordan and Iraq: a cross-sectional study
Authors: Ali Karrar Ehsan , Naser Abdallah Y. , Al-Rousan Rabaa , Alwafi Hassan , AbuAlhommos Amal Khaleel , Alsairafi Zahra Khalil , Salawati Emad M. , Samannodi Mohammed , Dairi Mohammad S.
Published: January 2022

Background

Pharmaceutical companies spend more than one-third of their sales revenue on marketing and promotion directed toward healthcare professionals. There has been a focus on the relationship between healthcare professionals and the pharmaceutical industry in recent years. This study aims to explore the attitude toward and acceptability of medical promotional tools and their influence on physicians’ prescribing practices in Jordan and Iraq.

Methods

A cross-sectional survey study was conducted to explore the influence of visits by medical representatives (MRs) and medical promotions on physicians’ prescribing practices between June and October 2020 in Jordan and Iraq. Previously validated questionnaires were used.

Results

A total of 801 physicians completed the questionnaires. Face-to-face visits, followed by the dispensing of medical samples, were the two most common promotional methods used by MRs. 48% of participating physicians reported that they would accept the promotional marketing tools offered to them. MRs focused on the key selling points of their product during medical promotions, and 39.6% of the physicians reported that MRs had a negative attitude toward their competitors’ products. 69.9% of the physicians reported that they would change their practice after participating in conferences or meetings.

Conclusion

Medical promotional tools have a clear influence on physicians’ prescribing practices in Jordan and Iraq. Therefore, medical promotion should be controlled and guided by clear and country-specific ethical guidelines. This will ensure safe medical promotion to physicians and optimise the healthcare practices provided to patients.
ERDRP-0519 inhibits feline coronavirus in vitro
Authors: Camero Michele , Lanave Gianvito , Catella Cristiana , Lucente Maria Stella , Sposato Alessio , Mari Viviana , Tempesta Maria , Martella Vito , Buonavoglia Alessio
Published: January 2022

Background

Coronaviruses (CoVs) are major human and animal pathogens and antiviral drugs are pursued as a complementary strategy, chiefly if vaccines are not available. Feline infectious peritonitis (FIP) is a fatal systemic disease of felids caused by FIP virus (FIPV), a virulent pathotype of feline enteric coronavirus (FeCoV). Some antiviral drugs active on FIPV have been identified, but they are not available in veterinary medicine. ERDRP-0519 (ERDRP) is a non-nucleoside inhibitor, targeting viral RNA polymerase, effective against morbilliviruses in vitro and in vivo.

Results

The antiviral efficacy of ERDRP against a type II FIPV was evaluated in vitro in Crandell Reese Feline Kidney (CRFK) cells. ERDRP significantly inhibited replication of FIPV in a dose-dependent manner. Viral infectivity was decreased by up to 3.00 logarithms in cell cultures whilst viral load, estimated by quantification of nucleic acids, was reduced by nearly 3.11 logaritms.

Conclusions

These findings confirm that ERDRP is highly effective against a CoV. Experiments will be necessary to assess whether ERDRP is suitable for treatment of FIPV in vivo.
Adherence to malaria management guidelines by health care workers in the Busoga sub-region, eastern Uganda
Authors: Mpimbaza Arthur , Babikako Harriet , Rutazanna Damian , Karamagi Charles , Ndeezi Grace , Katahoire Anne , Opigo Jimmy , Snow Robert W. , Kalyango Joan N.
Published: January 2022

Background

Appropriate malaria management is a key malaria control strategy. The objective of this study was to determine health care worker adherence levels to malaria case management guidelines in the Busoga sub-region, Uganda.

Methods

Health facility assessments, health care worker (HCW), and patient exit interview (PEI) surveys were conducted at government and private health facilities in the sub-region. All health centres (HC) IVs, IIIs, and a sample of HC IIs, representative of the tiered structure of outpatient service delivery at the district level were targeted. HCWs at these facilities were eligible for participation in the study. For PEIs, 210 patients of all ages presenting with a history of fever for outpatient care at selected facilities in each district were targeted. Patient outcome measures included testing rates, adherence to treatment, dispensing and counselling services as per national guidelines. The primary outcome was appropriate malaria case management, defined as the proportion of patients tested and only prescribed artemether-lumefantrine (AL) if positive. HCW readiness (e.g., training, supervision) and health facility capacity (e.g. availability of diagnostics and anti-malarials) to provide malaria case management were also assessed. Data were weighted to cater for the disproportionate representation of HC IIs in the study sample.

Results

A total of 3936 patients and 1718 HCW from 392 facilities were considered in the analysis. The median age of patients was 14 years; majority (63.4%) females. Most (70.1%) facilities were HCIIs and 72.7% were owned by the government. Malaria testing services were available at > 85% of facilities. AL was in stock at 300 (76.5%) facilities. Of those with a positive result, nearly all were prescribed an anti-malarial, with AL (95.1%) accounting for most prescriptions. Among those prescribed AL, 81.0% were given AL at the facility, lowest at HC IV (60.0%) and government owned (80.1%) facilities, corresponding to AL stock levels. Overall, 86.9% (95%CI 79.7, 90.7) of all enrolled patients received appropriate malaria case management. However, only 50.7% (21.2, 79.7) of patients seen at PFPs received appropriate malaria management.

Conclusion

Adherence levels to malaria case management guidelines were good, but with gaps noted mainly in the private sector. The supply chain for AL needs to be strengthened. Interventions to improve practise at PFP facilities should be intensified.
Changes in productivity in healthcare services in the Kingdom of Saudi Arabia
Authors: Al-Hanawi Mohammed Khaled , Makuta Innocent F.
Published: January 2022

Background

Amid the rising demand for healthcare services in Saudi Arabia, there is a need to monitor, evaluate, and improve performance in the delivery of these services. In this regard, the aim of this study was to estimate changes in total factor productivity (TFP) in healthcare services across the health system administrative regions in Saudi Arabia from 2006 to 2018. The contributions of changes in efficiency and technology to the observed changes in TFP were further evaluated.

Methods

The data used for this study were extracted from annual Ministry of Health Statistical Yearbooks for the period of 2006–2018. TFP changes were estimated using the Malmquist Productivity Index, in which technology frontiers were constructed through data envelopment analysis. The changes in TFP were decomposed into changes in technology, changes in pure technical efficiency, and changes in scale efficiency following the Färe-Grosskopf-Norris-Zhang method. As robustness checks, we used bootstrapping to construct intervals and applied alternative decomposition methods. The changes in TFP and its sources were also compared between public and private hospitals.

Results

Over the period from 2006 to 2018, TFP for healthcare services has decreased on average by 5.6% per year solely on account of a technical regress. Public hospitals registered a higher deterioration in productivity (6.0% per year) than private hospitals (4.8% per year).

Conclusion

Using the available resources, there is potential for realising gains in productivity of healthcare services by addressing existing technological challenges. Since the decline in TFP is entirely a problem of technical regress, the primary solution should focus on strategies for achieving technical progress (innovation) through investment in more or better machinery, equipment, and structures for healthcare service provision.
Construction of a quadruple gene-deleted vaccine confers complete protective immunity against emerging PRV variant challenge in piglets
Authors: Sun Leqiang , Tang Yajie , Yan Keji , Zhang Huawei
Published: January 2022

Background

Pseudorabies virus (PRV) causes Aujeszky’s disease or pseudorabies (PR) in pigs worldwide, which leads to heavy economic losses to the swine industry. Pigs are the natural host, meanwhile, animals such as dogs, cats, foxes, rabbits, cattle and sheep are susceptible to infection. In 2011, the emerging PRV variant led to the outbreak of PR in Bartha-K61 vaccinated pigs. The PR outbreaks demonstrated that the Bartha-K61 vaccine did not provide full protection against the emerging PRV variant. It is widely believed that PRV live attenuated vaccine could control PRV infection.

Methods

In this study, we developed a novel PRV live attenuated vaccine by deleting its gI, gE, US9, and US2 genes through CRISPR/Cas9, which was named PRV GDFS-delgI/gE/US9/US2.

Results

Safety experiments confirmed that PRV GDFS-delgI/gE/US9/US2 was safe for 5- to 7-day-old suckling piglets. Piglets immunized with the PRV GDFS-delgI/gE/US9/US2 vaccine did not produce PRV gE-specific antibodies but could generate PRV gB-specific antibodies and high neutralizing titers against the PRV GDFS strain (variant PRV strain) or PRV Ea strain (older PRV strain). After challenge with the emerging PRV GDFS variant, none of the piglets immunized with the PRV GDFS-delgI/gE/US9/US2 vaccine showed any clinical signs, and their rectal temperatures were normal. Moreover, the autopsy and histopathological analyses revealed that the piglets in the PRV GDFS-delgI/gE/US9/US2 vaccine group did not show apparent gross or pathological lesions. Furthermore, the piglets in the PRV GDFS-delgI/gE/US9/US2 vaccine groups did not present weight loss. According to the criteria of the OIE terrestrial manual, the results of the experiment confirmed that the PRV GDFS-delgI/gE/US9/US2 vaccine could provide full protection against the emerging PRV variant strain in piglets.

Conclusions

The PRV GDFS-delgI/gE/US9/US2 strain is a potential new live attenuated vaccine against emerging PRV variant strain infections in China.
Intra‐assessor reliability and measurement error of ultrasound measures for foot muscle morphology in older adults using a tablet‐based ultrasound machine
Authors: Willemse Lydia , Wouters Eveline J. M. , Pisters Martijn F. , Vanwanseele Benedicte
Published: January 2022

Background

To gain insight into the role of plantar intrinsic foot muscles in fall‐related gait parameters in older adults, it is fundamental to assess foot muscles separately. Ultrasonography is considered a promising instrument to quantify the strength capacity of individual muscles by assessing their morphology. The main goal of this study was to investigate the intra‐assessor reliability and measurement error for ultrasound measures for the morphology of selected foot muscles and the plantar fascia in older adults using a tablet‐based device. The secondary aim was to compare the measurement error between older and younger adults and between two different ultrasound machines.

Methods

Ultrasound images of selected foot muscles and the plantar fascia were collected in younger and older adults by a single operator, intensively trained in scanning the foot muscles, on two occasions, 1–8 days apart, using a tablet‐based and a mainframe system. The intra‐assessor reliability and standard error of measurement for the cross‐sectional area and/or thickness were assessed by analysis of variance. The error variance was statistically compared across age groups and machines.

Results

Eighteen physically active older adults (mean age 73.8 (SD: 4.9) years) and ten younger adults (mean age 21.9 (SD: 1.8) years) participated in the study. In older adults, the standard error of measurement ranged from 2.8 to 11.9%. The ICC ranged from 0.57 to 0.97, but was excellent in most cases. The error variance for six morphology measures was statistically smaller in younger adults, but was small in older adults as well. When different error variances were observed across machines, overall, the tablet‐based device showed superior repeatability.

Conclusions

This intra‐assessor reliability study showed that a tablet‐based ultrasound machine can be reliably used to assess the morphology of selected foot muscles in older adults, with the exception of plantar fascia thickness. Although the measurement errors were sometimes smaller in younger adults, they seem adequate in older adults to detect group mean hypertrophy as a response to training. A tablet‐based ultrasound device seems to be a reliable alternative to a mainframe system. This advocates its use when foot muscle morphology in older adults is of interest.
The transcriptional landscape and biomarker potential of circular RNAs in prostate cancer
Authors: Hansen Emma Bollmann , Fredsøe Jacob , Okholm Trine Line Hauge , Ulhøi Benedicte Parm , Klingenberg Søren , Jensen Jørgen Bjerggaard , Kjems Jørgen , Bouchelouche Kirsten , Borre Michael , Damgaard Christian Kroun , Pedersen Jakob Skou , Kristensen Lasse Sommer , Sørensen Karina Dalsgaard
Published: January 2022

Background

Circular RNAs (circRNAs) constitute a largely unexplored source for biomarker discovery in prostate cancer (PC). Here, we characterize the biomarker potential of circRNAs in PC, where the need for novel diagnostic and prognostic tools to facilitate more personalized management is pressing.

Methods

We profiled the transcriptomic landscape of circRNAs in PC by total RNA sequencing of 31 adjacent-normal and 143 tumor samples from localized (radical prostatectomy (RP)) and metastatic PC patients (cohort 1, training). Diagnostic and prognostic potential was evaluated in cohort 1, and 39 top circRNA candidates were selected for validation in two additional PC cohorts (cohort 2, n = 111; RP cohort 3, n = 191) by NanoString-based expression analysis. Biochemical recurrence (BCR)-free survival was assessed using Kaplan-Meier, univariate, and multivariate Cox regression analyses. The circRNA candidates were further detected in extracellular vesicle (EV)-enriched plasma samples from PC patients and controls (cohort 4, n = 54).

Results

Expression of circABCC4, circFAT3, circATRNL1, and circITGA7 was highly cancer-specific (area under the curve 0.71–0.86), while low circITGA7 expression was significantly (P < 0.05) associated with BCR in univariate analysis in two RP cohorts. Moreover, we successfully trained and validated a novel 5-circRNA prognostic signature (circKMD1A/circTULP4/circZNF532/circSUMF1/circMKLN1) significantly associated with BCR beyond routine clinicopathological variables (RP cohort 1: P = 0.02, hazard ratio = 2.1; RP cohort 3: P < 0.001, hazard ratio = 2.1). Lastly, we provide proof-of-principle for detection of candidate circRNAs in EV-enriched plasma samples from PC patients.

Conclusions

circRNAs hold great biomarker potential in PC and display both high cancer specificity and association to disease progression.
Closely related Salmonella Derby strains triggered distinct gut microbiota alteration
Authors: Yuan Xiaohui , Xue Han , Xu Xiaomeng , Jiao Xinan , Pan Zhiming , Zhang Yunzeng
Published: January 2022

Background

Salmonella Derby is one of the most predominant Salmonella serotypes that seriously threatens food safety. This bacterium can be further differentiated to sub-populations with different population sizes; however, whether and how the S. Derby–gut microbiota interactions affect epidemic patterns of S. Derby sub-populations remain largely unknown.

Results

We selected two representative strains, 14T and 14C, which represent rarely distributed and prevalent sub-populations of the S. Derby ST40 group, respectively, to address this question using a mouse model. Effects of oral administration of both strains was monitored for 14 days. Alpha diversity of gut microbiota at early stages of infection (4 h post infection) was higher in 14C-treated mice and lower in 14T-treated mice compared with controls. Strain 14T triggered stronger inflammation responses but with lower pathogen titer in spleen compared with strain 14C at 14 days post infection. Certain known probiotic bacteria that can hinder colonization of Salmonella, such as Bifidobacteriaceae and Akkermansiaceae, exhibited increased relative abundance in 14T-treated mice compared with 14C-treated mice. Our results also demonstrated that Ligilactobacillus strains isolated from gut microbiota showed stronger antagonistic activity against strain 14T compared with strain 14C.

Conclusions

We identified how S. Derby infection affected gut microbiota composition, and found that the 14T strain, which represented a rarely distributed S. Derby sub-population, triggered stronger host inflammation responses and gut microbiota disturbance compared with the 14C strain, which represented a prevalent S. Derby sub-population. This study provides novel insights on the impacts of gut microbiota on the epidemic patterns of Salmonella populations.
One-year spatiotemporal database of Emergency Medical Service (EMS) calls in Mashhad, Iran: data on 224,355 EMS calls
Authors: Hashtarkhani Soheil , Kiani Behzad , Mohammadi Alireza , MohammadEbrahimi Shahab , Eslami Saeid , Tara Mahmood , Matthews Stephen A.
Published: January 2022

Objectives

Emergency Medical Services (EMS) is the first point of service for the people who are in critical condition and in need of urgent health care. In Iran, as in other countries, people in need of emergency services often die or are left with a permanent injury due to the poor EMS-related infrastructure. It has been shown that a detailed examination of the response times and the spatiotemporal pattern of EMS calls for service can lead to improvements in time-sensitive patient outcomes. We performed a spatiotemporal study in city of Mashhad, the second-most populous city of Iran, to investigate the pattern of the EMS calls and now wish to release a comprehensive dataset resulting from this study.

Data description

The data include three data files plus a data dictionary file. Data file 1 contains the characteristics of EMS requests including sex, age group, date of call, different time periods of each EMS missions, the census tracts’ ID of callers, the chief complaint, and the EMS mission result. Two spatial data files include the boundaries of the census tracts in Mashhad and the point location of all EMS stations, respectively. A data dictionary file defines all fields and values across the data files.
Domestic violence during the COVID-19 confinement: do victims feel more socially isolated?
Authors: Drieskens Sabine , Braekman Elise , Ridder Karin De , Gisle Lydia , Charafeddine Rana , Hermans Lize , Demarest Stefaan
Published: January 2022

Background

Since March 13th 2020, confinement measures have been introduced in Belgium to curb the spread of the coronavirus (COVID-19). These measures also have an impact on people’s daily life (closure of school/businesses, teleworking, recommendation to stay at home). This can cause stress on social, economic and psychological levels and thereby can trigger domestic violence. Besides, confinement also fosters social isolation, which can complicate help seeking behaviour. The aim of this study is to determine the prevalence of domestic violence during the coronavirus crisis and to assess whether there is an association between domestic violence and social isolation.

Methods

Several online COVID-19 Health Surveys were organised among Belgian residents aged 18+ via snowball sampling. This study is based on the second (April 2020) and the sixth survey (March 2021). After excluding 1-person households and missing data, the sample size was respectively 25,251 and 12,589. Weighted prevalence of domestic violence was evaluated for the two surveys. The association (OR; 95% CI; p-value) between domestic violence and subjective social isolation was assessed with logistic regression stratified by survey and adjusted for covariates.

Results

In April 2020, 4.0% of the adult population reported being a victim of domestic violence (1.2% in the Health Interview Survey 2018); in March 2021, this was 6.2%. In April 2020, victims of domestic violence had higher odds of being unsatisfied with their social contacts (OR = 1.25; 95% CI: 1.08–1.44; p < .05), weak social support (OR = 2.26; 95% CI: 1.97–2.58; p < .0001) and having less confidence in health care services (OR = 1.38; 95% CI: 1.13–1.71; p < .05). In March 2021, victims had higher odds of being unsatisfied with their social contacts (OR = 1.30; 95% CI: 1.08–1.56; p < .05) and weak social support (OR = 2.41; 95% CI: 2.04–2.84; p < .0001), and social (OR = 2.64; 95% CI: 2.23–3.13; p < .0001) and emotional loneliness (OR = 2.22; 95% CI: 1.80–2.73; p < .0001).

Conclusions

More people have reported domestic violence since the start of the coronavirus crisis than did in 2018. An association between domestic violence and social isolation was determined. Although confinement is needed to counteract the virus, it can put people in a dangerous situation since they do not get the help they need. Therefore, adequate support is essential.
Heat and drought impact on carbon exchange in an age-sequence of temperate pine forests
Authors: Arain M. Altaf , Xu Bing , Brodeur Jason J. , Khomik Myroslava , Peichl Matthias , Beamesderfer Eric , Restrepo-Couple Natalia , Thorne Robin
Published: January 2022

Background

Most North American temperate forests are plantation or regrowth forests, which are actively managed. These forests are in different stages of their growth cycles and their ability to sequester atmospheric carbon is affected by extreme weather events. In this study, the impact of heat and drought events on carbon sequestration in an age-sequence (80, 45, and 17 years as of 2019) of eastern white pine (Pinus strobus L.) forests in southern Ontario, Canada was examined using eddy covariance flux measurements from 2003 to 2019.

Results

Over the 17-year study period, the mean annual values of net ecosystem productivity (NEP) were 180 ± 96, 538 ± 177 and 64 ± 165 g C m–2 yr–1 in the 80-, 45- and 17-year-old stands, respectively, with the highest annual carbon sequestration rate observed in the 45-year-old stand. We found that air temperature (Ta) was the dominant control on NEP in all three different-aged stands and drought, which was a limiting factor for both gross ecosystem productivity (GEP) and ecosystems respiration (RE), had a smaller impact on NEP. However, the simultaneous occurrence of heat and drought events during the early growing seasons or over the consecutive years had a significant negative impact on annual NEP in all three forests. We observed a similar trend of NEP decline in all three stands over three consecutive years that experienced extreme weather events, with 2016 being a hot and dry, 2017 being a dry, and 2018 being a hot year. The youngest stand became a net source of carbon for all three of these years and the oldest stand became a small source of carbon for the first time in 2018 since observations started in 2003. However, in 2019, all three stands reverted to annual net carbon sinks.

Conclusions

Our study results indicate that the timing, frequency and concurrent or consecutive occurrence of extreme weather events may have significant implications for carbon sequestration in temperate conifer forests in Eastern North America. This study is one of few globally available to provide long-term observational data on carbon exchanges in different-aged temperate plantation forests. It highlights interannual variability in carbon fluxes and enhances our understanding of the responses of these forest ecosystems to extreme weather events. Study results will help in developing climate resilient and sustainable forestry practices to offset atmospheric greenhouse gas emissions and improving simulation of carbon exchange processes in terrestrial ecosystem models.