bluuebunny/crossref_metadata_2025 huggingface dataset:
New records of water mites (Acari: Hydrachnidia) from Sri Lanka with description of four new species and some remarks of relationships

Authors: Zawal Andrzej , Szućko Izabela , Szenejko Magdalena , Skuza Lidia , Bańkowska Aleksandra , Michoński Grzegorz , Pešić Vladimir
Published: September 2020

New records of water mites (Acari: Hydrachnidia) from the standing waters of Sri Lanka are presented. Fifteen species have been registrated, among them four species, i.e. Piona srilankana (Pionidae), Neumania edytae (Unionicolidae), Krendowskia (Krendowskiella) srilankana (Krendowskiidae), and Mideopsis ewelinae (Mideopsidae) are described as new to science. DNA was extracted from 18 water mite specimens and DNA barcodes are given for the first time for nine species.
Bioecological aspects of mites associated with Vitis vinifera varieties in the state of Rio Grande Do Sul, Brazil

Authors: Da Silva Rita Tatiane Leão , Da Silva Vinicius Leão , Silva Darliane Evangelho , Do Nascimento Joseane Moreira , Schüssler Matheus , Spies Franciele Fernandes , Winter Berté Amália Luisa , Da Silva Guilherme Liberato , Johann Liana , Ferla Júlia Jantsch , De Freitas Elisete Maria , Ferla Noeli Juarez
Published: September 2020

Viticulture is an activity of economic importance in the state of Rio Grande do Sul, especially in Serra Gaúcha, which is the major grape-producing region. However, an increase in cultivated areas has been observed in other municipalities in the state. The aim of this study is to characterize mite diversity and community behavior on different varieties, recognizing which predatory species have potential to control phytophagous mites associated with Europan varieties in the Taquari Valley, Rio Grande do Sul state. The study was conducted in vineyards located in the municipalities of Marques de Souza: ‘BRS Vitória’ and cv ‘Itália’ “m”; Imigrante: cv ‘Itália’ “i”; Dois Lajeados: cv ‘Itália’ (c and f), ‘Tannat’ and ‘Chardonnay’; and Putinga: ‘Champanhe’ and ‘Moscato’. Samplings were carried out monthly in the period ranging from March 2017 to March 2018, during which twenty plants were randomly collected from each variety. Three leaves were clipped from each plant; one from the apical third, one from the median third, and one from the basal third, totaling 60 leaves per area. A total of 10,533 specimens were collected, belonging to 12 families, 38 genera, and 53 species, along with those belonging to the suborder Oribatida. The ‘Itália’ “c” variety had the highest abundance (2,012), followed by ‘Moscato’ (1,788) and ‘BRS Vitória’ (1,593). Phytoseiidae had the highest diversity among the mite families observed, with 20 species followed by Tetranychidae (8). The most abundant species were Polyphagotarsonemus latus (Banks) (3,420) and Euseius concordis (Chant) (565), present throughout the study period. ‘Chardonnay’ variety had the highest similarity (72.55%) among mite fauna compositions and the highest dissimilarity occurred between ‘BRS Vitória’ and ‘Champanhe’ varieties (95.48%). Environments evaluated in Dois Lajeados and Putinga were the most homogeneous concerning mite fauna diversity and abundance.
Arbitrary-order superdirectivity of circular sensor arrays
Authors: Wang Yong , Yang Yixin , Ma Yuanliang
Published: September 2020

Superdirectivity can yield large directivity using a small array aperture, but it suffers from high sensitivity to random errors. In a previously proposed model, robust Nth-order superdirectivity was obtained by combining low-order superdirectivity sub-solutions with orders from 0 to N. However, the orders N were exclusively positive integers, which may lead to an over-improved robustness with an excessively degraded directivity. This paper presents an arbitrary-order superdirectivity model of circular sensor arrays, which can achieve a more flexible compromise between directivity and robustness than the previous model. A coefficient η is weighted at the (N + 1)th-order entry of the optimal weighting vector and the new weighting vector will consist of the 0th- to Nth-order and the weighted (N + 1)th-order entries. The beampattern, the directivity factor, and the error sensitivity function can then be expressed as functions of the coefficient η. Moreover, broadband superdirective beampatterns with a desired directivity factor or error sensitivity function can be readily synthesized using the closed-form solutions derived from the arbitrary-order superdirectivity model. Simulations and experimental results show that the proposed model can easily synthesize superdirective beampatterns with arbitrary orders, and it is more flexible than the previous integer-order model. It is also demonstrated that the performance of the proposed method is similar to that of the optimization-based method, but it uses a simple closed-form weighting vector rather than a numerical algorithm.
Cryo-electron Microscopy Structure, Assembly, and Mechanics Show Morphogenesis and Evolution of Human Picobirnavirus
Authors: Ortega-Esteban Álvaro , Mata Carlos P. , Rodríguez-Espinosa María J. , Luque Daniel , Irigoyen Nerea , Rodríguez Javier M. , de Pablo Pedro J. , Castón José R.
Published: September 2020

Despite intensive study, human virus sampling is still sparse, especially for viruses that cause mild or asymptomatic disease. Human picobirnavirus (hPBV) is a double-stranded-RNA virus, broadly dispersed in the human population, but its pathogenicity is uncertain. Here, we report the hPBV structure derived from cryo-electron microscopy (cryo-EM) and reconstruction methods using three capsid protein variants (of different lengths and N-terminal amino acid compositions) that assemble as virus-like particles with distinct properties. The hPBV near-atomic structure reveals a quasisymmetric dimer as the structural subunit and tetramers as possible assembly intermediates that coassemble with nucleic acids. Our structural studies and atomic force microscopy analyses indicate that hPBV capsids are potentially excellent nanocages for gene therapy and targeted drug delivery in humans.
Offloading Role of a Discrete Thioesterase in Type II Polyketide Biosynthesis
Authors: Hua Kangmin , Liu Xiangyang , Zhao Yuchun , Gao Yaojie , Pan Lifeng , Zhang Haoran , Deng Zixin , Jiang Ming
Published: September 2020

Type II polyketides are a group of secondary metabolites with various biological activities. In nature, biosynthesis of type II polyketides involves multiple enzymatic steps whereby key enzymes, including ketoacyl-synthase (KS
α
), chain length factor (KS
β
), and acyl carrier protein (ACP), are utilized to elongate the polyketide chain through a repetitive condensation reaction. During each condensation, the biosynthesis intermediates are covalently attached to KS
α
or ACP via a thioester bond and are then cleaved to release an elongated polyketide chain for successive postmodification.
A Potent Postentry Restriction to Primate Lentiviruses in a Yinpterochiropteran Bat
Authors: Morrison James H. , Miller Caitlin , Bankers Laura , Crameri Gary , Wang Lin-Fa , Poeschla Eric M.
Published: September 2020

The COVID-19 pandemic suggests that bat innate immune systems are insufficiently characterized relative to the medical importance of these animals. Retroviruses, e.g., HIV-1, can be severe pathogens when they cross species barriers, and bat restrictions corresponding to retroviruses are comparatively unstudied. Here, we compared the abilities of retroviruses from three genera (
Lentivirus
,
Gammaretrovirus
, and
Spumavirus
) to infect cells of the large fruit-eating bat
P. alecto
and other mammals. We identified a major, specific postentry restriction to primate lentiviruses. HIV-1 and SIVmac are potently blocked at early life cycle steps, but nonprimate lentiviruses and foamy retroviruses are entirely unrestricted. Despite acting postentry and in a CypA-dependent manner with features reminiscent of antiretroviral factors from other mammals, this restriction was not saturable with virus-like particles and was independent of
P. alecto
TRIM5, TRIM21, TRIM22, TRIM34, and MX2. These results identify a novel restriction and highlight cyclophilin-capsid interactions as ancient species-specific determinants of retroviral infection.
Bacteria Contribute to Plant Secondary Compound Degradation in a Generalist Herbivore System
Authors: Francoeur Charlotte B. , Khadempour Lily , Moreira-Soto Rolando D. , Gotting Kirsten , Book Adam J. , Pinto-Tomás Adrián A. , Keefover-Ring Ken , Currie Cameron R.
Published: September 2020

Leaf-cutter ants are dominant neotropical herbivores capable of deriving energy from a wide range of plant substrates. The success of leaf-cutter ants is largely due to their external gut, composed of key microbial symbionts, specifically, the fungal mutualistL. gongylophorusand a consistent bacterial community. Both symbionts are known to have critical roles in extracting energy from plant material, yet comparatively little is known about their roles in the detoxification of plant secondary compounds. In this study, we assessed if the bacterial communities associated with leaf-cutter ant fungus gardens can degrade harmful plant chemicals. We identify plant secondary compound detoxification in leaf-cutter ant gardens as a process that depends on the degradative potential of both the bacterial community andL. gongylophorus. Our findings suggest that the fungus garden and its associated microbial community influence the generalist foraging abilities of the ants, underscoring the importance of microbial symbionts in plant substrate suitability for herbivores.
Oxalate-Degrading Bacillus subtilis Mitigates Urolithiasis in a Drosophila melanogaster Model
Authors: Al Kait F. , Daisley Brendan A. , Chanyi Ryan M. , Bjazevic Jennifer , Razvi Hassan , Reid Gregor , Burton Jeremy P.
Published: September 2020

Kidney stone disease is a morbid condition that is increasing in prevalence, with few nonsurgical treatment options. The majority of stones are composed of calcium oxalate. Unlike humans, some microbes can break down oxalate, suggesting that microbial therapeutics may provide a novel treatment for kidney stone patients. This study demonstrated that
Bacillus subtilis
168 (BS168) decreased stone burden, improved health, and complemented the microbiota in a
Drosophila melanogaster
urolithiasis model, while not exacerbating calcium oxalate aggregation or adhesion to renal cells
in vitro
. These results identify this bacterium as a candidate for ameliorating stone formation; given that other strains of
B. subtilis
are components of fermented foods and are used as probiotics for digestive health, strain 168 warrants testing in humans. With the severe burden that recurrent kidney stone disease imposes on patients and the health care system, this microbial therapeutic approach could provide an inexpensive therapeutic adjunct.
Marine Sediments Hold an Untapped Potential for Novel Taxonomic and Bioactive Bacterial Diversity
Authors: Bech Pernille Kjersgaard , Lysdal Klaus Lars , Gram Lone , Bentzon-Tilia Mikkel , Strube Mikael Lenz
Published: September 2020

Since bacterial resistance to antibiotics is developing worldwide, new antibiotics are needed. Most antibiotics discovered so far have been found in soil-dwelling bacteria, so we instead targeted marine environments as a novel source of bioactive potential. We used amplicon sequencing of bioactive gene clusters in the microbiome of coastal seawater and sandy sediments and found the bioactive potential to be comparable to, but distinct from, the bioactive potential of selected soil microbiomes. Moreover, most of this potential is not captured by culturing. Comparing the biosynthetic potential to the corresponding microbiome composition suggested that minor constituents of the microbiome likely hold a disproportionally large fraction of the biosynthesis potential.
Isolated convergence-retraction nystagmus secondary to intralesional haemorrhage of a pineal cyst: an easily missed neurological finding with potentially life-threatening consequences
Authors: Woodward Kristine , Sitaram Amith , Peters Steven
Published: September 2020

This case report describes a patient who presented to the emergency department with intermittent visual disturbance and was found to have convergence-retraction nystagmus. This occurred in the setting of supratherapeutic anticoagulation on warfarin for an aortic dissection graft repair. Urgent imaging demonstrated haemorrhagic transformation of a previously identified incidental pineal cyst. After close monitoring given the risk of secondary hydrocephalus, the patient was discharged in stable condition with symptom resolution and without any further significant complications. This case report highlights the importance of identifying subtle clinical findings and the risk of secondary haemorrhage of pineal cysts when on anticoagulation. While the risk of secondary hydrocephalus is a significant concern, clinically stable patients can be followed without need for neurosurgical intervention.
Utilisation of advanced MRI techniques to understand neurovascular complications of PHACE syndrome: a case of arterial stenosis and dissection
Authors: Eisenmenger Laura B , Rivera-Rivera Leonardo A , Johnson Kevin M , Drolet Beth A
Published: September 2020

PHACE syndrome is a rare disorder with posterior fossa brain malformations, segmental infantile haemangiomas, arterial anomalies, cardiac defects and eye anomalies. Cerebral and cervical arterial abnormalities occur commonly in these patients, predisposing subjects with PHACE syndrome to neurovascular complications including migraine-like headaches, moyamoya vasculopathy, arterial dissection and arterial ischaemia stroke. We leveraged institutional MRI protocols developed for adult neurovascular disease to better elucidate the pathogenesis of the arterial alternations observed in PHACE. Using high-resolution vessel wall and 4D flow MRI, we demonstrated enhancement, focal dissection and altered blood flow in a 7-year-old girl with PHACE syndrome. This is the first-time vessel wall imaging has been used to detail the known arterial changes in PHACE, and these findings may indicate that progressive vascular narrowing and vessel wall changes/inflammation are a factor in chronic headaches and other arterial complications seen in subjects with PHACE syndrome.
Prolonged RNA shedding of the 2019 novel coronavirus in an asymptomatic patient with a VP shunt
Authors: El-Baba Firas , Gabe Danielle , Frank Allan
Published: September 2020

A 33-year-old man with paranoid schizophrenia and a ventriculoperitoneal (VP) shunt was sent to our institution from an inpatient psychiatric facility due to concerns for the 2019 novel coronavirus (COVID-19). Per the facility, the patient had a fever and non-productive cough. On admission, the patient was afebrile and lacked subjective symptoms. A RNA reverse transcriptase PCR (RNA RT-PCR) test for COVID-19 was positive. A chest X-ray contained a small patchy opacity in the right middle lobe and another in the retrocardiac region concerning for pneumonia. Inflammatory markers were mildly elevated. He remained COVID-19 positive and asymptomatic for 36 days. This case details one asymptomatic carrier’s course with persistently positive COVID-19 nasopharyngeal swabs. It demonstrates that a VP shunt could be a possible predisposition for prolonged viral shedding.
Dental considerations in a paediatric patient with Diamond-Blackfan anaemia
Authors: Azam Imam , Rahul Morankar , Tewari Nitesh , Bansal Kalpana
Published: September 2020

Diamond-Blackfan anaemia (DBA) is a rare genetic disorder characterised by a decrease in the production of red blood cells due to bone marrow malfunction. The estimation of disease occurrence is approximately 1 in 100 000–2 00 000 live births. This paper presents the case of a 7-year-old male child diagnosed with DBA at the age of 4 months. The diagnosis was established with haematological findings, bone marrow biopsy and molecular testing. The case was managed successfully for dental symptoms without any complication.
Child with tuberculous meningitis and COVID-19 coinfection complicated by extensive cerebral sinus venous thrombosis
Authors: Essajee Farida , Solomons Regan , Goussard Pierre , Van Toorn Ronald
Published: September 2020

We herein report a case of a child with tuberculous meningitis and COVID-19 coinfection complicated by hydrocephalus, arterial ischaemic stroke and extensive cerebral sinus venous thrombosis. Both conditions induce a proinflammatory cytokine drive resulting, among others, in a prothrombotic state. The disruption of the coagulation system in this case was supported by elevated D-dimers, fibrinogen and ferritin levels, consistent with thrombotic complications reported in some adult patients infected with COVID-19. The child also exhibited prolonged viral shedding that suggests severe disease.
Efficacy and safety of insulin glargine 300 U/mL (Gla-300) during hospitalization and therapy intensification at discharge in patients with insufficiently controlled type 2 diabetes: results of the phase IV COBALTA trial
Authors: Perez Antonio , Carrasco-Sánchez Francisco Javier , González Carlos , Seguí-Ripoll José Miguel , Trescolí Carlos , Ena Javier , Borrell Mireia , Gomez Huelgas Ricardo
Published: September 2020

Introduction

This study assessed the efficacy and safety of insulin glargine 300 U/mL (Gla-300) during hospitalization and therapy intensification at discharge in insufficiently controlled people with type 2 diabetes.

Research design and methods

COBALTA (for its acronym in Spanish, COntrol Basal durante la hospitalizacion y al ALTA) was a multicenter, open-label, single-arm, phase IV trial including 112 evaluable inpatients with type 2 diabetes insufficiently controlled (glycosylated hemoglobin (HbA1c) 8%–10%) with basal insulin and/or non-insulin antidiabetic drugs. Patients were treated with a basal–bolus–correction insulin regimen with Gla-300 during the hospitalization and with Gla-300 and/or non-insulin antidiabetics for 6 months after discharge. The primary endpoint was the HbA1c change from baseline to month 6 postdischarge.

Results

HbA1c levels decreased from 8.8%±0.6% at baseline to 7.2%±1.1% at month 6 postdischarge (p<0.001, mean change 1.6%±1.1%). All 7-point blood glucose levels decreased from baseline to 24 hours predischarge (p≤0.001, mean changes from 25.1±66.6 to 63.0±85.4 mg/dL). Fasting plasma glucose also decreased from baseline to 24 hours predischarge (p<0.001), month 3 (p<0.001) and month 6 (p<0.001) postdischarge (mean changes 51.5±90.9, 68.2±96.0 and 77.6±86.4 mg/dL, respectively). Satisfaction was high and hyperglycemia/hypoglycemia perception was low according to the Diabetes Treatment Satisfaction Questionnaire at month 6 postdischarge. The incidence of confirmed (glucose<70 mg/dL)/severe hypoglycemia was 25.0% during hospitalization and 59.1% 6 months after discharge. No safety concerns were reported.

Conclusions

Inpatient and intensification therapy at discharge with Gla-300 improved significantly glycemic control of patients with type 2 diabetes insufficiently controlled with other basal insulin and/or non-insulin antidiabetic medication, with high treatment satisfaction. Gla-300 could therefore be a treatment choice for hospital and postdischarge diabetes management.
Wide-area transepithelial sampling in adjunct to forceps biopsy increases the absolute detection rates of Barrett’s oesophagus and oesophageal dysplasia: a meta-analysis and systematic review
Authors: Suresh Kumar Vishnu Charan , Harne Prateek , Patthipati Venkata Suresh , Subedi Abinash , Masood Umair , Sharma Anuj , Goyal Faith , Aggarwal Nancy , Sapkota Bishnu
Published: September 2020

Background

Wide-area transepithelial sampling (WATS) is a new technique that uses an abrasive brush to obtain samples from a larger surface area of the oesophagus. Studies have shown promising results that WATS in adjunct to forceps biopsy (FB) increases the detection rate of Barrett’s oesophagus (BE) as well as oesophageal dysplasia (ED). We conducted a systematic review and meta-analysis to compare the detection rates of BE and ED between FB and WATS in adjunct to FB.

Methods

A Literature search was done using electronic databases, including PubMed, Embase, Scopus, Cochrane and CINAHL from inception to 26 April 2020. A meta-analysis comparing detection rates of WATS in adjunct to FB versus FB using the random-effects model was done using RevMan V.5.3.

Results

Pooled data from 20 392 endoscopies across 11 studies showed an absolute increase in detection of 16% (95% CI 0.10% to 0.22%, p<0.00001). A relative increase of 1.62 was seen in detection rates of BE (95% CI 1.28 to 2.05, p<0.0001) when WATS was used with FB with the number needed to test (NNT) of 6.1 patients. For ED, a 2% absolute increase (95% CI 0.01 to 0.03, p=0.001) in additional diagnostic yield from WATS. A relative increase of 2.05 was seen in the detection rate of ED (95% CI 1.42 to 2.98, p=0.0001) yielding an NNT of 50 patients.

Conclusion

Our study shows that WATS, as an adjunct to FB, improves both the absolute detection rate and relative detection rate of both BE and ED as compared to FB alone.
Does adherence to evidence-based practices during childbirth prevent perinatal mortality? A post-hoc analysis of 3,274 births in Uttar Pradesh, India
Authors: Semrau Katherine EA , Miller Kate A , Lipsitz Stuart , Fisher-Bowman Jennifer , Karlage Ami , Neville Bridget A , Krasne Margaret , Gass Jonathon , Jurczak Amanda , Pratap Singh Vinay , Singh Shambhavi , Marx Delaney Megan , Hirschhorn Lisa R , Kodkany Bhalachandra , Kumar Vishwajeet , Gawande Atul A
Published: September 2020

Background

Evidence-based practices that reduce childbirth-related morbidity and mortality are core processes to quality of care. In the BetterBirth trial, a matched-pair, cluster-randomised controlled trial of a coaching-based implementation of the WHO Safe Childbirth Checklist (SCC) in Uttar Pradesh, India, we observed a significant increase in adherence to practices, but no reduction in perinatal mortality.

Methods

Within the BetterBirth trial, we observed birth attendants in a subset of study sites providing care to labouring women to assess the adherence to individual and groups of practices. We observed care from admission to the facility until 1 hour post partum. We followed observed women/newborns for 7-day perinatal health outcomes. Using this observational data, we conducted a post-hoc, exploratory analysis to understand the relationship of birth attendants’ practice adherence to perinatal mortality.

Findings

Across 30 primary health facilities, we observed 3274 deliveries and obtained 7-day health outcomes. Adherence to individual practices, containing supply preparation and direct provider care, varied widely (0·51 to 99·78%). We recorded 166 perinatal deaths (50·71 per 1000 births), including 56 (17·1 per 1000) stillbirths. Each additional practice performed was significantly associated with reduced odds of perinatal (OR: 0·82, 95% CI: 0·72, 0·93) and early neonatal mortality (OR: 0·78, 95% CI: 0·71, 0·85). Each additional practice as part of direct provider care was associated strongly with reduced odds of perinatal (OR: 0·73, 95% CI: 0·62, 0·86) and early neonatal mortality (OR: 0·67, 95% CI: 0·56, 0·80). No individual practice or single supply preparation was associated with perinatal mortality.

Interpretation

Adherence to practices on the WHO SCC is associated with reduced mortality, indicating that adherence is a valid indicator of higher quality of care. However, the causal relationships between practices and outcomes are complex.

Funding

Bill & Melinda Gates Foundation.

Trial registration details

ClinicalTrials.gov:NCT02148952; Universal Trial Number: U1111-1131-5647.
Systematic review of frameworks used to conceptualise health pathways of individuals diagnosed with cardiovascular diseases
Authors: Seguin Maureen L , Rangnekar Avanti , Renedo Alicia , Palafox Benjamin , McKee Martin , Balabanova Dina
Published: September 2020

The treatment of cardiovascular disease (CVD) is managed inadequately globally. Theoretically informed frameworks have the potential to account for the multiple elements which constitute the CVD patient pathway, and capture their inter-relationships and processes of change. However, a review and critique of such frameworks is currently lacking. This systematic review aims to identify and critically assess frameworks of access to and utilisation of care which capture the pathways of patients diagnosed with one or more CVDs. The specific objectives are to (1) review how existing frameworks have been used and adapted to capture CVD patient pathways and (2) draw on elements of Strong Structuration Theory to critically appraise them, in terms of their ability to capture the dynamics of the patient journey and the factors that influence it. Five bibliographic databases were searched in January 2019. We included qualitative and quantitative studies containing frameworks used to capture the patient pathway of individuals with CVD, encompassing symptoms, diagnosis, treatment and long-term management. Data on patient behaviour and structural factors were interpreted according to elements of Strong Structuration Theory to assess frameworks on their ability to capture a holistic patient journey. The search yielded 15 articles. The majority were quantitative and all focused on management of CVDs, primarily hypertension. Commonly used frameworks included the common-sense self-regulation model, transtheoretical model and theory of planned behaviour. A critique drawing on elements of Strong Structuration Theory revealed these frameworks narrowly focused on patient attributes (patient beliefs/attitudes) and resulting patient action, but neglected external structures that interacted with these to produce particular outcomes, which results in an individualistic and linear view of the patient pathway. We suggest that a framework informed by Strong Structuration Theory is sufficiently flexible to examine the patient pathway, while avoiding a strict linear view facilitated by other frameworks.
‘We are very individual’: anticipated effects on stroke survivors of using their person-generated health data
Authors: Dimaguila Gerardo Luis , Batchelor Frances , Merolli Mark , Gray Kathleen
Published: September 2020

Background

Person-generated health data (PGHD) are produced by people when they use health information technologies. People who use PGHD may experience changes in their health and care process, such as engagement with their own healthcare, and their sense of social support and connectedness. Research into evaluating those reported effects has not kept up; thus, a method for measuring PGHD outcomes was previously designed and applied to the exemplar case of Kinect-based stroke rehabilitation systems. A key step of the method ensures that the patient’s voice is included. Allowing stroke survivors to participate in the development and evaluation of health services and treatment can inform healthcare providers on decisions about stroke care, and thereby improve health outcomes.

Objective

This paper presents the perspectives of stroke survivors and clinicians on the anticipated effects of stroke survivors’ use of PGHD from a poststroke simulated rehabilitation technology.

Methods

This study gathered the perspectives of stroke survivors and clinicians through three focus groups and three interviews, recruited for convenience. Participants were also asked questions intended to encourage them to comment on the initial items of the patient-reported outcome measure-PGHD. Deductive thematic analysis was performed.

Results

This paper has further demonstrated that outcomes of using PGHD can be measured. For instance, stroke survivors described that using PGHD could result in positive, negative and nil effects on their health behaviours. Survivors and clinicians had varying perspectives in three of the six themes presented, and emphasise the importance of allowing stroke survivors to participate in the evaluation of digital health services.
Association between surgical volume and failure of primary total hip replacement in England and Wales: findings from a prospective national joint replacement register
Authors: Sayers Adrian , Steele Fiona , Whitehouse Michael R , Price Andrew , Ben-Shlomo Yoav , Blom Ashley W
Published: September 2020

Objective

To investigate the association of volume of total hip arthroplasty (THA) between consultants and within the same consultant in the previous year and the hazard of revision using multilevel survival models.

Design

Prospective cohort study using data from a national joint replacement register.

Setting

Elective THA across all private and public centres in England and Wales between April 2003 and February 2017.

Participants

Patients aged 50 years or more undergoing THA for osteoarthritis.

Intervention

The volume of THA conducted in the preceding 365 days to the index procedure.

Main outcome and measure

Revision surgery (excision, addition or replacement) of a primary THA.

Results

Of the 579 858 patients undergoing primary THA (mean baseline age 69.8 years (SD 10.2)), 61.1% were women. Multilevel survival found differing results for between and within-consultant effects. There was a strong volume–revision association between consultants, with a near-linear 43.3% (95% CI 29.1% to 57.4%) reduction of the risk of revision comparing consultants with volumes between 1 and 200 procedures annually. Changes in individual surgeons (within-consultant) case volume showed no evidence of an association with revision.

Conclusion

Separation of between-consultant and within-consultant effects of surgical volume reveals how volume contributes to the risk of revision after THA. The lack of association within-consultants suggests that individual changes to consultant volume alone will have little effect on outcomes following THA.

These novel findings provide strong evidence supporting the practice of specialisation of hip arthroplasty. It does not support the practice of low-volume consultants increasing their personal volume as it is unlikely their results would improve if this is the only change. Limiting the exposure of patients to consultants with low volumes of THA and greater utilisation of centres with higher volume surgeons with better outcomes may be beneficial to patients.
Central nervous system (CNS) medications and polypharmacy in later life: cross-sectional analysis of the English Longitudinal Study of Ageing (ELSA)
Authors: Slater Natasha , White Simon , Frisher Martin
Published: September 2020

Objectives

Many central nervous system (CNS) medications are considered potentially inappropriate for prescribing in older people; however, these medications are common in polypharmacy (≥5 medicines) regimens. This paper aims to determine the prevalence of CNS drug classes commonly taken by older people. Furthermore, this paper aims to determine whether polypharmacy and other factors, previously found to be associated with overall polypharmacy, are associated with the most common CNS drug classes.

Design

Cross-sectional study.

Setting

English Longitudinal Study of Ageing (wave 6).

Participants

7730 participants (≥50 years).

Main outcome measures

Adjusted Odds Ratios (OR) and 95% confidence intervals (CI) for CNS drug classes.

Results

31% of the sample were currently taking ≥5 medications (polypharmacy), of whom 58% (n=1362/2356) were taking CNS medicines as part of their regimen. The most common CNS drug classes in polypharmacy regimens were non-opioid analgesics, opioid analgesics, tricyclic and related antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs) (34.6%, 13.2%, 10.9% and 10.4%, respectively). Compared with people currently taking 1–4 prescribed medicines, polypharmacy was associated with adjusted ORs of 5.71 (95% CI: 4.29 to 7.61, p<0.01) for opioid analgesics, 3.80 (95% CI: 3.25 to 4.44, p<0.01) for non-opioid analgesics, 3.11 (95% CI: 2.43 to 3.98, p<0.01) for TCAs and 2.30 (95% CI: 1.83 to 2.89, p<0.01) for SSRIs. Lower wealth was also associated with the aforementioned CNS drug classes.

Conclusion

Opioid and non-opioid analgesics were the most prevalent classes of CNS medicines in this study. Polypharmacy is strongly associated with the aforementioned classes of analgesics. Polypharmacy is also associated with TCAs and SSRIs, although to a lesser extent than for analgesics. For all CNS medicine classes, polypharmacy may need to be considered in relation to reducing the risk of potential adverse events. After adjustment, lower wealth is associated particularly with analgesics, highlighting that socioeconomic factors may play a role in the prescribing of CNS medicines. These findings provide a baseline for future research into this area.
Scientific, professional and experiential validation of the model of preventive behaviours at work: protocol of a modified Delphi Study
Authors: Lecours Alexandra
Published: September 2020

Introduction

To offer an in-depth understanding of preventive behaviours, those complex behaviours considered as levers to foster work prevention, recent theoretical and empirical studies permitted to develop the model of preventive behaviours at work. The next step is to validate the model with researchers, professionals and workers. This article aims to describe the study protocol that will be used to validate the model of preventive behaviours at work.

Methods and analysis

This Delphi Study proposes seven systematic steps to conduct a scientifically rigorous validation study based on scientific and professional experts’ opinion. A focus group to collect workers’ opinion about the model has also been included in the protocol. Thirty experts (researchers and professionals) will be selected regarding their experience (eg, at least 5 years of experience) and expertise (eg, having published at least one article as the first author in the last 3 years) towards workers’ health or organisational behaviours. Workers will be recruited to have a diversity in terms of age, gender and working conditions. Quantitative data will be analysed to calculate the percentage of experts’ agreement on four content validity indicators (ie, comprehensiveness, representativeness, relevance and clarity). Qualitative data will be examined through a thematic analysis strategy.

Ethics and dissemination

Approval of the research ethics board of the Centre intégré universitaire de santé et de services sociaux de la Capitale Nationale has been obtained. Findings will be shared with various stakeholders inclusive of researchers, professionals and workers. Findings will be disseminated in workshops, peer-reviewed journals and conferences.
Work–health–personal life conflicts in naive patients with chronic hepatitis B receiving initial treatment in China: a qualitative study
Authors: Zheng Yingjing , Zhu Lin , Patrick Donald , Li Ying , Xu Fengjiao , Zhang Li , Song Mengna , Cheng Xiao , Chen Boyan , Chen Ying , Lu Xiaoyang , Wang Hongmei
Published: September 2020

Objectives

People with chronic hepatitis B (CHB) perform sick roles, work roles and personal roles simultaneously. At times, role conflicts arise because of failure to meet the expectations of different roles. Role conflicts may increase dissatisfaction in work and family and impair their physical and mental health. This study aimed to explore the perceptions of role conflicts of treatment-naive patients with CHB in work, personal and sick roles, together with ameliorating factors in the Chinese cultural context.

Design

A qualitative descriptive study. Semistructured interviews were used to collect the experience of work–health–personal life conflicts (WHPLCs), and a brief questionnaire was used to collect demographic and clinical information. SPSS V.21.0 was used for descriptive analysis and Dedoose (V.7.5.9) was used to code and analyse interview transcripts. This study selected six cities with different socioeconomic levels in Zhejiang Province, China. Then, researchers chose one tertiary hospital from each city as the study site, so a total of six tertiary hospitals were involved.

Participants

We recruited 32 patients with CHB (59.38% male) who had just started antiviral therapy for no more than three months. Participants were within the age range of 19-57 years, and the average age was 36.03 (SD=9.56) years.

Results

Participants noted that having CHB influenced their daily life and intersected with work and personal roles, therefore causing role conflicts. Role conflicts focused on three types: time-based conflicts, strain-based conflicts and behaviour-based conflicts. The contextual factors contributing to role conflicts were identified, including personal characteristics, financial strain, traditional social roles and work environment.

Conclusions

These findings enhance our understanding of the WHPLCs experience of treatment-naive patients with CHB in China. Our findings suggest that multidimensional role conflicts should be taken into account in the intervention design and psychological counselling to improve role balance and well-being among patients with CHB.
Association between maternal satisfaction and other indicators of quality of care at childbirth: a cross-sectional study based on the WHO standards
Authors: Lazzerini Marzia , Mariani Ilaria , Semenzato Chiara , Valente Emanuelle Pessa
Published: September 2020

Objectives

This study aimed to explore the association between maternal satisfaction and other indicators of quality of care (QoC) at childbirth, as defined by WHO standards.

Design

Cross-sectional study.

Setting

Referral hospital in Northeast Italy.

Participants

1244 consecutive mothers giving birth in the hospital participated in a survey.

Data collection and analysis

Univariate analyses were performed to evaluate the association between maternal satisfaction and 61 variables, including measures of ‘provision of care’, ‘experience of care’, ‘availability of resources’ and other maternal characteristics. Exploratory factor analysis was performed to create groups of correlated variables, which were used in multivariate analysis.

Results

Overall, 509 (40.9%) of women were >35 years of age, about half (52.7%) were highly educated, most (95.2%) were married/living with partner and employed (79.3%) and about half (52.9%) were primiparous. Overall, 189 (15.2%) were not born in Italy and 111 (8.9%) did not have Italian citizenship. Most women (84.2%) were highly satisfied (score ≥7/10) with the care received. Among the 61 variables explored, 46 (75.4%) were significantly associated with women’s satisfaction, 33 with higher satisfaction and 13 with lower satisfaction. Multivariate analysis largely confirmed univariate findings, with six out of eight groups of correlated variables being statistically significantly associated with women’s satisfaction. Factors most strongly associated with women’s satisfaction were ‘effective communication, involvement, listening to women’s needs, respectful and timely care’ (OR 16.84, 95% CI 9.90 to 28.61, p<0.001) and ‘physical structure’ (OR 6.51, 95% CI 4.08 to 10.40, p<0.001). Additionally, ‘victim of abuse, discrimination, aggressiveness’ was inversely associated with the wish to return to the facility or to recommend it to a friend (OR 0.35, 95% CI 0.17 to 0.70, p<0.003).

Conclusion

This study suggested that many variables are strongly associated with women’s satisfaction with care during childbirth and support the use of multiple measures to monitor the QoC at childbirth.
Prognostic significance of tissue factor in patients with pancreatic cancer: a systematic review protocol
Authors: Li Haiyuan , Yu Yang , Shi Qianling , Chen Xueping , Zheng Peng , Wang Dengfeng , Tao Pengxian , Gu Baohong , Li Xuemei , Zhang Tao , Xiang Lin , Xi Dayong , Gao Lei , Maswikiti Ewetse Paul , Chen Hao
Published: September 2020

Introduction

Pancreatic cancer is a highly aggressive digestive system tumour with poor prognosis. Venous thromboembolism (VTE) is a well-known complication of pancreatic cancer, and tissue factor (TF) contributes to the generation of a hypercoagulable state and thrombotic disease in pancreatic cancer. Several studies showed that an elevated TF level was related to the development of VTE and influenced the survival of patients with pancreatic cancer. Thus, we wish to conduct a systematic review of literature to clarify the prognostic significance of TF in pancreatic cancer.

Methods and analysis

Studies comparing the circulating microparticle-associated TF (MP TF) level between patients who had pancreatic cancer with and without VTE will be included to evaluate the roles of TF in VTE development. Studies comparing the survival data between patients with high TF expression and low TF expression will also be included to explore the association of TF expression with patient survival. The outcomes are plasma MP TF level and survival endpoints (overall and progression-free survival), respectively. Primary studies of any type published in English will be included. Two reviewers will search Medline, EMBASE and Cochrane databases from inception to June 2020, retrieve relevant studies, and independently select the literatures and extract data from the included studies. The quality of each included study will be assessed by the Newcastle-Ottawa Scale score. The HR and 95% CI of each study will be pooled for survival outcome, and the standardised mean difference (SMD) with 95% CIs will be used for continuous outcomes. If meta-analysis is inappropriate, the result will only be reported qualitatively. Subgroup and sensitivity analyses will be considered to identify sources of heterogeneity. The Grades of Recommendation, Assessment, Development and Evaluation method will be applied to assess the level of evidence of this systematic review.

Ethics and dissemination

There are no concerning ethical issues. The results will be published.

PROSPERO registration number

CRD42019133665.
Prevention of mother-to-child transmission of hepatitis B virus: protocol for a one-arm, open-label intervention study to estimate the optimal timing of tenofovir in pregnancy
Authors: Bierhoff Marieke , Nelson Kenrad E , Guo Nan , Jia Yuanxi , Angkurawaranon Chaisiri , Jittamala Podjanee , Carrara Verena , Watthanaworawit Wanitda , Ling Clare , Tongprasert Fuanglada , van Vugt Michele , Rijken Marcus , Nosten Francois , McGready Rose , Ehrhardt Stephan , Thio Chloe Lynne
Published: September 2020

Introduction

Hepatitis B virus (HBV) remains a public health threat and the main route of transmission is from mother to child (MTCT). Tenofovir disoproxil fumarate (TDF) treatment can reduce MTCT of HBV although the optimal timing to attain undetectable HBV DNA concentrations at delivery is unknown. This protocol describes the procedures following early initiation of maternal TDF prior to 20 weeks gestation to determine efficacy, safety and feasibility of this approach in a limited-resource setting.

Methods and analyses

One hundred and seventy pregnant women from the Thailand–Myanmar border between 12 and <20 weeks gestational age will be enrolled into a one-arm, open-label, TDF treatment study with cessation of TDF 1 month after delivery. Sampling occurs monthly prenatal, at birth and at 1, 2, 4 and 6 months post partum. Measurement of tenofovir concentrations in maternal and cord plasma is anticipated in 10–15 women who have detectable HBV DNA at delivery and matched to 20–30 women with no detectable HBV DNA. Infant HBsAg status will be determined at 2 months of age and HBV DNA confirmed in HBsAg positive cases. Adverse events including risk of flare and adherence, based on pill count and questionnaire, will be monitored. Infants will receive HBV vaccinations at birth, 2, 4 and 6 months and hepatitis B immunoglobulin at birth if the mother is hepatitis B e antigen positive. Infant growth and neurodevelopment at 6 months will be compared with established local norms.

Ethics and dissemination

This study has ethical approval by the Ethics Committee of the Faculty of Tropical Medicine, Mahidol University (FTM ECF-019-06), Johns Hopkins University (IRB no: 00007432), Chiang Mai University (FAM-2559-04227), Oxford Tropical Research Ethics Committee (OxTREC Reference: 49-16) and by the local Tak Community Advisory Board (TCAB-02/REV/2016). The article will be published as an open-access publication.

Trial registration number

NCT02995005, Pre-results.
Beta-alanine supplementation in patients with COPD receiving non-linear periodised exercise training or neuromuscular electrical stimulation: protocol of two randomised, double-blind, placebo-controlled trials
Authors: Meys Roy , Stoffels Anouk A F , de Brandt Jana , van Hees Hieronymus W H , Franssen Frits M E , Sillen Maurice J H , Wouters Emiel F M , Burtin Chris , Klijn Peter , bij de Vaate Eline , van den Borst Bram , Otker Jacqueline M , Donkers Jos , Schleich Florence N , Hayot Maurice , Pomiès Pascal , Everaert Inge , Derave Wim , Spruit Martijn A
Published: September 2020

Introduction

Exercise intolerance is common in patients with chronic obstructive pulmonary disease (COPD) and, although multifactorial, it is largely caused by lower-limb muscle dysfunction. Research has shown that patients with severe to very severe COPD have significantly lower levels of muscle carnosine, which acts as a pH buffer and antioxidant. Beta-alanine (BA) supplementation has been shown to consistently elevate muscle carnosine in a variety of populations and may therefore improve exercise tolerance and lower-limb muscle function. The primary objective of the current studies is to assess the beneficial effects of BA supplementation in enhancing exercise tolerance on top of two types of exercise training (non-linear periodised exercise (NLPE) training or neuromuscular electrical stimulation (NMES)) in patients with COPD.

Methods and analysis

Two randomised, double-blind, placebo-controlled trials have been designed. Patients will routinely receive either NLPE (BASE-TRAIN trial) or NMES (BASE-ELECTRIC trial) as part of standard exercise-based care during their 8-to-10 week pulmonary rehabilitation (PR) programme. A total of 222 patients with COPD (2×77 = 154 patients in the BASE-TRAIN trial and 2×34 = 68 patients in the BASE-ELECTRIC trial) will be recruited from two specialised PR centres in The Netherlands. For study purposes, patients will receive 3.2 g of oral BA supplementation or placebo per day. Exercise tolerance is the primary outcome, which will be assessed using the endurance shuttle walk test (BASE-TRAIN) or the constant work rate cycle test (BASE-ELECTRIC). Furthermore, quadriceps muscle strength and endurance, cognitive function, carnosine levels (in muscle), BA levels (in blood and muscle), markers of oxidative stress and inflammation (in blood, muscles and lungs), physical activity and quality of life will be measured.

Ethics and dissemination

Both trials were approved by CMO Regio Arnhem-Nijmegen, The Netherlands (NL70781.091.19. and NL68757.091.19).

Trial registration number

NTR8427 (BASE-TRAIN) and NTR8419 (BASE-ELECTRIC).