bluuebunny/crossref_metadata_2025 huggingface dataset:
Colonic motility in patients with type 1 diabetes and gastrointestinal symptoms
Authors: Klinge Mette Winther , Haase Anne‐Mette , Mark Esben Bolvig , Sutter Nanna , Fynne Lotte Vinskov , Drewes Asbjørn Mohr , Schlageter Vincent , Lund Sten , Borghammer Per , Krogh Klaus
Published: July 2020

Background

Gastrointestinal (GI) symptoms are common in patients with diabetes mellitus (DM). The electromagnetic 3D‐Transit system allows assessment of regional transit times and motility patterns throughout the GI tract. We aimed to compare GI transit times and detailed motility patterns of the colon in patients with DM and GI symptoms to those of healthy controls (HC). We further aimed to determine whether any abnormalities in motility were reversible by cholinergic stimulation.

Methods

We compared 18 patients with DM with 20 HC by means of the 3D‐Transit system. Patients were studied before and during oral administration of 60 mg pyridostigmine.

Key results

Compared to HC, patients had prolonged gastric emptying (DM: 3.3 hours (interquartile range (IQR) 2.6‐4.6); HC: 2.3 hours (IQR 1.7‐2.7) (P < .01)), colonic transit time (DM: 52.6 hours (IQR 23.3‐83.0); HC: 22.4 hours (IQR 18.9‐43.6) (P = .02)), and whole gut transit time (DM: 69.4 hours (IQR 32.9‐103.6); HC: 30.3 hours (IQR 25.2‐49.9) (P < .01)). In addition, compared to HC, patients had prolonged transit time in the ascending colon (DM: 20.5 hours (IQR 11.0‐44.0); HC: 8.0 hours (IQR 3.8‐21.0) (P < .05)) and more slow retrograde movements in the colon (DM: 2 movements (IQR 1‐4); HC: 1 movement (IQR 0‐1) (P = .01)). In patients, pyridostigmine increased the number of bowel movements (P < .01) and reduced small intestine transit times (P < .05).

Conclusions

Patients with DM and GI symptoms have longer than normal GI transit times. This is only partly reversible by pyridostigmine. The increased number of retrograde colonic movements in patients could potentially explain the abnormally long transit time in proximal colon.
Happiness and desire satisfaction
Authors: Heathwood Chris
Published: July 2020

This paper develops and defends a novel version of a relatively neglected category of theory of the nature of happiness: the desire‐satisfaction theory. My account is similar in its fundamentals to Wayne Davis's theory of happiness‐as‐subjective‐desire‐satisfaction. After arguing that this is the best general way to proceed for the desire‐based approach, I develop an improved version of subjective desire satisfactionism in light of recent arguments in the happiness literature.
Keeping up with the RALFs: how these small peptides control pollen–pistil interactions in Arabidopsis
Authors: Somoza Sofía C. , Sede Ana R. , Boccardo Noelia A. , Muschietti Jorge P.
Published: July 2020

The pollen and pistil RALF peptides, along with multiple receptor‐like kinases and leucine‐rich repeat extensins, regulate pollen tube growth and the final burst within the ovule, where sperm cells are released for fertilisation to occur. This review introduces some new questions that arose about the regulation of this complex process.
Lessons on health promotion from Japanese early childhood development
Authors: Miyake Kimihiro , Tomokawa Sachi , Asakura Takashi
Published: July 2020

Early childhood development (ECD) has received increasing attention in both developed and developing countries since the 1990s. In Japan, ECD facilities have pursued integrated practices of education and health care to provide appropriate services to promote children’s welfare. This ECD approach appears to embody objectives of health promotion in young children. Therefore, information about Japanese practices may help to support ECD in other countries, especially developing countries. In this context, the present study discussed the potential application of health‐related ECD practices in Japan for developing countries by reviewing an outline of Japanese ECD, along with a case study describing practices in ECD facilities in Japan. We identified four main points: (i) distinct legal grounds including a legal basis for allocating health specialists; (ii) outlines of activities based on national standards and flexible practices at the facility level; (iii) teachers’ attitudes that respect children’s initiative, and explicit and independent activities embedded in children’s daily lives that reflect the child’s developmental status; and (iv) various useful practices to enhance the effect of health‐related activities, such as cooperation with parents, lesson study and hoiku‐ (teachers) conference. As these practices are based on the Japanese context, it is essential to consider both the Japanese context and potential risks of transplanting such concepts, to enable optimum use of these lessons in other countries.
Noncompliance to blood donor selection criteria by men who have sex with men – Complidon 2017, France
Authors: Sauvage Claire , Charpentier François , Garrabé Éliane , Pelat Camille , Spinardi Roxane , Danic Bruno , Lot Florence , Morel Pascal , Laperche Syria , Pillonel Josiane
Published: July 2020

Background and objectives

In France, blood donation deferral for men who have sex with men (MSM) was reduced from permanent to 12 months in July 2016. Assessing noncompliance (rate and reasons) with this criterion is important to maintain a high level of viral safety in blood products.

Materials and methods

An anonymous online survey (Complidon) of a sample of blood donors was conducted in 2017. Data were post‐stratified to be representative of all those who donated blood between July 2016 and December 2017. A multivariable analysis was performed to assess factors associated with noncompliance.

Results

Among male donors, 0·73% [95% CI: 0·63–0·83] reported having sex with men in the 12 months preceding their donation. Factors associated with noncompliance were as follows: young age, a low educational level, concerns about privacy, and better knowledge of donor selection criteria and the window period than compliant men. More than half of noncompliant MSM donors (57·6% [95% CI: 50·6–64·3]) felt that sexual orientation should not be a criterion for donation, 47·2% [95% CI: 40·4–54·0] did not disclose their male‐to‐male sexual relations in order to avoid being excluded from donating, 40·5% [95% CI: 34·0–47·4] reported using condoms and 21·8% [95% CI: 16·7–27·9] had the same male partner for at least 12 months.

Conclusion

Complidon showed that compliance with blood donation criteria in MSM was high, but not optimal, especially among younger men. HIV residual risk did not increase after the implementation of 12‐month deferral. Data from Complidon helped French policymakers to assess the additional HIV risk posed by increased access to blood donation for MSM.
Financing Higher Education in Arab Countries: Challenges, Constraints and Solutions
Authors: Alkubaisi Huda , Rasool Noorjahan
Published: July 2020

This study related to the HE finance system aims primarily to systematically identify, summarize, examine and critically analyze the key challenges and constraints confronting HE finance as investigated in the research on this subject and propose solutions for further improvement. The findings from the defined sample of 24 relevant studies showed that major constraints and challenges facing HE financing certainly affects the flow of adequate finance provided to HEIs, including brain drain, existence of a gap between educational outcomes and labor market, reliance on policy learning and dependency on others, financial crisis, shortage of governmental resources, and poor participation of the private sector and civil society. The constraints and challenges were identified based on insightful theoretical constructs that highly characterized by principles and concepts which may not allow us to practicably develop a clear understanding of how to inspire the development of HE finance that would be a concern of policymakers and speedily acts on policy-making. However, the integration of such theoretical constructs (or others) and the introduction of serious attempts or thoughtful scenarios towards practical applications are mostly ignored. The need to acknowledge the constraints associated with limits on finance is fundamental for declining the hazardously high levels of unemployment for a sustainable economic growth. Finally, quantitative and mixed method research designs, and cross-sectional and panel analysis data are recommended to assess the influence of the HE finance systems and to identify the best opportunities and ways to meet challenges confronted by the countries, given their social and political paradigms.
Heterogeneity in subcellular muscle glycogen utilisation during exercise impacts endurance capacity in men
Authors: Jensen Rasmus , Ørtenblad Niels , Stausholm Marie‐Louise Holleufer , Skjærbæk Mette Carina , Larsen Daniel Nykvist , Hansen Mette , Holmberg Hans‐Christer , Plomgaard Peter , Nielsen Joachim
Published: July 2020

Key points

When muscle biopsies first began to be used routinely in research on exercise physiology five decades ago, it soon become clear that the muscle content of glycogen is an important determinant of exercise performance.

Glycogen particles are stored in distinct pools within the muscles, but the role of each pool during exercise and how this is affected by diet is unknown.

Here, the effects of diet and exercise on these pools, as well as their relation to endurance during prolonged cycling were examined.

We demonstrate here that an improved endurance capacity with high carbohydrate loading is associated with a temporal shift in the utilisation of the distinct stores of glycogen pools and is closely linked to the content of the glycogen pool closest to actin and myosin (intramyofibrillar glycogen).

These findings highlight the functional importance of distinguishing between different subcellular microcompartments of glycogen in individual muscle fibres.

In muscle cells, glycogen is stored in three distinct subcellular pools: between or within myofibrils (inter‐ and intramyofibrillar glycogen, respectively) or beneath the sarcolemma (subsarcolemmal glycogen) and these pools may well have different functions. Here, we investigated the effect of diet and exercise on the content of these distinct pools and their relation to endurance capacity in type 1 and 2 muscle fibres. Following consumption of three different diets (normal, mixed diet = MIX, high in carbohydrate = HIGH, or low in carbohydrate = LOW) for 72 h, 11 men cycled at 75% of max until exhaustion. The volumetric content of the glycogen pools in muscle biopsies obtained before, during, and after exercise were quantified by transmission electron micrographs. The mean (SD) time to exhaustion was 150 (30), 112 (22), and 69 (18) minutes in the HIGH, MIX and LOW trials, respectively (P < 0.001). As shown by multiple regression analyses, the intramyofibrillar glycogen content in type 1 fibres, particularly after 60 min of exercise, correlated most strongly with time to exhaustion. In the HIGH trial, intramyofibrillar glycogen was spared during the initial 60 min of exercise, which was associated with levels and utilisation of subsarcolemmal glycogen above normal. In all trials, utilisation of subsarcolemmal and intramyofibrillar glycogen was more pronounced than that of intermyofibrillar glycogen in relative terms. In conclusion, the muscle pool of intramyofibrillar glycogen appears to be the most important for endurance capacity in humans. In addition, a local abundance of subsarcolemmal glycogen reduces the utilisation of intramyofibrillar glycogen during exercise.
Variations in Constitutive Properties of the Fluid Elicit Divergent Vibrational and Pressure Response Under Shock Wave Loading
Authors: Alay Eren , Skotak Maciej , Chandrasekeran Subhalakshmi , Ziner Jonathan , Chandra Namas
Published: July 2020

We performed a characterization of the shock wave loading on the response of the specimen representing a simplified head model. A polycarbonate cylinder (2-in. outer diameter, wall thickness: 0.06 or 0.12 in.) was filled with two fluids: pure de-ionized water and 40% glycerol in water, which differ only slightly in their constitutive material properties. These two fluids were selected to represent the cerebrospinal fluid and cerebral blood, using their high strain rate viscosity as a primary selection criterion. The model specimen was exposed to a single shock wave with two nominal intensities: 70 and 130 kPa overpressure. The response of the model was measured using three strain gauges and three pressure sensors, one mounted on the front face of the cylinder and two embedded in the cylinder to measure the pressure inside of the fluid. We noted several discriminant characteristics in the collected data, which indicate that the type of fluid is strongly influencing the response. The vibrations of the cylinder walls are strongly correlated with the fluid kind. The similarity analysis via the Pearson coefficient indicated that the pressure waveforms in the fluid are only moderately correlated, and these results were further corroborated by Euclidean distance analysis. Continuous wavelet transform of pressure waveforms revealed that the frequency response is strongly correlated with the properties of the fluid. The observed differences in strain and pressure modalities stem from relatively small differences in the properties of the fluids used in this study.
Topical Antibiotic Elution in a Collagen-Rich Hydrogel Successfully Inhibits Bacterial Growth and Biofilm Formation
In Vitro
Authors: Min Jung Gi , Sanchez Rangel Uriel J. , Franklin Austin , Oda Hiroki , Wang Zhen , Chang James , Fox Paige M.
Published: July 2020

Chronic wounds are a prominent concern, accounting for $25 billion of health care costs annually. Biofilms have been implicated in delayed wound closure, but they are susceptible to developing antibiotic resistance and treatment options continue to be limited. A novel collagen-rich hydrogel derived from human extracellular matrix presents an avenue for treating chronic wounds by providing appropriate extracellular proteins for healing and promoting neovascularization. Using the hydrogel as a delivery system for localized secretion of a therapeutic dosage of antibiotics presents an attractive means of maximizing delivery while minimizing systemic side effects.
Comparison of a Novel Regimen of Rifapentine, Tedizolid, and Minocycline with Standard Regimens for Treatment of Pulmonary Mycobacterium kansasii
Authors: Chapagain Moti , Gumbo Tawanda , Heysell Scott K. , Srivastava Shashikant
Published: July 2020

The combination of isoniazid, rifampin, and ethambutol is recommended by the American Thoracic Society (ATS) for treatment of pulmonary
Mycobacterium kansasii
, while the British Thoracic Society (BTS) recommends clarithromycin, rifampin and ethambutol. Unfortunately, therapy duration for both regimens lasts for years. In this study, we administered tedizolid, minocycline, clarithromycin, and rifapentine as monotherapy as well as novel combinations in the intracellular hollow-fiber model system of
M. kansasii
(HFS-
Mkn
) in a 28-day study.
SufR, a [4Fe-4S] Cluster-Containing Transcription Factor, Represses the
sufRBDCSU
Operon in Streptomyces avermitilis Iron-Sulfur Cluster Assembly
Authors: Cheng Yaqing , Lyu Mengya , Yang Renjun , Wen Ying , Song Yuan , Li Jilun , Chen Zhi
Published: July 2020

Fe–S clusters function as cofactors of proteins controlling diverse biological processes, such as respiration, photosynthesis, nitrogen fixation, DNA replication, and gene regulation. The mechanism of how
Actinobacteria
regulate the expression of the sole Fe-S cluster assembly system in response to the various Fe–S cluster demands remains to be elucidated. In this study, we showed that SufR functions as a transcriptional repressor of the sole Fe-S cluster assembly system in the avermectin producer
S. avermitilis
. [4Fe-4S]-SufR binds to the promoter region of the
suf
operon and represses its expression. When Fe-S cluster levels are insufficient, SufR loses its [4Fe-4S] cluster and DNA-binding activity. Apo-SufR dissociates from the promoter region of
suf
operon, and the expression of the
suf
system is strongly increased by derepression to promote the synthesis of Fe-S clusters. The study clarifies how
Streptomyces
maintains its Fe-S cluster homeostasis through the activity of SufR to modulate the various Fe-S cluster demands.
Supplemental Material: Indo-Atlantic plate accelerations around the Cretaceous-Paleogene boundary: A time-scale error, not a plume-push signal
Authors: Pérez-Díaz Lucia , al. et
Published: July 2020

Magnetic isochron pick data set used in this study.
Placebos in chronic pain: evidence, theory, ethics, and use in clinical practice
Authors: Kaptchuk Ted J , Hemond Christopher C , Miller Franklin G
Published: July 2020

Despite their ubiquitous presence, placebos and placebo effects retain an ambiguous and unsettling presence in biomedicine. Specifically focused on chronic pain, this review examines the effect of placebo treatment under three distinct frameworks: double blind, deception, and open label honestly prescribed. These specific conditions do not necessarily differentially modify placebo outcomes. Psychological, clinical, and neurological theories of placebo effects are scrutinized. In chronic pain, conscious expectation does not reliably predict placebo effects. A supportive patient-physician relationship may enhance placebo effects. This review highlights “predictive coding” and “bayesian brain” as emerging models derived from computational neurobiology that offer a unified framework to explain the heterogeneous evidence on placebos. These models invert the dogma of the brain as a stimulus driven organ to one in which perception relies heavily on learnt, top down, cortical predictions to infer the source of incoming sensory data. In predictive coding/bayesian brain, both chronic pain (significantly modulated by central sensitization) and its alleviation with placebo treatment are explicated as centrally encoded, mostly non-conscious, bayesian biases. The review then evaluates seven ways in which placebos are used in clinical practice and research and their bioethical implications. In this way, it shows that placebo effects are evidence based, clinically relevant, and potentially ethical tools for relieving chronic pain.
Women’s experience of episiotomy: a qualitative study from China
Authors: He Siyuan , Jiang Hong , Qian Xu , Garner Paul
Published: July 2020

Objective

To describe women’s experience of episiotomy in urban China.

Design

This is a semistructured, indepth interview with women after episiotomy. We analysed transcriptions using thematic analysis in Chinese. Emerging themes were debated in English to finalise interpretation.

Setting

Two community health centres and four hospitals in Shanghai, China.

Participants

Purposive sampling of 30 postpartum women who had experienced episiotomy; 25 were primiparous and 4 had deliveries by forceps. We interviewed health providers to complement the data.

Results

We identified four main themes: (1) women’s views of the procedure vary considerably; (2) pain interferes with daily life for weeks; (3) long-term anxiety is a consequence for some, described as a ‘psychological shadow’; and (4) societal norms assume women will not complain.

Conclusion

Women receive little information in advance about episiotomy, yet the procedure has a wide range of physical and psychological consequences. This includes long-term anxiety about the damage done to them as women.
Behaviour change physiotherapy intervention to increase physical activity following hip and knee replacement (PEP-TALK): study protocol for a pragmatic randomised controlled trial
Authors: Smith Toby O , Parsons Scott , Fordham Beth , Ooms Alexander , Dutton Susan , Hing Caroline , Barber Vicki S , Png May Ee , Lamb Sarah
Published: July 2020

Introduction

While total hip replacement (THR) and total knee replacement (TKR) successfully reduce pain associated with chronic joint pathology, this infrequently translates into increased physical activity. This is a challenge given that over 50% of individuals who undergo these operations are physically inactive and have medical comorbidities such as hypertension, heart disease, diabetes and depression. The impact of these diseases can be reduced with physical activity. This trial aims to investigate the effectiveness of a behaviour change physiotherapy intervention to increase physical activity compared with usual rehabilitation after THR or TKR.

Methods and analysis

The PEP-TALK trial is a multicentre, open-labelled, pragmatic randomised controlled trial. 260 adults who are scheduled to undergo a primary unilateral THR or TKR and are moderately inactive or inactive, with comorbidities, will be recruited across eight sites in England. They will be randomised post-surgery, prior to hospital discharge, to either six, 30 min weekly group-based exercise sessions (control), or the same six weekly, group-based, exercise sessions each preceded by a 30 min cognitive behaviour approach discussion group. Participants will be followed-up to 12 months by postal questionnaire. The primary outcome is the University of California, Los Angeles (UCLA) Physical Activity Score at 12 months. Secondary outcomes include: physical function, disability, health-related quality of life, kinesiophobia, perceived pain, self-efficacy and health resource utilisation.

Ethics and dissemination

Research ethics committee approval was granted by the NRES Committee South Central (Oxford B - 18/SC/0423). Dissemination of results will be through peer-reviewed, scientific journals and conference presentations.

Trial registration number

ISRCTN29770908.
Community-based online survey on seeking care and information for lower limb pain and injury in Australia: an observational study
Authors: Bowden Jocelyn L , Lamberts Rod , Hunter David J , Melo Luciano Ricardo , Mills Kathryn
Published: July 2020

Objectives

Musculoskeletal pain is a leading cause of disability globally. In geographically and socioeconomically diverse countries, such as Australia, care seeking when someone experiences musculoskeletal pain is varied and potentially influenced by their individual characteristics, access to practitioners or perceived trustworthiness of information. This study explored how consumers currently access healthcare, how well it is trusted and if sociodemographic factors influenced healthcare utilisation.

Design

Anonymous online observational survey.

Setting

Australia.

Participants

A convenience sample of 831 community-based individuals (18+ years).

Outcome measures

Descriptive analyses and generalised estimating equations were used to quantify healthcare-seeking behaviours, sources and trust of health information for (A) first-contact practitioners, (B) medical practitioners, and (C) other sources of information.

Results

Of the 761 respondents, 73% were females, 54% resided in capital cities. 68% of respondents had experienced pain or injury in more than one lower limb joint. Despite this, more than 30% of respondents only sought help when there had not been natural resolution of their pain. Physiotherapists had the highest odds of being seen, asked and trusted for healthcare information. The odds of seeking care from general practitioners were no higher than seeking information from an expert website. Older individuals and women exhibited higher odds of seeking, asking and trusting health information.

Conclusion

Intelligible and trustworthy information must be available for consumers experiencing lower limb pain. Individuals, particularly younger people, are seeking information from multiple, unregulated sources. This suggests that healthcare professionals may need to invest time and resources into improving the trustworthiness and availability of healthcare information to improve healthcare quality.
Differences in regional distribution and inequality in health-resource allocation at hospital and primary health centre levels: a longitudinal study in Shanghai, China
Authors: Dong Enhong , Liu Shipeng , Chen Minjie , Wang Hongmei , Chen Li-Wu , Xu Ting , Wang Tao , Zhang Lufa
Published: July 2020

Objectives

To analyse differences in regional distribution and inequality in health-resource allocation at the hospital and primary health centre (PHC) levels in Shanghai over 7 years.

Design

A longitudinal survey using 2010–2016 data, which were collected for analysis.

Setting

The study was conducted at the hospital and PHC levels in Shanghai, China.

Outcome measures

Ten health-resource indicators were used to measure health-resource distribution at the hospital and PHC levels. In addition, the Theil Index was calculated to measure inequality in health-resource allocation.

Results

All quantities of healthcare resources per 1000 people in hospitals and PHCs increased across Shanghai districts from 2010 to 2016. Relative to suburban districts, the central districts had higher ratios, both in terms of doctors and equipment, and had faster growth in the doctor indicator and slower growth in the equipment indicator in hospitals and PHCs. The Theil Indices of all health-resource allocation in hospitals had higher values compared with those in PHCs every year from 2010 to 2016; furthermore, the Theil Indices of the indicators, except for technicians and doctors in hospitals, all exhibited downward time trends in hospitals and PHCs.

Conclusions

Increased healthcare resources and reduced inequality of health-resource allocation in Shanghai during the 7 years indicated that measures taken by the Shanghai government to deepen the new round of healthcare reform in China since 2009 had been successful. Meanwhile there still existed regional difference between urban and rural areas and inequality across different medical institutions. To solve these problems, we prescribe increased wages, improved working conditions, and more open access to career development for doctors and nurses; reduced investments in redundant equipment in hospitals; and other incentives for balancing the health workforce between hospitals and PHCs.
Empathy variation of undergraduate medical students after early clinical contact: a cross-sectional study in China
Authors: Ye Xiong , Guo Haiying , Xu Zhou , Xiao Hui
Published: July 2020

Objectives

Empathy education is very important for medical students. There is little research on the influence of early clinical practice on the development of empathy and other aspects of professionalism in medical students. The aim of this study was to compare the self-reported empathy levels of first-year and second-year undergraduate medical students before and after their early clinical contact curriculum.

Setting

The study was conducted at the Shanghai University of Medicine & Health Sciences, Shanghai, China.

Participants

A total of 257 undergraduate medical students participated in the study. The 154 first-year students were studying in 10 community-based teaching hospitals, and the 103 second-year students were studying in 3 university-affiliated hospitals.

Primary and secondary outcome measures

Primary measures: the Jefferson Scale of Empathy—Student version (JSE-S) was compared between students of different sexes and in different academic years before their early clinical contact course. Secondary measures: comparisons were made after they finished the curriculum 3 weeks later.

Results

A total of 219 of 257 students responded (85.21% response rate), and 214 answers could be analysed (135 first-year and 79 second-year students; 120 female and 94 male individuals). No significant differences in the empathy scores before early clinical contact were observed between students of different sexes and in different academic years. After early clinical contact, the mean JSE-S score of the participants was significantly higher than the mean score at the beginning of the curriculum.

Conclusions

Empathy-focused training during early clinical contact can improve the empathetic capacity of undergraduate medical students. Fostering empathetic attitudes among undergraduate medical students is necessary for the early stage of their medical education. Further research is needed on the long-term effects of empathy-focused education in entry-level medical students.
Can changes in spending on health and social care explain the recent mortality trends in Scotland? A protocol for an observational study
Authors: Wraw Christina , Minton Jon , Mitchell Rory , Wyper Grant M A , Campbell Clare , McCartney Gerry
Published: July 2020

Introduction

There have been steady reductions in mortality rates in the majority of high-income countries, including Scotland, since 1945. However, reductions in mortality rates have slowed down since 2012–2014 in these nations; and have reversed in some cases. Deaths among those aged 55+ explain a large amount of these changing mortality trends in Scotland. Increased pressures on health and social care services have been suggested as one factor explaining these changes. This paper outlines a protocol for the approach to testing the extent to which health and social care pressures can explain recent mortality trends in Scotland. Although a slower rate of mortality improvements have affected people of all ages, certain ages have been more negatively affected than the others. The current analyses will be run by age-band to test if the service pressure-mortality link varies across age-group.

Methods and analysis

This will be an observational ecological study based on the Scottish population. The exposures of interest will be the absolute (primary outcome) and percentage (secondary outcome) change in real terms per capita spending on social and healthcare services between 2011 and 2017. The outcome of interest will be the absolute (primary outcome) and percentage (secondary outcome) change in age-standardised mortality rate between 2012 and 2018 for men and women separately. The units of analysis will be the 32 local authorities and the 14 territorial health boards. The analyses will be run for both all age-groups combined and for the following age bands: <1, 1–15, 16–44, 45–64, 65–74, 75–84 and 85+.

A series of descriptive analyses will summarise the distribution of health and social care expenditure and mortality trends between 2011 and 2018. Linear regression analysis will be used to investigate the direct association between health care spending and mortality rates.

Ethics and dissemination

The data used in this study will be publicly available and aggregated and will not be individually identifiable; therefore, ethical committee approval is not needed. This work will not result in the creation of a new data set. On completion, the study will be stored within the National Health Service research governance system. All of the results will be published once they have been shared with partner agencies.
Effectiveness of psychological interventions on mental health, quality of life and relationship satisfaction for individuals and/or couples undergoing fertility treatment: a systematic review and meta-analysis protocol
Authors: Bright Katherine , Dube Loveness , Hayden K Alix , Gordon Jennifer L
Published: July 2020

Introduction

Infertility is a global public health problem affecting men, women and couples worldwide. The medical implications of infertility are often of primary focus in healthcare settings, but the experience of infertility also has a considerable social, emotional and psychological impact. Interventions aimed at alleviating psychological symptoms in individual and/or couples undergoing fertility treatment requires a systematic and comprehensive review of the literature to determine the efficacy of psychological interventions. The objective of this review is to evaluate the effectiveness, feasibility and acceptability of psychological interventions for individuals and/or couples seeking fertility to treat anxiety, depression, distress, quality of life and relationship satisfaction, as well as improve pregnancy rates.

Methods and analysis

The search strategy will involve 11 databases, including MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily (Ovid), EMBASE (Ovid), PsycINFO (Ovid), Cochrane Central Register of Controlled Trials (OVID), The Cumulative Index to Nursing and Allied Health Literature (CINAHL) with Full Text (EBSCO), Social Work Abstracts (EBSCO), SocINDEX with Full Text (EBSCO), Academic Search Complete (EBSCO), Family & Society Studies Worldwide (EBSCO), Family Studies Abstracts (EBSCO) and Scopus. These databases will be searched from their inception to September 2019. Independent reviewers will search peer-reviewed published studies through electronic databases and additional sources, will extract the data and assess the methodological quality. Random-effects meta-analysis will be carried out by calculating effect sizes as Cohen’s d indices. Heterogeneity will be examined by the I2 and the Q statistics.

Ethics and dissemination

The current review does not require ethics approval. The results will be disseminated through publications in peer-reviewed journals.

PROSPERO registration number

CRD42019133757.
What is the evidence for the impact of gardens and gardening on health and well-being: a scoping review and evidence-based logic model to guide healthcare strategy decision making on the use of gardening approaches as a social prescription
Authors: Howarth Michelle , Brettle Alison , Hardman Michael , Maden Michelle
Published: July 2020

Objective

To systematically identify and describe studies that have evaluated the impact of gardens and gardening on health and well-being. A secondary objective was to use this evidence to build evidence-based logic models to guide health strategy decision making about gardens and gardening as a non-medical, social prescription.

Design

Scoping review of the impact of gardens and gardening on health and well-being. Gardens include private spaces and those open to the public or part of hospitals, care homes, hospices or third sector organisations.

Data sources

A range of biomedical and health management journals was searched including Medline, CINAHL, Psychinfo, Web of Knowledge, ASSIA, Cochrane, Joanna Briggs, Greenfile, Environment Complete and a number of indicative websites were searched to locate context-specific data and grey literature. We searched from 1990 to November 2019.

Eligibility criteria

We included research studies (including systematic reviews) that assessed the effect, value or impact of any garden that met the gardening definition.

Data extraction and synthesis

Three reviewers jointly screened 50 records by titles and abstracts to ensure calibration. Each record title was screened independently by 2 out of 3 members of the project team and each abstract was screened by 1 member of a team of 3. Random checks on abstract and full-text screening were conducted by a fourth member of the team and any discrepancies were resolved through double-checking and discussion.

Results

From the 8896 papers located, a total of 77* studies was included. Over 35 validated health, well-being and functional biometric outcome measures were reported. Interventions ranged from viewing gardens, taking part in gardening or undertaking therapeutic activities. The findings demonstrated links between gardens and improved mental well-being, increased physical activity and a reduction in social isolation enabling the development of 2 logic models.

Conclusions

Gardens and gardening can improve the health and well-being for people with a range of health and social needs. The benefits of gardens and gardening could be used as a ‘social prescription’ globally, for people with long-term conditions (LTCs). Our logic models provide an evidence-based illustration that can guide health strategy decision making about the referral of people with LTCs to socially prescribed, non-medical interventions involving gardens and gardening.
Media coverage of calls to rename low-risk cancers: a content analysis
Authors: Nickel Brooke , Moynihan Ray , Barratt Alexandra , Brito Juan P , McCaffery Kirsten
Published: July 2020

Objectives

The use of more medicalised labels can increase both concern about illness and the desire for more invasive treatment. This study analyses the media’s coverage of an Analysis article in The BMJ which generated a large amount of high-profile international media coverage. It aims to understand how to better communicate messages about low-risk cancers and overdiagnosis to the public.

Design

Content analysis of media coverage.

Setting

Media was identified by Isentia Media Portal, searched in Google News and cross-checked in Factiva and Proquest databases from August 2018.

Methods

Media headlines, full text and open access public comments responding to the coverage on the article proposing to ‘rename low-risk conditions currently labelled as cancer’ were analysed to determine the main themes.

Results

45 original media articles and their associated public comments (n=167) were identified and included in the analysis. Overall, headlines focused on cancer generally and there was little mention of ‘low-risk’, ‘overdiagnosis’ or ‘overtreatment’. The full text generally presented a more balanced view of the evidence and were supportive of the proposal, however, public responses tended to be more negative towards the idea of renaming low-risk cancers and indicated confusion. Comments seemed to focus on the headlines rather than the full article.

Conclusions

This study offers a novel insight into media coverage of the complex and counterintuitive problem of overdiagnosis. Continued deliberation on how to communicate similar topics to the public through the mainstream media is needed. Future work in the area of low-risk cancer communication should consider the powerful impact of people’s previous experience with a cancer diagnosis and the criticism about being paternalistic and concealing the truth from patients.
Does probe-tube verification of real-ear hearing aid amplification characteristics improve outcomes in adult hearing aid users? A protocol for a systematic review
Authors: Almufarrij Ibrahim , Munro Kevin J , Dillon Harvey
Published: July 2020

Introduction

Using a probe-tube microphone to measure and adjust the real-ear performance of the hearing aid to match the prescription target is recommended and widely used in clinical practice. Hearing aid fitting software can approximately match the amplification characteristics of the hearing aid to the prescription without real-ear measurements (REMs), but using REM improves the match to the prescribed target. What is unclear is if the improved match results in a better patient-reported outcome. The primary objective of this review is to determine whether the use of REM improves patient-reported outcomes in adult hearing aid users.

Methods and analysis

The review’s methods are in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols guidelines. MEDLINE, EMBASE, PsycINFO, CINAHL, Web of Science and CENTRAL via Cochrane Library will be searched to identify relevant studies. The review’s population of interest will include adults with any degree of sensorineural or mixed hearing loss who have been prescribed with acoustic hearing aids. The included studies should compare REM fitting to the initial fit provided by the manufacturer’s fitting software. Hearing-specific health-related quality of life is the primary outcome but secondary outcomes include self-reported listening ability, speech recognition scores, generic health-related quality of life, hours of use, number of required follow-up sessions and adverse events. Randomised and non-randomised controlled trials will be included. The risk of bias in the included studies will be evaluated using Down and Black’s checklist. The quality of the overall evidence will be assessed using the Grading of Recommendations, Assessment, Development and Evaluations tool.

Ethics and dissemination

Ethical approval will not be sought because this systematic review will only retrieve and analyse data from published studies. Review results will be published in a peer-reviewed journal and presented at relevant scientific conferences.

PROSPERO registration number

CRD42020166074.
Quality of cancer end-of-life care: discordance between bereaved relatives and professional proxies
Authors: Bertocchi Elisabetta , Artioli Giovanna , Rabitti Elisa , Bedini Gabriele , Di Leo Silvia , Asensio Sierra Nuria Maria , Braglia Luca , Costantini Massimo
Published: July 2020

Background

Quality of care for patients dying in hospital remains suboptimal. A major problem is the identification of valid sources of information about the views and experiences of dying patients and their relatives.

Aim

This study aimed to estimate the agreement on quality of end-of-life care from the perspectives of bereaved relatives, physicians and nurses interviewed after the patients’ death.

Design

In this prospective study, we interviewed, after the patient death, the bereaved relatives, the attending physicians and the reference nurses, using the Toolkit After-death Family Interview and the View Of Informal Carers-Evaluation of Services (VOICES). Agreement was assessed using Lin’s concordance correlation coefficient, Cohen’s kappa, overall concordance correlation coefficient and Fleiss’ kappa.

Setting/participants

We enrolled a consecutive series of 40 adult patients who died of cancer between January and December 2016 who had spent at least 48 hours in the medical oncology ward of the Santa Maria Hospital of Reggio Emilia, Italy.

Results

We interviewed all physicians and nurses, and 26 (65.0%) out of 40 relatives. We found a poor agreement on overall quality of care among the three proxies (+0.21; −0.04 to 0.44), between relatives and nurses (+0.05; −0.39 to +0.47), and between relatives and physicians (+0.25; −0.13 to +0.57). A similar poor agreement was observed for all the other Toolkit and VOICES scales.

Conclusions

The agreement was rather poor, confirming previous results in different settings. Information from professional proxies should not be used for assessing the quality of care or for estimating missing information from bereaved relatives.
Small thrombus size, thrombus composition, and poor collaterals predict pre-interventional thrombus migration
Authors: Sporns Peter B , Krähling Hermann , Psychogios Marios N , Jeibmann Astrid , Minnerup Jens , Broocks Gabriel , Meyer Lukas , Brehm Alex , Wildgruber Moritz , Fiehler Jens , Kniep Helge , Hanning Uta
Published: July 2020

Background

Different imaging characteristics such as clot burden score, collaterals, and pre-interventional thrombus migration are associated with functional outcome in patients with acute ischemic stroke. Moreover, histological thrombus composition is associated with pre-interventional thrombus migration. We hypothesized that smaller clots may more likely migrate and that collateral status in ischemic stroke patients may mediate this tendency of the clot to migrate.

Methods

In this prospective cohort of consecutive ischemic stroke patients, clot burden scores and collateral scores were rated and the retrieved thrombi were histologically analyzed. We then investigated the relationship between clot burden score, probability for thrombus migration, and collateral scores using mediation analysis.

Results

163 patients are included of which 36 (22.1%) had a clot migration. Probability of thrombus migration was significantly associated with lower collateral scores (P<0.01), higher clot burden scores (P<0.01), shorter thrombi (P<0.01), and higher RBC count (P<0.01). In the mediator pathway, higher collateral scores were significantly associated with higher clot burden scores (P<0.01) and younger age (P=0.029). The total effect of an increase in clot burden score by one grade on thrombus migration is composed of the direct effect (+18%, P<0.01) and the collateral score-mediated indirect effect (−5%, P<0.01).

Conclusions

Smaller, erythrocyte-rich thrombi tend to migrate more often. Good collaterals seem to have a considerable effect on limiting migration. This supports the hypothesis that larger clots have stronger adherence with the vessel wall and that good collaterals increase the counter pressure distal of the clot.
Effects of plant morphology on root–soil hydraulic interactions ofSchefflera heptaphylla
Authors: Ng C.W.W. , Wang Z.J. , Ni J.J.
Published: July 2020

Root water uptake induces additional soil suction by soil water extraction. However, induced soil suction restricts root water uptake when beyond a threshold (st) and tends to stop water uptake at a limiting suction (sl). This process is called root–soil hydraulic interactions, whose relationship with plant morphology (e.g., plant height, leaf area, and root length) is unclear. This study aims to investigate the effects of plant morphology on response of the sink term (water uptake intensity; WUI) to soil suction for Schefflera heptaphylla. Laboratory tests were conducted on 26 individuals in five different height groups. A new empirical model was derived to consider effects of plant morphology on root water uptake distribution in the full soil suction range. The locations of maximum root length density (RLD) and WUI for taller individuals were relatively deeper and farther from centreline. Before soil suction reached st, water uptake length ability (WULA) remained at a maximum level, positively related to LR ratio (ratio between leaf area, LA, and root length, RL), but less affected by plant height. For taller plants, the decreasing rate of stwith LR ratio was larger, while the decreasing rate of WULA with soil suction beyond stappeared smaller. slappeared independent of height, LA, and RL.
Maximum Matching in the Online Batch-arrival Model
Authors: Lee Euiwoong , Singla Sahil
Published: July 2020

Consider a
two-stage matching
problem, where edges of an input graph are revealed in two stages (batches) and in each stage we have to immediately and irrevocably extend our matching using the edges from that stage. The natural greedy algorithm is half competitive. Even though there is a huge literature on online matching in adversarial
vertex arrival model
, no positive results were previously known in adversarial
edge arrival model
.

For two-stage bipartite matching problem, we show that the optimal competitive ratio is exactly 2/3 in both the fractional and the randomized-integral models. Furthermore, our algorithm for fractional bipartite matching is
instance optimal
, i.e., it achieves the best competitive ratio for any
given
first stage graph. We also study natural extensions of this problem to general graphs and to
s
stages and present randomized-integral algorithms with competitive ratio ½ + 2−
O(s)
.

Our algorithms use a novel
Instance-Optimal-LP
and combine graph decomposition techniques with online primal-dual analysis.
Introduction
Authors: Armstrong Deborah J.
Published: July 2020

In this issue, we depart from our usual format of an editorial and solely introduce the articles. We chose this course of action to encourage our readership to focus on the timely and provocative comments regarding the Covid-19 pandemic provided in the "Letter from the Chair."
Knockout of sulfatase 2 is associated with decreased steatohepatitis and fibrosis in a mouse model of nonalcoholic fatty liver disease
Authors: Kim Tae Hyo , Banini Bubu A. , Asumda Faizal Z. , Campbell Nellie A. , Hu Chunling , Moser Catherine D. , Shire Abdirashid M. , Han Shaoshan , Ma Chenchao , Krishnan Anuradha , Mounajjed Taofic , White Thomas A. , Gores Gregory J. , LeBrasseur Nathan K. , Charlton Michael R. , Roberts Lewis Rowland
Published: July 2020

We report for the first time that in wild-type (WT) mice, fast-food diet (FFD) induced a threefold increase in hepatic Sulf2 mRNA and a 2.2-fold increase in sulfatase 2 (SULF2) protein expression compared with WT mice on standard chow diet (SC). We showed that knockout of SULF2 ameliorates FFD-induced obesity, hyperlipidemia, steatohepatitis, and fibrosis. These data, along with work from other laboratories, suggest that SULF2 may be critical to the ability of the liver to progress to nonalcoholic steatohepatitis and fibrosis in conditions of overnutrition.