bluuebunny/crossref_metadata_2025 huggingface dataset:
Cosmic ray exposure ages for ureilites—New data and a literature study
Authors: Leya Ingo , Stephenson Peter C.
Published: March 2019

We report newly measured noble gas isotopic concentrations of He, Ne, and Ar for 21 samples from the 10 ureilites, DaG 084, DaG 319, DaG 340, Dho 132, HaH 126, JaH 422, JaH 424, Kenna, NWA 5928, and RaS 247, including the results of both single and stepwise heating extractions. Cosmic ray exposure (CRE) ages calculated using model calculations that fully account for all shielding depths and a wide range of preatmospheric radii, and are tailored to ureilite chemistry, range from 3.7 Ma for Dho 132 to 36.3 Ma for one of several measured Kenna samples. In a Ne‐three‐isotope plot, the data for DaG 340 and JaH 422 plot below the Necos/Neureilite mixing envelope, possibly indicating the presence of Ne produced from solar cosmic rays. In combination with literature data and correcting for pairing, we established a fully consistent database containing 100 samples from 40 different ureilites. The CRE age histogram shows a trend of decreasing meteorite number with increasing CRE age. We speculate that the parent body of the known ureilites is moving closer to a resonance and/or that there is a loss mechanism that acts on ureilites independent of their size. In addition, there is a slight indication for a peak in the range 30 Ma, which might indicate a larger impact on the ureilite daughter body. Finally, we confirm earlier results that the majority of the studied ureilites have relatively small preatmospheric radii less or equal ~20 cm.
Sodium‐powered stators of the bacterial flagellar motor can generate torque in the presence of phenamil with mutations near the peptidoglycan‐binding region
Authors: Ishida Tsubasa , Ito Rie , Clark Jessica , Matzke Nicholas J. , Sowa Yoshiyuki , Baker Matthew A. B.
Published: March 2019

The bacterial flagellar motor powers the rotation that propels the swimming bacteria. Rotational torque is generated by harnessing the flow of ions through ion channels known as stators which couple the energy from the ion gradient across the inner membrane to rotation of the rotor. Here, we used error‐prone PCR to introduce single point mutations into the sodium‐powered Vibrio alginolyticus/Escherichia coli chimeric stator PotB and selected for motors that exhibited motility in the presence of the sodium‐channel inhibitor phenamil. We found single mutations that enable motility under phenamil occurred at two sites: (i) the transmembrane domain of PotB, corresponding to the TM region of the PomB stator from V. alginolyticus and (ii) near the peptidoglycan binding region that corresponds to the C‐terminal region of the MotB stator from E. coli. Single cell rotation assays confirmed that individual flagellar motors could rotate in up to 100 µM phenamil. Using phylogenetic logistic regression, we found correlation between natural residue variation and ion source at positions corresponding to PotB F22Y, but not at other sites. Our results demonstrate that it is not only the pore region of the stator that moderates motility in the presence of ion‐channel blockers.
Association between delayed recall and T2* relaxation time of the subiculum in adolescents: Implications for ultra‐high‐field magnetic resonance imaging
Authors: Jeon Sehyun , Hwang Seok‐Il , Son Young Don , Kim Young‐Bo , Lee Yu Jin , Kim Seog Ju
Published: March 2019

Aim

The aim of this study was to assess neuropsychological correlations with the T2* relaxation time (T2*‐RT) of hippocampal subregions in adolescents using ultra‐high‐field (UHF) 7.0‐T magnetic resonance imaging (MRI).

Methods

We assessed the T2*‐RT of hippocampal subregions in 31 healthy 11th‐ or 12th‐grade high school students using an UHF 7.0‐T MRI system. T2*‐RT of the cornu ammonis (CA) 1, CA2, CA3, and CA4 subregions and the subiculum were calculated for both the left and right hippocampus. Seven subtests of the Cambridge Neuropsychological Test Automated Battery were administered to the subjects to assess visuospatial memory.

Results

Poor performances in delayed recall in the pattern‐recognition test were significantly correlated with longer T2*‐RT in the bilateral subiculum (right, r = −0.480, P = 0.006; left, r = −0.648, P < 0.001) and the left CA2 (r = −0.480, P = 0.006).

Conclusion

This study showed that longer T2*‐RT in the subiculum were associated with poorer performances in delayed recall in the visual memory tasks. This finding suggests that the subiculum might play a predominant role in delayed recall in adolescents.
Cyanine Modification Tuned for Amine Photorelease
Authors: Mathew Joel P. , Greer Alexander
Published: March 2019

Cyanines are emerging as useful agents for photoreleasing biological compounds because of their capability of utilizing near‐infrared (NIR) light. Another benefit is their ability to self‐sensitize to produce singlet oxygen for the release of aryl amines, a process that has not been as feasible in the past. Here, we highlight the paper by Schnermann et al. (https://doi.org/10.1111/php.13090), which reports on a cyanine conjugate for heterolytic photocleavage of aryl amines. This paper is timely—delving into a photorelease mechanism involving a domino rearrangement and β‐elimination triggered by NIR light.
Nightmares do result in psychophysiological arousal: A multimeasure ambulatory assessment study
Authors: Paul Franc , Alpers Georg W. , Reinhard Iris , Schredl Michael
Published: March 2019

Individuals who frequently experience nightmares report compromised sleep quality, poor daytime mood, and functioning. Previous research has aimed at linking these impairments with altered sleep architecture, but results were inconclusive. One plausible explanation is that only a few studies recorded markers of autonomic nervous system activity. For the first time, this study collected such markers under ecologically valid conditions with ambulatory assessment. In 19 individuals with frequent nightmares (≥1 nightmare/week) and 19 healthy control participants (<1 nightmare/month), measures indicating autonomic activation (heart rate, heart rate variability, respiration cycle length, electrodermal fluctuations, EEG arousals, saliva cortisol, REM density) were collected while applying ambulatory polysomnographic assessment during 3 consecutive nights. When nightmare participants reported a nightmare, we analyzed the last 5 min of REM sleep before awakening and compared these data to their non‐nightmares as well as to the dream episodes of control participants. Overall, there were no general differences in autonomic activation of nightmare sufferers compared to control participants. However, when nightmare participants experienced nightmares, autonomic activation was markedly increased compared to their own non‐nightmares and, to some extent, to control participant’s dreams. Significant intraindividual differences were found for all autonomic measures except in participant’s EEG arousals and cortisol levels. Group differences were found in EEG arousals and heart rate. In conclusion, ambulatory polysomnography demonstrates that nightmares are accompanied by increased autonomic activation. Results support the notion of impaired self‐reported sleep quality caused by one’s autonomic response rather than altered sleep pattern.
The promise of bioimpedance for volume management in American dialysis patients: An unfulfilled opportunity
Authors: Kotanko Peter
Published: March 2019

Evidence from both observational and randomized controlled studies indicates that the use of bioimpedance in the care of chronic hemodialysis patients is associated with improved outcomes, in particular better volume and blood pressure control. Bioimpedance as a means to assess fluid status in dialysis patients has been approved by numerous regulatory agencies and is being used in dozens of countries around the globe. The most notable exception to the worldwide acceptance of this technique is the US where no BIA device has been approved by the US Food and Drug Administration for use in dialysis patients. The reasons for this unfortunate situation are manifold and mostly flawed. They include the view that bioimpedance is inaccurate and not sufficiently validated, that clinical judgment is good enough to assess fluid status, that interdialytic changes in weight are satisfactory indicators of fluid status (overload, depletion, and euvolemia), costs, and regulatory and marketing barriers. Easing the path to approval and modifying the dialysis payment structure are necessary to bring dialysis care closer to the levels that will optimize patient outcomes.
Out of Africa? A dated molecular phylogeny of the cicada tribe Platypleurini Schmidt (Hemiptera: Cicadidae), with a focus on African genera and the genusPlatypleuraAmyot & Audinet‐Serville
Authors: Price Benjamin W. , Marshall David C. , Barker Nigel P. , Simon Chris , Villet Martin H.
Published: March 2019

The Platypleurini is a large group of charismatic cicadas distributed from Cape Agulhas in South Africa, through tropical Africa, Madagascar, India and eastern Asia to Japan, with generic diversity concentrated in equatorial and southern Africa. This distribution suggests the possibility of a Gondwanan origin and dispersal to eastern Asia from Africa or India. We used a four‐gene (three mitochondrial) molecular dataset, fossil calibrations and molecular clock information to explore the phylogenetic relationships of the platypleurine cicadas and the timing and geography of their diversification. The earliest splits in the tribe were found to separate forest genera in Madagascar and equatorial Africa from the main radiation, and all of the Asian/Indian species sampled formed a younger clade nested well within the African taxa. The tribe appears to have diversified during the Cenozoic, beginningc. 50–32 Ma, with most extant African lineages originating in the Miocene or later, well after the breakup of the Gondwanan landmass. Biogeographical analysis suggests an African origin for the tribe and a single dispersal event founding the Asian platypleurines, although additional taxon sampling and genetic data will be needed to confirm this pattern because key nodes in the tree are still weakly supported. Two Platypleurini genera from Madagascar (PycnaAmyot & Audinet‐Serville,YangaDistant) are found to have originated by late Miocene dispersal of a single lineage from Africa. The genusPlatypleurais recovered as polyphyletic, withPlatypleura signiferaWalker from South Africa and many Asian/Indian species apparently requiring assignment to different genera, and a newPlatypleuraconcept is proposed with the synonymization ofAzanicadaVilletsyn.n.The generaOrapaDistant andHamzaDistant, currently listed within separate tribes but suspected of platypleurine affinity, are nested deeply within the Platypleurini radiation. The tribe Orapinisyn.n. is here synonymized while the tribe Hamzini is pending a decision of the ICZN to preserve nomenclatorial stability.
Identification of a novel HLA‐DPB1, HLA‐DPB1*687:01, in an Italian renal transplant candidate
Authors: Biagini Chiara , Fornaciari Silvia , Mariotti Maria L. , Mazzoni Alessandro , Curcio Michele
Published: March 2019

Two adjacent nucleotide substitutions in exon 2 characterize the novel class II HLA‐DPB1*687:01 allele.
Hybrid single‐port laparoscopic cisterna chyli ablation for the adjunct treatment of chylothorax disease in dogs
Authors: Morris Katherine P. , Singh Ameet , Holt David E. , Stefanovski Darko , Singhal Sunil , Bosco Jessica , Capps Michelle , McCallum Michael , Runge Jeffrey J.
Published: March 2019

Objective

To describe a hybrid, single‐port, minimally invasive cisterna chyli ablation (CCA) technique in clinical cases of canine idiopathic chylothorax and evaluate this technique as a method for mesenteric lymphangiography (ML) in canine cadavers and clinical cases of idiopathic chylothorax.

Study design

Cadaveric and retrospective study.

Animals

Six canine cadavers and 14 client‐owned dogs with naturally occurring idiopathic chylothorax.

Methods

Both cadaveric and clinically affected dogs were placed in sternal recumbency. A wound retractor device (WRD) and a single‐port device were placed in the abdominal flank 2–3 cm caudal to the 13th rib. Mesenteric lymphangiography was evaluated by using indocyanine green (ICG) in 6 canine cadavers. Single‐port laparoscopic CCA was performed in all clinical cases with idiopathic chylothorax.

Results

Successful ML was completed by using ICG in all 6 canine cadavers. A right‐ or left‐sided single‐port laparoscopic CCA was successfully performed in 14 dogs with naturally occurring idiopathic chylothorax. Mesenteric lymphangiography was successfully performed through the WRD in 11 of these cases. No intraoperative complications were reported. Three dogs developed severe chyloabdomen postoperatively, with 1 dog requiring multiple abdominocenteses.

Conclusion

Direct ML and single‐port laparoscopic CCA was performed through a WRD in dogs positioned in sternal recumbency. Although minimal operative complications were noted, postoperative chyloabdomen was reported.

Clinical significance

This hybrid single‐port laparoscopic technique performed in sternal recumbency allows both a CCA and an intraoperative ML through the same incision. This procedure may be combined with thoracoscopic thoracic duct ligation and pericardectomy for the treatment of idiopathic chylothorax in dogs.
Coupling Effect of Vortex-Induced Vibration of a Submarine Pipeline and Local Scour Under Steady Current
Authors: Zhang Qi , Zhou Xiang-Lian , Xia Xiao-He , Li Wan-Ling , Zhang Shuo
Published: March 2019

The dynamic interaction between pipeline vibration and local scour is investigated numerically. The sediment scour model is adopted to calculate the local scour below pipeline. The general moving objects (GMO) model fully coupled with the fluids is established to simulate the pipeline vibration. The present results are consistent with the previous experimental results and show good agreement. The scour depth and scour hole scale are closely related to the amplitude of pipeline vibration. The effects of initial gap-to-diameter ratio, reduced velocity, and pipeline diameter on the local scour and pipeline vibration are investigated.
On the Planarization Mechanism and Pad Aging Effects of Soft Pad Polishing: A Perspective From the Micro-Mechanical Properties of Soft Pads
Authors: Jeng Yeau-Ren , Tsai Ping-Chi , Lin Yu-Zheng
Published: March 2019

The local viscoelastic properties of soft polishing pads with different usage durations are measured by a micro-scale mechanical analysis testing platform. The testing reveals stimulus-adaptive local viscoelasticity of soft pads under the activation of asperity contact. This phenomenon suggests asperity-dependent local modulus. Such an increase of local modulus induced by higher asperity provides a further enhancement effect to the planarization of surface asperity. Furthermore, the measurement outcomes suggest that the reaction of local micro-scale viscoelastic properties of the soft pad surface to the workpiece asperity will decay with usage time. The current study provides a detailed understanding of the aging effects for the soft pad and explains the performance decay during soft pad polishing from a local micro-scale interfacial perspective.
Elastic Wave Propagation in Hierarchical Honeycombs With Woodpile-Like Vertexes
Authors: Zhu Zhiwei , Deng Zichen , Du Jianke
Published: March 2019

This paper investigates the dispersion behavior of elastic wave propagation in hierarchical honeycombs using the finite element method in conjunction with the Bloch's theorem. The hierarchical honeycomb is constructed by replacing each vertex of a regular hexagonal honeycomb with smaller hexagons stacked in a woodpile pattern. Band structure analysis reveals that, in the considered range of frequency, the maximum band gap for the hierarchical honeycomb is localized in the frequency corresponding to the natural vibration frequency of the cell strut, and moreover, the width of this particular gap is significantly broadened as the order of hierarchy increases. In addition, for the hierarchical honeycombs satisfying an invariable ratio between the thickness and squared length of the cell strut, which is extracted from the expression of the natural frequency of the simply supported element beam, a coincidence among dispersion curves (or contours) for the hierarchical configurations with the same scale order occurs. The resulting identical band gaps as well as the quasi-static phase wave velocities provide an advantage or the hierarchical honeycombs in the manipulation of vibration and associated multifunction designs.
Haemostasis treatment using dual red imaging during endoscopic submucosal dissection: a multicentre, open-label, randomised controlled trial
Authors: Fujimoto Ai , Saito Yutaka , Abe Seiirhicro , Hoteya Shu , Nomura Kosuke , Yasuda Hiroshi , Matsuo Yasumasa , Uraoka Toshio , Kuribayashi Shiko , Saito Itaru , Tsuji Yosuke , Maehata Tadateru , Ochiai Yasutoshi , Nishizawa Toshihiro , Yahagi Naohisa
Published: March 2019

Introduction

Patients scheduled to undergo oesophageal, gastric and colorectal endoscopic submucosal dissection (ESD) are to be investigated to verify the efficacy of dual red imaging (DRI) for establishing haemostasis during ESD.

Methods and analysis

The trial is designed as a multicentre, open-label randomised, parallel-group, controlled intervention study. Registered patients will be randomly assigned to DRI and white light imaging (WLI) groups. In the DRI group, the mucosal incision and submucosal dissection will be performed by WLI, and haemostasis will be managed by DRI when bleeding occurs. In the WLI group, the mucosal incision and submucosal dissection are to be performed by WLI and the haemostasis management is to be performed by WLI. The primary endpoint is the time from the recognition of bleeding up to the achievement of complete haemostasis (haemostasis time). The secondary endpoints are the operation time, the proportion of cases in which perforation occurs, and the psychological stress experienced by the endoscopist during haemostasis treatment.

Ethics and dissemination

This trial was approved by the Keio University Review Board for Clinical Trials (5 December 2016).

Discussion

This will be the first multicentre collaborative research using DRI for haemostasis treatment during ESD. When the safety and simplicity of DRI as a treatment for haemostasis during ESD can be proven, the ESD procedure can be simplified and disseminated more widely in clinical practice.

Trial registration number

UMIN000025134
Latent class analysis of the social determinants of health-seeking behaviour for delivery among pregnant women in Malawi
Authors: Yorlets Rachel R , Iverson Katherine R , Leslie Hannah H , Gage Anna Davies , Roder-DeWan Sanam , Nsona Humphreys , Shrime Mark G
Published: March 2019

Introduction

In the era of Sustainable Development Goals, reducing maternal and neonatal mortality is a priority. With one of the highest maternal mortality ratios in the world, Malawi has a significant opportunity for improvement. One effort to improve maternal outcomes involves increasing access to high-quality health facilities for delivery. This study aimed to determine the role that quality plays in women’s choice of delivery facility.

Methods

A revealed-preference latent class analysis was performed with data from 6625 facility births among women in Malawi from 2013 to 2014. Responses were weighted for national representativeness, and model structure and class number were selected using the Bayesian information criterion.

Results

Two classes of preferences exist for pregnant women in Malawi. Most of the population 65.85% (95% CI 65.847% to 65.853%) prefer closer facilities that do not charge fees. The remaining third (34.15%, 95% CI 34.147% to 34.153%) prefers central hospitals, facilities with higher basic obstetric readiness scores and locations further from home. Women in this class are more likely to be older, literate, educated and wealthier than the majority of women.

Conclusion

For only one-third of pregnant Malawian women, structural quality of care, as measured by basic obstetric readiness score, factored into their choice of facility for delivery. Most women instead prioritise closer care and care without fees. Interventions designed to increase access to high-quality care in Malawi will need to take education, distance, fees and facility type into account, as structural quality alone is not predictive of facility type selection in this population.
‘Grandmother, aren’t you going to sing for us?’ Current childcare practices and caregivers’ perceptions of and receptivity to early childhood development activities in rural Burkina Faso
Authors: Hollowell Jennifer , Dumbaugh Mari , Belem Mireille , Kousse Sylvain , Swigart Tessa , Korsaga Chantal , Lankoande Pokiandi Solange , Lawson Kokovi Hogban , Hill Zelee
Published: March 2019

Introduction

Effective stimulation and responsive caregiving during the first 2 years is crucial for children’s development. By age 3–4 years, over 40% of children in sub-Saharan Africa fail to meet basic cognitive or socioemotional milestones, but there are limited data on parenting and childcare practices. This study, conducted to inform the design of a mass media intervention, explored practices, perceptions, motivators and obstacles to childhood development-related practices among parents and caregivers of children aged 0–2 years in rural Burkina Faso.

Methods

We performed two rounds of six focus groups with 41 informants in two villages, using an adapted version of the Trials of Improved Practices methodology. These first explored beliefs and practices, then introduced participants to the principles and benefits of early childhood development (ECD) and provided illustrative examples of three practices (interactive ways of talking, playing and praising) to try with their children. One week later, further discussions explored participants’ experiences and reactions. Data were analysed inductively using thematic content analysis.

Results

Existing activities with young children were predominantly instructive with limited responsive interaction and stimulation. Participants were receptive to the practices introduced, noted positive changes in their children when they adopted these practices and found engagement with children personally rewarding.

Conclusion

Interactive, stimulating activities with young children did not appear to be widespread in the study area, but caregivers were receptive to information about the importance of early stimulation for children’s development. ECD messages should be tailored to the local sociocultural context and consider time limitations.
How the health-seeking behaviour of pregnant women affects neonatal outcomes: findings of system dynamics modelling in Pakistan
Authors: Ahmad Raheelah , Zhu Nina Jiayue , Lebcir Reda Mohamed , Atun Rifat
Published: March 2019

Background

Limited studies have explored how health-seeking behaviour during pregnancy through to delivery affect neonatal outcomes. We modelled health-seeking behaviour across urban and rural settings in Pakistan, where poor neonatal outcomes persist with wide disparities.

Methods and findings

A system dynamics model was developed and parameterised. Following validation tests, the model was used to determine neonatal mortality for pregnant women considering their decisions to access, refuse and switch antenatal care services in four provider sectors: public, private, traditional and charitable. Four health-seeking scenarios were tested across different pregnancy trimesters. Health-seeking behaviour in different subgroups by geographical locations and social network effect was modelled. The largest reduction in neonatal mortality was achieved with antenatal care provided by skilled providers in public, private or charitable sectors, combined with the use of institutional delivery. Women’s social networks had strong influences onif, when and whereto seek care. Interventions by Lady Health Workers had a minimal impact on health-seeking behaviour and neonatal outcomes after trimester 1. Optimal benefits were achieved for urban women when antenatal care was accessed within trimester 2, but for rural women within trimester 1. Antenatal care access delayed to trimester 3 had no protective impact on neonatal mortality.

Conclusions

System dynamics modelling enables capturing the complexity of health-seeking behaviours and impact on outcomes, informing intervention design, implementation of targeted policies and uptake of services specific to urban/rural settings considering structural enablers/barriers to access, cultural contexts and strong social network influences.
Risk factors associated with oral manifestations and oral health impact of gastro-oesophageal reflux disease: a multicentre, cross-sectional study in Pakistan
Authors: Warsi Ibrahim , Ahmed Javeria , Younus Anjum , Rasheed Abdur , Akhtar Tayyab Saeed , Ain Qurrat Ul , Khurshid Zohaib
Published: March 2019

Objective

Gastro-oesophageal reflux disease (GORD) is a relatively common disorder and manifests with extraoesophageal symptoms, such as dental erosions (DE), cough, laryngitis, asthma, and oral soft- and hard-tissue pathologies. This study aimed (1) to identify oral soft and hard-tissue changes in patients with GORD and (2) to evaluate these oral changes as indices for assessing GORD and its severity.

Setting

This cross-sectional study was conducted at four major tertiary care government hospitals, in two metropolitan cities of Pakistan.

Participants

In total, 187 of 700 patients who underwent oesophago–gastro–duodenoscopy and having GORD were included in the study. Patients with GORD were divided according to the presence of DE into group A (with DE, chronic/severe GORD) and group B (without DE, mild GORD). Patients who were unconscious and had extremely limited mouth opening were excluded.

Primary and secondary outcome measures

Abnormal conditions and lesions of the oral mucosa were recorded. The impact of oral hard and soft-tissue changes on the oral health-related quality of life was assessed using the Pakistani (Urdu) version of the validated Oral Health Impact Profile-14 (OHIP-14) instrument.

Results

Oral submucous fibrosis (66.3%), ulceration (59.4%) and xerostomia (47.6%) were significantly more common in group A (p<0.05). The prevalence of GORD was 26.7%, within which the prevalence of DE was 35.3%. Unhealthy dietary pattern, nausea/vomiting, oesophagitis, xerostomia, ulceration, gingivitis and angular cheilitis showed a statistically significant association with chronic GORD and DE. All subscales of OHIP-14 were positively correlated (p<0.05) in patients with GORD and DE, with notable impact on psychological discomfort (rs=0.30), physical disability (rs=0.29), psychological disability (rs=0.27) and functional limitation (rs=0.20).

Conclusion

Patients with GORD and DE presented with more severe oral manifestations than did those with GORD and no DE. We recommend timely dental check-ups to assess the severity of both systemic and oral disease.
Employment status and unmet dental care needs in South Korea: a population-based panel study
Authors: Choi Jae Woo , Choi Young , Lee Tae-Hoon , Lee Hyo Jung , Ju Yeong Jun , Park Eun-Cheol
Published: March 2019

Objectives

This study was designed to evaluate whether employment status is associated with the experience of unmet dental care needs.

Methods

A total of 4620 workers were retrieved from Korea Health Panel data (2010–2013), and potential relationships were explored among their income levels, changes in employment and unmet dental care needs.

Results

Among the 4620 workers, 17.3% said they had failed at least once to get dental treatment or check-up, despite their needs. Precarious workers and those not in employment were more likely to experience unmet dental care needs due to economic burden compared with permanent workers (OR 1.36, 1.40, respectively). In addition, people in low-income group were 4.46 times more likely to experience unmet dental care needs caused by economic burden, compared with those with the highest income.

Conclusion

This disparity means that precarious workers and those not in employment are more likely to face barriers in obtaining needed health services. Given the insecure employment status of low income people, meeting their healthcare needs is an important consideration.
What matters to medical ward patients, and do we measure it? A qualitative comparison of patient priorities and current practice in quality measurement, on UK NHS medical wards
Authors: Pannick Samuel , Archer Stephanie , Long Susannah Jane , Husson Fran , Athanasiou Thanos , Sevdalis Nick
Published: March 2019

Objectives

To compare the quality metrics selected for public display on medical wards to patients’ and carers’ expressed quality priorities.

Methods

Multimodal qualitative evaluation of general medical wards and semi-structured interviews.

Setting

UK tertiary National Health Service (public) hospital.

Participants

Fourteen patients and carers on acute medical wards and geriatric wards.

Results

Quality metrics on public display evaluated hand hygiene, hospital-acquired infections, nurse staffing, pressure ulcers, falls and patient feedback. The intended audience for these metrics was unclear, and the displays gave no indication as to whether performance was improving or worsening. Interviews identified three perceived key components of high-quality ward care: communication, staff attitudes and hygiene. These aligned poorly with the priorities on display. Suboptimal performance reporting had the potential to reduce patients’ trust in their medical teams. More philosophically, patients’ and carers’ ongoing experiences of care would override any other evaluation, and they felt little need for measures relating to previous performance. The display of performance reports only served to emphasise patients’ and carers’ lack of control in this inpatient setting.

Conclusions

There is a gap between general medical inpatients’ care priorities and the aspects of care that are publicly reported. Patients and carers do not act as ‘informed choosers’ of healthcare in the inpatient setting, and tokenistic quality measurement may have unintended consequences.
Reduced long-term care cost by social participation among older Japanese adults: a prospective follow-up study in JAGES
Authors: Saito Masashige , Aida Jun , Kondo Naoki , Saito Junko , Kato Hirotaka , Ota Yasuhiro , Amemiya Airi , Kondo Katsunori
Published: March 2019

Objectives

Reducing costs related to functional disabilities and long-term care (LTC) is necessary in ageing societies. We evaluated the differences in the cumulative cost of public LTC insurance (LTCI) services by social participation.

Design

Prospective observational study.

Setting

Our baseline survey was conducted in March 2006 among people aged 65 or older who were not eligible for public LTCI benefits and were selected using a complete enumeration in Tokoname City, Japan. We followed up with their LTC services costs over a period of 11 years. Social participation was assessed by the frequency of participation in clubs for hobbies, sports or volunteering. We adopted a classical linear regression analysis and an inverse probability weighting (IPW), with multiple imputation of missing values.

Participants

Functionally independent 5377 older adults.

Primary outcome measures

The cumulative cost of public LTCI services for 11 years.

Results

Even when adjusting for the confounding variables, social participation at the baseline was negatively associated with the cumulative cost of LTCI services. The IPW model showed that in respondents who participated in hobby activities once a week or more, the cumulative cost of LTCI services for 11 years was lower, approximately US$3500 per person, in comparison to non-participants. Similarly, that in respondents who participated in sports group or clubs was lower, approximately US$6000 than non-participants.

Conclusions

Older adults’ participation in community organisations may help reduce future LTC costs. Promoting participation opportunities in the community could ensure the financial stability of LTCI services.
Treatment outcomes of initial differential antiretroviral regimens among HIV patients in Southwest China: comparison from an observational cohort study
Authors: Kang Ruihua , Luo Liuhong , Chen Huanhuan , Zhu Qiuying , Liao Lingjie , Xing Hui , Zhu Jinhui , Shen Zhiyong , Lan Guanghua , Tang Zhenzhu , Shao Yiming , Yang Wenmin , Ruan Yuhua
Published: March 2019

Objectives

China has continued to expand antiretroviral therapy (ART) services and optimise ART guidelines in an effort to significantly reduce and prevent mortality and transmission rates among HIV patients. However, no study to date has compared treatment outcomes of initial differential antiretroviral regimens among HIV patients in a real-world setting in China. This study aimed to compare the effects of different ART regimens on treatment outcomes among adults.

Design

Observational retrospective cohort study.

Setting

Data from 2011 to 2013 in Guangxi, China.

Participants

Patients aged ≥18 years (n=25 732) were selected.

Results

A total of 25 732 patients were included in this study. The average mortality and attrition rate were 2.64 and 4.98, respectively, per 100 person-years. Using Cox proportional hazard models, zidovudine-based (AZT-based) regimen versus stavudine-based (D4T-based) regimen had an adjusted HR (AHR) for death of 0.65 (95% CI 0.58 to 0.73); the AHR of tenofovir-based (TDF-based) versus D4T-based regimens was 0.81 (95% CI 0.71 to 0.92), and of lopinavir–ritonavir-based (LPV/r-based) versus D4T-based regimens, 1.19 (95% CI 1.04 to 1.37). AZT-based versus D4T-based regimens had an AHR for dropout of 0.89 (95% CI 0.81 to 0.97); this ratio for TDF-based versus D4T-based regimens was 0.88 (95% CI 0.80 to 0.98), and for LPV/r-based versus D4T-based regimens, 1.42 (95% CI 1.27 to 1.58). AZT-based and TDF-based regimens had a lower risk compared with D4T-based regimens, while LPV/r-based regimens had a higher risk. High gastrointestinal reactions and poor adherence were observed among HIV patients whose initial ART regimen was LPV/r-based.

Conclusions

Our study found that the treatment outcomes of initial ART regimens that were AZT-based or TDF-based were significantly better than D4T-based or LPV/r-based regimens. This finding could be related to the higher rates of gastrointestinal reactions and poorer adherence associated with the LPV/r-based regimens compared with other initial ART regimens.
Diagnostic accuracy of contemporary and high-sensitivity cardiac troponin assays used in serial testing, versus single-sample testing as a comparator, to triage patients suspected of acute non-ST-segment elevation myocardial infarction: a systematic review protocol
Authors: Zhelev Zhivko , Ohtake Hirotaka , Iwata Mitsunaga , Terasawa Teruhiko , Rogers Morwenna , Peters Jaime L , Hyde Chris
Published: March 2019

Introduction

Although the new generation of cardiac troponin assays have revolutionised the diagnosis of myocardial infarction (MI), their application in triaging patients with suspected acute coronary syndrome requires further investigation. The objectives of the current systematic review are to evaluate the diagnostic accuracy of contemporary and high-sensitivity cardiac troponin assays used in serial testing, versus single-sample testing as a comparator, to identify patients with non-ST-segment-elevation MI in the emergency department.

Methods and analysis

We will conduct systematic searches of MEDLINE, EMBASE, Science Citation Index, the Cochrane Database of Systematic Reviews and the CENTRAL database covering the period from 1 January 2006 to present, with no restrictions on language or publication status. Two review authors will independently screen studies for inclusion, extract data from eligible studies and assess their methodological quality using Quality Assessment of Diagnostic Accuracy Studies version 2. Studies will be included if they evaluate contemporary or high-sensitivity cardiac troponin assays used in serial testing, in patients presenting to the ED with suspicion of MI. Estimates of sensitivity and specificity from each study will be presented in forest plots and in the receiver-operating characteristics space. If appropriate, we will pool the results using Bayesian hierarchical models that allow correction for imperfect reference standard. We will obtain summary estimates of sensitivity and specificity of alternative testing protocols and compare their accuracy. We will also investigate the impact of prespecified sources of heterogeneity and methodological quality items. If pooling of results is considered inappropriate, we will present our findings in tables and diagrams and will describe them narratively.

Ethics and dissemination

No formal ethical approval will be sought, but we will report on the ethical approval of the included studies. Dissemination of findings will be through publications in peer-reviewed journals, presentations at conferences and the websites of the universities.

PROSPERO registration number

CRD42018106379.
Effectiveness of the Diagnose-Intervene- Verify-Adjust (DIVA) model for integrated primary healthcare planning and performance improvement: an embedded mixed methods evaluation in Kaduna state, Nigeria
Authors: Eboreime Ejemai Amaize , Nxumalo Nonhlanhla , Ramaswamy Rohit , Ibisomi Latifat , Ihebuzor Nnenna , Eyles John
Published: March 2019

Objectives

This study evaluates the real-world effectiveness of Diagnose-Intervene-Verify-Adjust (DIVA), an innovative quality improvement mode, in improving primary healthcare (PHC) bottlenecks impeding health system performance in Kaduna, a northern Nigerian state.

Design

An embedded mixed method study design involving participant observation.

Setting

PHCs in 23 local government areas of Kaduna state, Nigeria.

Participants

138 PHC managers across the state (PHC directors and programme managers in the 23 local governments).

Intervention

DIVA is a four-step improvement model in which ‘Diagnose’ identifies constraints to effective coverage, ‘Intervene’ develops/implements action plans addressing constraints, while ‘Verify/Adjust’ monitor performance and revise plans.

Primary and secondary outcome measures

The model, as adapted in Nigeria, is designed to evaluate and improve the availability of health commodities, human resources, geographical accessibility, acceptability, continuous utilisation and quality of four PHC interventions (immunisation, integrated management of childhood illnesses, antenatal care and skilled birth attendance).

Results

183 bottlenecks were identified by local government teams across all interventions in 2013. 41% of bottlenecks concern human resources. Geographical access and availability of commodities ranked least. Availability of commodities was the most improved determinant although among the least constrained, probably indicating skewed implementation of operational plans. 1562 activities were planned to address identified bottlenecks in the state, of which only 568 (36%) were completely implemented

Conclusion

Our study demonstrates that PHC planning using the DIVA model can potentially improve health system performance. However, effective implementation is critical and may require some central government oversight.
Methodological advantages and disadvantages of parallel and crossover randomised clinical trials on methylphenidate for attention deficit hyperactivity disorder: a systematic review and meta-analyses
Authors: Krogh Helle B , Storebø Ole Jakob , Faltinsen Erlend , Todorovac Adnan , Ydedahl-Jensen Erica , Magnusson Frederik Løgstrup , Holmskov Mathilde , Gerner Trine , Gluud Christian , Simonsen Erik
Published: March 2019

Objective

To assess the methodological advantages and disadvantages of parallel and crossover designs in randomised clinical trials on methylphenidate for children and adolescents with attention deficit hyperactivity disorder (ADHD).

Design

Secondary analyses of a Cochrane systematic review.

Setting and participants

We searched relevant databases up to March 2015 and included data from parallel and crossover randomised trials assessing children and adolescents up to 18 years with ADHD.

Interventions

Methylphenidate compared with placebo or no-treatment interventions.

Primary and secondary outcomes

The primary outcomes were teacher-rated ADHD symptoms and serious adverse events. The secondary outcomes were non-serious adverse events.

Results

We included 38 parallel trials (n=5111) and 147 crossover trials (n=7134). When comparing methylphenidate with placebo or no-treatment on ADHD symptoms, we found no differences between the end of parallel trials and the first-period from crossover trials (Χ²=1.06, df=1, p=0.30, I²=5.5%). We also found no differences when combining the end of first-period crossover trials with the end of parallel trials and comparing them to the end of last-period crossover trials (Χ²=3.25, df=1, p=0.07, I²=69.2%). We found no differences in serious and non-serious adverse events, and no risk of period and carryover effects. However, only two trials contributed data to the latter analyses.

Conclusions

Both parallel and crossover trials seem suitable for investigating methylphenidate in children and adolescents with ADHD, with comparable estimates on ADHD symptom severity and adverse events. However, parallel trials might still offer ethical and statistical advantages over crossover trials.
Joint observation in NICU (JOIN): study protocol of a clinical randomised controlled trial examining an early intervention during preterm care
Authors: Schneider Juliane , Borghini Ayala , Morisod Harari Mathilde , Faure Noemie , Tenthorey Chloé , Le Berre Aurélie , Tolsa Jean-François , Horsch Antje
Published: March 2019

Introduction

Preterm birth may generate significant distress among the parents, who often present with difficulties in appropriating their parental role. Parental stress and low perceived parental self-efficacy may interfere with the infant’s socioemotional and cognitive development, particularly through disrupted parent–infant interactions. Perceived parental self-efficacy represents the belief of efficacy in caring for one’s own infant and successful incarnation of the parental role, as well as the perception of one’s own abilities to complete a specified task. Interventions to support parental role, as well as infant development, are needed, and parental self-efficacy represents a useful indicator to measure the effects of such early interventions.

Methods and analysis

This study protocol describes a randomised controlled trial that will test an early intervention in the neonatal intensive care unit (NICU) (JOIN: Joint Observation In Neonatology) carried out by an interdisciplinary staff team. Mothers of preterm neonates born between 28 and 32 6/7 weeks of gestational age are eligible for the study. The intervention consists of a videotaped observation by a clinical child psychologist or child psychiatrist and a study nurse of a period of care delivered to the neonate by the mother and a NICU nurse. The care procedure is followed by an interactive video guidance intended to demonstrate the neonate’s abilities and resources to his parents. The primary outcome will be the difference in the perceived maternal self-efficacy between the intervention and control groups assessed by self-report questionnaires. Secondary outcomes will be maternal mental health, the perception of the parent– infant relationship, maternal responsiveness and the neurodevelopment of the infant at 6 months corrected age.

Ethics and dissemination

Ethical approval was granted by the Human Research Ethics Committee of the Canton de Vaud (study number 496/12). Results from this study will be disseminated at national and international conferences, and in peer-reviewed journals.

Trial registration number

NCT02736136, Pre-results.
Aetiology and risks factors associated with the fatal outcomes of childhood pneumonia among hospitalised children in the Philippines from 2008 to 2016: a case series study
Authors: Dembele Bindongo Price Polycarpe , Kamigaki Taro , Dapat Clyde , Tamaki Raita , Saito Mariko , Saito Mayuko , Okamoto Michiko , Igoy Mary Ann U , Mercado Edelwisa Segubre , Mondoy Melisa , Tallo Veronica L , Lupisan Socorro P , Egawa Shinichi , Oshitani Hitoshi
Published: March 2019

Objective

Pneumonia remains the leading cause of hospitalisations and deaths among children aged <5 years. Diverse respiratory pathogens cause acute respiratory infections, including pneumonia. Here, we analysed viral and bacterial pathogens and risk factors associated with death of hospitalised children.

Design

A 9-year case series study.

Setting

Two secondary-care hospitals, one tertiary-care hospital and one research centre in the Philippines.

Participants

5054 children aged <5 years hospitalised with severe pneumonia.

Methods

Nasopharyngeal swabs for virus identification, and venous blood samples for bacterial culture were collected. Demographic, clinical data and laboratory findings were collected at admission time. Logistic regression analyses were performed to identify the factors associated with death.

Results

Of the enrolled patients, 57% (2876/5054) were males. The case fatality rate was 4.7% (238/5054), showing a decreasing trend during the study period (p<0.001). 55.0% of the patients who died were either moderately or severely underweight. Viruses were detected in 61.0% of the patients, with respiratory syncytial virus (27.0%) and rhinovirus (23.0%) being the most commonly detected viruses. In children aged 2–59 months, the risk factors significantly associated with death included age of 2–5 months, sensorial changes, severe malnutrition, grunting, central cyanosis, decreased breath sounds, tachypnoea, fever (≥38.5°C), saturation of peripheral oxygen <90%, infiltration, consolidation and pleural effusion on chest radiograph.

Among the pathogens, adenovirus type 7, seasonal influenza A (H1N1) and positive blood culture for bacteria were significantly associated with death. Similar patterns were observed between the death cases and the aforementioned factors in children aged <2 months.

Conclusion

Malnutrition was the most common factor associated with death and addressing this issue may decrease the case fatality rate. In addition, chest radiographic examination and oxygen saturation measurement should be promoted in all hospitalised patients with pneumonia as well as bacteria detection to identify patients who are at risk of death.