bluuebunny/crossref_metadata_2025 huggingface dataset:
Activation tagging identifies Arabidopsis transcription factor AtMYB68 for heat and drought tolerance at yield determining reproductive stages
Authors: Deng Mingde , Wang Yang , Kuzma Monika , Chalifoux Maryse , Tremblay Linda , Yang Shujun , Ying Jifeng , Sample Angela , Wang Hung‐Mei , Griffiths Rebecca , Uchacz Tina , Tang Xurong , Tian Gang , Joslin Katelyn , Dennis David , McCourt Peter , Huang Yafan , Wan Jiangxin
Published: October 2020

Heat stress occurring at reproductive stages can result in significant and permanent damage to crop yields. However, previous genetic studies in understanding heat stress response and signaling were performed mostly on seedling and plants at early vegetative stages. Here we identify, using a developmentally defined, gain‐of‐function genetic screen with approximately 18 000Arabidopsis thalianaactivation‐tagged lines, a mutant that maintained productive seed set post‐severe heat stress during flowering. Genome walking indicated this phenotype was caused by the insertion of 35S enhancers adjacent to a nuclear localized transcription factor AtMYB68. Subsequent overexpression analysis confirmed thatAtMYB68was responsible for the reproductive heat tolerance of the mutant. Furthermore, these transgenic Arabidopsis plants exhibited enhanced abscisic acid sensitivity at and post‐germination, reduced transpirational water loss during a drought treatment, and enhanced seed yield under combined heat and drought stress during flowering. Ectopic expression ofAtMYB68inBrassica napusdriven either by 35S or by heat‐inducible promoter recapitulated the enhanced reproductive heat stress and drought tolerance phenotypes observed in the transgenic Arabidopsis. The improvement to heat stress is likely due to enhanced pollen viability observed in the transgenic plants. More importantly, the transgenic canola showed significant yield advantages over the non‐transgenic controls in multiple locations, multiple season field trials under various drought and heat stress conditions. Together these results suggest thatAtMYB68regulate plant stress tolerance at the most important yield determining stage of plant development, and is an effective target for crop yield protection under current global climate volatility.
Reducing the Incidence of Amiodarone‐related Phlebitis Through Utilization of Evidence‐based Practice
Authors: Murphy Kristie , Murphy Jane , Fischer‐Cartlidge Erica
Published: October 2020

Background

Intravenous (IV) amiodarone has multiple indications including treatment of hemodynamically unstable patients and the prevention of atrial or ventricular arrhythmias after thoracic surgery. Inflammation of the vein, or phlebitis, is the most common adverse event associated with peripherally administered amiodarone. In 2017, a rise in reported phlebitis incidents was occurring at one large academic medical center.

Aim

This evidence‐based quality improvement initiative aimed to decrease and enhance early detection of phlebitis in patients receiving amiodarone.

Methods

Due to the variation in assessment and management standards, evidence‐based practice (EBP) methodology was utilized to establish a process for quality improvement. A thorough literature search was completed, identifying evidence‐based interventions to decrease phlebitis and enhance early detection. Thorough critiques of the literature and synthesis of the evidence were completed. Multidisciplinary guidelines based on the literature were created. The guidelines included interventions such as an increase in IV assessment frequency, vein selection criteria, and the utilization of a standardized grading tool for assessment.

Results

Phlebitis was reduced by 30%–88%. In the first 6 months post‐intervention, there was a 48% reduction in phlebitis cases. In addition, the severity of phlebitis and the quality of reporting also improved dramatically.

Linking Evidence to Action

This evidence‐based quality improvement process led to identifying relevant knowledge gaps in care that could be streamlined into everyday nursing practice to decrease patient harm. This paper describes an in‐depth process of how EBP helped to quickly take a clinical inquiry and adapt change based on findings from the evidence. Other organizations can utilize EBP to solve patient safety concerns using similar processes.
Experimental Frequency-Domain Vibration Based Fault Diagnosis of Roller Element Bearings Using Support Vector Machine
Authors: Salunkhe Vishal G. , Desavale R. G. , Jagadeesha T.
Published: October 2020

In heavy rotating machines and assembly lines, bearing failure in any one of them may result in shut down and affects the overall cost and quality of the product. Condition monitoring of bearing systems avoids breakdown and saves time and cost of preventive and corrective maintenance. This research paper proposes advanced fault detection strategies for taper rolling bearings. In this, a mathematical model using dimension analysis by matrix method (DAMM) and support vector machine (SVM) is developed to predict the vibration characteristic of the rotor-bearing system. Various types of defects created using an electric discharge machine (EDM) are analyzed by correlating dependent and independent parameters. Experiments were performed to classify the rotor dynamic characteristic of the bearings and validated the models developed using DAMM and SVM. Results showed the potential of DA and SVM to predict the dynamic response and contribute to the service life extension, efficiency improvement, and reduce failure of bearings. Thus, the automatic online diagnosis of bearing faults is possible with a developed model-based by DAMM and SVM.
Pulp and Paper Mill Steady State Analysis for Carbon Neutral Integration of a Small Modular Reactor
Authors: Worsham Elizabeth K. , Terry Stephen D.
Published: October 2020

Small modular reactors (SMRs) are small-scale reactor designs (< 300 MWe), generally planned for deployment as multi-module nuclear power plants. Due to their small size, SMR modules could be manufactured in a factory and deployed to a site via truck or rail for installation and fueling. SMRs are being evaluated for their ability to provide both power and steam, such that they could be a viable replacement for fossil fuels. SMRs have been considered for coupling to manufacturing processes in addition to being connected to the grid, allowing them to follow the net grid demand in a “load following” operational mode during times of high renewable generation. Alternately, SMRs could be used to replace cogeneration and combined-cycle processes at manufacturing plants which utilize natural gas and other fossil fuels. Idaho National Laboratory (INL) is studying the use of SMRs for large-scale manufacturing processes that require both electricity and steam. The current study examines the integration of a SMR with two mid-size pulp and paper mills in the southeastern United States. The study consists of three parts: steady-state analysis of the mill, elimination of fossil fuel use in the lime kilns, and economic analysis of the modified plant operations. A steady-state model of each mill is developed in Aspen HYSIS based on real data from the operation of each mill. The steady-state model is then modified to include the SMR while maintaining production steam quality and making as few changes to existing equipment as possible. This model gives an estimate of the minimum requirements for SMR output, as well as the change in generation by existing boilers and turbines. With an overall picture of the new plant operation and determining the number of SMR modules required, further changes are suggested to minimize or completely eliminate fossil fuel use from the plant. Apart from steam generation, the largest consumer of fossil fuels at the plant is typically the lime kilns. Conversion of the lime kilns from fossil fuel combustion to electric heating is the most feasible solution to eliminate fossil fuels. This study finds that electric lime kilns are economical when the plant has a surplus This study presents a feasible example of using an SMR as a substitute for fossil fuel cogeneration. If this approach were expanded across the manufacturing industry, it would have a significant impact on environmental emissions and air quality.
Thermal Performance With Entropy Generation Analysis of Fluid Flow in a Heat Exchanger Pipe With Single and Double Strip Helical Screw Tape Inserts
Authors: Chaurasia Shashank Ranjan , Sarviya R. M.
Published: October 2020

In heat exchangers, twisted tape insert is a technique to enhance heat transfer. In this paper, the experimental investigation is arranged to analyse thermal performance and entropy generation analysis on fluid flow in helical screw inserts with number of strips. The Nusselt number is achieved enhancement with double strip as compared to single strip helical screw inserts at decreased values of twist ratio and increased values of flow rates. The Nusselt number is achieved maximum enhancement of 112% with double strip helical screw insert than plain tube at 4000 of Reynolds number, whereas it is found higher value at Reynolds number of 16000. The common correlations of Nusselt number and friction factor with repect of Reynolds number, number of the strips and twist ratio are generated. The entropy generation analysis is also performed. The thermal performance factor is found increment with double strip than single strip helical screw inserts at twist ratio of 2.5 and 3, whereas, it is attained maximum value of 1.5 at twist ratio 2.5 and Reynolds number of 16000 with double strip helical screw insert. The double strip helical screw inserts are suitable for reducing the size of heat exchanger, which could dercrease the size of many thermal applications as solar water heater, radiator, electronic cooling systems.
Characterization of Precipitates and Formed Oxides in Fatigue Crack of Alloy 617 in a Steam Environment at 750°C
Authors: Yoshida Masumi , Araki Kosuke , Takeda Yoichi , Nakano Susumu
Published: October 2020

Alloy 617 is a Ni-base superalloy and is a candidate material for high temperature steam piping systems and casings for advanced ultra-supercritical power generation technology because of its excellent high temperature creep strength. It is expected in the near future that the installation of variable renewable energies with large output fluctuations will increase. Therefore, adjusting the supply and demand of electricity is requested for thermal power generation. This leads to the issue of fatigue damage caused by repeated thermal stress due to the startup and shutdown procedures.

It was reported that the fatigue crack growth of alloy 617 changed from transgranular to intergranular at 750°C, with a decreasing loading frequency in a steam environment. It was also indicated that the increase in the crack growth rate in lower loading frequency conditions; however, the specific acceleration mechanism governing the crack growth has not been elucidated.

In this study, morphology of oxide and precipitates at fatigue crack tip region were analyzed by transmission electron microscope. All of examined crack tip were filled with oxides. Especially, the double layered oxide film was formed in the crack tip which propagated under the lower loading frequencies. In addition, unoxidized precipitates mainly consisting of Mo and Co were observed in the intergranular cracks. It was suggested that the changes in the oxidation morphologies depending on the loading frequency influenced the crack growth rate.
Study on Gas-Liquid Two-Phase Flow Distribution Inside a Flute Header
Authors: Pang Liping , Li Shangmin , Yuan Hu , Duan Liqiang
Published: October 2020

When the supercritical boiler is working at low load during flexible operation, the uneven distribution of the gas-liquid flow at the intermediate header may affect the safety of the water-cooled wall at the vertical parallel panels. In order to improve the uniformity of gas-liquid flow distribution in the water-cooled wall of intermediate header and study the internal flow mechanism, a flute inside the header is applied with parallel vertical parallel channels and experiments under different operating conditions are conducted to verify the effectiveness of this geometrical structure. The flow pattern in the experiment belongs to stratified and wavy flow. Computational fluid dynamic (CFD) simulation is conducted in order to investigate two-phase flow distribution behavior inside a flute header. It was found that the radial gas phase distribution in the flute tube shows a symmetrical relationship, and there are two vortexes in opposite directions. With the increasing distance from the inlet, the uniformity of the gas phase distribution becomes even. The gravity is greater than the drag force, which has effect on the two-phase flow distribution. The gas phase velocity has been improved inside flute section and liquid phase flow has more even flow distribution along annular section. It makes liquid phase sent to far end of flute header. That benefits two-phase flow distribution along 10 parallel channels equally.
Escherichia coli K12 Upregulates Programmed Cell Death Ligand 1 (PD-L1) Expression in Gamma Interferon-Sensitized Intestinal Epithelial Cells via the NF-κB Pathway
Authors: Lee Seul A. , Wang Yiming , Liu Fang , Riordan Stephen M. , Liu Lu , Zhang Li
Published: October 2020

Programmed cell death ligand-1 (PD-L1) is an immune checkpoint protein which is used by tumor cells for immune evasion. PD-L1 is upregulated in inflamed intestinal tissues. The intestinal tract is colonized by millions of bacteria, most of which are commensal bacterial species. We hypothesized that under inflammatory conditions, some commensal bacterial species contribute to increased PD-L1 expression in intestinal epithelium and examined this hypothesis. Human intestinal epithelial HT-29 cells with and without interferon (IFN)-γ sensitization were incubated with six strains of four enteric bacterial species.
Evaluation of a Fecal Shedding Test To Detect Badger Social Groups Infected with Mycobacterium bovis
Authors: Murphy Andrew R. J. , Travis Emma R. , Hibberd Victoria , Porter David , Wellington Elizabeth M. H.
Published: October 2020

Bovine tuberculosis (bTB) is an economically important disease affecting the cattle industry in England and Wales. bTB, caused by
Mycobacterium bovis
, also causes disease in the Eurasian badger (
Meles meles
), a secondary maintenance host. Disease transmission between these two species is bidirectional. Infected badgers shed
M. bovis
in their feces. The Animal and Plant Health Agency (APHA) of the United Kingdom organized a comparative trial to determine the performance of tests in detecting
M. bovis
in badger feces for the Department for Environment, Food, and Rural Affairs (DEFRA).
High-Resolution Genome-Wide Occupancy in
Candida
spp. Using ChEC-seq
Authors: Tebbji Faiza , Khemiri Inès , Sellam Adnane
Published: October 2020

Systemic fungal infections caused by
Candida albicans
and the “superbug”
Candida auris
are becoming a serious public health threat. The ability of these yeasts to cause disease is linked to their faculty to modulate the expression of genes that mediate their escape from the immune surveillance and their persistence in the different unfavorable niches within the host. Comprehensive knowledge on gene expression control of fungal fitness is consequently an interesting framework for the identification of essential infection processes that could be hindered by chemicals as potential therapeutics. Here, we expanded the use of ChEC-seq, a technique that was initially developed in the yeast model
Saccharomyces cerevisiae
to identify genes that are modulated by a transcriptional regulator, in pathogenic yeasts from the genus
Candida
. This robust technique will allow a better characterization of key gene expression regulators and their contribution to virulence and antifungal resistance in these pathogenic yeasts.
Descriptive, Retrospective Study of the Clinical Characteristics of Asymptomatic COVID-19 Patients
Authors: Han Huan , Xu Zaichao , Cheng Xiaoming , Zhong Youquan , Yuan Li , Wang Fubing , Li Yan , Liu Fang , Jiang Yingan , Zhu Chengliang , Xia Yuchen
Published: October 2020

Asymptomatic transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a potential problem for pandemic control through public health strategies. Our results demonstrate that asymptomatic COVID-19 patients have better outcomes than symptomatic patients. This may have been due to more active cellular immune responses and normal liver function. Since asymptomatic patients have no clinical symptoms which can easily prevent timely diagnosis and treatment, they may cause a greater risk of virus transmission than symptomatic patients, which poses a major challenge to infection control. Evidence suggests that nonpharmaceutical public health interventions, like social distancing and face mask ordinances, play important roles in the control of COVID-19. Looking forward, it may be necessary to proceed cautiously while reopening businesses in areas of epidemicity to prevent potential waves of COVID-19 in the future.
Clinical, pharmacokinetic and economic analysis of the first switch to an extended half-life factor IX (albutrepenonacog alfa, rFIX-FP) in Spain
Authors: Rodríguez López Manuel , Megías Vericat Juan Eduardo , Albo López Carmen , Bonanad Santiago
Published: October 2020

Extended half-life of factor IX (FIX) demonstrated clinical benefit and lower treatment burden than standard half-life FIX products in clinical trials. We analysed the impact in efficacy, pharmacokinetics (PKs) and costs of the switch from nonacog alfa (rFIX) to albutrepenonacog alfa (rFIX-FP) in the first patient with haemophilia B (HB) treated in Spain outside clinical trials. A 7-year-old boy presented with HB with poor venous access and repetition infections using rFIX, which was switched to rFIX-FP. Prophylaxis was adjusted by PKs using WAPPS-Hemo tailoring from 100 IU/kg/week of rFIX to 80 IU/kg/3 weeks of rFIX-FP. Comparing 6 months before, rFIX-FP reduced 68.5% FIX consumption/kg and 58.3% infusion frequency, but total costs/weight showed a slight increase. Ratio of half-life between rFIX and rFIX-FP was 3.4–3.7. This case report revealed that switch to rFIX-FP decreased frequency and FIX consumption, without adverse events and bleeds.
Targeting rehabilitation to improve outcomes after total knee arthroplasty in patients at risk of poor outcomes: randomised controlled trial
Authors: Hamilton David F , Beard David J , Barker Karen L , Macfarlane Gary J , Tuck Christopher E , Stoddart Andrew , Wilton Timothy , Hutchinson James D , Murray Gordon D , Simpson A Hamish R W
Published: October 2020

Objective

To evaluate whether a progressive course of outpatient physiotherapy offers superior outcomes to a single physiotherapy review and home exercise based intervention when targeted at patients with a predicted poor outcome after total knee arthroplasty.

Design

Parallel group randomised controlled trial.

Setting

13 secondary and tertiary care centres in the UK providing postoperative physiotherapy.

Participants

334 participants with knee osteoarthritis who were defined as at risk of a poor outcome after total knee arthroplasty, based on the Oxford knee score, at six weeks postoperatively. 163 were allocated to therapist led outpatient rehabilitation and 171 to a home exercise based protocol.

Interventions

All participants were reviewed by a physiotherapist and commenced 18 sessions of rehabilitation over six weeks, either as therapist led outpatient rehabilitation (progressive goal oriented functional rehabilitation protocol, modified weekly in one-one contact sessions) or as physiotherapy review followed by a home exercise based regimen (without progressive input from a physiotherapist).

Main outcome measures

Primary outcome was Oxford knee score at 52 weeks, with a 4 point difference between groups considered to be clinically meaningful. Secondary outcomes included additional patient reported outcome measures of pain and function at 14, 26, and 52 weeks post-surgery.

Results

334 patients were randomised. Eight were lost to follow-up. Intervention compliance was more than 85%. The between group difference in Oxford knee score at 52 weeks was 1.91 (95% confidence interval −0.18 to 3.99) points, favouring the outpatient rehabilitation arm (P=0.07). When all time point data were analysed, the between group difference in Oxford knee score was a non-clinically meaningful 2.25 points (0.61 to 3.90, P=0.01). No between group differences were found for secondary outcomes of average pain (0.25 points, −0.78 to 0.28, P=0.36) or worst pain (0.22 points, −0.71 to 0.41, P=0.50) at 52 weeks or earlier time points, or of satisfaction with outcome (odds ratio 1.07, 95% confidence interval 0.71 to 1.62, P=0.75) or post-intervention function (4.64 seconds, 95% confidence interval −14.25 to 4.96, P=0.34).

Conclusions

Outpatient therapist led rehabilitation was not superior to a single physiotherapist review and home exercise based regimen in patients at risk of poor outcomes after total knee arthroplasty. No clinically relevant differences were observed across primary or secondary outcome measures.

Trials registration

Current Controlled Trials
ISRCTN23357609
and ClinicalTrials.gov
NCT01849445
.
Prescribing trends over time by non-medical independent prescribers in primary care settings across Wales (2011–2018): a secondary database analysis
Authors: Alghamdi Saeed Saad A , Hodson Karen , Deslandes Paul , Gillespie David , Haines Kath , Hulme Elliott , Courtenay Molly , Deslandes Rhian
Published: October 2020

Introduction

As of 2015, as part of the implementation of the Welsh Government primary care plan and primary care clusters, the Welsh Government has encouraged non-medical healthcare professionals working in primary care to train as independent prescribers (IPs).

Objectives

This research aimed to identify the number of NMIPs in primary care in Wales and describe their prescribing trend of items between 2011 and 2018, in order to compare their prescribing pattern before and after the implementation of primary care clusters for Wales.

Design

Retrospective secondary data analysis and interrupted time series analysis in order to compare prescribing by non-medical independent prescribers (NMIPs) preimplementation and postimplementation of primary care clusters across Wales.

Results

Over the study period, 600 NMIPs (nurses n=474 and pharmacists n=104) had prescribed at least one item. The number of nurse IPs increased by 108% and pharmacists by 325% (pharmacists had the largest increase between July 2015 and March 2018). The number of items prescribed by NMIPs increased over time by an average of 1380 per month (95% CI 904 to 1855, p<0.001) after the implementation of primary care clusters compared with 496 (95% CI 445 to 548, p<0.001) prior its implementation. Approximately one-third of the items prescribed by NMIPs was within Betsi Cadwaladr University Health Board (HB) with only 4% in Powys Teaching HB.

Conclusion

The number of NMIPs and their volume of prescribing in primary care in Wales has increased following the implementation of primary care clusters in 2015. This suggests that the Government’s recommendations of using NMIPs in primary care have been implemented. Future studies should focus on efficiency and quality of prescribing by NMIPs in primary care.
Patient-reported experiences with general practitioners: a randomised study of mail and web-based approaches following a national survey
Authors: Iversen Hilde Hestad , Holmboe Olaf , Bjertnaes Oyvind
Published: October 2020

Objective

The standard data-collection procedure in the Norwegian national patient experience survey programme is post-discharge mail surveys, which include a pen-and-paper questionnaire with the option to answer electronically. A purely electronic protocol has not previously been explored in Norway. The aim of this study was to compare response rates, background characteristics, data quality and main study results for a survey of patient experiences with general practitioners (GPs) administered by the standard mail data-collection procedure and a web-based approach.

Design

Cross-sectional survey.

Setting

GP offices in Norway.

Participants

The sample consisted of 6999 patients aged 16 years and older registered with a GP in November 2018.

Intervention

Based on a three-stage sampling design, 6999 patients of GPs aged 16 or older were randomised to one of two survey administration protocols: Group A, who were mailed an invitation with both a pen-and-paper including an electronic response option (n=4999) and Group B, who received an email invitation with electronic response option (n=2000).

Main outcome measures

Response rates, background characteristics, data quality and main study results.

Results

The response rate was markedly higher for the mail survey (42.6%) than for the web-based survey (18.3%). A few of the background variables differed significantly between the two groups, but the data quality and patient-reported experiences were similar.

Conclusions

Web-based surveys are faster and less expensive than standard mail surveys, but their low response rates and coverage problems threaten their usefulness and legitimacy. Initiatives to increase response rates for web-based data collection and strategies for tailoring data collection to different groups should be key elements in future research.
Effect of mHealth tool on knowledge regarding reproductive health of school going adolescent girls: a before-after quasi-experimental study
Authors: Ahmed Tanima
Published: October 2020

Objective

This study was executed to (1) assess the effect of mHealth (mobile health) tool on knowledge regarding reproductive health (RH) of adolescent girls and (2) determine the utilisation of mHealth tool among school girls.

Design

Before-after type of quasi-experimental study.

Setting

Dhaka North City Corporation in Bangladesh.

Participants

400 adolescent girls aged 14–19 years were selected based on defined criteria.

Interventions

Short message service (SMS) intervention on RH was delivered through a mobile phone.

Primary and secondary outcome measures

8 schools out of 61 were randomly selected in the study area. A total of 400 girls were selected randomly on permission from those schools and parents. SMS interventions were delivered for 8 weeks. The data were collected using a self-administered questionnaire before and after SMS intervention to evaluate the effect. The number of responses to weekly SMS determined mHealth usage or practice.

Results

Postintervention knowledge score (mean 70.8%±9.7%) on RH was significantly higher (paired t=69.721, p<0.001) than preintervention knowledge score (mean 44.71%±9.13%) with a large effect size (cohen’s d=3.6). The knowledge score on RH was (p<0.001) correlated (+0.636) with SMS response. Multiple linear regression indicated that increase response to one SMS intervention there was an increase of knowledge score by 2.661% (linear slope 2.66, at 95% CI, p<0.001) after controlling the confounder. The mean knowledge score in all five knowledge segments of RH increased significantly (p<0.001) after SMS intervention.

Conclusion

The result indicated that the SMS tool of the mHealth approach is an easy and effective way to improve RH knowledge for adolescent girls. SMS intervention was well accepted by the girls. Thereby this mHealth tool can be chosen to provide health information for a mass approach.
Perioperative intravenous lignocaine infusion for postoperative pain control in patients undergoing surgery of the spine: protocol for a systematic review and meta-analysis
Authors: Licina Ana , Silvers Andrew
Published: October 2020

Introduction

Intravenous lignocaine is an amide local anaesthetic known for its analgesic, antihyperalgesic and anti-inflammatory properties. Administration of intravenous lignocaine has been shown to enhance perioperative recovery parameters. This is the protocol for a systematic review which intends to summarise the evidence base for perioperative intravenous lignocaine administration in patients undergoing spinal surgery.

Methods and analysis

Our primary outcomes include: postoperative pain scores at rest and movement at predefined early, intermediate and late time points and adverse events. Other outcomes of interest include perioperative opioid consumption, composite morbidity, surgical complications and hospital length of stay. We will include randomised controlled trials, which compared intravenous lignocaine infusion vs standard treatment for perioperative analgesia. We will search electronic databases from inception to present; MEDLINE, EMBASE and Cochrane Library (Cochrane Database of Systematic Reviews and CENTRAL). Two team members will independently screen all citations, full-text articles and abstract data. The individual study risk of bias will be appraised using the Cochrane risk of bias tool. We will obtain a risk ratio or mean difference (MD) from the intervention and control group event rates based on the nature of data. We will correct for the variable measurement tools by using the standardised MD (SMD). We will use a random-effects model to synthesise data. We will conduct five subgroup analysis: major versus minor surgery, emergency versus elective surgery, patients with chronic pain conditions versus patients without, duration of lignocaine infusion and adult versus paediatric. Confidence in cumulative evidence for will be classified according to the Grading of Recommendations, Assessment, Development and Evaluation system. We will construct summary of findings tables supported detailed evidence profile tables for predefined outcomes.

Ethics and dissemination

Formal ethical approval is not required as primary data will not be collected. The results will be disseminated through a peer-reviewed publication.

PROSPERO registration number

CRD420201963314
Factors contributing to the patient safety culture in Saudi Arabia: a systematic review
Authors: Albalawi Abdulmajeed , Kidd Lisa , Cowey Eileen
Published: October 2020

Background

Patient safety, concerned with the prevention of harm to patients, has become a fundamental component of the global healthcare system. The evidence regarding the status of the patient safety culture in Arab countries in general shows that it is at a suboptimal level due to a punitive approach to errors and deficits in the openness of communications.

Objectives

To identify factors contributing to the patient safety culture in Saudi Arabia.

Design

Systematic review.

Methods

A systematic search was carried out in May 2018 in five electronic databases and updated in July 2020—MEDLINE, CINAHL, Embase, PsycINFO and the Cochrane Database of Systematic Reviews. Relevant journals and reference lists of included studies were also hand-searched. Two independent reviewers verified that the studies met the inclusion criteria, assessed the quality of studies and extracted their relevant characteristics. The Yorkshire Contributory Factors Framework (YCFF) was used to categorise factors affecting safety culture in the included papers.

Results

14 papers were included and the majority of studies were appraised as being of good quality. Strength and weakness factors that contribute to patient safety culture were identified. Ineffective leadership, a blame culture, workload/inadequate staffing and poor communication are reported as the main factors hindering a positive patient safety culture in Saudi Arabia. Conversely, ‘strength’ factors contributing to a positive patient safety culture included supportive organisational attitudes to learning/continuous improvement, good teamwork within units and support from hospital management for patient safety. There is an absence of patient perspectives regarding patient safety culture in Saudi Arabia.

Conclusion

Policymakers in the Saudi healthcare system should pay attention to the factors that may contribute to a positive patient safety culture, especially establishing a blame-free culture, improving communications and leadership capacity, learning from errors and involving patient perspectives in safety initiatives. Further research is required to understand in depth the barriers and facilitators to the implementation of a positive patient safety culture in Saudi Arabia.
Rehabilitative management of back pain in children: protocol for a mixed studies systematic review
Authors: Cancelliere Carol , Wong Jessica J , Yu Hainan , Mior Silvano , Brunton Ginny , Shearer Heather M , Rudoler David , Hestbæk Lise , Papaconstantinou Efrosini , Cedraschi Christine , Swain Michael , Connell Gaelan , Verville Leslie , Taylor-Vaisey Anne , Côté Pierre
Published: October 2020

Introduction

Little is known about effective, efficient and acceptable management of back pain in children. A comprehensive and updated evidence synthesis can help to inform clinical practice.

Objective

To inform clinical practice, we aim to conduct a systematic review of the literature and synthesise the evidence regarding effective, cost–effective and safe rehabilitation interventions for children with back pain to improve their functioning and other health outcomes.

Methods and analysis

We will search MEDLINE, Embase, PsycINFO, CINAHL, the Index to Chiropractic Literature, the Cochrane Controlled Register of Trials and EconLit for primary studies published from inception in all languages. We will include quantitative studies (randomised controlled trials, cohort and case–control studies), qualitative studies, mixed-methods studies and full economic evaluations. To augment our search of the bibliographic electronic databases, we will search reference lists of included studies and relevant systematic reviews, the WHO International Clinical Trials Registry Platform and consult with content experts. We will assess the risk of bias using appropriate critical appraisal tools. We will extract data about study and participant characteristics, intervention type and comparators, context and setting, outcomes, themes and methodological quality assessment. We will use a sequential approach at the review level to integrate data from the quantitative, qualitative and economic evidence syntheses.

Ethics and dissemination

Ethics approval is not required. We will disseminate findings through activities, including (1) presentations in national and international conferences; (2) meetings with national and international decision makers; (3) publications in peer-reviewed journals and (4) posts on organisational websites and social media.

PROSPERO registration number

CRD42019135009.
Troponin T but not C reactive protein is associated with future surgery for aortic stenosis: a population-based nested case-referent study
Authors: Holmgren Anders , Ljungberg Johan , Hultdin Johan , Johansson Bengt , Bergdahl Ingvar A , Näslund Ulf , Söderberg Stefan
Published: October 2020

Aims

High-sensitivity troponin T (hs-TnT) and high-sensitivity C reactive protein (hs-CRP) may convey prognostic information in patients with aortic stenosis (AS). This study evaluated if hs-TnT and hs-CRP associate with myocardial mass, and risk of future surgery for AS.

Methods

In total, 336 patients (48% women) with surgery for AS with previous participation in large population surveys were identified. Preoperatively, myocardial mass and the presence of coronary artery disease (CAD) were assessed. Two matched referents were allocated for each case, and hs-TnT and hs-CRP were determined in stored plasma from the baseline survey. Conditional logistic regression analysis was used to estimate the risk (OR (95% CI)) related to one (natural logarithm) SD increase in hs-TnT and hs-CRP. Kaplan-Mayer and Cox regression analyses were used to evaluate time to surgery.

Results

Median age (IQR) was 59.8 (10.3) years at survey, and median time between survey and surgery was 10.9 (9.3) years. Hs-TnT was independently associated with surgery for AS (1.24 (1.06–1.44)) irrespective of CAD, whereas Hs-CRP was not (1.05 (0.90–1.22)). Elevated hs-TnT levels at survey associated with shorter time to surgery (p<0.001), and with increased myocardial mass (p=0.002). Hs-CRP did not associate with time to surgery or with myocardial mass.

Conclusions

Hs-TnT—but not hs-CRP—was associated with increased risk of—and shorter time to—future surgery for AS. Hs-TnT associated with myocardial mass at surgery which indicates that hs-TnT could be a potential biomarker for determining intervention.
Factors associated with treatment satisfaction in patients with rheumatoid arthritis: data from the biological register RABBIT
Authors: Schäfer Martin , Albrecht Katinka , Kekow Jörn , Rockwitz Karin , Liebhaber Anke , Zink Angela , Strangfeld Anja
Published: October 2020

Objective

To assess satisfaction with the effectiveness and tolerability of treatments in patients with rheumatoid arthritis (RA).

Methods

Patients from the RABBIT register, starting a biological (b) or targeted synthetic (ts) disease-modifying antirheumatic drug (DMARD), or a conventional synthetic (cs)DMARD treatment after ≥1 csDMARD failure, were included. Treatment satisfaction was measured after 1 year of treatment in four categories and binarised for analysis. Logistic regression models were performed to calculate ORs for factors associated with treatment satisfaction.

Results

Data of 10 646 patients (74% women, mean 58 years) were analysed. At baseline, 55% of the patients were satisfied with the efficacy and 68% with the tolerability of their previously given treatments. After 1 year, 85% of the patients were satisfied with treatment effectiveness and 90% with tolerability. Baseline satisfaction (OR 2.98, 95% CI 2.58 to 3.44), seropositivity (OR 1.36, 95% CI 1.17 to 1.57), reduction of DAS28 (OR 1.38, 95% CI 1.31 to 1.46) and pain (OR 1.26, 95% CI 1.22 to 1.31), and the improvement of physical capacity (OR 1.22, 95% CI 1.17 to 1.29) were positively associated with treatment satisfaction at follow-up while glucocorticoids (GCs) >5 mg/day, depression, fibromyalgia, obesity, prior bDMARDs and therapy changes were negatively associated. The impact of GC on satisfaction was dose-dependent, becoming strongest for GC >15 mg (OR 0.24, 95% CI 0.16 to 0.34). A 5 mg/day reduction within 12 months was positively associated with satisfaction regarding efficacy (OR 1.19, 95% CI 1.11 to 1.27) and tolerability (OR 1.11, 95% CI 1.03 to 1.21).

Conclusion

Most patients were satisfied with their treatment’s effectiveness and tolerability after 1 year of treatment. Tapering GCs was positively associated with the improvement of patients’ satisfaction.
The relationship between altitudinal gradients, diversity, and body size in a dung beetle (Coleoptera: Scarabaeinae: Onthophagus) model system
Authors: Salomão R.P. , Arriaga-Jiménez A. , Kohlmann B.
Published: October 2020

Mountainous regions represent an excellent model to test ecological hypotheses encompassing assemblage diversity and body traits of species. Among insects, there is no uniform body size pattern across temperature gradients, suggesting that processes controlling body size may differ among species. The aim of this study was to explore diversity and body size patterns of dung beetle species of the genus Onthophagus Latreille, 1802 across altitudinal gradients at two mountains in Mexico. Tropical mountain species were sampled from 2200 to 3400 m a.s.l. In both mountains, there was a decrease of richness and abundance of Onthophagus with increasing altitude. There were contrasting relationships between beetle body size and altitude, which varied depending on the data set analyzed. Furthermore, interspecific variations of body size were not related to the number of altitudinal bands recorded by each species. Species from high altitudes were also recorded at lower mountain altitudes, suggesting that diversity at the highest altitudes represents a subgroup of lowland diversity. This may indicate that the fauna inhabiting higher elevations could be the most eurytopic one. Here we present an example of an assemblage that partially contradicts Bergmann’s rule, with contrasting effects of altitude on dung beetle body size.
Play, Curiosity, and Cognition
Authors: Chu Junyi , Schulz Laura E.
Published: October 2020

Few phenomena in childhood are as compelling—and mystifying—as play. We review five proposals about the relationship between play and development. We believe each captures important aspects of play across species; however, we believe none of them accounts for the extraordinary richness of human play or its connection to distinctively human learning. In thinking about play, we are particularly struck by the profligacy with which children set seemingly arbitrary rewards and incur unnecessary costs. We suggest that researchers take the seeming inutility of play seriously and consider why it might be useful to engage in apparently useless behavior. We propose that humans’ ability to choose arbitrary costs and rewards allows us to pursue novel goals, discover unexpected information, and invent problems we would not otherwise encounter. Because problems impose constraints on search, these invented problems may help solve a big problem: how to generate new ideas and plans in an otherwise infinite search space.
Criminal Trials and Reforms Intended to Reduce the Impact of Race: A Review
Authors: O'Brien Barbara , Grosso Catherine M.
Published: October 2020

This review collects initiatives and legal decisions designed to mitigate discrimination in pretrial decision making, jury selection, jury unanimity, and jury deliberations. It also reviews initiatives to interrupt implicit racial biases. Among these, Washington's new rule for jury selection stands alone in treating racism as the product of both individual actors’ decisions and long-standing legal structures. Washington's rule shows the limits of recent US Supreme Court decisions addressing discrimination in cases with unusual and clearly problematic facts. The court presents these cases as rare remediable aberrations, ignoring the well-documented history of racism in jury selection. The final section juxtaposes limited reforms with the contemporary prison abolitionist movement to illuminate boundaries of incremental reforms. Reforms must reflect cognizance of the extent to which racism exists at multiple levels. Reforms that do not are less likely to make change, because they are either narrow in scope or focused on discrimination by individuals.
Microbiota Effects on Carcinogenesis: Initiation, Promotion, and Progression
Authors: Lopez Lacey R. , Bleich Rachel M. , Arthur Janelle C.
Published: October 2020

Carcinogenesis is a multistep process by which normal cells acquire genetic and epigenetic changes that result in cancer. In combination with host genetic susceptibility and environmental exposures, a prominent procarcinogenic role for the microbiota has recently emerged. In colorectal cancer (CRC), three nefarious microbes have been consistently linked to cancer development: ( a) Colibactin-producing Escherichia coli initiates carcinogenic DNA damage, ( b) enterotoxigenic Bacteroides fragilis promotes tumorigenesis via toxin-induced cell proliferation and tumor-promoting inflammation, and ( c) Fusobacterium nucleatum enhances CRC progression through two adhesins, Fap2 and FadA, that promote proliferation and antitumor immune evasion and may contribute to metastases. Herein, we use these three prominent microbes to discuss the experimental evidence linking microbial activities to carcinogenesis and the specific mechanisms driving this stepwise process. Precisely defining mechanisms by which the microbiota impacts carcinogenesis at each stage is essential for developing microbiota-targeted strategies for the diagnosis, prognosis, and treatment of cancer.
Multi-Level Regulation of Opioid-Induced Respiratory Depression
Authors: Palkovic Barbara , Marchenko Vitaliy , Zuperku Edward J. , Stuth Eckehard A. E. , Stucke Astrid G.
Published: October 2020

Opioids depress minute ventilation primarily by reducing respiratory rate. This results from direct effects on the preBötzinger Complex as well as from depression of the Parabrachial/Kölliker-Fuse Complex, which provides excitatory drive to preBötzinger Complex neurons mediating respiratory phase-switch. Opioids also depress awake drive from the forebrain and chemodrive.
Combined Treatment of Non‐Small‐Cell Lung Cancer Using Shenyi Capsule and Platinum‐Based Chemotherapy: A Meta‐Analysis and Systematic Review
Authors: Xu Yong , Peng Wenpan , Han Di , Wang Zhichao , Gu Cheng , Feng Fanchao , Zhou Xianmei , Wu Qi
Published: October 2020

Background.The efficacy and safety of combined treatment of non‐small‐cell lung cancer (NSCLC) using Shenyi capsules and platinum‐based chemotherapy were comprehensively evaluated. Methods. A computer‐based search was used to identify reports on clinical randomized controlled trials (RCTs) on this combined treatment for NSCLC from the PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), VIP, China Biomedical (CBM), and Wanfang Data electronic databases. The databases were searched from their start to February 2020. The quality of the included studies was evaluated and then crosschecked by two independent evaluators. A meta‐analysis was conducted using RevMan5.3. Results. A total of 27 RCTs involving 2,663 patients were included in the meta‐analysis, including 1,380 and 1,283 patients in the treatment and control groups, respectively. The results of the meta‐analysis showed that, compared to platinum‐based chemotherapy alone, the 1‐year survival rate (relative risk (RR) = 1.27, 95% confidence interval (CI) [1.10, 1.47], P < 0.01), 2‐year survival rate (RR = 1.35, 95% CI [1.10, 1.65], P < 0.01), objective tumour remission rate (RR = 1.52, 95% CI [1.35, 1.71], P < 0.01), and body CD4+/CD8+ ratio (standardized mean difference (SMD) = 0.12, 95% CI [0.07, 0.17], P < 0.01) were increased for the combined treatment of NSCLC using Shenyi capsules and platinum‐based chemotherapy; moreover, quality of life was also improved (RR = 2.09, 95%CI [1.75, 2.50], P < 0.01) and it reduced leukocyte toxicity (RR = 0.49, 95%CI [0.39, 0.63], P < 0.01), haemoglobin toxicity (RR = 0.48, 95% CI [0.28, 0.81], P < 0.01), platelet toxicity (RR = 0.44, 95% CI [0.28, 0.70], P < 0.01), vomiting reaction (RR = 0.60, 95% CI [0.45, 0.78], P < 0.01), and serum vascular endothelial growth factor level (SMD = −63.67, 95% CI [−67.59, −59.75], P < 0.01). Conclusions. The treatment of NSCLC using Shenyi capsules together with routine platinum‐based chemotherapy could enhance short‐ and long‐term efficacy, improve patient quality of life, alleviate toxicity and side‐effects of platinum‐based chemotherapeutic drugs, boost body immune function, and inhibit tumour neovascularisation. These findings require further validation in large‐sample, high‐quality RCTs.