bluuebunny/crossref_metadata_2025 huggingface dataset:
Nursing Students’ Perceptions of the Dedicated Education Unit Model in 2 UAE Hospitals
Authors: Hooper Rose Ann , AlMekkawi Mohamad , Williams Gerald , Thompson Belinda , Zeeman Marlize
Published: July 2020

Background: Initially developed in Australia, Dedicated Education Unit (DEU) is an innovative approach to support the growth and development of nursing students while on clinical placement in the hospital setting. With the increasing number of nursing students requiring clinical placement, nursing needed to explore further ways to support students and preceptors in the clinical area. Methods: The study followed a sequential explanatory mixed-methods design to investigate participants’ perceptions of the effectiveness of the DEU model in improving nursing students’ learning experiences. The DEU model was implemented in 2 Abu Dhabi Health Services Company (SEHA) hospitals in Al Ain City, and feedback was obtained from both students and their preceptors via survey and focus group sessions. Results: The study showed positive results with students feeling supported to learn new knowledge and skills by their preceptors. Preceptors reported that they were better able to facilitate student placements in an environment that supported learning. Conclusion: The introduction of the DEU model has supported increasing numbers of students in the clinical area and provided an improved environment for learning.
Can camp get you into a better secondary school? A field experiment of targeted instruction in Kenya
Authors: Schueler Beth E. , Rodriguez-Segura Daniel
Published: July 2020

Access to quality secondary schooling can be life-changing for students in developing contexts. In Kenya, entrance to such schools was historically determined by performance on a high-stakes exam. Understandably then, preparation for this exam is a high priority for Kenyan families and educators. To increase the share of students entering these schools, some educational providers offer targeted instruction for students they believe have a chance of securing a spot. We use a randomized control trial to evaluate the impact of these “symposia” programs—week-long, sleep-away camps where eighth grade students receive a burst of academic instruction from teachers selected based on merit. While similar models have been tested in the U.S., less is known about this type of intervention in developing settings. We find these programs were not particularly effective for the average nominated student relative to a typical week of school. However, we find large, positive effects among students attending schools from which few students are nominated for symposia. We provide suggestive evidence that this was because students from lowrepresentation schools had less pre-camp practice test resources outside of school. The results have implications for program design and the growing literature on the effectiveness of appropriately targeted individualized instruction.
Syntax-Guided Controlled Generation of Paraphrases
Authors: Kumar Ashutosh , Ahuja Kabir , Vadapalli Raghuram , Talukdar Partha
Published: July 2020

Given a sentence (e.g., “I like mangoes”) and a constraint (e.g., sentiment flip), the goal of controlled text generation is to produce a sentence that adapts the input sentence to meet the requirements of the constraint (e.g., “I hate mangoes”). Going beyond such simple constraints, recent work has started exploring the incorporation of complex syntactic-guidance as constraints in the task of controlled paraphrase generation. In these methods, syntactic-guidance is sourced from a separate exemplar sentence. However, these prior works have only utilized limited syntactic information available in the parse tree of the exemplar sentence. We address this limitation in the paper and propose Syntax Guided Controlled Paraphraser (SGCP), an end-to-end framework for syntactic paraphrase generation. We find that Sgcp can generate syntax-conforming sentences while not compromising on relevance. We perform extensive automated and human evaluations over multiple real-world English language datasets to demonstrate the efficacy of Sgcp over state-of-the-art baselines. To drive future research, we have made Sgcp’s source code available. 1
Typification of the name Galatella sorrentinoi (Asteraceae)

Authors: DI GRISTINA EMILIO , SCAFIDI FILIPPO , DOMINA GIANNIANTONIO
Published: July 2020

Tripolium sorrentinoi (Todaro 1858: 42) Raimondo & Greuter (2005: 59) (Asteraceae) is a species endemic to Sicily. In this island, it grows on badlands in the Palermo, Enna, Caltanissetta, and Agrigento Provinces, between the coast and the hinterland mountains. Its phytogeographical interest is remarkable because it occurs in selective habitats, where it is often the sole phanerogamic inhabitant. Due to its small population size and to a continuing decline of mature individuals, T. sorrentinoi was assessed as “Vulnerable” (VU) according to the IUCN criteria (Domina & Troia 2016).
A new genus and species of slug caterpillar (Lepidoptera: Limacodidae) from Taiwan
Authors: LIN YU-CHI , BRABY M.F. , HSU YU-FENG
Published: July 2020

The genus Epsteinius Lin, Braby & Hsu gen. nov. is established to accommodate a new, diminutive species of limacodid moth, E. translucidus Lin, sp. nov., from central Taiwan. Although the new species is the sister taxon to Microleon Butler, 1885 according to molecular phylogenetic data, it differs fundamentally from that genus in adult morphology, wing color pattern, male and female genitalia, and larval morphology. Larvae of E. translucidus Lin, sp. nov. represent an interesting case in which crypsis is based on transparency through its body color, resting behavior, and feeding pattern.
On the two ‘forms’ of Dotilla intermedia De Man, 1888 (Crustacea: Brachyura: Dotillidae) from the Bay of Bengal, India, with description of a new species
Authors: MITRA SANTANU , TRIVEDI JIGNESHKUMAR N. , MENDOZA JOSE CHRISTOPHER E.
Published: July 2020

Two distinct morphotypes of sand bubbler crab (Dotillidae) from eastern India were assigned to Dotilla intermedia De Man, 1888, by British carcinologist, Stanley Kemp in 1919, due to similarities in the areolation of the carapace and the occurrence of these two forms in the same locality. Kemp, however, also illustrated the differences in the morphology of the male thoracic sternums, chelae, and first gonopods and, accordingly, divided D. intermedia into two subcategories which he called the “high form” and the “low form”. The recent designation of a lectotype for D. intermedia, which corresponds with Kemp’s “high form”, makes it possible to recognize the “low form” as a distinct and new species, D. fraternalis n. sp., which is described here. Furthermore, Kemp’s synonymization of Dotilla clepsydrodactylus Alcock, 1900, under Dotilla intermedia is affirmed here after examination of the surviving syntypes. A lectotype is selected to stabilize the taxonomy of this species.
Role of inflammatory markers in corona virus disease (COVID-19) patients: A review
Authors: Upadhyay Jyoti , Tiwari Nidhi , Ansari Mohd N
Published: July 2020

The whole world is locked down due to the outbreak of novel Coronavirus Disease 2019 (nCOVID-19). A novel virus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative agent of coronavirus pandemic 2019. Investigating the role of inflammatory mediators and understanding the virology of nCOVID-19 virus help in designing a rational and effective therapy for this infection. This review provides an overview of the inflammatory mediators activated during nCOVID-19 infection and the pathophysiology of this viral infection. In this review, the authors have a detailed discussion about the types of viral strains of nCOVID-19, its mechanism of action, host immune response, and the dysregulation caused by the viruses in the host immune system causing disease progression. Understanding the role of inflammatory cytokines, chemokines, and clinical immunology will be the approach to find out the possible novel therapeutic interventions. Therapies involving regulation of immune responses help in inhibiting the various steps in the pathologies of infection. Also, updated knowledge regarding the dysregulation of immune system and disease outcome in critically ill patients serves as a precautionary measure in the development and evaluation of vaccine.

Impact statement

In late 2019, a novel virus called SARS-CoV-2, expanded globally from Wuhan, China and was declared a pandemic on 11 March 2020 by the WHO. The mechanism of virus entry inside the host cell depends upon the cellular proteases including cathepsins, HAT, and TMPRSS2, which splits up the spike protein and causes further penetration. MERS coronavirus uses DPP4, while coronavirus HCoV-NL63 and SARS-CoV and SARS-CoV-2 employ ACE-2 as the key receptor. Cytokine storm syndrome was analyzed in critically ill nCOVID-19 patients and it is presented with high inflammatory mediators, systemic inflammation, and multiple organ failure. Among various inflammatory mediators, the level of interleukins (IL-2, IL-7, IL-10), G-CSF, MIP1A, MCP1, and TNF-α was reported to be higher in critically ill patients. Understanding this molecular mechanism of ILs, T cells, and dendritic cells will be helpful to design immunotherapy and novel drugs for the treatment of nCOVID-19 infection.
Long‐term outcomes of patients with ulcerative proctitis: Analysis from a large referral centre cohort
Authors: Dubois Evelyne , Moens Annick , Geelen Rob , Sabino João , Ferrante Marc , Vermeire Séverine
Published: July 2020

Introduction

Long‐term outcomes of patients with ulcerative proctitis (UP) have been poorly investigated, since these patients are excluded from participation in randomized controlled clinical trials.

Objective

The aim of this study was to investigate the prognostic and therapeutic long‐term outcomes of patients with UP.

Methods

A retrospective study of patients with UP followed at our referral centre between 1 January 1998 and 1 January 2019 was performed. Treatment success was defined as clinical response (significant improvement in UP‐related symptoms) and endoscopic response (mayo endoscopic sub‐score of 0 or 1) if available at last follow‐up.

Results

From a total of 1561 patients with ulcerative colitis, 118 patients with UP were identified. A total of 36 (31%) patients were refractory to rectal and oral therapy with 5‐ASA and corticosteroids, necessitating azathioprine as monotherapy in 19 (16%) patients and/or biological therapies in 33 (28%) patients. After a median follow‐up of 71 months (interquartile range 29–149 months), treatment success was observed in 103/118 (87%) UP patients and in 25/36 (69%) patients with refractory UP. Clinical response rates were significantly higher for refractory UP patients treated with biologicals (23/33; 70%) compared to ones treated with azathioprine (2/19; 11%; p   =  0.001).

Conclusion

Good clinical outcomes were recorded in UP, with treatment success in 87% of patients. Nevertheless, 28% needed escalation to biologicals. Long‐term outcome in patients on biologicals was superior to azathioprine.
A risk-stratified therapy for infants with acute lymphoblastic leukemia: a report from the JPLSG MLL-10 trial
Authors: Tomizawa Daisuke , Miyamura Takako , Imamura Toshihiko , Watanabe Tomoyuki , Moriya Saito Akiko , Ogawa Atsushi , Takahashi Yoshihiro , Hirayama Masahiro , Taki Tomohiko , Deguchi Takao , Hori Toshinori , Sanada Masashi , Ohmori Shigeru , Haba Masami , Iguchi Akihiro , Arakawa Yuki , Koga Yuhki , Manabe Atsushi , Horibe Keizo , Ishii Eiichi , Koh Katsuyoshi
Published: July 2020

The prognosis for infants with acute lymphoblastic leukemia (ALL), particularly those with KMT2A gene rearrangement (KMT2A-r), is dismal. Continuous efforts have been made in Japan to investigate the role of hematopoietic stem cell transplantation (HSCT) for infants with KMT2A-r ALL, but improvement in outcome was modest. In the Japanese Pediatric Leukemia/Lymphoma Study Group MLL-10 trial, infants with ALL were stratified into 3 risk groups (low risk [LR], intermediate risk [IR], and high risk [HR]) according to KMT2A status, age, and presence of central nervous system leukemia. Children’s Oncology Group AALL0631 modified chemotherapy with the addition of high-dose cytarabine in early intensification was introduced to KMT2A-r patients, and the option of HSCT was restricted to HR patients only. The role of minimal residual disease (MRD) was also evaluated. Ninety eligible infants were stratified into LR (n = 15), IR (n = 19), or HR (n = 56) risk groups. The 3-year event-free survival (EFS) rate for patients with KMT2A-r ALL (IR + HR) was 66.2% (standard error [SE], 5.6%), and for those with germline KMT2A (KMT2A-g) ALL (LR), the 3-year EFS rate was 93.3% (SE, 6.4%). The 3-year EFS rate was 94.4% (SE, 5.4%) for IR patients and 56.6% (SE, 6.8%) for HR patients. In multivariable analysis, female sex and MRD ≥0.01% at the end of early consolidation were significant factors for poor prognosis. Risk stratification and introduction of intensive chemotherapy in this study were effective and were able to eliminate HSCT for a subset of infants with KMT2A-r ALL. Early clearance of MRD seems to have translated into favorable outcomes and should be incorporated into risk stratifications in future trials. This trial was registered at the University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR) as #UMIN000004801.
The dual PI3Kδ/CK1ε inhibitor umbralisib exhibits unique immunomodulatory effects on CLL T cells
Authors: Maharaj Kamira , Powers John J. , Achille Alex , Mediavilla-Varela Melanie , Gamal Wael , Burger Karen L. , Fonseca Renee , Jiang Kun , Miskin Hari P. , Maryanski Dave , Monastyrskyi Andrii , Duckett Derek R. , Roush William R. , Cleveland John L. , Sahakian Eva , Pinilla-Ibarz Javier
Published: July 2020

The in-clinic phosphatidylinositol 3-kinase (PI3K) inhibitors idelalisib (CAL-101) and duvelisib (IPI-145) have demonstrated high rates of response and progression-free survival in clinical trials of B-cell malignancies, such as chronic lymphocytic leukemia (CLL). However, a high incidence of adverse events has led to frequent discontinuations, limiting the clinical development of these inhibitors. By contrast, the dual PI3Kδ/casein kinase-1-ε (CK1ε) inhibitor umbralisib (TGR-1202) also shows high rates of response in clinical trials but has an improved safety profile with fewer severe adverse events. Toxicities typical of this class of PI3K inhibitors are largely thought to be immune mediated, but they are poorly characterized. Here, we report the effects of idelalisib, duvelisib, and umbralisib on regulatory T cells (Tregs) on normal human T cells, T cells from CLL patients, and T cells in an Eμ-TCL1 adoptive transfer mouse CLL model. Ex vivo studies revealed differential effects of these PI3K inhibitors; only umbralisib treatment sustained normal and CLL-associated FoxP3+ human Tregs. Further, although all 3 inhibitors exhibit antitumor efficacy in the Eμ-TCL1 CLL model, idelalisib- or duvelisib-treated mice displayed increased immune-mediated toxicities, impaired function, and reduced numbers of Tregs, whereas Treg number and function were preserved in umbralisib-treated CLL-bearing mice. Finally, our studies demonstrate that inhibition of CK1ε can improve CLL Treg number and function. Interestingly, CK1ε inhibition mitigated impairment of CLL Tregs by PI3K inhibitors in combination treatment. These results suggest that the improved safety profile of umbralisib is due to its role as a dual PI3Kδ/CK1ε inhibitor that preserves Treg number and function.
Glasdegib as maintenance therapy for patients with AML and MDS patients at high risk for postallogeneic stem cell transplant relapse
Authors: Kent Andrew , Vasu Sumithira , Schatz Derek , Monson Natalie , Devine Steven , Smith Clayton , Gutman Jonathan A. , Pollyea Daniel A.
Published: July 2020

Key Points

Posttransplantation, glasdegib maintenance therapy in patients at high risk for relapse did not meaningfully reduce relapse incidence. Use of glasdegib in the posttransplantation setting was complicated by adverse events requiring drug holds and occasional discontinuation.
Comparative Study of Selenides and Tellurides of Transition Metals (Nb and Ta) with Respect to its Catalytic, Antimicrobial, and Molecular Docking Performance
Authors: Altaf S. , Haider A. , Naz S. , Ul-Hamid A. , Haider J. , Imran M. , Shahzadi A. , Naz M. , Ajaz H. , Ikram M.
Published: July 2020

The present research is a comparative study that reports an economical and accessible method to synthesize niobium (Nb) and Tantalum (Ta) selenides and tellurides with useful application in the removal of pollutants in textile, paper, and dyeing industries as well as in medical field. In this study, solid-state process was used to generate nanocomposites and various characterization techniques were employed to compare two groups of materials under investigation. Structure, morphology, elemental constitution, and functional groups of synthesized materials were analyzed with XRD, FESEM coupled with EDS, FTIR, and Raman spectroscopy, respectively. HR-TEM images displayed nanoscale particles with tetragonal and monoclinic crystal structures. The optical properties were evaluated in terms of cut-off wavelength and optical band gap using UV-visible spectroscopy. A comparative behavior of both groups of compounds was assessed with regards to their catalytic and microcidal properties. Extracted nanocomposites when used as catalysts, though isomorphs of each other, showed markedly different behavior in catalytic degradation of MB dye in the presence of NaBH4 that was employed as a reducing agent. This peculiar deviation might be attributed to slight structural differences between them. Escherichia coli and Staphylococcus aureus (G –ve and + ve bacteria, respectively) were designated as model strains for in vitro antibacterial tests of both clusters by employing disk diffusion method. Superior antibacterial efficacy was observed for telluride system (significant inhibition zones of 26-35 mm) compared with selenide system (diameter of inhibition zone ranged from 0.8 mm to 1.9 mm). In addition, molecular docking study was undertaken to ascertain the binding interaction pattern between NPs and active sites in targeted cell protein. The findings were in agreement with antimicrobial test results suggesting NbTe4 to be the best inhibitor against FabH and FabI enzymes.
Inbreeding depression for kit survival at birth in a rabbit population under long-term selection
Authors: Curik Ino , Kövér György , Farkas János , Szendrő Zsolt , Romvári Róbert , Sölkner Johann , Nagy Istvan
Published: July 2020

Background

Accumulation of detrimental mutations in small populations leads to inbreeding depression of fitness traits and a higher frequency of genetic defects, thus increasing risk of extinction. Our objective was to quantify the magnitude of inbreeding depression for survival at birth, in a closed rabbit population under long-term selection.

Methods

We used an information theory-based approach and multi-model inference to estimate inbreeding depression and its purging with respect to the trait ‘kit survival at birth’ over a 25-year period in a closed population of Pannon White rabbits, by analysing 22,718 kindling records. Generalised linear mixed models based on the logit link function were applied, which take polygenic random effects into account.

Results

Our results indicated that inbreeding depression occurred during the period 1992–1997, based on significant estimates of the z-standardised classical inbreeding coefficient z.FL (CI95% − 0.12 to − 0.03) and of the new inbreeding coefficient of the litter z.FNEWL (CI95% − 0.13 to − 0.04) as well as a 59.2% reduction in contributing founders. Inbreeding depression disappeared during the periods 1997–2007 and 2007–2017. For the period 1992–1997, the best model resulted in a significantly negative standardised estimate of the new inbreeding coefficient of the litter and a significantly positive standardised estimate of Kalinowski’s ancestral inbreeding coefficient of the litter (CI95% 0.01 to 0.17), which indicated purging of detrimental load. Kindling season and parity had effects on survival at birth that differed across the three periods of 1992–1997, 1997–2007 and 2007–2017.

Conclusions

Our results support the existence of inbreeding depression and its purging with respect to kit survival at birth in this Pannon White rabbit population. However, we were unable to exclude possible confounding from the effects of parity and potentially other environmental factors during the study period, thus our results need to be extended and confirmed in other populations.
Extending long-range phasing and haplotype library imputation algorithms to large and heterogeneous datasets
Authors: Money Daniel , Wilson David , Jenko Janez , Whalen Andrew , Thorn Steve , Gorjanc Gregor , Hickey John M.
Published: July 2020

Background

We describe the latest improvements to the long-range phasing (LRP) and haplotype library imputation (HLI) algorithms for successful phasing of both datasets with one million individuals and datasets genotyped using different sets of single nucleotide polymorphisms (SNPs). Previous publicly available implementations of the LRP algorithm implemented in AlphaPhase could not phase large datasets due to the computational cost of defining surrogate parents by exhaustive all-against-all searches. Furthermore, the AlphaPhase implementations of LRP and HLI were not designed to deal with large amounts of missing data that are inherent when using multiple SNP arrays.

Methods

We developed methods that avoid the need for all-against-all searches by performing LRP on subsets of individuals and then concatenating the results. We also extended LRP and HLI algorithms to enable the use of different sets of markers, including missing values, when determining surrogate parents and identifying haplotypes. We implemented and tested these extensions in an updated version of AlphaPhase, and compared its performance to the software package Eagle2.

Results

A simulated dataset with one million individuals genotyped with the same 6711 SNPs for a single chromosome took less than a day to phase, compared to more than seven days for Eagle2. The percentage of correctly phased alleles at heterozygous loci was 90.2 and 99.9% for AlphaPhase and Eagle2, respectively. A larger dataset with one million individuals genotyped with 49,579 SNPs for a single chromosome took AlphaPhase 23 days to phase, with 89.9% of alleles at heterozygous loci phased correctly. The phasing accuracy was generally lower for datasets with different sets of markers than with one set of markers. For a simulated dataset with three sets of markers, 1.5% of alleles at heterozygous positions were phased incorrectly, compared to 0.4% with one set of markers.

Conclusions

The improved LRP and HLI algorithms enable AlphaPhase to quickly and accurately phase very large and heterogeneous datasets. AlphaPhase is an order of magnitude faster than the other tested packages, although Eagle2 showed a higher level of phasing accuracy. The speed gain will make phasing achievable for very large genomic datasets in livestock, enabling more powerful breeding and genetics research and application.
Extracerebral choroid plexus papilloma in the pharynx with airway obstruction in a newborn: a case report
Authors: Lee Narae , Bae Mi Hye , Han Young Mi , Park Kyung Hee , Hwang Jae-Yeon , Hwang Cheong-Soo , Lee Jin-Choon , Byun Shin Yun
Published: July 2020

Background

Choroid plexus papillomas (CPPs) are rare, usually benign, neoplasms originating in the central nervous system. In this study, we present the first case of a giant airway-obstructing CPP in the pharynx of a newborn.

Case presentation

A cystic mass located in the pharynx was noted in a fetus at the 29th week of gestation. Elective cesarean section was performed at the 38th week of gestation with successful intubation and ex utero intrapartum treatment. On computed tomography, there was a huge airway-obstructing cystic mass in the choana and pharynx. Elective surgery with total excision was performed, and histological examination confirmed the diagnosis of CPP.

Conclusion

We report the first case of an extracerebral airway-obstructing CPP in the pharynx of a newborn. Radiologic examinations are not enough for the diagnosis of CPPs, and complete excision of the tumor with histological confirmation is indispensable for accurate diagnosis and treatment.
Role of anti-Müllerian hormone and testosterone in follicular growth: a cross-sectional study
Authors: Lv Ping-Ping , Jin Min , Rao Jin-Peng , Chen Jian , Wang Li-Quan , Huang Chang-Chang , Yang Song-Qing , Yao Qiu-Ping , Feng Lei , Shen Jin-Ming , Feng Chun
Published: July 2020

Background

Anti-Müllerian hormone (AMH) is now considered the best serum biomarker of ovarian reserve, while basal sex hormones are classic markers used for assessing ovarian reserve. The interaction between AMH and sex hormones are complicated and not sufficiently addressed. In this study, we took diminished ovarian reserve (DOR) and polycystic ovarian syndrome (PCOS) as two extremes of ovarian reserve (deficient and excessive respectively) to investigate the role of AMH and sex hormones in follicular growth.

Methods

A retrospective cross-sectional survey was performed. The patients assessed AMH and basal sex hormones in the Second Hospital of Zhejiang University from April 2016 to March 2019 were involved in this study. Serum AMH and sex hormone concentrations were tested with electrochemiluminescence method. Stepwise linear regression and binary logistic regression was used to determine the predictors of AMH level and to explore the involved factors determining DOR and PCOS.

Results

In the present study, we found that age and follicle-stimulating hormone (FSH) were main negative correlation factors, and luteinizing hormone (LH) and testosterone (T) were main positive factors of AMH. In DOR group, age, FSH and estradiol (E2) increased and T decreased, while in PCOS group, LH and T increased. Binary logistic regression found that age, weight, FSH, E2, and T were the significant factors which independently predicted the likelihood of DOR, and that age, body mass index (BMI), AMH, LH, and T predicted the likelihood of PCOS.

Conclusions

Our study demonstrated that age, FSH, and T were factors that most closely correlated with AMH level, and T was involved in both DOR and PCOS. Since DOR and PCOS are manifested with insufficient AMH and excessive AMH respectively, it is suggested that total testosterone correlated with AMH closely and plays an important role in follicular growth. More attention should be given to testosterone level during controlled ovarian hyperstimulation (COH) process.
When accountability meets power: realizing sexual and reproductive health and rights
Authors: Sen Gita , Iyer Aditi , Chattopadhyay Sreeparna , Khosla Rajat
Published: July 2020

This paper addresses a critical concern in realizing sexual and reproductive health and rights through policies and programs – the relationship between power and accountability. We examine accountability strategies for sexual and reproductive health and rights through the lens of power so that we might better understand and assess their actual working. Power often derives from deep structural inequalities, but also seeps into norms and beliefs, into what we ‘know’ as truth, and what we believe about the world and about ourselves within it. Power legitimizes hierarchy and authority, and manufactures consent. Its capillary action causes it to spread into every corner and social extremity, but also sets up the possibility of challenge and contestation.

Using illustrative examples, we show that in some contexts accountability strategies may confront and transform adverse power relationships. In other contexts, power relations may be more resistant to change, giving rise to contestation, accommodation, negotiation or even subversion of the goals of accountability strategies. This raises an important question about measurement. How is one to assess the achievements of accountability strategies, given the shifting sands on which they are implemented?

We argue that power-focused realist evaluations are needed that address four sets of questions about: i) the dimensions and sources of power that an accountability strategy confronts; ii) how power is built into the artefacts of the strategy – its objectives, rules, procedures, financing methods inter alia; iii) what incentives, disincentives and norms for behavior are set up by the interplay of the above; and iv) their consequences for the outcomes of the accountability strategy. We illustrate this approach through examples of performance, social and legal accountability strategies.
Using RIGHT (Reporting Items for Practice Guidelines in Healthcare) to evaluate the reporting quality of WHO guidelines
Authors: Wang Xiaoqin , Zhou Qi , Chen Yaolong , Yang Nan , Pottie Kevin , Xiao Yujie , Tong Yajing , Yao Liang , Wang Qi , Yang Kehu , Norris Susan L.
Published: July 2020

Background

Without adequate reporting of research, valuable time and resources are wasted. In the same vein, adequate reporting of practice guidelines to optimise patient care is equally important. Our study examines the quality of reporting of published WHO guidelines, over time, using the RIGHT (Reporting Items for Practice Guidelines in HealThcare) reporting checklist.

Methods

We examined English-language guidelines approved by the WHO Guidelines Review Committee from inception of the committee in 2007 until 31 December 2017. Pairs of independent, trained reviewers assessed the reporting quality of these guidelines. Descriptive data were summarised with frequencies and percentages.

Results

We included 182 eligible guidelines. Overall, 25 out of the 34 RIGHT items were reported in 75% or more of the WHO guidelines. The reporting rates improved over time. Further, 90% of the guidelines reported document type in the title. The identification of evidence, the rationale for recommendations and the review process were reported in more than 80% of guidelines. The certainty of the evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system was assessed in 81% of the guidelines assessed. While 82% of guidelines reported funding sources, only 25% mentioned the role of funders.

Conclusions

WHO guidelines provide adequate reporting of many of the RIGHT items and reporting has improved over time. WHO guidelines compare favourably to guidelines produced by other organisations. However, reporting can be further improved in a number of areas.
A critical interpretive synthesis of the roles of midwives in health systems
Authors: Mattison Cristina A. , Lavis John N. , Wilson Michael G. , Hutton Eileen K. , Dion Michelle L.
Published: July 2020

Background

Midwives’ roles in sexual and reproductive health and rights continues to evolve. Understanding the profession’s role and how midwives can be integrated into health systems is essential in creating evidence-informed policies. Our objective was to develop a theoretical framework of how political system factors and health systems arrangements influence the roles of midwives within the health system.

Methods

A critical interpretive synthesis was used to develop the theoretical framework. A range of electronic bibliographic databases (CINAHL, EMBASE, Global Health database, HealthSTAR, Health Systems Evidence, MEDLINE and Web of Science) was searched through to 14 May 2020 as were policy and health systems-related and midwifery organisation websites. A coding structure was created to guide the data extraction.

Results

A total of 4533 unique documents were retrieved through electronic searches, of which 4132 were excluded using explicit criteria, leaving 401 potentially relevant records, in addition to the 29 records that were purposively sampled through grey literature. A total of 100 documents were included in the critical interpretive synthesis. The resulting theoretical framework identified the range of political and health system components that can work together to facilitate the integration of midwifery into health systems or act as barriers that restrict the roles of the profession.

Conclusions

Any changes to the roles of midwives in health systems need to take into account the political system where decisions about their integration will be made as well as the nature of the health system in which they are being integrated. The theoretical framework, which can be thought of as a heuristic, identifies the core contextual factors that governments can use to best leverage their position when working to improve sexual and reproductive health and rights.
Partnering and parenting transitions in Australian men and women: associations with changes in weight, domain-specific physical activity and sedentary behaviours
Authors: Tian Jing , Smith Kylie J. , Cleland Verity , Gall Seana , Dwyer Terence , Venn Alison J.
Published: July 2020

Background

Partnering and parenting are important life-stage transitions often accompanied by changes in social networks, roles and responsibilities. There have been no longitudinal studies examining associations of partnering and parenting with changes in domain-specific physical activity (PA) and sedentary behaviours, and our understanding of whether these transitions are associated with weight change is limited.

Methods

Two thousand one hundred and twenty-four Australian adults from a national cohort (mean age 31.7 (2.7) years, 47.5% male) completed questionnaires at baseline (2004–06) and follow-up (2009–11), reporting marital and parental status. Weight (kg) was measured at baseline and self-reported at follow-up. PA and sedentary behaviours (sitting and television (TV) viewing) were self-reported in a subset (n = 1221). Linear regression estimated the longitudinal associations of parenting and partnering transitions with PA, sedentary behaviours and weight at follow-up, adjusted for baseline value of the respective outcome variable, age, education, follow-up duration and other life-stage transition.

Results

During the 5-year follow-up, 17.3% men and 12.9% women partnered, and 27.3% men and 19.1% women had their first child. Compared to staying not partnered, partnering was associated with an increase in total PA (177.5mins/week, 95% Confidence Interval (CI) 18.0 to 337.0) among men and a greater weight gain (2.2 kg, 95% CI 0.6 to 3.7) among women. Compared to remaining child-free, having a first child was associated with greater reductions in total PA (− 123.9mins/week, 95% CI − 248.8 to 1.1) and TV viewing time (− 27.0mins/day, 95% CI − 50.6 to − 3.3) among men. Women who had their first child had greater weight gain (1.4 kg, 95% CI 0.1 to 2.7) but spent less time sitting (− 103.8mins/day, 95% CI − 135.5 to − 72.1) than those remaining child-free. For women, having additional children was associated with less sitting time (− 39.4mins/week, 95% CI − 66.0 to − 12.8) than having the same number of children.

Conclusions

Partnering was associated with an increase in men’s total PA and women’s weight. Transitions into parenthood with a first child or additional children were associated with potentially health-impairing changes in weight and PA, but health-promoting changes in sedentary behaviours. Future PA promotion strategies should pay attention to men who had their first child to mitigate declining total PA.
Correction to: Runners’ metabolomic changes following marathon
Authors: Shi Rengfei , Zhang Jin , Fang Biqing , Tian Xiangyang , Feng Yu , Cheng Zepeng , Fu Zhongyu , Zhang Jingjing , Wu Jiaxi
Published: July 2020

An amendment to this paper has been published and can be accessed via the original article.
Health technology assessment and priority setting for universal health coverage: a qualitative study of stakeholders’ capacity, needs, policy areas of demand and perspectives in Nigeria
Authors: Uzochukwu Benjamin S. C. , Okeke Chinyere , O’Brien Niki , Ruiz Francis , Sombie Issiaka , Hollingworth Samantha
Published: July 2020

Introduction

Health technology assessment (HTA) is an effective tool to support priority setting and generate evidence for decision making especially en route to achieving universal health coverage (UHC). We assessed the capacity needs, policy areas of demand, and perspectives of key stakeholders for evidence-informed decision making in Nigeria where HTA is still new.

Methods

We surveyed 31 participants including decision makers, policy makers, academic researchers, civil society organizations, community-based organizations, development partners, health professional organizations. We revised an existing survey to qualitatively examine the need, policy areas of demand, and perspectives of stakeholders on HTA. We then analyzed responses and explored key themes.

Results

Most respondents were associated with organizations that generated or facilitated health services research. Research institutes highlighted their ability to provide expertise and skills for HTA research but some respondents noted a lack of human capacity for HTA. HTA was considered an important and valuable priority-setting tool with a key role in the design of health benefits packages, clinical guideline development, and service improvement. Public health programs, medicines and vaccines were the three main technology types that would especially benefit from the application of HTA. The perceived availability and accessibility of suitable local data to support HTA varied widely but was mostly considered inadequate and limited. Respondents needed evidence on health system financing, health service provision, burden of disease and noted a need for training support in research methodology, HTA and data management.

Conclusion

The use of HTA by policymakers and communities in Nigeria is very limited mainly due to inadequate and insufficient capacity to produce and use HTA. Developing sustainable and institutionalized HTA systems requires in-country expertise and active participation from a range of stakeholders. Stakeholder participation in identifying HTA topics and conducting relevant research will enhance the use of HTA evidence produced for decision making. Therefore, the identified training needs for HTA and possible research topics should be considered a priority in establishing HTA for evidence-informed policy making for achieving UHC particularly among the most vulnerable people in Nigeria.
Dosimetric comparison between RapidArc and HyperArc techniques in salvage stereotactic body radiation therapy for recurrent nasopharyngeal carcinoma
Authors: Ho Hsiu-Wen , Lee Steve P. , Lin Hisu-Man , Chen Hsiao-Yun , Huang Chun-Chiao , Wang Shih-Chang , Yang Ching-Chieh , Lin Yu-Wei
Published: July 2020

Background

To evaluate dosimetric differences of salvage irradiations using two commercially available volumetric modulated arc therapy (VMAT) stereotactic body radiation therapy (SBRT) techniques: RapidArc (RA) and HyperArc (HA), for recurrent nasopharyngeal carcinoma (NPC) after initial radiation therapy.

Methods

Ten patients with recurrent NPC status previously treated with radiation therapy were considered suitable candidates for salvage SBRT using VMAT approach. Two separate treatment plans were created with HA and RA techniques for each case, with dosimetric outcomes compared with respect to tumor target coverage and organs-at-risk (OARs) sparing. Furthermore, the cumulative radiobiological effects to the relevant OARs from the original radiotherapy to the respective salvage SBRT plans were analyzed in terms of biologically effective dose (BED).

Results

Treatment with HA exhibited similar target dose coverage as with RA, while delivering a higher mean dose to the targets. Using RA technique, the mean maximal doses to optic apparatus and the mean brain dose were reduced by 1 to 1.5 Gy, comparing to HA technique. The conformity index, gradient radius, and intermediate dose spillage in HA plans were significantly better than those in RA. With HA technique, the volume of brain receiving 12 Gy or more was reduced by 44%, comparing to RA technique. The cumulative BEDs to spinal cord and optic apparatus with RA technique were 1 to 2 Gy3 less than those with HA. HA technique significantly reduced the volume within body that received more than 100 Gy.

Conclusions

With better dose distribution than RA while maintaining sufficient target dose coverage, HA represents an attractive salvage SBRT technique for recurrent NPC.
Prenatal diagnosis of rearrangements in the fetal 22q11.2 region
Authors: Li Suping , Jin Yuxia , Yang Jing , Yang Li , Tang Ping , Zhou Chiyan , Wu Liping , Dong Jinhua , Chen Jie , Shen Huaxiang
Published: July 2020

Background

22q11.2 deletion syndrome (22q11.2DS) and 22q11.2 duplication syndrome (22q11.2DupS) are the most common copy number variations in humans. The clinical phenotypes of these two syndromes are variable, and there are no large sample data on the prenatal detection rate for these two syndromes in the Chinese population.

Results

We recruited 411 pregnant women who showed either abnormal prenatal ultrasound findings or positive prenatal BoBs™ results or who had given birth to a child with chromosomal abnormalities. SNP-array analysis and interphase FISH analysis identified five fetuses with 22q11.2 copy number variants (CNVs), three of which were 22q11.2 deletion syndrome (22q11.2DS) (3/411) and two of which were 22q11.2 duplication syndrome (22q11.2DupS). In all 5 cases of diagnosed 22q11.2 abnormalities, inheritance could not be identified because the parents did not undergo further testing.

Conclusion

Our case reports provide a detection rate of 22q11.2 CNVs for fetuses with prenatal diagnostic indications, and early diagnosis of these two syndromes was essential for prenatal intervention in these cases. SNP-array technology is an effective tool in the prenatal diagnosis of 22q11.2 CNVs. The prenatal diagnosis of these two syndromes is helpful for early intervention, which is of great clinical significance.
Correction to: Pre-metastatic niche triggers SDF-1/CXCR4 axis and promotes organ colonisation by hepatocellular circulating tumour cells via downregulation of Prrx1
Authors: Tang Yujun , Lu Yishi , Cheng Yuan , Luo Lei , Cai Lei , Peng Bangjian , Huang Wenbin , Liao Hangyu , Zhao Liang , Pan Mingxin
Published: July 2020

An amendment to this paper has been published and can be accessed via the original article.
Efficacy and safety of the extracorporeal shockwave therapy in patients with postherpetic neuralgia: study protocol of a randomized controlled trial
Authors: Chen Lu , Zhou Ruihao , Sun Fuguo , Weng Yan , Ye Ling , Yang Pingliang
Published: July 2020

Background

Postherpetic neuralgia (PHN) is one of the most common types of chronic neuropathic pain, which seriously affects quality of the life because of pain severity and poor response to the currently available treatments. The main strategies for PHN management are medication and invasive interventional therapies; however, these approaches have many adverse effects, so it is important to find another effective and safe treatment for PHN.

Methods

A single-center, single-blind randomized clinical trial will evaluate 98 study participants randomized in a 1:1 ratio into control and experimental groups. The control group will receive conventional treatment including medication therapy and invasive interventional therapy. The experimental group will receive extracorporeal shockwave therapy (ESWT) in addition to conventional therapy. The primary outcome is pain intensity assessed on a visual analogue scale (VAS); the secondary outcomes are the following: quality of life assessed by the 36-Item Short-Form Health Survey (SF-36), psychological state for anxiety and depression measured by the Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS), and sleep quality measured by the Pittsburgh Sleep Quality Index (PSQI). Assessors blinded to the randomization will collect data during the intervention period at baseline and weeks 1, 4, and 12. The plasma levels of tumor necrosis factor-α and interleukin-6 will be assessed before and after ESWT to explore the biochemical mechanisms of ESWT in the treatment of PHN.

Discussion

This randomized controlled trial will evaluate the effectiveness and safety of ESWT in patients with PHN and thus will provide clinical evidence for its use in the management of PHN and explore the potential biochemical mechanisms of this treatment.

Trial registration

www.ChiCTR.org.cn, identifier: ChiCTR1900025828. Registered on 10 September 2019
Engineering microbial pathways for production of bio-based chemicals from lignocellulosic sugars: current status and perspectives
Authors: Francois Jean Marie , Alkim Ceren , Morin Nicolas
Published: July 2020

Lignocellulose is the most abundant biomass on earth with an annual production of about 2 × 1011 tons. It is an inedible renewable carbonaceous resource that is very rich in pentose and hexose sugars. The ability of microorganisms to use lignocellulosic sugars can be exploited for the production of biofuels and chemicals, and their concurrent biotechnological processes could advantageously replace petrochemicals’ processes in a medium to long term, sustaining the emerging of a new economy based on bio-based products from renewable carbon sources. One of the major issues to reach this objective is to rewire the microbial metabolism to optimally configure conversion of these lignocellulosic-derived sugars into bio-based products in a sustainable and competitive manner. Systems’ metabolic engineering encompassing synthetic biology and evolutionary engineering appears to be the most promising scientific and technological approaches to meet this challenge. In this review, we examine the most recent advances and strategies to redesign natural and to implement non-natural pathways in microbial metabolic framework for the assimilation and conversion of pentose and hexose sugars derived from lignocellulosic material into industrial relevant chemical compounds leading to maximal yield, titer and productivity. These include glycolic, glutaric, mesaconic and 3,4-dihydroxybutyric acid as organic acids, monoethylene glycol, 1,4-butanediol and 1,2,4-butanetriol, as alcohols. We also discuss the big challenges that still remain to enable microbial processes to become industrially attractive and economically profitable.
Safety and efficacy of cell therapies in pediatric heart disease: a systematic review and meta-analysis
Authors: Martinez John , Zoretic Sarah , Moreira Axel , Moreira Alvaro
Published: July 2020

Background

Adult clinical trials have reported safety and the therapeutic potential of stem cells for cardiac disease. These observations have now translated to the pediatric arena. We conducted a meta-analysis to assess safety and efficacy of cell-based therapies in animal and human studies of pediatric heart disease.

Methods and results

A literature search was conducted to examine the effects of cell-based therapies on: (i) safety and (ii) cardiac function. In total, 18 pre-clinical and 13 human studies were included. Pre-clinical: right ventricular dysfunction was the most common animal model (80%). Cardiac-derived (28%) and umbilical cord blood (24%) cells were delivered intravenously (36%) or intramyocardially (35%). Mortality was similar between cell-based and control groups (OR 0.94; 95% CI 0.05, 17.41). Cell-based treatments preserved ejection fraction by 6.9% (p < 0.01), while intramyocardial at a dose of 1–10 M cells/kg optimized ejection fraction. Clinical: single ventricle physiology was the most common cardiac disease (n = 9). Cardiac tissue was a frequent cell source, dosed from 3.0 × 105 to 2.4 × 107 cells/kg. A decrease in adverse events occurred in the cell-based cohort (OR 0.17, p < 0.01). Administration of cell-based therapies improved ejection fraction (MD 4.84; 95% CI 1.62, 8.07; p < 0.01).

Conclusions

In this meta-analysis, cell-based therapies were safe and improved specific measures of cardiac function. Implications from this review may provide methodologic recommendations (source, dose, route, timing) for future clinical trials. Of note, many of the results described in this study pattern those seen in adult stem cell reviews and meta-analyses.