bluuebunny/crossref_metadata_2025 huggingface dataset:
Adversities in Syria and their relation to their physical and mental health conditions as Syrian refugees in Turkey
Authors: Balcilar Mehmet , Nugent Jeffrey B. , Xu Jiahui
Published: August 2021

The purpose of this paper is to examine the extent to which different health problems among Syrian refugees in Turkey can be traced back to three different conditions in Syria (Family Member Killed, House Damaged, and Income) as well as to Commonality among Neighbors back in Syria as well as in Turkey. As is common, the findings show their effects on mental health to be most common, especially among females, but also that (1) the effects on diseases and physical/mobility problems are also quite significant, (2) in most cases, the effects of income in Syria on Health adversities are positive, and (3) that some of these adverse effects have been growing over time since fleeing Syria.
HLA‐B*27 typing using a triplex real time PCR in routine laboratory
Authors: Viken Marte K. , Pedersen Alice L. , Andersen Menaka , Jensen Tore , Lie Benedicte A. , Boulland Line M. L.
Published: August 2021

We have established an in‐house HLA‐B*27 multiplex typing assay by using a combination of previously published, newly designed and commercial primers and probes for use with real‐time PCR instruments. Hence, facilitating quick and large‐scale HLA‐B*27 typing.
Comparability of six different immunoassays measuring SARS‐CoV‐2 antibodies with neutralizing antibody levels in convalescent plasma: From utility to prediction
Authors: Lamikanra Abigail , Nguyen Dung , Simmonds Peter , Williams Sarah , Bentley Emma M. , Rowe Cathy , Otter Ashley David , Brooks Tim , Gilmour Kimberly , Mai Annabelle , Dadhra Jusvinder , Csatari Mabel , Ziyenge Sheba , Oliveira Marta , Ploeg Rutger , Tsang Pat , Zambon Maria , Gopal Robin , Xiao Julie Huiyuan , Townsend Alain , Roberts David , Harvala Heli
Published: August 2021

Background

Convalescent plasma (CP) therapy for coronavirus disease (COVID‐19) provides virus‐neutralizing antibodies that may ameliorate the outcome of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infections. The effectiveness of CP likely depends on its antiviral neutralizing potency and is determined using in vitro neutralizing antibody assays.

Study design and methods

We evaluated abilities of three immunoassays for anti‐spike antibodies (EUROimmun, Ortho, Roche), a pseudotype‐based neutralization assay, and two assays that quantify ACE2 binding of spike protein (GenScript and hemagglutination test [HAT]‐based assay) to predict neutralizing antibody titers in 113 CP donations. Assay outputs were analyzed through linear regression and calculation of sensitivities and specificities by receiver operator characteristic (ROC) analysis.

Results

Median values of plasma samples containing neutralizing antibodies produced conversion factors for assay unitage of ×6.5 (pseudotype), ×19 (GenScript), ×3.4 (HAT assay), ×0.08 (EUROimmun), ×1.64 (Roche), and ×0.10 (Ortho). All selected assays were sufficient in identifying the high titer donations based on ROC analysis; area over curve ranged from 91.7% for HAT and GenScript assay to 95.6% for pseudotype assay. However, their ability to predict the actual neutralizing antibody levels varied substantially as shown by linear regression correlation values (from 0.27 for Ortho to 0.61 for pseudotype assay).

Discussion

Overall, the study data demonstrate that all selected assays were effective in identifying donations with high neutralizing antibody levels and are potentially suitable as surrogate assays for donation selection for CP therapy.
Retrospective evaluation of the prognostic utility of plasma lactate concentration and serial lactate measurements in dogs and cats presented to the emergency room (January 2012 – December 2016): 4863 cases
Authors: Saint‐Pierre Laurence M. , Hopper Kate , Epstein Steven E.
Published: August 2021

Objective

To determine the prognostic significance of plasma lactate concentration, plasma lactate clearance, and delta lactate in dogs and cats presented to an emergency room (ER).

Design

Retrospective study.

Setting

University teaching hospital.

Animals

A total of 8,321 animals with a plasma lactate concentration measured with 4,863 presenting to the ER and 1,529 dogs and 444 cats having a measurement within 4 hours of admission.

Interventions

None.

Measurements and main results

Plasma lactate concentration of dogs and cats presented to a university teaching hospital was retrospectively evaluated. Of dogs and cats with a plasma lactate concentration measured within 4 hours of admission to the ER, hyperlactatemia was common, and the prevalence of hyperlactatemia for dogs 78% (361/462) and cats 67% (78/116) was highest when evaluated within the first 30 minutes following admission. The distribution of patient's plasma lactate concentration was significantly higher in non‐survivors compared to survivors at all time points evaluated (P0.001). Both lactate clearance (P = 0.010) and delta lactate (P = 0.013) were significantly different between survivors and nonsurvivors. A delta lactate > 4.5 mmol/L was 100% (95% CI: 95 to 100%) specific for nonsurvival in patients with hyperlactatemia measured within 1 hour of admission to the ER. The most common cause of hyperlactatemia was shock in dogs (24%) and urinary tract diseases in cats (22%). Shock was associated with the highest mortality rate in both dogs (61%) and cats (77%). Hyperlactatemia was significantly associated with increased mortality for dogs with shock (P = 0.001), respiratory diseases (P = 0.022), diabetes mellitus (P = 0.018), and liver dysfunction (P = 0.006).

Conclusions

Hyperlactatemia was associated with mortality in both dogs and cats when measured at any time point in the 4 hours following admission to the ER. Serial lactate measurement may also be a valuable tool to guide clinical management decisions.
A molecular approach to maggot debridement therapy with Lucilia sericata and its excretions/secretions in wound healing
Authors: Tombulturk Fatma Kubra , Kanigur‐Sultuybek Gonul
Published: August 2021

Chronic wounds caused by underlying physiological causes such as diabetic wounds, pressure ulcers, venous leg ulcers and infected wounds affect a significant portion of the population. In order to treat chronic wounds, a strong debridement, removal of necrotic tissue, elimination of infection and stimulation of granulation tissue are required. Maggot debridement therapy (MDT), which is an alternative treatment method based on history, has been used quite widely. MDT is an efficient, simple, cost‐effective and reliable biosurgery method using mostly larvae of Lucilia sericata fly species. Larvae can both physically remove necrotic tissue from the wound site and stimulate wound healing by activating molecular processes in the wound area through the enzymes they secrete. The larvae can stimulate wound healing by activating molecular processes in the wound area through enzymes in their excretions/secretions (ES). Studies have shown that ES has antibacterial, antifungal, anti‐inflammatory, angiogenic, proliferative, hemostatic and tissue‐regenerating effects both in vivo and in vitro. It is suggested that these effects stimulate wound healing and accelerate wound healing by initiating a direct signal cascade with cells in the wound area. However, the enzymes and peptides in ES are mostly still undefined. Examining the molecular content of ES and the biological effects of these ingredients is quite important to illuminate the molecular mechanism underlying MDT. More importantly, ES has the potential to have positive effects on wound healing and to be used more as a therapeutic agent in the future, so it can be applied as an alternative to MDT in wound healing.
Reciclagem dos resíduos sólidos de rochas ornamentais: the case of waste of the dimension stones
Authors: Mothé Filho Heitor Fernandes , Polivanov Helena , Mothé Cheila Gonçalves
Published: August 2021

Dimension stone industry produces a great amount of effluents, about 200,000 ton/year per solid residue. Espírito Santo State has about 600 companies, and their average consume per industry is around are 10,000 l/ day of water. Those rejects are displaced in decant lagoons, and landfill. In this work was used material provided by marble & granite industry from Cachoeiro de Itapemirim, ES. Those residues were characterized by chemical and mineral composition, physical properties, sintering process, and point load test. The results provided from physical indices and sintering material were compared with the results of commercial granite named in Industry as "granito rosa bavena". Analysis allowed us to get a conclusion about the reject. These analyses showed that reject could be used as a source for ceramic material, with the possibility of choosing for a greater or lower resistance.
Chondrichthyan fauna from the Pirabas Formation, Miocene of Northern Brazil, with comments on paleobiogeography
Authors: Reis Márcia Aparecida Fernandes dos
Published: August 2021

The chondrichthyan fauna from the Pirabas Formation is redescribed.Only thirteen nominal taxa are considered valid. From these taxa, ten were reassigned to extant taxa (Carcharhinus sorrah, Carcharhinus perezii,Galeocerdo cuvier, Rhizoprionodon lalandii, Sphyrna sp., Hemipristis elongatus, Carcharodon carcharias, Isurus oxyrinchus, Nebrius ferrugineus, and indeterminate Myliobatidae), confirming the Neogene age of this formation. This elasmofauna is compared with other Caribbean and African Tertiary faunas.
Amplitude-Dependent Damping and Driving Rates of High-Frequency Thermoacoustic Oscillations in a Lab-Scale Lean-Premixed Gas Turbine Combustor
Authors: Hofmeister Thomas , Sattelmayer Thomas
Published: August 2021

This paper presents the numerical investigations of amplitude-dependent stability behavior of thermoacoustic oscillations at screech level frequencies in a lean-premixed, atmospheric, swirl-stabilized, lab-scale gas turbine combustor. A hybrid computational fluid dynamics/computational aeroacoustics (CFD/CAA) approach is applied to individually compute thermoacoustic damping and driving rates for various acoustic amplitude levels at the combustors' first transversal (T1) eigenfrequency. Harmonically forced CFD simulations with the unsteady Reynolds-averaged Navier–Stokes (URANS) equations mimic the real combustor's rotating T1 eigenmode. A slow and monotonous increase of the forcing amplitude over time allows observation of the amplitude-dependent flow field and flame evolution. In accordance with measured OH*-chemiluminescence images, a pulsation amplitude-dependent flame contraction is reproduced in the CFD simulations, where acoustically induced backflow at the combustion chamber inlet is identified as the root cause of this phenomenon. At several amplitude levels, period-averaged flow fields are then denoted as reference states, which serve as inputs for the CAA part. There, eigenfrequency simulations with linearized flow equations are performed with the finite element method. The outcomes are damping and driving rates as a response to the amplitude dependency of the mean flow field, which combined give the net thermoacoustic growth rate. It is found that driving due to flame-acoustics interactions only governs a weak amplitude dependency, which agrees with prior, experimentally based studies at the authors' institute. This disqualifies the perception of heat release saturation as the root cause for limit-cycle oscillations—at least in this high-frequency thermoacoustic system. Instead, significantly increased dissipation due to the interaction of acoustically induced vorticity perturbations with the mean flow is identified, which may explain the formation of a limit cycle.
Temperature dependent performance of ITO Schottky contacts on β-Ga2O3
Authors: Xia Xinyi , Xian Minghan , Fares Chaker , Ren Fan , Tadjer Marko , Pearton Stephen J.
Published: August 2021

Sputtered indium tin oxide (ITO) was used as a rectifying contact on lightly n-type (n ∼ 1016 cm−3) β-Ga2O3 and found to exhibit excellent Schottky characteristics up to 500 K, with no thermally driven degradation to this temperature. The barrier height extracted from current–voltage characteristics was 1.15 ± 0.04 eV at 300 K and 0.78 ± 0.03 eV at 500 K, with thermionic behavior of charge carriers over the image force lowered Schottky barriers dominating the carrier transport at low temperatures. The breakdown voltages were 246, 185, and 144 V at 300, 400 and 500 K, respectively. At 600 K, the diodes suffered irreversible thermal damage. The diode on/off ratio was >105 for reverse biases up to 100 V. At higher reverse voltage, the current shows an I ∝ Vn relationship with voltage, indicating a trap-assisted space-charge-limited conduction (SCLC) mechanism. We observed this SCLC relation when the reverse voltage was larger than 100 V for 300 and 400 K and at <100 V at 500 K. The ITO can also be used to make Ohmic contacts on heavily doped Ga2O3 suggesting the possibility of completely optically transparent power devices.
Toward inclusion of atmospheric effects in the aircraft community noise predictions
Authors: Yunus Furkat , Casalino Damiano , Avallone Francesco , Ragni Daniele
Published: August 2021

This paper presents an atmospheric propagation model, based on ray acoustics, that accounts for realistic weather conditions in the evaluation of the noise footprint of an aircraft. Noise sources, obtained using the Ffowcs Williams and Hawkings acoustic analogy applied to scale-resolved flow simulation data, are stored on a hemisphere surrounding the vehicle. These noise sources are propagated using a propagation model that takes into account the vertical variability of air temperature and wind velocity. The electric vertical takeoff and landing aircraft, presented by Casalino, van der Velden, and Romani [(2019). in Proceedings of the AIAA Scitech 2019 Forum, January 7–11, San Diego, CA, pp. 1834–1851], is used as a case study; noise footprints, obtained considering various vertically varying temperature and wind velocity distributions, are compared. It is shown that weather conditions in the acoustic wave propagation can contribute to mismatch up to 4 dBA in the illuminated zone and a significant drop in the refractive shadow zone caused by the vertical air temperature and wind velocity gradients. This work constitutes the first accomplishment in including realistic atmospheric effects in aircraft community noise prediction based on scale-resolved flow simulations.
The influence of lexical characteristics and talker accent on the recognition of English words by native speakers of Korean
Authors: Choi Min-Kyoung , Holliday Jeffrey J. , Munson Benjamin
Published: August 2021

This study investigated the influences of lexical characteristics and talker accent on English spoken word recognition by first-language (L1) Korean second-language (L2) speakers of English. Stimuli were words that varied in phonological neighborhood density (PND) and word frequency (WF), produced by a L1 English speaker (L1 talker) and a L1 Korean speaker (L2 talker). Participants were 60 listeners from three groups: 20 L1 English speakers, 20 Korean L2 English speakers studying in the United States, and 20 Korean L2 English speakers studying in Korea. The 40 L2 English speakers varied widely in their estimated English proficiency. The results showed significant main effects of talkers, PND, and listener proficiency on word-recognition accuracy as well as significant interactions among stimulus talker (i.e., L1 vs L2 talker), PND, and WF and between stimulus talker and listener groups. However, we did not find that PND differentially affects word recognition in L2 learners, as had been found previously by Imai et al. [(2005). J. Acoust. Soc. Am. 117, 896–907] using the same design. Instead, our results paralleled closely those of Yoneyama and Munson [(2017). J. Acoust. Soc. Am. 141, 1308–1320], who examined L2 English speakers whose L1 was Japanese. These findings are discussed in light of the influence of L1 lexical structure on L2 phonological processing.
Urban noise distributions and the influence of geometric spreading on skewness
Authors: Wilson D. Keith , Kamrath Matthew J. , Haedrich Caitlin E. , Breton Daniel J. , Hart Carl R.
Published: August 2021

Statistical distributions of urban noise levels are influenced by many complex phenomena, including spatial and temporal variations in the source level, multisource mixtures, propagation losses, and random fading from multipath reflections. This article provides a broad perspective on the varying impacts of these phenomena. Distributions incorporating random fading and averaging (e.g., gamma and noncentral Erlang) tend to be negatively skewed on logarithmic (decibel) axes but can be positively skewed if the fading process is strongly modulated by source power variations (e.g., compound gamma). In contrast, distributions incorporating randomly positioned sources and explicit geometric spreading [e.g., exponentially modified Gaussian (EMG)] tend to be positively skewed with exponential tails on logarithmic axes. To evaluate the suitability of the various distributions, one-third octave band sound-level data were measured at 37 locations in the North End of Boston, MA. Based on the Kullback-Leibler divergence as calculated across all of the locations and frequencies, the EMG provides the most consistently good agreement with the data, which were generally positively skewed. The compound gamma also fits the data well and even outperforms the EMG for the small minority of cases exhibiting negative skew. The lognormal provides a suitable fit in cases in which particular non-traffic noise sources dominate.
Positive chronotropic effect caused by transthoracic ultrasound in heart of rats
Authors: Coiado Olivia C. , Yerrabelli Rahul S. , Christensen Anton P. , Wozniak Marcin , Lucas Alex , O'Brien William D.
Published: August 2021

Pulsed ultrasound can produce chronotropic and inotropic effects on the heart with potential therapeutic applications. Fourteen 3-month-old female rats were exposed transthoracically to 3.5-MHz 2.0-MPa peak rarefactional pressure amplitude ultrasonic pulses of increasing 5-s duration pulse repetition frequency (PRF) sequences. An increase in the heart rate was observed following each PRF sequence: an ∼50% increase after the 4-5-6 Hz sequence, an ∼57% increase after the 5-6-7 Hz sequence, and an ∼48% increase after the 6-7-8 Hz sequence. Other cardiac parameters showed a normal or indicated a compensatory decrease at 3 and 15 min post-ultrasound compared to control.
Influence of Occupational Socialization on Sport Pedagogy Doctoral Students’ Beliefs and Actions
Authors: Jowers Richard F. , Brunsdon Jamie J. , Peterson Jacob T. , Mitchell Hayden L. , Curtner-Smith Matthew D.
Published: August 2021

Purpose: To examine the influence of occupational socialization on the beliefs and actions of six sport pedagogy doctoral students (DSs) in terms of physical education (PE) teaching and physical education teacher education (PETE). Method: Data were collected with five qualitative techniques and analyzed by employing analytic induction and constant comparison. Results: DSs had conservative or liberal views about PE and endorsed hybrid forms of PETE, which included elements of the behavioristic, traditional/craft, and critical inquiry orientations. Patterns of socialization that shaped these beliefs and actions were both congruent and contrasting with those described in past research. Conclusions: The study highlights the importance of asking potential DSs about their beliefs and the forces that shaped those beliefs during recruitment. In addition, it indicates that the potency of doctoral education can be enhanced when it has a dual focus on PETE and research and when DSs experience it within a cohort.
Emerging roles of PLCγ1 in endothelial biology
Authors: Chen Dongying , Simons Michael
Published: August 2021

The enzyme PLCγ1 is an important effector of key signaling pathways in endothelial cells.
Targeting Polyphosphate Kinases in the Fight against Pseudomonas aeruginosa
Authors: Baijal Kanchi , Downey Michael
Published: August 2021

Polyphosphate (polyP) is a universally conserved molecule that plays critical roles in managing bacterial stress responses, in addition to biofilm formation and virulence. The enzymes that make polyphosphate molecules are called polyphosphate kinases (PPKs).
Dynamics of SARS-CoV-2 Spike Proteins in Cell Entry: Control Elements in the Amino-Terminal Domains
Authors: Qing Enya , Kicmal Tom , Kumar Binod , Hawkins Grant M. , Timm Emily , Perlman Stanley , Gallagher Tom
Published: August 2021

Adaptive changes that increase SARS-CoV-2 transmissibility may expand and prolong the coronavirus disease 2019 (COVID-19) pandemic. Transmission requires metastable and dynamic spike proteins that bind viruses to cells and catalyze virus-cell membrane fusion.
The dCache Chemoreceptor TlpA of Helicobacter pylori Binds Multiple Attractant and Antagonistic Ligands via Distinct Sites
Authors: Johnson Kevin S. , Elgamoudi Bassam A. , Jen Freda E.-C. , Day Christopher J. , Sweeney Emily Goers , Pryce Megan L. , Guillemin Karen , Haselhorst Thomas , Korolik Victoria , Ottemann Karen M.
Published: August 2021

Numerous chemotactic bacterial pathogens depend on the ability to sense a diverse array of signals through chemoreceptors to achieve successful colonization and virulence within their host. The signals sensed by chemoreceptors, however, are not always fully understood.
Gut Microbiome Structure and Association with Host Factors in a Korean Population
Authors: Lim Mi Young , Hong Seungpyo , Bang So-Jung , Chung Won-Hyong , Shin Ji-Hee , Kim Jung-Ha , Nam Young-Do
Published: August 2021

Comparing the gut microbiomes of healthy controls and disease patients showed that the composition of the gut microbiome is associated with various host health conditions. The gut microbiome in healthy Western populations is well characterized, while that of non-Western populations, with different diet patterns, lifestyles, and genetic backgrounds, is not clearly defined.
Time-Resolved Proteome Analysis of
Listeria monocytogenes
during Infection Reveals the Role of the AAA+ Chaperone ClpC for Host Cell Adaptation
Authors: Birk Marlène S. , Ahmed-Begrich Rina , Tran Stefan , Elsholz Alexander K. W. , Frese Christian K. , Charpentier Emmanuelle
Published: August 2021

Survival and proliferation of pathogenic bacteria inside the host depend on their ability to adapt to the changing environment. Profiling the underlying changes on the bacterial proteome level during the infection process is important to gain a better understanding of the pathogenesis and the host-dependent adaptation processes.
Species-Specific Endotoxin Stimulus Determines Toll-Like Receptor 4- and Caspase 11-Mediated Pathway Activation Characteristics
Authors: Ernst Orna , Khan Mohd M. , Oyler Benjamin L. , Yoon Sung Hwan , Sun Jing , Lin Fang-Yu , Manes Nathan P. , MacKerell Alexander D. , Fraser Iain D. C. , Ernst Robert K. , Goodlett David R. , Nita-Lazar Aleksandra
Published: August 2021

Macrophages and monocytes are innate immune cells playing an important role in orchestrating the initial innate immune response to bacterial infection and the tissue damage. This response is facilitated by specific receptors on the cell surface and intracellularly.
Identification of a GrgA-Euo-HrcA Transcriptional Regulatory Network in Chlamydia
Authors: Wurihan Wurihan , Zou Yi , Weber Alec M. , Weldon Korri , Huang Yehong , Bao Xiaofeng , Zhu Chengsheng , Wu Xiang , Wang Yaqun , Lai Zhao , Fan Huizhou
Published: August 2021

Chlamydia trachomatis
is the most prevalent sexually transmitted bacterial pathogen worldwide and is a leading cause of preventable blindness in underdeveloped areas as well as some developed countries.
Chlamydia
carries genes that encode a limited number of known transcription factors. While Euo is thought to be critical for early chlamydial development, the functions of GrgA and HrcA in the developmental cycle are unclear.
Comprehensive Strain-Level Analysis of the Gut Microbe Faecalibacterium prausnitzii in Patients with Liver Cirrhosis
Authors: Chen Yaowen , Liu Pu , Liu Runyan , Hu Shuofeng , He Zhen , Dong Guohua , Feng Chao , An Sijing , Ying Xiaomin
Published: August 2021

Most metagenomic studies focus on microbes at the species level, thus ignoring the different effects of different strains of the same species on the host. In this study, we explored the different microbes at the strain level in the intestines of patients with liver cirrhosis and of healthy people.
Genome-Scale Metabolic Models and Machine Learning Reveal Genetic Determinants of Antibiotic Resistance in Escherichia coli and Unravel the Underlying Metabolic Adaptation Mechanisms
Authors: Pearcy Nicole , Hu Yue , Baker Michelle , Maciel-Guerra Alexandre , Xue Ning , Wang Wei , Kaler Jasmeet , Peng Zixin , Li Fengqin , Dottorini Tania
Published: August 2021

Escherichia coliis a major public health concern given its increasing level of antibiotic resistance worldwide and extraordinary capacity to acquire and spread resistance via horizontal gene transfer with surrounding species and via mutations in its existing genome.E. colialso exhibits a large amount of metabolic pathway redundancy, which promotes resistance via metabolic adaptability. In this study, we developed a computational approach that integrates machine learning with metabolic modeling to understand the correlation between AMR and metabolic adaptation mechanisms in this model bacterium.
Supplemental Material: Carbon and nitrogen isotope evidence for widespread presence of anoxic intermediate waters before and during the Permian-Triassic mass extinction
Authors: Wu Baojin , Luo Genming , al et.
Published: August 2021

Table S1: Geochemical data.
Oral ulceration in Stüve-Wiedemann syndrome: a new presentation
Authors: Singh Kiran , Borghol Khaled , Williams Rhodri , McMillan Kevin
Published: August 2021

Stüve-Wiedemann syndrome (SWS) is a rare, autosomal recessive disorder, causing dysautonomia and multisystem failure. Symptoms include skeletal malformations, restricted joint mobility and desensitisation to pain. Patients with SWS presenting with intraoral lesions are extremely rare and this is probably due to their shortened lifespan. We present a case of a 9-month-old patient who presented to our Oral and Maxillofacial Surgery (OMFS)Unit with a chronic inflamed ulcer affecting the tongue, secondary to trauma from erupting central incisors. We believe that depapillation in conjunction with an increased pain threshold contributed to its development. The patient was successfully treated by extraction of the lower central incisors and intralesional steroid injections under general anaesthetic. This case highlights that patients with SWS can present to the OMFS clinician with oral lesions and that they can be safely managed under general anaesthesia.
Minimally invasive management of de Garengeot hernia with staged robotic hernia repair
Authors: Cohen Ryan B , Nerwal Teena , Winikoff Stephen , Hubbard Matthew
Published: August 2021

De Garengeot hernia is a rare phenomenon describing the migration of the appendix into a femoral hernia sac. Many repair strategies have been described although an open inguinal approach with suture repair is the most common technique. Despite strong evidence that mesh limits recurrence, most forgo mesh use in the presence of appendicitis for fear of contamination. We report a case in a 68-year-old man managed completely with minimally invasive strategies. We performed a staged laparoscopic appendectomy followed by robotic hernia repair with polypropylene mesh. This is the first described two-stage minimally invasive approach and the first report demonstrating the feasibility of robotic hernia repair in the setting of de Garengeot hernia. It is our opinion that using a staged approach may encourage mesh repair by minimising the risk of implant contamination. Furthermore, we believe a fully minimally invasive technique may result in improved outcomes.
Prevalence and determinants of inappropriate antibiotic dispensing at private drug retail outlets in urban and rural areas of Indonesia: a mixed methods study
Authors: Wulandari Luh Putu Lila , Khan Mishal , Liverani Marco , Ferdiana Astri , Mashuri Yusuf Ari , Probandari Ari , Wibawa Tri , Batura Neha , Schierhout Gill , Kaldor John , Guy Rebecca , Law Matthew , Day Richard , Hanefeld Johanna , Parathon Harry , Jan Stephen , Yeung Shunmay , Wiseman Virginia
Published: August 2021

Introduction

The aim of this mixed-method study was to determine the extent and determinants of inappropriate dispensing of antibiotics by licensed private drug retail outlets in Indonesia.

Methods

Standardised patients (SPs) made a total of 495 visits to 166 drug outlets (community pharmacies and drug stores) between July and August 2019. The SPs presented three clinical cases to drug outlet staff: parent of a child at home with diarrhoea; an adult with presumptive tuberculosis (TB); and an adult with upper respiratory tract infection (URTI). The primary outcome was the dispensing of an antibiotic without prescription, with or without the client requesting it. We used multivariable random effects logistic regression to assess factors associated with the primary outcome and conducted 31 interviews with drug outlet staff to explore these factors in greater depth.

Results

Antibiotic dispensing without prescription occurred in 69% of SP visits. Dispensing antibiotics without a prescription was more likely in standalone pharmacies and pharmacies attached to clinics compared with drug stores, with an OR of 5.9 (95% CI 3.2 to 10.8) and OR of 2.2 (95% CI 1.2 to 3.9); and more likely for TB and URTI SP-performed cases compared with child diarrhoea cases, with an OR of 5.7 (95% CI 3.1 to 10.8) and OR of 5.2 (95% CI 2.7 to 9.8). Interviews revealed that inappropriate antibiotic dispensing was driven by strong patient demand for antibiotics, unqualified drug sellers dispensing medicines, competition between different types of drug outlets, drug outlet owners pushing their staff to sell medicines, and weak enforcement of regulations.

Conclusion

This study shows that inappropriate dispensing of antibiotics by private drug retail outlets is widespread. Interventions will need to address not only the role of drug sellers, but also the demand for antibiotics among clients and the push from drug outlet owners to compete with other outlets.
Measuring oxygen access: lessons from health facility assessments in Lagos, Nigeria
Authors: Graham Hamish R , Olojede Omotayo E , Bakare Ayobami A , Iuliano Agnese , Olatunde Oyaniyi , Isah Adamu , Osebi Adams , Ahmed Tahlil , Burgess Rochelle Ann , McCollum Eric D , Colbourn Tim , King Carina , Uchendu Obioma C , Falade Adegoke G
Published: August 2021

The COVID-19 pandemic has highlighted global oxygen system deficiencies and revealed gaps in how we understand and measure ‘oxygen access’. We present a case study on oxygen access from 58 health facilities in Lagos state, Nigeria. We found large differences in oxygen access between facilities (primary vs secondary, government vs private) and describe three key domains to consider when measuring oxygen access: availability, cost, use. Of 58 facilities surveyed, 8 (14%) of facilities had a functional pulse oximeter. Oximeters (N=27) were typically located in outpatient clinics (12/27, 44%), paediatric ward (6/27, 22%) or operating theatre (4/27, 15%). 34/58 (59%) facilities had a functional source of oxygen available on the day of inspection, of which 31 (91%) facilities had it available in a single ward area, typically the operating theatre or maternity ward. Oxygen services were free to patients at primary health centres, when available, but expensive in hospitals and private facilities, with the median cost for 2 days oxygen 13 000 (US$36) and 27 500 (US$77) Naira, respectively. We obtained limited data on the cost of oxygen services to facilities. Pulse oximetry use was low in secondary care facilities (32%, 21/65 patients had SpO2documented) and negligible in private facilities (2%, 3/177) and primary health centres (<1%, 2/608). We were unable to determine the proportion of hypoxaemic patients who received oxygen therapy with available data. However, triangulation of existing data suggested that no facilities were equipped to meet minimum oxygen demands. We highlight the importance of a multifaceted approach to measuring oxygen access that assesses access at the point-of-care and ideally at the patient-level. We propose standard metrics to report oxygen access and describe how these can be integrated into routine health information systems and existing health facility assessment tools.
Disregarding the restrictive vial-opening policy for BCG vaccine in Guinea-Bissau: impact and cost-effectiveness for tuberculosis mortality and all-cause mortality in children aged 0–4 years
Authors: Thysen Sanne M , Fisker Ane Baerent , Byberg Stine , Aaby Peter , Roy Partho , White Richard , Griffiths Ulla , Harris Rebecca C
Published: August 2021

Objective

BCG vaccination is frequently delayed in low-income countries. Restrictive vial-opening policies, where a vial of BCG vaccine is not opened for few children, are a major reason for delay. During delays, children are unprotected against tuberculosis (TB) and deprived of non-specific effects of BCG. We assessed the potential effect and cost-effectiveness of disregarding the restrictive vial-opening policy, on TB and all-cause mortality, in children aged 0–4 years in Guinea-Bissau.

Methods

Using static mathematical models, we estimated the absolute and percentage change in TB and all-cause deaths, in children aged 0–4 years, between the current BCG vaccine restrictive-opening policy scenario, and a non-restrictive policy scenario where all children were vaccinated in the first health-facility contact. Incremental cost-effectiveness was estimated by integration of vaccine and treatment costs.

Findings

Disregarding the restrictive BCG vial-opening policy was estimated to reduce TB deaths by 11.0% (95% uncertainty range (UR):0.5%–28.8%), corresponding to 4 (UR:0–15) TB deaths averted per birth cohort in Guinea-Bissau, resulting in incremental cost-effectiveness of US$ 911 per discounted life-year gained (LYG) (UR:145–9142). For all-cause deaths, the estimated reduction was 8.1% (UR: 3.3%–12.7%) corresponding to 392 (UR:158–624) fewer all-cause deaths and an incremental cost-effectiveness of US$ 9 (UR:5–23) per discounted LYG.

Conclusions

Disregarding the restrictive BCG vial-opening policy was associated with reductions in TB deaths and all-cause deaths and low cost-effectiveness ratios. Our results suggest that it would be cost-effective to disregard the restrictive vial-opening policy. Other settings with similar practice are also likely to gain from disregarding this policy.
Impact of drug diversity on treatment effectiveness in relapsing-remitting multiple sclerosis (RRMS) in Germany between 2010 and 2018: real-world data from the German NeuroTransData multiple sclerosis registry
Authors: Braune Stefan , Rossnagel Fabian , Dikow Heidi , Bergmann Arnfin
Published: August 2021

Objective

To evaluate the impact of drug diversity on treatment effectiveness in relapsing-remitting multiple sclerosis (RRMS) in Germany.

Design

This study employs real-world data captured in-time during clinical visits in 67 German neurology outpatient offices of the NeuroTransData (NTD) multiple sclerosis (MS) registry between 1 January 2010 and 30 June 2019, including 237 976 visits of 17 553 patients with RRMS. Adherence and clinical effectiveness parameters were analysed by descriptive statistics, time-to-event analysis overall and by disease-modifying therapies (DMTs) stratified by administration modes (injectable, oral and infusion). Three time periods were compared: 2010–2012, 2013–2015 and 2016–2018.

Results

Between 2010 and 2018, an increasing proportion of patients with RRMS were treated with DMTs and treatment was initiated sooner after diagnosis of MS. Introduction of oral DMT temporarily induced higher readiness to switch. Comparing the three index periods, there was a continuous decrease of annualised relapse rates, less frequent Expanded Disability Status Scale (EDSS) progression and increasing periods without relapse, EDSS worsening and with stability of no-evidence-of-disease-activity 2 and 3 criteria, lower conversion rates to secondary progressive MS on oral and on injectable DMTs.

Conclusion

Sparked by the availability of new mainly oral DMTs, RRMS treatment effectiveness improved clinically meaningful between 2010 and 2018. As similar effects were seen for injectable and oral DMTs more than for infusions, a better personalised treatment allocation in many patients is likely. These results indicate that there is an overall beneficial effect for the whole patient with MS population as a result of the greater selection of available DMTs, a benefit beyond the head-to-head comparative efficacy, resulting from an increased probability and readiness to individualise MS therapy.
New prophylaxis regimen for SARS-CoV-2 infection in health professionals with low doses of hydroxychloroquine and bromhexine: a randomised, double-blind placebo clinical trial (ELEVATE Trial)
Authors: Granados-Montiel Julio , Hazan-Lasri Eric , Franco-Cendejas Rafael , Chávez-Heres Tatiana , Silva-Bermudez Phaedra , Aguilar-Gaytán Rocio , Manzano-León Natalia , Méndez-Maldonado Karla , Alvarez-Arce Alejandro , Martínez-Portilla Raigam Jafet
Published: August 2021

Introduction

SARS-CoV-2 infection in Mexico has caused ~2.7 million confirmed cases; around 20%–25% of health workers will be infected by the virus at their workplace, with approximately 4.4% of mortality. High infectivity of SARS-CoV-2 is related with cell entry mechanism, through the ACE receptor. SARS-CoV-2 requires transmembrane protease serine 2 to cleave its spike glycoprotein and ensure fusion of host cell and virus membrane. We propose studying prophylactic treatment with hydroxychloroquine (HCQ) and bromhexine (BHH), which have been shown to be effective in preventing SARS-CoV-2 infection progression when administered in early stages. The aim of this study is to assess the efficacy of HCQ and BHH as prophylactic treatments for SARS-CoV-2 infection in healthy health workers exposed to the virus.

Methods and analysis

Double-blind randomised clinical trial, with parallel allocation at a 1:1 ratio with placebo, of low doses of HCQ plus BHH, for 60 days. Study groups will be defined as follows: (1) HCQ 200 mg/day+BHH 8 mg/8 hours versus (2) HCQ placebo plus BHH placebo. Primary endpoint will be efficacy of both interventions for the prevention of SARS-CoV-2 infection, determined by the risk ratio of infected personnel and the absolute risk. At least a 16% reduction in absolute risk is expected between the intervention and placebo groups; a minimum of 20% infection is expected in the placebo group. The sample size calculation estimated a total of 214 patients assigned: two groups of 107 participants each.

Ethics and dissemination

This protocol has been approved by the local Medical Ethics Committee (National Institute of Rehabilitation ‘Luis Guillermo Ibarra Ibarra’, approval number INRLGII/25/20) and by the Federal Commission for Protection against Sanitary Risks (COFEPRIS, approval number 203 300 410A0058/2020). The results of the study will be submitted for publication in peer-reviewed journals and disseminated through conferences.

Trial registration number

NCT04340349.
Is the fluorescence optical imaging (FOI) able to discriminate between rheumatoid arthritis patients with and without need of rituximab retherapy? A cohort study
Authors: Ridha Ali Schahrasad Lisa , Glimm Anne-Marie , Burmester Gerd R , Hoff Paula , Schmittat Gabriela , Hermann Sandra , Backhaus Marina , Klotsche Jens , Ohrndorf Sarah
Published: August 2021

Objective

To evaluate the ability of fluorescence optical imaging (FOI) Xiralite in the discrimination between rheumatoid arthritis (RA) patients with and without need of rituximab (RTX) retherapy—in comparison to clinical, laboratory and musculoskeletal ultrasound parameters.

Patients and methods

Patients with established RA were prospectively followed over 1 year by Disease Activity Score 28, patient’s global disease activity (visual analogue scale 0–100 mm), C reactive protein and erythrocyte sedimentation rate, ultrasound seven joint (US7) score and FOI in phases 1–3 and automatically generated PrimaVista mode (PVM) at baseline (before RTX) and after 3, 6 and 12 months. The need for RTX retherapy was decided by the treating rheumatologist—blinded to imaging data.

Results

31 patients (female 77.4%, mean age 60.1±11.4, mean disease duration 14.9±7.1 years) were included. Fourteen (45.2%) patients received RTX retherapy within 12 months. In the group with RTX retherapy, FOI in PVM mode was the only parameter that presented significant increase over time (β: 0.40, 95% CI: 0.08 to 0.71, p=0.013)—compared with the group without retherapy. In the prediction model via ROC analysis, FOI in PVM reached the highest values of all imaging, clinical and laboratory parameters which was associated with retherapy over 1 year with an area under the curve (AUC) of 0.78 (OR: 0.84, 95% CI: 0.72 to 0.98, p=0.031). US7 GS synovitis score revealed similar association with an AUC of 0.73 (p=0.049).

Conclusion

US7 GS synovitis score and FOI in PVM are able to discriminate between patients with and without need for RTX retherapy better than clinical and laboratory parameters.
Perceptions and experiences of healthcare providers during COVID-19 pandemic in Karachi, Pakistan: an exploratory qualitative study
Authors: Shahil Feroz Anam , Pradhan Nousheen Akber , Hussain Ahmed Zarak , Shah Mashal Murad , Asad Nargis , Saleem Sarah , Siddiqi Sameen
Published: August 2021

Objective

To explore healthcare provider’s perspectives and experiences of the barriers and facilitators to treat and manage COVID-19 cases.

Design and setting

We conducted an exploratory qualitative study using a purposive sampling approach, at a private tertiary care teaching hospital in Karachi, Pakistan. Study data were analysed manually using the conventional content analysis technique.

Participants

Key-informant interviews (KIIs) were conducted with senior management and hospital leadership and in-depth interviews (IDIs) were conducted with front-line healthcare providers.

Results

A total of 31 interviews (KIIs=19; IDIs=12) were conducted, between April and May 2020. Three overarching themes emerged. The first was ‘challenges faced by front-line healthcare providers working in COVID-19 wards. Healthcare workers experienced increased anxiety due to the fear of acquiring infection and transmitting it to their family members. They felt overwhelmed due to the exhaustive donning and doffing process, intense work and stigmatisation. The second theme was ‘enablers supporting healthcare providers to deal with the COVID-19 pandemic’. Front liners pointed out several enabling factors that supported hospital staff including a safe hospital environment, adequate training, a strong system of information sharing and supportive management. The third theme was ‘recommendations to support the healthcare workforce during the COVID-19 crisis’. Healthcare workers recommended measures to mitigate current challenges including providing risk allowance to front-line healthcare providers, preparing a backup health workforce, and establishing a platform to address the mental health needs of the healthcare providers.

Conclusion

This study provides an initial evidence base of healthcare providers’ experiences of managing patients with COVID-19 in the early stage of the pandemic and highlights measures needed to address the encountered challenges. It offers lessons for hospitals in low-income and middle-income countries to ensure a safe working environment for front-line workers in their fight against COVID-19.
Rationalising oxygen usage in a level II special newborn care unit in Madhya Pradesh, India
Authors: Parmar Jaiprakash , Pawar Vandana , Warathe Aarti , Singh Manish , Bajaj Rajashree , Kumar Jogender , Thukral Anu , Chawla Deepak , Kumar Praveen , Deorari Ashok
Published: August 2021

Non-judicious oxygen use in preterm infants is associated with increased risk of retinopathy of prematurity, bronchopulmonary dysplasia and longer hospital stay. Despite established guidelines on oxygen therapy, compliance with the best oxygen practices remains suboptimal. Excessive use of oxygen also consumes a large proportion of the annual maintenance budget of special newborn care units (SNCUs) in the districts. In this project, we aimed to reduce the oxygen consumption in the SNCU at Sehore, Madhya Pradesh, India from eight to four cylinders per day, by rationalising the indications, monitoring and method of oxygen delivery.

We tested two sets of interventions using the Plan–Do–Study–Act (PDSA) approach. The first intervention was the introduction of a written ‘oxygen policy’ regarding indications of starting/stopping oxygen and the use of saturation targets. The second was using short binasal infant prongs (at 0.5–1 L/min), instead of oxygen hoods as the primary method of oxygen delivery in spontaneously breathing neonates requiring oxygen. In the first PDSA cycle, we assessed the feasibility of the intervention in a small set (n=30) of neonates and later scaled up to all eligible neonates in the second phase.

We observed a significant reduction in oxygen consumption (from median (IQR) 8 (7–8) to 3 (3–4) cylinders per day) that can lead to a direct saving of 590 000 Indian rupees (US$9000) per year. There was a significant reduction in the number of neonates on oxygen support on a given day. We did not observe any increase in mortality or nasal injury. The change was sustained for the next 8 months.

We conclude that by having a contextual oxygen policy and using nasal prongs instead of oxygen hoods as the preferred delivery method, we can achieve a sustainable reduction in oxygen consumption.
Reducing healthcare-associated infections by improving compliance to aseptic non-touch technique in intravenous line maintenance: a quality improvement approach
Authors: Shettigar Savithri , Somasekhara Aradhya Abhishek , Ramappa Srinath , Reddy Venugopal , Venkatagiri Praveen
Published: August 2021

Background

Lack of standardisation and failure to maintain aseptic techniques during procedures contributes to healthcare-associated infections (HCAI). Although numerous procedures are performed in neonatal intensive care units (NICU), handling peripheral intravenous lines is one of the simple and common procedures performed daily. Despite evidence-based care bundle approach variability is higher, and compliance to asepsis is less in routine clinical practice. In this study, we aimed to standardise and improve compliance with Aseptic non-technique (ANTT) in intravenous line maintenance of neonates admitted to NICU to reduce HCAI by 50% over 6 months.

Methods

All nurses were subjects of assessment for compliance with intravenous line maintenance. All admitted neonates with intravenous lines were subjects for the HCAI data collection. At baseline, the current practices for intravenous line maintenance were observed on a generic ANTT audit proforma. Pictorial standard operating procedure (SOP) was developed based on ANTT. Implementation and sustenance were ensured by Plan-Do-Study-Act cycles. Audit data on compliance to ANTT and trends of HCAI rates were displayed using run charts monthly. Qualitative experience from the nursing staff was also recorded.

Results

Significant improvement was seen in compliance to various components—use of the aseptic field (0% to 100%), closed ports (0% to 100%), key part contamination reduction (80% to 0%), and intravenous hub scrubbing (0% to 72%). SOP of intravenous line maintenance based on ANTT could be implemented and sustained throughout for 9 months. There was a reduction of HCAI from 26 per 1000 patient days to 8 per 1000 patient days. Qualitative experience showed the main determinant of compliance to scrub the hub was the neonate’s sickness level.

Conclusions

Using a quality improvement model of improvement, ANTT in intravenous line maintenance was implemented stepwise. Improving compliance with ANTT principles in intravenous line maintenance reduced HCAI. Scrub the hub requires longer sustained efforts to become part of the practice.