bluuebunny/crossref_metadata_2025 huggingface dataset:
Metagenomic sequencing of cyanobacterial-dominated Lake Victoria—an African Great Lake
Authors: Zepernick Brittany N. , Hart Lauren N. , Natwora Kaela E. , Brown Katelyn M. , Obuya Julia A. , Olokotum Mark , Okech Eric O. , Keating Natalie G. , Lomeo Davide , Tebbs Emma J. ,   NSF-IRES 2022-2023 Lake Victoria Research Consortium, Sheik Cody S. , Sherman David H. , Dick Gregory J. , Wilhelm Steven W. , Drouillard Ken G. , Lawrence Theodore , Getabu Albert , Owuor Bethwell , Shitandi Anakalo , Omondi Reuben , Njiru James , Sitoki Lewis , Otiso Kefa M. , McKay R. Michael L. , Bullerjahn George S. , Achieng Dorine , Achieng Tonny , Achiya James , Abibo Adem Jack , Adhikari Anjana , Allan Trinity , Barker Katelyn B. , Barnard Malcolm A. , Basweti George M. , Beal Max , Byrne Aidan , Chepkirui Mercy , Cody William R. , Nasrin Khan Nusrat , Kiteresi Linet I. , Miruka Jared B. , Mohney Samantha , Moseti Martha , Okutoyi Pamela , Otieno Dennis , Owino Omondi A. , Owoko Winnie , Radock Lisa , Stoll Jordyn , Swaleh Mariam , Wagner Ryan S. , Varga Emily
Published: November 2024

We report 40 metagenomic libraries collected from the Winam Gulf of Lake Victoria during May–July of 2022–2023 and an additional eight opportunistic libraries from adjacent Lakes Simbi, Naivasha, and regional river systems. The sampling period captured cyanobacterial bloom events – shedding insight onto community composition and genomic potential.
Understanding brewing trait inheritance in
de novo
Lager yeast hybrids
Authors: Zavaleta Vasni , Pérez-Través Laura , Saona Luis A. , Villarroel Carlos A. , Querol Amparo , Cubillos Francisco A.
Published: November 2024

Hybridization between
Saccharomyces cerevisiae
and
Saccharomyces eubayanus
resulted in the emergence of
S. pastorianus
, a crucial yeast for lager fermentation. However, our understanding of hybridization success and hybrid vigor between these two species remains limited due to the scarcity of
S. eubayanus
parental strains. Here, we explore hybridization success and the impact of hybridization on fermentation performance and volatile compound profiles in newly formed lager hybrids. By selecting parental candidates spanning a diverse array of lineages from both species, we reveal that the Beer and PB-2 lineages exhibit high rates of hybridization success in
S. cerevisiae
and
S. eubayanus
, respectively. Polyploid hybrids were generated through a spontaneous diploid hybridization technique (rare-mating), revealing a prevalence of triploids and diploids over tetraploids. Despite the absence of heterosis in fermentative capacity, hybrids displayed phenotypic variability, notably influenced by maltotriose consumption. Interestingly, ploidy levels did not significantly correlate with fermentative capacity, although triploids exhibited greater phenotypic variability. The
S. cerevisiae
parental lineages primarily influenced volatile compound profiles, with significant differences in aroma production. Interestingly, hybrids emerging from the Beer
S. cerevisiae
parental lineages exhibited a volatile compound profile resembling the corresponding
S. eubayanus
parent. This pattern may result from the dominant inheritance of the
S. eubayanus
aroma profile, as suggested by the over-expression of genes related to alcohol metabolism and acetate synthesis in hybrids including the Beer
S. cerevisiae
lineage. Our findings suggest complex interactions between parental lineages and hybridization outcomes, highlighting the potential for creating yeasts with distinct brewing traits through hybridization strategies.

IMPORTANCE

Our study investigates the principles of lager yeast hybridization between
Saccharomyces cerevisiae
and
Saccharomyces eubayanus
. This process gave rise to the lager yeast
Saccharomyces pastorianus
. By examining how these novel hybrids perform during fermentation and the aromas they produce, we uncover the genetic bases of brewing trait inheritance. We successfully generated polyploid hybrids using diverse strains and lineages from both parent species, predominantly triploids and diploids. Although these hybrids did not show improved fermentation capacity, they exhibited varied traits, especially in utilizing maltotriose, a key sugar in brewing. Remarkably, the aroma profiles of these hybrids were primarily influenced by the
S. cerevisiae
parent, with Beer lineage hybrids adopting aroma characteristics from their
S. eubayanus
parent. These insights reveal the complex genetic interactions in hybrid yeasts, opening new possibilities for crafting unique brewing yeasts with desirable traits.
Genome streamlining of
Pseudomonas putida
B6-2 for bioremediation
Authors: Fan Siqing , Ren Hao , Fu Xueni , Kong Xiangyu , Wu Hao , Lu Zhenmei
Published: November 2024

Microbial transformation is a favored approach for environmental remediation. However, the effectiveness of microbial remediation has been limited by the lack of chassis cells with satisfactory contaminant degradation performance.
Pseudomonas putida
B6-2, with a wide substrate spectrum and high solvent tolerance, is a chassis strain with great potential for application in environmental remediation. Here, guided by bioinformatic analyses and genome-scale metabolic model (GEM) predictions, we successfully optimized
P. putida
B6-2 by rationally reducing its nonessential genetic components and generating a more robust genome-streamlined strain,
P. putida
BGR4. Several improvements were observed compared with the original
P. putida
B6-2 strain, including a 1.4 × 10
5
-fold increase in electroporation efficiency, an 8.3-fold increase in conjugation efficiency, improved glycerol utilization capability, and increased phenol utilization after heterologous expression of the phenol monooxygenase encoded by
dmpKLMNOP
. Additionally,
P. putida
BGR4 exhibited enhanced tolerance to several stressors, including starvation, oxidative stress, and DNA damage. Transcriptomic analysis revealed that genome streamlining led to the upregulation of genes involved in the “carbon metabolism” and “tricarboxylic acid cycle” pathways in
P. putida
BGR4, which likely contributed to the superior phenotype of
P. putida
BGR4 in terms of carbon source utilization and contaminant degradation capabilities. Furthermore, the absence of four prophages was identified as a potential cause of the enhanced stress resistance observed in
P. putida
BGR4. Overall, we developed a combined genome-streamlining strategy involving bioinformatic analyses and GEM predictions and generated a more robust chassis strain,
P. putida
BGR4, which expands the repertoire of chassis cells for environmental remediation.

IMPORTANCE

Despite the development of many chassis cells, there is still a lack of robust chassis cells with satisfactory contaminant degradation performance. Targeted genome streamlining is an effective way to provide powerful chassis cells. However, genome streamlining does not always lead to the improved phenotypes of genome-streamlined chassis cells. In this research, a novel procedure that combined bioinformatic analyses and GEM predictions was proposed to guide genome streamlining and predict the effects of genome streamlining. This genome streamlining procedure was successfully applied to
Pseudomonas putida
B6-2, which was a chassis cell with great potential for application in environmental remediation and resulted in the generation of a more robust chassis cell,
P. putida
BGR4, thereby providing a superior chassis cell for efficient and sustainable environmental remediation and a valuable framework for guiding the genome streamlining of strains for other applications.
Doxifluridine effectively kills antibiotic-resistant
Staphylococcus aureus
in chronic obstructive pulmonary disease
Authors: Zhang Lianshen , Zhang Yingzhang , Tian Lijie , Shen Qiang , Ma Xiaolong
Published: November 2024

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality globally, often exacerbated by infections such as methicillin-resistant
Staphylococcus aureus
(MRSA). The rise in antibiotic-resistant strains complicates treatment and underscores the need for novel therapeutic drugs. In this paper, we further investigated the antimicrobial potential of a fluoropyrimidine anticancer drug doxifluridine against multidrug-resistant
S. aureus
. Determination of minimum inhibitory concentration (MIC) or minimum bactericidal concentration (MBC), monitoring of growth curve, time-kill assays, biofilm bactericidal assays, and chequerboard studies were conducted to evaluate the antibacterial efficacy of doxifluridine. Safety was assessed via hemolysis and cytotoxicity assays, and an
in vivo Galleria mellonella
larvae model was employed to test protective effects. Doxifluridine demonstrated significant antibacterial activity against clinical multidrug resistance (MDR)
S. aureus
isolates, with MIC and MBC values ranging from 0.5 to 2 µg/mL and 1 to 4 µg/mL, respectively. The results revealed doxifluridine’s potent bactericidal effects within 8 hours. Moreover, doxifluridine-treated bacteria showed a substantial reduction in biofilm mass and viability. Furthermore, chequerboard assays indicated synergistic interactions between doxifluridine and other antibiotics, reducing MIC values by two- to eightfold. More importantly, safety evaluations confirmed that doxifluridine did not exhibit hemolytic toxicity or cytotoxicity. Finally, doxifluridine significantly increased the survival rate of MRSA-infected
G. mellonella
larvae
in vivo
. In brief, doxifluridine exhibited promising
in vitro
and
in vivo
antibacterial activity against MRSA, suggesting its potential as a repurposed drug for treating resistant bacterial infections in COPD patients.

IMPORTANCE

The study provides robust evidence for the antibacterial efficacy of doxifluridine against Methicillin-resistant
Staphylococcus aureus
in chronic obstructive pulmonary disease (COPD) patients. Its rapid action, ability to disrupt biofilms, and synergistic effects with other antibiotics, combined with a favorable safety profile, highlight its potential as a repurposed therapeutic agent. Future clinical trials will be essential to confirm these findings and pave the way for its integration into clinical practice. This work not only provides candidate for tackling the management of bacterial infections in COPD but also exemplifies the potential of drug repurposing in combating antibiotic-resistant infections.
Symptomatic presentation and imaging features of a chylous cystic lymphangioma
Authors: Kwak Lily , Hakim Matteen , Ivey Gabriel , Brookmeyer Claire
Published: November 2024

A woman in her 60s presenting with 5 days of diffuse abdominal pain was diagnosed preoperatively with a chylolymphatic mesenteric cyst. MRI and CT imaging demonstrated a 5.8 cm unilocular cyst containing a fluid-fluid level within the mesentery. Following an uncomplicated open excision, the lesion was characterised by pathology as a cystic lymphangioma due to the presence of focal smooth muscle and lymphoid tissue in the wall. This case report discusses the radiologic features of rare lymphatic mesenteric cysts that can help guide preoperative diagnosis and highlights that postoperative diagnosis remains definitive. This case also underscores the importance of considering mesenteric cysts as a rare cause of abdominal pain in patients who have non-specific abdominal symptoms and a mass on imaging not associated with any single organ.
Severe haemophilia A in a neonate from a resource-limited country
Authors: Uygen Glenn Patrick Montalbo , Alinea Ma Cecilia , Estanislao Jochrys
Published: November 2024

Literature on haemophilia in the Philippines is sparse, especially in the neonatal group. This report showcases a newborn from a resource-limited country who was worked up for haemophilia after presenting with a strong family history and a large haematoma on his blood extraction site. Laboratory tests showed a normal platelet count, deranged coagulation parameters and severely decreased Factor VIII activity levels. Due to the unavailability of Factor VIII concentrate, the patient was transfused with fresh frozen plasma with no recurrence of bleeding and was discharged well. He was referred to haemophilia foundations for procurement of Factor VIII concentrates for emergency use. Subsequently, the patient presented with spontaneous left cheek swelling at 3 months old. Repeat coagulation parameters showed a twice elevated partial thromboplastin time and he was given Factor VIII concentrate at the emergency room. This report also discusses the challenges in the diagnosis and management of haemophilia in the Philippines.
Short-term intraocular pressure changes after intravitreal aflibercept 2 mg, aflibercept 8 mg and faricimab: a prospective, comparative study
Authors: Paris Arianna , Volpe Giulio , Perruchoud-Ader Kathrin , Casanova Alex , Menghini Moreno , Grimaldi Gabriela
Published: November 2024

Background/aims

Intravitreal injection (IVT) of anti-vascular endothelial growth factor agents is the standard of care for several retinal diseases but can cause intraocular pressure (IOP) elevations. This study investigates short-term postinjection IOP changes following aflibercept 8 mg and faricimab, compared with aflibercept 2 mg.

Methods

This observational, prospective study included 90 patients with age-related macular degeneration or diabetic macular oedema, divided into three groups, receiving aflibercept 2 mg, aflibercept 8 mg or faricimab. IOP was measured using an iCare IC200-tonometer preinjection (T0) and at 30 s (T1), 5 min (T2) and 15 min (T3) postinjection. Primary outcomes included IOP changes at the four time points within and between treatment groups. The incidence of transient visual loss requiring paracentesis was recorded.

Results

All groups experienced a significant IOP increase at T1, with mean IOP increase being 41.47±12.95 mm Hg for aflibercept 2 mg, 43.46±8.97 mm Hg for aflibercept 8 mg and 32.19±11.06 mm Hg for faricimab. By T2, IOP differences were not significant, and by T3, mean IOP returned within normal limits across all groups. Faricimab showed a smaller initial IOP spike than both aflibercept formulations, but this difference was not statistically significant at T2 and T3.

Conclusion

Transient IOP spikes are observed post-IVT of aflibercept 8 mg and faricimab, with similar trends to aflibercept 2 mg. The initial IOP elevation normalised within 15 min. Faricimab had a lower initial spike, but overall IOP profiles were comparable across different agents.
Boston Marathon athlete performance outcomes and intra-event medical encounter risk associated with low energy availability indicators
Authors: Whitney Kristin E , DeJong Lempke Alexandra F , Stellingwerff Trent , Burke Louise M , Holtzman Bryan , Baggish Aaron L , D'Hemecourt Pierre A , Dyer Sophia , Troyanos Chris , Adelzadeh Kaya , Saville Grace H , Heikura Ida A , Farnsworth Nicole , Reece Laura , Hackney Anthony C , Ackerman Kathryn E
Published: November 2024

Objective

To determine the association between survey-based self-reported problematic low energy availability indicators (LEA-I) and race performance and intra-event medical encounters during the Boston Marathon.

Methods

1030 runners who were registered for the 2022 Boston Marathon completed an electronic survey (1–4 weeks pre-race) assessing LEA-I, training and medical history. De-identified survey data were linked to event wearable timing chips and medical encounter records. LEA-I was defined as: an elevated Eating Disorder Examination Questionnaire score, elevated Low Energy Availability (LEA) in Females Questionnaire score, LEA in Males Questionnaire with a focus on gonadal dysfunction score and/or self-report of diagnosed eating disorder/disordered eating.

Results

The prevalence of LEA-I was 232/546 (42.5%) in females and 85/484 (17.6%) in males. Athletes without LEA-I (non-LEA-I) achieved significantly better race times versus those with LEA-I (accounting for demographic and anthropomorphic data, training history and marathon experience), along with better division finishing place (DFP) mean outcomes (women’s DFP: 948.9±57.6 versus 1377.4±82.9, p<0.001; men’s DFP: 794.6±41.0 versus 1262.4±103.3, p<0.001). Compared with non-LEA-I athletes, LEA-I athletes had 1.99-fold (95% CI: 1.15 to 3.43) increased relative risk (RR) of an intra-event medical encounter of any severity level, and a 2.86-fold increased RR (95% CI:1.31 to 6.24) of a major medical encounter.

Conclusion

This is the largest study to link LEA-I to intra-event athletic performance and medical encounters. LEA-I were associated with worse race performance and increased risk of intra-event medical encounters, supporting the negative performance and medical risks associated with problematic LEA-I in marathon athletes.
Wall-eyed bilateral internuclear ophthalmoplegia (WEBINO) syndrome secondary to dorsal pontine infarction
Authors: Zhang Lin-Yuan , Zhu Ming , Wang Yu , Wang Guo-Dong , Wang Yan , Wu Yun-Cheng , Zhu Xiao-Ying
Published: November 2024

Background

Wall-eyed bilateral internuclear ophthalmoplegia (WEBINO) is an uncommon ocular motor disorder which is featured by binocular exotropia and bilateral internuclear ophthalmoplegia.

Methods

A 71-year-old man with hypertension presented to the emergency department with sudden-onset diplopia. Neurological examination, neuroimaging, blood and cerebrospinal fluid (CSF) testing were performed.

Results

We presented a typical WEBINO syndrome case with a clear dorsal pontine infarction involving bilateral medial longitudinal fasciculi (MLF) on brain MR scan. The patient’s eye movement abnormalities improved and MR lesions disappeared at 60-day follow-up after treatment of clopidogrel and atorvastatin. Furthermore, we summarised the aetiology and pathophysiology of WEBINO by retrospectively analysing all published WEBINO cases. We found that WEBINO can result from various underlying pathologies, with inflammation most common in the young, and stroke most common in the elderly. Simultaneous lesions of bilateral MLF definitely contribute to the pathophysiology of WEBINO.

Conclusions

This case underscores the importance of early recognising WEBINO in the emergency department. A timely diagnosis of stroke-induced WEBINO is important so that acute treatment can be considered and for initiating secondary stroke preventive measures to potentially improve the prognosis.
Global trends in the burden of rheumatoid arthritis by sociodemographic index: a joinpoint and age–period–cohort analysis based on the Global Burden of Disease Study 2019
Authors: Chen Cheng , Shi QiLin , He WenBao , Tian HaoJun , Ye TianBao , Yang YunFeng
Published: November 2024

Objective

To describe temporal trends in the incidence and disability-adjusted life years (DALYs) of rheumatoid arthritis (RA) across sociodemographic index (SDI) quintiles and sexes from 1990 to 2019.

Methods

Data on RA incidence and DALYs with a 95% uncertainty interval from 1990 to 2019 were extracted from the Global Burden of Disease 2019. Subsequently, trends across SDI quintiles and sexes from 1990 to 2019 were determined using joinpoint regression and age–period–cohort analyses.

Results

A significant upward trend in the global age-standardised incidence rate (ASIR) of RA was observed for both sexes from 1990 to 2019 (average annual per cent change (AAPC): 0.214, 95% CI 0.179 to 0.249, p<0.001). Specifically, the ASIR of RA for both sexes demonstrated a significant increasing trend at all SDI levels, with the highest AAPC observed in the low SDI regions. A non-significant increasing trend in the global age-standardised DALYs rate (ASDR) of RA was observed for both sexes from 1990 to 2019 (AAPC: 0.017, 95% CI −0.051 to 0.085, p=0.621). Varying trends in ASDR were observed for both sexes and across SDI quintiles. Additionally, diverse age–period–cohort patterns in incidence and DALYs were observed across SDI quintiles and sexes.

Conclusion

The significant heterogeneity observed in the temporal trends of the incidence and DALYs of RA across SDI quintiles and sexes suggests potential disparities in the prevention, management and treatment of RA. Therefore, establishment of practical and customised healthcare initiatives for specific populations across SDI quintiles and sexes and allocation of supplementary health resources to high-risk populations are crucial for effective management of RA.
Atezolizumab monotherapy as first-line treatment for non-small cell lung cancer ineligible for treatment with a platinum-containing regimen (IPSOS): a cost-effectiveness analysis in the USA
Authors: Li Biao , Rong Dingchao , Lin Hui
Published: November 2024

Objective

This study explores the cost-effectiveness of atezolizumab monotherapy compared with chemotherapy as first-line treatment for stage IIIB or IV non-small cell lung cancer (IIIB/IV-NSCLC) ineligible for platinum-based chemotherapy from a US payer perspective.

Design

This is based on the IPSOS clinical trial. We conducted a comprehensive assessment of the cost-effectiveness of atezolizumab monotherapy versus single-agent chemotherapy over a 15-year duration. Employing a robust Markov model incorporating data from 453 patients, we calculated total costs, life-years (LYs), quality-adjusted life-years (QALYs) and the incremental cost-effectiveness ratio (ICER) at a willingness-to-pay (WTP) threshold of $150 000 per QALY. We performed one-way, two-way and probabilistic sensitivity analyses to validate our model.

Setting

The US payer perspective.

Participants

A cohort with NSCLC ineligible for treatment with a platinum-containing regimen from IPSOS clinical trial.

Interventions

Atezolizumab monotherapy versus chemotherapy.

Primary outcome measure

Cost, QALYs, LYs and ICER.

Result

Chemotherapy resulted in an average survival of 0.930 QALYs (1.528 LYs) per patient at an average cost of $67 579. Atezolizumab treatment provided an additional 0.309 QALYs but incurred an extra cost of $66 472, leading to an ICER of $215 069 per QALY compared with chemotherapy. The cost of atezolizumab had the most significant impact on the model outcomes. Probabilistic sensitivity analysis showed that atezolizumab had a 30.2% probability of being considered cost-effective at a WTP threshold of $150 000 per QALY in the USA. These results remained consistent across various scenarios and sensitivity analyses employing both deterministic and probabilistic approaches.

Conclusion

The current price of atezolizumab renders it an unlikely cost-effective treatment option for patients with IIIB/IV-NSCLC from the payer’s perspective in the USA. To achieve cost-effectiveness, substantial discounts are necessary.

Trial registration number

The IMpower-110, an open-label, randomised, phase 3 clinical trial (NCT02409342). The IPSOS clinical trial (NCT03191786).
Prevalence of comorbidities among patients with rheumatoid arthritis in the UAE: a case–control study
Authors: Al-Saleh Jamal , Ali Khan Naureen , Zamani Noura , AlSaidi Hend , Rachidi Wafae
Published: November 2024

Objectives

Data on the rate of comorbidities in Arab patients with rheumatoid arthritis (RA) are limited, and extrapolating the prevalence of comorbidities from international studies is challenging. This study aimed to investigate the prevalence of comorbidities in patients with RA, compare it with that in non-RA controls and explore the association between the body mass index of patients with RA and comorbidities.

Design

This is a retrospective, case–control study.

Setting

This study included patients receiving secondary care at the Rheumatology Department of a public hospital in the Emirate of Dubai. The controls were recruited from patients receiving primary and secondary care at the Dubai Academic Health Corporation in the fourth quarter of 2022.

Participants

This study included all consecutive UAE national patients with RA who visited the rheumatology clinic. The study included 1756 participants in an age-matched and sex-matched control group and 439 patients with RA. Of these, 88.6% were female, and the median age was 55 years. Each RA case was randomly matched with four controls of the same age and sex. All relevant information, including case and control demographics and comorbidities, was retrieved from the electronic medical record.

Primary and secondary outcome measures

The relative risk of comorbidities was compared between patients with RA and age-matched controls. The relationship between obesity in RA and the frequency of comorbidities was determined.

Results

This study revealed that 188 (42.8%) patients with RA had at least one comorbidity, whereas only 636 (36.2%) individuals in the control group had at least one comorbidity (OR 1.3; 95% CI 1.1 to 1.6, p<0.01). Patients with RA were more likely to have ischaemic heart disease (OR 3.9; 95% CI 2.3 to 6.6, p<0.0001), fibromyalgia (OR 25; 95% CI 13 to 34, p<0.0001), cataract (OR 5.8; 95% CI 4 to 8.5, p<0.0001), osteoporosis (OR 6.8; 95% CI 4.6 to 10, p<0.0001) and knee osteoarthritis (OR 6.1; 95% CI 4.8 to 7.8, p<0.0001).

Conclusions

Patients with RA were more likely to have cardiovascular, pulmonary and musculoskeletal comorbidities compared with the control group. Obese patients with RA had a higher incidence of comorbidity than non-obese patients with RA.
‘If you’ve lost your personality, there’s no point in changing the valve’—a qualitative study of older adults’ attitudes towards treatment of aortic stenosis with comorbid dementia
Authors: Skaar Elisabeth , Rostoft Siri , Cruz-Jentoft Alfonso , Jackson Thomas , Bleie Øyvind , Packer Erik , Øksnes Anja , Schaufel Margrethe Aase
Published: November 2024

Objectives

Due to prognostic uncertainty and limited decision-making capacity, the choice to perform transcatheter aortic valve implantation (TAVI) in patients with severe aortic stenosis (AS) and comorbid dementia is challenging. This study explores older adults’ perspectives on complex decision-making preceding TAVI in the hypothetical setting of comorbid dementia.

Design

Qualitative study entailing semistructured interviews. Analysis was by systematic text condensation. The interview guide addressed their attitudes regarding treatment dilemmas before TAVI in patients living with dementia.

Setting

Patients were recruited from the TAVI outpatient clinic at a university hospital performing TAVI.

Participants

A purposive sample of 10 older adults (5 women) with AS and without dementia (range 77–94 years), where 8/10 had undergone TAVI were included.

Results

Three main challenges were identified: (1) Risk assessment. Participants found it hard to compare the burden of aortic stenosis vs dementia. They acknowledged the dilemma of implanting a new heart valve to achieve symptom relief while risking severe dementia in the future due to prolonged life span. (2) Autonomous capacity. A profound uncertainty was described regarding who should participate in decision-making if the person was incapacitated due to dementia. (3) Customised information. Participants advocated for thorough information describing facts and uncertainty, aiming to protect and support the person living with dementia.

Conclusion

Older adults with severe aortic stenosis find it hard relating to dilemmas arising from providing TAVI in patients living with dementia. There is a need for tailor-made information to support autonomy and decision-making under uncertainty.
Burden and determinants of scabies in a pastoralist community: a case–control study from Southwest Ethiopia
Authors: Shifera Nigusie , Yosef Tewodros
Published: November 2024

Background

Scabies is a skin infestation caused by the human itch mite, affecting people globally across all demographics. However, it is more prevalent among children, individuals with poor hygiene, those in overcrowded or slum areas and people affected by drought and war. There is limited research on scabies in Ethiopia and none specifically focused on marginalised communities. This study aimed to assess the burden of scabies and its contributing factors among pastoralist communities in Ethiopia.

Methods

A community-based, unmatched case–control study (1:2 ratio) was conducted in Meinit Goldiya District to assess risk factors for scabies. The researchers collected line-listed data on scabies and conducted face-to-face interviews from January to February 2023, with a sample of 156 cases and 312 controls. Data were gathered using a structured questionnaire and analysed with SPSS V.22. OR, p values and 95% CI were calculated to identify associated factors. Independent factors were determined using a p value of <0.05 and the corresponding 95% CI in the multivariable model.

Results

A total of 4269 scabies cases were reported in the district, with an attack rate of 7.9%. Of the reported cases, 52.8% (2254 cases) were male. The multivariable analysis identified several factors significantly associated with scabies: sleeping with infected individuals (adjusted OR (AOR)=3.70 (2.08, 6.61)), sharing washing facilities with patients with scabies in the past 6 months (AOR=4.05 (2.30, 7.13)), placing clothes together with infected individuals’ clothes (AOR=4.71 (2.64, 8.42)) and households with a daily water consumption of ≥25 L per person per day, which was a protective factor (AOR=0.06 (0.03, 0.12)).

Conclusion

Scabies is a public health issue in the district, with significant risk factors including sleeping, washing and contact with patients with scabies, as well as daily water consumption levels. To address this, the study recommends strengthening active case surveillance, offering health education and ensuring health facilities are stocked with treatment medications.
Validating the recording of exacerbations of asthma in electronic health records: a systematic review protocol
Authors: Moore Elizabeth , Gassasse Zakariah Z , Quint Jennifer K
Published: November 2024

Introduction

Asthma exacerbations or ‘attacks’ can vary in severity from mild worsening of symptoms to life-threatening changes that require urgent hospital care. Understanding these exacerbations is crucial to improving treatment and support for patients. Electronic health records (EHR) using anonymised data from people with asthma in primary and secondary care can be used to understand exacerbations and outcomes. However, previous studies found significant heterogeneity in the algorithms used to define asthma exacerbations. Validating definitions of asthma exacerbations in EHR will lead to more robust and comparable evidence in future research.

Methods and analysis

Medline and Embase will be searched for the key concepts relating to asthma exacerbations, EHR and validation. All studies that validate exacerbations of asthma in EHR and administrative claims databases published before 30 May 2024 and written in English will be considered. Validated algorithms for asthma exacerbations or attacks must be compared against a reference or gold standard definition, and a measure of validity must be included. Articles will be screened for inclusion by two independent reviewers with any disagreements resolved by consensus or arbitration by a third reviewer. Study details will be extracted, and the risk of bias will be assessed using a QUADAS-2 tailored to this review.

Ethics & dissemination

No ethical approval is required as this is a review of previously published literature. Results will be disseminated in a peer-reviewed journal with the aim of being used in future research to help identify asthma exacerbation in EHR.

PROSPERO registration number

CRD42024545081
Attitudes towards patient safety among physicians and nurses in Iranian governmental teaching hospitals: a cross-sectional survey
Authors: Kakemam Edris , Miri Farzaneh , Sadeghpour Sevda , Mirzaei Alireza , Saeidpour Jalal
Published: November 2024

Objectives

To assess and compare attitudes towards patient safety among physicians and nurses in Iranian governmental teaching hospitals and to identify factors associated with attitudes towards patient safety.

Design

An institution-based, cross-sectional survey was carried out from July to August 2023.

Setting

10 governmental teaching hospitals in Tehran, Iran.

Participants

The study participants comprised a random sample of 186 nurses and 90 physicians who had worked for at least 6 months in their current hospitals.

Outcome measures

The primary outcome measures were mean and SD scores for individual items and the nine main patient safety domains assessed by the Attitudes Toward Patient Safety Questionnaire-III. The secondary outcome measure was the proportion of physicians and nurses who responded positively to each item, expressed as percentages for each group.

Results

Physicians and nurses exhibited moderately positive attitudes towards patient safety (mean scores of 3.79±0.33 and 3.83±0.36, respectively). Both professional groups reported the most positive attitudes in the same dimensions: ‘team functioning’ and ‘working hours as a cause for error’ (mean scores of >4 out of 5). Conversely, the lowest scores were observed in ‘importance of patient safety in the curriculum’, indicating potential gaps in their understanding of patient safety (mean scores of <3.5 out of 5). Physicians displayed significantly more positive attitudes in the domain of ‘error inevitability’, while nurses held more positive attitudes in ‘error reporting confidence’ and ‘disclosure responsibility’ (p<0.05). Multiple linear regression analysis demonstrated that the factors associated with more positive attitudes towards patient safety included lower workload (B=0.131; 95% CI 0.047 to 0.215; p=0.002), reporting of adverse events (B=0.100; 95% CI 0.009 to 0.191; p=0.030) and receiving patient safety training (B=0.134; 95% CI 0.019 to 0.249; p< 0.023).

Conclusion

Both professional groups demonstrated moderately positive attitudes towards patient safety. However, the findings highlighted the need for future patient safety training to prioritise enhancement of healthcare professionals’ understanding of medical errors. Such training initiatives should be engaging and directly relevant to the specific needs of both nurses and physicians, ensuring its perceived value to their ongoing professional development. Furthermore, fostering a supportive and blame-free environment that encourages the reporting of medical errors is crucial.
ICU follow-up services and their impact on post-intensive care syndrome: a scoping review protocol
Authors: Zhang Rui-xue , Xu Yu , Tian Yongming , He Lin , Chu Yuan
Published: November 2024

Introduction

Post-intensive care syndrome (PICS) seriously affects the quality of life of intensive care unit (ICU) survivors, their ability to return to work and society and the quality of life of their families, increasing overall care costs and healthcare expenditures. ICU follow-up services have important potential to improve PICS. However, the best clinical practice model of ICU follow-up service has not been fully defined and its benefits for ICU survivors are not clear. This review will synthesise and map the current types of follow-up services for ICU survivors and summarise the impact of follow-up services on PICS.

Methods and analysis

This scoping review will be conducted by applying the five-stage protocol proposed by Arksey and O’Malley in an updated version of the Joanna Briggs Institute. Eight academic databases including the Cochrane Library, MEDLINE, Web of Science, Embase, EBSCO Academic, CINAHL, PsycInfo and SinoMed (China Biology Medicine) will be systematically searched from inception to the present. Peer-reviewed literature and grey literature will be included. Qualitative, quantitative and mixed methods studies will be included. Studies published in English or Chinese will be included. There will be no time restriction. Two reviewers will screen and select the articles independently and if there is any disagreement, the two reviewers will discuss or invite a third reviewer to make decisions together. Descriptive analysis will be used to conduct an overview of the literature. The results will be presented in a descriptive format in response to the review questions accompanied by the necessary tables or charts.

Ethics and dissemination

Ethical approval is not required for this scoping review because data could be obtained by reviewing published primary study results and do not involve human participants. Findings should be disseminated at scientific meetings and published in peer-reviewed journals.
Use of the walking and turning test to accurately discriminate between independently ambulatory community-dwelling older Thai adults with and without a history of falls: a retrospective diagnostic study
Authors: Duangsanjun Winut , Poncumhak Puttipong
Published: November 2024

Objectives

This study developed and investigated the possibility of using the walking and turning test (WTT) to indicate fall risk in community-dwelling older adults.

Design

Retrospective diagnostic study.

Setting

The study was carried out in a community setting.

Participants

The study focused on community-dwelling older Thai adults.

Primary and secondary outcome measures

The participants were assessed based on demographics, fear of falls using a ‘yes/no’ question and the Short Falls Efficacy Scale International, as well as fall data in the previous 6 months. The participants then performed the WTT, timed up and go test, five times sit-to-stand test and handgrip strength test (HG) in random order.

Results

There were a total of 86 participants with an average age of 69.95±6.10 years (range from 60 to 88 years), most of whom were female (67.44%). 40 participants (46.51%) reported that they had fallen at least once in the previous 6 months. A comparison of various physical ability tests revealed significant differences between faller and non-faller participants (p<0.001). The outcomes of the WTT showed significant correlations with fall variables, balance and muscle strength (0.394 to 0.853, p<0.001). Based on sensitivity, specificity and area under the curve, the cut-off score of 6.40 s showed the highest level of ability to indicate falls among community-dwelling older adults, with a sensitivity of 92.50% and a specificity of 78.26%.

Conclusions

The study suggests the clinical usefulness of the WTT in determining falls in older individuals. WTT is a physical ability measurement that indicates balance ability and muscle strength. The test is practical, requires little space and equipment and can be used in large populations.
Median nerve electrical stimulation for restoring consciousness in patients with traumatic brain injury: study protocol for a systematic review and meta-analysis
Authors: Yang Ying , Luo Yulan , Feng Mei , Luo Ping , Zeng Jiarong , Shi Xinmao , Tang Menglin
Published: November 2024

Introduction

Traumatic brain injury (TBI) is one of the prevalent critical illnesses encountered in clinical practice, often resulting in a spectrum of consciousness disorders among survivors. Prolonged states of impaired consciousness can significantly elevate the susceptibility to complications such as urinary tract infections and pulmonary issues, consequently leading to a compromised prognosis and substantially impacting the quality of life for affected individuals. Clinical studies have reported that median nerve electrical stimulation (MNES) may have a therapeutic effect in the treatment of disorders of consciousness (DOC). We plan to conduct a systematic review and meta-analysis to evaluate the efficacy and safety of MNES in the management of DOC subsequent to TBI.

Methods and analysis

We will conduct a comprehensive literature search in the following electronic databases: Web of Science, Embase, PubMed, Cochrane Library, China Biology Medicine, China National Knowledge Infrastructure, Wan Fang Database and Chinese Scientific Journal Database. The search will be performed from the inception of the databases until 30 September 2024. Furthermore, we will search for relevant ongoing trials in the International Clinical Trial Registry Platform, ClinicalTrials.gov and China Clinical Trial Registry. Grey literature will also be sourced from reputable sources like GreyNet International, Open Grey and Google Scholar. We will include eligible randomised controlled trials. The primary outcome of interest will be the assessment of consciousness disorder severity. To ensure rigour and consistency, two independent reviewers will screen the studies for inclusion, extract relevant data and assess the risk of bias. Any discrepancies will be resolved through discussion or consultation with a third reviewer. The quality of evidence will be evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation approach. Data synthesis and meta-analysis will be conducted using STATA 15.1 software.

Ethics and dissemination

This systematic review and meta-analysis do not involve the collection or use of any individual patient data, thereby obviating the necessity for ethical review. The research findings will be disseminated through publication in peer-reviewed scientific journals.

PROSPERO registration number

CRD42024533359.
Aligning implementation research and clinical operations: a partnership to promote implementation research in primary care
Authors: Chepp Valerie , Masiano Steven , Scarcipino Mario , Hudak Audrey , Steinel Eva , Babiuch Christopher , Misra-Hebert Anita D
Published: November 2024

The rigorous evaluation of the implementation of evidence into routine practice in a health system requires strong alignment between research and clinical operational teams. Implementation researchers benefit from understanding operational processes and contextual factors when designing data collection while operational teams gain an understanding of implementation frameworks and outcomes using both qualitative and quantitative data. However, interventions to build capacity for these evaluation partnerships—particularly those tailored for clinical operational practitioners—are limited. We developed a model for a research–clinical operational partnership to build capacity for rigorous implementation evaluation. The model incorporated didactic and interactive education alongside small group discussion. Using reflective qualitative analysis, we show how the year-long partnership resulted in an effective collaboration that built capacity for rigorous operational evaluation, informed plans for data collection to include provider and patient barriers to adoption and increased awareness of implementation cost barriers. Improved capacity for implementation evaluation was demonstrated by the knowledge acquisition that resulted for both teams as a result of the collaboration and the education that penetrated to other aspects of the operational team’s work beyond the immediate project. Programme successes and improvement opportunities were also identified. The partnership model shows how a formal research–clinical operational collaboration can build capacity for rigorous implementation evaluation and close the gap between implementation researchers and practitioners in a large health system. While larger-scale process evaluation is common, creating space for project-specific capacity-building initiatives, with varying levels of research involvement, can also advance the field of implementation science, offering new perspectives and partnerships, as well as opportunities to advance learning even for smaller-scale evidence translation.
‘We listened and supported and depended on each other’: a qualitative study of how leadership influences implementation of QI interventions
Authors: Ginsburg Liane , Easterbrook Adam , Geerts Ariane , Berta Whitney , van Dreumel Lynda , Estabrooks Carole A , Norton Peter G , Wagg Adrian
Published: November 2024

Background

There is growing recognition in the literature of the ‘Herculean’ efforts required to bring about change in healthcare processes and systems. Leadership is recognised as a critical lever for implementation of quality improvement (QI) and other complex team-level interventions; however, the processes by which leaders facilitate change are not well understood. The aim of this study is to examine ‘how’ leadership influences implementation of QI interventions.

Methods

We drew on the leadership literature and used secondary data collected as part of a process evaluation of the Safer Care for Older Persons in residential Environments (SCOPE) QI intervention to gain insights regarding the processes by which leadership influences QI implementation. Specifically, using detailed process evaluation data from 31 unit-based nursing home teams we conducted a thematic analysis with a codebook developed a priori based on the existing literature to identify leadership processes.

Results

Effective leaders (ie, those who care teams felt supported by and who facilitated SCOPE implementation) successfully developed and reaffirmed teams’ commitment to the SCOPE QI intervention (theme 1), facilitated learning capacity by fostering follower participation in SCOPE and empowering care aides to step into team leadership roles (theme 2) and actively supported team-oriented processes where they developed and nurtured relationships with their followers and supported them as they navigated relationships with other staff (theme 3). Together, these were the mechanisms by which care aides were brought on board with the intervention, stayed on board and, ultimately, transplanted the intervention into the facility. Building learning capacity and creating a culture of improvement are thought to be the overarching processes by which leadership facilitates implementation of complex interventions like SCOPE.

Conclusions

Results highlight important, often overlooked, relational and sociocultural aspects of successful QI leadership in nursing homes that can guide the design, implementation and scaling of complex interventions and can guide future research.
Endocrine pathology in young rabbits with cystic fibrosis
Authors: Liang Xiubin , Hou Xia , Chen Y Eugene , Jin Jian-Ping , Zhang Kezhong , Xu Jie
Published: November 2024

Background

Cystic fibrosis (CF) is an autosomal recessive genetic disorder caused by loss-of-function mutations in the CF transmembrane conductance regulator gene. CF-related pancreatic lesions are known to cause exocrine dysfunctions such as pancreatic insufficiency, and endocrine dysfunctions, including CF-related diabetes. In a previous study, we generated rabbits with CF using CRISPR/Cas9 (Clustered regularly interspaced short palindromic repeats/CRISPR-associated protein 9)-mediated gene editing.

Methods

Rabbits with CF were subjected to histological analysis with a focus on CF-associated pancreatic lesions. Endocrine function-related assays were conducted to evaluate CF-related pancreatic endocrine disorders in these animals.

Results

We report that rabbits with CF develop spontaneous pancreatic lesions at a young age, characterised by pancreatic inflammation and fibrosis, vacuolar degeneration, epithelium mucus-secretory cell metaplasia and pancreatic duct dilation. The size of the pancreatic islets in the rabbits with CF is significantly smaller than that of the wild-type animals. Consistent with these pathological findings, young rabbits with CF exhibited signs of pancreatic endocrine-related disorders such as lower insulin levels and impaired glucose metabolism.

Conclusions

Our results suggest that the CF rabbit could serve as a valuable model for translational research on CF-related pancreatic endocrine dysfunction.