bluuebunny/crossref_metadata_2025 huggingface dataset:
A Mechanical Model for Carbon Paper Gas Diffusion Layers for PEM Fuel Cells Including Fiber and Binder Failure
Authors: Benz Felix
Published: February 2025

In this paper, the microscopic deformation of carbon fiber papers for PEM fuel cell gas diffusion layers under compression is investigated numerically. A nonlinear model for mechanical simulations of the fiber structure is described. It is based on the Timoshenko beam bending theory applied to a random fiber structure. Additional nonlinear effects are included in the model to ensure realistic mechanical behavior. The effect of the binder material is included in the model via a spring coupling between close fibers. Damage to fibers and binder, as well as additional fiber contacts, are considered. Second-order terms are added to the beam theory. The model can predict the microscopic deformations of the individual fibers and helps to understand the damage accumulating in the fiber structure during the assembly of a fuel cell. The results of the model highlight the importance of including damage terms in the theoretical description of GDLs. The hysteresis in the stress strain curve seen in compression experiments of GDLs is reproduced qualitatively. It is shown that the hysteresis is based on both binder damage and fiber damage. While damage to the carbon fibers is limited to large compression ratios greater than 0.16, the model predicts damage to the binder throughout the whole compression range. To understand the influence of the individual components of the system, a parameter study is carried out.
Revolutionizing Hybrid Wind/PV/Battery Systems: State-of-the-Art Predictive Control and Real-Time Testing for Optimal Performance
Authors: Benadli Ridha , Abbassi Abdekader , Houari Azeddine , Bjaoui Marwen , Sellami Anis
Published: February 2025

The paper presents the design of a Continuous-Time Model Predictive Control (CTMPC) incorporating a disturbance observer (DO) for ensuring robustness against load disturbances. The developed model addresses the control effectiveness in grid-connected hybrid energy systems, under unknown variations of parameters in different operating conditions. These multiple power conversion subsystems are integrated to compose the entire configuration: a boost DC/DC converter for the photovoltaic generator, a bidirectional DC/DC converter for the battery energy storage system, an AC/DC converter for the wind turbine, and a Voltage Source Inverter (VSI) for interfacing with the grid. All of these components are connected through a common DC bus, which is the backbone of the hybrid system. To mitigate disturbances affecting the performance of power converters based on the renewable energy sources, a DO is added to the proposed CTMPC. This ensures a balanced distribution of active power between the common DC bus and the grid via the bidirectional DC/DC converter and maintains a stable DC link voltage through the VSI. Extensive simulations performed in Matlab/Simulink under different operating scenarios prove the superiority of the CTMPC-DO controller against conventional Proportional Integral (PI). The obtained results showed near-perfect tracking performance and significantly improved overall system stability, demonstrating the potential of the CTMPC-DO approach to replace conventional control strategies. Finally, an experimental validation of the proposed CTMPC-DO method by using the Hardware-In-the Loop (HIL) was developed to verify the applicability and efficiency of the controller in a DC microgrid. This largely proves the ability of the developed controller in handling hybrid energy system complexities and this is considered a major contribution towards improving control strategies in DC microgrids.
Numerical Investigation of Ammonia/n-Heptane Dual-Fuel Spray Flames Using Large-Eddy Simulations
Authors: Singh Harsimram , Pal Pinaki , Aggarwal Suresh K.
Published: February 2025

Diesel engines are extensively used in heavy-duty transportation, power generation, and marine vehicles due to their superior thermal efficiency and extended high-load operability compared to spark ignition (SI) engines. However, combustion in diesel engines is generally characterized by locally rich fuel-air mixtures and high combustion temperatures, causing significant amounts of soot and NOx emissions from these engines. Utilizing carbon-free alternative fuels and enhancing fuel efficiency represent promising strategies to mitigate greenhouse gas (GHG) and other emissions in the heavy-duty transportation sector. In this context, ammonia (NH3), as a hydrogen carrier, has received significant attention as a viable substitute for hydrocarbon fuels, due to its carbon-free composition, relatively high energy density, and well-established infrastructure. Many previous studies have considered combustion and emission characteristics of ammonia-hydrocarbon fuel blends in engines and simplified flames. However, detailed investigations on the effect of ammonia on the performance of hydrocarbon fuels under engine conditions are lacking. In the present study, we perform large-eddy simulations (LES) of the ignition and flame processes in a constant volume combustion reactor, where n–heptane is injected in an ammonia/air ambient mixture in a diesel-like environment. A detailed and validated reaction mechanism containing 302 species and 1981 reactions is employed. The ECN Spray H experimental data is used to validate the spray model under non-reacting and reacting conditions. Dual-fuel combustion is simulated using the well-stirred reactor (WSR) approach. Results are presented for two spray cases: (1) Single fuel (SF) with n-heptane injected into a mixture of air and combustion products; (2) Dual-fuel (DF) with the injection of n-heptane in a mixture of air, ammonia, and combustion products. It is observed that the presence of ammonia has a significant effect on the ignition and flame development processes. With ammonia addition, both the first and second stage ignition delay times increase, but the effect of ammonia on the second stage ignition is significantly more prominent. In addition, the ignition kernel size and growth rate decrease noticeably. For SF spray, the main ignition is characterized by multiple ignition kernels near spray tip, whereas for DF spray, a single relatively small ignition kernel forms and grows slowly in the downstream direction. The flame development and the final quasi-steady flame structure are also modified due to ammonia. The outcome of this research would enable better understanding of ammonia-diesel dual-fuel spray flame behavior and guide development of associated engine combustion strategies.
Research on a stacking ensemble model with adaptive feature weighting for predicting the tribological properties of lubricating grease
Authors: Xia Yanqiu , Cheng Xuemin , Feng Xin , Liu Chaoqi
Published: February 2025

To optimize traditional stacking ensemble method and accurately predict the tribological properties of lubricating grease, this study proposed a stacking ensemble model based on adaptive feature weighting and improved whale optimization algorithm (LGWOA-AFWStacking) to predict the tribological properties of small sample composite lithium-based grease. The tribological test selected ILs-WS2 and ILs-MoS2 as additives and used MFT-R4000 reciprocating friction and wear machine to investigate the tribological properties of lubricating grease. Firstly, machine learning models with excellent performance were selected as the base learners. Secondly, the Lévy flight strategy and golden sine algorithm were introduced to improve whale optimization algorithm (LGWOA). Finally, based on LGWOA and base learner performance, the model adjustment coefficient was optimized adaptively. The corresponding weights were assigned to base learners according to prediction precision, goodness of fit, and adjustment coefficient of each base learner. Weighted summation was realized. The experimental results demonstrated LGWOA-AFWStacking model could effectively predict the frictional properties of composite lithium-based grease, with predicted R2 values of 0.972 and 0.914 for average friction coefficient and wear width, respectively.
Fast reverberation-reduction algorithm based on inexact matrix decomposition
Authors: Zhu Yunchao , Duan Rui , Yang Kunde , Sun Qindong
Published: February 2025

Traditionally, matrix-based methods for reverberation reduction have prioritized a high signal-to-reverberation ratio over low time consumption. This letter describes a fast reverberation-reduction algorithm. The reverberation-reduction problem is formulated as an inexact matrix decomposition. A low-rank matrix is obtained through the reverberation extraction in a low-dimensional matrix, and a two-stage structure optimizes the computation iterative frame. The proposed algorithm's convergence, time consumption, and error are numerically simulated. Field data processing results demonstrate that the algorithm achieves a similar receiver operating characteristic (ROC) curve as with the alternating direction multiplier method (ADMM) but reduces the time consumption by 33%.
Glycoproteins gM and gN are indispensable factors for rhesus macaque rhadinovirus replication and spread but can be reconstituted by KSHV chimeras
Authors: Golas Gavin , Park Byung S. , Wong Scott W.
Published: February 2025

Rhesus macaque rhadinovirus (RRV) is a primate gamma-2 herpesvirus (rhadinovirus) closely related to Kaposi sarcoma-associated herpesvirus (KSHV), the human oncovirus that causes Kaposi sarcoma. Like other herpesviruses, KSHV and RRV encode numerous envelope glycoproteins involved in cell attachment, entry, as well as assembly and release of progeny virions from infected cells. Two glycoproteins postulated to form a complex and reported to be virus-neutralizing targets are glycoproteins M (gM) and N (gN). To investigate gM and gN in rhadinovirus infection, we utilized infectious and pathogenic bacterial artificial chromosomes (BAC). RRV BACmids with nonsense mutations introduced into gM or gN did not yield an infectious virus. However, when gM or gN of RRV were exchanged for gM or gN from KSHV, each of the KSHV-chimeric RRV BACmids restored virus replication and infectious spread. Interestingly, we also discovered that the substitution of KSHVgM into the RRV BACmid was associated with attenuation in viral spread, an effect that was not countered by a double-chimeric virus. In contrast, the substitution of RRV gN into a KSHV BACmid negatively affected the assembly of KSHV, independent of gM/gN complex formation. Therefore, here, we revealed that in KSHV and RRV, gM and gN are interchangeable, contribute to crucial functions for viral assembly and spread, and have evolved in a virus-specific manner. Although more research is needed to define the roles of gM and gN, our work establishes the first glycoprotein-chimeric viruses for KSHV and RRV, which can now be used to corroborate gM/gN as targets for a cancer vaccine.

IMPORTANCE

Kaposi sarcoma (KS) is a human cancer caused by KSHV and is one of the most frequently occurring cancers in HIV/AIDS patients, as well as in regions where KSHV is endemic. In this report, we have constructed and authenticated the first KSHV glycoprotein-encoding chimeric viruses for evaluations in the RRV/rhesus macaque model and have also uncovered fundamental roles for the glycoproteins gM and gN. Our work is significant by successfully bridging the human-specific, species barrier that has previously restricted preclinical evaluations of the KSHV glycoproteins as vaccine targets
in vivo
. Although there is no KSHV-specific animal model that is widely used, these KSHV-chimeric viruses may be useful as tools to guide future vaccine design and strategy as vaccine candidates progress toward clinical trials.
A dual insect symbiont and plant pathogen improves insect host fitness under arginine limitation
Authors: Kwak Younghwan , Argandona Jacob A. , Miao Sen , Son Thomas J. , Hansen Allison K.
Published: February 2025

Some facultative bacterial symbionts are known to benefit insects, but nutritional advantages are rare among these non-obligate symbionts. Here, we demonstrate that the facultative symbiont
Candidatus Liberibacter psyllaurous
enhances the fitness of its psyllid insect host,
Bactericera cockerelli
, by providing nutritional benefits.
L. psyllaurous
, an unculturable pathogen of solanaceous crops, also establishes a close relationship with its insect vector,
B. cockerelli
, increasing in titer during insect development, vertically transmitting through eggs, and colonizing various tissues, including the bacteriome, which houses the obligate nutritional symbiont,
Carsonella. Carsonella
supplies essential amino acids to its insect host but has gaps in some of its essential amino acid pathways that the psyllid complements with its own genes, many of which have been acquired through horizontal gene transfer (HGT) from bacteria. Our findings reveal that
L. psyllaurous
increases psyllid fitness on plants by reducing developmental time and increasing adult weight. In addition, through metagenomic sequencing, we reveal that
L. psyllaurous
maintains complete pathways for synthesizing the essential amino acids arginine, lysine, and threonine, unlike the psyllid’s other resident microbiota,
Carsonella,
and two co-occurring
Wolbachia
strains. RNA sequencing reveals the downregulation of a HGT collaborative psyllid gene (
ASL
), which indicates a reduced demand for arginine supplied by
Carsonella
when the psyllid is infected with
L. psyllaurous
. Notably, artificial diet assays show that
L. psyllaurous
enhances psyllid fitness on an arginine-deplete diet. These results corroborate the role of
L. psyllaurous
as a beneficial insect symbiont, contributing to the nutrition of its insect host.

IMPORTANCE

Unlike obligate symbionts that are permanently associated with their hosts, facultative symbionts rarely show direct nutritional contributions, especially under nutrient-limited conditions. This study demonstrates, for the first time, that
Candidatus Liberibacter psyllaurous
, a facultative symbiont and a plant pathogen, enhances the fitness of its
Bactericera cockerelli
host by supplying an essential nutrient arginine that is lacking in the plant sap diet. Our findings reveal how facultative symbionts can play a vital role in helping their insect hosts adapt to nutrient-limited environments. This work provides new insights into the dynamic interactions between insect hosts, their symbiotic microbes, and their shared ecological niches, broadening our understanding of symbiosis and its role in shaping adaptation and survival.
Complete genome sequence of
Methylocystis echinoides
strain RIM isolated from soil
Authors: Abdel-Hamid Ahmed M. , Putman Taylor , Furukawa Megan , Palivos William , Walden Kimberly K. O. , Fields Christopher J. , Schimmel Patrick , Mackie Roderick I. , Cann Isaac
Published: February 2025

We report here the complete genome sequence of a type II methanotrophic bacterium,
Methylocystis echinoides
strain RIM, isolated from the soil surface at Urbana, Illinois. This genome was obtained via HiFi PacBio Sequel II sequencing.
mSphere of Influence: Rapid evolution of pathogenesis and drug resistance in human pathogenic fungi
Authors: Hu Pengjie
Published: February 2025

Pengjie Hu works in the field of fungal pathogenesis, drug resistance, and evolution. In this mSphere of Influence article, he reflects on how three works, “Transposon mobilization in the human fungal pathogen
Cryptococcus
is mutagenic during infection and promotes drug resistance in vitro” and “Genome-wide analysis of heat stress-stimulated transposon mobility in the human fungal pathogen
Cryptococcus deneoformans
” by Gusa et al. and “Rapid evolution of an adaptive multicellular morphology of
Candida auris
during systemic infection” by Bing et al. have impacted his work on the evolution of virulence, resistance, and adaptation in human fungal pathogens.
Supplemental Material: Neoproterozoic mantle connections during the West Gondwana assembly in the Vazante Carbonate Platform, Central Brazil
Authors: Ferreira Alanielson , et al.
Published: February 2025

Detailed information on the methods and analytical procedures for Electron Microscopy Imaging, Petrographic and Mineral Chemical Analysis, U-Pb zircon dating, and Sm-Nd isotopic studies, including the instruments, conditions, and procedures used for data collection and processing.
Supplemental Material: Environmental controls on Early Cambrian macroevolution: Insights from the Tarim Basin, Northwest China
Authors: Wei Tianyuan , Cai Chunfang , et al.
Published: February 2025

Tables S1 and S2 and Figures S1–S6.
Minimum Acceptable Simulation Box Size Based on a Comparison of the Stability of Lysozyme Oligomers Using Molecular Dynamics
Authors: Kordonskaya Yu. V. , Garipov I. F. , Timofeev V. I. , Marchenkova M. A. , Dyakova Yu. A. , Pisarevsky Yu. V. , Kovalchuk M. V.
Published: February 2025

The duration of a simulation directly depends on the size of the system under study: the larger its volume, the longer the calculations. Using a simulation box of minimal size is the most efficient in terms of calculation speed; however, its reduction is permissible only as long as it does not lead to a loss of accuracy of the results. To establish the threshold to which a box can be reduced, the molecular dynamics of lysozyme dimers and hexamers in a crystallization solution is modelled in simulation boxes of different sizes. Since dimers (and octamers) are present in lysozyme crystallization solutions, but hexamers (and tetramers) are absent, a comparison of their stability makes it possible to determine the correctness of the simulation results in each box. It is found that the dimer is more stable than the hexamer in all boxes under consideration, the smallest of which is set so that the minimum distance between the protein atoms and the box face is 1 nm. Thus, this offset is the minimum permissible one in the study of protein crystallization solutions.
Demographic, occupational factors and pandemic-related stressors associated with heightened mental health difficulties among UK health and social care workers supported by regional Resilience Hubs during the COVID-19 pandemic
Authors: Varese Filippo , Allsopp Kate , Carter Lesley-Anne , Wilkinson Jack , Shields Gemma E , Rowlandson Aleix , Chung Priscilla , Hassan Alysha A , White Hannah , Wright Sally-Anne , Young Ellie , Davey Jess , Barrett Alan , Bhutani Gita , Hind Daniel , McGuirk Katherine , Huntley Fay , Sarsam May , Walker Holly , Jordan Joanne , Ten Cate Hein , Watson Ruth , Willbourn Jenni , French Paul
Published: February 2025

Background

During the COVID-19 pandemic, 40 mental health and well-being hubs were funded in England to support health and social care staff affected by the pandemic.

Aims

To describe the characteristics of staff accessing four hubs for support and identify characteristics associated with clinically significant mental health difficulties and work and social functioning.

Method

Routinely collected screening data were analysed from 1973 individuals across 4 hubs, including mental health, demographic and occupational data and pandemic-related stressors. Factors associated with clinically significant mental health difficulties were identified via logistic regression.

Results

Most hub clients identified as white women who worked for the UK National Health Service; other groups were less well represented. Hub clients reported high levels of clinically significant mental health difficulties: 60% had severe and often co-occurring difficulties (ie, depression, anxiety, post-traumatic stress disorder or alcohol use) and 80% reported significantly impaired functioning. Younger age, disability status, identifying as from a minority ethnic group, and sexual orientations excluding heterosexual were associated with higher likelihood of having clinically significant mental health difficulties. Suffering financial loss during the pandemic, and prepandemic emotional well-being concerns were the most consistent factors associated with higher difficulties.

Conclusions

The hubs supported health and social care staff with significant mental health difficulties. Outreach and engagement with under-represented groups should be undertaken to address potential barriers to service access. The findings add to the knowledge base on the support needs of the health and social care workforce and the planning of support in response to future crises.
Evidence map of liver surgery: study protocol of a living systematic review
Authors: Heersche Sidney , Giron Héloïse , Uldry Emilie , Joliat Gaëtan-Romain , Hüttner Felix , Probst Pascal , Melloul Emmanuel , Labgaa Ismail
Published: February 2025

Introduction

The amount of scientific data on liver surgery is exploding. There is a critical unmet need to develop tools that will facilitate navigating the literature and offer easy, fast and accurate access to data with a high level of evidence. Evidence maps (EM) combining living systematic reviews (SR) and user-friendly synthesis with graphs and figures were developed for this purpose in other medical fields and showed promising results but remain yet unavailable in liver surgery. The present study protocol aims to generate an EM in liver surgery, gathering randomised clinical trials (RCT) and SR.

Methods and analysis

A systematic search will be conducted in the Cochrane Central Register of Controlled Trials, Web of Science, Embase and Medline to identify all RCT and SR concerning liver surgery. RCT and SR will be classified in research topics. Selected endpoints will be extracted and meta-analysed. Results will be freely available for patients, clinicians and researchers via a web-based evidence map platform. EM and meta-analyses (MA) will be updated at regular intervals.

Ethics and dissemination

Including publicly available data, this type of study design did not require ethical committee approval. EM displays the required properties to facilitate literature search and to get a rapid overview of the current evidence, an unavailable tool in liver surgery, to date. Generating such an aid may considerably help patients, clinicians and researchers in many aspects: accessing accurate data, helping in decision-making and identifying gaps in the field. On completion of the project, results will be published, freely available viawww.evidencemap.surgeryand permanently updated.

PROSPERO registration number

CRD42023489201 (https://www.crd.york.ac.uk/prospero/)
Evaluating an evidence-based iSupport for Dementia programme in routine care services: study protocol for a hybrid type II trial
Authors: Xiao Lily Dongxia , Cheng Ada , Xie Candy , Chiu Kam , Yu Ying , Ullah Shahid , Wang Jing , Hu Rujun , Xu Dingxin , Pan Xiaoying , Zhang Angela Rong Yang
Published: February 2025

Introduction

Disparities in supporting carers of people with dementia exist in carer populations. The WHO developed an evidence-based iSupport for Dementia programme to address the disparities. However, evidence on how to embed the iSupport programme in routine health and aged care services to optimise support for carers remains largely unknown.

Methods and analysis

This study will apply a hybrid type II effectiveness-implementation trial to evaluate the embedment of two iSupport innovations: ‘usual iSupport’ and ‘tailored iSupport’ in health and aged care services in Australia and China. The RE-AIM framework informed the study design. Three aged care organisations in Australia, two public hospitals and a community health centre in China will participate in the trial by delivering the two iSupport innovations to 158 carers of people with dementia with 79 carers in each intervention group using a randomised controlled trial design. The effectiveness of the two iSupport innovations will be determined by measuring the quality of life and self-efficacy of carers, and the quality of life of people with dementia, unplanned hospital admissions, emergency department presentations and admissions to permanent nursing homes and perceived quality of care of people with dementia at baseline, 3 months and 6 months. The effectiveness of strategies used to embed the iSupport innovations in routine care services will be evaluated using qualitative data collected from focus groups or interviews with carers, staff and management involved in the study and records from the participating organisations.

Ethics and dissemination

Ethics approval was obtained from Flinders University (project number: 5819), Xi’an Jiaotong University (project number: 2023–1629) and Zunyi Medical University (project number: KLL-2023–245). We will obtain informed written or oral consent from participants in the trial. We will publish the results in peer-reviewed journals to disseminate the study and generate impact on policy and practice changes.

Trial registration number

ACTRN12623000323628; The Australian New Zealand Clinical Trials Registry (ANZCTR); registered on 27 March 2023.
mHealth intervention (mTB-Tobacco) for smoking cessation in people with drug-sensitive pulmonary tuberculosis in Bangladesh and Pakistan: protocol for an adaptive design, cluster randomised controlled trial (Quit4TB)
Authors: Zahid Maham , Rahman Fahmidur , Chowdhury Asiful , Rana Shakhawat Hossain , Ansaari Saeed , Lim Ai Keow , Danaee Mahmoud , Boeckmann Melanie , Parrott Steve , Norrie John , Khan Amina , Huque Rumana , Siddiqi Kamran
Published: February 2025

Introduction

People with tuberculosis (TB) who continue to smoke are more likely to have poor health outcomes than those who quit. Established smoking cessation approaches such as mHealth may help patients with TB quit smoking. This paper summarises the methodology proposed to assess the effectiveness and cost-effectiveness of mTB-Tobacco (an mHealth intervention) in helping patients with TB stop smoking and have improved health outcomes.

Methods and analysis

A two-arm, parallel, open-label, multicentre, cluster randomised, two-stage adaptive design trial is proposed to first evaluate the superiority of mTB-Tobacco, compared with usual care and then the non-inferiority of mTB-tobacco compared with face-to-face behaviour support. Study settings include TB treatment centres in Bangladesh and Pakistan. The study population includes adult patients, newly diagnosed (within 4 weeks) with pulmonary TB disease, daily smokers, willing to quit and have access to mobile phones. The primary outcome includes biochemically verified continuous smoking abstinence assessed at 6 months per Russell Standard. A generalised linear mixed-effects model will be used to assess the impact of mTB-Tobacco intervention on continuous outcomes, incorporating fixed effects for the intervention, random effects for clusters and relevant covariates. Cost-effectiveness analysis will be done to estimate the cost per quitter and cost per quality-adjusted life year gained, calculate the incremental cost-effectiveness ratios to establish the value for money for mTB-Tobacco.

Ethics and dissemination

This trial will be conducted in compliance with International Council on Harmonisation - Good Clinical Practice guidelines and the Declaration of Helsinki. The study has been approved by the ethics committees of the University of Edinburgh Medical School Research Ethics Committee (EMREC) of UK, the Bangladesh Medical Research Council (BMRC) and the National Bioethics Committee (PMRC) of Pakistan. The results of this trial will be disseminated in peer-reviewed journals and presented in academic conferences.

Trial registration number

ISRCTN86971818(https://doi.org/10.1186/ISRCTN86971818); pre-enrolment, submission date: 29 August 2023; registration date: 11 September 2023.
Effectiveness of SMS-based interventions in enhancing antenatal care in developing countries: a systematic review
Authors: Kante Mahamadou , Målqvist Mats
Published: February 2025

Objectives

Pregnant women in low- and middle-income countries (LMICs), including Mali, often face challenges such as limited access to comprehensive health information and services. Mobile health (mHealth) interventions, particularly SMS-based interventions, have shown promise in addressing maternal health challenges. This review aims to provide an overview of existing SMS-based antenatal care (ANC) applications and assess their effectiveness in improving maternal and child health outcomes.

Design

A systematic literature review was conducted based on updated PRISMA 2020 guidelines.

Data sources

PubMed, Scopus, Web of Science, Cochrane Library, Association for Information Systems eLibrary, Direct Science and Google Scholar were searched through 25 March 2024.

Eligibility criteria

Studies that focused on SMS-based interventions designed to improve ANC information and attendance, published in English or French, conducted in LMICs and published between 2014 and 2024 were included. Exclusion criteria eliminated studies that did not report primary outcomes or did not directly involve SMS-based interventions for ANC.

Data extraction and synthesis

Relevant data were systematically extracted, including study characteristics, intervention details, and outcome measures. The risk of bias was assessed using the Cochrane Risk of Bias tool for randomised trials (RoB 2), the Risk Of Bias In Non-randomised Studies-of Interventions (ROBINS-I) and the Checklist for Reporting the Development and Evaluation of Complex Interventions in Healthcare (CReDECI), depending on the study design. A subgroup analysis was performed to explore variations in outcomes by region and study design.

Results

The review identified a range of SMS-based interventions (n=12) that differed in target audience, message frequency (weekly, pregnancy stage-oriented) and content (reminders (91.7% of cases, 11/12), educational (75%) and danger signs (16.7%)). Regional analysis highlighted significant research activity in East Africa but with mixed significance levels. The study design analysis revealed that randomised controlled trials yielded the most significant results, with five of eight studies showing full significance, whereas quasi-experimental studies demonstrated consistent but less frequent effectiveness. Implementation tools varied from SMS gateways to custom applications and third-party platforms, with some interventions combining these approaches. SMS interventions positively impacted ANC attendance, maternal health knowledge and behaviours, with effectiveness varying based on the intervention type, content, frequency and implementation approach.

Conclusion

SMS-based interventions have the potential to enhance ANC in LMICs by providing tailored health information and promoting healthy behaviours. Further research should focus on refining or replicating these interventions and exploring their long-term effects on maternal and child health outcomes, particularly in underrepresented regions.
Motivational interviewing training for caregiver counsellors: study protocol of a mixed-methods evaluation using the Kirkpatrick model
Authors: Schmidt Johanna , Bösl Sophia , Lauer Natascha , Graessel Elmar , Henßler Oliver-Timo , Pendergrass Anna
Published: February 2025

Introduction

Caring for a relative in the home environment is a great challenge for many informal caregivers (CGs). Caregiver counselling offers support to the CGs and can, thus, help them improve CGs’ burdensome home care situations, especially if the caregiver counsellors (CCs) have good communication skills. Motivational interviewing (MI) has the potential to further enhance the communication skills of CCs and the effectiveness of MI has been demonstrated internationally in a wide variety of contexts. However, MI has not been implemented and evaluated in the caregiver counselling context yet.

Methods and analysis

The goals of our prospective, interventional, mixed-methods study are the development, implementation and evaluation of a training course for CCs on the topic of ‘Motivational Interviewing for caregiver counselling’ in Germany. The training is specifically adapted to the caregiver counselling context and consists of an e-Learning, an on-site workshop and a voluntary follow-up support phase. Its quality and benefits will be evaluated according to Kirkpatrick’s four-level evaluation model. Measured outcomes will be participants' satisfaction with the training (level I: reaction), MI knowledge (level II: learning), perceived use (level III: behaviour) and counselling competence, self-efficacy, social cognitions about the use of MI and perceived impact of MI (level IV: results). Primary outcome is counselling competence measured by Counsellor Activity Self-Efficacy Scale. The data will be collected at baseline (t0), after the on-site workshop (t1), after the voluntary follow-up support (t2) and 6 months after the training (t6). Quantitative data will be analysed with several repeated-measures ANOVAs and qualitative data with qualitative content analysis. Recruitment is ongoing until 31 July 2024.

Ethics and dissemination

All procedures were approved by the Ethics Committee of the Friedrich–Alexander University Erlangen–Nürnberg (project number 24–108-B). Informed consent will be obtained before participants are enrolled. Serious adverse events are not expected. Results will be published in peer-reviewed journals and presented at conferences.

Trial registration number

ISRCTN14218056.
Physical and psychological predictors for persistent and recurrent non-specific neck pain: a protocol for a systematic review and meta-analysis
Authors: Yu Cho Wai Geoffrey , Wongwitwichote Kanya , Mansfield Michael , Deane Janet , Falla Deborah
Published: February 2025

Introduction

Both physical adaptations (e.g., altered neck kinematics and muscle coordination) and psychological features are common in people presenting with neck pain (NP). Additionally, both physical and psychological features may be relevant for the development of persistent or recurrent NP. Although a number of original studies have reported this, currently there is no available systematic review reporting physical and psychological predictors for the recurrence of non-specific NP.

Methods and analysis

The report of this systematic review protocol follows the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. Studies will be searched from PubMed, MEDLINE, EMBASE, CINAHL Plus, PsycINFO and grey literature. Title, abstract and full-text screening, data extraction and risk of bias assessment will be conducted by two independent reviewers. Studies investigating the prediction of persistent or recurrent NP from physical or psychological predictors will be included. Physical predictors will be commonly reported objective measures including neck kinematics, measures of muscle activity and sensory function. Psychological predictors will include variables such as kinesiophobia, self-efficacy, pain coping strategies and quality of life. The main outcomes of interest are the Neck Disability Index, presence of pain recurrence, as well as pain intensity and frequency during a persistent or recurrent NP episode. Observational cohort studies will be included, and studies on both single-factor and multifactor predictions or associations will be investigated. Risk of bias will be assessed using the Quality in Prognosis Studies (QUIPS) tool. The certainty of evidence will be rated using Grading of Recommendations Assessment, Development and Evaluation (GRADE). A random-effect meta-analysis will be conducted if methodological and clinical homogeneity is deemed satisfactory.

Ethics and dissemination

Ethical approval will not be required for this review as there is no primary data collection involving humans. The findings will be published in peer-reviewed journals.

PROSPERO registration number

CRD42024596844.
How do patient and practitioner characteristics influence empathy in healthcare? Protocol for a systematic review and meta-analysis
Authors: White Cleo Laura , Khunti Kamlesh , Gillies Clare , Meissner Karin , Palipana Dinesh , Nockels Keith , Harrell Cathy , Howick Jeremy
Published: February 2025

Introduction

Empathy is a core component of high-quality care yet is expressed and received in different ways depending on the characteristics (including gender, race, socioeconomic status and disability) of both practitioners and patients. However, the evidence exploring how these characteristics or their overlap (‘intersectionality’) influence empathy has not been synthesised.

Methods and analysis

We will systematically review and meta-analyse studies exploring the influence of healthcare practitioners and patient characteristics on empathy in healthcare. MEDLINE, EMBASE (via Scopus), Scopus, PsycINFO, CINAHL, CENTRAL Web of Science, Cochrane Database of Systematic Reviews and Database of Abstracts of Reviews of Effects will be searched from database inception to present. Reference chasing will be used to identify additional studies. Studies that report empathy levels using either (1) the patient-reported Consultation and Relational Empathy Measure or (2) the practitioner or student-reported Jefferson Scale of Empathy. This will include validated versions or translations of both scales.

Two reviewers will independently screen titles, abstracts, and full texts and extract data using Rayyan. Discrepancies will be resolved in discussion with a third author if necessary. Two independent authors will evaluate the risk of bias using the Joanna Briggs Institute tools.

Continuous data will be analysed based on the mean, SD, sample size and 95% CIs. Sensitivity analyses will be used to explore the potential impact of risk of bias and use of imputed data. We will explore differences between countries, demographic characteristics, disciplines and lengths of time in practice experience, as well as differences over time (comparing more recent with older studies). We will also explore differences between patient-reported and practitioner-reported empathy.

We will report our findings following the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines and flowchart.

Ethics and dissemination

Ethical approval is not required for this review as primary data will not be collected. The review will be disseminated through peer-reviewed publication and presented at conferences.

PROSPERO registration number

CRD42024604677.
Holistic Integrated Care in Ovarian Cancer (HICO)—reducing inequalities due to age, frailty, poor physical and mental health
Authors: Frost Jonathan , Newton Claire , Dumas Lucy
Published: February 2025

Older patients have disproportionally poorer survival outcomes for ovarian cancer in the UK. Half of new diagnoses occur in those aged >65 years. Older patients are more likely to have other medical comorbidities reducing their fitness to receive chemotherapy or undergo cytoreductive surgery resulting in fewer patients receiving treatment. The Holistic Integrated Care in Ovarian Cancer (HICO) programme introduced a structured holistic patient assessment with both universal and targeted interventions to improve physical function and psychological well-being to reduce inequalities due to age, frailty, physical and psychosocial problems. The aim of the project was to evaluate the feasibility and impact of the intervention in patients being considered for the treatment of ovarian cancer. During the implementation of the project, all recruited patients underwent a holistic assessment followed by prehabilitation and rehabilitation support from physiotherapists, occupational therapists, dietitians, geriatricians, nurse specialists and psychologists according to need. The HICO intervention was successfully integrated into the patient pathway in both trusts. Patients who participated in the HICO project provided positive feedback. Overall global health scores improved in 59.6% of the 57 patients who undertook at least two assessments (p=0.006). The proportion of patients who underwent platinum doublet chemotherapy in the HICO cohort was higher (76.2%) compared with a retrospective cohort (57.6%) (p=0.0189). However, no significant difference in the rate of cytoreductive surgery was shown. The proportion of patients alive at 1 year from diagnosis was higher in the HICO intervention group (88.9%) compared with the historical cohort (80.0%) despite higher stage in the HICO group. Although not statistically significant (p=0.289), these data are not yet mature and further study is ongoing. Initial data on costs of ovarian cancer care demonstrated no increase, although the data are not yet mature. This pilot project was funded through the Ovarian Cancer Action IMPROVE UK Pilot Award scheme.
Developing a platform to investigate the heterogeneity of outcomes for patients with ovarian cancer
Authors: Baxter Kathryn , Booth J , Hawarden A , Wood N , Fisher A , Bhagat N , Morrison J , Cullimore V , Newhouse R , Yagel I , Shah A , Yap J , Woodman H , Olaoye T , Do V , MacDonald M , Long E , WIbmer L , Fotopoulou C , Edmondson Richard
Published: February 2025

Background

The geographical variation in treatment patterns for patients with ovarian cancer is profound, long-standing and worrying. Although these variations were highlighted in a recent UK registry audit, granular data to provide explanations for these variations have been lacking.

Methods

A consortium of six UK centres was generated to curate and submit data for all patients treated at their centre for a 2-year period. Descriptive statistics were combined with Cox regression and Kaplan-Meier analysis to confirm the findings from the national registry audit and identify possible drivers of the heterogeneity previously described.

Results

Records for 1117 patients treated in six centres in 2018 and 2019 were collated. Although there were differences in the clinical characteristics of patients between centres, these were not enough to account for the significant variation in survival outcomes between centres (p<0.001). Treatment rates varied between centres with between 30% and 76% of patients receiving combination therapy but in Cox models ‘treatment centre’ remained a predictor of 1 year survival independent of patient, tumour factors and treatment choice.

Conclusion

Variations in outcome seen between UK centres are not related solely to casemix but rather to the approach and ethos of each centre towards advanced ovarian cancer treatment options. Although important, differences in treatment patterns do not completely explain the variations seen and further work is required to understand the drivers of difference seen.
All Wales Ovarian Cancer Prehabilitation Project (AWOCPP)
Authors: McMullan Josh Courtney , Smith Catherine , Jones Rosalind , Butterworth Caryl , Davies Christine , Long Helen , Pottle Jacqueline , Jarrom Claire , Peevor Richard , Jones Rachel , Gupta Preeti , Hanna Louise , Hudson Emma , Jones Sadie
Published: February 2025

Over 50% of patients with ovarian cancer are diagnosed with advanced disease (stage 3+) in Wales when treatment typically involves chemotherapy, combined with cytoreductive surgery. Postoperative morbidity is common resulting in prolonged hospital stays and delays in returning to chemotherapy. Patients with advanced ovarian cancer commonly have modifiable risk factors that can be targeted for improvement with personalised prehabilitation. Multimodal personalised prehabilitation has been shown to have a positive impact on perioperative outcomes and length of stay (LOS).

Quality improvement methods were used to implement a multimodal prehabilitation programme for all patients with advanced ovarian cancer planned for surgery in Wales. A unique approach to determining an individual patient’s modifiable risk factors was devised that enabled a personalised prehabilitation programme to be created including exercise, smoking cessation, medical and nutritional optimisation and emotional support. Data were collected to enable future health economic evaluation of the programme in anticipation of national role out as standard of care. To evaluate if the prehabilitation intervention was impacting the quality of care, the following outcome measures were assessed: LOS, postoperative complications and surgery to chemotherapy interval (SCI). These measures were compared with a historical Welsh data set from 2018 to 2019 when access to prehabilitation was not available.

Following the implementation of prehabilitation for ovarian cancer, the median LOS reduced from 6 to 5 days (p=0.29). There was a reduction in postoperative complications: from 16.9% to 12.7% (Grade 2), 4.4% to 1.8% (Grade 3), 0.6% to 0% (Grade 4+5). The median SCI following prehabilitation was 43.5 days (range 27–91) compared with 40 days (range 15–182 (p=0.65)).

Prehabilitation has had a positive impact on the treatment pathways for advanced ovarian cancer in Wales. Means of improving patient engagement and establishing cost-effective delivery need to be developed to make this intervention standard of care.
Northern Ireland ovarian cancer prehabilitation project
Authors: McMullan Josh Courtney , Lee Davinia , Ranaghan Lisa , Gowan Nicola , McWilliams Lisa , McGreevy Bernie , O'Hagan Danielle , Nugent Brenda , Dobbs Stephen
Published: February 2025

Patients with ovarian cancer are often diagnosed late, in advanced stages (stages III–IV) and are often deconditioned due to disease burden. Frailty is reported in up to 60% of gynaecological oncology patients and many report malnutrition, anxiety and depression. As surgery is the mainstay of treatment for ovarian cancer, with maximum surgical effort being a priority, patients are at increased risk of perioperative morbidity and mortality.

Multimodal prehabilitation aims to improve the functional capacity of surgical patients. Prehabilitation commonly includes physical, nutritional, medical optimisation, smoking cessation and emotional well-being interventions. Many surgical specialties have well established evidence for the use of prehabilitation showing a reduction in length of stay and perioperative complications. There is, however, limited evidence for the use of prehabilitation in the surgically vulnerable group of patients with advanced ovarian cancer.

This project aimed to introduce a multimodal prehabilitation pathway for patients with advanced ovarian cancer. All patients with advanced ovarian cancer were included, regardless of the treatment modality decided at the regional gynaecological oncology multidisciplinary team meeting. The pathway included exercise, nutritional and psychological interventions. The outcome measures included the Rockwood Frailty Score, 6 min Walk Test (6MWT), 30 s Chair to Stand test, grip strength and Eastern Cooperative Oncology Group performance status as a measure of functional capacity. Nutritional intervention outcomes included the Malnutrition Universal Screening Tool (MUST) score, Body mass index and mid-arm circumference. The psychological intervention outcomes included a holistic needs assessment, the distress thermometer and EQ-5D-5L quality of life status.

Of the 75 patients enrolled, 45 (60%) completed the project. In patients who completed the project improved 6MWT and 30-CST was observed in 67% and 44%, respectively, while 67% of patients with moderate to extreme anxiety/depression scores reported lowering from baseline level and 71% of patients with medium to high-risk MUST scores baseline weight was maintained or increased.