bluuebunny/crossref_metadata_2025 huggingface dataset:
Structural–visual approach for dental examination in children with autism spectrum disorder: A systematic review
Authors: Octavia Alfini , Sitthisettapong Thanya , Dewanto Iwan
Published: January 2023

Introduction

Conducting Dental examination in children with autism is challenging due to the limitation in cooperativeness that is caused by impairment of communication, social interaction, and sensory sensitivities.

Aims

This study aims to provide evidence base for the structural–visual approach in reducing uncooperativeness behavior to dental care in children with autism spectrum disorder (ASD).

Methods

Searches were conducted in the electronic databases PubMed, PsycINFO, and Cochrane from inception to October 2021 (CRD42022383409). Randomized controlled trials (RCTs), non‐RCTs, and pre/post‐test and qualitative studies that conducting visual pedagogy and visual learning methods were included. The quality of evidence was assessed with Cochrane Collaboration's Risk of Bias Tool for RCTs, Risk of Bias in Non‐randomized Studies—of Interventions (ROBINS‐I) for non‐RCTs, and Critical Appraisal Skill Program (CASP) for qualitative studies.

Results

The initial search identified 270 studies, and 256 remained after removing duplicates. After screening titles and abstracts, 62 studies were remained for full‐text assessed, and finally 13 eligible studies were selected for reviews. The studies analyzed various structural–visual interventions, participants, study design, countries, and outcomes.

Conclusion

The structural–visual approach could reduce uncooperative behavior in children with ASD. Future study should investigate the wide range of age and varied behavior approach as the evidence‐based of the clinical management.
Sedimentary facies characterization through CPTU profiles: An effective tool for subsurface investigation of modern alluvial and coastal plains
Authors: Campo Bruno , Bruno Luigi , Amorosi Alessandro
Published: January 2023

Cone penetration tests, a method that is typically used to determine the engineering properties of soils, can be used as an effective tool for refined subsurface stratigraphic investigations of alluvial and coastal plains, aside from the geographic location. High‐resolution calibration of piezocone penetration tests (CPTU) with 20 sediment cores enabled the detailed characterization of alluvial, deltaic and coastal depositional systems of the Po Plain. Twelve cored facies associations, typical of alluvial and coastal plain environments, were characterized based on four distinct CPTU profiles: basic cone resistance (Qc), sleeve friction (Fs), water pore pressure (U) and friction ratio (FR). Sandy facies associations (fluvial/distributary channel, bay‐head delta, transgressive barrier, delta‐front/beach‐ridge) typically have high (>4 MPa) Qc, low‐to‐negative U and low (<2%) FR. Muddy deposits (well‐drained/poorly‐drained floodplain, swamp, lagoon and prodelta) exhibit opposite trends. Heterolithic facies associations (crevasse‐levée, offshore/delta‐front transition) display characteristic seesaw profiles. Plotting of late Quaternary deposits onto the latest version of the cone penetration test typical soil behaviour chart (Robertson, 2010) enables the identification of distinctive facies associations reflecting distinctive grain size. CPTU interpretation leads to sedimentary facies recognition well beyond the simple lithological differentiation and, in particular, allows the refined characterization of clay‐rich and silt‐rich depositional units (swamp clays and peats, central‐inner and outer lagoon, proximal/distal prodelta deposits) that exhibit only subtle differences in lithology. CPTU data can also serve for the accurate detection of key stratigraphic surfaces with potential engineering applications, such as the Pleistocene–Holocene boundary. This latter, a common feature of several alluvial and coastal plain successions, is commonly marked by an abrupt upward decrease of basic cone resistance and sleeve friction from Late Pleistocene, pedogenized, stiff strata to overlying Holocene, organic‐rich, soft deposits. This study offers an updated CPTU‐facies characterization method that could be suitable for subsurface investigations of modern alluvial and coastal plains worldwide.
Policy recommendations to promote health and well‐being in sexual and gender minority populations in the United States
Authors: Talley Amelia E. , Ibora Melisa Williams , Le Tran H. , Vugrin Margaret
Published: January 2023

This narrative review examines literature informing policy and laws relevant to the health and well‐being of lesbian, gay, bisexual, transgender, and queer (LGBTQ+) adult populations. Empirical factors related to structural stigma, specifically policy and law, were examined. Empirical studies examining structural stigma and health‐related outcomes in LGBTQ+ populations have proliferated since the publication of the Institute of Medicine's The Health of Lesbian, Gay, Bisexual and Transgender People (2010) and Hatzenbuehler's theoretical work on stigma‐related influences on LGBTQ+ health. Databases were searched using a priori terms. Over 2,100 articles were identified that included original data from the United States since 2010. Studies identified for inclusion (n = 78) were roughly evenly split according to whether results related to the influence of federal‐, state‐, or local‐level policies on LGBTQ+ adults’ health. Policy recommendations center around the expansion of anti‐discrimination law and policy, abolishment of law and policy that restricts access and rights of LGBTQ+ adults, supplemental training in relevant cultural competencies, and the provision of additional resources for vulnerable subpopulations of LGBTQ+ adults.
Divergence in the soil and rhizosphere microbial communities of monoculture and silvopastoral traditional C. dodecandra agroforestry systems in Yucatan, Mexico
Authors: López‐Ramírez Tobías M. , Estrada‐Medina Héctor , Ferrer Miriam M. , O'Connor‐Sánchez Aileen
Published: January 2023

Numerous works have reported the impact on soil properties and microbial communities of intensive soil management, but very little is known about the impact caused by traditional agroforestry systems carried out by smallholders. To investigate whether the different smallholder's management between a monoculture plantation of Cordia dodecandra trees and a Silvopastoral system has led to a divergence in these ecosystems, soil properties, as well as soil and Cordia dodecandra rhizosphere microbial communities were analysed by MiSeq amplicon sequencing. The main findings were (i) Large variation in the soil properties of the Silvopastoral system suggests that it has a greater heterogeneity; (ii) Organic carbon, organic matter, carbonates, nitrogen, inorganic phosphorous and calcium, was significantly higher in the soil of the Silvopastoral system. (iii) The relative abundance of the major prokaryotic orders in soil and rhizospheres displayed small differences between the two agroforestry systems, and diversity indexes were slightly higher in the Silvopastoral system. (iv) The fungal orders Hypocreales and Pleosporales were more abundant in the Silvopastoral system than in the monoculture. Other evaluated parameters showed only minor or no difference. Thus, the main conclusion is that these soils have diverged in some properties and fungal orders, but not in their prokaryotic communities. To our knowledge, this is the first report on the divergence in soil properties and microbiota of these two extended smallholder agroforestry systems and therefore can serve as reference for future works.
The geographical ontology challenge in attending to anthropogenic climate change: regional geography revisited
Authors: Taylor Peter J.
Published: January 2023

Anthropogenic climate change is a complex process that does not respect political boundaries. Thus it is argued states are problematic agencies for tackling the global climate emergency. But it is the world political map that provides the geographical ontology foundation of the massive efforts of climate policy development. Geography's long tradition of regional study is suggested as a means of countering focus on states for policy development. Ontological inventions are proposed that transcend states. These take the form of experimenting with geographical regions encompassing human‐environmental interactions as alternative spatial policy framings to the world political map. Three examples are presented: intergovernmental resilient regions for mitigation; localization through urban sustainable regions; and regions for planetary stewardship of humans‐in‐nature. None of these are ‘solutions’, rather they are illustrations of possible future regional geographies intended to stimulate current cohorts of geographers to contribute necessary regional thinking to the scholarship unpinning climate change policymaking.
An Improved Approach for Forming Limit Prediction of Strongly Anisotropic Thin-Walled Tube Combining M–K Model and Ductile Fracture Criterion
Authors: Zhu Haihui , Lin Yanli , He Zhubin , Yuan Shijian
Published: January 2023

Accurate prediction of the forming limit at necking of strongly anisotropic thin-walled tubes is an urgent requirement in tube hydroforming. M–K model is one of the most widely used prediction models. However, the failure criterion in M–K model is based on the ratio of major true strain increments in the groove to uniform regions, which sometimes results in overestimation of the limit strains. To address this issue, a combined model of M–K model and ductile fracture criterion (DFC) for tube was proposed in this paper, in which the failure condition of the groove region is determined by the DFC. The characteristics of the M–K + DFC model were analyzed by combining with the DF2012 phenomenological DFC. To validate the M–K + DF2012 model, the limit strains at necking of an AA6061 tube with strong in-plane anisotropy were tested through tube-controllable biaxial loading experiments. The results show that the forming limit curve (FLC) predicted by the M–K + DFC model does not exceed the FLC calculated by the M–K model and the fracture forming limit curve (FFLC) determined by the corresponding DFC. The M–K + DF2012 model provides a reasonable forming limit prediction of the AA6061 tube, and the shortcoming of the M–K model mentioned earlier is overcome. Meanwhile, a reasonable constitutive model considering the in-plane anisotropy is very important in the forming limit prediction of a strongly anisotropic thin-walled tube.
Aerothermal Performance of Axially Varying Winglet-Squealer Blade Tips
Authors: Garg Anmol , Vadlamani Nagabhushana Rao , Srinivasan Balaji
Published: January 2023

High-pressure turbine blades are usually susceptible to secondary flow losses due to fluid flow between the casing and the blade tip. In this study, we have evaluated the performance of several blade tip designs for different combinations of winglets and squealer geometries toward mitigating tip leakage losses. The effects of considering relative casing motion (RCM) on the aerothermal performance are also brought out. In particular, we have considered three different blade tip designs, which include winglets, top winglet bottom squealer (TWBS), and top squealer bottom winglet (TSBW). Inspired by the partial winglet configurations studied in the literature, we have also examined designs with partial squealers and winglets. The performance of all the designs and the dynamics within the tip gap is discussed through the distributions of total pressure loss within the tip gap and Nusselt number over the blade tips. Of all the blade tip designs, the aerothermal performance of a 100% TWBS design is demonstrated to be superior, both with and without relative casing motion. When compared to a flat tip design, a 100% TWBS design showed a 15% reduction in total pressure loss and a 22% reduction in the average Nusselt number over the blade tip. For this design, accounting for the relative casing motion showed a marked reduction in the total pressure loss and the heat transferred to the blade tip. In particular, RCM is shown to suppress the “hot spot” associated with a cavity vortex within the squealer cavity.
On the Effect of Side Clearance in the Vaned Diffuser of a Centrifugal Compressor
Authors: Gibson Lee , Spence Stephen , Stuart Charles , Starke Andre , Kim Sung In
Published: January 2023

Environmental and regulatory pressures have prompted original equipment manufacturers (OEMs) to explore highly boosted internal combustion (IC) engines as a means to minimize toxic air pollutants and meet strict legislative targets. The exhaust gas turbocharger is a key technology used to achieve the boost pressures necessary for advanced engines of the future. Centrifugal compressors with vaneless diffusers have been widely implemented in turbochargers for IC engines, particularly passenger vehicles, primarily due to their compact size and ability to deliver high-pressure ratios over a wide range of flowrates. Methods to improve compressor efficiency near surge without reducing the surge margin have received considerable interest in the past. In many situations, changes to the impeller blade design and/or diffuser are limited by the need to meet the strict engine-rated power target. Such competing demands have encouraged designers to develop variable geometry compressors with the aim of improving near surge performance without sacrificing rated power performance. The on/off-type vaned diffuser is a variable geometry compressor capable of delivering a pressure ratio benefit near surge by utilizing a vaned diffuser rather than a vaneless diffuser. The vanes are retracted prior to the diffuser choking to form a vaneless diffuser in order to reach the engine-rated power condition. Diffuser vane-shaped clearances in the hub or the shroud end wall, termed side clearances, enable axial sliding variability of the vanes into and out of the diffuser passage. Unfortunately, the clearances manifest themselves as a discontinuity in the flow field which gives rise to an efficiency penalty. It is not yet clear how the side clearance geometry and position affect the compressor performance i.e., efficiency and stability. Hence, a numerical and experimental investigation was carried out to determine the impact of side clearance geometry and end wall position on compressor performance. It was found that a side clearance positioned at the shroud end wall reduced the surge margin of the investigated compressor for both types of clearance geometry considered. In contrast to this, a clearance positioned at the hub end wall improved the compressor surge margin but had the lowest efficiency benefit near surge. An experimentally validated Computational Fluid Dynamics (CFD) model was used to inspect the flow field and to elucidate the reasons behind the changes in compressor performance.
Majorization ladder in bosonic Gaussian channels
Authors: Van Herstraeten Z. , Jabbour M. G. , Cerf N. J.
Published: January 2023

We show the existence of a majorization ladder in bosonic Gaussian channels, that is, we prove that the channel output resulting from the nth energy eigenstate (Fock state) majorizes the channel output resulting from the (n+1)th energy eigenstate (Fock state). This reflects a remarkable link between the energy at the input of the channel and a disorder relation at its output as captured by majorization theory. This result was previously known in the special cases of a pure-loss channel and quantum-limited amplifier, and we achieve here its non-trivial generalization to any single-mode phase-covariant (or -contravariant) bosonic Gaussian channel. The key to our proof is the explicit construction of a column-stochastic matrix that relates the outputs of the channel for any two subsequent Fock states at its input. This is made possible by exploiting a recently found recurrence relation on multiphoton transition probabilities for Gaussian unitaries [Jabbour and Cerf, Phys. Rev. Res. 3, 043065 (2021)]. Possible generalizations and implications of these results are then discussed.
The Royal Tajo Opera Theatre of Lisbon: From architecture to acoustics
Authors: Tronchin Lamberto , Bevilacqua Antonella
Published: January 2023

Throughout history, many buildings of significant cultural value have been lost due to natural disasters (e.g., earthquakes, volcanic eruptions, subsidence, etc.) as well as other human causes (e.g., fire, war destruction, etc.). The Tajo Opera theatre was hit by an earthquake that led to the collapse of the entire structure eight months after it was built. This paper deals with the revival of the acoustic characteristics of one of the masterpieces of the architect Giovanni Carlo Sicinio Galli Bibiena. The realization of a three-dimensional (3D) model that faithfully reproduces the architectural features of the Royal Tajo Opera theatre of Lisbon allows the authors to perform acoustic simulations that reveal the sound field representing the environment perceived by the audience during artistic performances in Lisbon in 1755. In addition, the simulated results have been compared with the values of the Teatro Comunale of Bologna, which has a similar bell-shaped plan layout and has already been studied by the authors. For the comparison of the two opera theatres, both the stalls and the balconies have been considered.
Tunable composite lattice structure for low-frequency and ultra-broadband underwater sound absorption
Authors: Liu Botao , Huang Sibo , Zheng Bo , Chen Xuefeng , Zhao Jia , Qi Xinrui , Li Yong , Liu Shengchun
Published: January 2023

The underwater sound absorption technique in low-frequency and broadband has far-reaching prospects since it is essential for noise reduction of deep-sea operation requirements and evading advanced underwater target detection. Here, we propose an underwater sound-absorbing composite lattice with low-frequency and ultra-broadband characteristics. The composite lattice is constructed by regular spatially stacking cells with different sizes of metallic core spheres. All the core spheres are coated with silicon rubbers, and cells are embedded in the rubber matrix. In the composite lattice stereostructure, the lattice cells convert incident longitudinal waves into transverse waves through multiple local resonance coupling and multiple scattering. The energy is localized and dissipated in the composite lattice. We analyze the relationship among the corresponding absorption spectrums, the displacement clouds, and the resonance modes of lattice cells. Then, we construct a composite lattice and realize low-frequency broadband absorption from 693 to 1106 Hz with absorptance above 0.8. Further, our investigation demonstrates that the absorption bandwidth can be extended to ultra-broadband from 1077 to 10 000 Hz, where the thickness of the composite lattice is λ/17.05. The proposed composite lattice provides a practical approach to designing ultrathin low-frequency and ultra-broadband acoustic absorption coating for underwater noise suppression.
Closing the Gap Between Classroom-Based Physical Activity Intervention Adoption and Fidelity in Low-Resource Schools
Authors: Hasson Rebecca E. , Beemer Lexie R. , Eisman Andria B. , Friday Penelope
Published: January 2023

The adoption of classroom-based physical activity interventions in elementary schools is nearly universal (92%), but fewer than 22% of teachers who implement activity breaks achieve a dose of 10 min/day. Dissemination and implementation science frameworks provide a systematic approach to identifying and overcoming barriers likely to impede successful adoption and fidelity of evidence-based interventions. This review highlights the development and subsequent tailoring of a classroom-based physical activity intervention, Interrupting Prolonged sitting with ACTivity (InPACT), for delivery in low-resource schools using implementation science frameworks focused on equity. Unlike most classroom physical activity interventions, tailored InPACT includes a suite of implementation strategies (methods or techniques that support adoption, implementation, and sustainment of a program or practice) and, thus, has been designed for dissemination. These strategies were focused on increasing teacher self-efficacy and reducing multilevel implementation barriers in low-resource schools to promote intervention fidelity, effectiveness, and sustainment.
Revisiting Perfectionism in High-Level Ballet: A Longitudinal Collective Instrumental Case Study
Authors: Nordin-Bates Sanna M. , Aldoson Martin , Downing Charlotte
Published: January 2023

Using a case study design, we explored two ballet dancers’ perfectionism experiences via interviews and questionnaires at two time points 5 years apart. They represented the two types of “pure perfectionism” in the 2 × 2 model of perfectionism: a female representing pure personal standards perfectionism (high perfectionistic strivings, low perfectionistic concerns) and a male representing pure evaluative concerns perfectionism (low perfectionistic strivings, high perfectionistic concerns). The pure personal standards perfectionism dancer reported stable perfectionism across time, seemingly resilient to any perfectionistic concerns developing. She attributed this to her stable, grounded personality, also reporting autonomous motivation and performance success. The dancer representing pure evaluative concerns perfectionism reported increased perfectionistic strivings and lowered perfectionistic concerns over time; concurrently, his motivation became less controlled and more autonomous. He described the reasons in terms of improved basic psychological needs satisfaction and personal growth. Overall, autonomy might be important in mitigating perfectionism.
CRISPR technology: A decade of genome editing is only the beginning
Authors: Wang Joy Y. , Doudna Jennifer A.
Published: January 2023

The advent of clustered regularly interspaced short palindromic repeat (CRISPR) genome editing, coupled with advances in computing and imaging capabilities, has initiated a new era in which genetic diseases and individual disease susceptibilities are both predictable and actionable. Likewise, genes responsible for plant traits can be identified and altered quickly, transforming the pace of agricultural research and plant breeding. In this Review, we discuss the current state of CRISPR-mediated genetic manipulation in human cells, animals, and plants along with relevant successes and challenges and present a roadmap for the future of this technology.
A strained ring for stereoselective synthesis
Authors: Jankovic Christian L. , West F. G.
Published: January 2023

The spring-loaded tension of a cyclic allene expedites synthesis of a natural product
Denitrification by Bradyrhizobia under Feast and Famine and the Role of the bc1 Complex in Securing Electrons for N
2
O Reduction
Authors: Gao Yuan , Øverlie Arntzen Magnus , Kjos Morten , Bakken Lars R. , Frostegård Åsa
Published: January 2023

Legume cropped farmlands account for substantial N
2
O emissions globally. Legumes are commonly inoculated with N
2
-fixing bacteria, rhizobia, to improve crop yields.
“Failure To Launch”: Development of a Reproductive Organ Linked to Symbiotic Bacteria
Authors: McAnulty Sarah J. , Kerwin Allison H. , Koch Eric , Nuttall Barrett , Suria Andrea M. , Collins Andrew J. , Schleicher Tyler R. , Rader Bethany A. , Nyholm Spencer V.
Published: January 2023

Microbiota have profound effects on animal and plant development. Hosts raised axenically or without symbionts often suffer negative outcomes resulting in developmental defects or reduced organ function.
Listeria
InlB Expedites Vacuole Escape and Intracellular Proliferation by Promoting Rab7 Recruitment via Vps34
Authors: Cain Robert J. , Scortti Mariela , Monzó Héctor J. , Vázquez-Boland José A.
Published: January 2023

Avoidance of lysosomal killing by manipulation of the endosomal compartment is a virulence mechanism assumed to be largely restricted to intravacuolar intracellular pathogens. Our findings are important because they show that cytosolic pathogens like
L. monocytogenes
, which rapidly escape the phagosome after internalization, can also extensively subvert endocytic trafficking as part of their survival strategy.
Factors Influencing the Nitrogen-Source Dependent Flucytosine Resistance in Cryptococcus Species
Authors: Yang Dong-Hoon , Khanal Lamichhane Ami , Kwon-Chung Kyung J. , Chang Yun C.
Published: January 2023

5-FC is a commonly used antifungal drug for treatment of cryptococcosis caused by
Cryptococcus neoformans
and
C. gattii
species complexes. When various amino acids were used as the sole nitrogen source for growth, we found lineage dependent differences in 5-FC susceptibility.
Evaluation of the Rapid Antigen Detection Test for Diagnosing SARS-CoV-2 during the COVID-19 Pandemic: Experience from a Centralized Isolation Site in Shanghai, China
Authors: Zhong Xu , Zhang Li , Ma Di , Shi Yingying , Wu Jiayin , Xu Xiaosheng , Chen Weihong , Wu Beiwen , Tang Yiding , Qu Hongping , Xie Qing , Yang Yi , Liu Jialin , Xin Haiguang
Published: January 2023

RADTs have demonstrated excellent performance in many counties for screening SARS-CoV-2 infection, but very few studies have been conducted in China. The performance of RADTs is largely related to different real-life scenarios.
Erratum to: Several Articles in JETP Letters
Authors: Kotikov A. V. , Zemlyakov I. A. , Mogilevsky M. M. , Chugunin D. V. , Chernyshov A. A. , Kolpak V. I. , Moiseenko I. L. , Kasahara Y. , Miyoshi Y. , Ustavschikov S. S. , Levichev M. Yu. , Pashen’kin I. Yu. , Gusev N. S. , Gusev S. A. , Vodolazov D. Yu.
Published: January 2023

An Erratum to this paper has been published: https://doi.org/10.1134/S0021364022380015
Erratum to: Medium Effects for Hadron-Tagged Jets in Proton–Proton Collisions
Authors: Zakharov B. G.
Published: January 2023

An Erratum to this paper has been published: https://doi.org/10.1134/S0021364022420019
Blind loop mucocele of a side-to-end colorectal anastomosis as a rare cause of large bowel obstruction
Authors: Peacock Luke Philip Edward , Pangeni Anang , Shrestha Ashish , Allu Veera J
Published: January 2023

Large bowel obstruction (LBO) after colorectal surgery draws wide differentials. To our knowledge, LBO due to blind colonic limb mucocele of a side-to-end colorectal anastomosis has not yet been described. We report a man in his late 50s presenting with pain, abdominal distension and constipation. He had extensive surgical history; notably, a side-to-end colorectal anastomosis was fashioned following Hartmann-type colostomy reversal. CT and MRI suggested a mucus-filled short blind colonic segment compressing the anastomotic site and causing LBO. Flexible sigmoidoscopy under general anaesthesia showed external rectal compression and lumen narrowing. Transrectal needle aspiration of the blind segment yielded 145 mL of mucoid fluid. The patient’s symptoms improved and he was discharged with outpatient Gastrografin enema and flexible sigmoidoscopy which confirmed successful blind segment emptying. This case highlights that blind colonic loop mucoceles in colorectal anastomosis can rarely cause obstruction, and endoscopic management is feasible when accurate diagnosis is confirmed on imaging.
Is there a role for RDTs as we live with COVID-19? An assessment of different strategies
Authors: Bonnet Gabrielle , Vassall Anna , Jit Mark
Published: January 2023

Introduction

By 2022, high levels of past COVID-19 infections, combined with substantial levels of vaccination and the development of Omicron, have shifted country strategies towards burden reduction policies. SARS-CoV-2 rapid antigen tests (rapid diagnostic tests (RDTs)) could contribute to these policies by helping rapidly detect, isolate and/or treat infections in different settings. However, the evidence to inform RDT policy choices in low and middle-income countries (LMICs) is limited.

Method

We provide an overview of the potential impact of several RDT use cases (surveillance; testing, tracing and isolation without and with surveillance; hospital-based screening to reduce nosocomial COVID-19; and testing to enable earlier/expanded treatment) for a range of country settings. We use conceptual models and literature review to identify which use cases are likely to bring benefits and how these may change with outbreak characteristics. Impacts are measured through multiple outcomes related to gaining time, reducing the burden on the health system and reducing deaths.

Results

In an optimal scenario in terms of resources and capacity and with baseline parameters, we find marginal time gains of 4 days or more through surveillance and testing tracing and isolation with surveillance, a reduction in peak intensive care unit (ICU) or ICU admissions by 5% or more (hospital-based screening; testing, tracing and isolation) and reductions in COVID-19 deaths by over 6% (hospital-based screening; test and treat). Time gains may be used to strengthen ICU capacity and/or boost vulnerable individuals, though only a small minority of at-risk individuals could be reached in the time available. The impact of RDTs declines with lower country resources and capacity, more transmissible or immune-escaping variants and reduced test sensitivity.

Conclusion

RDTs alone are unlikely to dramatically reduce the burden of COVID-19 in LMICs, though they may have an important role alongside other interventions such as vaccination, therapeutic drugs, improved healthcare capacity and non-pharmaceutical measures.
Decision-making processes for essential packages of health services: experience from six countries
Authors: Baltussen Rob , Mwalim Omar , Blanchet Karl , Carballo Manuel , Eregata Getachew Teshome , Hailu Alemayehu , Huda Maryam , Jama Mohamed , Johansson Kjell Arne , Reynolds Teri , Raza Wajeeha , Mallender Jacque , Majdzadeh Reza
Published: January 2023

Many countries around the world strive for universal health coverage, and an essential packages of health services (EPHS) is a central policy instrument for countries to achieve this. It defines the coverage of services that are made available, as well as the proportion of the costs that are covered from different financial schemes and who can receive these services. This paper reports on the development of an analytical framework on the decision-making process of EPHS revision, and the review of practices of six countries (Afghanistan, Ethiopia, Pakistan, Somalia, Sudan and Zanzibar-Tanzania).

The analytical framework distinguishes the practical organisation, fairness and institutionalisation of decision-making processes. The review shows that countries: (1) largely follow a similar practical stepwise process but differ in their implementation of some steps, such as the choice of decision criteria; (2) promote fairness in their EPHS process by involving a range of stakeholders, which in the case of Zanzibar included patients and community members; (3) are transparent in terms of at least some of the steps of their decision-making process and (4) in terms of institutionalisation, express a high degree of political will for ongoing EPHS revision with almost all countries having a designated governing institute for EPHS revision.

We advise countries to organise meaningful stakeholder involvement and foster the transparency of the decision-making process, as these are key to fairness in decision-making. We also recommend countries to take steps towards the institutionalisation of their EPHS revision process.
Country readiness and prerequisites for successful design and transition to implementation of essential packages of health services: experience from six countries
Authors: Alwan Ala , Majdzadeh Reza , Yamey Gavin , Blanchet Karl , Hailu Alemayehu , Jama Mohamed , Johansson Kjell Arne , Musa Mohammed Yusuf Ahmed , Mwalim Omar , Norheim Ole Frithjof , Safi Najibullah , Siddiqi Sameen , Zaidi Raza
Published: January 2023

This paper reviews the experience of six low-income and lower middle-income countries in setting their own essential packages of health services (EPHS), with the purpose of identifying the key requirements for the successful design and transition to implementation of the packages in the context of accelerating progress towards universal health coverage (UHC). The analysis is based on input from three meetings of a knowledge network established by the Disease Control Priorities 3 Country Translation Project and working groups, supplemented by a survey of participating countries.

All countries endorsed the Sustainable Development Goals target 3.8 on UHC for achievement by 2030. The assessment of country experiences found that health system strengthening and mobilising and sustaining health financing are major challenges. EPHS implementation is more likely when health system gaps are addressed and when there are realistic and sustainable financing prospects. However, health system assessments were inadequate and the government planning and finance sectors were not consistently engaged in setting the EPHS in most of the countries studied. There was also a need for greater engagement with community and civil society representatives, academia and the private sector in package design. Leadership and reinforcement of technical and managerial capacity are critical in the transition from EPHS design to sustained implementation, as are strong human resources and country ownership of the process. Political commitment beyond the health sector is key, particularly commitment from parliamentarians and policymakers in the planning and finance sectors. National ownership, institutionalisation of technical and managerial capacity and reinforcing human resources are critical for success.

The review concludes that four prerequisites are crucial for a successful EPHS: (1) sustained high-level commitment, (2) sustainable financing, (3) health system readiness, and (4) institutionalisation.
Using costing to facilitate policy making towards Universal Health Coverage: findings and recommendations from country-level experiences
Authors: Gaudin Sylvestre , Raza Wajeeha , Skordis Jolene , Soucat Agnès , Stenberg Karin , Alwan Ala
Published: January 2023

As countries progress towards universal health coverage (UHC), they frequently develop explicit packages of health services compatible with UHC goals. As part of the Disease Control Initiative 3 Country Translation project, a systematic survey instrument was developed and used to review the experience of five low-income and lower-middle-income countries—Afghanistan, Ethiopia, Pakistan, Somalia and Sudan—in estimating the cost of their proposed packages. The paper highlights the main results of the survey, providing information about how costing exercises were conducted and used and what country teams perceived to be the main challenges. Key messages are identified to facilitate similar exercises and improve their usefulness. Critical challenges to be addressed include inconsistent application of costing methods, measurement errors and data reliability issues, the lack of adequate capacity building, and the lack of integration between costing and budgeting. The paper formulates four recommendations to address these challenges: (1) developing more systematic guidance and standard ways to implement costing methodologies, particularly regarding the treatment of health systems-related common costs, (2) acknowledging ranges of uncertainty of costing results and integrating sensitivity analysis, (3) building long-term capacity at the local level and institutionalising the costing process in order to improve both reliability and policy relevance, and (4) closely linking costing exercises to public budgeting.
Risk and timing of venous thromboembolism in patients with gastrointestinal cancer: a nationwide Danish cohort study
Authors: Tønnesen Jacob , Pallisgaard Jannik , Rasmussen Peter Vibe , Ruwald Martin H , Lamberts Morten , Nouhravesh Nina , Strange Jarl , Gislason Gunnar Hilmar , Hansen Morten Lock
Published: January 2023

Aims

Cancer is a well-known risk factor of venous thromboembolism (VTE). Some cancers are believed to be more thrombogenic. The purpose of this study was to investigate the characteristics of patients with incident gastrointestinal cancers (GI) and their associated 1-year risk and timing of venous thromboembolic events and the 1-year mortality.

Methods

This study was a retrospective cohort study. Through Danish nationwide registries, all patients with first-time GI cancer diagnosis from 2008 to 2018 were identified. Incident VTE events were identified within a 1-year follow-up after GI cancer diagnosis using the Aalen-Johansen estimator. Cox proportional-hazard models were applied to investigate risk factors for VTE events and the impact of VTE on mortality.

Results

A total of 87 069 patients were included and stratified by cancer types: liver (5.8%), pancreatic (12.0%), gastric (6.9%), small intestinal (1.9%), colorectal (61.8%), oesophageal (7.3%) and gallbladder (3%). Most VTE events happened close to onset of the cancer diagnosis with declining events by time. The 1-year cumulative incidence of VTE differed according to cancer type with pancreatic cancer being most thrombogenic (7.8%), and colorectal and liver cancer being the least (3.6%). Prior VTE, heart failure, chronic obstructive pulmonary disease (COPD), liver disease, chronic kidney disease (CKD) and diabetes increased the VTE risk. Overall, the patients with GI cancer had high 1-year mortality of 33.3% with patients with pancreatic cancer having the highest mortality (70.3%).

Conclusion

We found that most VTE events happen close to onset of the GI cancer diagnosis and thrombogenicity differed by type of GI cancer, ranging from 7.8% in patients with pancreatic cancer to 3.6% in colorectal and patients with liver cancer. Prior VTE, heart failure, COPD, liver disease, CKD and DM were associated with increased risk of VTE.
Comparison of the prevalence of SARS-CoV-2 nucleoprotein antibodies in healthcare workers and an unselected adult and paediatric all-comer patient population: insights from a longitudinal study of healthcare workers and concurrent serial cross-sectional studies of patients at an academic medical centre in Austria
Authors: Riesenhuber Martin , Nitsche Christian , Binder Christoph J , Schernhammer Eva S , Stamm Tanja , Jakse Friedrich , Anwari Elaaha , Hamidi Fardin , Haslacher Helmuth , Perkmann Thomas , Hengstenberg Christian , Zelniker Thomas A
Published: January 2023

Objectives

This study aimed to estimate and compare the prevalence of the virus-specific antibodies against the SARS-CoV-2 nucleoprotein antigen (anti-SARS-CoV-2 N) in healthcare workers and an all-comer paediatric and adult patient population.

Design, setting and participants

A longitudinal study enrolling healthcare professionals and concurrent serial cross-sectional studies of unselected all-comer patients were conducted at an Austrian academic medical centre. Healthcare workers were tested at enrolment and after 1, 2, 3, 6 and 12 months. The cross-sectional studies in patients were conducted at three time periods, which roughly coincided with the times after the first, second and third wave of SARS-CoV-2 in Austria (ie, 24 August–7 September 2020; 8–22 February 2021 and 9–23 November 2021). Anti-SARS-CoV-2 N antibodies were measured using a sandwich electrochemiluminescence assay (Roche).

Results

In total, 2735 and 9275 samples were measured in 812 healthcare workers (median age: 40 years, 78% female) and 8451 patients (median age: 55 years, 52% female), respectively. Over the entire study period, anti-SARS-CoV-2 N antibodies were detected in 98 of 812 healthcare workers, resulting in a seroprevalence of 12.1% (95% CI 10.0% to 14.5%), which did not differ significantly (p=0.63) from that of the all-comer patient population at the end of the study period (407/3184; 12.8%, 95% CI 11.7% to 14.0%). The seroprevalence between healthcare workers and patients did not differ significantly at any time and was 1.5-fold to 2-fold higher than the number of confirmed cases in Austria throughout the pandemic. In particular, there was no significant difference in the seroprevalence between paediatric and adult patients at any of the tested time periods.

Conclusion

Throughout the pandemic, healthcare staff and an adult and paediatric all-comer patient population had similar exposure to SARS-CoV-2.

Trial registration number

ClinicalTrials.gov Identifier:NCT04407429.
At the edge of chaos: a prospective multiple case study in Australian general practices adapting to COVID-19
Authors: Russell Grant , Lane Riki , Neil Jennifer , Advocat Jenny , Sturgiss Elizabeth Ann , Staunton Smith Timothy , Alexander Karyn , Hattle Simon , Crabtree Benjamin F , Miller William L
Published: January 2023

Objectives

The rapid onset and progressive course of the COVID-19 pandemic challenged primary care practices to generate rapid solutions to unique circumstances, creating a natural experiment of effectiveness, resilience, financial stability and governance across primary care models. We aimed to characterise how practices in Melbourne, Australia modified clinical and organisational routines in response to the pandemic in 2020–2021 and identify factors that influenced these changes.

Design

Prospective, qualitative, participatory case study design using constant comparative data analysis, conducted between April 2020 and February 2021. Participant general practitioner (GP) investigators were involved in study design, recruitment of other participants, data collection and analysis. Data analysis included investigator diaries, structured practice observation, documents and interviews.

Setting

The cases were six Melbourne practices of varying size and organisational model.

Participants

GP investigators approached potential participants. Practice healthcare workers were interviewed by social scientists on three occasions, and provided feedback on presentations of preliminary findings.

Results

We conducted 58 interviews with 26 practice healthcare workers including practice owners, practice managers, GPs, receptionists and nurses; and six interviews with GP investigators. Data saturation was achieved within each practice and across the sample. The pandemic generated changes to triage, clinical care, infection control and organisational routines, particularly around telehealth. While collaboration and trust increased within several practices, others fragmented, leaving staff isolated and demoralised. Financial and organisational stability, collaborative problem solving, creative leadership and communication (internally and within the broader healthcare sector) were major influences on practice ability to negotiate the pandemic.

Conclusions

This study demonstrates the complex influences on primary care practices, and reinforces the strengths of clinician participation in research design, conduct and analysis. Two implications are: telehealth, triage and infection management innovations are likely to continue; the existing payment system provides inadequate support to primary care in a global pandemic.
Quality of maternal healthcare and travel time influence birthing service utilisation in Ghanaian health facilities: a geographical analysis of routine health data
Authors: Dotse-Gborgbortsi Winfred , Tatem Andrew J , Matthews Zoe , Alegana Victor A , Ofosu Anthony , Wright Jim A
Published: January 2023

Objectives

To investigate how the quality of maternal health services and travel times to health facilities affect birthing service utilisation in Eastern Region, Ghana.

Design

The study is a cross-sectional spatial interaction analysis of birth service utilisation patterns. Routine birth data were spatially linked to quality care, service demand and travel time data.

Setting

131 Health facilities (public, private and faith-based) in 33 districts in Eastern Region, Ghana.

Participants

Women who gave birth in health facilities in the Eastern Region, Ghana in 2017.

Outcome measures

The count of women giving birth, the quality of birthing care services and the geographic coverage of birthing care services.

Results

As travel time from women’s place of residence to the health facility increased up to two2 hours, the utilisation rate markedly decreased. Higher quality of maternal health services haves a larger, positive effect on utilisation rates than service proximity. The quality of maternal health services was higher in hospitals than in primary care facilities. Most women (88.6%) travelling via mechanised transport were within two2 hours of any birthing service. The majority (56.2%) of women were beyond the two2 -hour threshold of critical comprehensive emergency obstetric and newborn care (CEmONC) services. Few CEmONC services were in urban centres, disadvantaging rural populations.

Conclusions

To increase birthing service utilisation in Ghana, higher quality health facilities should be located closer to women, particularly in rural areas. Beyond Ghana, routinely collected birth records could be used to understand the interaction of service proximity and quality.
Longitudinal patient-reported outcomes 1 year after thoracoscopic segmentectomy versus lobectomy for early-stage lung cancer: a multicentre, prospective cohort study protocol
Authors: Gao Xin , Dai Wei , Zhang Qi , Liu Wenwu , Liu Yangjun , Yang Lingjia , Wei Xing , Shi Qiuling , Pompili Cecilia , Pu Yang , Xie Shaohua , Xiang Run , Tian Bo , Hu Bin , Yang Xiaozun , Wang Xiang , Yang Xiaojun , Xie Tianpeng , Tang Yong , Qiao Guibin , Sun Nan , Gao Shan , Zhang Guangjian , Chen Dan , Cui Yue , Chen Xiaobo , He Yu , Zhang Rong , Li Qiang , Zhuang Xiang
Published: January 2023

Introduction

Segmentectomy and lobectomy are the main surgical procedures for early-stage lung cancer. However, few studies have analysed patient-reported outcomes after segmentectomy versus lobectomy. This study aims to compare patient-reported outcomes—such as symptoms, daily functioning and quality of life—between thoracoscopic segmentectomy and lobectomy for early-stage lung cancer during the 1 year after surgery.

Methods and analysis

Overall, 788 newly diagnosed patients with early-stage lung cancer (tumour size ≤2 cm), who are scheduled to undergo thoracoscopic segmentectomy or lobectomy, will be recruited in this multicentre, prospective cohort study. The patients will receive standardised care after surgery. The Perioperative Symptom Assessment for Lung Surgery—a validated lung cancer surgery-specific scale—will be used to assess the symptoms and functions at baseline, at discharge and monthly after discharge for 1 year. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 and Lung Cancer module 29 will be used to assess the patients’ quality of life at the same time points. The primary outcome will be the shortness of breath scores during the first year after thoracoscopic segmentectomy and lobectomy and will be compared using mixed-effects models. The secondary outcomes will include other symptoms, indicators of daily functioning, quality of life scores and traditional clinical outcomes. These will be compared using mixed-effects models and the Student’s t-test, non-parametric test or Χ2test. Propensity score matching will be used to ensure an even distribution of known confounders between the groups.

Ethics and dissemination

The Ethics Committee for Medical Research and New Medical Technology of Sichuan Cancer Hospital approved this study (approval number: SCCHEC-02-2022-002). All participants will be instructed to provide informed consent. The manuscript is based on protocol version 3.0. The study results will be presented at medical conferences and published in peer-reviewed journals.

Trial registration number

ChiCTR2200060753.