bluuebunny/crossref_metadata_2025 huggingface dataset:
Effectiveness of cognitive behavior therapy for patients with heart failure and depression: A systematic review protocol
Authors: Shabu Shancy , Jayasekara Rasika
Published: September 2019

The objective of this review is to determine the effectiveness of cognitive behavior therapy for patients with heart failure and depression, aged ≥18 years, in institutionalized healthcare settings. More specifically, the review aims to identify which cognitive behavior therapy strategy/strategies, including the method of delivery, is the most effective for the management of depression in hospitalized patients with heart failure. The review question is as follows: Is cognitive behavior therapy effective in reducing symptoms of depression in patients with heart failure? This systematic review will be conducted in accordance with the Joanna Briggs Institute methodology for systematic reviews of effectiveness evidence. This review only includes randomized controlled trials assessing the effectiveness of cognitive behavior therapy as a treatment for depression in adults (aged ≥18 years) with heart failure, compared with usual care, which might include medications.
Declining root water transport drives stomatal closure in olive under moderate water stress
Authors: Rodriguez‐Dominguez Celia M. , Brodribb Timothy J.
Published: September 2019

Efficient water transport from soil to leaves sustains stomatal opening and steady‐state photosynthesis. The aboveground portion of this pathway is well‐described, yet the roots and their connection with the soil are still poorly understood due to technical limitations.

Here we used a novel rehydration technique to investigate changes in the hydraulic pathway between roots and soil and within the plant body as individual olive plants were subjected to a range of water stresses.

Whole root hydraulic resistance (including the radial pathway from xylem to the soil–root interface) constituted 81% of the whole‐plant resistance in unstressed plants, increasing to > 95% under a moderate level of water stress. The decline in this whole root hydraulic conductance occurred in parallel with stomatal closure and contributed significantly to the reduction in canopy conductance according to a hydraulic model.

Our results demonstrate that losses in root hydraulic conductance, mainly due to a disconnection from the soil during moderate water stress in olive plants, are profound and sufficient to induce stomatal closure before cavitation occurs. Future studies will determine whether this core regulatory role of root hydraulics exists more generally among diverse plant species.
The bi‐dimensional rejection taxonomy: Organizing responses to interpersonal rejection along antisocial–prosocial and engaged–disengaged dimensions
Authors: Sunami Naoyuki , Nadzan Megan A. , Jaremka Lisa M.
Published: September 2019

Responses to interpersonal rejection vary widely in form and function. Existing theories of interpersonal rejection have exclusively focused on organizing these responses on a single antisocial–prosocial dimension. Accumulating evidence suggests a gap in this approach: Variability in social responses to rejection cannot solely be explained by the antisocial–prosocial dimension alone. To fill this gap, we propose the bi‐dimensional rejection taxonomy, consisting of the antisocial–prosocial x‐axis and engaged–disengaged y‐axis, a novel contribution to the literature. We demonstrate that both the x‐ and y‐axes are necessary for understanding interpersonal responses to rejection and avoiding erroneous conclusions. We also show how this new framework allows researchers to generate more nuanced and accurate hypotheses about how people respond when rejected. We further demonstrate how existing research about individual differences and situational factors that predict responses to rejection can be viewed in a new light within the bi‐dimensional rejection taxonomy. We conclude by suggesting how the taxonomy inspires innovative questions for future research, including understanding spontaneous responses and neurophysiological markers. The preprint of this paper is available at https://psyarxiv.com/56ptx/
Touch in health professional practice: a review
Authors: Davin Lorna , Thistlethwaite Jill , Bartle Emma , Russell Kylie
Published: September 2019

Background

The appropriate use of touch is central to effective and compassionate care in the clinical environment; however, in a time of the #MeToo movement, and with heightened awareness of child and elder abuse, the notion of physical contact is frequently viewed negatively, and may be associated with gender and power divides. The use of touch in the clinical context has increasing layers of complexity and is highly context specific.

… in a time of the #MeToo movement … the notion of physical contact is frequently viewed negatively …

Methods

We reviewed relevant literature, including textbooks, and have drawn on our own experiences to explore the concept and use of touch across medicine, nursing and dentistry.

Results

In the context of learning and teaching in health we recognised two types of physical touch: expressive and procedural.

Discussion

Our review legitimises the importance of learners and educators being equipped to consider the role and nuances of touch when engaging in professional behaviour. We provide suggestions for how this complex concept may be embedded into entry‐to‐practice curricula and approached in faculty development.
Cytomegalovirus renal infection: Rare manifestation of a common post‐transplant viral infection—A case series
Authors: Posadas Salas Maria Aurora , Thompson Jennifer , Kadian Manish , Ngo Tue , Bruner Evelyn , Self Sally
Published: September 2019

Cytomegalovirus is the most common viral infection in organ transplant recipients that usually affects the brain, lungs, liver, and gastrointestinal tract. Renal involvement of Cytomegalovirus (CMV) is otherwise rare. We present six cases of biopsy‐proven CMV renal infection. Five out of the six patients had detectable CMV viremia. Kidney biopsy revealed glomerulopathy in four cases and tubulointerstitial involvement in two cases. All patients exhibited decline in renal function at the onset of infection. Four out of six patients had improvement of renal function following treatment of CMV disease. To date, this is the largest case series of pure biopsy‐proven CMV renal infection described in a single center.
Determinants of transfusion decisions in the ICU: haemoglobin concentration, what else? – a retrospective cohort study
Authors: Kranenburg Floris J. , le Cessie Saskia , Caram‐Deelder Camila , van der Bom Johanna G. , Arbous M. Sesmu
Published: September 2019

Background and Objectives

The aim of this study was to assess potentially relevant clinical characteristics which influence the decision to transfuse red cells in critically ill patients with low haemoglobin concentrations (6.0–10.0 g/dl).

Materials and Methods

This was a retrospective observational cohort study of patients admitted between November 2004 and May 2016 at the intensive care unit (ICU) of the Leiden University Medical Center, Netherlands. Haemoglobin measurements, clinical variables and the subsequent transfusion decision were extracted from the electronic health records. Clinical variables were grouped by organ system. We first examined the association of each of the clinical variables with the decision to transfuse during the following 6 h after a haemoglobin measurement using generalized estimating equations. We then compared the predictive abilities of single variables within an organ system and the predictive ability of an organ system’s combined variables using the change in Akaike information criterion (AIC).

Results

A total of 83 394 haemoglobin measurements of 10 947 ICU admissions were included. Haemoglobin concentration was the most predictive for red cell transfusion. After the haemoglobin concentration, the combined variables for General Health, followed by the organ systems Cardiovascular and Pulmonary, were most predictive for red cell transfusion. Within these organ systems, the APACHE II score, referring department, APACHE admission diagnosis subgroup, troponin concentration, lactate concentration, respiratory rate, PaO2/FiO2 and ventilation mode had the highest predictive ability.

Conclusion

Haemoglobin concentration is the dominant predictor for red cell transfusion. Other clinical characteristics are also predictive, though to a lesser extent.
An Investigation of Surrogate Models for Efficient Performance-Based Decoding of 3D Point Clouds
Authors: Cunningham James D. , Simpson Timothy W. , Tucker Conrad S.
Published: September 2019

This work investigates surrogate modeling techniques for learning to approximate a computationally expensive function evaluation of 3D models. While in the past, 3D point clouds have been a data format that is too high dimensional for surrogate modeling, by leveraging advances in 3D object autoencoding neural networks, these point clouds can be mapped to a one-dimensional latent space. This leads to the fundamental research question: what surrogate modeling technique is most suitable for learning relationships between the 3D geometric features of the objects captured in the encoded latent vector and the physical phenomena captured in the evaluation software? Radial basis functions (RBFs), Kriging, and shallow 1D analogs of popular deep 2D image classification neural networks are investigated in this work. We find the nonintuitive result that departing from neural networks to decode latent representations of 3D objects into performance predictions is far more efficient than using a neural network decoder. In test cases using datasets of aircraft and watercraft 3D models, the non-neural network surrogate models achieve comparable accuracy to the neural network models. We find that an RBF surrogate model is able to approximate the lift and drag coefficients of 234 aircraft models with a mean absolute error of 1.97 × 10−3 and trains in only 3 seconds. Furthermore, the RBF surrogate model is able to rank a set of designs with an average percentile error of less than 8%. In comparison, a 1D ResNet achieves an average absolute error of 1.35 × 103 in 38 min for the same test case. We validate the comparable accuracy of the four techniques through a test case involving 214 3D watercraft models, but we also find that the distribution of the performance values of the data, in particular the presence of many outliers, has a significant negative impact on accuracy. These results contradict a common perception of neural networks as an efficient “one-size-fits-all” solution for learning black-box functions and suggests that even within systems that utilize multiple neural networks, potentially more efficient alternatives should be considered for each network in the system. Depending on the required accuracy of the application, this surrogate modeling approach could be used to approximate an expensive simulation software, or if the tolerance for error is low, it serves as a first pass which can narrow down the number of candidate designs to be analyzed more thoroughly.
Stability Margin of a Metamorphic Quadruped Robot With a Twisting Trunk
Authors: Zhang Chunsong , Zhang Chi , Dai Jian S. , Qi Peng
Published: September 2019

To date, most quadruped robots are either equipped with trunks that are rigid bodies or consist of blocks connected by passive joints. The kinematic performance of these quadruped robots is only determined by their legs. To release the mobility of trunks and enhance the performance of quadruped robots, this paper proposes a metamorphic quadruped robot with a moveable trunk (a planar six-bar closed-loop linkage), called MetaRobot I, which can implement active trunk motions. The robot can twist its trunk like natural quadrupeds. Through trunk twisting, the stability margin of the quadruped robot can be increased compared with that of a quadruped robot with a rigid trunk. The inner relationship between the stability margin and the twisting angle is analyzed in this paper. Finally, simulations are carried out to show the benefits facilitated by the twisting trunk to the quadruped robot.
Control-Oriented Finger Kinematic Model: Geometry-Based Approach
Authors: Won Jong-Seob , Robson Nina
Published: September 2019

This paper proposes a novel finger kinematic model for human hand configurations, which applies to the realization of a naturalistic human finger motion for robotic finger systems and artificial hands. The proposed finger model is derived based on the geometry of a hand shape grasping a virtual cylindrical object. The model is capable of describing the natural rotation configuration of the joints of a long finger with three degrees of freedom by a single parameter, i.e., the radius of a cylindrical object. Experimental validation of the model shows that it can simulate closely naturalistic human finger movements. With the use of the proposed model, discussions were made on how to achieve multifinger coordination that makes task-specific hand movements or a posture for specific hand actions. Due to the simplicity of the model to define joints angle configuration in a long finger by a single parameter, the combination of the proposed model and the multifinger coordination concept discussed can be seen as an inclusive framework in human-like hand systems design and control. This paper is the first step toward exploring future novel combined design–control strategies for the development of under-actuated prosthetic and powered orthotic devices for the naturalistic motion that are based on both Cartesian space trajectory tracking and joint angle coordination.
Slam-Induced Loads on a Three-Dimensional Bow With Various Pitch Angles
Authors: Wang Yiwen , Wu Weiguo , Wang Shan , Guedes Soares C.
Published: September 2019

A 3D water entry of a typical bow model of river-to-sea ship is studied experimentally. A large number of systematic experiments have been performed for the bow model with different pitch angles. Considering various pitch angles and impact velocities in the model tests, the slamming pressure distributions on the bottom of the bow are presented and discussed. The measured slamming pressures on the bow are identified in terms of the maximum slamming coefficient. The effects of the pitch angle and impact velocity on slamming pressure are discussed as well, based on the experimental measurements. It is shown that the slamming load on the bottom of the model increases as the pitch angle decreases in most cases. With a higher impact velocity, the coefficient of the maximum slamming pressure is smaller for most of the tested cases.
Operational Modal Response Characterization of Pipeline Systems Through Reynolds Number Variation
Authors: Chen Haobin , Hugo Ronald J. , Park Simon
Published: September 2019

An operational modal response method for application to the structure health and integrity of pipelines is investigated. The modal response characteristics of externally supported pipe structures are quantified through flow Reynolds number (Red) variation. Pipe flow turbulence and the resulting hydrodynamic pressure fluctuations on the interior pipe wall provide the structural forcing mechanism, and signals from wall-mounted accelerometers provide the system response. During experiments, the Reynolds number is varied from 51,000 to 154,000. Over this Reynolds number range, the pipe flow turbulence was found sufficient enough to excite the structure at frequencies up to 400 Hz. Modal response characteristics obtained through Reynolds number variation were found to be in agreement with results from impact hammer modal testing. The in-situ modal response method developed was applied to two different structural health monitoring investigations, one involving loss-of-material and the other involving loss-of-fluid. The loss-of-material scenario simulated the process of external pipe wall corrosion, and the developed method was able to detect material loss as small as 1.4%. The loss-of-fluid scenario simulated a small leak. Despite the low operating pressure of 0.024 MPa, the methodology was able to detect fluid loss as low as 0.1% of the bulk flow rate. The developed method has the potential to offer in-situ continuous pipeline health monitoring that relies on the continuous changes (flow rate, product viscosity, product density) that are inherent to an operational pipeline system.
Frequency-Domain Estimation Method for Vibration-Induced Additional Cable Tension Based on Acceleration Monitoring
Authors: Xu Bin , Dan Danhui , Zhao Yiming
Published: September 2019

Under excitation due to the environment or traffic load, cable vibration never ceases; thus, fatigue cycles generated by vibration-induced additional cable tension (VACT) owing to the change of the cable configuration from static to dynamic are significantly frequent. Therefore, VACT is a non-negligible cable-fatigue load. To investigate the cable dynamic stability and fatigue, it is necessary to determine VACT in a dynamic environment. Herein, a method for estimating VACT in the frequency-domain by using acceleration data is proposed. In this method, according to the cable vibration control equation, the frequency-domain relationship between the VACT and the vibration response of the measuring point is established based on the dynamic stiffness. Parameter analysis simplifies the proposed model to estimate VACT using only acceleration data. The proposed method is verified with cable acceleration data.
Social work students’ feedback about students’ suitability for field education and the profession
Authors: Zuchowski Ines , Watson Sally , Dickinson Tracey , Thomas Nicole , Croaker Sandra
Published: September 2019

INTRODUCTION: Many students successfully complete placement, while, for a minority of students, placement may be a time when questions are asked about suitability for placement and professional practice.METHOD: Research undertaken with final year social work students examined their ideas about suitability and unsuitability for field education and practice and presented them with a model developed with field educators in an earlier phase of the research. The aim of the study was to incorporate students’ understanding into the discourse of suitability/unsuitability to further develop a suitability/unsuitability model for collaborative discussions between students, educators and supervisors. Twenty-eight students responded to an online survey.RESULTS: The results show that students identify a critical understanding of self, skills, knowledge, attitudes and contextual factors as important in assessing students’ suitability for field education. Identified indicators of unsuitability included lack of preparedness to learn, lack of capacityto demonstrate an understanding of professional values and ethics and inability to maintain professional boundaries or demonstrate basic practice skills. Students overwhelmingly supported the use of the presented model and made suggestions for further development of the model.IMPLICATIONS: The discussion emphasises the importance of using a pedagogically informed formative assessment strategy in a timely manner to address professional suitability with students.
Potential Interactions between Clade SUP05 Sulfur-Oxidizing Bacteria and Phages in Hydrothermal Vent Sponges
Authors: Zhou Kun , Zhang Rui , Sun Jin , Zhang Weipeng , Tian Ren-Mao , Chen Chong , Kawagucci Shinsuke , Xu Ying
Published: September 2019

Chemosynthetic SUP05 bacteria dominate the microbial communities of deep-sea hydrothermal vents around the world, SUP05 bacteria utilize reduced chemical compounds in vent fluids and commonly form symbioses with invertebrate organisms. This symbiotic relationship could be key to adapting to such unique and extreme environments. Viruses are the most abundant biological entities on the planet and have been identified in hydrothermal vent environments. However, their interactions with the symbiotic microbes of the SUP05 clade, along with their role in the symbiotic system, remain unclear. Here, using metagenomic sequence-based analyses, we determined that bacteriophages may support metabolism in SUP05 bacteria and play a role in the sponge-associated symbiosis system in hydrothermal vent environments.
Hybrid Two-Component Sensors for Identification of Bacterial Chemoreceptor Function
Authors: Luu Rita A. , Schomer Rebecca A. , Brunton Ceanne N. , Truong Richard , Ta Albert P. , Tan Watumesa A. , Parales Juanito V. , Wang Yu-Jing , Huo Yu-Wen , Liu Shuang-Jiang , Ditty Jayna L. , Stewart Valley , Parales Rebecca E.
Published: September 2019

Relatively few of the thousands of chemoreceptors encoded in bacterial genomes have been functionally characterized. More importantly, although methyl-accepting chemotaxis proteins, the major type of chemoreceptors present in bacteria, are easily identified bioinformatically, it is not currently possible to predict what chemicals will bind to a particular chemoreceptor. Chemotaxis is known to play roles in biodegradation as well as in host-pathogen and host-symbiont interactions, but many studies are currently limited by the inability to identify relevant chemoreceptor ligands. The use of hybrid receptors and this simple
E. coli
reporter system allowed rapid and sensitive screening for potential chemoeffectors. The fusion site chosen for this study resulted in a high percentage of functional hybrids, indicating that it could be used to broadly test chemoreceptor responses from phylogenetically diverse samples. Considering the wide range of chemical attractants detected by soil bacteria, hybrid receptors may also be useful as sensitive biosensors.
Deoxyinosine and 7-Deaza-2-Deoxyguanosine as Carriers of Genetic Information in the DNA of
Campylobacter
Viruses
Authors: Crippen Clay S. , Lee Yan-Jiun , Hutinet Geoffrey , Shajahan Asif , Sacher Jessica C. , Azadi Parastoo , de Crécy-Lagard Valérie , Weigele Peter R. , Szymanski Christine M.
Published: September 2019

Bacteriophages are in a constant evolutionary struggle to overcome their microbial hosts’ defenses and must adapt in unconventional ways to remain viable as infectious agents. One mode of adaptation is modifying the viral genome to contain noncanonical nucleotides. Genome modification in phages is becoming more commonly reported as analytical techniques improve, but guanosine modifications have been underreported. To date, two genomic guanosine modifications have been observed in phage genomes, and both are low in genomic abundance. The significance of our research is in the identification of two novel DNA modification systems in
Campylobacter
-infecting phages, which replace all guanosine bases in the genome in a genus-specific manner.
Absence of Signal Peptide Peptidase, an Essential Herpes Simplex Virus 1 Glycoprotein K Binding Partner, Reduces Virus InfectivityIn Vivo
Authors: Wang Shaohui , Ghiasi Homayon
Published: September 2019

Glycoprotein K (gK) is an essential and highly conserved HSV-1 protein. Previously, we reported that gK binds to SPP, an endoplasmic reticulum (ER) protein, and blocking this binding reduces virus infectivityin vitroand also affects gK and UL20 subcellular localization. To evaluate the function of gK binding to SPPin vivo, we generated SPP-inducible knockout mice and observed the following in the absence of SPP: (i) that significantly less HSV-1 replication was seen in ocularly infected mice than in control mice; (ii) that expression of various HSV-1 genes and cellular infiltrates in the eye and trigeminal ganglia of infected mice was less than that in control mice; and (iii) that latency was significantly reduced in infected mice. Thus, blocking of gK binding to SPP may be a useful tool to control HSV-1-induced eye disease in patients with herpes stromal keratitis (HSK).
The TK0271 Protein Activates Transcription of Aromatic Amino Acid Biosynthesis Genes in the Hyperthermophilic Archaeon Thermococcus kodakarensis
Authors: Yamamoto Yasuyuki , Kanai Tamotsu , Kaneseki Tsuyoshi , Atomi Haruyuki
Published: September 2019

The mechanisms of transcriptional regulation in archaea are still poorly understood. In this study, we identified a transcriptional regulator in the hyperthermophilic archaeon
Thermococcus kodakarensis
that activates the transcription of three operons involved in the biosynthesis of aromatic amino acids. The study represents one of only a few that identifies a regulator in
Archaea
that activates transcription. The results also imply that transcriptional regulation of genes with the same function is carried out by diverse mechanisms in the archaea, depending on the lineage.
Transcriptome Profiling Analysis of Bovine Vaginal Epithelial Cell Response to an Isolated
Lactobacillus
Strain
Authors: Niu Chunyu , Cheng Chao , Liu Yanmin , Huang Shaolei , Fu Yanru , Li Peifeng
Published: September 2019

Bovine bacterial vaginitis causes infertility, abortion, and postpartum uterine diseases, causing serious economic loss to the dairy industry. The large-scale use of antibiotics destroys normal genital tract flora and hinders the defense mechanisms of the host. Recent research suggests that lactobacilli present in the vaginal microflora of healthy cows constitute the primary microbiological barrier to infection by genital pathogens, exerting a protective role on the reproductive tract via specific adherence to the epithelium and the production of inhibitory substances. Our research identified the mechanisms for
Lactobacillus
adhesion and pathogenic inhibition, providing valuable information for the development of new probiotics and the discovery of novel therapeutic targets for the prevention of infections in dairy cows.
Delirium superimposed on dementia precipitated by an unexpected bladder tumour
Authors: Redknap Caio , Kaitiff Daniel
Published: September 2019

A patient in her 70s presented with confusion, agitation and psychotic symptoms. No cause was found until the incidental discovery of urothelial carcinoma. Upon removal of the tumour, the psychiatric symptoms largely improved leaving residual symptoms indicative of dementia. The patient had not been diagnosed with dementia previously and this made for an interesting disease presentation and progression. We discuss the challenges of diagnosing delirium and dementia in complex patients such as these and the importance of identifying a cause when cognition has been impaired by a suspected delirium.
Intended place of residence in old age of internal migrants aged 15–64 years: a citywide cross-sectional study in Shanghai, China
Authors: Zhao Jing , Su Yan , Mao Yanyan , Chen An-na , Zhou Xiao-ping , Zhou Wei-jin , Zhu Qian-xi
Published: September 2019

Objectives

To explore the intentions of working-age internal migrants concerning their place of residence in old age and the relevant influencing factors.

Method

A cross-sectional survey was conducted in the 17 districts of Shanghai, China in 2013. Through multi-stage stratified sampling with probability proportional to size, 7968 internal migrants (aged 15–64 years) were selected and interviewed individually face to face. The primary outcome concerned the intended place of residence in old age of internal migrants living in Shanghai. Information was collected on demographic characteristics, health insurance, economic condition and participation in social activities. Multinomial logistic regression was performed to analyse the factors influencing migrants’ intentions concerning their place of residence in old age.

Results

A total of 7927 working-age migrants with complete data were analysed. Of these, 57.0% intended to live in their hometown in old age, 17.7% planned to remain in Shanghai and 25.3% were undecided. Those respondents who were male, less educated, from rural areas or Western China, living in rental houses or who had left family members behind in their hometowns were more likely to choose their hometown as their intended residence in old age (p<0.05). Engagement in business, longer residence duration, possession of social insurance and participation in social activities in Shanghai were identified as possible motivators for migrants who intended to remain in Shanghai in old age (p<0.05).

Conclusions

Most of the migrants expressed an intention to remigrate to their hometowns in old age. Education, economic capacity and social insurance influenced internal migrants in their decision. Relevant authorities should monitor the remigration pattern of ageing migrants, strengthen the senior care system and prepare health service resources that are more adequate, especially in the provinces or cities whence the migrants came.
Community perceptions on demand-side incentives to promote institutional delivery in Oyam district, Uganda: a qualitative study
Authors: Massavon William , Wilunda Calistus , Nannini Maria , Agaro Caroline , Amandi Simon , Orech John Bosco , De Vivo Emanuela , Lochoro Peter , Putoto Giovanni
Published: September 2019

Objective

To examine the perceptions of community members and other stakeholders on the use of baby kits and transport vouchers to improve the utilisation of childbirth services.

Design

A qualitative study.

Setting

Oyam district, Uganda.

Participants

We conducted 10 focus group discussions with 59 women and 55 men, and 18 key informant interviews with local leaders, village health team members, health facility staff and district health management team members. We analysed the data using qualitative content analysis.

Results

Five broad themes emerged: (1) context, (2) community support for the interventions, (3) health-seeking behaviours postintervention, (4) undesirable effects of the interventions and (5) implementation issues and lessons learnt. Context regarded perceived long distances to health facilities and high transport costs. Regarding community support for the interventions, the schemes were perceived to be acceptable and helpful particularly to the most vulnerable. Transport vouchers were preferred over baby kits, although both interventions were perceived to be necessary. Health-seeking behaviours entailed perceived increased utilisation of maternal health services and ‘bypassing’, promotion of collaboration between traditional birth attendants and formal health workers, stimulation of men’s involvement in maternal health, and increased community awareness of maternal health. Undesirable effects of the interventions included increased workload for health workers, sustainability concerns and perceived encouragement to reproduce and dependency. Implementation issues included information gaps leading to confusion, mistrust and discontent, transport voucher scheme design; implementation; and payment problems, poor attitude of some health workers and poor quality of care, insecurity, and a shortage of baby kits. Community involvement was key to solving the challenges.

Conclusions

The study provides further insights into the implementation of incentive schemes to improve maternal health services utilisation. The findings are relevant for planning and implementing similar schemes in low-income countries.
The accuracy of diagnostic Imaging techniques in patients with a suspected Fracture-related Infection (IFI) trial: study protocol for a prospective multicenter cohort study.
Authors: Govaert GAM , Hobbelink MGG , Reininga IHF , Bosch P , Kwee TC , de Jong PA , Jutte PC , Vogely HC , Dierckx RAJO , Leenen LPH , Glaudemans AWJM , IJpma FFA
Published: September 2019

Introduction

The optimal diagnostic imaging strategy for fracture-related infection (FRI) remains to be established. In this prospective study, the three commonly used advanced imaging techniques for diagnosing FRI will be compared. Primary endpoints are (1) determining the overall diagnostic performances of white blood cell (WBC) scintigraphy, fluorodeoxyglucose positron emission tomography (FDG-PET) and magnetic resonance imaging (MRI) in patients with suspected FRI and (2) establishing the most accurate imaging strategy for diagnosing FRI.

Methods and analysis

This study is a non-randomised, partially blinded, prospective cohort study involving two level 1 trauma centres in The Netherlands. All adult patients who require advanced medical imaging for suspected FRI are eligible for inclusion. Patients will undergo all three investigational imaging procedures (WBC scintigraphy, FDG-PET and MRI) within a time frame of 14 days after inclusion. The reference standard will be the result of at least five intraoperative sampled microbiology cultures, or, in case of no surgery, the clinical presence or absence of infection at 1 year follow-up. Initially, the results of all three imaging modalities will be available to the treating team as per local protocol. At a later time point, all scans will be centrally reassessed by nuclear medicine physicians and radiologists who are blinded for the identity of the patients and their clinical outcome. The discriminative ability of the imaging modalities will be quantified by several measures of diagnostic accuracy.

Ethics and dissemination

Approval of the study by the Institutional Review Board has been obtained prior to the start of this study. The results of this trial will be disseminated by publication of peer-reviewed manuscripts, presentation in abstract form at scientific meetings and data sharing with other investigators through academically established means.

Trial registration number

The IFI trial is registered in the Netherlands Trial Register (NTR7490).
The productivity development of total hip arthroplasty in Sweden: a multiple registry-based longitudinal study using the Malmquist Productivity Index
Authors: Goude Fanny , Garellick Göran , Kittelsen Sverre A C , Nemes Szilard , Rehnberg Clas
Published: September 2019

Objective

The increasing demand for total hip arthroplasty (THA) combined with limited resources in healthcare puts pressure on decision-makers in orthopaedics to provide the procedure at minimum costs and with good outcomes while maintaining or increasing access. The objective of this study was to analyse the development in productivity between 2005 and 2012 in the provision of THA.

Design

The study was a multiple registry-based longitudinal study.

Setting and participants

The study was conducted among 65 orthopaedic departments providing THA in Sweden from 2005 to 2012.

Outcome measures

The development in productivity was measured by Malmquist Productivity Index by relating department level total costs of THA to the number of non-cemented, hybrid and cemented THAs. We also break down the productivity change into changes in efficiency and technology.

Results

Productivity increased significantly in three periods (between 1.6% and 27.0%) and declined significantly in four periods (between 0.8% and 12.1%). Technology improved significantly in three periods (between 3.2% and 16.9%) and deteriorated significantly in two periods (between 10.2% and 12.6%). Significant progress in efficiency was achieved in two periods (ranging from 2.6% to 8.7%), whereas a significant regress was attained in one period (3.9%). For the time span as a whole, an average increase in productivity of 1.4% per year was found, where changes in efficiency contributed more to the improvement (1.1%) than did technical change (0.2%).

Conclusions

We found a slight improvement of productivity over time in the provision of THA, which was mainly driven by changes in efficiency. Further research is, however, needed where differences in quality of care and patient case mix between departments are taken into account.
“Stages of change, smoking behavior and acceptability of a textmessaging intervention for tobacco cessation among cigarette, dokha and shishasmokers: A qualitative research study.”
Authors: Elobaid Yusra Elhidaia , Jabari Andrea Leinberger , Al Hamiz Aisha , Al Kaddour Abdul Rizzak , Bakir Sherif , Barazi Heba , Kazim Elisa , Sherman Scott , Ali Raghib
Published: September 2019

Objectives

To explore: (A) the underlying motivators and barriers to smoking cessation among young Arabic speaking smokers and (B) to examine the suitability and preferences for tobacco cessation interventions (specifically text messages) and study the possibility of enrollment methods for a randomised controlled study using text messages as an intervention for tobacco cessation.

Design

Qualitative research using focus group discussions and content analysis.

Setting(s)

Two universities, one of them is the first and foremost comprehensive national university in the United Arab Emirates (UAE). The third setting is the largest hospital in the UAE and the flagship institution for the public health system in the emirate of Abu Dhabi.

Participants

Six focus group discussions with a total of 57 participants. Forty-seven men and 10 women. Fifty-three of them were current smokers.

Results

The analysis of six focus groups was carried out. Main themes arose from the data included: preferences for tobacco cessation interventions and acceptability and feasibility of text messaging as tobacco cessation intervention. Different motives and barriers for quitting smoking including shisha and dokha were explored.

Conclusion

Interventions using text messaging for smoking cessation have not been used in the Middle East and they could potentially be effective; however, tailoring and closely examining the content and acceptability of text messages to be used is important before the conduction of trials involving their use. Social media is perceived to be more effective and influential, with a higher level of penetration into communities of young smokers.
Cohort profile: the Canadian coordination and activity tracking in children (CATCH) longitudinal cohort
Authors: Cairney John , Veldhuizen Scott , Rodriguez M Christine , King-Dowling Sara , Kwan Matthew Y , Wade Terrance , Price David , Missiuna Cheryl , Timmons Brian
Published: September 2019

Purpose

Developmental coordination disorder (DCD) is a prevalent, neurodevelopmental disorder affecting 2% to 5% of children, which is characterised by fine and gross motor problems. Children with DCD have been shown to be less fit and physically active than other children; however, the direction of causality is unknown as previous studies have typically been done in older children when the differences in fitness and physical activity are already present. The aim of the Coordination and Activity Tracking in Children (CATCH) study is to specifically address the issue of precedence by recruiting a large sample of children in early childhood.

Participants

CATCH comprises a community-based sample of parents and children 4 to 5 years of age divided into two groups: at risk for DCD (rDCD; n=287) and typically developing (TD; n=301). Inclusion in the rDCD group required a score at or below the 16thpercentile on a standardised test of motor coordination and a score above 70 on a standardised test of intelligence.

Findings to date

Children in the rDCD group contained a higher proportion of males (67% vs 48%, χ2=21.9, p<0.001). Children in the rDCD group had lower mean IQs, aerobic and musculoskeletal fitness than children in the TD group (p<0.001 for all). There were no differences observed between groups for body composition or physical activity. Parent characteristics did not differ, with one exception: partners of reporting parents of rDCD children were less likely to hold a university degree (44% vs 57%, χ2=7.4, p=0.004). According to parent report, rDCD children experienced more problems in self-care, school and leisure activities (p<0.001 for all).

Future plans

Children are being followed up annually for 3 years. At each follow-up, motor coordination testing is repeated, and data are collected on physical activity, fitness and social-emotional problems.
Addressing clinical equipoise for hearing devices: the qualitative COACH (q-COACH) study protocol for Australian stakeholder involvement in the design of a randomised controlled trial
Authors: Rapport Frances , Auton Emilie , Warren Chris , Braithwaite Jeffrey
Published: September 2019

Introduction

Hearing loss is a common chronic problem which can be effectively managed with hearing devices. At present, only a limited number of people with hearing loss use hearing aids (HAs) and cochlear implants (CIs) to improve hearing and sound quality and enhance quality of life. Clinical equipoise, by which we mean healthcare professional uncertainty about which treatment options are the most efficacious due to the lack of evidence-based information, can lead to inconsistent and poorly informed referral processes for hearing devices.

A randomised controlled trial (RCT) that offers high-quality, generalisable information is needed to clarify which hearing device (HA or CI) is more suitable for different degrees of hearing loss and for which kinds of patients. Qualitative research can improve this RCT, by gathering the information on patient and provider perspectives, attitudes and values, which can inform design, conduct and information dissemination, either during preparatory stages of an intervention, or as a fully integrated methodology. The Comparison of Outcomes with hearing Aids and Cochlear implants in adults with moderately severe-to-profound bilateral sensorineural Hearing loss (COACH) study is being planned as an RCT with a qualitative arm (the qualitative COACH study, q-COACH), acting as a pretrial intervention examining views of HAs, CIs, equipoise and the impetus for an RCT of this nature.

Methods and analysis

The q-COACH study involves semistructured interviews and a demographic questionnaire which will be collected from four participant cohorts: General Practitioners (GPs) and Ear, Nose and Throat Surgeons (ENTs); audiologists; adult HA users and their support networks. Data will be analysed thematically and through descriptive statistics.

Ethics and dissemination

Macquarie University Human Research Ethics Committee, Australia, granted ethical approval (no. 5201833514848). Peer-reviewed journal articles, research conferences and a final report will present study findings.
Tolerogenic dendritic cell-based treatment for multiple sclerosis (MS): a harmonised study protocol for two phase I clinical trials comparing intradermal and intranodal cell administration
Authors: Willekens Barbara , Presas-Rodríguez Silvia , Mansilla MJ , Derdelinckx Judith , Lee Wai-Ping , Nijs Griet , De Laere Maxime , Wens Inez , Cras Patrick , Parizel Paul , Van Hecke Wim , Ribbens Annemie , Billiet Thibo , Adams Geert , Couttenye Marie-Madeleine , Navarro-Barriuso Juan , Teniente-Serra Aina , Quirant-Sánchez Bibiana , Lopez-Diaz de Cerio Ascensión , Inogés Susana , Prosper Felipe , Kip Anke , Verheij Herman , Gross Catharina C , Wiendl Heinz , Van Ham Marieke (SM) , Ten Brinke Anja , Barriocanal Ana Maria , Massuet-Vilamajó Anna , Hens Niel , Berneman Zwi , Martínez-Cáceres Eva , Cools Nathalie , Ramo-Tello Cristina
Published: September 2019

Introduction

Based on the advances in the treatment of multiple sclerosis (MS), currently available disease-modifying treatments (DMT) have positively influenced the disease course of MS. However, the efficacy of DMT is highly variable and increasing treatment efficacy comes with a more severe risk profile. Hence, the unmet need for safer and more selective treatments remains. Specifically restoring immune tolerance towards myelin antigens may provide an attractive alternative. In this respect, antigen-specific tolerisation with autologous tolerogenic dendritic cells (tolDC) is a promising approach.

Methods and analysis

Here, we will evaluate the clinical use of tolDC in a well-defined population of MS patients in two phase I clinical trials. In doing so, we aim to compare two ways of tolDC administration, namely intradermal and intranodal. The cells will be injected at consecutive intervals in three cohorts receiving incremental doses of tolDC, according to a best-of-five design. The primary objective is to assess the safety and feasibility of tolDC administration. For safety, the number of adverse events including MRI and clinical outcomes will be assessed. For feasibility, successful production of tolDC will be determined. Secondary endpoints include clinical and MRI outcome measures. The patients’ immune profile will be assessed to find presumptive evidence for a tolerogenic effect in vivo.

Ethics and dissemination

Ethics approval was obtained for the two phase I clinical trials. The results of the trials will be disseminated in a peer-reviewed journal, at scientific conferences and to patient associations.

Trial registration numbers

NCT02618902andNCT02903537; EudraCT numbers: 2015-002975-16 and 2015-003541-26.
Risk factors and regional variations of malnutrition among children under 5 in Myanmar: cross-sectional analyses at national and subnational levels
Authors: Khaing Hnin Thiri , Nomura Shuhei , Yoneoka Daisuke , Ueda Peter , Shibuya Kenji
Published: September 2019

Objective

The levels, distributions of child malnutrition and its potential risk factors are not very well known in Myanmar. The objectives included in this study were: to estimate the current national and subnational prevalence of four types of malnutrition (stunting, wasting, underweight and overweight) among children under 5 in Myanmar; to identify potential risk factors associated with each type of malnutrition and to investigate how the identified risk factors’ distributions explained the regional disparities in malnutrition prevalence.

Design/methods

Data from the Myanmar Demographic and Health Survey 2015–2016 were used to estimate the prevalence of four types of malnutrition at both national and subnational levels (15 regions). Logistic regression models were applied to examine the association between each type of malnutrition and its risk factors, including child’s factors, parental social status and household conditions. The risk factor-adjusted prevalence of the malnutrition was estimated at the subnational level based on the estimated parameters from the regression models.

Results

The national prevalence of stunting, wasting, underweight and overweight in children under 5 was estimated to be 29.1% (95% CI 27.7% to 30.6%), 6.8% (6.0% to 7.6%), 18.3% (17.0% to 19.5%) and 1.5% (1.1% to 1.9%), respectively. Substantial regional variations in the prevalence of each type of malnutrition were observed. Several risk factors of each type of malnutrition were identified, including low birth weight (LBW) and inadequate maternal nutritional status. Except for overweight, regional variations largely persisted even after adjustment for the risk factors investigated.

Conclusion

The prevalence of malnutrition among children under 5 is still high in Myanmar, most commonly stunting. Targeted interventions aimed at prevention of LBW, improving the maternal nutritional status, in addition to other sociodemographic conditions should be encouraged urgently. Further research is necessary to investigate the potential sources of regional variation in prevalence of malnutrition among children under 5 in the country.