bluuebunny/crossref_metadata_2025 huggingface dataset:
Biosecurity and more‐than‐human political economy: Veterinary interventions as productive economic forces in the ‘mozzarella landscape’ in Italy
Authors: Cseke László
Published: August 2022

The importance of veterinary interventions has been longstanding in animal farming. The intensification of farming methods, recurrence of infectious diseases and food quality concerns have made veterinary practices and expertise even more relevant. By engaging recent literature on more‐than‐human political economy, this paper explores how veterinary interventions, through political economic and biosecurity practices, become productive economic forces in intensive animal farming and the wider agri‐food production. Empirically, the article focuses on the challenges of buffalo farming in the ‘mozzarella landscape’ in Southern Italy, and it draws from multi‐sited and multispecies ethnography of water buffalo farming and mozzarella cheese production in the Campania region. One of the main elements of my fieldwork is a seven‐week‐long internship on a buffalo farm where participant and direct observation has been conducted. From a theoretical perspective, the article aims to bring the concept of veterinary bioeconomy to the forefront of animal geographies and political ecology.
The European Union's withdrawal of trade preferences for Cambodia
Authors: Tanaka Kiyoyasu
Published: August 2022

Following Cambodia's violation of human and labour rights, the European Union (EU) decided in February 2020 to withdraw trade preferences for the country temporarily from August 2020. This paper estimates the short‐run impact of preference withdrawal on EU imports from Cambodia. As the EU withdrew preferential tariffs only for certain products and maintained duty‐free quota‐free access for others, I adopt a difference‐in‐differences regression framework and provide supporting evidence for the parallel trend assumption. The results show that preference withdrawal has a significantly positive impact on EU import of affected goods from Cambodia in July 2020, consistent with a last‐minute shipment effect to avoid tariff increases. Subsequently, tariff increases have a significantly negative impact on the EU import of affected goods. These effects are heterogeneous across knitted garments, woven garments, and footwear products.
A Nonfield Analytical Method for Solving Some Nonlinear Problems in Heat Transfer
Authors: Kulish Vladimir , Sláma Pavel
Published: August 2022

This paper presents an extension of the nonfield analytical method—known as the method of Kulish—to some nonlinear problems in heat transfer. In view of the fact that solving nonlinear problems is very complicated in general, the extension of the method is presented in the form of several important illustrative examples. Two classes of problems are considered: first are the problems, in which the heat equation contains nonlinear terms, while the second type of problems includes some problems with nonlinear boundary conditions. From the practical viewpoint, the case considering asymptotic solutions is of the greatest interest: it is shown that, for complex heat transfer problems, where applications of the nonfield method are practically impossible due to a large volume of necessary computations, it is still possible to analyze the solution behavior and automatically determine similarity criteria for the limiting values of the parameters. Wherever possible the obtained solutions are compared with known solutions obtained by other methods. The practical advantages of the nonfield method over other analytical methods are emphasized in each case.
Finite Amplitude Cellular Thermohaline Convection
Authors: Rawoof Sayeed M. A. , Rameshwar Y.
Published: August 2022

In this paper, linear and nonlinear properties of thermohaline convection at the onset with the stress-free boundary conditions are investigated using perturbation analysis relevant to oceanic water and ground water. The nonlinear governing equations are expanded using linear stability solutions, related to the temperature, motion, and concentration in the series of nonhomogeneous linear equations. The proposed method yields finite amplitude steady solutions by means of successive approximations. The rate of heat transfer is studied up to sixth-order using an expansion of thermal Rayleigh number (Ra1) as proposed by Kuo (1961, “Solution of the Non-Linear Equations of the Cellular Convection and Heat Transport,” J. Fluid Mech., 10(04), pp. 611–630). The heat transfer rate of the system depends on Lewis number, Prandtl number, and thermal (Ra1) as well as solutal (Ra2) Rayleigh number. The result for the heat transport (N) in the system fits a power law of exponent of 0.288, i.e., N≃(Ra1/Ra1o)0.288 for Ra2=0, Pr = 10 and Ra1>4Ra1o. This power law of exponent value of 0.288 is close to the results (0.25) obtained by Kuo (1961, “Solution of the Non-Linear Equations of the Cellular Convection and Heat Transport,” J. Fluid Mech., 10(04), pp. 611–630), and also to the experimental results for laminar convection by Jakob (1949, Heat Transfer, Vol. 1, Wiley, New York.). The characteristics of heat transfer and flow field results are depicted by means of isotherms and streamlines, respectively. The path of convective heat transport and the comprehensive analysis of energy distribution by means of heatlines are explained using the concept of heat function. Laminar natural convection using entropy generation analysis due to fluid friction and heat transfer is also being studied. The numerical simulation for total entropy generation has been carried out for Prandtl numbers pertaining to ground water for different Ra1 and Ra2.
Analysis-Based Key Components Selection of Latent Heat Thermal Energy Storage System Along With Active Heat Transfer Enhancement
Authors: Agrawal Abhishek , Rakshit Dibakar
Published: August 2022

Energy storage is an effective approach to bridging the gap between energy supply and demand created due to the sporadic nature of solar energy. Thermal performance enhancement is a key research subject for effective energy storage using latent heat thermal energy storage (LHTES) systems. This paper focuses on the analysis-based design of suitable LHTES system components for solar absorption-based cooling applications with a working temperature of up to 200 °C. Initially, the medium-temperature range (80 °C to 200 °C) phase change material (PCM) is selected using the Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS). Further, a suitable heat transfer fluid (HTF) is selected along with the design of a geometrical assessment and an appropriate LHTES system. Finally, the effect of the stirrer on the thermal performance of the LHTES system has been discussed. The melting time of PCM reduces by 58% while input energy increases by 20 kJ with an increase in HTF inlet temperature from 180 °C to 190 °C. However, input energy increases faster with a further increase in HTF inlet temperature while melt time does not reduce significantly. Therefore, selecting optimum HTF inlet temperature is an important criterion for efficient LHTES system design. Implanting a rotating stirrer at 200 RPM inside a PCM tube decreases the net-input energy by 73 kJ. Using back-of-the-envelope calculations, the analysis-based selection of key components of the LHTES system will pave the way forward to designing an application-specific LHTES system. Further, this study can be instrumental in theoretically scrutinizing the stirring effect on PCM charging before experimental analysis.
Self-localization of mobile underwater vector sensor platforms using a source of opportunity
Authors: Sabra Karim G.
Published: August 2022

Using a network of a few compact mobile underwater platforms, each equipped with a single acoustic sensor, as a distributed sensing array is attractive but requires precise positioning of each mobile sensor. However, traditional accurate underwater positioning tools rely on active acoustic sources (e.g., acoustic pingers), which implies additional hardware and operational complexity. Hence, self-localization (i.e., totally passive) methods using only acoustic sources of opportunity (such as surface vessels) for locating the mobile sensors of a distributed array appear as a simpler alternative. Existing underwater self-localization methods have mainly been developed for mobile platforms equipped with time-synchronized hydrophones and rely only on the time-differences of arrival between multiple pairwise combinations of the mobile hydrophones as inputs for a complex non-linear inversion procedure. Instead, this article introduces a self-localization method, which uses a linear least-square formulation, for two mobile time-synchronized vector sensor platforms based on their acoustic recordings of a distant surface vessel and their inertial navigation system (INS) measurements. This method can be generalized to multiple vector sensor pairs to provide additional robustness toward input parameter errors (e.g., due to a faulty INS) as demonstrated experimentally using drifting buoys with inertial vector sensors deployed ∼100 m apart in shallow water.
Interpreting thoughts during sleep
Authors: De Zeeuw Chris I. , Canto Cathrin B.
Published: August 2022

Rapid eye movements during sleep are a readout of thoughts during mouse dreams
In Other Journals
Authors: Hines Pamela J. , Nusinovich Yevgeniya , Lopez Bianca , Hurtley Stella M. , McCartney Melissa , Lavine Marc S. , Szuromi Phil
Published: August 2022

Editors’ selections from the current scientific literature
Global drought experiment reveals the toll on plant growth
Authors: Pennisi Elizabeth
Published: August 2022

Artificial droughts sharply cut carbon storage
The Efficacy of Commercial Surface Sanitizers against Norovirus on Formica Surfaces with and without Inclusion of a Wiping Step
Authors: Faircloth Jeremy , Goulter Rebecca M. , Manuel Clyde S. , Arbogast James W. , Escudero-Abarca Blanca , Jaykus Lee-Ann
Published: August 2022

Human noroviruses (hNoVs) are the leading cause of acute gastroenteritis and food-borne disease worldwide. Noroviruses are difficult to inactivate, being recalcitrant to sanitizers and disinfectants commonly used by the retail food sector.
Lab-Attenuated Rabies Virus Facilitates Opening of the Blood-Brain Barrier by Inducing Matrix Metallopeptidase 8
Authors: Fang An , Yuan Yueming , Huang Fei , Wang Caiqian , Tian Dayong , Zhou Rui , Zhou Ming , Chen Huanchun , Fu Zhen F. , Zhao Ling
Published: August 2022

The ability to change BBB permeability was associated with the pathogenicity of RABV. BBB permeability was enhanced by infection with lab-attenuated RABV instead of wt RABV, allowing immune cells to infiltrate into the CNS.
Intraintestinal Analysis of the Functional Activity of Microbiomes and Its Application to the Common Marmoset Intestine
Authors: Uehara Mika , Inoue Takashi , Kominato Minori , Hase Sumitaka , Sasaki Erika , Toyoda Atsushi , Sakakibara Yasubumi
Published: August 2022

We developed an analysis method that integrates metagenomes and metatranscriptomes from multiple intestinal sites to elucidate how microbial function varies along the intestinal tract. This method enables spatial covariation analysis of the functional activity of microbiomes and accurate identification of gene expression changes among intestinal sites, including changes in the expression of unknown bacterial genes.
Engineered Fluorescent Strains of Cryptococcus neoformans: a Versatile Toolbox for Studies of Host-Pathogen Interactions and Fungal Biology, Including the Viable but Nonculturable State
Authors: de Castro Raffael Júnio Araújo , Rêgo Marco Túlio Aidar Mariano , Brandão Fabiana S. , Pérez Ana Laura Alfonso , De Marco Janice Lisboa , Poças-Fonseca Marcio José , Nichols Connie , Alspaugh J. Andrew , Felipe Maria Sueli S. , Alanio Alexandre , Bocca Anamélia Lorenzetti , Fernandes Larissa
Published: August 2022

Cryptococcus neoformans
is a human-pathogenic yeast that can undergo a dormant state and is responsible for over 180,000 deaths annually worldwide. We engineered a set of fluorescent transformants to aid in research on
C. neoformans
.
Paleoproterozoic geology of SW Montana: Implications for the paleogeography of the Wyoming craton and for the consolidation of Laurentia
Authors: Harms* Tekla A. , Baldwin* Julia A.
Published: August 2022

The Montana metasedimentary terrane (MMT) forms the NW margin of the Wyoming Province in present coordinates. The MMT preserves a multistage Paleoproterozoic tectonic history that clarifies the position of the Wyoming craton during assembly and breakup of the Precambrian Kenorland supercontinent and the subsequent assembly of Laurentia’s Precambrian basement. In SW Montana, burial, metamorphism, deformation, and partial melting attributed to orogeny were superimposed on Archean quartzofeldspathic orthogneisses and paragneisses at ca. 2.55 and ca. 2.45 Ga during the Tendoy and Beaverhead orogenies, respectively. Subsequent stability was disrupted at 2.06 Ga, when probable rift-related mafic dikes and sills intruded the older gneisses. The MMT was profoundly reworked by tectonism again as a consequence of the ca. 1.8–1.7 Ga Big Sky orogeny, during which juvenile metasupracrustal suites characteristic of an arc (the Little Belt arc) and back-arc basin collapsed against the Wyoming craton continental margin. The northern margin of the Wyoming craton occupied an upper-plate position south of a south-dipping subduction zone at that time.

Lithostratigraphic correlations link the southeastern Wyoming and southern Superior cratons at ca. 2.45 Ga with the Wyoming craton joined to the Kenorland supercontinent in an inverted position relative to present coordinates. This places the MMT along an open supercontinental margin, in a position permissive of collision or accretion and orogeny during a time when other parts of Kenorland were experiencing mafic volcanism and incipient rifting. The ca. 2.45 Ga Beaverhead orogeny in the MMT was most likely the consequence of collision with one of the Rae family of cratons, which share a history of tectonism at this time. The Beaverhead collision enveloped the Wyoming craton in a larger continental landmass and led to the 2.45–2.06 Ga period of tectonic quiescence in the MMT. Breakup of Kenorland occurred ca. 2.2–2.0 Ga. In the MMT, this is expressed by the 2.06 Ga mafic dikes and sills that crosscut older gneisses. The Wyoming craton would have been an island continent within the Manikewan Ocean after rifting from Kenorland on one side and from the Rae family craton on the MMT side. Subduction beneath the MMT in the Wyoming craton started no later than 1.87 Ga and was active until 1.79 Ga. This opened a back-arc basin and created the Little Belt arc to the north of the craton, contributed to the demise of the Manikewan Ocean, and culminated in collision along the Big Sky orogen starting ca. 1.78 Ga. Collision across the Trans-Hudson orogen in Canada occurred during a slightly earlier period. Thus, docking of the Wyoming craton reflects the final stage in the closure of the Manikewan Ocean and the amalgamation of the Archean cratons of Laurentia.
Type Specimens of Carrion or Meat Blue Flies (Diptera, Calliphoridae s. l.) in the Collection of the Zoological Institute of the Russian Academy of Sciences in St. Petersburg. I
Authors: Nartshuk E. P. , Paramonov N. M. , Suleymanova T. A.
Published: August 2022

A catalogue of the type specimens (holotypes, paratypes, and syntypes) of the species of the family Calliphoridae (Diptera) described by Th. Becker, B.B. Rohdendorf, H. Schumann, L.N. Khitzova, and K. Rognes and deposited in the collection of the Zoological Institute, Russian Academy of Sciences, St. Petersburg, Russia is presented. Photographs of the specimens and labels of the holotypes and syntypes are given.
Neonatal BCG: a time for change
Authors: Pillay Thillagavathie , Toldi Gergely , Hussain Abid , Magwenzi Mercy Murinye , Satodia Prakash , Radcliffe Ruth
Published: August 2022

The BCG vaccination programme in the UK is risk based and has usually been given to eligible babies soon after birth. On advice from the Joint Committee on Vaccination and Immunisation, NHS England and Improvement recently revised the timing of this vaccination to 28 days after birth or soon thereafter. In this article, we highlight the change in timing of vaccination, the rationale and barriers to BCG uptake that this change may pose.
How to interpret spirometry in a child with suspected asthma
Authors: Brown Anthony , McNaughten Benjamin , Russell Catherine , Watters Patricia , O'Donoghue Dara
Published: August 2022

Asthma is one of the most common chronic disorders of childhood. The typical symptoms are a result of reversible airway obstruction. There is no ‘gold-standard’ test to diagnose asthma, but the most commonly used investigation to help with a diagnosis is spirometry. This article outlines some of the technical aspects of spirometry together with how the forced expiration manoeuver and bronchodilator responsiveness testing can be performed and interpreted in a child with suspected asthma.
Infection mimicking skin condition: pyoderma gangrenosum
Authors: Burlage Ellen , Mulder Janneke W. C. M. , Nellensteijn Jorm M. , Zeegers Adelgunde V. C. M.
Published: August 2022

The a priori risk of infection is high when a patient presents with an ulcerative skin condition and elevated inflammatory parameters. If the ulceration is progressive despite adequate antibiotic therapy and tissue cultures are negative, pyoderma gangrenosum should be considered as the diagnosis. This rare infection mimicking skin condition can develop and worsen due to surgery. In this paper, we report two cases that illustrate the importance of making this clinical diagnosis in a timely manner in order to avoid unnecessary surgical interventions and worsening of the clinical picture.
Cystic lesion in parotid region: an unexpected diagnosis
Authors: Saraniti Carmelo , Patti Gaetano , Rodolico Vito , Verro Barbara
Published: August 2022

Benign tumours of salivary glands represent 2%–3% of all tumours and parotid gland is most often affected. Keratocystoma is a rare benign tumour with multilocular cystic lesions filled with keratin materials. Histologically, it is characterised by solid epithelium islands containing keratinised lamellae with multicystic spaces. We report a case of a woman in her mid-70s with painless mass in her left parotid gland which increased in size over 1 year. Ultrasound scan revealed a 38×20 mm diameter hypoanechoic mass. Neck CT with contrast medium and fine needle aspiration were performed with diagnostic hypothesis of Warthin tumour. So, extracapsular parotid dissection with no facial nerve damage was performed. Histological examination revealed a keratocystoma. The patient had a 16-month follow-up without signs of relapse or malignancy. Despite its rarity, keratocystoma must be considered among the possible differential diagnostic hypotheses when we find parotid masses, to ensure the best treatment to the patient.
Campylobacter jejunipancolitis complicated by toxic megacolon in an immunocompetent host
Authors: Hassan Syed Wajih Ul , Alam Sheena Nadeem , Syed Nazar Ulla , Ismail Muhammad
Published: August 2022

This is an unusual case of a middle-aged, immunocompetent man who developed toxic megacolon (TM) secondary to infection with a normally harmless bug,Campylobacter jejuni. He presented with diarrhoea, fever and abdominal pain. Faecal cultures were positive forC. jejuni. However, the patient did not show significant improvement after a trial of intravenous antibiotics. Bowel segment dilation on a CT scan combined with systemic signs (fever) led to the diagnosis of TM. A subtotal colectomy was planned but an unexpected positive response to conservative therapy deferred the surgery. Our case emphasises the crucial role that bowel rest and good nutritional support play in treating TM of infectious aetiology and how it can help avoid the need for a life-altering subtotal colectomy and ileostomy. For such presentations we also highlight how empirical steroid therapy or diagnostic sigmoidoscopy for suspected underlying ulcerative colitis can be detrimental to patient outcomes.
Case of anti-NMDA receptor encephalitis in a female adolescent with favourable response to second-line treatment with cyclophosphamide
Authors: Barbadillo April Faye Pamillaran , Quimpo Rhea Angela Salonga , Sanchez-Gan Benilda
Published: August 2022

We report the case of a female adolescent who presented with behavioural changes. She was admitted to our institution due to worsening psychiatric and neurological symptoms, subsequently diagnosed with anti-N-methyl-D-aspartate receptor encephalitis. Additional workup was facilitated to rule out a possible underlying teratoma, but all tests turned out unremarkable. First-line treatment with methylprednisolone pulse therapy and intravenous immunoglobulin was started, to which she showed marked improvement from baseline. One month after discharge, a decision for readmission was made because of persistent episodes of hallucinations, agitation and dyskinesias. In this case report, we highlight the use of cyclophosphamide over rituximab as second-line treatment in a resource-limited setting, owing to its greater availability and lesser cost. Cyclophosphamide treatment was given resulting in a more sustained clinical improvement with return to baseline function.
Prevalence of achlorhydria in an Asian population detected using Congo red staining during routine gastroscopy: 22 years’ experience from a single centre
Authors: Phaosawasdi Kamthorn , Sritunyarat Yingluk , Lopimpisuth Chawin , Nalinthassanai Nutbordee , Vorasettakarnkij Yongkasem , Kongkam Pradermchai
Published: August 2022

Objective

We aimed to study the prevalence of achlorhydria (AC) in a large Asian population.

Design

Medical records of patients who underwent oesophagogastroduodenoscopy (OGD) with Congo red staining method at the Vichaiyut Hospital from January 2010 to December 2019 were retrospectively reviewed.

Results

A total of 3597 patients was recruited; 223 were excluded due to concurrent use of proton pump inhibitors. Eighteen from 3374 patients (0.53%) had AC. Seven patients were presented with permanent AC (5F, 2M) (median age=69 years; range 58–92). Among 11 patients with temporary AC (5M, 6F: mean age 73.4 years; SD 13.2 years), all had gastrointestinalHelicobacter pyloribacterial infection and were over 45 years old. After successful treatment forH. pylori, AC was absent among patients with temporary AC. If counting only patients over 45 years of age, the prevalence of AC was 0.68% (18/2614). No adverse events arising from Congo red occurred.

Conclusion

AC is relatively rare. Permanent and temporary AC were found only when they were over 55 and 45 years old, respectively. Staining Congo red on gastric mucosa can be safely and routinely incorporated into the OGD procedure for early detection of AC. We recommended a low-cost screening test such as serum vitamin B levels for screening only in patients aged 50 and over.
The quality of veterinary medicines and their implications for One Health
Authors: Vidhamaly Vayouly , Bellingham Konnie , Newton Paul N , Caillet Céline
Published: August 2022

Objective

Substandard and falsified (SF) veterinary medicines affect animal health, agricultural production and food security and will influence antimicrobial resistance (AMR) in both animals and humans. Yet, our understanding of their extent and impact is poor. We assess the available public domain evidence on the epidemiology of SF veterinary medicines, to better understand their prevalence and distribution and their public health impact on animals and humans.

Methods

Searches were conducted in Embase, PubMed, MEDLINE, Global Health, Web of Science, CAB Abstracts, Scopus, Google Scholar, Google and websites with interest in veterinary medicines quality up to 28 February 2021. Identified articles in English and French were screened for eligibility. The Medicine Quality Assessment Reporting Guidelines were used to assess the quality of prevalence surveys.

Results

Three hundred and fourteen publications were included with a failure frequency (the percentage of samples that failed at least one quality test) of 6.5% (2335/35 733). The majority of samples were from post-marketing surveillance by medicines regulatory authorities of the Republic of Korea and China. A small proportion (3.5%) of samples, all anti-infectives, were from 20 prevalence surveys, with more than half (53.1%, 662/1246) collected in low-income and lower middle-income countries in Africa and Asia. The prevalence survey sample size ranged from 4 to 310 samples (median (Q1–Q3): 50 (27–80)); 55.0% of surveys used convenience outlet sampling methods. In 20 prevalence surveys more than half of the samples (52.0%, 648/1246) failed at least one quality test. The most common defects reported were out-of-specification active pharmaceutical ingredient(s) (API) content, failure of uniformity of units and disintegration tests. Almost half of samples (49.7%, 239/481) that failed API content tests contained at least one of the stated APIs below pharmacopoeial limits. Fifty-two samples (4.2% of all samples) contained one or more incorrect API. One hundred and twenty-three publications described incidents (recalls/seizures/case reports) of SF veterinary medicines in 29 countries.

Conclusion

The data suggest that SF veterinary products are likely to be a serious animal and public health problem that has received limited attention. However, few studies of SF veterinary medicines are available and are geographically restricted. Lower API content and disintegration/dissolution than recommended by pharmacopoeial standards risks treatment failure, animal suffering and contribute to AMR. Our findings highlight the need of more research, with robust methodology, to better inform policy and implement measures to assure the quality of veterinary medicines within supply chains. The mechanism and impact of SF veterinary products on animal and human health, agricultural production, their economy and AMR need more transdisciplinary research.
Cost-effectiveness of a dietary and physical activity intervention in adolescents: a prototype modelling study based on the Engaging Adolescents in Changing Behaviour (EACH-B) programme
Authors: Kalita Neelam , Cooper Keith , Baird Janis , Woods-Townsend Kathryn , Godfrey Keith , Cooper Cyrus , Inskip Hazel , Barker Mary , Lord Joanne
Published: August 2022

Objective

To assess costs, health outcomes and cost-effectiveness of interventions that aim to improve quality of diet and level of physical activity in adolescents.

Design

A Markov model was developed to assess four potential benefits of healthy behaviour for adolescents: better mental health (episodes of depression and generalised anxiety disorder), higher earnings and reduced incidence of type 2 diabetes and adverse pregnancy outcomes (in terms of preterm delivery). The model parameters were informed by published literature. The analysis took a societal perspective over a 20-year period. One-way and probabilistic sensitivity analyses for 10 000 simulations were conducted.

Participants

A hypothetical cohort of 100 adolescents with a mean age of 13 years.

Interventions

An exemplar school-based, multicomponent intervention that was developed by the Engaging Adolescents for Changing Behaviour programme, compared with usual schooling.

Outcome measure

Incremental cost-effectiveness ratio (ICER) as measured by cost per quality-adjusted life-year (QALY) gained.

Results

The exemplar dietary and physical activity intervention was associated with an incremental cost of £123 per adolescent and better health outcomes with a mean QALY gain of 0.0085 compared with usual schooling, resulting in an ICER of £14 367 per QALY. The key model drivers are the intervention effect on levels of physical activity, quality-of-life gain for high levels of physical activity, the duration of the intervention effects and the period over which effects wane.

Conclusions

The results suggested that such an intervention has the potential to offer a cost-effective use of healthcare-resources for adolescents in the UK at a willingness-to-pay threshold of £20 000 per QALY. The model focused on short-term to medium-term benefits of healthy eating and physical activity exploiting the strong evidence base that exists for this age group. Other benefits in later life, such as reduced cardiovascular risk, are more sensitive to assumptions about the persistence of behavioural change and discounting.

Trail registration number

ISRCTN74109264.
Predictors of burnout among US healthcare providers: a systematic review
Authors: Meredith Lisa S , Bouskill Kathryn , Chang Joan , Larkin Jody , Motala Aneesa , Hempel Susanne
Published: August 2022

Objective

One potential barrier to optimal healthcare may be provider burnout or occupational-related stress in the workplace. The objective of this study is to conduct a systematic review to identify the predictors of burnout among US. healthcare providers.

Design

Systematic review using in-depth critical appraisal to assess risk of bias and present the quality of evidence in synthesised results from the prognostic studies.

Data sources

We searched 11 databases, registries, existing reviews and contacted experts through 4 October 2021.

Eligibility criteria for selecting studies

We included all studies evaluating potential predictors and documenting the presence and absence of associations with burnout assessed as a multidimensional construct. We excluded studies that relied solely on a single continuous subscale of burnout. Data were abstracted from eligible studies and checked for accuracy by a content expert and a methodologist.

Data extraction and synthesis

Two reviewers independently screened citations and full-text publications using predetermined eligibility criteria.

Results

The 141 identified studies evaluated a range of burnout predictors. Findings for demographic characteristics were conflicting or show no association. Workplace factors, such as workload, work/life balance, job autonomy and perceived support from leadership, had stronger associations with risk for burnout. Mental health factors, such as anxiety, and physical health risks may increase the risk, although the direction of these associations is unclear as few prospective studies exist to address this question. Factors such as social support appear to have a protective effect.

Conclusion

We found the most evidence for workplace, mental health and psychosocial factors in predicting burnout but limited evidence for other potential predictors. However, more prospective studies are needed to improve our understanding about how to prevent provider burnout.

PROSPERO registration number

CRD4202014836.
Long-term effectiveness of rehabilitation services delivery for Wenchuan earthquake survivors with impairments over a 4-year period: a prospective cohort study
Authors: Reinhardt Jan , Zhang Xia , Chen Shi , Li Jianan , Zhou Mouwang , Khan Fary
Published: August 2022

Objective

To examine long-term effectiveness of rehabilitation services on physical function, pain severity and post-traumatic stress disorder (PTSD) in earthquake survivors over a 4-year period.

Design

Prospective cohort study with early and late intervention and geographical control group.

Setting

Three counties of Sichuan Province, China.

Participants

591 survivors of the 2008 Wenchuan earthquake were followed-up over a 4-year period ranging from 2008 to 2012.

Interventions

In Mianzhu county, a comprehensive hospital-based and community-based rehabilitation programme was implemented in September 2008; in Anxian county, the same programme was implemented 1 year later; in Shifang county, the programme was not implemented and survivors from this county served as a control group.

Outcomes

Physical function was measured using Modified Barthel Index (MBI), pain severity with Visual Analogue Scale and PTSD with the PTSD Checklist-Civilian Version. All outcomes were assessed at three time points (baseline from 2008 to 2009, 2010 and 2012) and analysed with mixed effects regression.

Results

400 patients completed all assessments. In all groups, physical function and pain severity improved over time. MBI improvement per month as compared with control was greater in the late rehabilitation (b=1.69, 95% CI 1.20 to 2.19) than the early rehabilitation group (b=0.96, 95% CI 0.68 to 1.24). This rehabilitation effect was however marginally decreasing over time. Superior improvement as compared with control with regard to pain was only found in the early rehabilitation group (b=−0.05, 95% CI −0.09 to −0.02). PTSD symptoms decreased over time, but the observed differences could not be specifically linked to the rehabilitation intervention.

Conclusion

Physical rehabilitation of earthquake survivors appears to be effective in improving physical function and, if delivered early, pain. Effects on mental health are less clear and need further examination using more consistent and frequent assessments of relevant outcomes and determinants.
Live well, die well – an international cohort study on experiences, concerns and preferences of patients in the last phase of life: the research protocol of the iLIVE study
Authors: Yildiz Berivan , Allan Simon , Bakan Misa , Barnestein-Fonseca Pilar , Berger Michael , Boughey Mark , Christen Andri , De Simone Gustavo G , Egloff Martina , Ellershaw John , Elsten Eline E C M , Eychmüller Steffen , Fischer Claudia , Fürst Carl Johan , Geijteman Eric C T , Goldraij Gabriel , Goossensen Anne , Halfdanardottir Svandis Iris , Haugen Dagny Faksvåg , Hedman Christel , Hoppe Tanja , Hughes Rosemary , Iversen Grethe Skorpen , Joshi Melanie , Kodba-Ceh Hana , Korfage Ida J , Lunder Urska , Lüthi Nora , Martín-Roselló Maria Luisa , Mason Stephen , McGlinchey Tamsin , Montilla Silvi , Rasmussen Birgit H , Ruiz-Torreras Inmaculada , Schelin Maria E C , Sigurdardottir Katrin Ruth , Sigurdardottir Valgerdur , Simon Judit , Smeding Ruthmarijke , Solvåg Kjersti , Strupp Julia , Tripodoro Vilma , van der Kuy Hugo M , van der Rijt Carin C D , van Zuylen Lia , Veloso Verónica I , Vibora-Martin Eva , Voltz Raymond , Zambrano Sofia C , van der Heide Agnes
Published: August 2022

Introduction

Adequately addressing the needs of patients at the end of life and their relatives is pivotal in preventing unnecessary suffering and optimising their quality of life. The purpose of the iLIVE study is to contribute to high-quality personalised care at the end of life in different countries and cultures, by investigating the experiences, concerns, preferences and use of care of terminally ill patients and their families.

Methods and analysis

The iLIVE study is an international cohort study in which patients with an estimated life expectancy of 6 months or less are followed up until they die. In total, 2200 patients will be included in 11 countries, that is, 200 per country. In addition, one relative per patient is invited to participate. All participants will be asked to fill in a questionnaire, at baseline and after 4 weeks. If a patient dies within 6 months of follow-up, the relative will be asked to fill in a post-bereavement questionnaire. Healthcare use in the last week of life will be evaluated as well; healthcare staff who attended the patient will be asked to fill in a brief questionnaire to evaluate the care that was provided. Qualitative interviews will be conducted with patients, relatives and healthcare professionals in all countries to gain more in-depth insights.

Ethics and dissemination

The cohort study has been approved by ethics committees and the institutional review boards (IRBs) of participating institutes in all countries. Results will be disseminated through the project website, publications in scientific journals and at conferences. Within the project, there will be a working group focusing on enhancing the engagement of the community at large with the reality of death and dying.

Trial registration number

NCT04271085.
Exploring the effectiveness of vitamin B12 complex and alpha-lipoic acid as a treatment for diabetes mellitus/neuropathy: a protocol for systematic review and meta-analysis of randomised controlled trials
Authors: Lekhanya Portia Keabetswe , Mokgalaboni Kabelo
Published: August 2022

Introduction

Diabetic neuropathy (DN) is common in patients diagnosed with diabetes mellitus. This often causes peripheral nerve damage. For many years vitamin B12 and alpha-lipoic acid (ALA) have been regarded as components that can be used in reducing markers of inflammation and oxidative stress. In this study, we will explore the effectiveness of vitamin B12 and ALA as a possible treatment for diabetic mellitus/neuropathy, emphasising markers of inflammation, lipid profile, and glucose metabolism.

Methods and analysis

We will conduct a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocol (PRISMA-P). The search strategies and information sources for the literature will be PubMed, Google Scholar, Web of Science and Science direct. The literature search will include studies published from inception until 30 June 2022. All included studies will be evaluated for quality and risk of bias according to the Cochrane guidelines. To investigate the stability of the results, we will conduct a sensitivity analysis of the outcomes. All data analysis will be performed using Review Manager V.5. 4.

Ethical and dissemination

This systematic review and meta-analysis will not require ethical approval from an institution committee as it does not have direct participants. We will obtain all our data from previous studies. The findings will be disseminated through publications in peer-reviewed journals and presented at local and international seminars and conferences.
Quality and performance indicators in Portuguese anatomical pathology laboratories: a panel validation by qualitative Delphi technique
Authors: Paulino Ana , Pedro Ana Rita , Roque Ruben , Dias Sónia
Published: August 2022

Background

In laboratory medicine, quality and performance indicators (QPIs) are essential tools to ensure the quality of healthcare services and patient safety. QPIs allow comparison of outcomes, favouring accountability and transparency. Internationally, there are some QPI evaluation models, but the fact that they are paid limits their dissemination in smaller/poorer laboratories. In Portugal, each laboratory defines its own QPIs, with no uniformity between institutions. The development of a free QPI panel suitable for anatomical pathology laboratories (APLs) would allow for quality assessment and improvement.

Objective

To develop a consensual and validated QPI panel suitable for Portuguese APLs.

Methods

The study was developed in two stages. First, a bibliographic review was carried out, selecting the adequate QPIs. Afterwards, these QPIs were evaluated by experts through the Delphi method, where they could also suggest other pertinent QPIs.

Results

By the end of the Delphi method, there was a consensus on 64 QPIs (31 for ‘structure’, 30 for ‘process’ and 3 for ‘result’). The consensual QPIs covered all phases of the total test cycle. The lack of specific anatomical pathology QPIs in the bibliography was noticeable. There was greater consensus on ‘process’ and ‘result’ QPIs than on ‘structure’. This was supported by the bibliography, where the first ones were more valued. Nevertheless, it is important to monitor all the main laboratory processes, prioritising the evaluation of QPIs with greater impact on healthcare quality and patient safety. These results should allow APLs to identify the causes behind poor performance and improve their services.

Conclusions

This panel is a valuable tool for APLs, contributing to quality awareness. It can be the first step towards the development of a free benchmarking quality programme in Portugal, encouraging competitiveness and cost-efficiency.
Clinical incidents in the emergency department: is there an association with emergency nursing shift patterns? A retrospective observational study
Authors: Roberts Kym , Thom Ogilvie , Hocking Julia , Bernard Anne , Doyle Tammy
Published: August 2022

Introduction

Clinical incident (CI) management within healthcare settings is a crucial component of patient safety and quality improvement. The complex environment in the emergency department (ED) and nursing work schedules are important aspects of human factor ergonomic (HFE) systems that requires closer examination. Nursing shifts are closely related to fatigue, including the late/early shift pattern and night shift. All nursing shifts were examined over a 1-year period when a CI occurred to a patient in the ED to identify if there was an association.

Methods

This was a retrospective observational study, conducted and reported using the Strengthening of the Reporting of Observational Studies in Epidemiology statement. All CIs reported in the ED over a 1-year period were reviewed by accessing the CI database, emergency department information system and patient health records. The nursing roster database was accessed to record nursing shifts and were de-identified.

Results

A total of n=244 CIs were eligible for inclusion into the study. ED nursing shift analysis included n=1095 nursing shifts. An analysis of early, late and night shifts, including days not worked by the ED nurse was conducted over a 48-hour and 96-hour period. There was no significant relationship identified between the CI and nursing shift patterns. ED length of stay (LOS) was significantly higher for a patient presentation when a CI occurred.

Conclusion

This study focused on the HFE system of nursing work schedules and CI events that occurred in the ED. This study found there was no relationship between emergency nursing shift patterns and an increased risk for the occurrence of a CI in the ED. Although a strong link was found between patients experiencing a CI in the ED and an extended LOS. This demonstrates the need for studies to investigate the interrelationships of multiple HFE systems in the ED, including the environment, patient, clinical team and organisational factors.
Development and assessment of an educational intervention to improve the recognition of frailty on an acute care respiratory ward
Authors: Leblanc Aaron , Diab Nermin , Backman Chantal , Huang Shirley , Pulfer Tammy , Chin Melanie , Kobewka Daniel M , McIsaac Daniel I , Lawson Julie , Forster Alan J , Mulpuru Sunita
Published: August 2022

Background

Frailty is a robust predictor of poor outcomes among patients with chronic obstructive pulmonary disease yet is not measured in routine practice. We determined barriers and facilitators to measuring frailty in a hospital setting, designed and implemented a frailty-focused education intervention, and measured accuracy of frailty screening before and after education.

Methods

We conducted a pilot cross-sectional mixed-methods study on an inpatient respiratory ward over 6 months. We recruited registered nurses (RNs) with experience using the Clinical Frailty Scale (CFS). RNs evaluated 10 clinical vignettes and assigned a frailty score using the CFS. A structured frailty-focused education intervention was delivered to small groups. RNs reassigned frailty scores to vignettes 1 week after education. Outcomes included barriers and facilitators to assessing frailty in hospital, and percent agreement of CFS scores between RNs and a gold standard (determined by geriatricians) before and after education.

Results

Among 26 RNs, the median (IQR) duration of experience using the CFS was 1.5 (1–4) months. Barriers to assessing frailty included the lack of clinical directives to measure frailty and large acute workloads. Having collateral history from family members was the strongest perceived facilitator for frailty assessment. The median (IQR) percent agreement with the gold-standard frailty score across all cases was 55.8% (47.2%–60.6%) prior to the educational intervention, and 57.2% (44.1%–70.2%) afterwards. The largest increase in agreement occurred in the ‘mildly frail’ category, 65.4%–81% agreement.

Conclusions

Barriers to assessing frailty in the hospital setting are external to the measurement tool itself. Accuracy of frailty assessment among acute care RNs was low, and frailty-focused rater training may improve accuracy. Subsequent work should focus on health system approaches to empower health providers to assess frailty, and on testing the effectiveness of frailty-focused education in large real-world settings.
The ‘miracle cure’: how do primary care physicians prescribe physical activity with the aim of improving clinical outcomes of chronic disease? A scoping review
Authors: Thornton Jane , Nagpal Taniya , Reilly Kristen , Stewart Moira , Petrella Robert
Published: August 2022

Objectives

To identify how primary care physicians (PCPs) prescribe physical activity for patients with chronic disease, and to determine characteristics of physical activity interventions with improved clinical outcomes of chronic disease.

Design

A scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews 2018 was completed.

Data sources

Four bibliographic databases (Medline, EMBASE, SPORTDiscus, CINAHL) and four grey literature/unpublished databases (Proquest, National Institute for Health and Care Excellence, Canadian Health Research Collections, Clinical Trials) were searched from inception to 7 March 2022.

Eligibility criteria for selecting studies

Studies involving PCP-delivered physical activity prescriptions or counselling for participants with a chronic disease or mental health condition, which reported clinical outcomes were included. Opinion papers, news and magazine articles and case reports were excluded, as were studies in which a physical activity intervention was provided for primary prevention of chronic disease, prescribed by healthcare providers or researchers other than PCPs, or for healthy participants without chronic disease.

Results

An initial search identified 4992 records. Fifteen studies met inclusion criteria. Characteristics of physical activity prescriptions that improved clinical outcomes included: personalised advice; brief intervention; behavioural supports (handouts and/or referrals) and physician follow-up. Reported adverse events were rare. Research gaps include optimal timing and length of follow-up, and the long-term and cost-effectiveness of interventions.

Summary/Conclusion

Several characteristics of physical activity counselling by PCPs for patients with chronic disease may improve clinical outcomes, although research gaps remain. Studies exploring the effectiveness of physical activity prescription for individuals with chronic conditions are urgently needed.