bluuebunny/crossref_metadata_2025 huggingface dataset:
Representación social de la diabetes tipo 2 en mujeres bajo la teoría del núcleo central
Authors: Landa Rivera Ruth Angelica , Castillo Arcos Lubia Del Carmen , Padilla Raygoza Nicolás
Published: March 2019

Introducción: La diabetes como enfermedad crónica es un evento catastrófico que origina comportamientos negativos hacia la adherencia terapéutica, lo que hace necesario usar teorías cognoscitivas y sociales para reorientar los cuidados de enfermería. Objetivo: Dar respuesta a las preguntas orientadoras de la investigación: ¿cuál es la representación social que la mujer tiene sobre la diabetes tipo 2? ¿Qué elementos integran el núcleo central y los sistemas periféricos de la representación social? Método: Revisión integrativa utilizando como guía el método prisma, de artículos cuyos descriptores primarios fueran “representaciones sociales”, “diabetes tipo 2” y “mujeres” y secundarios “pacientes con diabetes tipo 2”. La búsqueda se realizó en bases de datos informatizadas: Web of Science, Medline, PubMed, SciELO, LILACS, Bireme y CUIDEN. Resultados: Los hallazgos señalan que el fenómeno de la diabetes dio origen a una representación social irreversible. Este sistema de informaciones, actitudes y creencias se organizan y estructuran alrededor del padecimiento, alimentación, ejercicio y medicación, lo que dificulta la identidad social y, probablemente, la adherencia terapéutica a la enfermedad. Conclusión: El identificar la estructura de la representación social y elementos que integran el núcleo central les permite a los profesionales de la salud planear intervenciones que favorezcan la identidad social y la adherencia terapéutica de las mujeres en la diabetes tipo 2.
Trabalho em grupo: a percepção do profissional do sistema único saúde
Authors: Carvalho Valéria Cristina Dos Santos , Siqueira Junior Antonio Carlos , Siqueira Fernanda Paula Cerântola
Published: March 2019

Introdução: O trabalho em grupo no Sistema Único de Saúde é usado por profissionais como a promoção estratégica, prevenção e reabilitação da saúde, que fornece edifício reforçada pela prática necessidade coletiva. Objetivo: Identificar a percepção dos profissionais que atuam como serviços do Sistema Único Saúde - SUS sobre a atenção em grupo. Método: estudo qualitativo foi realizado em um pequeno distrito na região sudeste do Brasil, com o objecto de pesquisa profissional para realizar grupo gentilezas e usuários do Sistema Único de Saúde que participaram de algum grupo oferecido pela Unidade Saúde selecionada. Os dados foram coletados por meio de entrevista gravada e orientações abertas para o profissional e o usuário. Para a análise dos dados, utilizou-se a técnica de análise do conteúdo de Bardinnamodalidadmatica. Resultados: Nove profissionais de saúde que compõem uma equipe multiprofissional foram entrevistados. As seguintes categorias temáticas foram identificadas: 1) acompanhamento em grupo: com zelo, habilidades e benefícios necessários. 2) Prática de grupo como uma estratégia educacional e organizacional, e 3) Dificuldades: salva o desfazer e desempacotamento do profissional para desenvolver atividades em grupo. Conclusão: Os profissionais sentem-se despreparados e a necessidade de aperfeiçoar o conhecimento para desenvolver a prática em grupo. O grupo torna-se um recurso valioso para a promoção da saúde para a construção de novos conhecimentos e fortalecer o vínculo entre o profissional eo usuário, que é um recurso valioso para a promoção da saúde, para a construção novos conhecimentos e fortalecer o vínculo entre o profissional e o usuário.
Output Feedback Fractional Integral Sliding Mode Control of Robotic Manipulators
Authors: Muñoz-Vázquez Aldo Jonathan , Martínez-Reyes Fernando
Published: March 2019

The dynamic model of a robotic system is prone to parametric and structural uncertainties, as well as dynamic disturbances, such as dissipative forces, input noise and vibrations, to name a few. In addition, it is conventional to access only a part of the state, such that, when just the joint positions are available, the use of an observer, or a differentiator, is required. Besides, it has been demonstrated that some disturbances are not necessarily differentiable in any integer-order sense, requiring for a physically realizable but robust controller to face them. In order to enforce a stable tracking in the case of nondifferentiable disturbances, and accessing just to the robot configuration, an output feedback controller is proposed, which is continuous and induces the convergence of the system state into a stable integral error manifold, by means of a fractional-order reaching dynamics. Simulation and experimental studies are conducted to show the reliability of the proposed scheme.
A Formulation for Fluid–Structure Interactions in febio Using Mixture Theory
Authors: Shim Jay J. , Maas Steve A. , Weiss Jeffrey A. , Ateshian Gerard A.
Published: March 2019

Many physiological systems involve strong interactions between fluids and solids, posing a significant challenge when modeling biomechanics. The objective of this study was to implement a fluid–structure interaction (FSI) solver in the free, open-source finite element code FEBio, that combined the existing solid mechanics and rigid body dynamics solver with a recently developed computational fluid dynamics (CFD) solver. A novel Galerkin-based finite element FSI formulation was introduced based on mixture theory, where the FSI domain was described as a mixture of fluid and solid constituents that have distinct motions. The mesh was defined on the solid domain, specialized to have zero mass, negligible stiffness, and zero frictional interactions with the fluid, whereas the fluid was modeled as isothermal and compressible. The mixture framework provided the foundation for evaluating material time derivatives in a material frame for the solid and in a spatial frame for the fluid. Similar to our recently reported CFD solver, our FSI formulation did not require stabilization methods to achieve good convergence, producing a compact set of equations and code implementation. The code was successfully verified against benchmark problems from the FSI literature and an analytical solution for squeeze-film lubrication. It was validated against experimental measurements of the flow rate in a peristaltic pump and illustrated using non-Newtonian blood flow through a bifurcated carotid artery with a thick arterial wall. The successful formulation and implementation of this FSI solver enhance the multiphysics modeling capabilities in febio relevant to the biomechanics and biophysics communities.
Computational Design and Optimization of Nerve Guidance Conduits for Improved Mechanical Properties and Permeability
Authors: Zhang Shuo , Vijayavenkataraman Sanjairaj , Chong Geng Liang , Fuh Jerry Ying Hsi , Lu Wen Feng
Published: March 2019

Nerve guidance conduits (NGCs) are tubular tissue engineering scaffolds used for nerve regeneration. The poor mechanical properties and porosity have always compromised their performances for guiding and supporting axonal growth. Therefore, in order to improve the properties of NGCs, the computational design approach was adopted to investigate the effects of different NGC structural features on their various properties, and finally, design an ideal NGC with mechanical properties matching human nerves and high porosity and permeability. Three common NGC designs, namely hollow luminal, multichannel, and microgrooved, were chosen in this study. Simulations were conducted to study the mechanical properties and permeability. The results show that pore size is the most influential structural feature for NGC tensile modulus. Multichannel NGCs have higher mechanical strength but lower permeability compared to other designs. Square pores lead to higher permeability but lower mechanical strength than circular pores. The study finally selected an optimized hollow luminal NGC with a porosity of 71% and a tensile modulus of 8 MPa to achieve multiple design requirements. The use of computational design and optimization was shown to be promising in future NGC design and nerve tissue engineering research.
Relative Motion Between the Helmet and the Head in Football Impact Test
Authors: Joodaki Hamed , Bailey Ann , Lessley David , Funk James , Sherwood Chris , Crandall Jeff
Published: March 2019

Approximately 1.6–3.8 million sports-related traumatic brain injuries occur each year in the U.S. Researchers track the head motion using a variety of techniques to study the head injury biomechanics. To understand how helmets provide head protection, quantification of the relative motion between the head and the helmet is necessary. The purpose of this study was to compare helmet and head kinematics and quantify the relative motion of helmet with respect to head during experimental representations of on-field American football impact scenarios. Seven helmet-to-helmet impact configurations were simulated by propelling helmeted crash test dummies into each other. Head and helmet kinematics were measured with instrumentation and an optical motion capture system. The analysis of results, from 10 ms prior to the helmet contact to 20 ms after the loss of helmet contact, showed that the helmets translated 12–41 mm and rotated up to 37 deg with respect to the head. The peak resultant linear acceleration of the helmet was about 2–5 times higher than the head. The peak resultant angular velocity of the helmet ranged from 37% less to 71% more than the head, depending on the impact conditions. The results of this study demonstrate that the kinematics of the head and the helmet are noticeably different and that the helmet rotates significantly with respect to the head during impacts. Therefore, capturing the helmet kinematics using a video motion tracking methodology is not sufficient to study the biomechanics of the head. Head motion must be measured independently of the helmet.
An Adaptive Output Feedback Proportional-Integral-Derivative Controller for n-Link Type (m,s) Electrically Driven Mobile Manipulators
Authors: Shojaei Khoshnam
Published: March 2019

The design of a trajectory tracking controller for a general class of n-link type (m,s) electrically driven wheeled mobile manipulators has been addressed in this paper. In order to achieve a high level of the tracking performance, an adaptive robust proportional-integral-derivative (PID) controller is proposed which only requires position measurements by designing a velocity observer. Integral actions are incorporated into the design of both controller and observer to reduce the steady-state error as much as possible. The dynamic surface control approach is also applied to reduce the design complexity at the actuator level. Lyapunov's direct method is used to guarantee that tracking and observation errors are semiglobally uniformly ultimately bounded. Simulation results are presented to illustrate the effectiveness of the proposed controller for a group of mobile manipulators.
Multi-Objective Shape Optimization on the Inlet Pipe of a Vertical Inline Pump
Authors: Pei Ji , Gan Xingcheng , Wang Wenjie , Yuan Shouqi , Tang Yajing
Published: March 2019

Vertical inline pump is a single-stage single-suction centrifugal pump with a bent pipe before the impeller, which is usually used where installation space is a constraint. In this paper, with three objective functions of efficiencies at 0.5 Qd, 1.0 Qd, and 1.5 Qd, a multi-objective optimization on the inlet pipe of a vertical inline pump was proposed based on genetic algorithm with artificial neural network (ANN). In order to describe the shape of inlet pipe, the fifth-order and third-order Bezier curves were adopted to fit the mid curve and the trend of parameters of cross sections, respectively. Considering the real installation and computation complexity, 11 variables were finally used in this optimization. Latin hypercube sampling (LHS) was adopted to generate 149 sample cases, which were solved by CFD code ANSYS cfx 18.0. The calculation results and design variables were utilized to train ANNs, and these surrogate models were solved for the optimum design using multi-objective genetic algorithm (MOGA). The results showed the following: (1) There was a great agreement between numerical results and experimental results; (2) The ANNs could accurately fit the objective functions and variables. The maximum deviations of efficiencies at 0.5 Qd, 1.0 Qd, and 1.5 Qd, between predicted values and computational values, were 1.94%, 2.35%, and 0.40%; (3) The shape of inlet pipe has great influence on the efficiency at part-load and design conditions while the influence is slight at overload condition; (4) Three optimized cases were selected and the maximum increase of the efficiency at 0.5 Qd, 1.0 Qd, and 1.5 Qd was 4.96%, 2.45, and 0.79%, respectively; and (5) The velocity distributions of outflow in the inlet pipe of the three optimized cases were more uniform than the original one.
An Olfactory Display to Study the Integration of Vision and Olfaction in a Virtual Reality Environment
Authors: Micaroni Lorenzo , Carulli Marina , Ferrise Francesco , Gallace Alberto , Bordegoni Monica
Published: March 2019

The paper describes the design of an innovative virtual reality (VR) system, based on a combination of an olfactory display and a visual display, to be used for investigating the directionality of the sense of olfaction. In particular, the design of an experimental setup to understand and determine to what extent the sense of olfaction is directional and whether there is prevalence of the sense of vision over the one of smell when determining the direction of an odor, is described. The experimental setup is based on low-cost VR technologies. In particular, the system is based on a custom directional olfactory display (OD), a head mounted display (HMD) to deliver both visual and olfactory cues, and an input device to register subjects' answers. The paper reports the design of the olfactory interface as well as its integration with the overall system.
Contribution of Pretomanid to Novel Regimens Containing Bedaquiline with either Linezolid or Moxifloxacin and Pyrazinamide in Murine Models of Tuberculosis
Authors: Xu Jian , Li Si-Yang , Almeida Deepak V. , Tasneen Rokeya , Barnes-Boyle Kala , Converse Paul J. , Upton Anna M. , Mdluli Khisimuzi , Fotouhi Nader , Nuermberger Eric L.
Published: March 2019

Novel regimens combining bedaquiline and pretomanid with either linezolid (BPaL regimen) or moxifloxacin and pyrazinamide (BPaMZ regimen) shorten the treatment duration needed to cure tuberculosis (TB) in BALB/c mice compared to that of the first-line regimen and have yielded promising results in initial clinical trials. However, the independent contribution of the investigational new drug pretomanid to the efficacy of BPaMZ has not been examined, and its contribution to BPaL has been examined only over the first 2 months of treatment.
Assessment of the Potential for Inducing Resistance in Multidrug-Resistant Organisms from Exposure to Minocycline, Rifampin, and Chlorhexidine Used To Treat Intravascular Devices
Authors: Rosenblatt Joel , Vargas-Cruz Nylev , Reitzel Ruth A. , Raad Issam I.
Published: March 2019

To assess the potential for the induction of antimicrobial resistance following repeated subinhibitory exposures to the combination minocycline (MIN), rifampin (RIF), and chlorhexidine (CHX), a total of 29 clinical microbial pathogenic isolates were repeatedly exposed to subinhibitory concentrations of MIN, RIF, and CHX for 20 passages. MICs of the MIN, RIF, and CHX combination were assessed at each passage to evaluate the potential for resistance to have been induced.
Characterization of Early Stages of Human Alveolar Infection by the Q Fever Agent
Coxiella burnetii
Authors: Dragan Amanda L. , Kurten Richard C. , Voth Daniel E.
Published: March 2019

Human Q fever is caused by the intracellular bacterial pathogen
Coxiella burnetii
. Q fever presents with acute flu-like and pulmonary symptoms or can progress to chronic, severe endocarditis.
Metabolites Involved in Immune Evasion by
Batrachochytrium dendrobatidis
Include the Polyamine Spermidine
Authors: Rollins-Smith Louise A. , Ruzzini Antonio C. , Fites J. Scott , Reinert Laura K. , Hall Emily M. , Joosse Bryan A. , Ravikumar Vishvaas I. , Huebner Megan I. , Aka Audrey , Kehs Miles H. , Gillard Bria M. , Doe Emily , Tasca Julia A. , Umile Thomas P. , Clardy Jon , Minbiole Kevin P. C.
Published: March 2019

Amphibians have been declining around the world for more than four decades. One recognized driver of these declines is the chytrid fungus
Batrachochytrium dendrobatidis
, which causes the disease chytridiomycosis.
A Putative Type V Pilus Contributes to Bacteroides thetaiotaomicron Biofilm Formation Capacity
Authors: Mihajlovic Jovana , Bechon Nathalie , Ivanova Christa , Chain Florian , Almeida Alexandre , Langella Philippe , Beloin Christophe , Ghigo Jean-Marc
Published: March 2019

Although the gut anaerobeBacteroides thetaiotaomicronis a prominent member of the healthy human gut microbiota, little is known about its capacity to adhere to surfaces and form biofilms. Here, we identify that alteration of a surface-exposed protein corresponding to a type of pili found in manyBacteroidetesincreasesB. thetaiotaomicronbiofilm formation. This study lays the ground for establishing this bacterium as a model organism forin vitroandin vivostudies of biofilm-related phenotypes in gut anaerobes.
Native and Invading Yellow Starthistle (Centaurea solstitialis) Microbiomes Differ in Composition and Diversity of Bacteria
Authors: Lu-Irving Patricia , Harenčár Julia G. , Sounart Hailey , Welles Shana R. , Swope Sarah M. , Baltrus David A. , Dlugosch Katrina M.
Published: March 2019

Previous studies have found that introduced plants commonly experience more favorable microbial interactions in their non-native range, suggesting that changes to the microbiome could be an important contributor to invasion success. Little is known about microbiome variation across native and invading populations, however, and the potential sources of more favorable interactions are undescribed. Here, we report one of the first microbiome comparisons of plants from multiple native and invading populations, in the noxious weed yellow starthistle. We identify clear differences in composition and diversity of microbiome bacteria. Our findings raise new questions about the sources of these differences, and we outline the next generation of research that will be required to connect microbiome variation to its potential role in plant invasions.
Loss of the Two-Component System TctD-TctE in
Pseudomonas aeruginosa
Affects Biofilm Formation and Aminoglycoside Susceptibility in Response to Citric Acid
Authors: Taylor Patrick K. , Zhang Li , Mah Thien-Fah
Published: March 2019

Nutrient availability is an important contributor to the ability of bacteria to establish successful infections in a host.
Pseudomonas aeruginosa
is an opportunistic pathogen in humans causing infections that are difficult to treat. In part, its success is attributable to a high degree of metabolic versatility.
P. aeruginosa
is able to sense and respond to varied and limited nutrient stress in the host environment. Two-component systems are important sensors-regulators of cellular responses to environmental stresses, such as those encountered in the host. This work demonstrates that the response by the two-component system TctD-TctE to the presence of citric acid has a role in biofilm formation, aminoglycoside susceptibility, and growth in
P. aeruginosa
.
Temporal glioblastoma presenting as catatonia
Authors: Franssen Anouchka , Sienaert Pascal
Published: March 2019

The objective of this article is to describe the possible association of catatonia and temporal brain lesions. This is a case presentation of a 57-year-old man presenting with depression, with catatonia secondary to a temporal glioblastoma. He was referred to hospital because for a sudden deterioration in depressed state. He was diagnosed with catatonia and treated successfully with lorazepam. During his admission, he became increasingly disinhibited, and an MRI scan revealed an intracranial mass in the right temporal lobe, with uncal herniation and a mass effect. Surgical resection of the entire tumour was successful. Histological examination revealed a glioblastoma multiforme requiring additional chemoradiotherapy. Postoperatively, catatonic signs and symptoms were not detectable. A postsurgical frontal syndrome with disinhibition and logorrhoea was present and gradually normalised over the course of several weeks. Catatonia can be the presenting symptom of a temporal brain tumour, and should therefore prompt the physician to a thorough medical investigation.
Immunotherapy causing pneumonitis in a patient with non-small cell lung cancer (NSCLC)
Authors: Li Rui , Lee Gina , El-Sherief Ahmed
Published: March 2019

Our patient, who had been previously diagnosed with non-small cell lung cancer, presented with progressive dyspnoea after receiving second-line immunotherapy treatment with atezolizumab. Chest CT scan showed bilateral lung architectural distortion, bronchial dilatation, consolidative opacities, ground-glass opacities and linear opacities concerning for either infectious lung disease or treatment-related lung disease. A diagnostic bronchoscopy was performed and no evidence of malignancy or infection was detected. Discontinuing atezolizumab with the addition of oral corticosteroid improved the patient’s respiratory symptoms but the patient required continuous oxygen supplementation. Later, the patient was found to have radiologic findings suggestive of further progression of his pneumonitis after completion of a course of corticosteroid treatment and required another course of oral prednisone. Immune-mediated pneumonitis could present with mild to severe respiratory symptoms with a wide range of clinical and radiologic features and physicians should be aware of this diagnosis of exclusion. Although patients may experience progressive disease with or without immunotherapy rechallenge, most of these cases can be managed successfully with favourable outcomes.
Cytomegalovirus infection with pulmonary embolism, splenic vein thrombosis and monoclonal gammopathy of undetermined significance: a case and systematic review
Authors: de Rooij Esther , Verheul Rolf , de Vreede Mariëlle , de Jong Ype
Published: March 2019

A 62-year-old immunocompetent woman was admitted with cytomegalovirus (CMV) infection, pulmonary embolism, splenic vein thrombosis and monoclonal gammopathy of undetermined significance (MGUS). Anticoagulation therapy was started. Two months later, seroconversion of CMV IgM to IgG was observed, while the monoclonal protein was no longer detectable. This suggests a relationship between acute CMV infection, transient MGUS and thrombosis. In accordance with current best practice guidelines for provoked venous thromboembolism (VTE), anticoagulation therapy could be discontinued after 3 months instead of 6 for unprovoked VTE, thereby reducing unnecessary time at risk of bleeding complications. While the relationships between CMV and both MGUS and thrombosis have been described independently, we are first to describe these three conditions occurring simultaneously.Furthermore, we provide a systematic review on the relation between CMV, MGUS and thrombosis.
Gastric granular cell tumour, a rare entity
Authors: Santos Cláudia , Araújo Ana Virgínia , Contente Helena , Branco Cláudia
Published: March 2019

Granular cell tumours are rare neoplasms that may occur anywhere in the body. The most common locations are the oral cavity, skin and subcutaneous tissue, with only 8% of these tumours occurring at a gastrointestinal site. In the specific case of gastric granular cell tumours, only a few cases have been published until today. Granular cell tumours are usually benign; however, some malignant forms have been reported. Both endoscopic and surgical resection represent the treatment of choice. The authors report a new clinical case of a gastric granular cell tumour, treated with laparoscopic surgical resection, describing some endoscopic, imagiological and anatomopathological features.
Life-saving emergency clamshell thoracotomy with damage-control laparotomy
Authors: Farooqui Asif Masroor , Cunningham Clare , Morse Nick , Nzewi Onyekwelu
Published: March 2019

Clamshell thoracotomy for thoracic injuries is an uncommon emergency department procedure. The survival rates following emergency thoracotomy are very low at 9%–12% for penetrating trauma and 1%–2% for blunt trauma. We report an unusual case of survival after emergency department clamshell thoracotomy for penetrating thoracic trauma with cardiac tamponade in a 23-year-old man with multiple stab wounds on the chest and abdomen. The patient was awake and alert on arrival in the emergency department. Bilateral chest decompression by needle thoracostomy released air and blood. During subsequent chest drain insertion, the patient suddenly deteriorated and arrested. Clamshell thoracotomy was performed, and sinus rhythm restored before transfer to theatre. Following repair of the thoracic injuries, a midline laparotomy was performed as bleeding was suspected from the abdomen and a splenic injury repaired. The patient survived and has made a full recovery. This case demonstrates how clamshell thoracotomy can be a life-saving procedure.
Large air-filled intrapulmonary bronchogenic cyst associated with tension pneumothorax during air travel
Authors: Bayfield Nicholas , Stamp Nikki , Laycock Andrew , Merry Chris
Published: March 2019

A 38-year-old woman developed a spontaneous right-sided tension pneumothorax during light aircraft travel. The aircraft was diverted to a regional centre, where emergent needle thoracostomy and chest tube insertion were performed. History suggested that this was the second episode of pneumothorax, with an untreated event with similar symptomatology during air travel 1 year ago. She was taken for surgical intervention. Intraoperative findings were of a large right middle lobe cyst of uncertain origin; the procedure was subsequently aborted. A CT chest demonstrated a large multiseptated air-filled pulmonary cystic lesion. Inpatient stay was notable for persistent right pneumothorax with interval cyst rupture. A right middle lobectomy was subsequently performed with histopathology showing a benign epithelioid bronchogenic cyst. Recovery was unremarkable with no residual pneumothorax or further episodes at 2 months postoperatively. Preventative excision of air-filled pulmonary abnormalities should be considered prior to air travel.
Evaluation of the effects of a generic substitution policy implemented in Chile
Authors: Mansilla Cristián , Cárdenas Jorge , Kaplan Warren A. , Wirtz Veronika J. , Kuhn-Barrientos Lucy , Ortíz de Zárate Matías , Tobar Tatiana , Herrera Cristian A.
Published: March 2019

Introduction

Chile implemented a generic substitution policy in 2014 to improve access to medicines. This study aims to measure if the generic substitution policy had an effect on the sales volume and prices of referent and the branded generic products with demonstrated bioequivalence (BEQ) in the private pharmaceutical market.

Methods

The volume and total private sales of medicines sold at private sector retail outlets between November 2011 and October 2016 were considered in the analysis. We calculated the total number of daily defined doses (DDD) by adding up the number of DDDs of different presentations with the active pharmaceutical ingredient (API). We determined the ratio of the median prices of all BEQ per DDD presentations compared with the median price of the corresponding referent presentations per DDD in 2011 and 2016. Sixteen APIs representing 231 different conventional-release presentations were included in the analysis.

Results

Overall, the volume of sales of the referent products decreased over time after the intervention. However, this reduction was not mirrored by an increase in the corresponding branded generic BEQ volumes overall. In all cases, the median price per DDD of the referent was higher than its BEQ counterpart in 2011 and 2016.

Conclusion

Since referent products are more costly than branded BEQ generic products, reducing their consumption—and increasing the BEQ availability—should improve access to medicines in Chile. However, this must be accompanied by promotion of BEQ products to ensure savings for consumers in the long term. Future research should focus on identifying facilitating and inhibiting factors of generic substitution.
Investing in health R&D: where we are, what limits us, and how to make progress in Africa
Authors: Simpkin Victoria , Namubiru-Mwaura Evelyn , Clarke Lorcan , Mossialos Elias
Published: March 2019

Global research and development (R&D) pipelines for diseases that disproportionately affect African countries appear to be inadequate, with governments struggling to prioritise investment in R&D. This article provides insights into the sources of investment in health science research, available research capacity and level of research output in Africa. The African region comprises 15% of the world’s population, yet only accounted for 1.1% of global investments in R&D in 2016. There were substantial disparities within the continent, with Egypt, Nigeria and South Africa contributing 65.7% of the total R&D spending. In most countries of the Organisation for Economic Co-operation and Development, the largest source of R&D funding is the private sector. R&D in Africa is mainly funded by the public sector, with significant proportions of financing in many countries coming from international funding. Challenges that limit private sector investment include unstable political environments, poor governance and corruption. Evidence suggests various research output and research capacity limitations in Africa when considering a global context. Metrics that reflect this include university rankings, number of researchers, number of publications, clinical trials networks and pharmaceutical manufacturing capacity. Within the continent there are substantial regional disparities. Incentivising investment is crucial to foster current and future research output and research capacity. This paper outlines some of the many commendable initiatives under way. Innovative and collaborative financing mechanisms can stimulate further investment. Given the vast inequalities across Africa in R&D, strategies need to reflect the different capacities of countries to address this disparity.
Association between gaps in antihypertensive medication adherence and injurious falls in older community-dwelling adults: a prospective cohort study
Authors: Dillon Paul , Smith Susan M , Gallagher Paul John , Cousins Gráinne
Published: March 2019

Objective

Growing evidence suggests that older adults are at an increased risk of injurious falls when initiating antihypertensive medication, while the evidence regarding long-term use of antihypertensive medication and the risk of falling is mixed. However, long-term users who stop and start these medications may have a similar risk of falling to initial users of antihypertensive medication. Our aim was to evaluate the association between gaps in antihypertensive medication adherence and injurious falls in older (≥65 years) community-dwelling, long-term (≥≥1 year) antihypertensive users.

Design

Prospective cohort study.

Setting

Irish Community Pharmacy.

Participants

Consecutive participants presenting a prescription for antihypertensive medication to 106 community pharmacies nationwide, community-dwelling, ≥65 years, with no evidence of cognitive impairment, taking antihypertensive medication for ≥1 year (n=938).

Measures

Gaps in antihypertensive medication adherence were evaluated from linked dispensing records as the number of 5-day gaps between sequential supplies over the 12-month period prior to baseline. Injurious falls during follow-up were recorded via questionnaire during structured telephone interviews at 12 months.

Results

At 12 months, 8.1% (n=76) of participants reported an injurious fall requiring medical attention. The mean number of 5-day gaps in medication refill behaviour was 1.47(SD 1.58). In adjusted, modified Poisson models, 5-day medication refill gaps at baseline were associated with a higher risk of an injurious fall during follow-up (aRR 1.18, 95% CI 1.02 to 1.37,p=0.024).

Conclusion

Each 5-day gap in antihypertensive refill adherence increased the risk of self-reported injurious falls by 18%. Gaps in antihypertensive adherence may be a marker for increased risk of injurious falls. It is unknown whether adherence-interventions will reduce subsequent risk. This finding is hypothesis generating and should be replicated in similar populations.
Gonorrhoea and chlamydia diagnosis as an entry point for HIV pre-exposure prophylaxis: a modelling study
Authors: Kasaie Parastu , Schumacher Christina M , Jennings Jacky M , Berry Stephen A , Tuddenham Susan A , Shah Maunank S , Rosenberg Eli S , Hoover Karen W , Gift Thomas L , Chesson Harrell , German Danielle , Dowdy David W
Published: March 2019

Objectives

Neisseria gonorrhoeae(NG) andChlamydia trachomatis(CT) increase the risk of HIV transmission among men who have sex with men (MSM). Diagnosis of NG/CT may provide an efficient entry point for prevention of HIV through the delivery of pre-exposure prophylaxis (PrEP); however, the additional population-level impact of targeting PrEP to MSM diagnosed with NG/CT is unknown.

Design

An agent-based simulation model of NG/CT and HIV cocirculation among MSM calibrated against census data, disease surveillance reports and the US National HIV Behavioral Surveillance study.

Setting

Baltimore City, Maryland, USA.

Interventions

PrEP implementation was modelled under three alternative scenarios: (1) PrEP delivery at NG/CT diagnosis (targeted delivery), (2) PrEP evaluation at NG/CT screening/testing and (3) PrEP evaluation in the general community (untargeted).

Main outcome

The projected incidence of HIV after 20 years of PrEP delivery under two alternatives: when equal numbers of MSM are (1) screened for PrEP or (2) receive PrEP in each year.

Results

Assuming 60% uptake and 60% adherence, targeting PrEP to MSM diagnosed with NG/CT could reduce HIV incidence among MSM in Baltimore City by 12.4% (95% uncertainty range (UR) 10.3% to 14.4%) in 20 years, relative to no PrEP. Expanding the coverage of NG/CT screening (such that individuals experience a 50% annual probability of NG/CT screening and evaluation for PrEP on NG/CT diagnosis) can further increase the impact of targeted PrEP to generate a 22.0% (95% UR 20.1% to 23.9%) reduction in HIV incidence within 20 years. When compared with alternative implementation scenarios, PrEP evaluation at NG/CT diagnosis increased impact of PrEP on HIV incidence by 1.5(95% UR 1.1 to 1.9) times relative to a scenario in which PrEP evaluation happened at the time of NG/CT screening/testing and by 1.6 (95% UR 1.2 to 2.2) times relative to evaluating random MSM from the community.

Conclusions

Targeting MSM infected with NG/CT increases the efficiency and effectiveness of PrEP delivery. If high levels of sexually transmitted infection screening can be achieved at the community level, NG/CT diagnosis may be a highly effective entry point for PrEP initialisation.
Multilevel model of stigma and barriers to cancer palliative care in India: a qualitative study
Authors: Harding Richard , Nair Shoba , Ekstrand Maria
Published: March 2019

Introduction

Palliative care coverage and opioid consumption in India are relatively low compared with global data. The literature suggests commonplace concealment and collusion in withholding information, but these hypotheses lack evidence.

Objectives

This study aimed to develop an explanatory evidence-based model of stigma, communication and access to cancer palliative care in India that can be used to develop, test and implement future interventions.

Design

This cross-sectional qualitative study sampled advanced cancer patients (n=10), their family caregivers (n=10) and oncologists (n=10). Grounded theory procedures were utilised to analyse transcripts, and a theoretical model generated.

Setting

A tertiary teaching hospital in South India.

Results

The model explains how stigma associated with communicating a diagnosis of advanced cancer is enacted by treating oncologists, family members and community. This leads to patient expectations of cure and futile treatment uptake. Patients commonly only present needs with respect to pain, not within psychological, social or spiritual domains, likely due to the lack of patients’ insight into their diagnosis and prognosis. As a result of oncologists’ and families’ unwillingness to disclose the prognosis, and patient focus on pain due to their lack of insight, palliative care clinicians view their services as under-utilised, and patients perceive palliative care as a pain management service that is not ‘different’ from other clinical services. Advanced care needs and purchase of futile treatments lead to lost employment among families, increased family debt and high care costs, which are rarely disclosed due to their unwillingness to discuss their needs.

Conclusion

Our novel theoretical model is an essential first step to ensure that complex interventions are plausible, with mechanisms of action that address the needs of relevant stakeholders. A family-centred approach with an oncology workforce skilled in communication and an enabled patient population could increase access to palliative care, and improved outcomes may be attainable.
Can the appropriateness of eye care be measured through cross-sectional retrospective patient record review in eye care practices in Australia? The iCareTrack feasibility study
Authors: Ho Kam Chun , Rahardjo Dian , Stapleton Fiona , Wiles Louise , Hibbert Peter D , White Andrew J R , Hayen Andrew , Jalbert Isabelle
Published: March 2019

Objectives

The CareTrack study found that a wide range of appropriateness of care (ie, care in line with evidence-based or consensus-based guidelines) was delivered across many health conditions in Australia. This study therefore aimed to demonstrate the feasibility of using the CareTrack method (a retrospective onsite record review) to measure the appropriateness of eye care delivery.

Design

Cross-sectional feasibility study.

Setting and participants

Two hundred and thirteen patient records randomly selected from eight optometry and ophthalmology practices in Australia, selected through a combination of convenience and maximum variation sampling.

Methods

Retrospective record review designed to assess the alignment between eye care delivered and 93 clinical indicators (Delphi method involving 11 experts) extracted from evidence-based clinical practice guidelines.

Primary outcome measure

Number of eligible patient records, sampling rates and data collection time. This feasibility study also tested the ability of 93 clinical indicators to measure percentage appropriate eye care for preventative, glaucoma and diabetic eye care. A secondary outcome was the percentage of practitioner–patient encounters at which appropriate eye care was received.

Results

A median of 20 records (range 9 to 63) per practice were reviewed. Data collection time ranged from 3 to 5.5 hours (median 3.5). The most effective sampling strategy involved random letter generation followed by sequential sampling. The appropriateness of care was 69% (95% CI 67% to 70%) for preventative eye care, 60% (95% CI 56% to 58%) for glaucoma and 63% (95% CI 57% to 69%) for diabetic eye care.

Conclusions

Appropriateness of eye care can be measured effectively using retrospective record review of eye care practices and consensus-based care indicators.
Delays between the onset of symptoms and first rheumatology consultation in patients with rheumatoid arthritis in the UK: an observational study
Authors: Stack Rebecca Jayne , Nightingale Peter , Jinks Clare , Shaw Karen , Herron-Marx Sandy , Horne Rob , Deighton Chris , Kiely Patrick , Mallen Christian , Raza Karim
Published: March 2019

Objective

To investigate delays from symptom onset to rheumatology assessment for patients with a new onset of rheumatoid arthritis (RA) or unclassified arthritis.

Methods

Newly presenting adults with either RA or unclassified arthritis were recruited from rheumatology clinics. Data on the length of time between symptom onset and first seeing a GP (patient delay), between first seeing a general practitioner (GP) and being referred to a rheumatologist (general practitioner delay) and being seen by a rheumatologist following referral (hospital delay) were captured.

Results

822 patients participated (563 female, mean age 55 years). The median time between symptom onset and seeing a rheumatologist was 27.2 weeks (IQR 14.1–66 weeks); only 20% of patients were seen within the first 3 months following symptom onset. The median patient delay was 5.4 weeks (IQR 1.4–26.3 weeks). Patients who purchased over-the-counter medications or used ice/heat packs took longer to seek help than those who did not. In addition, those with a palindromic or an insidious symptom onset delayed for longer than those with a non-palindromic or acute onset. The median general practitioner delay was 6.9 weeks (IQR 2.3–20.3 weeks). Patients made a mean of 4 GP visits before being referred. The median hospital delay was 4.7 weeks (IQR 2.9–7.5 weeks).

Conclusion

This study identified delays at all levels in the pathway towards assessment by a rheumatologist. However, delays in primary care were particularly long. Patient delay was driven by the nature of symptom onset. Complex multi-faceted interventions to promote rapid help seeking and to facilitate prompt onward referral from primary care should be developed.
Use of metabolomics for predicting spontaneous preterm birth in asymptomatic pregnant women: protocol for a systematic review and meta-analysis
Authors: Souza Renato T , Galvão Rafael Bessa , Leite Debora Farias Batista , Passini Jr Renato , Baker Philip , Cecatti Jose Guilherme
Published: March 2019

Introduction

Preterm birth (PTB) is the leading cause of neonatal mortality and short- and long-term morbidity. The aetiology and pathophysiology of spontaneous PTB (sPTB) are still unclear, which makes the identification of reliable and accurate predictor markers more difficult, particularly for unscreened or asymptomatic women. Metabolomics biomarkers have been demonstrated to be potentially accurate biomarkers for many disorders with complex mechanisms such as PTB. Therefore, we aim to perform a systematic review of metabolomics markers associated with sPTB. Our research question is ‘What is the performance of metabolomics for predicting spontaneous preterm birth in asymptomatic pregnant women?’

Methods and analysis

We will focus on studies assessing metabolomics techniques for predicting sPTB in asymptomatic pregnant women. We will conduct a comprehensive systematic review of the literature from the last 10 years. Only observational cohort and case-control studies will be included. Our search strategy will be carried out by two independent reviewers, who will scan title and abstract before carrying out a full review of the article. The scientific databases to be explored include PubMed, MedLine, ScieLo, EMBASE, LILACS, Web of Science, Scopus and others.

Ethics and dissemination

This systematic review protocol does not require ethical approval. We intend to disseminate our findings in scientific peer-reviewed journal, the Preterm SAMBA study open access website, specialists’ conferences and to our funding agencies.

PROSPERO registration number

CRD42018100172.
Association between anxiety, depression and quality of life: study protocol for a systematic review of evidence from longitudinal studies
Authors: Hohls Johanna Katharina , König Hans-Helmut , Quirke Eleanor , Hajek André
Published: March 2019

Introduction

Evidence from individual longitudinal studies suggests that anxiety and depression may impact quality of life. However, systematic reviews synthesising current evidence have mainly focused on specific samples. Thus, the aim of this study is to synthesise evidence from longitudinal studies on the association between anxiety, depression and quality of life in a systematic review.

Methods and analysis

A systematic review of evidence from longitudinal studies analysing the association between anxiety, depression and quality of life will be conducted, taking into account the current Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Several electronic databases from relevant fields of research (PubMed, PsycINFO, PSYNDEX, EconLit, NHS EED) will be searched in September 2018 using defined search terms, with an updated search planned. Moreover, reference lists of included studies will be searched manually. Study eligibility will be appraised in a two-step process against pre-defined inclusion/exclusion criteria. Primarily, information on study design and assessment, statistical methods, participant characteristics as well as results regarding our research question will be extracted. The quality of included studies will be assessed using an appropriate tool. Study selection, data extraction and assessment of study quality will be performed by two reviewers. Disagreements will be resolved through discussion or by inclusion of a third party. Results will be synthesised narratively in text and tables. Depending on the number and heterogeneity of the studies included, a meta-analysis will be performed.

Ethics and dissemination

As no primary data will be collected, approval from an ethics committee is not required. Results will be disseminated through conference presentations and publication in a peer-reviewed, scientific journal.

PROSPERO registration number

CRD42018108008.
Respiratory syncytial virus prevalence in children admitted to five Kenyan district hospitals: a cross-sectional study
Authors: Le Geyt Jacqueline , Hauck Stephanie , Lee Mark , Mackintosh Jennifer , Slater Jessica , Razon Duke , Williams Bhanu
Published: March 2019

Acute respiratory infections (ARIs) are a leading cause of under-five mortality globally. In Kenya, the reported prevalence of respiratory syncytial virus (RSV) infections in single-centre studies has varied widely. Our study sought to determine the prevalence of RSV infection in children admitted with ARI fulfilling the WHO criteria for bronchiolitis. This was a prospective cross-sectional prevalence study in five hospitals across central and highland Kenya from April to June 2015. Two hundred and thirty-four participants were enrolled. The overall RSV positive rate was 8.1%, which is lower than in previous Kenyan studies. RSV-positive cases were on average 5 months younger than RSV-negative cases.
Blame and shame in the veterinary profession: barriers and facilitators to reporting significant events
Authors: Oxtoby Catherine , Mossop Liz
Published: March 2019

Significant event reporting is an important concept for patient safety in human medicine, but substantial barriers to the discussion and reporting of adverse events have been identified. This study explored the factors that influence the discussion and reporting of significant events among veterinary surgeons and nurses. Purposive sampling was used to generate participants for six focus groups consisting of a range of veterinary professionals of different ages and roles (mean N per group=9). Thematic analysis of the discussions identified three main themes: the effect of culture, the influence of organisational systems and the emotional effect of error. Fear, lack of time or understanding and organisational concerns were identified as barriers, while the effect of feedback, opportunity for learning and structure of a reporting system facilitated error reporting. Professional attitudes and culture emerged as both a positive and negative influence on the discussion of error. The results were triangulated against the findings in the medical literature and highlight common themes in clinician's concerns regarding the discussion of professional error. The results of this study have been used to inform the development of the ‘VetSafe’ tool, a web‐based central error reporting system.