bluuebunny/crossref_metadata_2025 huggingface dataset:
Repeated nasopharyngeal lavage predicts freedom from silent carriage of Streptococcus equi after a strangles outbreak
Authors: Pringle John , Aspán Anna , Riihimäki Miia
Published: January 2022

Background

The value of repeated nasopharyngeal lavage (NPL) to detect silent carriers of Streptococcus equi has not been investigated.

Hypothesis/Objectives

Determine if results of serial testing for S. equi by NPL predicts subsequent true carrier status as determined by both NPL and guttural pouch lavage.

Animals

An outbreak of strangles with 100% morbidity in 41 mature Icelandic horses was followed prospectively to investigate development of silent carriers. All were initially positive to S. equi on NPL. The farm was closed to horse movement during the entire study.

Methods

Prospective observational study. Testing for S. equi was performed by NPL at weeks 18, 28, 29, and 30 postindex case and subsequently at week 45 by both NPL and guttural pouch lavage. Carrier status at week 45 was compared to results obtained at weeks 18, 28, 29, and 30. Descriptive statistics were calculated. Comparisons were made using Fisher's exact test or the Freeman‐Halton extension with a P < .05 level of significance.

Results

Of 24 noncarriers at week 45, only 4 horses were negative on all 3 consecutive weekly NPL samples at weeks 28 to 30. However, 10 of the 11 horses with at least 3 negative NPL obtained from weeks 18, 28, 29, and 30 were S. equi‐free at week 45 (P = .03).

Conclusions and Clinical Importance

Repeated NPL on at least 3 separate occasions can assist in predicting S. equi carrier‐free status in horses after recovery from a strangles outbreak.
Effect of intestinal microbiota transplantation on cerebral ischemia reperfusion injury in aged mice via inhibition of IL‐17
Authors: Feng Yun , Zhang Dan , Zhao Yan , Duan Tianjiao , Sun Huanhuan , Ren Li , Ren Xiaoyang , Lu Guifang , Liu Yaping , Zhang Zhiyong , Li Yingchao , Li Hongxia , Jia Ai , He Shuixiang
Published: January 2022

Objectives

This study investigates the effects and mechanisms of intestinal microbiota transplantation on cerebral ischemia reperfusion injury in aged mice.

Methods

We constructed a middle cerebral artery occlusion model after fecal microbiota transplantation from young C57 mice to aged C57 mice for 30 consecutive days via enema. The neurological deficit score, cerebral infarction volume, fecal flora composition, and IL‐17 levels in the colon, brain, and serum were evaluated in young mice, aged mice, and aged mice that received fecal microbiota transplantation. Moreover, we administered rIL‐17A through caudal vein injection to verify its effect on cerebral ischemia reperfusion injury in aged mice.

Results

We find that aged mice exhibited larger cerebral infarction volume and more severe neurological deficit than young mice after middle cerebral artery occlusion. Bacteroidetes increased and firmicutes decreased significantly in the feces of aged mice after microbiota transplantation. Furthermore, the transplanted mice showed improved neurological function and reduced infarction volume after middle cerebral artery occlusion compared with the control aged mice. We also find that the neuroprotective effect of the microbiota transplantation was reversed by pre‐treatment of rIL‐17A.

Conclusion

In summary, intestinal microbiota transplantation can alleviate cerebral ischemia reperfusion injury in aged mice by restoring their microbiota environment and inhibiting IL‐17 in the gut, serum, and brain tissue.
Topoisomerase 1α is required for synchronous spermatogenesis in Physcomitrium patens
Authors: Gu Nan , Chen Chunli , Kabeya Yukiko , Hasebe Mitsuyasu , Tamada Yosuke
Published: January 2022

DNA topoisomerase 1 (TOP1) plays general roles in DNA replication and transcription by regulating DNA topology in land plants and metazoans. TOP1 is also involved in specific developmental events; however, whether TOP1 plays a conserved developmental role among multicellular organisms is unknown.

Here, we investigated the developmental roles of TOP1 in the moss Physcomitrium (Physcomitrella) patens with gene targeting, microscopy, 3D image segmentation and crossing experiments.

We discovered that the disruption of TOP1α, but not its paralogue TOP1β, leads to a defect in fertilisation and subsequent sporophyte formation in P. patens. In the top1α mutant, the egg cell was functional for fertilisation, while sperm cells were fewer and infertile with disordered structures. We observed that the nuclei volume of wild‐type sperm cells synchronously decreases during antheridium development, indicating chromatin condensation towards the compact sperm head. By contrast, the top1α mutant exhibited attenuated cell divisions and asynchronous and defective contraction of the nuclei of sperm cells throughout spermatogenesis.

These results indicate that TOP1α is involved in cell division and chromatin condensation during spermatogenesis in P. patens. Our results suggest that the regulation of DNA topology by TOP1 plays a key role in spermatogenesis in both land plants and metazoans.
Modeling vigilance in mixed‐species groups
Authors: van Langevelde Frank , Suselbeek Lennart , Brown Joel S.
Published: January 2022

Mixed‐species groups are usually explained by foraging advantages and reduced predation risk for at least one of the participating species. Given that animals trade‐off foraging and vigilance, the optimal level of vigilance of individuals in mixed‐species groups depends partly on the vigilance levels of both conspecifics and heterospecifics. However, the benefits and costs of being part of a mixed‐species group do not need to be evenly distributed between the species in a group. In this paper, we modeled the evolutionary stable strategy (ESS) for the optimal level of vigilance of an individual in a mixed‐species group influenced by the effects of “many eyes,” “dilution” and “attraction,” and unequal costs and benefits between the species. Our model illustrates under what conditions associations with other species may facilitate reduced predation risk for at least one of the participating species. We show that vigilance of individuals in mixed‐species groups becomes a social game, and that the ESS of these vigilance games may predict the individual's adaptive level of vigilance. This paper provides the first step in the development of a predictive theory for the numerous empirical studies on mixed‐species groups.
Time spent outdoors as an intervention for myopia prevention and control in children: an overview of systematic reviews
Authors: Dhakal Rohit , Shah Rakhee , Huntjens Byki , Verkicharla Pavan K , Lawrenson John G
Published: January 2022

Purpose

Outdoor light exposure is considered a safe and effective strategy to reduce myopia development and aligns with existing public health initiatives to promote healthier lifestyles in children. However, it is unclear whether this strategy reduces myopia progression in eyes that are already myopic. This study aims to conduct an overview of systematic reviews (SRs) reporting time spent outdoors as a strategy to prevent myopia or slow its progression in children.

Methods

We searched the Cochrane Library, EMBASE, MEDLINE and CINAHL from inception to 1 November 2020 to identify SRs that evaluated the association between outdoor light exposure and myopia development or progression in children. Outcomes included incident myopia, prevalent myopia and change in spherical equivalent refraction (SER) and axial length (AL) to evaluate annual rates of myopia progression. The methodological quality and risk of bias of included SRs were assessed using the AMSTAR‐2 and ROBIS tools, respectively.

Results

Seven SRs were identified, which included data from 47 primary studies with 63,920 participants. Pooled estimates (risk or odds ratios) consistently demonstrated that time outdoors was associated with a reduction in prevalence and incidence of myopia. In terms of slowing progression in eyes that were already myopic, the reported annual reductions in SER and AL from baseline were small (0.13–0.17 D) and regarded as clinically insignificant. Methodological quality assessment using AMSTAR‐2 found that all reviews had one or more critical flaws and the ROBIS tool identified a low risk of bias in only two of the included SRs.

Conclusion

This overview found that increased exposure to outdoor light reduces myopia development. However, based on annual change in SER and AL, there is insufficient evidence for a clinically significant effect on myopia progression. The poor methodological quality and inconsistent reporting of the included systematic reviews reduce confidence in the estimates of effect.
Strategic new product media planning under emergent channel substitution and synergy
Authors: Abedi Vahideh Sadat , Berman Oded , Feinberg Fred M. , Krass Dmitry
Published: January 2022

New product and service introductions require careful joint planning of production and marketing campaigns. Consequently, they typically utilize multiple information channels to stimulate customer awareness and resultant word‐of‐mouth (WOM), availing of standard budget allocation tools. By contrast, when enacting strategic allocation decisions—which must align with other management imperatives—dividing expenditures across channels is far more complex. To this end, we formulate a multichannel demand model for new products (or services), amenable to analysis of inter‐ and intrachannel interaction patterns and with the WOM process, without building such interactions directly into the modeling framework. To address the notorious complexity of media planning over time, we propose a novel decomposition of the multichannel dynamic programming problem into two distinct “tiers”: the strategic tier addresses how to allocate total expenditure across channels, while the tactical tier studies how to allocate the channel‐specific budgets (determined in the strategic tier) over time periods. This decomposition enables optimal media strategies to sidestep the curse of dimensionality and renders the model pragmatically estimable. Strategic tier analysis suggests a variety of novel insights, primarily that funds should not be allocated based on (relative) channel effectiveness alone but also systematically aligned with WOM generation. Specifically, each channel can face a “chasm‐crossing” threshold, abruptly transitioning the adoption process from lead‐users to mass‐market penetration. Moreover, the model provides actionable managerial insights into when, and which, channel interactions are synergistic versus substitutive. Specifically, a channel's interactions are governed primarily by its own “leverage” (potential demand impact) and the WOM‐based demand “momentum” (market penetration) it can generate, affording a novel basis for channel typography and firm action. The modeling framework is illustrated by examining camera sales for two media channels (free‐standing inserts and radio) and their effects over 28 months. We use Bayesian machinery to estimate a highly flexible diffusion‐based model, along with forecasts, media plans, and both theoretical and empirically‐based qualitative insights.
What’s the problem? How crowdsourcing and text‐mining may contribute to the understanding of unprecedented problems such as COVID‐19
Authors: Wahl Julian , Füller Johann , Hutter Katja
Published: January 2022

In this research, we explore how crowdsourcing combined with text‐mining can help to build a sound understanding of unstructured, complex and ill‐defined problems. Therefore, we gathered 101 problem descriptions contributed to a crowdsourcing contest about the impact of COVID‐19 on the tourism industry. Based on our findings we propose a five‐phase process model for problem understanding consisting of: (1) information gathering, (2) information pre‐structuring, (3) problem space mapping, (4) problem space exploration, and (5) problem understanding for solution search. While our study confirms that crowdsourcing and text‐mining facilitate fast generation and exploration of problem spaces at limited cost, it also reveals the necessity to follow certain process steps and to deal with challenges such as information loss and human interpretation. For practitioners, our model presents a guideline for how to get a faster grasp on complex and rather unprecedented problems.
Evaluating mail‐based security for electoral processes using attack trees
Authors: Scala Natalie M. , Goethals Paul L. , Dehlinger Josh , Mezgebe Yeabsira , Jilcha Betelhem , Bloomquist Isabella
Published: January 2022

Since the reports of Russian interference in the 2016 United States General Election, the security of voting processes has received increased attention from both state and federal authorities. The declaration by the US Department of Homeland Security in January 2017 that election systems be classified as the 17th component of critical infrastructure is just the beginning of a need for more secure voting processes. More recently, the COVID‐19 pandemic and the 2020 US General Election have placed greater emphasis specifically on mail‐based voting processes for electoral systems. The objective of this research is to provide greater insight into potential threats to mail‐based voting processes. Upon identifying an attack tree as an initial structure for evaluation, new threats are postulated, and an updated tree is proposed that accounts for more recent activities. Then, using an established assessment framework, the relative likelihood of each mail‐based voting process attack scenario is identified. The results facilitate providing election officials and policymakers with greater knowledge of how mail‐based voting system vulnerabilities develop as well as specific security measures that may be most beneficial.
Stem‐cell transplantation for children with primary immune deficiencies: A retrospective study of 19 patients from one centre in Mexico
Authors: Staines‐Boone Aidé Tamara , González‐Villareal María Guadalupe , Pompa‐Garza María Teresa , Muñiz‐Ronquillo Teodoro , Sandoval‐González Adriana Carolina , Muzquiz‐Zermeño David , Padilla‐Castro Marco Antonio , García‐Campos Jorge Alberto , Sánchez‐Sánchez Luz María , Venegas Montoya Edna , Lugo Reyes Saul O.
Published: January 2022

Introduction

For many patients with primary immune deficiency (PID), stem‐cell transplantation (SCT) may be life‐saving.

Objective

To review our experience of 11 years transplanting children with PID in Mexico.

Methods

Chart review of patients who underwent SCT from 2008 to 2018, to describe their diagnoses, time to transplant, conditioning regime, survival rate and outcomes. All patients received post‐transplant cyclophosphamide as graft‐versus‐host‐disease (GVHD) prophylaxis.

Results

19 patients with combined, phagocytic or syndromic PID from 5 states. Twelve of them were male (58%) and 14 survive (79%). Mean age at HSCT was 41.9 months; mean time from diagnosis was 31.2 months. Seven grafts were umbilical cord and 12 haploidentical. The conditioning regime was myeloablative, with five primary graft failures. Two patients had partial and 10 full chimerism. Five patients died within 2 months after transplant. Immune reconstitution was complete in 11 of 19 patients. We found a prevalence of 21% GVHD.

Discussion

We describe 19 patients from Mexico with 8 PID diagnoses who underwent allogenic HSCT over a period of 11 years. Survival rate and other outcomes compare well with industrialized countries. We recommend the use of post‐transplant cyclophosphamide to prevent GVHD in scenarios of resource scarcity and a lack of HLA‐identical donors.
3.0‐Tesla MRI of normal canine adrenal glands
Authors: Lee Eunji , Choi Bo‐kwon , Lee Sang‐kwon , Choi Jihye
Published: January 2022

Adrenal disease is a common problem in dogs and MRI is increasingly being used as an adjunctive diagnostic test. To date, the MRI features of normal canine adrenal glands have only been reported using 1.5‐Tesla (T) MRI. The aims of this prospective, methods‐comparison, exploratory study were to evaluate the effects of pulse sequence on the appearance of normal canine adrenal glands using 3 Tesla MRI. Six research beagle dogs were sampled and the following pulse sequences were acquired for each: (1) T2‐weighted images using two‐dimensional (2D) turbo spin‐echo (TSE), single‐shot spin‐echo (SSTSE), and three‐dimensional (3D) TSE, (2) T1‐weighted images using 2D TSE, 3D TSE, and 3D turbo field echo sequences, (3) post‐contrast T1‐weighted images, and (4) chemical shift imaging. The signal‐to‐noise ratio and contrast‐to‐noise ratio were measured for each dog and each pulse sequence. The signal intensity, clarity of the contour, distinction of the corticomedullary junction, degrees of motion, partial volume, and chemical shift artifact, and homogeneity of the contrast enhancement were evaluated qualitatively. In all sequences, except for chemical shift imaging, the adrenal glands were visualized in both planes with successful control of motion artifacts by manual ventilation. The adrenal contour was considered to be most clearly visualized with 2D TSE. Adrenal images were acquired within the shortest time using SSTSE although the contour was less clearly visualized than with TSE. Findings from this study in normal dogs can serve as background for further 3.0‐T MRI studies of dogs with adrenal disease.
Estallido intertextual, polifonía intersubjetiva y contravisualidad: prácticas artísticas cooperativas en la primavera latinoamericana
Authors: Alfonso Bouhaben Miguel , Soto Labbé María Paulina , Ureta Marín Carola
Published: January 2022

El documental experimental Fragmentos por venir (Miguel Alfonso-Bouhaben y estudiantes de Cine de UArtes 2020) y la plataforma digital y libro impreso La ciudad como texto (Carola Ureta Marín, Chile, 2020) son dispositivos creativos que se niegan a la desmemoria y que fijan en imágenes entretejidas la energía popular que irrumpió en el espacio público en ambos países en 2019, en lo que algunos medios han denominado la Primavera Latinoamericana. Esa energía ha sido generada por una masa anónima e informe que no reclama autoría, pero que comparte con el arte la potencia de la intención de decir algo, de comprometerse con un punto de vista transformador y que en su realización descubre una esperanza compartida que la convierte en comunidad orgánica y política. Ambos proyectos expresan sorpresa ante el “acontecimiento” y una cierta reverencia ante la impresionante potencia del pueblo que estalla, destruye, crea y recrea. Fragmentos por venir tiene por objeto la ruptura del discurso hegemónico de los medios de comunicación a través de las tácticas del collage y la reapropiación. La ciudad como texto es un trabajo colaborativo y autogestionado de conservación de la memoria grabada en los muros de la avenida protagonista de las manifestaciones en Chile durante el estallido social. Ambos proyectos con guran espacios de comunicación alternativa que contrarrestan las omisiones y los silenciamientos de los grandes medios, a través de un proceso crítico de deconstrucción, de rememorización y de reimaginación a través de la transformación de las imágenes.
Poéticas políticas y sonoras: pasado, presente y resignificación de la música popular en las manifestaciones públicas de Chile en 2019
Authors: Perez Valero Luis Ramon
Published: January 2022

Durante las manifestaciones de 2019 llevadas a cabo en Ecuador, Perú, Colombia y Chile, la música estuvo llena de contenido político y poético como canto común, símbolo de resistencia, confrontación y lucha. Este artículo tiene como objetivo problematizar el uso que tuvo la música en la revuelta social en Chile de 2019. Para ello, se toman los conceptos de acción política, poética política y teatro político, así como la protesta urbana y las estrategias de enfrentamiento entre el colectivo y el Estado. Metodológicamente, se realiza el estudio de tres casos a partir de la netnografía, el análisis intratextual y las metanarrativas entre los parámetros musicales y audiovisuales en la videoprotesta. Se ha evidenciado la resignificación de músicas populares: la cumbia como elemento ritual en las calles, la canción El baile de los que sobran de Los Prisioneros como recurso y estrategia de la memoria y, por último, el videoclip Plata ta tá de Mon Laferte como herramienta de protesta en el circuito de consumo comercial. Como conclusión, se ha establecido que el vínculo entre música y resistencia deviene el accionar simbólico del arte y la política en la ciudadanía, que deroga y exige cambios en un modelo político imperante.
La evolución jurisprudencial del Tribunal de Justicia de la Comunidad Andina (TJCA) en materia del nombre comercial
Authors: Diez Canseco Núñez Luis José , Sasaki Otani María Ángela
Published: January 2022

La presente investigación tiene por objetivo el estudio de la evolución jurisprudencial del Tribunal de Justicia de la Comunidad Andina (TJCA) en relación con el ámbito de protección territorial del nombre comercial: desde la jurisprudencia primigenia de la década de 1990 hasta la jurisprudencia actual, la cual retorna a la posición inicial del TJCA. Actualmente, la jurisprudencia andina precisa que la protección del nombre comercial (no registrado) debe tomar en cuenta “la amplitud de las operaciones” y el “ámbito geográfico” de su uso (Procesos 42-IP-2017 y 317-IP-2017). La metodología de investigación utilizada incluye los aspectos normativo, jurisprudencial y doctrinal, lo cual apoya la decisión del TJCA de modificar la posición —equivocada, por cierto— que se había establecido en el Proceso 99-IP-2014 (“el nombre comercial debe ser protegido en todo el territorio nacional”).
Historia, Estado y nación. El constitucionalismo y los procesos de descolonización
Authors: Riegner Michael , Bonilla Maldonado Daniel
Published: January 2022

El objetivo de este artículo es describir y analizar los patrones y elementos constitucionales que estructuran los procesos de descolonización. Más precisamente, el artículo presenta los siguientes cuatro argumentos. Primero, los patrones discursivos y prácticos estructurales que atraviesan los procesos constitucionales descoloniales giran en torno a las siguientes categorías: tiempo (historia), espacio (Estado) y sujeto (nación). Segundo, las comunidades políticas poscoloniales típicamente articulan la relación entre identidad, historia y constitución, haciendo uso de tres movimientos discursivos: mímesis, poiesis e hibridación. Las nuevas subjetividades colectivas e individuales que emergen en las sociedades poscoloniales se construyen, en parte, jurídicamente. Las constituciones poscoloniales contribuyen a construir estas identidades mediante las decisiones que toman sobre cómo ha de incorporarse e interpretarse el pasado político-jurídico imperial en el presente y el futuro de la nueva comunidad política. Tercero, la forma espacial que toma la nueva sociedad poscolonial es la del Estado independiente y soberano. Los fundadores de las sociedades poscoloniales disponían de modelos espaciales jurídicos y políticos alternativos para organizar espacialmente sus sociedades, entre otros, las federaciones de pueblos o Estados. No obstante, reprodujeron las premisas sustanciales y los patrones prácticos que constituyen la columna vertebral del modelo articulado paradigmáticamente en el Pacto de Westphalia. Finalmente, cuarto, la nación es el sujeto colectivo transtemporal que ocupa las coordenadas espaciales y temporales que estructuran a las nuevas sociedades poscoloniales. La gramática del constitucionalismo moderno, por tanto, potencia y al mismo tiempo limita la imaginación de los fundadores de las comunidades políticas poscoloniales.
Inteligencia artificial y derecho. Problemas, desafíos y oportunidades
Authors: Parra Sepúlveda Darío , Concha Machuca Ricardo
Published: January 2022

El desarrollo tecnológico está dando lugar a una profunda transformación de nuestra sociedad. Y una de las tecnologías más determinantes en la actualidad es la inteligencia artificial. El uso intensivo de esta tecnología, tanto en actividades complejas como en situaciones cotidianas, ha dado lugar a relaciones jurídicas no contempladas en nuestros marcos normativos. En este contexto, se estudian los principales problemas que plantea la inteligencia artificial a los sistemas jurídicos. La revisión se hace por medio de tres casos prácticos. Finalmente, se analizan los desafíos que se presentan al derecho, con la expansión de la inteligencia artificial.
Methyl-methacrylate based aluminum hybrid film grown via three-precursor molecular layer deposition
Authors: Oyakhire Solomon T. , Ablat Hayrensa , Richey Nathaniel E. , Bent Stacey F.
Published: January 2022

Molecular layer deposition (MLD) processes involving two precursors are commonly employed for the growth of conformal thin films. However, the use of two precursors limits the combinations of material properties that can be accessed during film synthesis. Here, we develop a robust, three-precursor MLD process for a hybrid film that incorporates a desirable acrylate, methyl-methacrylate (MMA), together with aluminum into its repeating structure. We report a film growth rate of 3.5 Å/cycle at 110 °C, constant growth per cycle between 100 and 130 °C, and good stability of the film when exposed to ambient. We propose reaction pathways for the incorporation of MMA into the film, and by using infrared spectroscopy and x-ray photoelectron spectroscopy, we identify the reaction pathway as a non-zwitterionic aminoacrylate reaction. This study offers new insight into the use of more than two precursors in the design of an acrylate-based MLD film and provides a framework that can be adopted for subsequent three-precursor film designs.
The role of speech planning in the articulation of pauses
Authors: Krivokapić Jelena , Styler Will , Byrd Dani
Published: January 2022

Extensive research has found that the duration of a pause is influenced by the length of an upcoming utterance, suggesting that speakers plan the upcoming utterance during this time. Research has more recently begun to examine articulation during pauses. A specific configuration of the vocal tract during acoustic pauses, termed pause posture (PP), has been identified in Greek and American English. However, the cognitive function giving rise to PPs is not well understood. The present study examines whether PPs are related to speech planning processes, such that they contribute additional planning time for an upcoming utterance. In an articulatory magnetometer study, the hypothesis is tested that an increase in upcoming utterance length leads to more frequent PP occurrence and that PPs are longer in pauses that precede longer phrases. The results indicate that PPs are associated with planning time for longer utterances but that they are associated with a relatively fixed scope of planning for upcoming speech. To further examine the relationship between articulation and speech planning, an additional hypothesis examines whether the first part of the pause predominantly serves to mark prosodic boundaries while the second part serves speech planning purposes. This hypothesis is not supported by the results.
Dissection and Reconstitution Provide Insights into Electron Transport in the Membrane-Bound Aldehyde Dehydrogenase Complex of Gluconacetobacter diazotrophicus
Authors: Miah Roni , Nina Shun , Murate Takeru , Kataoka Naoya , Matsutani Minenosuke , Ano Yoshitaka , Matsushita Kazunobu , Yakushi Toshiharu
Published: January 2022

Two membrane-bound enzymes of acetic acid bacteria, pyrroloquinoline quinone-dependent alcohol dehydrogenase and molybdopterin-dependent aldehyde dehydrogenase (ALDH), are responsible for vinegar production. Upon the oxidation of acetaldehyde, ALDH reduces ubiquinone in the cytoplasmic membrane.
Daytime urotherapy in nocturnal enuresis: a randomised, controlled trial
Authors: Borgström Malin , Bergsten Amadeus , Tunebjer Maria , Hedin Skogman Barbro , Nevéus Tryggve
Published: January 2022

Objective

According to international guidelines, children with enuresis are recommended urotherapy, or basic bladder advice, before treatment with evidence-based alternatives such as the enuresis alarm is given. The efficacy of this strategy has, however, not been supported by controlled studies. We wanted to test if basic bladder advice is useful in enuresis.

Design

Randomised, controlled trial.

Setting

Paediatric outpatient ward, regional hospital.

Patients

Treatment-naïve enuretic children aged ≥6 years, with no daytime incontinence.

Interventions

Three groups, each during 8 weeks: (A) basic bladder advice—that is, voiding and drinking according to a strict schedule and instructions regarding toilet posture, (B) enuresis alarm therapy and (C) no treatment (control group).

Main outcome measures

Reduction in enuresis frequency during week 7–8 compared with baseline.

Results

The median number of wet nights out of 14 before and at the end of treatment were in group A (n=20) 12.5 and 11.5 (p=0.44), in group B (n=22) 11.0 and 3.5 (p<0.001) and in group C (n=18) 12.5 and 12.0 (p=0.55). The difference in reduction of enuresis frequency between the groups was highly significant (p=0.002), but no difference was found between basic bladder advice and controls.

Conclusions

Urotherapy, or basic bladder advice, is ineffective as a first-line treatment of nocturnal enuresis. Enuretic children who are old enough to be bothered by their condition should be offered treatment with the alarm or desmopressin.

Trial registration number

NCT03812094.
Improving breast cancer outcomes for Aboriginal women: a mixed-methods study protocol
Authors: Christie Vita , Rice MacKenzie , Dracakis Jocelyn , Green Deb , Amin Janaki , Littlejohn Karen , Pyke Christopher , McCowen Debbie , Gwynne Kylie
Published: January 2022

Introduction

Breast cancer is the most commonly diagnosed cancer affecting Australian women, and the second highest cause of cancer death in Australian women. While the incidence of breast cancer is lower in Aboriginal women than non-Aboriginal women, the mortality rate for Aboriginal women is higher, with Aboriginal women 1.2 times more likely to die from the disease. In New South Wales, Aboriginal women are 69% more likely to die from their breast cancer than non-Aboriginal women.

Co-design is a research method recognised to enhance collaboration between those doing the research and those impacted by the research; which when used with Aboriginal communities, ensures research and services are relevant, culturally competent and empowers communities as co-researchers. We report the development of a new protocol using co-design methods to improve breast cancer outcomes for Aboriginal women.

Methods and analysis

Through a Community Mapping Project in 2018, we co-designed an iterative quantitative and qualitative study consisting of five phases. In Phase 1, we will establish a governance framework. In Phase 2, we will provide information to community members regarding the modified parts of the screening, diagnosis, treatment and follow-up processes and invite them to partake. In Phase 3, the research team will collect data on the outcomes of the modified processes and the outcomes for the women who have and have not participated. The data shall be analysed quantitatively and thematically in Phase 4 with Aboriginal community representatives and reported back to community. Lastly, in Phase 5, we evaluate the co-design process and adapt our protocol for use in partnership with other communities.

Ethics and dissemination

This study has ethics approval of the Aboriginal Health and Medical Research Council ref:1525/19. The findings will be published in the literature, presented at conferences and short summaries will be issued via social media.
Cohort-based association study of germline genetic variants with acute and chronic health complications of childhood cancer and its treatment: Genetic Risks for Childhood Cancer Complications Switzerland (GECCOS) study protocol
Authors: Waespe Nicolas , Strebel Sven , Nava Tiago , Uppugunduri Chakradhara Rao S , Marino Denis , Mattiello Veneranda , Otth Maria , Gumy-Pause Fabienne , Von Bueren André O , Baleydier Frederic , Mader Luzius , Spoerri Adrian , Kuehni Claudia E , Ansari Marc
Published: January 2022

Introduction

Childhood cancer and its treatment may lead to various health complications. Related impairment in quality of life, excess in deaths and accumulated healthcare costs are relevant. Genetic variations are suggested to contribute to the wide inter-individual variability of complications but have been used only rarely to risk-stratify treatment and follow-up care. This study aims to identify germline genetic variants associated with acute and late complications of childhood cancer.

Methods and analysis

The Genetic Risks for Childhood Cancer Complications Switzerland (GECCOS) study is a nationwide cohort study. Eligible are patients and survivors who were diagnosed with childhood cancers or Langerhans cell histiocytosis before age 21 years, were registered in the Swiss Childhood Cancer Registry (SCCR) since 1976 and have consented to the Paediatric Biobank for Research in Haematology and Oncology, Geneva, host of the national Germline DNA Biobank Switzerland for Childhood Cancer and Blood Disorders (BISKIDS).

GECCOS uses demographic and clinical data from the SCCR and the associated Swiss Childhood Cancer Survivor Study. Clinical outcome data consists of organ function testing, health conditions diagnosed by physicians, second primary neoplasms and self-reported information from participants. Germline genetic samples and sequencing data are collected in BISKIDS. We will perform association analyses using primarily whole-exome or whole-genome sequencing to identify genetic variants associated with specified health conditions. We will use clustering and machine-learning techniques and assess multiple health conditions in different models.

Discussion

GECCOS will improve knowledge of germline genetic variants associated with childhood cancer-associated health conditions and help to further individualise cancer treatment and follow-up care, potentially resulting in improved efficacy and reduced side effects.

Ethics and dissemination

The Geneva Cantonal Commission for Research Ethics has approved the GECCOS study.

Research findings will be disseminated through national and international conferences, publications in peer-reviewed journals and in lay language online.

Trial registration number

NCT04702321.
Educational differences in alcohol-related mortality and their impact on life expectancy and lifespan variation in Spain (2016–2018): a cross-sectional analysis using multiple causes of death
Authors: Trias-Llimós Sergi , Spijker Jeroen J. A.
Published: January 2022

Background

Socioeconomic inequalities in alcohol-related mortality in Spain exists, and are postulated to contribute to inequalities in all-cause mortality. We aim to assess absolute and relative educational inequalities in alcohol-related mortality, and to estimate the role of alcohol in educational inequalities in both life expectancy and lifespan variation in Spain.

Methods

We used multiple cause-of-death (MCOD) mortality data for individuals aged 30 and over for Spain (2016–2018) by educational attainment. We estimated by sex and educational attainment age-standardised alcohol-attributable mortality rates, relative and absolute indices of educational inequalities; and total life expectancy and lifespan variation at age 30 for all-cause mortality and after eliminating alcohol-attributable mortality.

Results

The use of MCOD resulted in an additional 2543 annual alcohol-related deaths (+75% among men and +50% among women) compared with estimates derived from underlying causes of death. In absolute terms, educational inequalities were the highest among men aged 45–84 and among women aged 45–64. In relative terms, higher inequalities raised in working ages, whereas at older ages inequalities tended to be lower, although still important among men. Alcohol contributed to educational inequalities in life expectancy (men: 0.13 years (3.2%); women 0.02 years (0.7%)) and lifespan variation (2.1% and 1.4% for men and women, respectively).

Conclusion

Alcohol consumption remains an important lifestyle habit to be tackled in order to reduce socioeconomic inequalities in mortality in Spain, particularly among men.
Role of primary care physician factors on diagnostic testing and referral decisions for symptoms of possible cancer: a systematic review
Authors: Hardy Victoria , Yue Adelaide , Archer Stephanie , Merriel Samuel William David , Thompson Matthew , Emery Jon , Usher-Smith Juliet , Walter Fiona M
Published: January 2022

Background

Missed opportunities for diagnosing cancer cause patients harm and have been attributed to suboptimal use of tests and referral pathways in primary care. Primary care physician (PCP) factors have been suggested to affect decisions to investigate cancer, but their influence is poorly understood.

Objective

To synthesise evidence evaluating the influence of PCP factors on decisions to investigate symptoms of possible cancer.

Methods

We searched MEDLINE, Embase, Scopus, CINAHL and PsycINFO between January 1990 and March 2021 for relevant citations. Studies examining the effect or perceptions and experiences of PCP factors on use of tests and referrals for symptomatic patients with any cancer were included. PCP factors comprised personal characteristics and attributes of physicians in clinical practice.

Data extraction and synthesis

Critical appraisal and data extraction were undertaken independently by two authors. Due to study heterogeneity, data could not be statistically pooled. We, therefore, performed a narrative synthesis.

Results

29 studies were included. Most studies were conducted in European countries. A total of 11 PCP factors were identified comprising modifiable and non-modifiable factors. Clinical judgement of symptoms as suspicious or 'alarm' prompted more investigations than non-alarm symptoms. ‘Gut feeling’ predicted a subsequent cancer diagnosis and was perceived to facilitate decisions to investigate non-specific symptoms as PCP experience increased. Female PCPs investigated cancer more than male PCPs. The effect of PCP age and years of experience on testing and referral decisions was inconclusive.

Conclusions

PCP interpretation of symptoms as higher risk facilitated testing and referral decisions for possible cancer. However, in the absence of 'alarm' symptoms or ‘gut feeling’, PCPs may not investigate cancer. PCPs require strategies for identifying patients with non-alarm and non-specific symptoms who need testing or referral.

PROSPERO registration number

CRD420191560515.
Effectiveness of a web-based behavioural activation intervention for individuals with depression based on the Health Action Process Approach: protocol for a randomised controlled trial with a 6-month follow-up
Authors: Krämer Lena Violetta , Mueller-Weinitschke Claudia , Zeiss Tina , Baumeister Harald , Ebert David Daniel , Bengel Jürgen
Published: January 2022

Introduction

Behavioural activation is a highly effective treatment for depression. However, there is considerable heterogeneity of interventions grouped under the term ‘behavioural activation’. A main reason for the heterogeneity is the lack of a unified theory in the intervention development: few of the established intervention manuals give a theoretical rationale for their intervention techniques. For the first time, this study will examine the effectiveness of a theory-based behavioural activation intervention (InterAKTIV) based on the Health Action Process Approach. The intervention is implemented online to ensure broad dissemination and standardisation.

Methods and analysis

In a two-arm randomised controlled trial, the effectiveness of a guided web-based behavioural activation intervention for people with depression will be evaluated. Participants are recruited via the print and online media of a large German healthcare insurance company. Individuals (age 18–65), who meet criteria for major depressive episode in a clinical interview and no exclusion criteria are eligible for inclusion. A target sample of 128 participants is randomly allocated to either the intervention group (immediate access to InterAKTIV) or treatment as usual (access after follow-up assessment). The primary outcome of depressive symptom severity (Quick Inventory of Depressive Symptomatology Clinician Rating) and secondary outcomes, including behavioural activation, physical activity and motivational and volitional outcomes are assessed at baseline, post treatment and 6-month follow-up. Data will be analysed on an intention-to-treat basis with additional per-protocol analyses.

Ethics and dissemination

This trial is approved by the ethics committee of the Albert-Ludwigs-University of Freiburg (no.: 20-1045). All participants are required to submit their informed consent online before study inclusion. The results will be submitted for publication in a peer-reviewed journal and presented at conferences.

Trial registration number

This trial was registered in the German Clinical Trials Register (DRKS): DRKS00024349 (date of registration: 29 January 2021).
Clinical exercise provision in the UK: comparison of staff job titles, roles and qualifications across five specialised exercise services
Authors: Crozier Anthony , Watson Paula Mary , Graves Lee E F , George Keith , Naylor Louise , Green Daniel J , Rosenberg Michael , Jones Helen
Published: January 2022

Objectives

In the UK, the National Health Service long-term plan advocates exercise as a key component of clinical services, but there is no clearly defined workforce to deliver the plan. We aimed to provide an overview of current UK clinical exercise services, focusing on exercise staff job titles, roles and qualifications across cardiovascular, respiratory, stroke, falls and cancer services.

Methods

Clinical exercise services were identified electronically between May 2020 and September 2020 using publicly available information from clinical commissioning groups, national health boards and published audit data. Data relating to staff job titles, roles, qualifications and exercise delivery were collected via electronic records and telephone/email contact with service providers.

Results

Data were obtained for 731 of 890 eligible clinical services (216 cardiac, 162 respiratory, 129 stroke, 117 falls, 107 cancer). Cardiac rehabilitation services provided both clinical (phase III) and community (phase IV) exercise interventions delivered by physiotherapists, exercise physiologists (exercise specific BSc/MSc) and exercise instructors (vocationally qualified with or without BSc/MSc). Respiratory, stroke and falls services provided a clinical exercise intervention only, mostly delivered by physiotherapists and occupational therapists. Cancer services provided a community exercise service only, delivered by vocationally qualified exercise instructors. Job titles of ‘exercise physiologists’ (n=115) bore little alignment to their qualifications, with a large heterogeneity across services.

Conclusion

In the UK, clinical exercise services job titles, roles and qualifications were inconsistent. Regulation of exercise job titles and roles is required to remove the current disparities in this area.
Proposed pathway for therapeutic drug monitoring and dose escalation of vedolizumab
Authors: Nassar Islam Osama , Cheesbrough Jonathan , Quraishi Mohammed Nabil , Sharma Naveen
Published: January 2022

Vedolizumab is a gut-selective monoclonal antibody approved for the management of Crohn’s disease and ulcerative colitis. The available data demonstrate a favourable response to dose escalation in patients with primary non-response or secondary loss of response to vedolizumab. While therapeutic drug monitoring has a proven clinical utility for tumour necrosis factor antagonists, the available guidance for therapeutic drug monitoring and dose escalation of vedolizumab is rather limited. The present review proposes a practical algorithm to use vedolizumab trough levels in the management of treatment failure. Therapeutic drug monitoring can differentiate underexposed patients from those with mechanistic failure. Underdosed patients can respond to dose escalation instead of unnecessarily switching to other treatment modalities. We also review the safety and potential cost-effectiveness of vedolizumab dose escalation, the role of antidrug antibodies and the possible applicability of this strategy to subcutaneous vedolizumab.
SARS-CoV-2 seroprevalence among firefighters in Los Angeles, California
Authors: Mulligan Karen , Berg Anders H , Eckstein Marc , Hori Acacia , Rodriguez Anna , Sobhani Kimia , Toubat Omar , Sood Neeraj
Published: January 2022

Objective

We estimate the seroprevalence of SARS-CoV-2 antibodies among a sample of firefighters in the Los Angeles (LA), California fire department in October 2020 and compare demographic and contextual factors for seropositivity.

Methods

We conducted a serological survey of firefighters in LA, California, USA, in October 2020. Individuals were classified as seropositive for SARS-CoV-2 if they tested positive for IgG, IgM or both. We compared demographic and contextual factors for seropositivity.

Results

All firefighters in LA, California, USA were invited to participate in our study, but only roughly 21% participated. Of 713 participants with valid serological data, 8.8% tested positive for SARS-CoV-2 antibodies, and among the 686 with complete survey data 8.9% tested positive for antibodies. Seropositivity was not associated with gender, age or race/ethnicity. Seropositivity was highest among firefighters who reported working in the vicinity of LA International Airport, which had a known outbreak in July 2020.

Conclusions

Seroprevalence among firefighters in our sample was 8.8%, however, we lack a full workplace seroprevalence estimate to compare the relative magnitude against general population seroprevalence (15%). Workplace safety protocols, such as access to personal protective equipment and testing, can mitigate increased risk of infection at work, and may have eliminated differences in disease burden by geography and race/ethnicity in our sample.
Characterising axial psoriatic arthritis: correlation between whole spine MRI abnormalities and clinical, laboratory and radiographic findings
Authors: Diaz Pamela , Feld Joy , Eshed Iris , Eder Lihi
Published: January 2022

Objective

To describe the prevalence of inflammatory and structural lesions using whole spine MRI in patients with psoriatic disease, and to assess their correlation with clinical features and with axial spondyloarthritis (axSpA) classification criteria.

Methods

This retrospective analysis included patients with whole spine and sacroiliac joints (SIJ) MRI, selected from 2 populations: (1) active psoriatic arthritis (PsA), irrespective of axial symptoms; (2) psoriasis with confirmed or suspected PsA and axSpA symptoms. MRI spondylitis and/or sacroiliitis (MRI-SpA) was defined according to Assessment of Spondyloarthritis International Society (ASAS) consensus and by radiologist impression. Agreement between MRI-SpA and different inflammatory back pain (IBP) definitions (Berlin/ASAS/rheumatologist criteria) and the axSpA classification criteria were calculated considering MRI as gold standard. Logistic regression determined MRI-SpA-associated factors.

Results

93 patients were analysed (69.9% PsA; 30.1% psoriasis). Back pain was present in 81.7%, defined as IBP in 36.6%–57%. MRI-SpA was found in 9.7% of patients by ASAS definition and in 12.9% by radiologist impression, of which 25% had isolated spondylitis.

Low agreement was found between the three IBP definitions and MRI-SpA. Rheumatologist criteria was the most sensitive (50%–55.6%) while ASAS and Berlin criteria were the most specific (61.9%–63%). axSpA criteria had poor sensitivity for MRI-SpA (22.2%–25%). Late onset of back pain or asymptomatic patients accounted for most cases with MRI-SpA not meeting axSpA or IBP criteria. Male sex was associated with MRI-SpA (OR 6.91; 95% CI 1.42 to 33.59) in multivariable regression analysis.

Conclusion

Prevalence of MRI-defined axSpA was low and showed poor agreement with IBP and axSpA criteria.