bluuebunny/crossref_metadata_2025 huggingface dataset:
Rural and frontier access to mental health prescribers and nonprescribers: A geospatial analysis in Oregon Medicaid
Authors: Charlesworth Christina J. , Nagy Dylan , Drake Coleman , Manibusan Brynna , Zhu Jane M.
Published: April 2023

Objective

Medicaid enrollees in rural and frontier areas face inadequate access to mental health services, but the extent to which access varies for different provider types is unknown. We assessed access to Medicaid‐participating prescribing and nonprescribing mental health clinicians, focusing on Oregon, which has a substantial rural population.

Methods

Using 2018 Medicaid claims data, we identified enrollees aged 18‐64 with psychiatric diagnoses and specialty mental health providers who billed Medicaid at least once during the study period. We measured both 30‐ and 60‐minute drive time to a mental health provider, and a spatial access score derived from the enhanced 2‐step floating catchment area (E2SFCA) approach at the level of Zip Code Tabulation Areas (ZCTAs). Results were stratified for prescribers and nonprescribers, across urban, rural, and frontier areas.

Results

Overall, a majority of ZCTAs (68.6%) had at least 1 mental health prescriber and nonprescriber within a 30‐minute drive. E2SFCA measures demonstrated that while frontier ZCTAs had the lowest access to prescribers (84.3% in the lowest quintile of access) compared to other regions, some frontier ZCTAs had relatively high access to nonprescribers (34.3% in the third and fourth quartiles of access).

Conclusions

Some frontier areas with relatively poor access to Medicaid‐participating mental health prescribers demonstrated relatively high access to nonprescribers, suggesting reliance on nonprescribing clinicians for mental health care delivery amid rural workforce constraints. Efforts to monitor network adequacy should consider differential access to different provider types, and incorporate methods, such as E2SFCA, to better account for service demand and supply.
Development of a reliable clinical assessment tool for meningoencephalitis in dogs: The neurodisability scale
Authors: Gonçalves Rita , Maddox Thomas W. , Phillipps Stephanie , Nagendran Aran , Cooper Camilla , Orlandi Rocio , Fentem Rory , Walmsley Gemma L.
Published: April 2023

Background

Meningoencephalitis of unknown origin (MUO) comprises a group of debilitating inflammatory diseases affecting the central nervous system of dogs. Currently, no validated clinical scale is available for the objective assessment of MUO severity.

Objectives

Design a neurodisability scale (NDS) to grade clinical severity and determine its reliability and whether or not the score at presentation correlates with outcome.

Animals

One hundred dogs with MUO were included for retrospective review and 31 dogs were subsequently enrolled for prospective evaluation.

Methods

Medical records were retrospectively reviewed for 100 dogs diagnosed with MUO to identify the most frequent neurological examination findings. The NDS was designed based on these results and evaluated for prospective and retrospective use in a new population of MUO patients (n = 31) by different groups of independent blinded assessors, including calculation of interobserver agreement and association with outcome.

Results

The most common clinical signs in MUO patients were used to inform categories for scoring in the NDS: seizure activity, ambulatory status, posture and cerebral, cerebellar, brainstem, and visual functions. The intraclass correlation coefficient (ICC) for prospective use of the NDS was 0.83 (95% confidence interval [CI], 0.68‐0.91) indicating good agreement, and moderate agreement was found between prospective and retrospective assessors (ICC, 0.71; 95% CI, 0.56‐0.83). No association was found between NDS score and long‐term outcome.

Conclusions and Clinical Importance

The NDS is a novel clinical measure for objective assessment of neurological dysfunction and showed good reliability when used prospectively in MUO patients but, in this small population, no association with outcome could be identified.
Empowering English as an Additional Language students through digital multimodal composing
Authors: Barnes Melissa , Tour Ekaterina
Published: April 2023

While digital multimodal composing, underpinned by a critical literacies approach, provides opportunities for students to make informed semiotic choices and voice concerns about social issues, there is limited research exploring how digital multimodal composing is employed to interrogate and challenge the entanglements of language, immigration status and power. This article explores how 23 primary‐aged English as an Additional Language (EAL) students (Years 3–6) engaged in digital multimodal composing, in the context of an after‐school multiliteracies programme in one Australian school. Conceptualising critical literacies as a bridge to access and transform codes of power, the article explores how the participating students selected and used different semiotic resources for their digital texts while challenging and redefining dominant discourses based on their lived experiences and interests. The study found that both students and pre‐service teachers found value in students having access to digital technologies and experimenting with a range of multimodal and multilingual resources to create digital texts, which reflected cultural and linguistic identities. The findings illustrate how the creation of digital multimodal and multilingual texts allows for opportunities for students to reposition themselves as knowledgeable and active meaning‐makers with strategic support from teachers and peers.
Non‐tuberculous mycobacteriosis of the liver responsive to empiric therapy
Authors: Siciliani Luisa , Vanoli Alessandro , Berton Francesca , Mondelli Mario U.
Published: April 2023

This case demonstrates that clinical and pathological suspicion of NTM could be sufficient to start an empiric treatment even when microbiological isolation is unavailable. Moreover, disseminated mycobacteriosis may underlie an occult aggressive neoplasm.
The Mediating Alliance
Authors: Pujol Laura , Armadans Immaculada , Medina Francisco J. , Munduate Lourdes , Anguera M. Teresa
Published: April 2023

This article proposes the conceptualization of the term “mediating alliance” to further the development of theories about success factors in mediation. Extending Bordin's pan‐theoretical conceptualization of the “working alliance” to the field of mediation, we first define the term “mediating alliance.” We then apply research on success factors in mediation to elements of the alliance as it relates to goals, tasks, and bonds developed in the mediation process. We offer the mediating alliance as a framework in which cooperative interaction emerges. At a theoretical level, the mediating alliance, as an integrative framework, contributes to the study of effectiveness in mediation. Methodologically, the operationalization of this concept, based on the theory of speech acts, facilitates the application of a mixed methods approach to future lines of research. At a practical level, this new concept, and the results of future research, will allow scholars to develop hypotheses about the effectiveness of communication strategies in mediation that can be applied to the practice of mediation and the training of mediators.
Early sedation with dexmedetomidine in post‐operative adult intensive care unit patients
Authors: Yiewong Tenzin , Corry Margarita , Mooney Mary
Published: April 2023

Background

Delirium is a leading healthcare concern in adult Intensive Care Units (ICU) and has a reported prevalence of up to 80%. Although individual studies report that early sedation with dexmedetomidine in post‐operative patients including its nocturnal administration can improve sleep quality and reduction in ICU delirium, these have not been synthesized in a systematic review.

Aim

The aim of this systematic review was to evaluate the effectiveness of early administration of dexmedetomidine infusion in the prevention of delirium, reduction in agitation, and improved sleep quality among post‐operative adults in ICU.

Study Design

A systematic search was conducted across PubMed, CINAHL, MEDLINE, and EMBASE, together with a search for grey literature. Two authors independently screened the search results, extracted data, and assessed risk of bias (ROB). Data were meta‐analysed using RevMan 5.4 software. A simplified Cochrane approach was used in this review.

Results

Five randomized controlled trials with 2173 participants were included. ROB was assessed with the five studies included in this review. Of the five included studies, two were identified as having components with a high ROB; one study reporting high ROB in the domain of other biases, and the other study in the domains of allocation concealment as well as in the domains of blinding of participants and personnel. All other studies and domains were either low or unclear ROB. The result indicated that the incidence of delirium was reduced among the dexmedetomidine group (RR: 0.08, 95% CI −0.15 to −0.01, 3 studies, 1045 patients) when compared with those who received other medications. There was no difference in agitation (RR: 0.85, 95% CI 0.51 to 1.44, 2 studies, 779 patients), and although better sleep was associated with the dexmedetomidine group, no data focusing on the sleep quality was reported.

Conclusion

The pooled result of this systematic review indicated a reduction in the incidence of delirium among ventilated patients who received early administration of dexmedetomidine post‐operatively. Although pooled sample sizes are relatively high, each outcome is based on one or two studies of primarily low or unclear ROB. Further research is warranted to determine the potential benefit of dexmedetomidine on agitation and sleep quality.

Relevance to clinical practice

The findings from this study support the use of light sedation, such as dexmedetomidine as recommended in the Society of Critical Care Medicine's guidelines.
The microbiome in adolescents with irritable bowel syndrome and changes with percutaneous electrical nerve field stimulation
Authors: Castillo Daniel F. , Denson Lee A. , Haslam David B. , Hommel Kevin A. , Ollberding Nicholas J. , Sahay Rashmi , Santucci Neha R.
Published: April 2023

Background

Irritable bowel syndrome (IBS), a disorder of the gut–brain axis, is affected by the microbiome. Microbial studies in pediatric IBS, especially for centrally mediated treatments, are lacking. We compared the microbiome between pediatric IBS patients and healthy controls (HC), in relation to symptom severity, and with percutaneous electrical nerve field stimulation (PENFS), a non‐invasive treatment targeting central pain pathways.

Methods

We collected a stool sample, questionnaires and a 1–2 week stool and pain diary from 11 to 18 years patients with IBS. A patient subset completed 4 weeks of PENFS and repeated data collection immediately after and/or 3 months after treatment. Stool samples were collected from HC. Samples underwent metagenomic sequencing to evaluate diversity, composition, and abundance of species and MetaCyc pathways.

Key Results

We included 27 cases (15.4 ± 2.5 year) and 34 HC (14.2 ± 2.9 year). Twelve species including Firmicutes spp., and carbohydrate degradation/long‐chain fatty acid (LCFA) synthesis pathways, were increased in IBS but not statistically significantly associated with symptom severity. Seventeen participants (female) who completed PENFS showed improvements in pain (p = 0.012), disability (p = 0.007), and catastrophizing (p = 0.003). Carbohydrate degradation and LCFA synthesis pathways decreased post‐treatment and at follow‐up (FDR p‐value <0.1).

Conclusions and Inferences

Firmicutes, including Clostridiaceae spp., and LCFA synthesis pathways were increased in IBS patients suggesting pain‐potentiating effects. PENFS led to marked improvements in abdominal pain, functioning, and catastrophizing, while Clostridial species and LCFA microbial pathways decreased with treatment, suggesting these as potential targets for IBS centrally mediated treatments.
Analysis of the Risk Factors for Free Flap Necrosis in Soft Tissue Reconstruction of the Lower Limbs
Authors: Liu Hao , Liu Jun , Wu Yongwei , Ma Yunhong , Zhou Ming , Xue Yuan , Rui Yongjun
Published: April 2023

Objective

Free flaps are widely used for the repair of soft tissue defects in the lower limbs, but there is still a specific rate of necrosis. Few clinical retrospective studies have analyzed the nontechnical risk factors for lower limb free flap necrosis. This study aimed to analyze the nontechnical causes of flap necrosis in lower limb soft tissue reconstruction in order to identify risk factors and improve the survival rate of free flaps.

Methods

Clinical data from 244 cases of soft tissue defects of the leg or foot that were repaired with a free flap from January 2011 to June 2020 were retrospectively analyzed. The flap results were divided into complete survival and necrosis groups. The patients' general information, smoking history, soft tissue defect site, Gustilo‐Anderson classification, shock after injury, type and size of the flap, and time from injury to flap coverage were recorded. A logistic regression model was used to analyze the correlations between flap necrosis and possible risk factors.

Results

Of the 244 flaps, 32 suffered from partial or total necrosis, and 212 completely survived. Univariate analysis showed that age, smoking history, soft tissue defect site, and time from injury to flap coverage were significantly correlated with flap necrosis (p ≤ 0.2). Multivariate logistic regression analysis showed that moderate‐to‐severe smoking history (p < 0.001, odds ratio [OR] = 10.259, 95% confidence interval [CI] = 2.886–36.468), proximal leg defect (p = 0.006, OR = 7.095, 95% CI = 1.731–29.089), and time from injury to flap coverage >7 days (p = 0.003, OR = 12.351, 95% CI = 2.343–65.099) were statistically significant risk factors for flap necrosis (p < 0.05), and age was excluded (p = 0.666; p = 0.924).

Conclusion

The risk of flap necrosis was significantly increased when the soft tissue defect was located in the proximal leg, the time from injury to flap coverage was >7 days, and the patient had a moderate‐to‐severe smoking history. These three risk factors have an increased influence on flap necrosis and have guiding significance in predicting flap prognosis.
Plasmodium infection and dysbiosis: A new paradigm in the host–parasite interaction
Authors: Winaris Nuning , Pawestri Aulia Rahmi , Azizah Syafiatul , Alifia Lustyafa Inassani , Asiyah Rokhmatul , Ayuningtyas Tita Rachma , Fitri Loeki Enggar , Sardjono Teguh Wahju
Published: April 2023

The mucosal immune system contributes for the largest component of the tissue immune system due to its massive surface area and constant exposure to the microbiota. The gut microbiota comprises a complex micro‐ecosystem in the intestine and plays a major role in regulating innate and adaptive immunity. Several studies revealed that infectious diseases involve bidirectional interactions in the gut microenvironment, including changes in the gut microbiota composition. During Plasmodium infection, an increase of pro‐inflammatory cells in the lamina propria and a shift in the composition of the gut microbiota contribute to intestinal ecosystem dysbiosis. Although the mechanisms of this dysbiosis is still uncertain, it is thought to be associated with the sequestration of infected red blood cells in the intestinal microvascular system, leading to endothelial villous disruption, and thus activating effector immune cells scattered in the intestinal epithelium and lamina propria. This review provides information on this conjoint interaction which will be beneficial to modulate the host immune response in malaria through manipulation of the gut microbiota composition.
Blockchains for emergency and crisis management
Authors: Chen Wendy D. , Murtazashvili Ilia
Published: April 2023

Public managers and administrators confront the increasing scale and prevalence of crises. Despite some deployments, blockchain applications by governments for emergency management and response management have only begun to scratch the surface. To facilitate greater awareness of the promises and challenges of blockchain applications to the public sector, we consider the ways in which distributed ledger technologies can improve emergency and crisis management across the dimensions of transparency, public trust, and social equity. The article ends with a call for a public administration research agenda on blockchains for emergency and crisis management.
The performance function in local government: Does location impact performance data use?
Authors: Rivenbark William C. , Fasiello Roberta , Tassi Francesco
Published: April 2023

Research has demonstrated that certain drivers increase the probability of performance data use in local government. One performance driver that has received minimal attention is where the performance function is organizationally located, even though prior research has shown that the organizational placement of the performance function can potentially influence the design and use of performance measurement systems. Our study explores how the organizational placement of the performance function in local government influences key drivers of performance data use. We find evidence that performance functions located outside the budget office are more likely to promote the drivers of measurement system maturity, other management processes, and devolved decision‐making, which in turn increases the probability that local officials engage in performance data use. We also identify several research implications to advance the study and practice of performance management in local government and conclude with research limitations and suggestions for future research opportunities.
Early start hemodialysis with a catheter may be associated with greater mortality: A propensity score analysis
Authors: Laham Gustavo , Pujol Gervasio Soler , Guzman Jenny , Boccia Natalia , Abib Anabel , Diaz Carlos H.
Published: April 2023

Introduction

Deciding when and how to initiate hemodialysis (HD) is still controversial. An early start (ES) seems to show a lack of benefit. “Lead time bias” and comorbidities have been associated with different outcomes in ES groups. On the other hand, it is well accepted that the impact the type of vascular access (VA) has on patient survival. Our aim was to evaluate survival with early start (ES) versus late start (LS) on HD, taking into account the vascular access (VA) used.

Methods

Between 01/1995 and 06/2018, 503 incidental patients initiated HD at our Dialysis Unit. eGFR was estimated by the CKD‐EPI equation. Diabetes mellitus (DM), coronary disease (CD), and peripheral vascular disease (PVD) were considered comorbid conditions. According to eGFR and VA, patients were divided into four groups: G1: ES (eGFR > 7 mL/min) with catheter (ES + C), G2: ES with fistula or graft (F/G) (ES + F/G), G3: LS (eGFR< 7 mL/min) with catheter (LS + C), and G4: LS with F/G (LS + F/G). The cut‐off value to define ES or LS was based on median eGFR for these 503 patients. We compared patient's survival rates by Kaplan–Meier and log‐rank test. The four groups were compared before and after matching with propensity scores (PS). Cox analysis was performed to determine the impact of predictors of mortality.

Results

Median eGFR was 7 (5.3–9.5) mL/min/1.73 m2, median follow‐up time was 30.9 (13–50) months, 52.1% had F/G access at entry, and 46.9% died during the observation period. Among the four groups, the ES + C were significantly older, and there were more diabetics and comorbid conditions, while phosphatemia, iPTH, albumin, and hemoglobin were significantly higher in the LS groups. Before propensity score (PS) matching, the ES + C group had a poor survival rate (p < 0.0001), while LS + F/G access had the best survival. After PS, a total of 180 patients were selected in the same four groups and ES + C kept showing a statistically significant poorer survival. Multivariate analysis revealed that ES + C was an independent predictor of mortality.

Conclusion

In this retrospective study, ES + C on HD was associated with a higher mortality rate than LS. This association persisted after PS matching.
Geopolitical conflicts, sanctions and international knowledge flows: EU–Russia collaboration during the Ukraine crisis
Authors: Makkonen Teemu , Mitze Timo
Published: April 2023

This article studies the development of scientific co‐publications between EU countries and Russia since the start of the Ukraine crisis in 2014. We investigate if economic sanctions and counter‐sanctions imposed during the crisis affected EU–Russia knowledge flows even before all science collaborations between the EU countries and Russia were eventually suspended as part of the EU sanctions in 2022. Our econometric analysis uses a gravity model framework and a comprehensive dataset covering more than 540 million scientific publications and 8.6 million international co‐publications for 35 countries (EU, BRICS, Belarus and Ukraine) during 1995–2018. Findings indicate that the imposition of EU sanctions and Russian counter‐sanctions from 2014 onwards had a significantly negative effect on EU–Russia co‐publication intensities. As a lower bound estimate, we find that sanctions reduced the EU–Russia scientific co‐publication intensity by 15% at the aggregate level. Effects are higher in specific scientific fields. We uncover transmission channels of this effect, for example, related to dual‐use technologies and growing resentments, and assess the robustness of our estimates. Time–dynamic regressions show that the sanctions effect on scientific collaboration increases over time. This underlines the susceptibility of global knowledge flows to geopolitical conflicts.
Exploring the Role of Productive Audiences in Promoting Intercultural Understanding: A Study of Chinese YouTube Influencer Liziqi's Channel
Authors: Li Jingfang , Adnan Hamedi Mohd
Published: April 2023

This exploratory study on YouTube videos investigates the role of Chinese YouTube channels created by influential individuals in facilitating intercultural communication and understanding. Specifically, it explores how YouTube viewers respond, interact, and express their views on Chinese culture. The nature of audience engagement with intercultural communication was explored through the lens of creative textual engagement using a qualitative research approach and textual analysis of five hundred video comments on one of the most subscribed Chinese YouTube channel (i.e., Liziqi). Audience's interpretation goes through a logic of consumption from cognition to emotion to attitudinal change and behavioural intention; the process by an audience promotes intercultural understanding and acquires an identity. Additionally, the interactive relationship between the text and the audience is reciprocal and democratic. Audiences can incorporate and form interpretive communities, regardless of their cultural composition, and cooperate to produce a common meaning regardless of varying interpretations. This study contributes to extending the concept of Fiske's productive audience to intercultural communication and broadens the path for an audience to negotiate and understand Chinese culture.
Exploring Societal Perplexes & Cultural Quandary in Amulya Malladi’s The Mango Season
Authors: Sindhu C. , Vishnu Priya N. S.
Published: April 2023

Literature is a work of art blended with an aesthetic and artistic creation specifically in the written form. There are indeed many different kinds of literature around the globe, but Indian English Literature has its special qualities that make it stand out to readers. Indian English Literature is an amalgamation of various themes such as socio-historical, multicultural, and multilingual objectives. Amulya Malladi is an Indian women diasporic writer, she brings the concept of cultural dilemmas in her work. This paper investigates Amulya’s second fiction ‘The Mango Season’ and highlights the societal complications/ cultural confusions faced by the protagonist Priya Rao. Due to religious and cultural differences, the protagonist suffers a lot to decide between her love for her family and her love for her beloved. Cultural dilemmas are primarily the result of two living experiences that develop in one’s own country and in the host land. ‘The Mango Season’ is very naturalistic in its depiction of cultural confusions & societal norms faced by the protagonist who is well educated and graduated in the West while her parents are down-rooted in the Orient culture.
Poincaré constant on manifolds with ends
Authors: Grigor'yan Alexander , Ishiwata Satoshi , Saloff‐Coste Laurent
Published: April 2023

We obtain optimal estimates of the Poincaré constant of central balls on manifolds with finitely many ends. Surprisingly enough, the Poincaré constant is determined by the second largest end. The proof is based on the argument by Kusuoka–Stroock where the heat kernel estimates on the central balls play an essential role. For this purpose, we extend earlier heat kernel estimates obtained by the authors to a larger class of parabolic manifolds with ends.
Acquisition of Gonococcal AniA-NorB Pathway by the Neisseria meningitidis Urethritis Clade Confers Denitrifying and Microaerobic Respiration Advantages for Urogenital Adaptation
Authors: Tzeng Yih-Ling , Sannigrahi Soma , Berman Zachary , Bourne Emily , Edwards Jennifer L. , Bazan Jose A. , Turner Abigail Norris , Moir James W. B. , Stephens David S.
Published: April 2023

Neisseria meningitidishistorically has been an infrequent and sporadic cause of urethritis and other urogenital infections.
Genetic Differences between 129S Substrains Affect Antiretroviral Immune Responses
Authors: Zhang Robert Z. , Mele Vincent , Robben Lia , Kane Melissa
Published: April 2023

Understanding the genetic basis for production of protective antiviral immune responses is crucial for the development of novel vaccines and adjuvants. Additionally, characterizing the genetic and phenotypic variability in inbred mice has implications for the selection of strains for targeted mutagenesis, choice of controls, and for broader understanding of the requirements for protective immunity.
Complete Chloroplast Genome of an Endophytic
Ostreobium
sp. (Ostreobiaceae) from the U.S. Virgin Islands
Authors: Alesmail Mustafa , Becerra Yulissa , Betancourt Kimberly J. , Bracy Shelly M. , Castro Anevay T. , Cea Cynthia , Chavez Justin , Del Angel Janet , Diaz Edgar , Diaz-Guzman Yael , Dominguez Jonathan , Estrada Jocelynnicole G. , Frei Lashabelle G. , Gabrielson Paul W. , Gallardo Andrea , Garcia Miriam R. , Gonzalez Eva , Gonzalez Rocha Anthony , Guzman-Bermudez Diego , Hebert Cassidy R. , Hernandez Marlene , Hughey Jeffery R. , Lee Zachary , Leyva Romero Alexandra , Martinez Eric , Martinez Nathaniel , Medina Kazimiera H. , Morales Miguel , Moreno Alexis M. , Nava Isabella , Nono Alyssa N. , Ochoa Samuel A. , Perez Amy , Perez Natasha , Perez Pulido Edwin , Poduska Sophie , Ramirez Kimberly N. , Reyes Denise , Richardson Kelsey , Rodriguez Juanaisa , Rodriguez Alondra M. , Serrano-Lopez Clarisa , Velasquez Andrea G. , Villanueva Gezelle
Published: April 2023

We present the complete chloroplast genome sequence of an endophytic
Ostreobium
sp. isolated from a 19th-century coralline red algal specimen from St. Croix, U.S. Virgin Islands. The chloroplast genome is 84,848 bp in length, contains 114 genes, and has a high level of gene synteny to other Ostreobiaceae.
Whole-Genome Sequence of the Multidrug-Resistant Staphylococcus warneri Strain G1M1F, Isolated from Mice with Mastitis
Authors: Hoque M. Nazmul , Moyna Zannatara , Faisal Golam Mahbub , Das Ziban Chandra
Published: April 2023

We sequenced the genome of
Staphylococcus warneri
G1M1F, a multidrug-resistant strain isolated from fecal samples of mice with induced mastitis. The complete genome of G1M1F consists of one chromosome of 2,504,515 bp and two plasmid replicons of 28,679 and 8,615 bp; it comprises 32.7% GC content, with 60× genome coverage.
The Environmental Stability of SARS-CoV-2 Variants Omicron BA.1 and BA.5 on the Surfaces of Widely Used Transport Packaging Materials
Authors: Wang Bei , Chen Lan , Sui Hongtao , Dong Xiaojing , Huang He , Wang Xinming , Xiao Yan , Xiao Xia , Wu Chao , Gao Hong , Shu Yuelong , Ren Lili , Wang Jianwei
Published: April 2023

This study shows the environmental stability of SARS-CoV-2 Variants Omicron BA.1 and BA.5 on surfaces of widely used transport packaging materials. The findings demonstrate that the environmental stability of the SARS-CoV-2 Omicron variants varies based on material type.
Comparative Susceptibility of Plasmodium ovale and Plasmodium falciparum Field Isolates to Reference and Lead Candidate Antimalarial Drugs in Ghana
Authors: Aniweh Yaw , Soulama Alamissa , Chirawurah Jersley , Ansah Felix , Danwonno Harry A. , Sogore Fanta , Rouillier Melanie , Campo Brice , Amenga-Etego Lucas , Djimde Abdoulaye A. , Awandare Gordon A. , Dembele Laurent
Published: April 2023

Current malaria control and elimination tools such as drug treatments are not specifically targeting
P.ovale
.
P. ovale
can form hypnozoite and cause relapsing malaria.
P. ovale
is the third most dominant species in Africa and requires radical cure treatment given that it can form liver dormant forms called hypnozoites that escape all safe treatments. The inappropriate treatment of
P. ovale
would sustain its transmission in Africa where the medical need is the greatest.
Mass wasting records the first stages of the Messinian Salinity Crisis in the eastern Mediterranean
Authors: Oppo Davide , al. et
Published: April 2023

Information on the seismic data, MTC thickness and volume calculation, and uninterpreted seismic data. 
One-field, two-field and five-field handheld retinal imaging compared with standard seven-field Early Treatment Diabetic Retinopathy Study photography for diabetic retinopathy screening
Authors: Salongcay Recivall P , Jacoba Cris Martin P , Salva Claude Michael G , Rageh Abdulrahman , Aquino Lizzie Anne C , Saunar Aileen V , Alog Glenn P , Ashraf Mohamed , Peto Tunde , Silva Paolo S
Published: April 2023

Background/aims

To determine agreement of one-field (1F, macula-centred), two-field (2F, disc–macula) and five-field (5F, macula, disc, superior, inferior and nasal) mydriatic handheld retinal imaging protocols for the assessment of diabetic retinopathy (DR) as compared with standard seven-field Early Treatment Diabetic Retinopathy Study (ETDRS) photography.

Methods

Prospective, comparative instrument validation study. Mydriatic retinal images were taken using three handheld retinal cameras: Aurora (AU; 50° field of view (FOV), 5F), Smartscope (SS; 40° FOV, 5F), and RetinaVue (RV; 60° FOV, 2F) followed by ETDRS photography. Images were evaluated at a centralised reading centre using the international DR classification. Each field protocol (1F, 2F and 5F) was graded independently by masked graders. Weighted kappa (Kw) statistics assessed agreement for DR. Sensitivity (SN) and specificity (SP) for referable diabetic retinopathy (refDR; moderate non-proliferative diabetic retinopathy (NPDR) or worse, or ungradable images) were calculated.

Results

Images from 225 eyes of 116 patients with diabetes were evaluated. Severity by ETDRS photography: no DR, 33.3%; mild NPDR, 20.4%; moderate, 14.2%; severe, 11.6%; proliferative, 20.4%. Ungradable rate for DR: ETDRS, 0%; AU: 1F 2.23%, 2F 1.79%, 5F 0%; SS: 1F 7.6%, 2F 4.0%, 5F 3.6%; RV: 1F 6.7%, 2F 5.8%. Agreement rates of DR grading between handheld retinal imaging and ETDRS photography were (Kw, SN/SP refDR) AU: 1F 0.54, 0.72/0.92; 2F 0.59, 0.74/0.92; 5F 0.75, 0.86/0.97; SS: 1F 0.51, 0.72/0.92; 2F 0.60, 0.75/0.92; 5F 0.73, 0.88/0.92; RV: 1F 0.77, 0.91/0.95; 2F 0.75, 0.87/0.95.

Conclusion

When using handheld devices, the addition of peripheral fields decreased the ungradable rate and increased SN and SP for refDR. These data suggest the benefit of additional peripheral fields in DR screening programmes that use handheld retinal imaging.
Impact assessment of a raw coal ban on maternal and child health outcomes in Ulaanbaatar: a protocol for an interrupted time series study
Authors: Dickinson-Craig Emma , Badarch Jargalsaikhan , Bartington Suzanne , Hemming Karla , Thayakaran Rasiah , Day Rosie , Pope Francis , Chuluunbaatar Bataa , Boldbaatar Damdindorj , Ochir Chimedsuren , Warburton David , Thomas Graham Neil , Manaseki-Holland Semira
Published: April 2023

Introduction

Despite a decade of policy actions, Ulaanbaatar’s residents continue to be exposed to extreme levels of air pollution, a major public health concern, especially for vulnerable populations such as pregnant women and children. In May 2019, the Mongolian government implemented a raw coal ban (RCB), prohibiting distribution and use of raw coal in households and small businesses in Ulaanbaatar. Here, we present the protocol for an interrupted time series (ITS; a strong quasi-experimental study design for public health interventions) that aims to assess the effectiveness of this coal ban policy on environmental (air quality) and health (maternal and child) outcomes.

Methods and analysis

Routinely collected data on pregnancy and child respiratory health outcomes between 2016 and 2022 in Ulaanbaatar will be collected retrospectively from the four main hospitals providing maternal and/or paediatric care as well as the National Statistics Office. Hospital admissions data for childhood diarrhoea, an unrelated outcome to air pollution exposure, will be collected to control for unknown or unmeasured coinciding events. Retrospective air pollution data will be collected from the district weather stations and the US Embassy. An ITS analysis will be conducted to determine the RCB intervention impact on these outcomes. Prior to the ITS, we have proposed an impact model based on a framework of five key factors, which were identified through literature search and qualitative research to potentially influence the intervention impact assessment.

Ethics and dissemination

Ethical approval has been obtained via the Ministry of Health, Mongolia (No.445) and University of Birmingham (ERN_21-1403). To inform relevant stakeholders of our findings, key results will be disseminated on both (inter)national and population levels through publications, scientific conferences and community briefings. These findings are aimed to provide evidence for decision-making in coal pollution mitigation strategies in Mongolia and similar settings throughout the world.
Self-reported sexually transmitted infections among adolescent girls and young women in Mali: analysis of prevalence and predictors
Authors: Appiah Collins Kwame , Dowou Robert Kokou , Balame Samuel Kwaku , Adzigbli Leticia Akua , Yeboah Paa Akonor , Aboagye Richard Gyan , Cadri Abdul
Published: April 2023

Objective

To examine the prevalence and predictors of self-reported sexually transmitted infections (SR-STIs) among adolescent girls and young women in Mali.

Design

We performed a cross-sectional analysis of data from the Demographic and Health Survey of Mali, which was conducted in 2018. A weighted sample of 2105 adolescent girls and young women aged 15–24 was included. Percentages were used to summarise the results of the prevalence of SR-STIs. We used a multilevel binary logistic regression analysis to examine the predictors of SR-STIs. The results were presented using an adjusted odds ratio (aOR) with 95% confidence interval (CI). Statistical significance was set at p<0.05.

Setting

Mali.

Participants

Adolescent girls (15–19 years) and young women (20–24 years).

Outcome measure

SR-STIs.

Results

The prevalence of SR-STIs among the adolescent girls and young women was 14.1% (95% CI=12.3 to 16.2). Adolescent girls and young women who had ever tested for HIV, those with one parity, those with multiparity, those with two or more sexual partners, those residing in urban areas, and those exposed to mass media were more likely to self-report STIs. However, those residing in Sikasso and Kidal regions were less likely to report STIs.

Conclusion

Our study has shown that SR-STIs are prevalent among adolescent girls and young women in Mali. Health authorities in Mali and other stakeholders should formulate and implement policies and programmes that increase health education among adolescent girls and young women and encourage free and easy access to STI prevention and treatment services.
Patient and public involvement to inform the protocol of a clinical trial comparing total hip arthroplasty with exercise: an exploratory qualitative case study
Authors: Frydendal Thomas , Thomsen Kristine Sloth , Mechlenburg Inger , Mikkelsen Lone Ramer , Overgaard Søren , Ingwersen Kim Gordon , Myburgh Cornelius
Published: April 2023

Objective

To explore patient, clinician and decision-maker perceptions on a clinical trial evaluating the effectiveness of total hip arthroplasty (THA) compared with exercise to inform the trial protocol.

Design

This is an exploratory qualitative case study using a constructivist paradigm.

Setting and participants

Participants were enrolled into three key stakeholder groups: patients eligible for THA, clinicians, and decision makers. Focus group interviews were conducted in undisturbed conference rooms at two hospitals in Denmark, according to group status using semi-structured interview guides.

Analysis

Interviews were recorded, transcribed verbatim and thematic analysed using an inductive approach.

Results

We conducted 4 focus group interviews with 14 patients, 1 focus group interview with 4 clinicians (2 orthopaedic surgeons and 2 physiotherapists) and 1 focus group interview with 4 decision-makers. Two main themes were generated. ‘Treatment expectations and beliefs impact management choices’ covered three supporting codes: Treatment without surgery is unlikely to lead to recovery; Clinician authority impacts the management narrative; The ‘surgery vs exercise’ debate. ‘Factors influencing clinical trial integrity and feasibility’ highlighted three supporting codes: Who is considered eligible for surgery?; Facilitators and barriers for surgery and exercise in a clinical trial context; Improvements in hip pain and hip function are the most important outcomes.

Conclusions

Based on key stakeholder treatment expectations and beliefs, we implemented three main strategies to improve the methodological rigorousness of our trial protocol. First, we added an observational study investigating the generalisability to address a potential low enrolment rate. Second, we developed an enrolment procedure using generic guidance and balanced narrative conveyed by an independent clinician to facilitate communication of clinical equipoise. Third, we adopted change in hip pain and function as the primary outcome. These findings highlight the value of patient and public involvement in the development of trial protocols to reduce bias in comparative clinical trials evaluating surgical and non-surgical management.

Trial registration number

NCT04070027(pre-results).
The SEE-IT Trial: emergency medical servicesStreamingEnabledEvaluationInTrauma: study protocol for an interventional feasibility randomised controlled trial
Authors: Ollis Lucie , Skene Simon S , Williams Julia , Lyon Richard , Taylor Cath
Published: April 2023

Introduction

Accurate and timely dispatch of emergency medical services (EMS) is vital due to limited resources and patients’ risk of mortality and morbidity increasing with time. Currently, most UK emergency operations centres (EOCs) rely on audio calls and accurate descriptions of the incident and patients’ injuries from lay 999 callers. If dispatchers in the EOCs could see the scene via live video streaming from the caller’s smartphone, this may enhance their decision making and enable quicker and more accurate dispatch of EMS. The main aim of this feasibility randomised controlled trial (RCT) is to assess the feasibility of conducting a definitive RCT to assess the clinical and cost effectiveness of using live streaming to improve targeting of EMS.

Methods and analysis

The SEE-IT Trial is a feasibility RCT with a nested process evaluation. The study also has two observational substudies: (1) in an EOC that routinely uses live streaming to assess the acceptability and feasibility of live streaming in a diverse inner-city population and (2) in an EOC that does not currently use live streaming to act as a comparator site regarding the psychological well-being of EOC staff using versus not using live streaming.

Ethics and dissemination

The study was approved by the Health Research Authority on 23 March 2022 (ref: 21/LO/0912), which included NHS Confidentiality Advisory Group approval received on 22 March 2022 (ref: 22/CAG/0003). This manuscript refers to V.0.8 of the protocol (7 November 2022). The trial is registered with the ISRCTN (ISRCTN11449333). The first participant was recruited on 18 June 2022.

The main output of this feasibility trial will be the knowledge gained to help inform the development of a large multicentre RCT to evaluate the clinical and cost effectiveness of the use of live streaming to aid EMS dispatch for trauma incidents.

Trial registration number

ISRCTN11449333.
Widening educational inequalities in mortality in more recent birth cohorts: a study of 14 European countries
Authors: Long Di , Mackenbach Johan P , Klokgieters Silvia , Kalėdienė Ramunė , Deboosere Patrick , Martikainen Pekka , Heggebø Kristian , Leinsalu Mall , Bopp Matthias , Brønnum-Hansen Henrik , Costa Giuseppe , Eikemo Terje , Nusselder Wilma J
Published: April 2023

Background

Studies of period changes in educational inequalities in mortality have shown important changes over time. It is unknown whether a birth cohort perspective paints the same picture. We compared changes in inequalities in mortality between a period and cohort perspective and explored mortality trends among low-educated and high-educated birth cohorts.

Data and methods

In 14 European countries, we collected and harmonised all-cause and cause-specific mortality data by education for adults aged 30–79 years in the period 1971–2015. Data reordered by birth cohort cover persons born between 1902 and 1976. Using direct standardisation, we calculated comparative mortality figures and resulting absolute and relative inequalities in mortality between low educated and high educated by birth cohort, sex and period.

Results

Using a period perspective, absolute educational inequalities in mortality were generally stable or declining, and relative inequalities were mostly increasing. Using a cohort perspective, both absolute and relative inequalities increased in recent birth cohorts in several countries, especially among women. Mortality generally decreased across successive birth cohorts among the high educated, driven by mortality decreases from all causes, with the strongest reductions for cardiovascular disease mortality. Among the low educated, mortality stabilised or increased in cohorts born since the 1930s in particular for mortality from cardiovascular diseases, lung cancer, chronic obstructive pulmonary disease and alcohol-related causes.

Conclusions

Trends in mortality inequalities by birth cohort are less favourable than by calendar period. In many European countries, trends among more recently born generations are worrying. If current trends among younger birth cohorts persist, educational inequalities in mortality may further widen.
High tumor mutational burden predicts favorable response to anti-PD-(L)1 therapy in patients with solid tumor: a real-world pan-tumor analysis
Authors: Jung Jaeyun , Heo You Jeong , Park Sehhoon
Published: April 2023

Background

Tumor mutation burden (TMB) is an important biomarker to predict response to anti-PD-L1 treatment across cancer types. TruSight Oncology 500 (TSO500) is currently used globally as a routine assay for TMB.

Methods

Between 2019 and 2021, 1744 patients with cancer received TSO500 assay as part of a real-world clinical practice at the Samsung Medical Center, and 426 received anti-PD-(L)1 treatment. Correlations between TMB and clinical outcomes of anti-PD-(L)1 were analyzed. Digital spatial profiling (DSP) was used to investigate the tumor immune environment’s influence on the treatment response to anti-PD-(L)1 in high TMB (TMB-H) patients (n=8).

Results

The incidence of TMB-H (≥10 mutations (mt)/megabase (Mb)) was 14.7% (n=257). Among TMB-H patients, the most common cancer type was colorectal cancer (n=108, 42.0%), followed by gastric cancer (GC; n=49, 19.1%), bladder cancer (n=21, 8.2%), cholangiocarcinoma (n=21, 8.2%), non-small cell lung cancer (n=17, 6.6%), melanoma (n=8, 3.1%), gallbladder cancer (GBC; n=7, 2.7%), and others (n=26, 10.1%). The response rate to anti-PD-(L)1 therapy was substantially higher in GC (71.4% vs 25.8%), GBC (50.0% vs 12.5%), head and neck cancer (50.0% vs 11.1%), and melanoma (71.4% vs 50.7%) among TMB-H patients when compared with low TMB (TMB-L) (<10 mt/Mb) patients with statistical significance. Additional analysis of patients with TMB ≥16 mt/Mb demonstrated prolonged survival after anti-PD-(L)1 therapy compared with patients with TMB-L (not reached vs 418 days, p=0.03). The benefit of TMB ≥16 mt/Mb was greater when combined with microsatellite status and PD-L1 expression profiles. Among the TMB-H patients, those who responded to anti-PD-L1 therapy had numerous active immune cells that infiltrated the tumor regions during the DSP analysis. Natural killer cells (p=0.04), cytotoxic T cells (p<0.01), memory T cells (p<0.01), naïve memory T cells (p<0.01), and proteins related to T-cell proliferation (p<0.01) were observed in a responder group compared with a non-responder group. In contrast, exhausted T-cell and M2 macrophage counts were increased in the non-responder group.

Conclusions

The overall incidence of TMB status was analyzed by the TSO500 assay, and TMB-H was observed in 14.7% of the pan-cancer population. In a real-world setting, TMB-H identified by a target sequencing panel seemed to predict response to anti-PD-(L)1 therapy, especially in patients with a higher proportion of immune cells enriched in the tumor region.