bluuebunny/crossref_metadata_2025 huggingface dataset:
Ollo de Sapo Cambro‐Ordovician volcanics from the Central Iberian basement—A multiphase evolution
Authors: von Raumer Jürgen F. , Stampfli Gérard M.
Published: July 2018

The Cambro‐Ordovician rhyodacitic to dacitic volcanics from the Central Iberian basement, currently known as Ollo de Sapo (toads eye), have been reported as a specific group of felsic porphyritic rocks with blue quartz and large phenocrysts of K‐feldspar, in a partly vitreous or fine‐grained matrix. Interpreted to form Cambro‐Ordovician volcanic domes, they are accompanied by tuffs, ignimbrites and products of reworking in a near‐surface environment. The coarse‐ to fine‐grained rocks exhibit rather large K‐feldspar phenocrysts, plagioclase and rounded blue quartz, representing former corroded phenocrysts. Their colouration indicates unmixing of TiO2 at around 900°C during cooling from relatively high crystallisation temperatures, indicating their origin at hot lower crustal conditions. We propose at least a two‐step evolution (1) starting around 495 Ma in the lower crust of a collapsing cordillera, generating a phenocryst‐rich mush and adiabatic melting of the lower crustal protolith to produce the spectacular Ollo de Sapo porphyrites, before (2) magma ascent and crustal extension leading to a different thermal regime around 483 Ma.
Sporotrichosis in Southern Brazil, towards an epidemic?
Authors: Poester Vanice Rodrigues , Mattei Antonella Souza , Madrid Isabel Martins , Pereira Juliana Tavora Bertazo , Klafke Gabriel Baracy , Sanchotene Karine Ortiz , Brandolt Tchana Martinez , Xavier Melissa Orzechowski
Published: July 2018

Rio Grande do Sul (RS) is the second highest state with respect to sporotrichosis incidence in Brazil, with most cases occurring in the southern region. Given the importance of epidemiologic monitoring in hyperendemic areas, this study evaluated the spatial, geographical and annual sporotrichosis incidence over a period of 7 years in the southern region of RS, as well as the disease evolution over the last two decades. Data were collected from the Mycology Laboratory of the Federal University of Rio Grande (FAMED‐FURG) and from the Centre for Zoonosis Control (CZC) of the Prefeitura Municipal of Pelotas city. All feline cases of sporotrichosis diagnosed between 2010 and 2016 were included and analysed. In addition, cases of human and canine sporotrichosis were accounted for. Over the 7‐year period (2010–2016), 372 feline, 34 canine and 83 human cases of sporotrichosis were diagnosed, being the mean number of cases/year 18.33 in the first 3 years of the study and 116.33 in the last 3 years. Cases were distributed among 34 and 28 neighbourhoods in Rio Grande and Pelotas city, respectively. Socioeconomic features reinforced the result that the disease is already spreading across a major part of the southern region. In addition, the study demonstrated the intensification and expansion of the high endemicity areas. Therefore, given that the number of feline sporotrichosis cases in southern RS reached alarming proportions, we suggested that this region will promptly face an epidemic of sporotrichosis if no preventive or control measures are undertaken.
Titi monkey biogeography: Parallel Pleistocene spread byPlecturocebusandCheracebusinto a post‐Pebas Western Amazon
Authors: Byrne Hazel , Lynch Alfaro Jessica W. , Sampaio Iracilda , Farias Izeni , Schneider Horacio , Hrbek Tomas , Boubli Jean P.
Published: July 2018

Titi monkeys, subfamily Callicebinae, are a diverse, species‐rich group of Neotropical primates with an extensive range across South America. Their distribution in space and time makes them an interesting primate model for addressing questions of Neotropical historical biogeography. Our aim was to reconstruct the biogeographic history of Callicebinae to better understand their diversification patterns and the history of their colonisation of South America since the late Miocene. We reconstructed a time‐calibrated phylogeny of 19 titi species under Bayesian inference using two mitochondrial and 11 nuclear loci. Species were assigned across eight Neotropical areas of endemism, and statistical biogeographic methods implemented in BioGeoBEARSwere employed to estimate ancestral areas using 12 biogeographic models. Our results indicate that the most recent common ancestor to extant titi monkeys was widespread from the present‐day Andean foothills in the Colombian Amazon, through the wet and dry savannas of Bolivia and Brazil, to the southern Atlantic forest of eastern Brazil. Genus‐level divergences were characterised by vicariance of ancestral range in the late Miocene. Species‐level diversification inCheracebusand thePlecturocebus molochgroup occurred as they spread across the Amazon in the Pleistocene and were largely characterised by a sequential, long‐distance “island‐hopping” dispersal model of speciation from a narrow area of origin through jump dispersal across rivers. This study comprises the first large‐scale investigation of the evolutionary history of titi monkeys in the context of Amazonian and South American historical biogeography and sheds light on the processes that generated the great diversity found among Callicebinae.
Endocrine Effects of Relative Energy Deficiency in Sport
Authors: Elliott-Sale Kirsty J. , Tenforde Adam S. , Parziale Allyson L. , Holtzman Bryan , Ackerman Kathryn E.
Published: July 2018

The term Relative Energy Deficiency in Sport was introduced by the International Olympic Committee in 2014. It refers to the potential health and performance consequences of inadequate energy for sport, emphasizing that there are consequences of low energy availability (EA; typically defined as <30 kcal·kg−1 fat-free mass·day−1) beyond the important and well-established female athlete triad, and that low EA affects populations other than women. As the prevalence and consequences of Relative Energy Deficiency in Sport become more apparent, it is important to understand the current knowledge of the hormonal changes that occur with decreased EA. This paper highlights endocrine changes that have been observed in female and male athletes with low EA. Where studies are not available in athletes, results of studies in low EA states, such as anorexia nervosa, are included. Dietary intake/appetite-regulating hormones, insulin and other glucose-regulating hormones, growth hormone and insulin-like growth factor 1, thyroid hormones, cortisol, and gonadal hormones are all discussed. The effects of low EA on body composition, metabolic rate, and bone in female and male athletes are presented, and we identify future directions to address knowledge gaps specific to athletes.
Intraobserver and Interobserver Reliability of a Method to Measure Ankle Plantar-Flexion Range of Motion in the Hook-Lying Position
Authors: Nunes Guilherme S. , Bayer Gabriela S. , da Costa Leticia M.R. , de Noronha Marcos
Published: July 2018

Context: Physical therapists often have to measure ankle range of motion (ROM) to decide on intervention and investigate improvements. The most common method of measurement is goniometry, but it has been questioned due to its unsatisfactory levels of reliability. Objective: To investigate the intraobserver and interobserver reliability of a new method of measuring plantar-flexion ROM. Design: Prospective and descriptive. Setting: Laboratory. Participants: 20 healthy participants (12 women and 8 men). Main Outcome Measurements: Ankle plantar flexion was measured by 3 observers (A, B, and C) with 3 methods (goniometry, measurement in hook-lying position [MHP], and static-image analysis [SIA]). Observer A was the most experienced therapist, and C, the least. MHP was performed with the participant in the supine position, knees flexed, and first and fifth metatarsals in contact with the treatment table. SIA was recorded and analyzed in the same position. Goniometry was performed with participant seated, lower legs unsupported, and axis positioned on the lateral malleolus. Results: For the interobserver analysis, the ICC2,1 was high for the MHP (.88), high for SIA (.87), and moderate for goniometry (.57). For the intraobserver analysis, the ICC2,1 was high or very high for MHP (.91-.92), high for SIA (.79-.83), and low to moderate for goniometry (.18-.60). Conclusion: MHP is inexpensive, fast, and more reliable than goniometry for measuring plantar-flexion ROM.
Aquatic-Treadmill Walking: Quantifying Drag Force and Energy Expenditure
Authors: Bressel Eadric , Smith Gerald , Miller Andrew , Dolny Dennis
Published: July 2018

Context: Quantification of the magnitudes of fluid resistance provided by water jets (currents) and their effect on energy expenditure during aquatic-treadmill walking is lacking in the scientific literature. Objective: To quantify the effect of water-jet intensity on jet velocity, drag force, and oxygen uptake (VO2) during aquatic-treadmill walking. Design: Descriptive and repeated measures. Setting: Athletic training facility. Participants, Interventions, and Measures: Water-jet velocities were measured using an electromagnetic flow meter at 9 different jet intensities (0-80% maximum). Drag forces on 3 healthy subjects with a range of frontal areas (600, 880, and 1250 cm2) were measured at each jet intensity with a force transducer and line attached to the subject, who was suspended in water. Five healthy participants (age 37.2 ± 11.3 y, weight 611 ± 96 N) subsequently walked (~1.03 m/s or 2.3 miles/h) on an aquatic treadmill at the 9 different jet intensities while expired gases were collected to estimate VO2. Results: For the range of jet intensities, water-jet velocities and drag forces were 0-1.2 m/s and 0-47 N, respectively. VO2 increased nonlinearly, with values ranging from 11.4 ± 1.0 to 22.2 ± 3.8 mL × kg-1 × min-1 for 0-80% of jet maximum, respectively. Conclusions: This study presented methodology for quantifying water-jet flow velocities and drag forces in an aquatic-treadmill environment and examined how different jet intensities influenced VO2 during walking. Quantification of these variables provides a fundamental understanding of aquatic-jet use and its effect on VO2. In practice, these results indicate that VO2 may be substantially increased on an aquatic treadmill while maintaining a relatively slow walking speed.
Reliability of Measurement of Maximal Isometric Lateral Trunk-Flexion Strength in Athletes Using Handheld Dynamometry
Authors: Newman Bram L. , Pollock Courtney L. , Hunt Michael A.
Published: July 2018

Context: Lateral trunk-flexion strength is an important determinant of overall trunk stability and function, but the reliability in measuring this outcome clinically in athletic individuals is not known. Objective: To determine the interrater and intrarater reliability of lateral trunk-flexion strength measurement in athletic individuals using handheld dynamometry. Design: Reliability study. Setting: Research laboratory. Participants: 12 healthy, athletic individuals. Intervention: Lateral trunk-flexion strength was measured using handheld dynamometry across 2 different trunk placements (lateral aspect of the axilla and laterally at the level of the midtrunk) and 2 testing occasions by 2 therapists. Three maximum-effort trials during a "make test" at each placement were completed for each therapist on both occasions. Main Outcome Measures: Maximum force output was identified and converted to a torque. Intraclass correlation coefficients (ICC2,1) were calculated for each dynamometer placement, therapist, and test occasion to determine intrarater and interrater reliability. Results: Intrarater reliability was moderate to good (ICC2,1 = .53-.77), while interrater reliability was good to very good (ICC2,1 = .79-81) at the axilla position. For the midtrunk position, intrarater reliability was good to very good (ICC2,1 = .80-.86), while interrater reliability was good on both days (ICC2,1 = .87-.88). Finally, the standard errors of measurement were low for the axilla position (0.20 Nm/kg; 95% CI .15, .28) and midtrunk position (0.09 Nm/kg; 95% CI .07, .12). Conclusions: Maximum lateral trunk-flexion strength can be reliably measured in athletic individuals with greater overall strength. Based on the 2 positions used in this study, measurement with a dynamometer placement at the midtrunk may be more reliable than that obtained at the axilla.
Physical Literacy and Human Flourishing
Authors: Durden-Myers Elizabeth J. , Whitehead Margaret E. , Pot Niek
Published: July 2018

This article explores the relationship between physical literacy and human flourishing. Understanding the contribution physical literacy may have in nurturing human flourishing extends the philosophical rationale and importance of physical literacy in relation to maximizing human potential. This article proposes that the concept of physical literacy is being embraced worldwide, in part due to the contribution physical literacy may make in nurturing human flourishing. Therefore, this article discusses the relationship between physical literacy and human flourishing in detail, unveiling what value this connection may hold in promoting physical literacy as an element integral in enhancing quality of life. Aspects of human flourishing are presented and examined alongside physical literacy. Synergies between physical literacy and human flourishing are not hard to find, and this gives credence to the growing adoption of physical literacy as a valuable human capability.
Middle East Respiratory Syndrome Coronavirus Spike Protein Is Not Activated Directly by Cellular Furin during Viral Entry into Target Cells
Authors: Matsuyama Shutoku , Shirato Kazuya , Kawase Miyuki , Terada Yutaka , Kawachi Kengo , Fukushi Shuetsu , Kamitani Wataru
Published: July 2018

Previous studies using the furin inhibitor dec-RVKR-CMK suggest that MERS-CoV utilizes a cellular protease, furin, to activate viral glycoproteins during cell entry. However, we found that dec-RVKR-CMK inhibits not only furin but also other proteases. Furthermore, we found no evidence that MERS-CoV uses furin. These findings suggest that previous studies in the virology field based on dec-RVKR-CMK should be reexamined carefully. Here we describe appropriate experiments that can be used to assess the effect of protease inhibitors on virus cell entry.
Growth-Adaptive Mutations in the Ebola Virus Makona Glycoprotein Alter Different Steps in the Virus Entry Pathway
Authors: Ruedas John B. , Arnold Catherine E. , Palacios Gustavo , Connor John H.
Published: July 2018

Zaire ebolavirus
(EBOV) is the causative agent of the highly lethal Ebola virus disease and poses a significant threat to the global health community. Approved antivirals against EBOV are lacking; however, promising therapies targeting the EBOV glycoprotein are being developed. Efficacy testing of these candidate therapeutics relies on EBOV laboratory stocks, which when grown in tissue culture may acquire mutations in the glycoprotein. These mutations can produce inaccurate results in therapeutic testing. Until recently, distinguishing between tissue culture mutations and naturally occurring polymorphisms in EBOV GP was difficult in the absence of consensus clinical GP sequences. Here, we utilize recombinant VSV (rVSV) pseudotyped with the consensus clinical EBOV Makona GP to identify several mutations that have emerged or have potential to emerge in EBOV GP during tissue culture passage. Identifying these mutations informs the EBOV research community as to which mutations may arise during preparation of laboratory virus stocks.
A Xenobiotic Detoxification Pathway through Transcriptional Regulation in Filamentous Fungi
Authors: Sang Hyunkyu , Hulvey Jonathan P. , Green Robert , Xu Hao , Im Jeongdae , Chang Taehyun , Jung Geunhwa
Published: July 2018

Fungi are known to utilize transcriptional regulation of genes that encode efflux transporters to detoxify xenobiotics; however, to date it is unknown how fungi transcriptionally regulate and coordinate different phases of detoxification system (phase I, modification; phase II, conjugation; and phase III, secretion). Here we present evidence of an evolutionary convergence between the fungal and mammalian lineages, whereby xenobiotic detoxification genes (phase I coding for cytochrome P450 monooxygenases [CYP450s] and phase III coding for ATP-binding cassette [ABC] efflux transporters) are transcriptionally regulated by structurally unrelated proteins. Following next-generation RNA sequencing (RNA-seq) analyses of a filamentous fungus,
Sclerotinia homoeocarpa
, the causal agent of dollar spot on turfgrasses, a multidrug resistant (MDR) field strain was found to overexpress phase I and III genes, coding for CYP450s and ABC transporters for xenobiotic detoxification. Furthermore, there was confirmation of a gain-of-function mutation of the fungus-specific transcription factor
S. homoeocarpa
XDR1 (ShXDR1), which is responsible for constitutive and induced overexpression of the phase I and III genes, resulting in resistance to multiple classes of fungicidal chemicals. This fungal pathogen detoxifies xenobiotics through coordinated transcriptional control of CYP450s, biotransforming xenobiotics with different substrate specificities and ABC transporters, excreting a broad spectrum of xenobiotics or biotransformed metabolites. A
Botrytis cinerea
strain harboring the mutated ShXDR1 showed increased expression of phase I (
BcCYP65
) and III (
BcatrD
) genes, resulting in resistance to fungicides. This indicates the regulatory system is conserved in filamentous fungi. This molecular genetic mechanism for xenobiotic detoxification in fungi holds potential for facilitating discovery of new antifungal drugs and further studies of convergent and divergent evolution of xenobiotic detoxification in eukaryote lineages.

IMPORTANCE
Emerging multidrug resistance (MDR) in pathogenic filamentous fungi is a significant threat to human health and agricultural production. Understanding mechanisms of MDR is essential to combating fungal pathogens; however, there is still limited information on MDR mechanisms conferred by xenobiotic detoxification. Here, we report for the first time that overexpression of phase I drug-metabolizing monooxygenases (cytochrome P450s) and phase III ATP-binding cassette efflux transporters is regulated by a gain-of-function mutation in the fungus-specific transcription factor in the MDR strains of the filamentous plant-pathogenic fungus
Sclerotinia homoeocarpa
. This study establishes a novel molecular mechanism of MDR through the xenobiotic detoxification pathway in filamentous fungi, which may facilitate the discovery of new antifungal drugs to control pathogenic fungi.
Phagocytes from Mice Lacking the Sts Phosphatases Have an Enhanced Antifungal Response to Candida albicans
Authors: Frank David , Naseem Shamoon , Russo Gian Luigi , Li Cindy , Parashar Kaustubh , Konopka James B. , Carpino Nick
Published: July 2018

Mice lacking expression of the homologous phosphatases Sts-1 and Sts-2 (Sts−/−mice) are resistant to disseminated candidiasis caused by the fungal pathogenCandida albicans. To better understand the immunological mechanisms underlying the enhanced resistance of Sts−/−mice, we examined the kinetics of fungal clearance at early time points. In contrast to the rapidC. albicansgrowth seen in normal kidneys during the first 24 h postinfection, we observed a reduction in kidney fungal CFU within Sts−/−mice beginning at 12 to 18 h postinfection. This corresponds to the time period when large numbers of innate leukocytes enter the renal environment to counter the infection. Because phagocytes of the innate immune system are important for host protection against pathogenic fungi, we evaluated responses of bone marrow leukocytes. Relative to wild-type cells, Sts−/−marrow monocytes and bone marrow-derived dendritic cells (BMDCs) displayed a heightened ability to inhibitC. albicansgrowthex vivo. This correlated with significantly enhanced production of reactive oxygen species (ROS) by Sts−/−BMDCs downstream of Dectin-1, a C-type lectin receptor that plays a critical role in stimulating host responses to fungi. We observed no visible differences in the responses of other antifungal effector pathways, including cytokine production and inflammasome activation, despite enhanced activation of the Syk tyrosine kinase downstream of Dectin-1 in Sts−/−cells. Our results highlight a novel mechanism regulating the immune response to fungal infections. Further understanding of this regulatory pathway could aid the development of therapeutic approaches to enhance protection against invasive candidiasis.

IMPORTANCESystemic candidiasis caused by fungalCandidaspecies is becoming an increasingly serious medical problem for which current treatment is inadequate. Recently, the Sts phosphatases were established as key regulators of the host antifungal immune response. In particular, genetic inactivation of Sts significantly enhanced survival of mice infected intravenously withCandida albicans. The Sts−/−in vivoresistance phenotype is associated with reduced fungal burden and an absence of inflammatory lesions. To understand the underlying mechanisms, we studied phagocyte responses. Here, we demonstrate that Sts−/−phagocytes have heightened responsiveness toC. albicanschallenge relative to wild-type cells. Our data indicate the Sts proteins negatively regulate phagocyte activation via regulating selective elements of the Dectin-1–Syk tyrosine kinase signaling axis. These results suggest that phagocytes lacking Sts respond to fungal challenge more effectively and that this enhanced responsiveness partially underlies the profound resistance of Sts−/−mice to systemic fungal challenge.
Cross-Regulation between Bacteria and Phages at a Posttranscriptional Level
Authors: Altuvia Shoshy , Storz Gisela , Papenfort Kai
Published: July 2018

The study of bacteriophages (phages) and prophages has provided key insights into almost every cellular process as well as led to the discovery of unexpected new mechanisms and the development of valuable tools. This is exemplified for RNA-based regulation. For instance, the characterization and exploitation of the antiphage CRISPR (clustered regularly interspaced short palindromic repeat) systems is revolutionizing molecular biology. Phage-encoded proteins such as the RNA-binding MS2 protein, which is broadly used to isolate tagged RNAs, also have been developed as valuable tools. Hfq, the RNA chaperone protein central to the function of many base-pairing small RNAs (sRNAs), was first characterized as a bacterial host factor required for Qβ phage replication. The ongoing studies of RNAs are continuing to reveal regulatory connections between infecting phages, prophages, and bacteria and to provide novel insights. There are bacterial and prophage sRNAs that regulate prophage genes, which impact bacterial virulence as well as bacterial cell killing. Conversely, phage- and prophage-encoded sRNAs modulate the expression of bacterial genes modifying metabolism. An interesting subcategory of the prophage-encoded sRNAs are sponge RNAs that inhibit the activities of bacterial-encoded sRNAs. Phages also affect posttranscriptional regulation in bacteria through proteins that inhibit or alter the activities of key bacterial proteins involved in posttranscriptional regulation. However, what is most exciting about phage and prophage research, given the millions of phage-encoded genes that have not yet been characterized, is the vast potential for discovering new RNA regulators and novel mechanisms and for gaining insight into the evolution of regulatory RNAs.
Avoidable mortality from respiratory tract infection and sudden unexplained death in children with chronic conditions: a data linkage study
Authors: Verfürden Maximiliane L , Gilbert Ruth , Sebire Neil , Hardelid Pia
Published: July 2018

Objective

To determine the risk of death from two potentially avoidable causes with different aetiologies: respiratory tract infection (RTI) and sudden unexplained death (SUD) in children with and without chronic conditions.

Design

Whole-country, birth cohort study using linked administrative health databases from Scotland.

Setting and participants

Children aged 2 months to less than 5 years in Scotland between 2000 and 2014.

Main outcome measures

Relative risk of death (expressed as the HR) related to RTIs or SUD, in children with and without chronic conditions. We separately analysed deaths at ages 2–11 months and at 1–4 years and adjusted for birth characteristics, socioeconomic status and vaccination uptake using Cox regression.

Results

The cohort comprised 761 172 children. Chronic conditions were recorded in 9.6% (n=72 901) of live births, 82.4% (n=173) of RTI-related deaths and 17.4% (n=49) of SUDs. Chronic conditions were very strongly associated with RTI mortality (2–11 months: HR 68.48, 95% CI (40.57 to 115.60), 1–4 years: HR 38.32, 95% CI (23.26 to 63.14)) and strongly associated with SUD (2–11 months: HR 2.42, 95% CI (1.67 to 3.63), 1–4 years: HR 2.53, 95% CI (1.36 to 4.71)).

Conclusions

The very strong association with chronic conditions suggests that RTI-related mortality may sometimes be a consequence of a terminal decline and not possible to defer or prevent in all cases. Recording whether death was expected on death certificates could indicate which RTI-related deaths might be avoidable through healthcare and public health measures.
Risk factors for refractory anastomotic strictures after oesophageal atresia repair: a multicentre study
Authors: Vergouwe Floor W T , Vlot John , IJsselstijn Hanneke , Spaander Manon C W , van Rosmalen Joost , Oomen Matthijs W N , Hulscher Jan B F , Dirix Marc , Bruno Marco J , Schurink Maarten , Wijnen René M H
Published: July 2018

Objective

To determine the incidence of refractory anastomotic strictures after oesophageal atresia (OA) repair and to identify risk factors associated with refractory strictures.

Methods

Retrospective national multicentre study in patients with OA born between 1999 and 2013. Exclusion criteria were isolated fistula, inability to obtain oesophageal continuity, death prior to discharge and follow-up <6 months. A refractory oesophageal stricture was defined as an anastomotic stricture requiring ≥5 dilations at maximally 4-week intervals. Risk factors for development of refractory anastomotic strictures after OA repair were identified with multivariable logistic regression analysis.

Results

We included 454 children (61% male, 7% isolated OA (Gross type A)). End-to-end anastomosis was performed in 436 (96%) children. Anastomotic leakage occurred in 13%. Fifty-eight per cent of children with an end-to-end anastomosis developed an anastomotic stricture, requiring a median of 3 (range 1–34) dilations. Refractory strictures were found in 32/436 (7%) children and required a median of 10 (range 5–34) dilations. Isolated OA (OR 5.7; p=0.012), anastomotic leakage (OR 5.0; p=0.001) and the need for oesophageal dilation ≤28 days after anastomosis (OR 15.9; p<0.001) were risk factors for development of a refractory stricture.

Conclusions

The incidence of refractory strictures of the end-to-end anastomosis in children treated for OA was 7%. Risk factors were isolated OA, anastomotic leakage and the need for oesophageal dilation less than 1 month after OA repair.
Two-thumb-encircling advantageous for lay responder infant CPR: a randomised manikin study
Authors: Pellegrino Jeffrey L , Bogumil David , Epstein Jonathan L , Burke Rita V
Published: July 2018

Objective

Paediatric health providers and educators influence infant mortality through advocacy and training within families and communities. This research sought to establish the efficacy and training of two-finger versus two-thumb-encircling techniques for lone responder infant chest compressions with ventilations in initially trained infant caregivers.

Design

This is a randomised, cross-over educational intervention assessed on instrumented manikins using the 2015 guideline measures of quality infant cardiopulmonary resuscitation (CPR). Additional subjective data on the experience were collected through self-reporting.

Setting

Non-healthcare community organisations and secondary school classrooms.

Participants

Fourteen years or older, fluent in English and had not taken infant CPR in the last 5 years.

Interventions

Groups of eight participants were randomised to learn one technique, practised and then tested for 8 min. After a 30 min rest, the group repeated the process using the other technique.

Main outcome measures

Mean chest compression depth and rate, compression fraction, and correct hand position; tiredness and pain as reported by the caregiver.

Results

The two-thumb-encircling technique achieved a deeper mean compression depth over the 8 min period (2.0 mm, p<0.01), closer to the minimum recommendation of 40 mm; the two-finger technique achieved higher percentages of compression fraction and complete recoil. Caregivers preferred the two-thumb technique (64%), and of these 70% had long fingernails.

Conclusions

The two-thumb-encircling technique improved compression depth, over an 8 min scenario, and was preferred by caregivers. This adds to the existing literature on the advantages of two-thumb-encircling as a technique for lone and team infant CPR, which counters current guidelines.
Patient-rated importance of key information on screening colonoscopy in Germany: a survey of statutory health insurance members
Authors: Dreier Maren , Krueger Kathrin , Walter Ulla
Published: July 2018

Background

Primary colonoscopic screening is considered to be of great benefit but also has the potential to cause severe harm. Thus, eligible subjects should be supported in making an informed choice whether to participate.

Objectives

To identify information on screening colonoscopy that colonoscopy-naïve subjects rate as particularly important for decision making.

Design

Survey of German statutory health insurance members using a written questionnaire in November 2015.

Study population

Colonoscopy-naïve individuals aged 50 to 65 years.

Main outcome measures

Importance of key information about screening colonoscopy, including potential risks and benefits, baseline risk of colorectal cancer/polyps and practical aspects of the procedure, as well as associations between participants’ characteristics and their judgement of information as to being ‘very important’.

Results

Of 1871 respondents (overall response rate: 31%), a subgroup of 370 colonoscopy-naïve subjects was eligible for inclusion (average age: 55 years, 47% male). Information on the risks was rated as very important by most respondents, unimportant by 6%. Information on the benefits was considered unimportant by 26%. Regression analysis showed that less educated persons regarded most items to be more often relevant than highly educated subjects. A greater proportion of women than men rated details regarding pain and practical aspects as very important. Subjects with a low educational level living alone were identified as the group with the least interest in information on risks.

Conclusion

Cultivating awareness around the central meaning of the (quantitative) benefits of screening in informed decision making should be focused on more in future information materials. The high requirement of less educated people to become more informed provides a strong motivation for further efforts to develop evidence-based information that adequately informs this group. Tailoring information according to gender-specific needs may be warranted in light of the observed differences in information preferences between women and men.
Evaluating the impact of a community health worker programme on non-communicable disease, malnutrition, tuberculosis, family planning and antenatal care in Neno, Malawi: protocol for a stepped-wedge, cluster randomised controlled trial
Authors: Dunbar Elizabeth L , Wroe Emily B , Nhlema Basimenye , Kachimanga Chiyembekezo , Gupta Ravi , Taylor Celia , Michaelis Annie , Cundale Katie , Dullie Luckson , Jumbe Arnold , Nazimera Lawrence , McBain Ryan , Lilford Richard J , Watson Samuel Ian
Published: July 2018

Introduction

This protocol concerns the implementation and evaluation of an intervention designed to realign the existing cadre of community health workers (CHWs) in Neno district, Malawi to better support the care needs of the clients they serve. The proposed intervention is a ‘Household Model’ where CHWs will be reassigned to households, rather than to specific patients with HIV and/or tuberculosis (TB).

Methods and analysis

Using a stepped-wedge, cluster-randomised design, this study investigates whether high HIV retention rates can be replicated for non-communicable diseases (NCDs), and the model’s impact on TB and paediatric malnutrition case finding, as well as the uptake of family planning and antenatal care. Eleven sites (health centres and hospitals) were arranged into six clusters (average cluster population 21 800). Primary outcomes include retention in care for HIV and chronic NCDs, TB case finding, paediatric malnutrition case finding, and utilisation of early and complete antenatal care. Clinical outcomes are based on routinely collected data from the Ministry of Health’s District Health Information System 2 and an OpenMRS electronic medical record supported by Partners In Health. Additionally, semistructured qualitative interviews with various stakeholders will assess community perceptions and context of the Household Model.

Ethics and dissemination

Ethics approval has been obtained from the Malawian National Health Science Research Committee (#16/11/1694) in Lilongwe, Malawi; Partners Healthcare Human Research Committee (#2017P000548/PHS) in Somerville, Massachusetts; and the Biomedical and Scientific Research Ethics Sub-Committee (REGO-2017–2060) at the University of Warwick in Coventry, UK. Dissemination will include manuscripts for peer-reviewed publication as well as a full report detailing the findings of the intervention for the Malawian Ministry of Health.

Trial registration number

NCT03106727.

Primary sponsor

Partners In Health | Abwenzi Pa Za Umoyo P.O. Box 56, Neno, Malawi. Protocol Version 4, March 2018.
Importance of clinical educators to research use and suggestions for better efficiency and effectiveness: results of a cross-sectional survey of care aides in Canadian long-term care facilities
Authors: Lo T K T , Hoben Matthias , Norton Peter G , Teare Gary F , Estabrooks Carole A
Published: July 2018

Objective

This study explored the effect of clinical educators as facilitators of research use and how it may be modified by organisational context in the settings.

Design

Cross-sectional observational study.

Setting

A representative sample of 91 residential long-term care (LTC) facilities across Western Canada.

Participants

We used surveys to collect data from the frontline care aides and information about the organisational context of the care units.

Outcome measure and explanatory variables

We assessed research use (the outcome) with the Conceptual Research Utilization (CRU) scale. Explanatory variables in the multiple regression analysis were facilitation, organisational context and the interaction terms. Facilitation was measured by the frequency of contacts between care aides and clinical educator or person who brings new ideas about resident care. Three core organisational context variables were measured using the Alberta Context Tool.

Results

We included data of 3873 care aides from 294 care units in the LTC facilities. We found significant associations between CRU and facilitation, leadership, culture and evaluation. Interactions of facilitation x leadership and facilitation x culture were negative. The coefficient of the facilitation x evaluation term in the regression model was positive (0.019, 95% CI 0.012 to 0.026), suggesting synergistic effects between facilitation and a well-developed process to evaluate care quality using relevant data.

Conclusions

Findings indicate clinical educators are effective facilitators of research use among the care aides, but the effect is modified by organisational context. For greatest impact, managers can direct efforts of the clinical educators to care units where leadership and culture ratings are lowest, but a proficient feedback and evaluation process is in place. This understanding enables managers to deploy clinical educators (a scarce resource in LTC settings) most efficiently.
Smartphone application for preventing depression: study protocol for a workplace randomised controlled trial
Authors: Deady Mark , Johnston David A , Glozier Nick , Milne David , Choi Isabella , Mackinnon Andrew , Mykletun Arnstein , Calvo Rafael A , Gayed Aimee , Bryant Richard , Christensen Helen , Harvey Samuel B
Published: July 2018

Introduction

Depression is the leading cause of life years lost due to disability. Appropriate prevention has the potential to reduce the incidence of new cases of depression, however, traditional prevention approaches face significant scalability issues. Prevention programmes delivered by via smartphone applications provide a potential solution. The workplace is an ideal setting to roll out this form of intervention, particularly among industries that are unlikely to access traditional health initiatives and whose workplace characteristics create accessibility and portability issues. The study aims to evaluate the effectiveness of a smartphone application designed to prevent depression and improve well-being. The effectiveness of the app as a universal, selective and indicated prevention tool will also be evaluated.

Methods and analysis

A multicentre randomised controlled trial, to determine the effectiveness of the intervention compared with an active mood monitoring control in reducing depressive symptoms (primary outcome) and the prevalence of depression at 3 months, with secondary outcomes assessing well-being and work performance. Employees from a range of industries will be invited to participate. Participants with likely current depression at baseline will be excluded. Following baseline assessment, participants, blinded to their allocation, will be randomised to receive one of two versions of the application: headgear (a 30-day mental health intervention) or a control application (mood monitoring for 30 days). Both versions of the app contain a risk calculator to provide a measure of future risk. Analyses will be conducted within an intention-to-treat framework using mixed modelling, with additional analyses conducted to compare the moderating effect of baseline risk level and depression symptom severity on the intervention’s effectiveness.

Ethics and dissemination

The current trial has received ethics approval from the University of New South Wales Human Research Ethics Committee (HC17021). Study results will be disseminated through peer-reviewed journals and conferences.

Trial registration number

ACTRN12617000548336; Results.
Associations between sleep quality and its domains and insufficient physical activity in a large sample of Croatian young adults: a cross-sectional study
Authors: Štefan Lovro , Sporiš Goran , Krističević Tomislav , Knjaz Damir
Published: July 2018

Objectives

The main purpose of the present study was to explore the associations between sleep quality and insufficient physical activity.

Design

Cross-sectional.

Setting

Faculties in Croatia.

Participants

2100 university students (1049 men and 1051 women) aged 18–24 years were recruited.

Primary outcome

To assess the domains of sleep quality (independent variables) and ‘insufficient’ physical activity (dependent variable), we used previously validated Pittsburgh Sleep Quality Index and International Physical Activity questionnaires. Logistic regressions were used to calculate the associations between the sleep quality and ‘insufficient’ physical activity.

Results

When sleep quality domains were entered separately into the model, very bad subjective sleep quality (OR 3.09; 95% CI 1.50 to 6.56), >60 min of sleep latency (OR 2.17; 95% CI 1.39 to 3.39), <7 hours of sleep (OR 1.56; 95% CI 1.24 to 1.96), <65% of habitual sleep efficiency (OR 2.26; 95% CI 1.26 to 4.05), sleep disturbances >1/week (OR 1.61; 95% CI 1.03 to 2.52), use of sleep medication >1/week (OR 3.35; 95% CI 1.83 to 6.10), very big daytime dysfunction problem (OR 2.78; 95% CI 1.57 to 4.93) and poor sleep quality (1.53; 95% CI 1.23 to 1.91) were associated with ‘insufficient’ physical activity. When all sleep quality domains were entered simultaneously into the model, the same significant associations remained, except for sleep disturbances. Both models were adjusted for gender, body mass index, self-rated health, life satisfaction, socioeconomic status, presence or absence of chronic diseases, smoking status, binge drinking and psychological distress.

Conclusions

Our results show that ‘poor’ sleep quality is associated with ‘insufficient’ physical activity in young adults. In order to improve, special strategies and policies that leverage ‘good sleep’ quality are warranted.
Which type of tobacco product warning imagery is more effective and sustainable over time? A longitudinal assessment of smokers in Canada, Australia and Mexico
Authors: Anshari Dien , Yong Hua-Hie , Borland Ron , Hammond David , Swayampakala Kamala , Thrasher Jim
Published: July 2018

Objective

This study examined smokers’ responses to pictorial health warnings (PHWs) with different types of imagery under natural exposure conditions.

Methods

Adult smokers from online panels in Canada (n=2357), Australia (n=1671) and Mexico (n=2537) were surveyed every 4 months from 2012 to 2013. Participants were shown PHWs on packs in their respective countries and asked about: (1) noticing PHWs; (2) negative affects towards PHWs; (3) believability of PHWs; (4) PHW-stimulated discussions; and (5) quit motivation due to PHWs. Country-specific generalised estimating equation models regressed these outcomes on time (ie, survey wave), PHW imagery type (ie, symbolic representations of risk, suffering from smoking and graphic depictions of bodily harm) and interactions between them.

Results

In all countries, PHW responses did not significantly change over time, except for increased noticing PHWs in Canada and Mexico, increased negative affect in Australia and decreased negative affect in Mexico. For all outcomes, symbolic PHWs were rated lower than suffering and graphic PHWs in Canada (the only country with symbolic PHWs). Graphic PHWs were rated higher than suffering PHWs for negative affect (all countries), discussions (Canada) and quit motivation (Australia). Suffering PHWs were rated higher than graphic PHWs for noticing PHWs (Canada), believability (all countries), discussions (AustraliaandMexico) and quit motivation (Mexico). Changes in noticing, believability and discussions varied somewhat by imagery type across countries.

Conclusions

The different PHW imagery appears to have different pathways of influence on adult smokers. Reactions to specific PHWs are similar over 1–2 years, suggesting that wear-out of PHW effects is due to decreased attention rather than the diminishing effectiveness of content.
Use of a safe procedure checklist in the cardiac catheterisation laboratory
Authors: Lindsay Alistair C , Bishop Jeremy , Harron Katie , Davies Simon , Haxby Elizabeth
Published: July 2018

Background

The use of the WHO safe surgery checklist has been shown to reduce morbidity and mortality from surgical procedures. However, whether a WHO-style safe procedure checklist can improve safety in the cardiac catheterisation laboratory (CCL) has not previously been investigated.

Objectives

The authors sought to design and implement a safe procedure checklist suitable for all CCL procedures, and to assess its impact over the course of 1 year.

Methods

In the first 3 months, weekly PDSA cycles (Plan-Do-Study-Act) were used to optimise the design of the checklist through testing and staff feedback, and team briefing sessions were introduced before each procedure list. The impact of the checklist and team briefs was assessed by analysing in-house procedural data subsequently submitted to national audit databases. Staff and patient questionnaires were performed throughout the year.

Results

Introduction of the checklist was associated with a significant reduction of 3 min in average turnaround time (95% CI 25 s to 6 min, p=0.027). Similarly, an initial reduction in patient radiation exposure was recorded (dose area product reduction of 641.5 cGy/cm2; 95% CI 255.9 to 1027.1, p=0.002). The rate of reported complications from all procedures fell significantly from 2.0% in 2012/2013 (95% CI 1.6% to 2.4%) to 0.8% in 2013/2014 (95% CI 0.6% to 1.1%, p≤0.001). Staff climate questionnaires showed that technicians and radiographers gave more positive responses at the end of the study period compared with the beginning (p=0.001).

Conclusions

The use of a team brief and WHO-derived safe procedure checklist in the CCL was associated with decreased radiation exposure, fewer procedural complications, faster turnarounds and improved staff experience.
Formative evaluation of the video reflexive ethnography method, as applied to the physician–nurse dyad
Authors: Manojlovich Milisa , Frankel Richard M , Harrod Molly , Heshmati Alaa , Hofer Timothy , Umberfield Elizabeth , Krein Sarah
Published: July 2018

Background

Despite decades of research and interventions, poor communication between physicians and nurses continues to be a primary contributor to adverse events in the hospital setting and a major challenge to improving patient safety. The lack of progress suggests that it is time to consider alternative approaches with greater potential to identify and improve communication than those used to date. We conducted a formative evaluation to assess the feasibility, acceptability and utility of using video reflexive ethnography (VRE) to examine, and potentially improve, communication between nurses and physicians.

Methods

We begin with a brief description of the institutional review boardapproval process and recruitment activities, then explain how we conducted the formative evaluation by describing (1) the VRE process itself; (2) our assessment of the exposure to the VRE process; and (3) challenges encountered and lessons learnt as a result of the process, along with suggestions for change.

Results

Our formative evaluation demonstrates that it is feasible and acceptable to video-record communication between physicians and nurses during patient care rounds across many units at a large, academic medical centre. The lessons that we learnt helped to identify procedural changes for future projects. We also discuss the broader application of this methodology as a possible strategy for improving other important quality and safety practices in healthcare settings.

Conclusions

The VRE process did generate increased reflection in both nurse and physician participants. Moreover, VRE has utility in assessing communication and, based on the comments of our participants, can serve as an intervention to possibly improve communication, with implications for patient safety.