bluuebunny/crossref_metadata_2025_split huggingface dataset:
Are low and middle-income countries prioritising high-value healthcare interventions?
Authors: Leech Ashley A , Kim David D , Cohen Joshua T , Neumann Peter J 
Published: February 2020

IntroductionSince resources are finite, investing in services that produce the highest health gain ‘return on investment’ is critical. We assessed the extent to which low and middle-income countries (LMIC) have included cost-saving interventions in their national strategic health plans.MethodsWe used the Tufts Medical Center Global Health Cost-Effectiveness Analysis Registry, an open-source database of English-language cost-per-disability-adjusted life year (DALY) studies, to identify analyses published in the last 10 years (2008–2017) of cost-saving health interventions in LMICs. To assess whether countries prioritised cost-saving interventions within their latest national health strategic plans, we identified 10 countries, all in sub-Saharan Africa, with the highest measures on the global burden of disease scale and reviewed their national health priority plans.ResultsWe identified 392 studies (63%) targeting LMICs that reported 3315 cost-per-DALY ratios, of which 207 ratios (6%) represented interventions reported to be cost saving. Over half (53%) of these targeted sub-Saharan Africa. For the 10 countries we investigated in sub-Saharan Africa, 58% (79/137) of cost-saving interventions correspond with priorities identified in country plans. Alignment ranged from 95% (21/22 prioritised cost-saving ratios) in South Africa to 17% (2/12 prioritised cost-saving ratios) in Cameroon. Human papillomavirus vaccination was a noted priority in 70% (7/10) of national health prioritisation plans, while 40% (4/10) of countries explicitly included prenatal serological screening for syphilis. HIV prevention and treatment were stated priorities in most country health plans, whereas 40% (2/5) of countries principally outlined efforts for lymphatic filariasis. From our sample of 45 unique interventions, 36% of interventions (16/45) included costs associated directly with the implementation of the intervention.ConclusionOur findings indicate substantial variation across country and disease area in incorporating economic evidence into national health priority plans in a sample of sub-Saharan African countries. To make health economic data more salient, the authors of cost-effectiveness analyses must do more to reflect implementation costs and other factors that could limit healthcare delivery.
Comprehensive survey among statistical members of medical ethics committees in Germany on their personal impression of completeness and correctness of biostatistical aspects of submitted study protocols
Authors: Rauch Geraldine , Hafermann Lorena , Mansmann Ulrich , Pigeot Iris 
Published: February 2020

ObjectivesTo assess biostatistical quality of study protocols submitted to German medical ethics committees according to personal appraisal of their statistical members.DesignWe conducted a web-based survey among biostatisticians who have been active as members in German medical ethics committees during the past 3 years.SettingThe study population was identified by a comprehensive web search on websites of German medical ethics committees.ParticipantsThe final list comprised 86 eligible persons. In total, 57 (66%) completed the survey.QuestionnaireThe first item checked whether the inclusion criterion was met. The last item assessed satisfaction with the survey. Four items aimed to characterise the medical ethics committee in terms of type and location, one item asked for the urgency of biostatistical training addressed to the medical investigators. The main 2×12 items reported an individual assessment of the quality of biostatistical aspects in the submitted study protocols, while distinguishing studies according to the German Medicines Act (AMG)/German Act on Medical Devices (MPG) and studies non-regulated by these laws.Primary and secondary outcome measuresThe individual assessment of the quality of biostatistical aspects corresponds to the primary objective. Thus, participants were asked to complete the sentence ‘In x% of the submitted study protocols, the following problem occurs’, where 12 different statistical problems were formulated. All other items assess secondary endpoints.ResultsFor all biostatistical aspects, 45 of 49 (91.8%) participants judged the quality of AMG/MPG study protocols much better than that of ‘non-regulated’ studies. The latter are in median affected 20%–60% more often by statistical problems. The highest need for training was reported for sample size calculation, missing values and multiple comparison procedures.ConclusionsBiostatisticians being active in German medical ethics committees classify the biostatistical quality of study protocols as low for ‘non-regulated’ studies, whereas quality is much better for AMG/MPG studies.
Protocol for the process and feasibility evaluations of a new model of primary care service delivery for managing pain and function in patients with knee osteoarthritis (PARTNER) using a mixed methods approach
Authors: Bowden Jocelyn L , Egerton Thorlene , Hinman Rana S , Bennell Kim L , Briggs Andrew M , Bunker Stephen J , Kasza Jessica , French Simon D , Pirotta Marie , Schofield Deborah J , Zwar Nicholas A , Hunter David J 
Published: February 2020

IntroductionThis protocol outlines the rationale, design and methods for the process and feasibility evaluations of the primary care management on knee pain and function in patients with knee osteoarthritis (PARTNER) study. PARTNER is a randomised controlled trial to evaluate a new model of service delivery (the PARTNER model) against ‘usual care’. PARTNER is designed to encourage greater uptake of key evidence-based non-surgical treatments for knee osteoarthritis (OA) in primary care. The intervention supports general practitioners (GPs) to gain an understanding of the best management options available through online professional development. Their patients receive telephone advice and support for OA management by a centralised, multidisciplinary ‘Care Support Team’. We will conduct concurrent process and feasibility evaluations to understand the implementation of this new complex health intervention, identify issues for consideration when interpreting the effectiveness outcomes and develop recommendations for future implementation, cost effectiveness and scalability.Methods and analysisThe UK Medical Research Council Framework for undertaking a process evaluation of complex interventions and the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) frameworks inform the design of these evaluations. We use a mixed-methods approach including analysis of survey data, administrative records, consultation records and semistructured interviews with GPs and their enrolled patients. The analysis will examine fidelity and dose of the intervention, observations of trial setup and implementation and the quality of the care provided. We will also examine details of ‘usual care’. The semistructured interviews will be analysed using thematic and content analysis to draw out themes around implementation and acceptability of the model.Ethics and disseminationThe primary and substudy protocols have been approved by the Human Research Ethics Committee of The University of Sydney (2016/959 and 2019/503). Our findings will be disseminated to national and international partners and stakeholders, who will also assist with wider dissemination of our results across all levels of healthcare. Specific findings will be disseminated via peer-reviewed journals and conferences, and via training for healthcare professionals delivering OA management programmes. This evaluation is crucial to explaining the PARTNER study results, and will be used to determine the feasibility of rolling-out the intervention in an Australian healthcare context.Trial registration numberACTRN12617001595303; Pre-results.
Removal of distal fragments of liquid embolic agents during arteriovenous malformation embolization using the TIGERTRIEVER 13: a technical report
Authors: Ho Faith LY , Chapot René 
Published: February 2020

BackgroundArteriovenous malformations (AVMs) are vascular lesions that may be treated by an endovascular approach using liquid embolic agents but the control of the liquid embolic agent remains poor and a potential complication may be distal migration of embolic material. The TIGERTRIEVER 13 is a new stent retriever designed for stroke thrombectomy and has a version ideal for distal occlusions. We report our experience in the removal of embolic agent which had migrated into the distal vessels using the TIGERTRIEVER during PHIL/Onyx embolization of AVMs.Clinical presentationsThree patients with brain and spinal AVMs underwent endovascular embolization. During trans-arterial embolization of the AVM with PHIL/Onyx, retrograde filling of distal arterial feeders was followed by migration into the normal arterial branches (cortical middle cerebral artery, distal posterior cerebral artery, and anterior spinal artery). This resulted in occlusion or sluggish distal flow in these branches with potential significant neurological deficits. In all three cases, a Headway Duo microcatheter was navigated distally in the occluded vessel beyond the embolic material using a Traxcess microwire. The TIGERTRIEVER 13 was deployed with recanalization of the vessel after a single attempt. In all three patients there were no complications related to the retrieval of embolic agent.ConclusionDistal migrated embolic agents such as PHIL or Onyx can be removed from various arterial vascular territories using stent retrievers dedicated to small vessels.
Evolution of non-flat cosmos via GGPDE f(R) model
Authors: Javed Wajiha , Nawazish Iqra , Shahid Fatima , Irshad Nimra 
Published: February 2020

AbstractThis paper is devoted to explore the cosmic evolution of non-flat Friedmann Robertson Walker universe through generalized ghost pilgrim dark energy model in the background of f(R) gravity. For this purpose, we consider two well known scale factors, i.e., power-law and unified scale factors in terms of red shift parameter. For these scale factors, we reconstruct the given dark energy model in f(R) gravity and determine its stability/instability through squared speed of sound parameter. In order to discuss the behavior of reconstructed and dark energy models, we evaluate well known cosmological parameter such as equation of state parameter along with $$\omega $$ω–$$\omega '$$ω′ plane. In addition to this, we also investigate compatibility of new models with standard cosmological models through state-finder parameters. The density parameter is formulated for both ordinary matter as well as dark energy components and results are compared with Planck 2018 constraints. It is concluded that cosmological parameters reveal consistency with recent observations while the value of density parameter suggested by Planck 2018 is achieved by power-law scale factor in most of the cases as compared to unified scale factor.
Epigenetic Modulation of the Tumor Immune Microenvironment to Potentiate Immune Checkpoint Blockade Therapy
Authors: Menzel Johannes , Black Joshua C. 
Published: February 2020

Abstract

Summary:
Response rates to immune checkpoint blockade (ICB) in KRAS-mutant lung adenocarcinoma remain poor. In this issue of Cancer Discovery, Li and colleagues report an in vivo CRISPR screen of epigenetic regulators of the tumor immune microenvironment that uncovers Asf1a as a tumor-intrinsic suppressor of ICB through suppression of GM-CSF expression.
See related article by Li et al., p. 270.
Cost-Effectiveness of a Multifaceted Quality Improvement Intervention for Acute Ischemic Stroke in China
Authors: Pan Yuesong , Zhang Lei , Li Zixiao , Meng Xia , Wang Yilong , Li Hao , Liu Liping , Wang Yongjun 
Published: February 2020

Background and Purpose—
Multifaceted quality improvement interventions of stroke care have been shown to improve hospital personnel adherence to evidence-based performance measures and subsequent stroke outcomes. This study aimed to evaluate the cost-effectiveness of a multifaceted quality improvement intervention for stroke care in China, the world’s largest low- and middle-income country.

Methods—
A short-term decision tree model and a long-term Markov model were used to analyze the cost-effectiveness of a multifaceted quality improvement intervention for patients with acute ischemic stroke. Outcomes, transition probability, and cost data were obtained from a recent clinical trial and the published literature. The benefit of the intervention was assessed by the costs per quality-adjusted life-years gained in the short- and long-term. One-way and probabilistic sensitivity analyses were performed to assess the uncertainty of the findings.

Results—
Compared with usual care, a multifaceted quality improvement intervention for stroke care was found to be cost-effective in the first year and highly cost-effective from the second year onward. In the long-term, the intervention yielded a lifetime gain of 0.246 quality-adjusted life-years at an additional cost of Chinese Yuan Renminbi 1510 (US $230), resulting in a cost of Chinese Yuan Renminbi 6138 (US $940) per quality-adjusted life-year gained. Probabilistic sensitivity analysis indicated that the intervention was highly cost-effective in 99.9% of the simulation runs at a willingness-to-pay threshold of Chinese Yuan Renminbi 59 700 (1× gross domestic product per capita of China in 2017, US $9200) per quality-adjusted life-year.

Conclusions—
A multifaceted quality improvement intervention for stroke care was highly cost-effective in China. The results of this study may be used as a reference for delivering such interventions in low- and middle-income countries and in underserved areas of high-income countries.
Henry Care, Roger L’ Estrange and the Contested Memory of Erasmus and the Reformation in Restoration England
Authors: Dodds Gregory D. 
Published: February 2020

Abstract
Henry Care and Roger L’ Estrange fought a bitter battle in the public press in Restoration England. Exploring the ways in which each employed the writings and reputation of Desiderius Erasmus provides insight into the deep fault lines dividing English society in the decade from 1678 to 1688. Their divergent uses of Erasmus demonstrate how late-seventeenth-century interpretations of the early sixteenth-century Reformation became critical points of conflict in the most significant political and religious debates of the period. Paying attention to the reception of Erasmus also helps explain how these two bitter enemies eventually joined William Penn in supporting James II’s Indulgence for Liberty of Conscience.
Transcranial direct current stimulation for improving gross motor function in children with cerebral palsy: A systematic review
Authors: Diego Anna Patricia Nicole , Leung Ada WS 
Published: February 2020

Introduction The functional abilities of children with cerebral palsy are often compromised because of limited motor function. Transcranial direct current stimulation is a neuromodulation tool used as an adjunct to other therapeutic modalities to improve gross motor function. This review aimed to examine the quality of evidence and the effectiveness of transcranial direct current stimulation for improving gross motor function in children with cerebral palsy. Method A systematic review was conducted, and eligible studies were critically appraised for methodological quality. Randomised controlled trials were selected to undergo meta-analysis for assessing the effectiveness of transcranial direct current stimulation on clinical outcomes. Results Eight studies, including seven randomised controlled trials, fitted the inclusion criteria. All the randomised controlled trials were rated ‘moderate’ quality based on the grading of recommendations assessment, development and evaluation (GRADE) system. Using meta-analysis, only cadence, an outcome measure of gait variables, demonstrated efficacy of intervention, mean difference 16.57 (10.88, 22.25); I2 = 0%, P = 0.83. Other gross motor and functional outcomes had either inconsistent mean difference or high heterogeneity. Conclusion Overall, the effectiveness of transcranial direct current stimulation as a treatment in children with cerebral palsy remains unclear, and the findings should be interpreted with caution. The quality of evidence was mostly moderate, and more vigorous research incorporating functional outcomes should be conducted to guide clinical practice.
Investigation and Analysis of Undergraduate Nursing Students’ Attitudes Toward Advanced Care Planning and Their Willingness to Implement
Authors: Shi Zheng-Yan , Li Xiao-Ling , Tang Meng-Yan , Peng Yao-Yao 
Published: February 2020

Objective: The purpose of this study is to understand the attitude of undergraduate nursing students toward advanced care planning (ACP) and their willingness to implement ACP and to analyze its influencing factors, so as to provide evidence-based basis for life and death education and ACP-related training in colleges and universities. Methods: A total of 312 nursing undergraduates from a university in Chengdu (China) were surveyed by using general information questionnaire, attitude scale of ACP, and willingness questionnaire to implement ACP. Results: The scores of undergraduate nursing students’ attitude toward ACP were 24.97 ± 2.75, and the scores of total willingness to ACP were 79.26 ± 9.70. Univariate analysis and multivariate linear regression analysis showed that religious belief, grade, family relationship, and family discussion of death were the factors influencing the willingness of nursing students to carry out ACP. Conclusions: The attitude of undergraduate nursing students toward ACP tended to be positive, but their cognition of ACP was misunderstood, and their willingness to implement ACP needed to be improved. To improve the awareness and implementating willingness of undergraduate nursing students to ACP, it was recommended that colleges and universities carried out systematic standardized life and death education courses and ACP-related training.
Gender-specific difference of in-vivo kinematics in patients with unilateral total hip arthroplasty
Authors: Peng Yun , Arauz Paul , Kwon Young-Min 
Published: February 2020

Purpose: Asymmetric gait patterns are known to persist in patients with unilateral total hip arthroplasty (THA). Little is known about the effect of gender on gait asymmetry. This study aimed to determine whether gait asymmetry differs between genders in unilateral THA patients and can be explained by component positioning. Methods: 23 female and 10 male unilateral THA patients were included. Asymmetric hip kinematics during gait and component positioning were quantified using a combined computed tomography-based modelling and dual fluoroscopic imaging system. Multiple regression was performed to examine the unique and mediated contribution of gender to observed gait asymmetry. Results: Female and male patients differed most significantly in frontal plane gait asymmetry ( p = 0.001) and bilateral difference of vertical femoral offset ( p = 0.048). Compared with the native hip, the implanted hip exhibited significantly increased adduction ( p = 0.007) in females but significantly increased abduction ( p = 0.001) in males. The stem head of the implanted hip was more superiorly positioned compared to the native femoral head in female but more inferiorly positioned in male. Gender accounted for 41.5% variance of frontal plane gait asymmetry and was partially mediated by the bilateral difference of vertical femoral offset. Conclusions: Female unilateral THA patients exhibited significantly increased adduction in the implanted hip compared to the native hip, which is partially attributable to a more superiorly positioned femoral stem centre of rotation. The understanding of gender-specific differences of kinematic patterns may benefit female patients through targeted preoperative planning and postoperative rehabilitation.
Genomic and ecological attributes of marine bacteriophages encoding bacterial virulence genes
Authors: Silveira Cynthia B. , Coutinho Felipe H. , Cavalcanti Giselle S. , Benler Sean , Doane Michael P. , Dinsdale Elizabeth A. , Edwards Robert A. , Francini-Filho Ronaldo B. , Thompson Cristiane C. , Luque Antoni , Rohwer Forest L. , Thompson Fabiano 
Published: February 2020

Abstract
Background
Bacteriophages encode genes that modify bacterial functions during infection. The acquisition of phage-encoded virulence genes is a major mechanism for the rise of bacterial pathogens. In coral reefs, high bacterial density and lysogeny has been proposed to exacerbate reef decline through the transfer of phage-encoded virulence genes. However, the functions and distribution of these genes in phage virions on the reef remain unknown.

Results
Here, over 28,000 assembled viral genomes from the free viral community in Atlantic and Pacific Ocean coral reefs were queried against a curated database of virulence genes. The diversity of virulence genes encoded in the viral genomes was tested for relationships with host taxonomy and bacterial density in the environment. These analyses showed that bacterial density predicted the profile of virulence genes encoded by phages. The Shannon diversity of virulence-encoding phages was negatively related with bacterial density, leading to dominance of fewer genes at high bacterial abundances. A statistical learning analysis showed that reefs with high microbial density were enriched in viruses encoding genes enabling bacterial recognition and invasion of metazoan epithelium. Over 60% of phages could not have their hosts identified due to limitations of host prediction tools; for those which hosts were identified, host taxonomy was not an indicator of the presence of virulence genes.

Conclusions
This study described bacterial virulence factors encoded in the genomes of bacteriophages at the community level. The results showed that the increase in microbial densities that occurs during coral reef degradation is associated with a change in the genomic repertoire of bacteriophages, specifically in the diversity and distribution of bacterial virulence genes. This suggests that phages are implicated in the rise of pathogens in disturbed marine ecosystems.