bluuebunny/crossref_metadata_2025_split huggingface dataset:
Update on ventilatory management of extremely preterm infants—A Neonatal Intensive Care Unit perspective
Authors: Schulzke Sven M. , Stoecklin Benjamin 
Published: December 2021

AbstractExtremely preterm infants commonly suffer from respiratory distress syndrome. Ventilatory management of these infants starts from birth and includes decisions such as timing of respiratory support in relation to umbilical cord management, oxygenation targets, and options of positive pressure support. The approach of early intubation and surfactant administration through an endotracheal tube has been challenged in recent years by primary noninvasive respiratory support and newer methods of surfactant administration via thin catheters. Available data comparing the thin catheter method to endotracheal tube and delayed extubation in extremely preterm infants born before 28 weeks of gestation did not show differences in survival free of bronchopulmonary dysplasia. Data from numerous randomized trials comparing conventional ventilation with high‐frequency oscillatory ventilation did not show differences in meaningful outcomes. Among conventional modes of ventilation, there is good evidence to favor volume‐targeted ventilation over pressure‐limited ventilation. The former reduces the combined risk of bronchopulmonary dysplasia or death and several important secondary outcomes without an increase in adverse events. There are no evidence‐based guidelines to set positive end‐expiratory pressure in ventilated preterm infants. Recent research suggests that the forced oscillation technique may help to find the lowest positive end‐expiratory pressure at which lung recruitment is optimal. Benefits and risks of the various modes of noninvasive ventilation depend on the clinical setting, degree of prematurity, severity of lung disease, and competency of staff in treating associated complications. Respiratory care after discharge includes home oxygen therapy, lung function monitoring, weaning from medication started in the neonatal unit, and treatment of asthma‐like symptoms.
Irish Public Health Nursing Services and Home Support Services: governance of older persons’ home care
Authors: McDonald Anne , Frazer Kate , Warters Austin 
Published: December 2021

AbstractObjectiveTo describe experiences of nurses in the Irish Public Health Nursing service working with Home Support Services (HSS) when providing home care for older people.DesignQualitative design. Two of twenty‐four focus groups undertaken in 2018 are examined to report specific experiences of registered nurses.SampleThe first group comprised three Public Health Nurses (PHNs) and two community Registered General Nurses (cRGNs) and the second comprised three PHNs and one cRGN. In total nine nurses participated.MeasurementsFocus group interviews were used to collect data, discussions lasted 60–90 minutes and were audio‐recorded, professionally transcribed verbatim, and anonymised.Results and conclusionsGaps in lines of authority and accountability in day‐to‐day care exist, posing risks to safety. Establishing an enhanced home care model for complex cases and levels of accountability and supervision is critical. Investigating ways of adopting digital solutions to share commissioned home care plans with primary care teams (PCTs) would clarify responsibility and roles and reduce the risks of care left undone. Formally defining the role of commissioned home care agencies in primary care and that which they are expected to play during times of crisis, such as during COVID‐19 pandemic will enhance integrated care and governance.
The function of expert involvement in China's local policy making
Authors: Shen Yongdong , Ieong Meng U. , Zhu Zihang 
Published: December 2021

AbstractPolicy making in authoritarian regimes is assumed to be exclusive. The selective use of experts in China questions that assumption. Through three case studies from Hangzhou, Zhejiang province, we illustrate experts' functions in China. Local policy makers rely on them as science arbiters and to provide policy legitimization, just like their counterparts in the democracies of the Western world. They also have a function we call an “accountability facilitator,” which highlights the uniqueness of expert involvement in China. These cases describe the benefits the Chinese government receives from experts and explain why it is willing to listen to the public in certain circumstances.Related ArticlesBryson, John R., Michael Taylor, and Peter W. Daniels. 2008. “Commercializing ‘Creative’ Expertise: Business and Professional Services and Regional Economic Development in the West Midlands, United Kingdom.” Politics & Policy 36(2): 306–28. https://doi.org/10.1111/j.1747‐1346.2008.00107.xNwalie, Martin Ike. 2019. “Advocacy Coalition Framework and Policy Changes in a Third‐World Country.” Politics & Policy 47(3): 545–68. https://doi.org/10.1111/polp.12302Svallfors, Stefan. 2016. “Out of the Golden Cage: PR and the Career Opportunities of Policy Professionals.” Politics & Policy 44(1): 56–73. https://doi.org/10.1111/polp.12149
BioTherapeutics, Education and Research Foundation position paper: Assessing the competency of clinicians performing maggot therapy
Authors: Sherman Ronald Arlen , Chon Rachell , Armstrong David G. , Bernard Lisa , Contreras‐Ruiz Jose , Fonseca‐Muñoz Alicia , Mendez Sharon , Mumcuoglu Kosta Y. , Niezgoda Jeffrey A. , Rogers Lee C. , Shapiro Charles E. , Tantawi Tarek I. , Tippett Aletha , Vincent Carlos 
Published: December 2021

AbstractIn its mission to optimise the quality of patient care and the level of clinician training within the fields of biotherapy, the BioTherapeutics, Education and Research (BTER) Foundation and its Maggot Therapy Competency Committee identified qualities and achievements assessed to be the minimum standards that health care professionals should attain in order to be deemed competent in maggot therapy. The set of six standards were selected to reflect the same high degree of professionalism that is used by the Accreditation Council of Graduate Medical Education for assessing other medical specialists, but with an emphasis on the principles and practice of maggot therapy. For each domain in which competency is expected, the rationale has been explained, specific competencies have been articulated, and methods for demonstrating or evaluating those competencies have been suggested. Applicable to any clinician applying maggot dressings professionally, these recommendations should assist those who wish to identify, assess, or achieve competency in maggot therapy. Specifically, these six competencies include: (1) knowledge about wound care in general and maggot therapy in particular; (2) skill in general patient care, to a level commensurate with their professional role; (3) ability to communicate effectively with colleagues, patients, and the general public; (4) professional and ethical behaviour; (5) ability to deliver systems‐based health care; (6) incorporation of continuing education and quality improvement into their practice.
Orai1‐ and Orai2‐, but not Orai3‐mediated ICRAC is regulated by intracellular pH
Authors: Rychkov Grigori Y. , Zhou Fiona H. , Adams Melissa K. , Brierley Stuart M. , Ma Linlin , Barritt Greg J. 
Published: December 2021

AbstractThree Orai (Orai1, Orai2, and Orai3) and two stromal interaction molecule (STIM1 and STIM2) mammalian protein homologues constitute major components of the store‐operated Ca2+ entry mechanism. When co‐expressed with STIM1, Orai1, Orai2 and Orai3 form highly selective Ca2+ channels with properties of Ca2+ release‐activated Ca2+ (CRAC) channels. Despite the high level of homology between Orai proteins, CRAC channels formed by different Orai isoforms have distinctive properties, particularly with regards to Ca2+‐dependent inactivation, inhibition/potentiation by 2‐aminoethyl diphenylborinate and sensitivity to reactive oxygen species. This study characterises and compares the regulation of Orai1, Orai2‐ and Orai3‐mediated CRAC current (ICRAC) by intracellular pH (pHi). Using whole‐cell patch clamping of HEK293T cells heterologously expressing Orai and STIM1, we show that ICRAC formed by each Orai homologue has a unique sensitivity to changes in pHi. Orai1‐mediated ICRAC exhibits a strong dependence on pHi of both current amplitude and the kinetics of Ca2+‐dependent inactivation. In contrast, Orai2 amplitude, but not kinetics, depends on pHi, whereas Orai3 shows no dependence on pHi at all. Investigation of different Orai1–Orai3 chimeras suggests that pHi dependence of Orai1 resides in both the N‐terminus and intracellular loop 2, and may also involve pH‐dependent interactions with STIM1.
imageKey points
It has been shown previously that Orai1/stromal interaction molecule 1 (STIM1)‐mediated Ca2+ release‐activated Ca2+ current (ICRAC) is inhibited by intracellular acidification and potentiated by intracellular alkalinisation.
The present study reveals that CRAC channels formed by each of the Orai homologues Orai1, Orai2 and Orai3 has a unique sensitivity to changes in intracellular pH (pHi). The amplitude of Orai2 current is affected by the changes in pHi similarly to the amplitude of Orai1. However, unlike Orai1, fast Ca2+‐dependent inactivation of Orai2 is unaffected by acidic pHi. In contrast to both Orai1 and Orai2, Orai3 is not sensitive to pHi changes.
Domain swapping between Orai1 and Orai3 identified the N‐terminus and intracellular loop 2 as the molecular structures responsible for Orai1 regulation by pHi.
Reduction of ICRAC dependence on pHi seen in a STIM1‐independent Orai1 mutant suggested that some parts of STIM1 are also involved in ICRAC modulation by pHi.
Geographic barriers to establishing a successful hospital referral system in rural Madagascar
Authors: Ihantamalala Felana Angella , Bonds Matthew H , Randriamihaja Mauricianot , Rakotonirina Luc , Herbreteau Vincent , Révillion Christophe , Rakotoarimanana Serge , Cowley Giovanna , Andriatiana Tsirinomen’ny Aina , Mayfield Alishya , Rich Michael L , Rakotonanahary Rado J L , Finnegan Karen E , Ramarson Andriamanolohaja , Razafinjato Benedicte , Ramiandrisoa Bruno , Randrianambinina Andriamihaja , Cordier Laura F , Garchitorena Andres 
Published: December 2021

BackgroundThe provision of emergency and hospital care has become an integral part of the global vision for universal health coverage. To strengthen secondary care systems, we need to accurately understand the time necessary for populations to reach a hospital. The goal of this study was to develop methods that accurately estimate referral and prehospital time for rural districts in low and middle-income countries. We used these estimates to assess how local geography can limit the impact of a strengthened referral programme in a rural district of Madagascar.MethodsWe developed a database containing: travel speed by foot and motorised vehicles in Ifanadiana district; a full mapping of all roads, footpaths and households; and remotely sensed data on terrain, land cover and climatic characteristics. We used this information to calibrate estimates of referral and prehospital time based on the shortest route algorithms and statistical models of local travel speed. We predict the impact on referral numbers of strategies aimed at reducing referral time for underserved populations via generalised linear mixed models.ResultsAbout 10% of the population lived less than 2 hours from the hospital, and more than half lived over 4 hours away, with variable access depending on climatic conditions. Only the four health centres located near the paved road had referral times to the hospital within 1 hour. Referral time remained the main barrier limiting the number of referrals despite health system strengthening efforts. The addition of two new referral centres is estimated to triple the population living within 2 hours from a centre with better emergency care capacity and nearly double the number of expected referrals.ConclusionThis study demonstrates how adapting geographic accessibility modelling methods to local scales can occur through improving the precision of travel time estimates and pairing them with data on health facility use.
Testing a newly developed activity pacing framework for chronic pain/fatigue: a feasibility study
Authors: Antcliff Deborah , Keenan Anne-Maree , Keeley Philip , Woby Steve , McGowan Linda 
Published: December 2021

ObjectivesTo test the feasibility of using a new activity pacing framework to standardise healthcare professionals’ instructions of pacing, and explore whether measures of activity pacing/symptoms detected changes following treatment.DesignSingle-arm, repeated measures study.SettingOne National Health Service (NHS) Pain Service in Northern England, UK.ParticipantsAdult patients with chronic pain/fatigue, including chronic low back pain, chronic widespread pain, fibromyalgia and chronic fatigue syndrome/myalgic encephalomyelitis.InterventionsSix-week rehabilitation programme, standardised using the activity pacing framework.Outcome measuresFeasibility was explored via patients’ recruitment/attrition rates, adherence and satisfaction, and healthcare professionals’ fidelity. Questionnaire data were collected from patients at the start and end of the programme (T1 and T2, respectively) and 3 months’ follow-up (T3). Questionnaires included measures of activity pacing, current/usual pain, physical/mental fatigue, depression, anxiety, self-efficacy, avoidance, physical/mental function and quality of life. Mean changes in activity pacing and symptoms between T1-T2, T2-T3 and T1-T3 were estimated.ResultsOf the 139 eligible patients, 107 patients consented (recruitment rate=77%); 65 patients completed T2 (T1-T2 attrition rate=39%), and 52 patients completed T3 (T1-T3 attrition rate=51%). At T2, patients’ satisfaction ratings averaged 9/10, and 89% attended ≥5 rehabilitation programme sessions. Activity pacing and all symptoms improved between T1 and T2, with smaller improvements maintained at T3.ConclusionThe activity pacing framework was feasible to implement and patients’ ability to pace and manage their symptoms improved. Future work will employ a suitable comparison group and test the framework across wider settings to explore the effects of activity pacing in a randomised controlled trial.Trial registration numberNCT03497585.
Convalescent plasma for treatment of COVID-19: study protocol for an open randomised controlled trial in Sweden
Authors: Dillner Joakim , Ursing Johan 
Published: December 2021

IntroductionAlthough there are many studies on the use of convalescent plasma (CP) for treatment of COVID-19, it is not clear (1) which groups of patients may benefit, (2) what dose of plasma to give, or (3) which antibody levels the plasma should contain. Previous phase I/II studies and literature review suggest that CP should only be given to patients with viraemia, that a daily infusion should be given until the patient becomes virus free and that the neutralising antibody titre should preferably be >1:640Methods and analysisAn open randomised controlled trial enrolling patients with COVID-19, who must be SARS-CoV-2 positive in both airway and blood samples and admitted to a study hospital. Block randomisation 2:1 is to either 200 mL CP (preferably titre ≥1/640) daily for up to 10 days (until virus negative in blood) plus standard care or standard care only (control arm). The primary endpoint is mortality by day 28 after study inclusion. Secondary endpoints include mortality by day 60 and doses of plasma needed to clear viraemia. Assuming a reduced mortality of approximately 30% by the CP therapy and 85%–88% survival in the control arm, approximately 600 participants will be enrolled to the CP therapy arm and 300 participants to the control arm.Ethics and disseminationEthical approval has been granted by the Swedish Ethical Review Authority (reference: 2020-06277). Results from this trial will be compiled in a clinical study report, disseminated via journal articles and communicated to stakeholders.Trial registration numberNCT04649879.
EXercise to Prevent frailty and Loss Of independence in insulin treated older people with DiabetEs (EXPLODE): protocol for a feasibility randomised controlled trial (RCT)
Authors: Stocker Rachel , Shaw James , Taylor Guy S , Witham Miles D , West Daniel J 
Published: December 2021

IntroductionThere are 3.9 million people in the UK with diabetes. Sarcopenia, increased frailty and loss of independence are often unappreciated complications of diabetes. Resistance exercise shows promise in reducing these complications in older adult diabetes patients. The aim of this feasibility randomised controlled trial is to (1) characterise the physical function, cardiovascular health and the health and well-being of older adults with mild frailty with/without diabetes treated with insulin, (2) to understand the feasibility and acceptability of a 4-week resistance exercise training programme in improving these parameters for those with diabetes and (3) to test the feasibility of recruiting and randomising the diabetic participant group to a trial of resistance training.Methods and analysisThirty adults aged ≥60 years with insulin-treated diabetes mellitus (type 1 or 2), and 30 without, all with mild frailty (3–4 on the Rockwood Frailty Scale) will be recruited. All will complete blood, cardiovascular and physical function testing. Only the diabetic group will then proceed into the trial itself. They will be randomised 1:1 to a 4-week semisupervised resistance training programme, designed to increase muscle mass and strength, or to usual care, defined as their regular physical activity, for 4 weeks. This group will then repeat testing. Primary outcomes include recruitment rate, attrition rate, intervention fidelity and acceptability, and adherence to the training programme. A subset of participants will be interviewed before and after the training programme to understand experiences of resistance training, impact on health and living with diabetes (where relevant) as they have aged. Analyses will include descriptive statistics and qualitative thematic analysis.Ethics and disseminationThe North East-Newcastle and North Tyneside 2 Research Ethics Committee (20/NE/0178) approved the study. Outputs will include feasibility data to support funding applications for a future definitive trial, conference and patient and public involvement presentations, and peer-reviewed publications.Trial registration numberISRCTN13193281.
Study protocol: the OxWell school survey investigating social, emotional and behavioural factors associated with mental health and well-being
Authors: Mansfield Karen Laura , Puntis Stephen , Soneson Emma , Cipriani Andrea , Geulayov Galit , Fazel Mina 
Published: December 2021

IntroductionImproving our understanding of the broad range of social, emotional and behavioural factors that contribute to mental health outcomes in adolescents will be greatly enhanced with diverse, representative population samples. We present a protocol for a repeated self-report survey assessing risk and protective factors for mental health and well-being in school pupils aged 8–18 years with different socioeconomic backgrounds in England. The survey will provide a comprehensive picture of mental health and associated risks at the community level to inform the development of primary and secondary prevention and treatment strategies in schools.Methods and analysisThis protocol is for a large-scale online repeated self-report survey, representative of children and adolescents aged 8–18 years attending schools or further education colleges in participating counties in England. The survey consists of around 300 questions, including validated measures of mental health and well-being, risk and protective factors, and care-seeking behaviour and preferences. Additional questions each year vary to address current events and novel hypotheses, developed by the research team, collaborators and stakeholders. Primary analyses will investigate current and changing risk and protective factors, care-seeking behaviour and attitudes to allowing linkage of their sensitive data to other databases for research, and will compare measures of mental health to measures of well-being.Ethics and disseminationThe study was approved by the University of Oxford Research Ethics Committee (Reference: R62366). Tailored data summaries will be provided to participating schools and stakeholders within 3 months of data collection. The main findings will be presented at scientific meetings, published in peer-reviewed journals and shared via digital and social media channels. At the end of the study, other researchers will be able to apply for access to anonymous data extracts.
Intrarater reliability of the Abilitator—a self-report questionnaire on work ability and functioning aimed at the population in a weak labour market position: a test–retest study
Authors: Wikström Miia , Kouvonen Anne , Joensuu Matti 
Published: December 2021

ObjectivesThe Abilitator is a patient-reported outcome measure (PROM) of work ability and functioning of those in a weak labour market position. It covers items for work ability and self-rated health, for example, and summary scales for social, psychological, cognitive and physical functioning, as well as everyday skills. The aim of this study was to evaluate the intrarater test–retest reliability, internal consistency and basic psychometric properties of the Finnish version of the Abilitator.Design, setting and outcomeThe test–retest study was conducted in European Social Fund projects in 2018–2019. The participants completed two Abilitator questionnaires over 7–14 days. The internal consistency analysis was based on data collected in 2017–2019 in services for the long-term unemployed. The reliability was assessed using correlations (r, rs, intraclass correlation coefficient (ICC)), agreement with Bland-Altman analysis and internal consistency with Cronbach’s alpha.ParticipantsThe test–retest study had 67 participants (52% men, mean age 43.9 years) and the internal consistency study 10 923 (48% men, mean age 38.58 years), respectively. Of all the participants, 80% had been unemployed for over a year.ResultsThe test–retestrorrsranged from 0.71 to 0.93 and ICC from 0.74 to 0.93 for the items and summary scales. An exception was the life satisfaction item, with anrsof 0.60 and ICC of 0.45. A statistically significant difference was observed in the summary scale for social functioning (t=−2.01, p=0.049). Agreement was observed for all variables except social functioning. Alphas for summary scales ranged from 0.74 to 0.91.ConclusionsThe Finnish version of the Abilitator is a reliable PROM for the target group and has acceptable to excellent intrarater test–retest reliability and internal consistency, apart from the life satisfaction item. Further testing is needed for the social functioning summary scale.