bluuebunny/crossref_metadata_2025_split huggingface dataset:
Is ‘Health for All’ synonymous with ‘antibiotics for all’: changes in antibiotic prescribing in a performance-based financing pilot in Zanzibar
Authors: Hadley Mary B , Beard James 
Published: September 2019

Abstract
Universal Health Coverage, to meet the Sustainable Development Goal of ‘Health for All’, aims to increase the access of preventative and curative care services, particularly to the poor and vulnerable. However, the very provision of curative services by health providers in the primary care setting in low-income countries is considered one of the major drivers of antimicrobial resistance. The Zanzibar Ministry of Health introduced performance-based financing (PBF) in 2 of 10 Health Districts in July 2013. Payments to health facilities and staff were on a fee-for-service basis using ‘direct quality indicators’. Results of an evaluation of secondary data of two indicators, ‘treatment according to guidelines’ and ‘antibiotics prescribed according to guidelines’ from 31 Primary Health Care Units in the two PBF pilot districts are compared with 28 in non-PBF districts. The proportion of patients treated with an antibiotic not in accordance with treatment guidelines after the introduction of PBF fell to 2%, 6% and 5% in 2014, 2015 and 2016, respectively, compared with an increase from 25% (2013) to 31% (2014) and 22% (2015, 2016) in non-PBF facilities. The key take-home messages from this evaluation are firstly that ‘direct quality indicators’ to improve the use of treatment guidelines, introduced into a national PBF reform that includes financial incentives and rigorous verification of register entries, have the potential to significantly reduce inappropriate use of antibiotics in high population density settings in Africa. Secondly, for a sustained reduction in the overall proportion of unnecessary antibiotic prescriptions rigorous monitoring of health worker behaviour is required to address changes in prescribing practice. A well-designed and monitored PBF with ‘direct quality indicators’ has the potential to ensure that ‘Health for All’, in terms of increased access to primary health services is not synonymous with ‘antibiotics for all’.
Going operational with health systems governance: supervision and incentives to health workers for increased quality of care in Tanzania
Authors: Francetic Igor , Tediosi Fabrizio , Salari Paola , de Savigny Don 
Published: September 2019

Abstract
Improving the quality of care is increasingly recognized as a priority of health systems in low- and middle-income countries. Given the labour-intensive nature of healthcare interventions, quality of care largely depends upon the number, training and management of health workers involved in service delivery. Policies available to boost the performance of health workers—and thus the quality of healthcare—include regulation, incentives and supervision—all of which are typically included in quality improvement frameworks and policies. This was the case in Tanzania, where we assessed the role of selected quality improvement policies. To do so, we analysed data from a representative sample of Tanzanian government-managed health facilities, part of the 2014/15 Service Provision Assessment component of the Demographic and Health Survey. We constructed two healthcare quality indicators from data on patient visits: (1) compliance with Integrated Management of Childhood Illness (IMCI) guidelines and (2) patient satisfaction. Using multilevel ordered logistic regression models, we estimated the associations between the outcomes and selected indicators of incentives and supervisory activity at health worker and health facility level. We did not identify any association for the different indicators of top-down supervision at facility and individual level, neither with IMCI compliance nor with patients’ satisfaction. Bottom-up supervision, defined as meetings between community and health facility staff, was significantly associated with higher patient satisfaction. Financial incentives in the form of salary top-ups were positively associated with both IMCI compliance and patient satisfaction. Both housing allowances and government-subsidized housing were positively associated with our proxies of quality of care. Good healthcare quality is crucial for promoting health in Tanzania not only through direct outcomes of the process of care but also through increased care-seeking behaviour in the communities. The results of this study highlight the role of community involvement, better salary conditions and housing arrangements for health workers.
Use of evidence and negotiation in the review of national standard treatment guidelines and essential medicines list: experience from Ghana
Authors: Koduah Augustina , Asare Brian A , Gavor Edith , Gyansa-Lutterodt Martha , Andrews Annan Edith , Ofei Francis W 
Published: September 2019

AbstractUnderstanding how countries review their national standard treatment guidelines (STGs) and essential medicines list (EML) is important in the light of ever-changing trends in public health and evidence supporting the selection and use of medicines in disease management. This study examines the 2017 STGs and EML review process, the actors involved and how the list of medicines and disease conditions evolved between the last two editions. We examined expert committee reports, stakeholder engagement reports and the last two editions (2010, 2017) STGs and EML. The review process occurred in both bureaucratic and public arenas where various actors with varied power and interest engaged in ways to consolidate their influence with the use of evidence from research and practice. In the bureaucratic arena, a national medicines selection committee inaugurated by the Minister of Health assessed the 2010 edition through technical sessions considering the country’s disease burden, hierarchical healthcare structure and evidence on safety and efficacy and expert opinion. To build consensus and ensure credibility service providers, professional bodies and healthcare managers scrutinized the assessed guidelines and medicines list in public arenas. In such public arenas, technical discussions moved towards negotiations with emphasis on practicability of the policies. Updates in the 2017 guidelines involved the addition of 64 new disease conditions in the STG, with the EML including 153 additional medicines and excluding 56 medicines previously found in the 2010 EML. Furthermore, the level of care categorization for Level ‘A’ [i.e. community-based health planning and services (CHPS)] and Level ‘M’ (i.e. midwifery and CHPS with a midwife) evolved to reflect the current primary healthcare and community mobilization activities for healthcare delivery in Ghana. Ghana’s experience in using evidence from research and practice and engaging wide stakeholders can serve as lessons for other low and middle-income countries.
Systemic AAV8-mediated delivery of a functional copy of muscle glycogen phosphorylase (Pygm) ameliorates disease in a murine model of McArdle disease
Authors: McNamara Elyshia L , Taylor Rhonda L , Clayton Joshua S , Goullee Hayley , Dilworth Kimberley L , Pinós Tomàs , Brull Astrid , Alexander Ian E , Lisowski Leszek , Ravenscroft Gianina , Laing Nigel G , Nowak Kristen J 
Published: September 2019

Abstract
McArdle disease is a disorder of carbohydrate metabolism that causes painful skeletal muscle cramps and skeletal muscle damage leading to transient myoglobinuria and increased risk of kidney failure. McArdle disease is caused by recessive mutations in the muscle glycogen phosphorylase (PYGM) gene leading to absence of PYGM enzyme in skeletal muscle and preventing access to energy from muscle glycogen stores. There is currently no cure for McArdle disease. Using a preclinical animal model, we aimed to identify a clinically translatable and relevant therapy for McArdle disease. We evaluated the safety and efficacy of recombinant adeno-associated virus serotype 8 (rAAV8) to treat a murine model of McArdle disease via delivery of a functional copy of the disease-causing gene, Pygm. Intraperitoneal injection of rAAV8-Pygm at post-natal day 1–3 resulted in Pygm expression at 8 weeks of age, accompanied by improved skeletal muscle architecture, reduced accumulation of glycogen and restoration of voluntary running wheel activity to wild-type levels. We did not observe any adverse reaction to the treatment at 8 weeks post-injection. Thus, we have investigated a highly promising gene therapy for McArdle disease with a clear path to the ovine large animal model endemic to Western Australia and subsequently to patients.
Superior mesenteric flow pattern during counterpulsation: is simply a shorter balloon the solution for visceral hypoperfusion?
Authors: de Jong Monique M J , Parise Orlando , Matteucci Francesco , Tetta Cecilia , Maessen Jos G , Gelsomino Sandro 
Published: September 2019

Abstract

OBJECTIVES
We studied the flow pattern in the superior mesenteric artery (SMA) during intra-aortic balloon pump support, comparing 2 intra-aortic balloons of 2 different lengths.

METHODS
Sixteen Landrace pigs (mean weight 84.0 kg ± 6.0) were used in this study. The animals were randomly assigned to 2 groups: group 1 received an 8-Fr, 40-ml standard balloon; group 2 received an 8-Fr, 40-ml short balloon. SMA flow was measured during early, mid- and telediastole.

RESULTS
The standard balloon led to a reduction in SMA flow in early diastole (P &lt; 0.001), a negative flow in mid-diastole (P &lt; 0.001) and a reincrease in telediastole (P &lt; 0.001). In contrast, in early diastole a significant reduction was observed with the short balloon (P &lt; 0.001), followed by another drop in mid-diastole (P &lt; 0.001), without reaching negative values and by a telediastolic increase (P &lt; 0.001). SMA flows were comparable between balloons during early diastole (P = 0.66), whereas they were higher with the short balloon during mid (P &lt; 0.001) and telediastole (P = 0.02). Overall, the diastolic area was significantly larger when the short balloon was used (P &lt; 0.001). Finally, during counterpulsation, mesenteric resistances increased significantly (P &lt; 0.001), although, with the short balloon, they were lower than with the standard balloon (P = 0.01).

CONCLUSIONS
Despite better overall mean mesenteric diastolic flow, the short balloon leads to early- and mid-diastolic flow reduction, although to a lesser extent than the standard intra-aortic balloon pump balloon. Our data are a call for improvement in the design of the short balloon.
Skin marking with computed tomography at functional residual capacity to predict lung nodule site
Authors: Miyoshi Ryo , Yamashina Akihiko , Nishikawa Shigeto , Tamari Shigeyuki , Noguchi Misa , Hijiya Kyoko , Chihara Koji 
Published: September 2019

Abstract
Various marking techniques for lung nodules may be complex and can cause serious complications. In this study, we aimed to describe and evaluate the feasibility of CTFRC marking, a novel preoperative skin marking technique guided by computed tomography (CT) at functional residual capacity (FRC). This simple and non-invasive marking technique only requires a preoperative CT scan without any anaesthesia. We retrospectively reviewed CTFRC markings performed for 109 lung nodules in 108 patients. The mean nodule size was 11.4 ± 5.0 mm. The mean distance from the nodule to the lung marking point was 3.8 ± 7.3 mm. We found no procedure-associated complications. CTFRC marking is a simple, safe and non-invasive method to predict the precise location of lung nodules during thoracoscopic surgery.
Dietary n-3 polyunsaturated fatty acids, fish intake and healthy ageing
Authors: García-Esquinas Esther , Ortolá Rosario , Banegas Jose Ramón , Lopez-García Esther , Rodríguez-Artalejo Fernando 
Published: September 2019

AbstractBackgroundSeafood consumption and dietary intake of n-3 polyunsaturated fatty acids (PUFA) protect from cardiovascular disease, muscle wasting and mortality; however, their role in delaying unhealthy ageing is uncertain.MethodsA prospective cohort study with 1592 community-dwelling individuals aged ≥60 years recruited in 2008–2010, and followed through 2015. Intake of seafood and n-3 PUFA [eicosapentanoic acid (EPA) and docosahexanoic acid (DHA)] was estimated using a validated diet history and food composition tables. Unhealthy ageing was assessed across the domains of physical and cognitive function, mental health, morbidity, self-rated health and vitality.ResultsHigher blue fish consumption was negatively associated with unhealthy ageing in 2015 [multivariate ß (95% confidence interval) per interquartile range (IQR) increase of fish: −0.49 (−0.90; −0.08)] and, specifically, was associated with lower accumulation of functional impairments [−1.00 (−1.71; −0.28)] and morbidities [−0.30 (−0.73; 0.13)]. Individuals with high intakes of EPA (≥0.47 g/day) and DHA (≥0.89 g/day) presented the highest reductions in age-related deficits accumulation: −1.61 (−3.01; −0.22) and −1.34 (−2.76; 0.08), respectively. Intake of EPA and DHA were negatively associated with the accumulation of functional deficits [results per IQR increase: −0.79 (−1.64; −0.06) and −0.84 (−1.67; −0.01), respectively] and morbidities [−0.60 (−1.10; −1.11) and −0.60 (−1.09; −0.11)]. No associations were observed between n-3 PUFA and self-rated or mental health, or between white fish and unhealthy ageing.ConclusionsIn this cohort of Spanish individuals with elevated intake of fish and a high adherence to the Mediterranean diet, consumption of blue fish and n-3 PUFA had a prospective protective association with deficits accumulation.
Cytokine Induction in Nipah Virus–Infected Primary Human and Porcine Bronchial Epithelial Cells
Authors: Elvert Mareike , Sauerhering Lucie , Maisner Andrea 
Published: September 2019

Abstract
During the Nipah virus (NiV) outbreak in Malaysia, pigs and humans were infected. While pigs generally developed severe respiratory disease due to effective virus replication and associated inflammation processes in porcine airways, respiratory symptoms in humans were rare and less severe. To elucidate the reasons for the species-specific differences in NiV airway infections, we compared the cytokine responses as a first reaction to NiV in primary porcine and human bronchial epithelial cells (PBEpC and HBEpC, respectively). In both cell types, NiV infection resulted in the expression of type III interferons (IFN-λ). Upon infection with similar virus doses, viral RNA load and IFN expression were substantially higher in HBEpC. Even if PBEpC expressed the same viral RNA amounts as NiV-infected HBEpC, the porcine cells showed reduced IFN- and IFN-dependent antiviral gene expression. Despite this inherently limited IFN response, the expression of proinflammatory cytokines (IL-6, IL-8) in NiV-infected PBEpC was not decreased. The downregulation of antiviral activity in the presence of a functional proinflammatory cytokine response might be one of the species-specific factors contributing to efficient virus replication and acute inflammation in the lungs of pigs infected with the Malaysian NiV strain.
Pneumococci Can Become Virulent by Acquiring a New Capsule From Oral Streptococci
Authors: Nahm Moon H , Brissac Terry , Kilian Mogens , Vlach Jiri , Orihuela Carlos J , Saad Jamil S , Ganaie Feroze 
Published: September 2019

Abstract
Pneumococcal conjugate vaccines have been successful, but their use has increased infections by nonvaccine serotypes. Oral streptococci often harbor capsular polysaccharide (PS) synthesis loci (cps). Although this has not been observed in nature, if pneumococcus can replace its cps with oral streptococcal cps, it may increase its serotype repertoire. In the current study, we showed that oral Streptococcus strain SK95 and pneumococcal strain D39 both produce structurally identical capsular PS, and their genetic backgrounds influence the amount of capsule production and shielding from nonspecific killing. SK95 is avirulent in a well-established in vivo mouse model. When acapsular pneumococcus was transformed with SK95 cps, the transformant became virulent and killed all mice. Thus, cps from oral Streptococcus strains can make acapsular pneumococcus virulent, and interspecies cps transfer should be considered a potential mechanism of serotype replacement. Our findings, along with publications from the US Centers for Disease Control and Prevention, highlight potential limitations of the 2013 World Health Organization criterion for studying pneumococcal serotypes carried without isolating bacteria.
We show that an oral streptococcal strain, SK95, and a pneumococcal strain, D39, both produce chemically identical capsular PS. We also show that transferring SK95 cps into noncapsulated, avirulent pneumococcus gave it the capacity for virulence in a mouse model.
The International Trade Regime and the Quest for Free Digital Trade
Authors: Azmeh Shamel , Foster Christopher , Echavarri Jaime 
Published: September 2019

AbstractThe global economy is experiencing the digitalization of production, exchange, and consumption of goods and services. The internet and cross-border data flows are becoming important channels of trade as more products are traded through the web or integrate features that rely on digital connectivity. Reflecting the autonomy states have to enact such policies, national variations in internet governance have expanded over the previous decade, with states increasingly looking to use internet and data policies for economic and trade objectives. These dynamics are having important implications on the international trade regime through challenging existing trade rules and creating demands for new rules. This has resulted in growing debates in the trade arena around “digital trade,” as a number of states, led by the United States, push for rules as a way to discipline national internet policies and support trade in digital goods and services. This paper examines the political economy of this campaign. We argue that the objectives of this campaign go beyond updating rules to better fit the “Internet age” into achieving further liberalization of trade in goods and services. We highlight the technological contingency of existing international rules and show how technological shifts have been a driver of competitive regime creation and forum shifting contributing to processes of fragmentation of the international trade regime.
Opportunities to reduce antibiotic prescribing for patients with COPD in primary care: a cohort study using electronic health records from the Clinical Practice Research Datalink (CPRD)
Authors: Rockenschaub Patrick , Jhass Arnoupe , Freemantle Nick , Aryee Anna , Rafiq Meena , Hayward Andrew , Shallcross Laura 
Published: September 2019

Abstract

Background
In primary care there is uncertainty about which patients with acute exacerbations of COPD (AECOPD) benefit from antibiotics.

Objectives
To identify which types of COPD patients get the most antibiotics in primary care to support targeted antibiotic stewardship.

Methods
Observational study of COPD patients using a large English primary care database with 12 month follow-up. We estimated the incidence of and risk factors for antibiotic prescribing relative to the number of AECOPD during follow-up, considering COPD severity, smoking, obesity and comorbidity.

Results
From 157 practices, 19594 patients were diagnosed with COPD, representing 2.6% of patients and 11.5% of all prescribed antibiotics. Eight hundred and thirty-three (4.5%) patients with severe COPD and frequent AECOPD were prescribed six to nine prescriptions per year and accounted for 13.0% of antibiotics. Individuals with mild to moderate COPD and zero or one AECOPD received one to three prescriptions per year but accounted for 42.5% of all prescriptions. In addition to COPD severity, asthma, chronic heart disease, diabetes, heart failure and influenza vaccination were independently associated with increased antibiotic use.

Conclusions
Patients with severe COPD have the highest rates of antibiotic prescribing but most antibiotics are prescribed for patients with mild to moderate COPD. Antibiotic stewardship should focus on the dual goals of safely reducing the volume of prescribing in patients with mild to moderate COPD, and optimizing prescribing in patients with severe disease who are at significant risk of drug resistance.
People Rely Less on Consumer Reviews for Experiential than Material Purchases
Authors: Dai Hengchen , Chan Cindy , Mogilner Cassie 
Published: September 2019

AbstractAn increasingly prevalent form of social influence occurs online where consumers read reviews written by other consumers. Do people rely on consumer reviews differently when making experiential purchases (events to live through) versus when making material purchases (objects to keep)? Though people often use consumer reviews both when making experiential and material purchases, an analysis of more than six million reviews on Amazon.com and four laboratory experiments reveal that people are less likely to rely on consumer reviews for experiential purchases than for material purchases. This effect is driven by beliefs that reviews are less reflective of the purchase’s objective quality for experiences than for material goods. These findings not only indicate how different types of purchases are influenced by word of mouth, but also illuminate the psychological processes underlying shoppers’ reliance on consumer reviews. Furthermore, as one of the first investigations into how people choose among various experiential and material purchase options, these findings suggest that people are less receptive to being told what to do than what to have.
Effect of increased expression of both ras-related C3 botulinum toxin substrate 1 and p21-activated kinase 1 in patients with N0M0 upper urinary tract urothelial carcinoma and cancer-free surgical margins
Authors: Kuroda Kenji , Asano Takako , Horiguchi Akio , Ito Keiichi 
Published: September 2019

Abstract

Background
As a member of the Rho small guanosine triphosphatase family, ras-related C3 botulinum toxin substrate 1 (RAC1) interacts with various specific effectors, and p21-activated kinase 1 (PAK1), which has a role in both carcinogenesis and cellular invasion, binds to RAC1, after which activated PAK1 regulates cellular functions. There have been few reports about the simultaneous analysis of RAC1 and its downstream effector PAK1 in upper urinary tract urothelial carcinoma (UTUC). We assessed the expressions of both RAC1 and PAK1 and evaluated their association with clinicopathological parameters.

Methods
Immunohistochemical studies of RAC1 or PAK1 were performed with specimens from 104 patients with N0M0 UTUC and cancer-free surgical margins. Correlation of the positive expression of RAC1 or PAK1 or both with clinicopathological parameters was evaluated.

Results
A hazard model showed that the presence of mixed histologic features and moderate or strong positive expression of both RAC1 and PAK1 were independent factors for shortened disease-specific survival time (Ps = 0.041 and 0.016, respectively), and another hazard model revealed that only moderate or strong positive expression of both RAC1 and PAK1 was an independent factor for shortened recurrence-free survival time in the multivariate analysis (P = 0.036). Neither moderate or strong positive expression of RAC1 alone nor moderate or strong positive expression of PAK1 alone was an independent factor for a worse rate of disease-specific or recurrence-free survival in multivariate analysis.

Conclusions
Patients with N0M0 UTUC, cancer-free surgical margins and moderate or strong positive expression of both RAC1 and PAK1 should be carefully monitored after surgery.