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AnteayerPLOS ONE Medicine&Health

Effects of spousal migration on access to healthcare for women left behind: A cross-sectional follow-up study

by Heidi S. West, Mary E. Robbins, Corrina Moucheraud, Abdur Razzaque, Randall Kuhn


Women left behind by migration represent a unique and growing population yet remain understudied as key players in the context of migration and development. Using a unique longitudinal survey of life in Bangladesh, the Matlab Health and Socioeconomic Surveys, we examined the role of spousal migration in healthcare utilization for women. The objective of this study was to assess realized access to care (do women actually get healthcare when it is needed) and consider specific macrostructural, predisposing, and resource barriers to care that are related to migration.

Methods and findings

In a sample of 3,187 currently married women, we estimated multivariate logistic and multinomial regression models controlling for a wide range of baseline sociodemographic factors measured as far back as 1982. Our analyses also controlled for selection effects and explored two mechanisms through which spousal migration can affect healthcare utilization for women, remittances and frequent contact with spouses. We found that women with migrant spouses were approximately half as likely to lack needed healthcare compared to women whose spouses remained in Bangladesh (predicted probability of not getting needed healthcare 11.7% vs. 21.8%, p Conclusions

Wives of international migrants showed significantly better access to healthcare even when accounting for selection into a migrant family. While the overall story is one of positive migration effects on healthcare access due to reductions in financial barriers to care, results also showed an increase in family-related barriers such as not being permitted to get care by a family member or travel alone to a facility, indicating that some of the benefits of migration for women left behind may be diluted by gendered family structures.

Femoral head collapse after hip intra-articular corticosteroid injection: An institutional response to improve practice and increase patient safety

by Brandon J. Kelly, Benjamin R. Williams, Amy A. Gravely, Kersten Schwanz, V. Franklin Sechriest II


Femoral head collapse (FHC) is a rarely reported complication of hip intra-articular corticosteroid injection (IACSI). Upon observing a high rate of FHC after hip IACSI, we sought to (1) describe how we addressed the problem through a systematic evaluation of clinical data and institutional care practices followed by process improvement efforts; and (2) report our results.


Patients receiving hip IACSI during a 27-month period underwent retrospective review to determine the rate of FHC and to identify associated patient factors or practice shortfalls. Findings led to institution-wide interventions: (1) to improve patient/provider awareness of this association; and (2) to develop/implement practice guidelines. Rates of FHC after hip IACSI and practice patterns among providers before and after intervention were compared.


Initial FHC rate after hip IACSI was 20.4%. Patient-related factors included body mass index (p = 0.025), history of cancer therapy (p = 0.012), Vitamin D level (p = 0.030), and multiple injections (p = 0.004). Volume/dose of injectate and post-injection surveillance methods varied widely. Quality improvement (QI) intervention resulted in fewer treatment referrals (from 851 to 436), fewer repeat injections (mean = 1.61 to 1.37; p = 0.0006), and a 5% lower FHC rate (p = 0.1292). Variation in practice patterns persisted, so a systems-based Clinical Pathway was established.


When a high rate of FHC after hip IACSI was found to be associated with certain patient and practice factors, introduction of education materials and treatment guidelines decreased number of referrals, number of injections per patient, and FHC rate. In the absence of the systems-based Pathway, the type, dose, and volume of injectate and post-procedure follow-up remained variable.

Innovative method for encapsulating highly pigmented biomass from <i>Aspergillus nidulans</i> mutant for copper ions removal and recovery

by Ailton Guilherme Rissoni Toledo, Jazmina Carolina Reyes Andrade, Mauricio Cesar Palmieri, Denise Bevilaqua, Sandra Regina Pombeiro Sponchiado

Biosorption has been considered a promising technology for the treatment of industrial effluents containing heavy metals. However, the development of a cost-effective technique for biomass immobilization is essential for successful application of biosorption in industrial processes. In this study, a new method of reversible encapsulation of the highly pigmented biomass from Aspergillus nidulans mutant using semipermeable cellulose membrane was developed and the efficiency of the encapsulated biosorbent in the removal and recovery of copper ions was evaluated. Data analysis showed that the pseudo-second-order model better described copper adsorption by encapsulated biosorbent and a good correlation (r2 > 0.96) to the Langmuir isotherm was obtained. The maximum biosorption capacities for the encapsulated biosorbents were higher (333.5 and 116.1 mg g-1 for EB10 and EB30, respectively) than that for free biomass (92.0 mg g-1). SEM-EDXS and FT-IR analysis revealed that several functional groups on fungal biomass were involved in copper adsorption through ion-exchange mechanism. Sorption/desorption experiments showed that the metal recovery efficiency by encapsulated biosorbent remained constant at approximately 70% during five biosorption/desorption cycles. Therefore, this study demonstrated that the new encapsulation method of the fungal biomass using a semipermeable cellulose membrane is efficient for heavy metal ion removal and recovery from aqueous solutions in multiple adsorption-desorption cycles. In addition, this reversible encapsulation method has great potential for application in the treatment of heavy metal contaminated industrial effluents due to its low cost, the possibility of recovering adsorbed ions and the reuse of biosorbent in consecutive biosorption/desorption cycles with high efficiency of metal removal and recovery.

Assessing the introduction risk of vector-borne animal diseases for the Netherlands using MINTRISK: A Model for INTegrated RISK assessment

by Clazien J. de Vos, Wil H. G. J. Hennen, Herman J. W. van Roermund, Sofie Dhollander, Egil A. J. Fischer, Aline A. de Koeijer

To evaluate and compare the risk of emerging vector-borne diseases (VBDs), a Model for INTegrated RISK assessment, MINTRISK, was developed to assess the introduction risk of VBDs for new regions in an objective, transparent and repeatable manner. MINTRISK is a web-based calculation tool, that provides semi-quantitative risk scores that can be used for prioritization purposes. Input into MINTRISK is entered by answering questions regarding entry, transmission, establishment, spread, persistence and impact of a selected VBD. Answers can be chosen from qualitative answer categories with accompanying quantitative explanation to ensure consistent answering. The quantitative information is subsequently used as input for the model calculations to estimate the risk for each individual step in the model and for the summarizing output values (rate of introduction; epidemic size; overall risk). The risk assessor can indicate his uncertainty on each answer, and this is accounted for by Monte Carlo simulation. MINTRISK was used to assess the risk of four VBDs (African horse sickness, epizootic haemorrhagic disease, Rift Valley fever, and West Nile fever) for the Netherlands with the aim to prioritise these diseases for preparedness. Results indicated that the overall risk estimate was very high for all evaluated diseases but epizootic haemorrhagic disease. Uncertainty intervals were, however, wide limiting the options for ranking of the diseases. Risk profiles of the VBDs differed. Whereas all diseases were estimated to have a very high economic impact once introduced, the estimated introduction rates differed from low for Rift Valley fever and epizootic haemorrhagic disease to moderate for African horse sickness and very high for West Nile fever. Entry of infected mosquitoes on board of aircraft was deemed the most likely route of introduction for West Nile fever into the Netherlands, followed by entry of infected migratory birds.

Feed intake, nutrient digestibility, and selected rumen parameters in feedlot bulls fed diets with different feed additives

by Breno de Castro Silva, Marcos Vinicius Carneiro Pacheco, Letícia Artuzo Godoi, Gilyard Angelo Pinheiro de Souza, Nathália Veloso Trópia, Pauliane Pucetti, Flávia Adriane de Sales Silva, Ana Clara Baião Menezes, Luciana Navajas Rennó, Mário Fonseca Paulino, Jon Patrick Schoonmaker, Sebastião de Campos Valadares Filho

An experiment was conducted to evaluate the feed intake, nutrient digestibility and selected rumen parameters in feedlot bulls fed diets containing different feed additives. Six rumen-cannulated Nellore bulls (age = 8 ± 1.0 months; initial BW = 225 ± 13.2 kg) were distributed in a 6 × 6 Latin square design. Six experimental diets based on 30% corn silage and 70% concentrate on a dry matter (DM) basis were evaluated. Diets differed in feed additive on a DM basis, as follows: 1.4% bicarbonate and magnesium oxide in 3:1 ratio (BOX); 36 ppm lasalocid sodium (LAS); 30 ppm monensin sodium (MON); 25 ppm virginiamycin (VIR); 30 ppm monensin sodium plus 25 ppm virginiamycin (MV); and 3.15% commercial mineral supplement containing D-limonene and exogenous α-amylase (EOA). The experiment lasted 144 d, with six periods of 24 d. Each period consisted of 14 d for dietary adaptation, 3 d for feces and urine collection, and 7 d for omasal and ruminal digesta collection. Bulls fed the BOX diet showed greater (P P > 0.05) the DM, OM, apNDF, CP, or starch intake of feedlot bulls. Bulls fed the EOA diet showed greater (trend; P = 0.09) ruminal digestibility of starch compared to the other diets. The feed additives did not affect (P > 0.05) the intestinal or total tract digestibility of starch, rumen pH, microbial efficiency, total rumen fluid, dilution rate, rate of intake, rate of degradation, or passage rate of the DM, OM, apNDF, and starch. In conclusion, LAS, MON, VIR, MV, and EOA diets reduced nutrient intake compared to BOX. Although all feed additives presented similar effects on rumen pH, temperature, and kinetics the presence of exogenous α-amylase in the EOA diet may increase ruminal starch digestibility and apparent total tract digestibility of DM and OM.

Incidence and predictors of preterm neonatal mortality at Mbarara Regional Referral Hospital in South Western Uganda

by Leevan Tibaijuka, Stephen M. Bawakanya, Asiphas Owaraganise, Lydia Kyasimire, Elias Kumbakumba, Adeline A. Boatin, Musa Kayondo, Joseph Ngonzi, Stephen B. Asiimwe, Godfrey R. Mugyenyi


Preterm neonatal mortality contributes substantially to the high neonatal mortality globally. In Uganda, preterm neonatal mortality accounts for 31% of all neonatal deaths. Previous studies have shown variability in mortality rates by healthcare setting. Also, different predictors influence the risk of neonatal mortality in different populations. Understanding the predictors of preterm neonatal mortality in the low-resource setting where we conducted our study could guide the development of interventions to improve outcomes for preterm neonates. We thus aimed to determine the incidence and predictors of mortality among preterm neonates born at Mbarara Regional Referral Hospital (MRRH) in South Western Uganda.


We prospectively enrolled 538 live preterm neonates born at MRRH from October 2019 to September 2020. The neonates were followed up until death or 28 days, whichever occurred first. We used Kaplan Meier survival analysis to describe preterm neonatal mortality and Cox proportional hazards regression to assess predictors of preterm neonatal mortality over a maximum of 28 days of follow up.


The cumulative incidence of preterm neonatal mortality was 19.8% (95% C.I: 16.7–23.5) at 28 days from birth. Birth asphyxia (adjusted hazard ratio [aHR], 14.80; 95% CI: 5.21 to 42.02), not receiving kangaroo mother care (aHR, 9.50; 95% CI: 5.37 to 16.78), delayed initiation of breastfeeding (aHR, 9.49; 95% CI: 2.84 to 31.68), late antenatal care (ANC) booking (aHR, 1.81 to 2.52; 95% CI: 1.11 to 7.11) and no ANC attendance (aHR, 3.56; 95% CI: 1.51 to 8.43), vaginal breech delivery (aHR, 3.04; 95% CI: 1.37 to 5.18), very preterm births (aHR, 3.17; 95% CI: 1.24 to 8.13), respiratory distress syndrome (RDS) (aHR, 2.50; 95% CI: 1.11 to 5.64) and hypothermia at the time of admission to the neonatal unit (aHR, 1.98; 95% CI: 1.18 to 3.33) increased the risk of preterm neonatal mortality. Attending more than 4 ANC visits (aHR, 0.35; 95% CI: 0.12 to 0.96) reduced the risk of preterm neonatal mortality.


We observed a high cumulative incidence of mortality among preterm neonates born at a low-resource regional referral hospital in Uganda. The predictors of mortality among preterm neonates were largely modifiable factors occurring in the prenatal, natal and postnatal period (lack of ANC attendance, late ANC booking, vaginal breech delivery, birth asphyxia, respiratory distress syndrome, and hypothermia at the time of admission to the neonatal unit, not receiving kangaroo mother care and delayed initiation of breastfeeding). These findings suggest that investment in and enhancement of ANC attendance, intrapartum care, and the feasible essential newborn care interventions by providing the warm chain through kangaroo mother care, encouraging early initiation of breastfeeding, timely resuscitation for neonates when indicated and therapies reducing the incidence and severity of RDS could improve outcomes among preterm neonates in this setting.

Compensation incentives and heat exposure affect farm worker effort

by Qianyao Pan, Daniel A. Sumner, Diane C. Mitchell, Marc Schenker

Farm workers are exposed to high risk of heat-related illness, especially when their jobs require working outside at a fast pace during hot days. Climate change has increased the number of days with high temperatures, and thereby the amount of time that farm workers are likely exposed to extreme heat. To better understand how high heat exposure affects farm workers, this study investigates how crop workers respond to heat exposure and estimates the effects of different pay and work arrangements on workers’ responses to heat exposure. We explore, specifically, whether piece-rate arrangements increase workers’ effort during periods with high heat exposure compared to workers paid by hourly wages. We use observational data from detailed measurements of localized heat exposure and individual workers’ effort in the field. First, these results show workers adjust their effort in response to heat exposure when the heat exposure level changes. Second, piece-rate arrangements increase workers’ effort during work shifts. Third, piece-rate arrangements allow workers to modify their effort more easily during different heat exposure levels. When facing low levels of heat exposure, workers who were paid by piece-rate arrangements exert a higher effort than workers paid by hourly wages, up until WBGT is 26.6˚C. When facing high levels of heat exposure (with WBGT exceeding 29.6˚C), workers paid by piece-rate arrangements lower their effort compared to workers paid by hourly wage arrangements.

<i>In silico</i> repurposing of a Novobiocin derivative for activity against latency associated <i>Mycobacterium tuberculosis</i> drug target nicotinate-nucleotide adenylyl transferase (Rv2421c)

by Ruben Cloete, Mohd Shahbaaz, Melanie Grobbelaar, Samantha L. Sampson, Alan Christoffels

Nicotinamide-nucleotide adenylyl transferase (Rv2421c) was selected as a potential drug target, because it has been shown, in vitro, to be essential for Mycobacterium tuberculosis growth. It is conserved between mycobacterium species, is up-regulated during dormancy, has a known 3D crystal structure and has no known human homologs. A model of Rv2421c in complex with nicotinic acid adenine dinucleotide and magnesium ion was constructed and subject tovirtual ligand screening against the Prestwick Chemical Library and the ZINC database, which yielded 155 potential hit molecules. Of the 155 compounds identified five were pursued further using an IC50 based 3D-QSAR study. The 3D-QSAR model validated the inhibition properties of the five compounds based on R2 value of 0.895 and Q2 value of 0.944 compared to known inhibitors of Rv2421c. Higher binding affinities was observed for the novel ZINC13544129 and two FDA approved compounds (Novobiocin sodium salt, Sulfasalazine). Similarly, the total interaction energy was found to be the highest for Cromolyn disodium system (-418.88 kJ/mol) followed by Novobiocin (-379.19 kJ/mol) and Sulfasalazine with (-330.13 kJ/mol) compared to substrate DND having (-185.52 kJ/mol). Subsequent in vitro testing of the five compounds identified Novobiocin sodium salt with activity against Mycobacterium tuberculosis at 50 μM, 25μM and weakly at 10μM concentrations. Novobiocin salt interacts with a MG ion and active site residues His20, Thr86, Gly107 and Leu164 similar to substrate DND of Mycobacterium tuberculosis Rv2421c. Additional in silico structural analysis of known Novobiocin sodium salt derivatives against Rv2421c suggest Coumermycin as a promising alternative for the treatment of Mycobacterium tuberculosis based on large number of hydrogen bond interactions with Rv2421c similar in comparison to Novobiocin salt and substrate DND.

Dietary acrylamide and physical performance tests: A cross-sectional analysis

by Nicola Veronese, Ligia J. Dominguez, Saverio Ragusa, Luisa Solimando, Lee Smith, Francesco Bolzetta, Stefania Maggi, Mario Barbagallo


Dietary acrylamide is found in certain foods, such as deep frying, baking and roasting, and is associated with higher inflammatory and oxidative stress parameters. The association between dietary acrylamide and physical performance has not yet been explored. The aim of the study was to investigate the relationship between dietary acrylamide intake and physical performance tests in a large cohort of North American individuals affected by knee osteoarthritis or at high risk for this condition.


Dietary acrylamide intake was obtained through a food frequency questionnaire and reported in quartiles and as an increase in deciles. Physical performance was explored using the 20-meter usual pace test, the 400-meter walking distance, and the chair stands time. The association between dietary acrylamide and physical performance tests was explored using linear regression analysis, adjusted for potential confounders.


4,436 participants (2,578 women, mean age: 61.3) were enrolled. People in the highest quartile of dietary acrylamide reported significantly longer 20-meter walking (15.53±3.32 vs. 15.15±2.91 s), 400-meter walking (312±54 vs. 305±58 s) and chair stands (11.36±4.08 vs. 10.67±3.50 s) times than their counterparts in Q1. In adjusted linear regression analyses, each increase in one decile in dietary acrylamide was associated with a longer time in walking for 20 meters (beta = 0.032; 95%CI: 0.016–0.048; p = 0.04), 400 meters (beta = 0.048; 95%CI: 0.033–0.063; p = 0.002) and chair stands (beta = 0.016; 95%CI: 0.005–0.037; p = 0.04) times.


Higher dietary acrylamide intake was significantly associated with poor physical performance, also after accounting for potential confounders, suggesting a role for this food contaminant as a possible risk factor for sarcopenia.

Critical reappraisal of neoadjuvant concurrent chemoradiotherapy for treatment of locally advanced colon cancer

by Yen-Cheng Chen, Hsiang-Lin Tsai, Ching-Chun Li, Ching-Wen Huang, Tsung-Kun Chang, Wei-Chih Su, Po-Jung Chen, Tzu-Chieh Yin, Chun-Ming Huang, Jaw-Yuan Wang


Locally advanced colon cancer (LACC) is associated with surgical challenges during R0 resection, increased postoperative complications, and unfavorable treatment outcomes. Neoadjuvant concurrent chemoradiotherapy followed by surgical resection is an effective treatment strategy that can increase the complete surgical resection rate and improve the patient survival rate. This study investigated the efficacy and toxicity of concurrent chemoradiotherapy in patients with LACC as well as the prognosis and long-term clinical outcomes of these patients.


From January 2012 to July 2020, we retrospectively reviewed the real-world data of 75 patients with LACC who received neoadjuvant concurrent chemoradiotherapy. The chemotherapy regimen consisted of folinic acid, 5-fluorouracil, and oxaliplatin (FOLFOX). The following data were obtained from medical records: patients’ characteristics, pathologic results, toxicity, and long-term oncologic outcome.


Of the 75 patients, 13 (17.3%) had pathologic complete responses. Hematologic adverse effects were the most common (grade 1 anemia: 80.0% and leukopenia: 82.7%). Conversely, grade 2 or 3 adverse effects were relatively uncommon (P = 0.019). The estimated 5-year overall and disease-free survival rates were 68.6% and 50.6%, and the medians of overall and disease-free survival periods were 72.3 and 58.7 months, respectively. Moreover, patients with pathologic complete responses had improved overall survival (P = 0.039) and an improved local recurrence control rate (P = 0.042) but an unfavorable distant metastasis control rate (P = 0.666) in the long-term follow-up.


The long-term oncologic outcome of patients with LACC following concurrent chemoradiotherapy is acceptable, and the adverse effects seem to be tolerable. Pathologic N downstaging was an independent prognostic factor for patients’ overall survival. However, a large prospective, randomized control study is required to confirm the current results.

Music and low-frequency vibrations for the treatment of chronic musculoskeletal pain in elderly: A pilot study

by Thom A. H. Eshuis, Peter J. C. Stuijt, Hans Timmerman, Peter Michael L. Nielsen, André Paul Wolff, Remko Soer


Transcutaneous vagal nerve stimulation has analgesic potential and might be elicited by abdominally administered low-frequency vibrations. The objective was to study the safety and effect of a combination of music and abdominally administered low-frequency vibrations on pain intensity in elderly patients with chronic musculoskeletal pain.


This trial was an international multicenter, randomized controlled pilot study. Patients at age ≥ 65 years with musculoskeletal pain for ≥ 3 months and a daily pain score ≥ 4 out of 10 were recruited at three centers. They were randomized to receive either a combination of music and low-frequency (20–100 Hz) vibrations administered to the abdomen, or a combination with the same music but with higher frequency (200–300 Hz) vibrations administered to the abdomen. Low-frequency vibrations were expected to result in pain reduction measured with a numeric pain rating scale (NRS). Patients in both groups received eight treatments of the music combined with the vibrations in three weeks. Primary outcomes were safety (Serious Adverse Events) and pain intensity measured at baseline, after the last treatment and at six weeks follow-up. Multilevel linear model analyses were performed to study group and time effects.


A total of 45 patients were analyzed according to intention-to-treat principle. After 344 treatments, 1 Adverse Event was found related to the intervention, while 13 Adverse Events were possibly related. A multilevel linear model showed that the interaction effect of group by time did not predict pain intensity (F[1, 45.93] = 0.002, p = 0.97) when comparing pain intensity at baseline, after the last treatment and at follow-up.


The combination of music and abdominally administered vibrations was found to be safe and well tolerated by the elderly patients. However, over time, neither the low-frequency treatment group nor the high-frequency treatment group provided clinically meaningful pain relief. There is no evidence that the low-frequency treatment elicited vagal nerve stimulation.

Trial registration

The trial was prospectively registered in the Netherlands Trial Register (NTR: NL7606) on 21-03-2019.

Self-medication practices to prevent or manage COVID-19: A systematic review

by Alvaro Quincho-Lopez, Christeam A. Benites-Ibarra, Maryori M. Hilario-Gomez, Renatta Quijano-Escate, Alvaro Taype-Rondan


Previous studies have assessed the prevalence and characteristics of self-medication in COVID-19. However, no systematic review has summarized their findings.


We conducted a systematic review to assess the prevalence of self-medication to prevent or manage COVID-19.


We used different keywords and searched studies published in PubMed, Scopus, Web of Science, Embase, two preprint repositories, Google, and Google Scholar. We included studies that reported original data and assessed self-medication to prevent or manage COVID-19. The risk of bias was assessed using the Newcastle–Ottawa Scale (NOS) modified for cross-sectional studies.


We identified eight studies, all studies were cross-sectional, and only one detailed the question used to assess self-medication. The recall period was heterogeneous across studies. Of the eight studies, seven assessed self-medication without focusing on a specific symptom: four performed in the general population (self-medication prevalence ranged between Conclusions

Studies that assessed self-medication for COVID-19 found heterogeneous results regarding self-medication prevalence and medications used. More well-designed and adequately reported studies are warranted to assess this topic.

Predictive factors of in-hospital mortality in patients with laboratory-confirmed <i>Escherichia coli</i>, <i>Klebsiella</i> species or <i>Pseudomonas aeruginosa</i> bloodstream infections

by Eleanor Mitchell, Mark Pearce, Anthony Roberts, Julia Newton

Gram-negative bloodstream infections (GNBSI) are confirmed by the presence of gram-negative bacteria in the bloodstream and pose a significant healthcare issue as they increase the risk of sepsis and mortality. In England, the aim is to reduce GNBSI cases and further deterioration through enhanced population surveillance of patients with a laboratory-confirmed GNBSI to inform on healthcare policies. The objective of this study was to evaluate the factors associated with in-hospital mortality in patients with a laboratory-confirmed Escherichia coli, Klebsiella or Pseudomonas aeruginosa GNBSIs, with data obtained from the enhanced data capture for the surveillance of GNBSIs. All patients with a laboratory-confirmed GNBSI at a single centre, admitted between April 2017 and March 2019, were included in this retrospective observational study. Demographic and recent exposure to healthcare risk factors were collected and assessed for the association with in-hospital mortality. In 1113 patients with laboratory-confirmed GNBSIs, the in-hospital mortality rate was 13%. Multivariable analysis confirmed that patients with respiratory (OR = 3.73, 95%CI = 2.05–6.76), gastrointestinal (2.61; 1.22–5.58) or skin (3.61; 1.24–10.54) infection primary focus had a greater risk of in-hospital mortality, compared to upper urinary tract infections. Increased risk of in-hospital mortality was also observed in patients with hospital-onset GNBSIs (OR = 1.87; 1.17–2.97) compared with community-onset healthcare acquired GNBSIs, or who were on dialysis at the time of the GNBSI (3.28; 1.01–10.14), as well as in patients who had recently been discharged from hospital (1.55; 1.01–2.38), or had a vascular device recently manipulated (2.41; 1.01–5.74). Results confirm that the data obtained from the enhanced data capture for GNBSIs in England can predict in-hospital mortality in patients with a GNBSI. Several factors associated with an increased risk of in-hospital mortality have been identified. Results should be reported back to clinicians in order to identify patients at a greater risk of dying in-hospital who may benefit from further monitoring.

Remote delivery of alcohol and/or substance misuse interventions for adults: A systematic review protocol

by Neil Howlett, Jaime Garcia-Iglesias, Gavin Breslin, Suzanne Bartington, Julia Jones, Katherine Brown, Wendy Wills


Alcohol and substance misuse are a public health priority. The World Health Organisation (WHO) estimates that harmful alcohol use accounts for 5.1% of the global burden of disease and that 35.6 million people worldwide are affected by substance misuse. The Coronavirus Disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has disrupted delivery of face-to-face alcohol and substance misuse interventions and has forced the development of alternative remote interventions or adaptation to existing ones. Although existing research on remote interventions suggests they might be as effective as face-to-face delivery, there has been a lack of systematic exploration of their content, the experience of service users, and their effectiveness for behavioural outcomes. This review will provide a narrative synthesis of the behaviour change techniques (BCT) contained in interventions for alcohol and/or substance misuse and their association with effectiveness.

Methods and analysis

Systematic searches will be conducted in MEDLINE, Scopus, PsycINFO (ProQuest), and the Cochrane Library. Included studies will be those reporting remote interventions focusing on alcohol and/or substance misuse among adults living in the community and which have a primary behaviour change outcome (i.e., alcohol levels consumed). Data extraction will be conducted by one author and moderated by a second, and risk of bias and behaviour change technique (BCT) coding will be conducted by two authors independently. A narrative synthesis will be undertaken focussing upon the association of BCTs with intervention effectiveness using promise ratios.

Patient and Public Involvement (PPI)

The Public Involvement in Research Group (PIRG), part of the NIHR-funded PHIRST, will be involved in refining the review questions, eligibility criteria, data synthesis and dissemination.


Dissemination will be through an academic peer reviewed publication, alongside other outputs to be shared with non-academic policy, professional, and public audiences, including local authorities, service users and community organisations.

Chromosomal variants accumulate in genomes of the spontaneous aborted fetuses revealed by chromosomal microarray analysis

by Sen Li, Lei-Ling Chen, Xing-Hua Wang, Hai-Jing Zhu, Xiao-Long Li, Xie Feng, Lei Guo, Xiang-Hong Ou, Jun-Yu Ma

Spontaneous abortion is an impeding factor for the success rates of human assistant reproductive technology (ART). Causes of spontaneous abortion include not only the pregnant mothers’ health conditions and lifestyle habits, but also the fetal development potential. Evidences had shown that fetal chromosome aneuploidy is associated with fetal spontaneous abortion, however, it is still not definite that whether other genome variants, like copy number variations (CNVs) or loss of heterozygosity (LOHs) is associated with the spontaneous abortion. To assess the relationship between the fetal genome variants and abortion during ART, a chromosomal microarray data including chromosomal information of 184 spontaneous aborted fetuses, 147 adult female patients and 78 adult male patients during ART were collected. We firstly analyzed the relationship of fetal aneuploidy with maternal ages and then compared the numbers and lengths of CNVs (

The relative effectiveness of law enforcement policies aimed at reducing illegal trade: Evidence from laboratory markets

by Chian Jones Ritten, Christopher Bastian, Owen Phillips

Despite recent emphasis and implementation of national and international anti-money laundering policies, illegal product markets, and their associated illicit profit remain a global problem. In addition to law enforcement aimed at reducing money-laundering, enforcement also takes place during (1) the production (e.g. crop eradication) and (2) sale (e.g. seizure of products during transportation that interrupts buyer and seller transactions) of the illegal product. Since funds for enforcement come from limited budgets, understanding where in this production-trade-laundering cycle law enforcement is most impactful becomes a global question. Using laboratory experimental markets and a seizure rate of 20%, we find that law enforcement focused on seizing laundered profits does little to reduce illegal market activity when compared to no law enforcement, suggesting that focusing law enforcement on money laundering will likely be ineffective at reducing crime. Results further show the amount of illicit trade is nearly 32% lower when law enforcement is focused at the point of sale, and there may be additional economic incentives that reduce illicit trade in the long run when compared to no law enforcement. Enforcement at the point of production also reduces market activity, but not as effectively as enforcement at the point of sale. Lastly, the empirical findings deviate from equilibrium predictions, suggesting law enforcement policy based on theory alone may lead to inefficient allocation of limited law enforcement resources.

The prevalence of suicidal behavior and its associated factors among wives with polygamy marriage living in Gedeo zone, southern Ethiopia, 2020

by Chalachew Kassaw, Seid Shumye


Polygamy is a trend of marriage characterized by having two and more wives or husbands at the same time. In low and middle-income countries including Ethiopia, polygamy has a significant negative effect on the social, economic, physical, and mental well-being of women. Therefore, this study aimed to assess the prevalence and associated factors of suicidal behavior among wives with polygamy marriage living in the Gedeo zone, Southern Ethiopia, 2020.


A community-based study employing cross-sectional design and systematic sampling technique was used to select wives with polygamy marriage who are residents of Gedeo Zone from November to December 2020. The World Health Organization Suicidal Behavior Questions (SBQ-5) was adapted to explore the outcome variable. The Logistic regression at 95% CI, p Results

This study enrolled 423 respondents. The study revealed that, the overall prevalence of suicidal behavior was 157(37%). Illiteracy, being a wife of a husband with three and more other wives, current history of depression, intimate partner violence, and poor social support were significantly associated with suicidal behavior at 95% confidence interval, p Conclusion

This study found that one-third of the respondents had suicidal behavior. Different significant socio-demographic and psychosocial variables were identified. Thus, due attention should be given to minimize the practice and its effect on the mental wellbeing of a mother and their children.

Characterizations of the viability and gene expression of dispersal cells from <i>Pseudomonas aeruginosa</i> biofilms released by alginate lyase and tobramycin

by Said M. Daboor, Renee Raudonis, Zhenyu Cheng

Biofilm infections are hard to manage using conventional antibiotic treatment regimens because biofilm structures discourage antibiotics from reaching the entire bacterial community and allow pathogen cells to persistently colonize and develop a plethora of tolerance mechanisms towards antibiotics. Moreover, the dispersed cells from biofilms can cause further complications by colonizing different sites and establishing new cycles of biofilms. Previously, we showed that alginate lyase enzyme (AlyP1400), purified from a marine Pseudoalteromonas bacterium, reduced Pseudomonas aeruginosa biofilm biomass and boosted bactericidal activity of tobramycin by degrading alginate within the biofilm extracellular polymeric substances matrix. In this work, we used a flow cytometry-based assay to analyze collected dispersal cells and demonstrated the synergy between tobramycin with AlyP1400 in enhancing the release of both live and dead biofilm cells from a mucoid P. aeruginosa strain CF27, which is a clinical isolate from cystic fibrosis (CF) patients. Interestingly, this enhanced dispersal was only observed when AlyP1400 was combined with tobramycin and administered simultaneously but not when AlyP1400 was added in advance of tobramycin in a sequential manner. Moreover, neither the combined nor sequential treatment altered the dispersal of the biofilms from a non-mucoid P. aeruginosa laboratory strain PAK. We then carried out the gene expression and tobramycin survival analyses to further characterize the impacts of the combined treatment on the CF27 dispersal cells. Gene expression analysis indicated that CF27 dispersal cells had increased expression in virulence- and antibiotic resistance-related genes, including algR, bdlA, lasB, mexF, mexY, and ndvB. In the CF27 dispersal cell population, the combinational treatment of AlyP1400 with tobramycin further induced bdlA, mexF, mexY, and ndvB genes more than non-treated and tobramycin-treated dispersal cells, suggesting an exacerbated bacterial stress response to the combinational treatment. Simultaneous to the gene expression analysis, the survival ability of the same batch of biofilm dispersal cells to a subsequent tobramycin challenge displayed a significantly higher tobramycin tolerant fraction of cells (~60%) upon the combinational treatment of AlyP1400 and tobramycin than non-treated and tobramycin-treated dispersal cells, as well as the planktonic cells (all below 10%). These results generate new knowledge about the gene expression and antibiotic resistance profiles of dispersed cells from biofilm. This information can guide the design of safer and more efficient therapeutic strategies for the combinational use of alginate lyase and tobramycin to treat P. aeruginosa biofilm-related infections in CF lungs.

Long-term stability of physiological signals within fluctuations of brain state under urethane anesthesia

by Nicholas R. G. Silver, Rachel Ward-Flanagan, Clayton T. Dickson

Urethane, an acute laboratory anesthetic, produces distinct neurophysiological and physiological effects creating an effective model of the dynamics of natural sleep. As a model of both sleep-like neurophysiological activity and the downstream peripheral function urethane is used to model a variety of physiological and pathophysiological processes. As urethane is typically administered as a single-bolus dose, it is unclear the stability of peripheral physiological functions both within and between brain-states under urethane anesthesia. In this present study, we recorded respiration rate and heart rate concurrently with local field potentials from the neocortex and hippocampus to determine the stability of peripheral physiological functions within and between brain-states under urethane anesthesia. Our data shows electroencephalographic characteristics and breathing rate are remarkable stable over long-term recordings within minor reductions in heart rate on the same time scale. Our findings indicate that the use of urethane to model peripheral physiological functions associated with changing brain states are stable during long duration experiments.

Disease-associated variants of Gap Junction Beta 2 protein (<i>GJB2</i>) in the deaf population of Southern Punjab of Pakistan

by Nabila Kausar, Asma Haque, Muhammad Shareef Masoud, Nazia Nahid, Usman Ali Ashfaq, Ali Muhammad Waryah, Rashid Bhatti, Muhammad Qasim

Hearing impairment (HI) is a highly heterogeneous genetic disorder and is classified into nonsyndromic (without any other clinical manifestations) and syndromic (if combined with other clinical presentations) forms. Variations in GJB2 gene are the leading cause of autosomal recessive nonsyndromic hearing loss (ARNSHL) in several populations worldwide. This study was carried out to investigate the prevalence of GJB2 variations in severe-to-profound hearing impaired families of Southern Punjab of Pakistan. Ten families segregating ARNSHL were recruited from different areas of the region. Sanger sequencing of GJB2 coding region was carried out. In two out of ten families, NM_004004:c.*71G>A (p.(Trp24*)) and NM_004004:c.358_360del (p.(Glu120del)) homozygous variants were identified as the cause of hearing loss. Our study showed that GJB2-related hearing loss accounts for at least 20% of all cases with severe-to-profound hearing loss in the Southern Punjab population of Pakistan.