Global Perspectives on Task Shifting and Task Sharing in Neurosurgery

BACKGROUND

Neurosurgical task shifting and task sharing (TS/S), delegating clinical care to non-neurosurgeons, is ongoing in many hospital systems in which neurosurgeons are scarce. Although TS/S can increase access to treatment, it remains highly controversial. This survey investigated perceptions of neurosurgical TS/S to elucidate whether it is a permissible temporary solution to the global workforce deficit.

METHODS

The survey was distributed to a convenience sample of individuals providing neurosurgical care. A digital survey link was distributed through electronic mailing lists of continental neurosurgical societies and various collectives, conference announcements, and social media platforms (July 2018-January 2019). Data were analyzed by descriptive statistics and univariate regression of Likert Scale scores.

RESULTS

Survey respondents represented 105 of 194 World Health Organization member countries (54.1%; 391 respondents, 162 from high-income countries and 229 from low- and middle-income countries [LMICs]). The most agreed on statement was that task sharing is preferred to task shifting. There was broad consensus that both task shifting and task sharing should require competency-based evaluation, standardized training endorsed by governing organizations, and maintenance of certification. When perspectives were stratified by income class, LMICs were significantly more likely to agree that task shifting is professionally disruptive to traditional training, task sharing should be a priority where human resources are scarce, and to call for additional TS/S regulation, such as certification and formal consultation with a neurosurgeon (in person or electronic/telemedicine).

CONCLUSIONS

Both LMIC and high-income countries agreed that task sharing should be prioritized over task shifting and that additional recommendations and regulations could enhance care. These data invite future discussions on policy and training programs.

Global health, global surgery and mass casualties: II. Mass casualty centre resources, equipment and implementation

Trauma/stroke centres optimise acute 24/7/365 surgical/critical care in high-income countries (HICs). Concepts from low-income and middle-income countries (LMICs) offer additional cost-effective healthcare strategies for limited-resource settings when combined with the trauma/stroke centre concept. Mass casualty centres (MCCs) integrate resources for both routine and emergency care-from prevention to acute care to rehabilitation. Integration of the various healthcare systems-governmental, non-governmental and military-is key to avoid both duplication and gaps. With input from LMIC and HIC personnel of various backgrounds-trauma and subspecialty surgery, nursing, information technology and telemedicine, and healthcare administration-creative solutions to the challenges of expanding care (both daily and disaster) are developed. MCCs are evolving initially in Chile and Pakistan. Technologies for cost-effective healthcare in LMICs include smartphone apps (enhance prehospital care) to electronic data collection and analysis (quality improvement) to telemedicine and drones/robots (support of remote regions and resource optimisation during both daily care and disasters) to resilient, mobile medical/surgical facilities (eg, battery-operated CT scanners). The co-ordination of personnel (within LMICs, and between LMICs and HICs) and the integration of cost-effective advanced technology are features of MCCs. Providing quality, cost-effective care 24/7/365 to the 5 billion who lack it presently makes MCCs an appealing means to achieve the healthcare-related United Nations Sustainable Development Goals for 2030.

Correction: Variation in surface properties, metabolic capping, and antibacterial activity of biosynthesized silver nanoparticles: comparison of bio-fabrication potential in phytohormone-regulated cell cultures and naturally grown plants

Correction for ‘Variation in surface properties, metabolic capping, and antibacterial activity of biosynthesized silver nanoparticles: comparison of bio-fabrication potential in phytohormone-regulated cell cultures and naturally grown plants’ by Tariq Khan et al., RSC Adv., 2020, 10, 38831–38840, DOI: 10.1039/D0RA08419K.

Variation in surface properties, metabolic capping, and antibacterial activity of biosynthesized silver nanoparticles: comparison of bio-fabrication potential in phytohormone-regulated cell cultures and naturally grown plants

We compared surface properties, metabolic capping and antibacterial activity of silver nanoparticles, synthesized through extracts of cell cultures of Fagonia indica and its naturally grown form. Extracts from cell cultures (produced with thidiazuron (TDZ) or melatonin (MLN)) were compared to the naturally grown whole plant extracts (WPEs) for their reducing potential, and their effects on physical and biochemical properties of the biosynthesized silver nanoparticles. UV-Vis spectroscopy revealed that the surface plasmon resonance peaked at λ = 415 nm for MLN-AgNPs, λ = 430 nm for TDZ-AgNPs and λ = 460–465 nm for WPE-AgNPs. Transmission electron microscopy and energy dispersive X-rays of AgNPs showed that compared to WPE-AgNPs (mean diameter = 22 nm), extracts from MLN- and TDZ-induced cell cultures produced particles with spherical shapes and smaller diameters (i.e. mean diameter = 15 nm and 19 nm, respectively). Size distribution analysis also showed that TDZ-AgNPs were nearer to a symmetric distribution in terms of diameter (skewness = 0.80) as compared to WPE-AgNPs (skewness = 0.9) and MLN-AgNPs (skewness = 1.4). Furthermore, MLN-induced cell culture extracts produced AgNPs in higher concentration (210 μg mL⁻¹) compared to AgNPs from TDZ-induced cell culture extracts (160 μg mL⁻¹) and WPE (138 μg mL⁻¹). Two-way comparisons of LC-MS/MS profiles of TDZ-AgNPs, MLN-AgNPs, and WPE-AgNPs revealed differences in their secondary metabolite profiles, which might account for differences in their differential response in bio-fabrication, and size distribution. Activity against different pathogenic bacterial strains, Escherichia coli, Bacillus cereus, Xanthomonas citri, Agrobacterium tumefaciens, Streptomyces griseus, and Erwinia carotovora suggested that MLN-AgNPs were more effective compared to TDZ- and WPE-AgNPs. These results indicated that phytohormones induced cell cultures can enhance the production, physical and biochemical properties of AgNPs.

We compared surface properties, metabolic capping and antibacterial activity of biosynthesized silver nanoparticles, synthesized through extracts of cell cultures of Fagonia indica and its naturally grown form.

Anticancer Plants: A Review of the Active Phytochemicals, Applications in Animal Models, and Regulatory Aspects

The rising burden of cancer worldwide calls for an alternative treatment solution. Herbal medicine provides a very feasible alternative to western medicine against cancer. This article reviews the selected plant species with active phytochemicals, the animal models used for these studies, and their regulatory aspects. This study is based on a meticulous literature review conducted through the search of relevant keywords in databases, Web of Science, Scopus, PubMed, and Google Scholar. Twenty plants were selected based on defined selection criteria for their potent anticancer compounds. The detailed analysis of the research studies revealed that plants play an indispensable role in fighting different cancers such as breast, stomach, oral, colon, lung, hepatic, cervical, and blood cancer cell lines. The in vitro studies showed cancer cell inhibition through DNA damage and activation of apoptosis-inducing enzymes by the secondary metabolites in the plant extracts. Studies that reported in vivo activities of these plants showed remarkable results in the inhibition of cancer in animal models. Further studies should be performed on exploring more plants, their active compounds, and the mechanism of anticancer actions for use as standard herbal medicine.

Global health, global surgery and mass casualties. I. Rationale for integrated mass casualty centres

It has been well-documented recently that 5 billion people globally lack surgical care. Also well-documented is the need to improve mass casualty disaster response. Many of the United Nations (UN) Sustainable Development Goals (SDGs) for 2030-healthcare and economic milestones-require significant improvement in global surgical care, particularly in low-income and middle-income countries. Trauma/stroke centres evolved in high-income countries with evidence that 24/7/365 surgical and critical care markedly improved morbidity and mortality for trauma and stroke and for cardiovascular events, difficult childbirth, acute abdomen. Duplication of emergency services, especially civilian and military, often results in suboptimal, expensive care. By combining all healthcare resources within the ongoing healthcare system, more efficient care for both individual emergencies and mass casualty situations can be achieved. We describe progress in establishing mass casualty centres in Chile and Pakistan. In both locations, planning among the stakeholders (primarily civilian and military) indicates the feasibility of such integrated surgical and emergency care. We also review other programmes and initiatives to provide integrated mass casualty disaster response. Integrated mass casualty centres are a feasible means to improve both day-to-day surgical care and mass casualty disaster response. The humanitarian aspect of mass casualty disasters facilitates integration among stakeholders-from local healthcare systems to military resources to international healthcare organisations. The benefits of mass casualty centres-both healthcare and economic-can facilitate achieving the 2030 UN SDGs.

Complete Measurement of the Λ Electromagnetic Form Factors

The exclusive process e^{+}e^{-}→ΛΛ[over ¯], with Λ→pπ^{-} and Λ[over ¯]→p[over ¯]π^{+}, has been studied at sqrt[s]=2.396  GeV for measurement of the timelike Λ electric and magnetic form factors, G_{E} and G_{M}. A data sample, corresponding to an integrated luminosity of 66.9  pb^{-1}, was collected with the BESIII detector for this purpose. A multidimensional analysis with a complete decomposition of the spin structure of the reaction enables a determination of the modulus of the ratio R=|G_{E}/G_{M}| and, for the first time for any baryon, the relative phase ΔΦ=Φ_{E}-Φ_{M}. The resulting values are R=0.96±0.14(stat)±0.02(syst) and ΔΦ=37°±12°(stat)±6°(syst), respectively. These are obtained using the recently established and most precise value of the asymmetry parameter α_{Λ}=0.750±0.010 measured by BESIII. In addition, the cross section is measured with unprecedented precision to be σ=118.7±5.3(stat)±5.1(syst)  pb, which corresponds to an effective form factor of |G|=0.123±0.003(stat)±0.003(syst). The contribution from two-photon exchange is found to be negligible. Our result enables the first complete determination of baryon timelike electromagnetic form factors.

Amplitude Analysis of D_{s}^{+}→π^{+}π^{0}η and First Observation of the W-Annihilation Dominant Decays D_{s}^{+}→a_{0}(980)^{+}π^{0} and D_{s}^{+}→a_{0}(980)^{0}π^{+}

We present the first amplitude analysis of the decay D_{s}^{+}→π^{+}π^{0}η. We use an e^{+}e^{-} collision data sample corresponding to an integrated luminosity of 3.19  fb^{-1} collected with the BESIII detector at a center-of-mass energy of 4.178 GeV. We observe for the first time the W-annihilation dominant decays D_{s}^{+}→a_{0}(980)^{+}π^{0} and D_{s}^{+}→a_{0}(980)^{0}π^{+}. We measure the absolute branching fraction B(D_{s}^{+}→a_{0}(980)^{+(0)}π^{0^{(}+)},a_{0}(980)^{+(0)}→π^{+(0)}η)=(1.46±0.15_{stat}±0.23_{sys})%, which is larger than the branching fractions of other measured pure W-annihilation decays by at least one order of magnitude. In addition, we measure the branching fraction of D_{s}^{+}→π^{+}π^{0}η with significantly improved precision.

Consensus statement from the International Consensus Meeting on the Role of Decompressive Craniectomy in the Management of Traumatic Brain Injury : Consensus statement

BACKGROUND

Two randomised trials assessing the effectiveness of decompressive craniectomy (DC) following traumatic brain injury (TBI) were published in recent years: DECRA in 2011 and RESCUEicp in 2016. As the results have generated debate amongst clinicians and researchers working in the field of TBI worldwide, it was felt necessary to provide general guidance on the use of DC following TBI and identify areas of ongoing uncertainty via a consensus-based approach.

METHODS

The International Consensus Meeting on the Role of Decompressive Craniectomy in the Management of Traumatic Brain Injury took place in Cambridge, UK, on the 28th and 29th September 2017. The meeting was jointly organised by the World Federation of Neurosurgical Societies (WFNS), AO/Global Neuro and the NIHR Global Health Research Group on Neurotrauma. Discussions and voting were organised around six pre-specified themes: (1) primary DC for mass lesions, (2) secondary DC for intracranial hypertension, (3) peri-operative care, (4) surgical technique, (5) cranial reconstruction and (6) DC in low- and middle-income countries.

RESULTS

The invited participants discussed existing published evidence and proposed consensus statements. Statements required an agreement threshold of more than 70% by blinded voting for approval.

CONCLUSIONS

In this manuscript, we present the final consensus-based recommendations. We have also identified areas of uncertainty, where further research is required, including the role of primary DC, the role of hinge craniotomy and the optimal timing and material for skull reconstruction.

Study of e^{+}e^{-}→γωJ/ψ and Observation of X(3872)→ωJ/ψ

We study the e^{+}e^{-}→γωJ/ψ process using 11.6  fb^{-1} e^{+}e^{-} annihilation data taken at center-of-mass energies from sqrt[s]=4.008  GeV to 4.600 GeV with the BESIII detector at the BEPCII storage ring. The X(3872) resonance is observed for the first time in the ωJ/ψ system with a significance of more than 5σ. The relative decay ratio of X(3872)→ωJ/ψ and π^{+}π^{-}J/ψ is measured to be R=1.6_{-0.3}^{+0.4}±0.2, where the first uncertainty is statistical and the second systematic (the same hereafter). The sqrt[s]-dependent cross section of e^{+}e^{-}→γX(3872) is also measured and investigated, and it can be described by a single Breit-Wigner resonance, referred to as the Y(4200), with a mass of 4200.6_{-13.3}^{+7.9}±3.0  MeV/c^{2} and a width of 115_{-26}^{+38}±12  MeV. In addition, to describe the ωJ/ψ mass distribution above 3.9  GeV/c^{2}, we need at least one additional Breit-Wigner resonance, labeled as X(3915), in the fit. The mass and width of the X(3915) are determined. The resonant parameters of the X(3915) agree with those of the Y(3940) in B→KωJ/ψ and of the X(3915) in γγ→ωJ/ψ observed by the Belle and BABAR experiments within errors.

Evaluation of the antibacterial potential of silver nanoparticles synthesized through the interaction of antibiotic and aqueous callus extract of Fagonia indica

Fagonia indica is a widely known medicinal plant. The extracts of Fagonia species contain secondary metabolites such as flavonoids, phenolic compounds, and terpenoids. Silver nanoparticles are known for antibacterial properties. In this study, AgNPs were synthesized using the callus extract of F. indica as a reducing agent. Characterization through different techniques suggests that the AgNPs absorbed light and gave SPR peaks at 414 nm while in case of ciprofloxacin supplemented callus mediated AgNPs the peak were recorded at 419 nm. Furthermore, FTIR analysis revealed the role of amides, acyl group, nitro group of callus extract of F. indica, and some functional groups of the ciprofloxacin in the reduction process as well as the capping and stabilization of AgNPs. Similarly, X-Ray Diffraction analysis indicate the structure of AgNPs as face-centered cubic crystalline particles. The antibacterial activity of AgNPs and ciprofloxacin and callus extract as control against resistant bacteria such as Escherichia coli, Citrobacter amalonaticus, Shigella sonnei, and Salmonella typhi was studied. The combination of AgNPs and antibiotic showed better antibacterial activity as compared to AgNPs alone and ciprofloxacin alone. Maximum inhibition zone of E. coli, C. amalonaticus, S. sonnei, and S. typhi in response to AgNPs and ciprofloxacin was 38.5 mm, 35.5 mm, 33 mm, and 35.5 mm, respectively. It can, therefore, be suggested that the AgNPs along with Ciprofloxacin might have worked in interaction and resulted in better antibacterial activity against all the tested pathogens.

Observation of the Decay X(3872)→π^{0}χ_{c1}(1P)

Using a total of 9.0  fb^{-1} of e^{+}e^{-} collision data with center-of-mass energies between 4.15 and 4.30 GeV collected by the BESIII detector, we search for the processes e^{+}e^{-}→γX(3872) with X(3872)→π^{0}χ_{cJ} for J=0, 1, 2. We report the first observation of X(3872)→π^{0}χ_{c1}, a new decay mode of the X(3872), with a statistical significance of more than 5σ for all systematic fit variations. Normalizing to the previously established process e^{+}e^{-}→γX(3872) with X(3872)→π^{+}π^{-}J/ψ, we find B(X(3872)→π^{0}χ_{c1})/B(X(3872)→π^{+}π^{-}J/ψ)=0.88_{-0.27}^{+0.33}±0.10, where the first error is statistical and the second is systematic. We set 90% confidence level upper limits on the corresponding ratios for the decays to π^{0}χ_{c0} and π^{0}χ_{c2} of 19 and 1.1, respectively.

Precision Measurement of the Branching Fractions of η^{'} Decays

Based on a sample of (1310.6±7.0)×10^{6}J/ψ events collected with the BESIII detector, we present measurements of J/ψ and η^{'} absolute branching fractions using the process J/ψ→γη^{'}. By analyzing events where the radiative photon converts into an e^{+}e^{-} pair, the branching fraction for J/ψ→γη^{'} is measured to be (5.27±0.03±0.05)×10^{-3}. The absolute branching fractions of the five dominant decay channels of the η^{'} are then measured for the first time and are determined to be B(η^{'}→γπ^{+}π^{-})=(29.90±0.03±0.55)%, B(η^{'}→ηπ^{+}π^{-})=(41.24±0.08±1.24)%, B(η^{'}→ηπ^{0}π^{0})=(21.36±0.10±0.92)%, B(η^{'}→γω)=(2.489±0.018±0.074)%, and B(η^{'}→γγ)=(2.331±0.012±0.035)%, where the first uncertainties are statistical and the second systematic.

Measurement of the Dynamics of the Decays D_{s}^{+}→η^{(')}e^{+}ν_{e}

Using e^{+}e^{-} annihilation data corresponding to an integrated luminosity of 3.19  fb^{-1} collected at a center-of-mass energy of 4.178 GeV with the BESIII detector, we measure the absolute branching fractions B_{D_{s}^{+}→ηe^{+}ν_{e}}=(2.323±0.063_{stat}±0.063_{syst})% and B_{D_{s}^{+}→η^{'}e^{+}ν_{e}}=(0.824±0.073_{stat}±0.027_{syst})% via a tagged analysis technique, where one D_{s} is fully reconstructed in a hadronic mode. Combining these measurements with previous BESIII measurements of B_{D^{+}→η^{(')}e^{+}ν_{e}}, the η-η^{'} mixing angle in the quark flavor basis is determined to be ϕ_{P}=(40.1±2.1_{stat}±0.7_{syst})°. From the first measurements of the dynamics of D_{s}^{+}→η^{(')}e^{+}ν_{e} decays, the products of the hadronic form factors f_{+}^{η^{(')}}(0) and the Cabibbo-Kobayashi-Maskawa matrix element |V_{cs}| are determined with different form factor parametrizations. For the two-parameter series expansion, the results are f_{+}^{η}(0)|V_{cs}|=0.4455±0.0053_{stat}±0.0044_{syst} and f_{+}^{η^{'}}(0)|V_{cs}|=0.477±0.049_{stat}±0.011_{syst}.

Evidence of a Resonant Structure in the e^{+}e^{-}→π^{+}D^{0}D^{*-} Cross Section between 4.05 and 4.60 GeV

The cross section of the process e^{+}e^{-}→π^{+}D^{0}D^{*-} for center-of-mass energies from 4.05 to 4.60 GeV is measured precisely using data samples collected with the BESIII detector operating at the BEPCII storage ring. Two enhancements are clearly visible in the cross section around 4.23 and 4.40 GeV. Using several models to describe the dressed cross section yields stable parameters for the first enhancement, which has a mass of 4228.6±4.1±6.3  MeV/c^{2} and a width of 77.0±6.8±6.3  MeV, where the first uncertainties are statistical and the second ones are systematic. Our resonant mass is consistent with previous observations of the Y(4220) state and the theoretical prediction of a DD[over ¯]_{1}(2420) molecule. This result is the first observation of Y(4220) associated with an open-charm final state. Fits with three resonance functions with additional Y(4260), Y(4320), Y(4360), ψ(4415), or a new resonance do not show significant contributions from either of these resonances. The second enhancement is not from a single known resonance. It could contain contributions from ψ(4415) and other resonances, and a detailed amplitude analysis is required to better understand this enhancement.