bluuebunny/crossref_metadata_2025 huggingface dataset:
Is Rifampin Use Associated With Better Outcome in Staphylococcal Prosthetic Valve Endocarditis? A Multicenter Retrospective Study
Authors: Le Bot Audrey , Lecomte Raphaël , Gazeau Pierre , Benezit François , Arvieux Cédric , Ansart Séverine , Boutoille David , Le Berre Rozenn , Chabanne Céline , Lesouhaitier Matthieu , Dejoies Loren , Flecher Erwan , Chapplain Jean-Marc , Tattevin Pierre , Revest Matthieu
Published: July 2020

Background

International guidelines recommend rifampin-based combinations for staphylococcal prosthetic valve endocarditis (PVE). However, no robust clinical data support this recommendation, and rifampin tolerability is an issue. We aimed to evaluate the impact of rifampin for the treatment of staphylococcal PVE.

Methods

An observational retrospective cohort study of all adults with staphylococcal PVE (modified Duke criteria) was conducted in 3 referral centers for endocarditis, during years 2000–2018. Primary outcome measurement was 1-year mortality.

Results

We enrolled 180 patients with PVE due to Staphylococcus aureus (n = 114, 63.3%), or coagulase-negative staphylococci (n = 66, 36.7%), on bioprosthesis (n = 111, 61.7%), mechanical valve (n = 67, 37.2%), or both (n = 2). There were 132 males (73.3%), and mean age was 70.4 ± 12.4 years. Valvular surgery was performed in 51/180 (28.3%) cases. Despite all isolates were susceptible to rifampin, only 101 (56.1%) were treated with rifampin, for a median duration of 33.0 days, whereas 79 (43.9%) received no rifampin. Baseline characteristics were similar in both groups. One-year mortality was, respectively, 37.6% (38/101), and 31.6% (25/79), in patients treated with, or without, rifampin (P = .62). Relapse rates were 5.9% (6/101), and 8.9% (7/79), P = .65. Patients treated with rifampin had longer hospital length-of-stay: 42.3 ± 18.6 vs 31.3 ± 14.0 days (P < .0001). On multivariate analysis, only cerebral emboli (odds ratio [OR] 2.95, 95% confidence interval [CI], 1.30–6.70, P = .009), definite endocarditis (OR 7.15, 95% CI, 1.47–34.77, P = .018), and methicillin-resistant S. aureus (OR 6.04, 95% CI, 1.34–27.26, P = .019), were associated with 1-year mortality.

Conclusions

A large proportion (43.9%) of staphylococcal PVE received no rifampin. One-year survival and relapse rates were similar in patients treated with or without rifampin.
Multi-inflammatory Syndrome in Children Related to Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in Spain
Authors: Moraleda Cinta , Serna-Pascual Miquel , Soriano-Arandes Antoni , Simó Silvia , Epalza Cristina , Santos Mar , Grasa Carlos , Rodríguez Maria , Soto Beatriz , Gallego Nerea , Ruiz Yolanda , Urretavizcaya-Martínez María , Pareja Marta , Sanz-Santaeufemia Francisco José , Fumadó Victoria , Lanaspa Miguel , Jordan Iolanda , Prieto Luis , Belda Sylvia , Toral-Vázquez Belén , Rincón Elena , Gil-Villanueva Nuria , Méndez-Echevarría Ana , Castillo-Serrano Ana , Rivière Jacques G , Soler-Palacín Pere , Rojo Pablo , Tagarro Alfredo ,   EPICO-AEP Working Group, del Valle Rut , Barrios Ana , Villanueva Sara , Contreras Jesús R , Gutiérrez Lourdes , Calvo Cristina , Molino Paula R , José Mellado María , de Ceano María , Penin María , Villaverde Serena , José Pérez María , Otheo Enrique , Dolores Falcón María , Neth Olaf , Olbrich Peter , Goycoechea Walter , Martín Laura , Isabel Iglesias María , Antonio Alonso Cadenas José , Herrero Blanca , Cobo Elvira , Tovizi Mariam , Galán Pilar , Guillén Sara , Navas Adriana , Luz García-García M , Llorente Marta , Pérez Sara , Figueroa Lucía , Bermejo Amanda , Mendoza Pablo , Sabrido Gema , José Hernández María , Belén Jiménez Ana , Berzosa Arantxa , Illán Marta , Bernardino María , Jensen Julia , Vidal Paula , Domínguez Sara , Gutiérrez Lourdes , Ocaña Angustias , Romero Isabel , Fernanda Guzmán María , Pascual M J , López Machín Ana , Ruiz Beatriz , Menasalvas Ana , Méndez María , Hurtado Ángela , Ara Fátima , Cabañas Fernando , Oltra Manuel , Villarroya Álvaro , Sánchez-Códez María , Montesinos Elena , Herranz Aguirre Mercedes , Rius Neus , Gómez Alba , Bretón Rafael , Rodríguez-Benjumea Margarita , Campos Ana , García Reymundo Mercedes
Published: July 2020

Some clusters of children with a multisystem inflammatory syndrome (MIS-C) associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have been reported. We describe the epidemiological and clinical features of children with MIS-C in Spain. MIS-C is a potentially severe condition that presents in children with recent SARS-CoV-2 infection.
Postpandemic Testing of Severe Acute Respiratory Syndrome Coronavirus 2 in the Huanan Seafood Market Area in Wuhan, China
Authors: Li Jingwen , Wu Chengbi , Zhang Xing , Chen Lan , Wang Xinyi , Guan Xiuli , Li Jinghong , Lin Zhicheng , Xiong Nian
Published: July 2020

Seventy-six days after the coronavirus disease 2019 epidemic was contained in Wuhan, the Chinese government carried out a citywide severe acute respiratory syndrome coronavirus 2 nucleic acid testing initiative for all residents from 14 May to 1 June 2020. Our hospital tested 107 662 residents around Huanan seafood market, uncovering a positivity rate of 0.006%.
Importance of Lifetime Sexual History on the Prevalence of Genital Human Papillomavirus (HPV) Among Unvaccinated Adults in the National Health and Nutrition Examination Surveys: Implications for Adult HPV Vaccination
Authors: Rositch Anne F , Patel Eshan U , Petersen Molly R , Quinn Thomas C , Gravitt Patti E , Tobian Aaron A R
Published: July 2020

Background

Although the United States Food and Drug Administration recently approved the human papillomavirus (HPV) vaccine for individuals aged 27–45 years, the Centers for Disease Control and Prevention did not change its guidelines for routine HPV vaccination. Since recommendations for adult vaccination emphasize shared clinical decision-making based on risk of new infections, we examined the relationship between HPV prevalence and sexual behavior.

Methods

This study was conducted among 5093 HPV-unvaccinated, sexually experienced adults aged 18–59 years in the National Health and Nutrition Examination Surveys (2013–2016). For each sex and age group, adjusted prevalences of 9-valent vaccine–specific, high-risk, and any HPV infection were estimated by number of lifetime sexual partners (LTSPs) using logistic regression. An analysis restricted to persons who did not have a new sexual partner in the past year (ie, removing those at highest risk of newly acquired HPV) was also conducted.

Results

In each age group, genital HPV prevalence was higher among persons with >5 LTSPs compared with 1–5 LTSPs in both males and females. There were only slight reductions in HPV prevalence after removing participants who reported a new sexual partner in the past year. For example, among females aged 27–45 years with >5 LTSPs, the adjusted prevalence of 9-valent vaccine–type HPV infection was 13.4% (95% confidence interval [CI], 9.9%–17.0%) in the full population compared to 12.1% (95% CI, 8.8%–15.4%) among those with no new sexual partners.

Conclusions

Prevalent HPV infection was primarily reflective of cumulative exposures over time (higher LTSPs). New exposures had limited impact, emphasizing the need to consider sexual history in the decision-making process for adult HPV vaccination.
Risk of Coronavirus Disease 2019 Transmission in Train Passengers: an Epidemiological and Modeling Study
Authors: Hu Maogui , Lin Hui , Wang Jinfeng , Xu Chengdong , Tatem Andrew J , Meng Bin , Zhang Xin , Liu Yifeng , Wang Pengda , Wu Guizhen , Xie Haiyong , Lai Shengjie
Published: July 2020

Background

Train travel is a common mode of public transport across the globe; however, the risk of coronavirus disease 2019 (COVID-19) transmission among individual train passengers remains unclear.

Methods

We quantified the transmission risk of COVID-19 on high-speed train passengers using data from 2334 index patients and 72 093 close contacts who had co-travel times of 0–8 hours from 19 December 2019 through 6 March 2020 in China. We analyzed the spatial and temporal distribution of COVID-19 transmission among train passengers to elucidate the associations between infection, spatial distance, and co-travel time.

Results

The attack rate in train passengers on seats within a distance of 3 rows and 5 columns of the index patient varied from 0 to 10.3% (95% confidence interval [CI], 5.3%–19.0%), with a mean of 0.32% (95% CI, .29%–.37%). Passengers in seats on the same row (including the adjacent passengers to the index patient) as the index patient had an average attack rate of 1.5% (95% CI, 1.3%–1.8%), higher than that in other rows (0.14% [95% CI, .11%–.17%]), with a relative risk (RR) of 11.2 (95% CI, 8.6–14.6). Travelers adjacent to the index patient had the highest attack rate (3.5% [95% CI, 2.9%–4.3%]) of COVID-19 infection (RR, 18.0 [95% CI, 13.9–23.4]) among all seats. The attack rate decreased with increasing distance, but increased with increasing co-travel time. The attack rate increased on average by 0.15% (P = .005) per hour of co-travel; for passengers in adjacent seats, this increase was 1.3% (P = .008), the highest among all seats considered.

Conclusions

COVID-19 has a high transmission risk among train passengers, but this risk shows significant differences with co-travel time and seat location. During disease outbreaks, when traveling on public transportation in confined spaces such as trains, measures should be taken to reduce the risk of transmission, including increasing seat distance, reducing passenger density, and use of personal hygiene protection.
Ecospatiality: transforming Kerala’s post-flood ‘riskscapes’
Authors: Raman K Ravi
Published: July 2020

Kerala’s 2018 floods and landslides offer great lessons on risk governance and climate policies. The challenges in each phase of rescue, relief and rebuilding were addressed in this case study. Through the strategic use of ‘ecospatiality’, it is shown that the ‘state–society synergy’ does exist in its potentiality, although, by and large, it is ignored in already existing ‘riskscape’ scholarship. However, the context of this study proves to be an ideal site for illustrating the possibilities of actualising this latent potential through ecospatiality planning. Such attempts can, at the same time, be of local effectiveness and global significance.
How genomics reclassifies diseases: the case of Alport syndrome
Authors: Torra Roser , Furlano Monica , Ars Elisabet
Published: July 2020

In this issue, Matthews et al. provide a comprehensive review of published cohorts with heterozygous pathogenic variants in COL4A3 or COL4A4, documenting the wide spectrum of the disease. Due to the extreme phenotypes that patients with heterozygous pathogenic variants in COL4A3 or COL4A4 may show, the disease has been referred to in a variety of ways, including ‘autosomal dominant Alport syndrome’, ‘thin basement membrane disease’, ‘thin basement membrane nephropathy’, ‘familial benign hematuria’ and ‘carriers of autosomal dominant Alport syndrome’. This confusion over terminology has prevented nephrologists from being sufficiently aware of the relevance of the entity. Nowadays, however, next-generation sequencing facilitates the diagnosis and it is becoming a relatively frequent finding in haematuric–proteinuric nephropathies of unknown origin, even in non-familial cases. There is a need to raise awareness among nephrologists about the disease in order to improve diagnosis and provide better management for these patients.
Work-Efficient Parallel Non-Maximum Suppression Kernels
Authors: Oro David , Fernández Carles , Martorell Xavier , Hernando Javier
Published: July 2020

In the context of object detection, sliding-window classifiers and single-shot convolutional neural network (CNN) meta-architectures typically yield multiple overlapping candidate windows with similar high scores around the true location of a particular object. Non-maximum suppression (NMS) is the process of selecting a single representative candidate within this cluster of detections, so as to obtain a unique detection per object appearing on a given picture. In this paper, we present a highly scalable NMS algorithm for embedded graphics processing unit (GPU) architectures that is designed from scratch to handle workloads featuring thousands of simultaneous detections on a given picture. Our kernels are directly applicable to other sequential NMS algorithms such as FeatureNMS, Soft-NMS or AdaptiveNMS that share the inner workings of the classic greedy NMS method. The obtained performance results show that our parallel NMS algorithm is capable of clustering 1024 simultaneous detected objects per frame in roughly 1 ms on both Tegra X1 and Tegra X2 on-die GPUs, while taking 2 ms on Tegra K1. Furthermore, our proposed parallel greedy NMS algorithm yields a 14–40x speed up when compared to state-of-the-art NMS methods that require learning a CNN from annotated data.
Infant acid suppression use is associated with the development of eosinophilic esophagitis
Authors: Kuhn Benjamin R , Young Amanda J , Justice Anne E , Chittoor Geetha , Walton Nephi A
Published: July 2020

Eosinophilic esophagitis (EoE) is an esophageal allergic inflammatory disorder often presenting with infant/toddler gastroesophageal reflux symptoms refractory to treatment, including acid suppression trials with histamine H2 antagonists and proton pump inhibitors. We propose to evaluate the impact of infant acid suppressant exposure in EoE. Geisinger’s pediatric EoE cases were matched to controls (1:5 EoE case control ratio) using age, race, sex, and ages at other diagnoses of asthma, eczema, and environmental allergies, totaling 526 EoE cases and 2,630 controls. Comparisons between EoE cases and matched controls were tested with regard to rates of acid suppression use with H2 antagonists and PPIs during infancy. Our analyses found the use of acid suppression in infancy was positively associated with EoE: PPI (5.7% EoE cases vs. 1.6% controls; P < 0.0001), H2 antagonists (8.8% EoE cases vs. 4.5% controls; P < 0.0001). Additionally, analysis of EoE cases using acid suppression during infancy indicated a likelihood for the diagnosis with EoE at an earlier age. Early acid suppression use in infants is significantly associated with the diagnosis of EoE in childhood in this well-matched retrospective cohort study. The potential link warrants additional investigation. Our study further reinforces the evidence-based stewardship of acid suppressant use, especially in our most vulnerable populations.
Hospital volume of esophageal cancer surgery in relation to outcomes from primary anti-reflux surgery
Authors: Markar Sheraz , Santoni Giola , Maret-Ouda John , Lagergren Jesper
Published: July 2020

No previous study has sought to identify the effect of hospital volume of esophagectomy on anti-reflux surgery outcomes. The hypothesis under investigation was hospitals performing esophagectomies, particularly those of higher annual volume, have better outcomes from primary anti-reflux surgery. This population-based cohort study included adult individuals (≥18 years) in Sweden receiving primary anti-reflux surgery for a recorded gastro-esophageal reflux disease in 1997–2010, with follow-up until 2013 The ‘exposure’ was hospital volume of esophagectomy, with hospitals conducting esophagectomies divided into 0, >0–1, >1–3 and ≥ 4 based on annual volume, and hospitals not conducting esophagectomies were the reference category. The outcomes were 30-day re-intervention and surgical re-intervention during the entire follow-up after anti-reflux surgery. Multivariable Cox regression provided hazard ratios (HRs) with 95% confidence intervals (CIs), adjusted for age, sex, comorbidity, type of anti-reflux surgery, and year of anti-reflux surgery. Among 10,959 participants having undergone primary anti-reflux surgery, the 30-day re-intervention rate was 1.1%, and the rate of surgical re-intervention during the entire follow-up was 6.8%. Compared with hospitals not performing esophagectomy, hospitals in the highest volume group of esophagectomy showed no decreased risks of 30-day re-intervention (HR = 1.46, 95% CI 0.89–2.39) or surgical re-intervention (HR = 1.21, 95%CI 0.91–1.60) during follow-up. Similarly, the intermediate hospital volume categories of esophageal cancer surgery had no decreased risk of surgical re-interventions after anti-reflux surgery. This study provides no evidence for centralization of primary anti-reflux surgery to centers for esophageal cancer surgery.
Predicting Rice Stem Stink Bug Population Dynamics Based on GAMLSS Models
Authors: Seidel E J , Pazini J B , Tomazella V L D , Vieira A M C , Silva F F , Martins J F S , Barrigossi J A F
Published: July 2020

The rice stem stink bug, Tibraca limbativentris Stål (Hemiptera: Pentatomidae), is one of the most harmful insects for Brazilian rice fields. Aiming to define the most appropriate time and place for pest management measures in commercial paddy fields, we adjusted regression models (Poisson, Zero Inflated Poisson, reparametrized Zero Inflated Poisson, Negative Binomial and Zero Inflated Negative Binomial) for modeling the population variation of T. limbativentris along the phenological cycle of the flooded rice cultivation. We hypothesize that the rice stem stink bug population’s size is influenced by the rice cycle (time) and geographical positions within the crop. It was possible to predict the occurrence of the rice stem stink bug in the commercial flooded rice crop. The population of the rice stem stink bug increased significantly with the time or phenological evolution of rice. Our results indicated that the start of T. limbativentris monitoring should occur up to 45 d After Plant Emergence (DAE), from the regions along the edges of the rice paddies, which are the points of entry and higher concentration of the insect. In addition, 45 and 60 DAE were considered the crucial times for T. limbativentris control decision making in flooded rice paddies.
Worldwide Feeding Host Plants of Spotted Lanternfly, With Significant Additions From North America
Authors: Barringer Lawrence , Ciafré Claire M
Published: July 2020

The spotted lanternfly Lycorma delicatula (White) is an invasive insect spreading throughout southeast Asia and eastern North America. The rapid spread of this species is facilitated by the prevalence of its preferred host, tree of heaven (Ailanthus altissima (Mill.) Swingle), as well as its use of many other host plants. While the spotted lanternfly has been previously reported to use over 65 plant species, most of these reports are from Asia and may not be applicable in North America. Additionally, many of the known hosts have not been specified as feeding hosts or as egg laying substrates. To better understand the potential impacts of this invasive insect on natural and cultivated systems in North America, we reviewed records from published and unpublished results and observations of host plant use by spotted lanternfly. We aggregated 172 host plant records worldwide and found feeding behaviors associated with 103 plant taxa across 33 families and 17 orders, 20 of which were not previously known to be associated with SLF and 15 of which were not confirmed as feeding hosts. North American records account for 56 of these taxa which include native, cultivated, and nonnative species. As a result, the spotted lanternfly has the potential to impact a wide assortment of ecosystems throughout its potential range and its North American distribution may not be limited by the presence of tree of heaven.
Making a ‘New Conservatism’: The Tory Reform Committee and Design for Freedom, 1942–1949
Authors: Love Gary
Published: July 2020

This article offers the first analytical overview of the political thinking and organisational history of the Tory Reform Committee (TRC). It is also a contribution to wider scholarly debates about the making of a ‘New Conservatism’ in the 1940s and the development of Conservative thought in the twentieth century. The TRC’s leading members drew on the party’s Disraelian one-nation tradition to free them from adopting doctrinaire positions. They wanted to emphasise the merits of either state intervention, planning and social reform, or private enterprise, individualism and freedom, depending on the country’s economic and social position—and the party’s electoral position. Most Tory Reformers imposed limits on the malleability of their Conservatism by rejecting laissez-faire individualism, socialism, and the earliest signs of neoliberalism. Although the group was replaced by the Design for Freedom Movement, which adopted a similar political outlook on a non-party basis between 1947 and 1949, its broader significance relates to how its support for the principles of ‘design’ and ‘freedom’ influenced Conservative debates about economic and social policy at a pivotal moment in the party’s history. Continuities of thought suggest that we should be wary of interpretations which impose an ‘origins of neoliberalism’ or proto-Thatcherite framework on the 1940s. The TRC’s ‘New Conservatism’ was meant to be adaptable, practical and Keynesian. It was a pitch for the centre ground and it was integral to the political thought of Conservative governments between 1951 and 1974.
Feasibility of using deep learning to detect coronary artery disease based on facial photo
Authors: Lin Shen , Li Zhigang , Fu Bowen , Chen Sipeng , Li Xi , Wang Yang , Wang Xiaoyi , Lv Bin , Xu Bo , Song Xiantao , Zhang Yao-Jun , Cheng Xiang , Huang Weijian , Pu Jun , Zhang Qi , Xia Yunlong , Du Bai , Ji Xiangyang , Zheng Zhe
Published: July 2020

Aims

Facial features were associated with increased risk of coronary artery disease (CAD). We developed and validated a deep learning algorithm for detecting CAD based on facial photos.

Methods and results

We conducted a multicentre cross-sectional study of patients undergoing coronary angiography or computed tomography angiography at nine Chinese sites to train and validate a deep convolutional neural network for the detection of CAD (at least one ≥50% stenosis) from patient facial photos. Between July 2017 and March 2019, 5796 patients from eight sites were consecutively enrolled and randomly divided into training (90%, n = 5216) and validation (10%, n = 580) groups for algorithm development. Between April 2019 and July 2019, 1013 patients from nine sites were enrolled in test group for algorithm test. Sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) were calculated using radiologist diagnosis as the reference standard. Using an operating cut point with high sensitivity, the CAD detection algorithm had sensitivity of 0.80 and specificity of 0.54 in the test group; the AUC was 0.730 (95% confidence interval, 0.699–0.761). The AUC for the algorithm was higher than that for the Diamond–Forrester model (0.730 vs. 0.623, P < 0.001) and the CAD consortium clinical score (0.730 vs. 0.652, P < 0.001).

Conclusion

Our results suggested that a deep learning algorithm based on facial photos can assist in CAD detection in this Chinese cohort. This technique may hold promise for pre-test CAD probability assessment in outpatient clinics or CAD screening in community. Further studies to develop a clinical available tool are warranted.
Arrhythmogenic substrate detection in chronic ischaemic patients undergoing ventricular tachycardia ablation using multidetector cardiac computed tomography: compared evaluation with cardiac magnetic resonance
Authors: Jáuregui Beatriz , Soto-Iglesias David , Zucchelli Giulio , Penela Diego , Ordóñez Augusto , Terés Cheryl , Chauca Alfredo , Acosta Juan , Fernández-Armenta Juan , Linhart Markus , Perea Rosario J , Prat-González Susana , Bosch Xavier , Ortiz-Pérez José T , Mont Lluís , Berruezo Antonio
Published: July 2020

Aims

Late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) permits characterizing ischaemic scars, detecting heterogeneous tissue channels (HTCs) which constitute the arrhythmogenic substrate (AS). Late gadolinium enhancement cardiac magnetic resonance also improves the arrhythmia-free survival when used to guide ventricular tachycardia (VT) substrate ablation. However, its availability may be limited. We sought to evaluate the performance of multidetector cardiac computed tomography (MDCT) imaging in identifying HTCs detected by LGE-CMR in ischaemic patients undergoing VT substrate ablation.

Methods and results

Thirty ischaemic patients undergoing both LGE-CMR and MDCT before VT substrate ablation were included. Using a dedicated post-processing software, two blinded operators, assigned either to LGE-CMR or MDCT analysis, characterized the presence of CMR and computed tomography (CT) channels, respectively. Cardiac magnetic resonance channels were classified as endocardial (layers < 50%), epicardial (layers ≥ 50%), or transmural. Cardiac magnetic resonance- vs. CT-channel concordance was considered when showing the same orientation and American Heart Association (AHA) segment. Mean age was 69 ± 10 years; 90% were male. Mean left ventricular ejection fraction was 35 ± 10%. All patients had CMR channels (n = 76), whereas only 26/30 (86.7%) had CT channels (n = 91). Global sensitivity (Se) and positive predictive values for detecting CMR channels were 61.8% and 51.6%, respectively. MDCT performance improved in patients with epicardial CMR channels (Se 80.5%) and transmural scars (Se 72.2%). In 4/11 (36%) patients with subendocardial myocardial infarction (MI), MDCT was unable to identify the AS.

Conclusions

Compared to LGE-CMR, myocardial wall thickness assessment using MDCT fails to detect the presence of AS in 36% of patients with subendocardial MI, showing modest sensitivity identifying HTCs but a better performance in patients with transmural scars.
Migrant carers in Europe in times of COVID-19: a call to action for European health workforce governance and a public health approach
Authors: Kuhlmann Ellen , Falkenbach Michelle , Klasa Kasia , Pavolini Emmanuele , Ungureanu Marius-Ionut
Published: July 2020

The present study explores the situation of migrant carers in long-term care (LTC) in European Union Member States and the disruptions caused by the COVID-19 pandemic from a public health perspective. The aim is to bring LTC migrant carers into health workforce research and highlight a need for trans-sectoral and European heath workforce governance. We apply an exploratory approach based on secondary sources, document analysis and expert information. A framework comprising four major dimensions was developed for data collection and analysis: LTC system, LTC health labour market, LTC labour migration policies and specific LTC migrant carer policies during the COVID-19 crisis March to May 2020. Material from Austria, Italy, Germany, Poland and Romania was included in the study. Results suggest that undersupply of carers coupled with cash benefits and a culture of family responsibility may result in high inflows of migrant carers, who are channelled in low-level positions or the informal care sector. COVID-19 made the fragile labour market arrangements of migrant carers visible, which may create new health risks for both the individual carer and the population. Two important policy recommendations are emerging: to include LTC migrant carers more systematically in public health and health workforce research and to develop European health workforce governance which connects health system needs, health labour markets and the individual migrant carers.
Impact of fees on access to dental care: evidence from France
Authors: Bas Anne-Charlotte , Dourgnon Paul , Azogui-Levy Sylvie , Wittwer Jérôme
Published: July 2020

Background

For financial reasons, dental prosthetics is one of the major unmet dental healthcare needs [Financial-SUN (F-SUN)]. Private fees for dental prosthetics result in significant out-of-pocket payments for users. This study analyzes the impact of geo-variations in protheses fees on dental F-SUN.

Methods

Using a nationwide French declarative survey and French National Health Insurance administrative data, we empirically tested the impact of prosthetic fees on dental F-SUN, taking into account several other enabling factors. Our empirical strategy was built on the homogeneous quality of the dental prosthesis selected and used to compute our price index.

Results

Unmet dental care needs due to financial issues concern not only the poorest but also people with middle incomes. The major finding is the positive association between dental fees and difficulty in gaining access to dental care when other enabling factors are taken into account (median fee in the highest quintile: OR = 1.35; P value = 0.024; 95% CI 1.04–1.76). People with dental F-SUN are those who have to make a greater financial effort due to a low/middle income or a lack of complementary health insurance. For identical financial reasons, the tendency to give up on healthcare increases as health deteriorates.

Conclusions

The results underscore the need for fee regulation regarding dental prosthetics. This is in line with the current French government dental care reform.
Electronic cigarette use among 14- to 17-year-olds in Europe
Authors: Kinnunen Jaana M , Rimpelä Arja H , Lindfors Pirjo L , Clancy Luke , Alves Joana , Hoffmann Laura , Richter Matthias , Kunst Anton E , Lorant Vincent
Published: July 2020

Background

Studies comparing adolescent e-cigarette use in different countries are scarce. We study students’ e-cigarette and conventional cigarette ever-use, their social correlates and e-liquid use in seven EU countries.

Methods

SILNE-R data (N=12 167, response rate 79.4%) of 14–17-year-olds from Amersfoort (NL), Coimbra (PT), Dublin (IR), Hanover (GE), Latina (IT), Namur (BE) and Tampere (FI) were used. E-cigarette and conventional cigarette ever-use, dual-use, type of e-liquid and social correlates were measured with a school survey and analyzed with cross-tabulations and multinomial logistic regression.

Results

About 34% had tried e-cigarettes, but the variation was large between the cities (Latina 50%; Hanover 23%). Of e-cigarette ever-users, 37% had used nicotine e-liquid, 43% exclusively non-nicotine liquid and 20% did not know the content. Nicotine e-liquid was more prevalent among monthly e-cigarette users and weekly smoking e-cigarette users. The social correlates were mainly the same for exclusive e-cigarette ever-use, exclusive conventional cigarette ever-use and dual-use. Boys had greater odds for exclusive e-cigarette and dual-use compared to girls. Of social correlates, low academic achievement and parental smoking were positively associated with all categories of use, but parental education and immigrant background were not. The strongest association was found between peer smoking (most/all best friends smoke) and dual-use (OR 34.29).

Conclusions

Students’ e-cigarette ever-use varies greatly between EU countries. E-cigarettes seem not to be a substitute for conventional cigarettes but more a complementary product. Tobacco control policies might also prevent e-cigarette use but specific regulations on e-cigarettes are needed to prevent nicotine addiction originating from them.
Autism and education—international policy in small EU states: policy mapping in Malta, Cyprus, Luxembourg and Slovenia
Authors: van Kessel Robin , Hrzic Rok , Czabanowska Katarzyna , Baranger Aurélie , Azzopardi-Muscat Natasha , Charambalous-Darden Nefi , Brayne Carol , Baron-Cohen Simon , Roman-Urrestarazu Andres
Published: July 2020

Background

Special education provides an array of support that can advantageously meet special education needs (SEN) of children with autism. This report maps autism and SEN policies, and tension of international legislation in Malta, Cyprus, Luxembourg and Slovenia.

Methods

A policy path analysis was performed using a scoping review as fundamental methodological framework.

Results

Education for children with SEN developed from limited education towards segregation, and further to integration, and inclusion in mainstream education. International policy has greatly influenced the education systems under study. The rights to education and to have SEN addressed have been adopted in all countries. Inclusion is seen to be gradually incorporated by Malta, Cyprus and Luxembourg—closely following values of international documents through concise SEN policies. Slovenia’s education system remains segregated, indicating potential tension.

Conclusions

It appears that mainstream schools offer SEN services until no longer feasible for the child in the majority of investigated countries. Inclusion has become a guiding principle for most education systems under study. Finally, small states either commit to the implementation of inclusion or delay it and attempt to improve the education system for children with SEN in different ways.
A spiritual inheritance? Family spirit, virtue and vocation in the Vies of the Lamoignon dévots
Authors: Forrestal Alison
Published: July 2020

Members of the Parisian robe Lamoignon family were among the most prominent dévots of the French Catholic Reformation. This article explores the family’s religious engagement through six substantial biographies or vies written by close relatives between 1663 and 1688–90, which reflected on the devotional lives of Chrétien and Marie Lamoignon and three of their four children, Guillaume, Anne and Madeleine. It analyses how the authors adopted the popular strategy of life-writing to recall, reflect on and interpret the significance of their religious choices and experiences for themselves and for the family as a whole. Appraisal of their habits became building blocks for the construction of what the authors defined as a Lamoignon ‘family spirit’, which included a rhetoric of humility that was designed to withstand pride, deflect accusations of venality, validate the family’s advancement and inflect their history with a cohesive spiritual identity.
Modelling capsizing icebergs in the open ocean
Authors: Bonnet P , Yastrebov V A , Queutey P , Leroyer A , Mangeney A , Castelnau O , Sergeant A , Stutzmann E , Montagner J-P
Published: July 2020

At near-grounded glacier termini, calving can lead to the capsize of kilometre-scale (i.e. gigatons) unstable icebergs. The transient contact force applied by the capsizing iceberg on the glacier front generates seismic waves that propagate over teleseismic distances. The inversion of this seismic signal is of great interest to get insight into actual and past capsize dynamics. However, the iceberg size, which is of interest for geophysical and climatic studies, cannot be recovered from the seismic amplitude alone. This is because the capsize is a complex process involving interactions between the iceberg, the glacier and the surrounding water. This paper presents a first step towards the construction of a complete model, and is focused on the capsize in the open ocean without glacier front nor ice-mélange. The capsize dynamics of an iceberg in the open ocean is captured by computational fluid dynamics (CFD) simulations, which allows assessing the complexity of the fluid motion around a capsizing iceberg and how far the ocean is affected by iceberg rotation. Expressing the results in terms of appropriate dimensionless variables, we show that laboratory scale and field scale capsizes can be directly compared. The capsize dynamics is found to be highly sensitive to the iceberg aspect ratio and to the water and ice densities. However, dealing at the same time with the fluid dynamics and the contact between the iceberg and the deformable glacier front requires highly complex coupling that often goes beyond actual capabilities of fluid-structure interaction softwares. Therefore, we developed a semi-analytical simplified fluid-structure model (SAFIM) that can be implemented in solid mechanics computations dealing with contact dynamics of deformable solids. This model accounts for hydrodynamic forces through calibrated drag and added-mass effects, and is calibrated against the reference CFD simulations. We show that SAFIM significantly improves the accuracy of the iceberg motion compared with existing simplified models. Various types of drag forces are discussed. The one that provides the best results is an integrated pressure-drag proportional to the square of the normal local velocity at the iceberg’s surface, with the drag coefficient depending linearly on the iceberg’s aspect ratio. A new formulation based on simplified added-masses or computed added-mass proposed in the literature, is also discussed. We study in particular the change of hydrodynamic-induced forces and moments acting on the capsizing iceberg. The error of the simulated horizontal force ranges between 5 and 25 per cent for different aspect ratios. The added-masses affect the initiation period of the capsize, the duration of the whole capsize being better simulated when added-masses are accounted for. The drag force mainly affects the amplitude of the fluid forces and this amplitude is best predicted without added-masses.
From research to international scale-up: stakeholder engagement essential in successful design, evaluation and implementation of paediatric HIV testing intervention
Authors: Mugo Cyrus , Njuguna Irene , Nduati Margaret , Omondi Vincent , Otieno Verlinda , Nyapara Florence , Mabele Elizabeth , Moraa Hellen , Sherr Kenneth , Inwani Irene , Maleche-Obimbo Elizabeth , Wamalwa Dalton , John-Stewart Grace , Slyker Jennifer , Wagner Anjuli D
Published: July 2020

Stakeholder engagement between researchers, policymakers and practitioners is critical for the successful translation of research into policy and practice. The Counseling and Testing for Children at Home (CATCH) study evaluated a paediatric index case testing model, targeting the children of HIV-infected adults in care in Kenya. Researchers collaborated with stakeholders in the planning, execution and evaluation, and dissemination phases of CATCH. They included a community advisory board, the national HIV programme, County health departments, institutional ethics review bodies, a paediatric bioethics group, facility heads and frontline healthcare workers . Stakeholder analysis considered the power and interest of each stakeholder in the study. All stakeholders had some power to influence the success of the project in the different phases. However, support from institutions with higher hierarchical power increased acceptance of the study by stakeholders lower in the hierarchy. During the planning, execution and evaluation, and dissemination phases, the study benefitted from deliberate stakeholder engagement. Through engagement, changes were made in the approach to recruitment to ensure high external validity, placing recruitment optimally within existing clinic flow patterns. Choices in staffing home visits were made to include the appropriate cadre of staff. Adaptations were made to the consenting process that balanced the child’s evolving autonomy and risks of HIV disclosure. Dissemination involved delivering site-specific results in each HIV clinic, local and international conferences and sharing of study tools, resulting in the study approach being scaled up nationally. The deliberate engagement of stakeholders early in intervention development optimized study validity and accelerated adoption of the CATCH approach in nationwide HIV testing campaigns by the Ministry of Health and inclusion of paediatric index-case testing in national HIV testing guidelines. Involving policymakers and frontline healthcare workers throughout the study cycle builds capacity in the implementing team for quick adoption and scale-up of the evidence-based practice.
Insights into genetic variants associated with NASH-fibrosis from metabolite profiling
Authors: Mann Jake P , Pietzner Maik , Wittemans Laura B , Rolfe Emmanuela De Lucia , Kerrison Nicola D , Imamura Fumiaki , Forouhi Nita G , Fauman Eric , Allison Michael E , Griffin Jules L , Koulman Albert , Wareham Nicholas J , Langenberg Claudia
Published: July 2020

Several genetic discoveries robustly implicate five single-nucleotide variants in the progression of non-alcoholic fatty liver disease to non-alcoholic steatohepatitis and fibrosis (NASH-fibrosis), including a recently identified variant in MTARC1. To better understand these variants as potential therapeutic targets, we aimed to characterize their impact on metabolism using comprehensive metabolomics data from two population-based studies. A total of 9135 participants from the Fenland study and 9902 participants from the EPIC-Norfolk cohort were included in the study. We identified individuals with risk alleles associated with NASH-fibrosis: rs738409C>G in PNPLA3, rs58542926C>T in TM6SF2, rs641738C>T near MBOAT7, rs72613567TA>T in HSD17B13 and rs2642438A>G in MTARC1. Circulating levels of 1449 metabolites were measured using targeted and untargeted metabolomics. Associations between NASH-fibrosis variants and metabolites were assessed using linear regression. The specificity of variant-metabolite associations were compared to metabolite associations with ultrasound-defined steatosis, gene variants linked to liver fat (in GCKR, PPP1R3B and LYPLAL1) and gene variants linked to cirrhosis (in HFE and SERPINA1). Each NASH-fibrosis variant demonstrated a specific metabolite profile with little overlap (8/97 metabolites) comprising diverse aspects of lipid metabolism. Risk alleles in PNPLA3 and HSD17B13 were both associated with higher 3-methylglutarylcarnitine and three variants were associated with lower lysophosphatidylcholine C14:0. The risk allele in MTARC1 was associated with higher levels of sphingomyelins. There was no overlap with metabolites that associated with HFE or SERPINA1 variants. Our results suggest a link between the NASH-protective variant in MTARC1 to the metabolism of sphingomyelins and identify distinct molecular patterns associated with each of the NASH-fibrosis variants under investigation.
High Levels of Psychological Resilience Associated With Less Disease Activity, Better Quality of Life, and Fewer Surgeries in Inflammatory Bowel Disease
Authors: Sehgal Priya , Ungaro Ryan C , Foltz Carol , Iacoviello Brian , Dubinsky Marla C , Keefer Laurie
Published: July 2020

Background

Stress and depression are risk factors for inflammatory bowel disease (IBD) exacerbations. It is unknown if resilience, or one’s ability to recover from adversity, impacts disease course. The aim of this study was to examine the association between resilience and IBD disease activity, quality of life (QoL), and IBD-related surgeries.

Methods

We performed a cross-sectional study of IBD patients at an academic center. Patients completed the Connor-Davidson Resilience Scale questionnaire, which measures resilience (high resilience score ≥ 35). The primary outcome was IBD disease activity, measured by Mayo score and Harvey-Bradshaw Index (HBI). The QoL and IBD-related surgeries were also assessed. Multivariate linear regression was conducted to assess the association of high resilience with disease activity and QoL.

Results

Our patient sample comprised 92 patients with ulcerative colitis (UC) and 137 patients with Crohn disease (CD). High resilience was noted in 27% of patients with UC and 21.5% of patients with CD. Among patients with UC, those with high resilience had a mean Mayo score of 1.54, and those with low resilience had a mean Mayo score of 4.31, P < 0.001. Among patients with CD, those with high resilience had a mean HBI of 2.31, and those with low resilience had a mean HBI of 3.95, P = 0.035. In multivariable analysis, high resilience was independently associated with lower disease activity in both UC (P < 0.001) and CD (P = 0.037) and with higher QoL (P = 0.016). High resilience was also associated with fewer surgeries (P = 0.001) among patients with CD.

Conclusions

High resilience was independently associated with lower disease activity and better QoL in patients with IBD and fewer IBD surgeries in patients with CD. These findings suggest that resilience may be a modifiable factor that can risk-stratify patients with IBD prone to poor outcomes.
A 20-year retrospective on the provision of fisheries subsidies in the European Union
Authors: Skerritt Daniel J , Arthur Robert , Ebrahim Naazia , Le Brenne Valérie , Le Manach Frédéric , Schuhbauer Anna , Villasante Sebastián , Sumaila U Rashid
Published: July 2020

The next few months will be crucial in determining whether the world’s major fishing nations will deliver on commitments under the Sustainable Development Goals (SDGs) of the United Nations to prohibit harmful fisheries subsidies. Timing is of heightened importance given that the EU—the second-largest subsidizer—is reforming its financial instrument for fisheries. This article therefore examines the last 20 years of subsidies provided to the fisheries sector by the EU and supports discussion of the potential future for EU fisheries subsidies and the chance of success for the SDGs. Significant changes have occurred to EU fisheries subsidies during this period. Partly these changes have occurred as a result of the removal of certain capacity-enhancing subsidies and partly due to additional funds being allocated to beneficial forms of public funding. However, progress is slow and a significant amount of capacity-enhancing subsidies remain. Furthermore, the true extent of any reduction in capacity-enhancing subsidies may be shrouded by the Pollyannaish classifications of subsidization, but most disconcerting are the recent positions adopted by both the European Parliament and Council of the EU, which aim to reintroduce some of the most harmful subsidies, thereby putting the progress needed to achieve sustainable fisheries at risk.
Modelling the spatial–temporal distributions and associated determining factors of a keystone pelagic fish
Authors: Andrews Samantha , Leroux Shawn J , Fortin Marie-Josée
Published: July 2020

Mobile pelagic species habitat is structured around dynamic oceanographic and ecological processes that operate and interact horizontally and vertically throughout the water column and change over time. Due to their extensive movements, pelagic species distributions are often poorly understood. We use the Maxent species distribution model to assess how changes in the relative importance of modelled oceanographic (e.g. temperature) and climatic variables (e.g. the North Atlantic Oscillation) over 17 years affect the monthly average horizontal and vertical distribution of a keystone pelagic forage species, Atlantic Canadian capelin (Mallotus villosus). We show that the range and distribution of capelin occurrence probabilities vary across horizontal and vertical axes over time, with binary presence/absence predictions indicating capelin occupy between 0.72% (April) and 3.45% (November) of the total modelled space. Furthermore, our analysis reveals that the importance of modelled oceanographic variables, such as temperature, varies between months (44% permutation importance in August to 2% in May). By capturing the spatial dynamics of capelin over horizontal, vertical, and temporal axes, our analysis builds on work that improves our understanding and predictive modelling ability of pelagic species distributions under current and future conditions for proactive ecosystem-based management.
Clinically significant incidental findings during preoperative computed tomography of patients undergoing cardiac surgery
Authors: Sef Davorin , Birdi Inderpaul
Published: July 2020

With the development of minimally invasive cardiac surgery, chest and abdominal computed tomography (CT) scans are becoming an integral part of preoperative assessment and planning. Therefore, the number of incidental findings (IFs) detected with CT is rising. We aimed to investigate the frequency of clinically significant IFs on chest and abdominal CT scans performed during the preoperative assessment of patients undergoing adult cardiac surgery in a 2-year period. In a cohort of 401 patients (mean age 67.4 ± 12.3, female gender 28.9%, median logistic EuroSCORE 5.8 [0.9, 90.5]) who underwent chest or abdominal CT imaging during the study period, we identified 75 patients (18.7%) with clinically significant IFs who needed a further treatment or work-up to confirm the diagnosis or postoperative follow-up. Our data indicate that clinically significant IFs in patients referred for cardiac surgery are frequent. It is important to identify clinically significant Ifs, as a clear postoperative follow-up plan should be made.