bluuebunny/crossref_metadata_2025 huggingface dataset:
Independent effects of adiposity measures on risk of atrial fibrillation in men and women: a study of 0.5 million individuals
Authors: Camm C Fielder , Lacey Ben , Massa M Sofia , Von Ende Adam , Gajendragadkar Parag , Stiby Alexander , Valdes-Marquez Elsa , Lewington Sarah , Wijesurendra Rohan , Parish Sarah , Casadei Barbara , Hopewell Jemma C
Published: September 2021

Background

Atrial fibrillation (AF) has a higher prevalence in men than in women and is associated with measures of adiposity and lean mass (LM). However, it remains uncertain whether the risks of AF associated with these measures vary by sex.

Methods

Among 477 904 UK Biobank participants aged 40–69 without prior AF, 23 134 incident AF cases were identified (14 400 men, 8734 women; median follow-up 11.1 years). Cox proportional hazards models were used to estimate the covariate adjusted hazard ratios (HRs) describing the association of AF with weight, measures of adiposity [fat mass (FM), waist circumference (WC)] and LM, and their independent relevance, by sex.

Results

Weight and WC were independently associated with risk of AF [HR: 1.25 (1.23–1.27) per 10 kg, HR: 1.11 (1.09–1.14) per 10 cm, respectively], with comparable effects in both sexes. The association with weight was principally driven by LM, which, per 5 kg, conferred double the risk of AF compared with FM when mutually adjusted [HR: 1.20 (1.19–1.21), HR: 1.10 (1.09–1.11), respectively]; however, the effect of LM was weaker in men than in women (p-interaction = 4.3 x 10−9). Comparing the relative effects of LM, FM and WC identified different patterns within each sex; LM was the strongest predictor for both, whereas WC was stronger than FM in men but not in women.

Conclusions

LM and FM (as constituents of weight) and WC are risk factors for AF. However, the independent relevance of general adiposity for AF was more limited in men than in women. The relevance of both WC and LM suggests a potentially important role for visceral adiposity and muscle mass in AF development.
Attributable risks of hospitalizations for urologic diseases due to heat exposure in Queensland, Australia, 1995–2016
Authors: Lu Peng , Xia Guoxin , Zhao Qi , Green Donna , Lim Youn-Hee , Li Shanshan , Guo Yuming
Published: September 2021

Background

Heat exposure is a risk factor for urologic diseases. However, there are limited existing studies that have examined the relationship between high temperatures and urologic disease. The aim of this study was to examine the associations between heat exposure and hospitalizations for urologic diseases in Queensland, Australia, during the hot seasons of 1995–2016 and to quantify the attributable risks.

Methods

We obtained 238 427 hospitalized cases with urologic diseases from Queensland Health between 1 December 1995 and 31 December 2016. Meteorological data were collected from the Scientific Information for Land Owners—a publicly accessible database of Australian climate data that provides daily data sets for a range of climate variables. A time-stratified, case-crossover design fitted with the conditional quasi-Poisson regression model was used to estimate the associations between temperature and hospitalizations for urologic diseases at the postcode level during each hot season (December–March). Attributable rates of hospitalizations for urologic disease due to heat exposure were calculated. Stratified analyses were performed by age, sex, climate zone, socio-economic factors and cause-specific urologic diseases.

Results

We found that a 1°C increase in temperature was associated with a 3.3% [95% confidence interval (CI): 2.9%, 3.7%] increase in hospitalization for the selected urologic diseases during the hot season. Hospitalizations for renal failure showed the strongest increase 5.88% (95% CI: 5.25%, 6.51%) among the specific causes of hospital admissions considered. Males and the elderly (≥60 years old) showed stronger associations with heat exposure than females and younger groups. The sex- and age-specific associations with heat exposure were similar across specific causes of urologic diseases. Overall, nearly one-fifth of hospitalizations for urologic diseases were attributable to heat exposure in Queensland.

Conclusions

Heat exposure is associated with increased hospitalizations for urologic disease in Queensland during the hot season. This finding reinforces the pressing need for dedicated public health-promotion campaigns that target susceptible populations, especially for those more predisposed to renal failure. Given that short-term climate projections identify an increase in the frequency, duration and intensity of heatwaves, this public health advisory will be of increasing urgency in coming years.
Maternal exposure to fine particulate matter over the first trimester and umbilical cord insertion abnormalities
Authors: Michikawa Takehiro , Morokuma Seiichi , Takeda Yuki , Yamazaki Shin , Nakahara Kazushige , Takami Akinori , Yoshino Ayako , Sugata Seiji , Saito Shinji , Hoshi Junya , Kato Kiyoko , Nitta Hiroshi , Nishiwaki Yuji
Published: September 2021

Background

Our hypothesis was that exposure to fine particulate matter (PM2.5) is related to abnormal cord insertion, which is categorized as a form of placental implantation abnormality. We investigated the association between exposure to total PM2.5 and its chemical components over the first trimester and abnormal cord insertion, which contributes to the occurrence of adverse birth outcomes.

Methods

From the Japan Perinatal Registry Network database, we used data on 83 708 women who delivered singleton births at 39 cooperating hospitals in 23 Tokyo wards (2013–2015). We collected PM2.5 on a filter and measured daily concentrations of carbon and ion components. Then, we calculated the average concentrations over the first trimester (0–13 weeks of gestation) for each woman. A multilevel logistic-regression model with the hospital as a random effect was used to estimate the odds ratios (ORs) of abnormal cord insertion.

Results

Among the 83 708 women (mean age at delivery = 33.7 years), the frequency of abnormal cord insertion was 4.5%, the median concentration [interquartile range (IQR)] of total PM2.5 was 16.1 (3.61) μg/m3 and the OR per IQR for total PM2.5 was 1.14 (95% confidence interval = 1.06–1.23). In the total PM2.5-adjusted models, total carbon, organic carbon, nitrate, ammonium and chloride were positively associated with abnormal insertion. Organic carbon was consistently, and nitrate tended to be, associated with specific types of abnormal insertion (marginal or velamentous cord insertion).

Conclusions

Exposure to total PM2.5 and some of its components over the first trimester increased the likelihood of abnormal cord insertion.
Impact of paternal education on epigenetic ageing in adolescence and mid-adulthood: a multi-cohort study in the USA and Mexico
Authors: Joyce Brian T , Gao Tao , Koss Kalsea , Zheng Yinan , Cardenas Andres , Heiss Jonathan , Just Allan , Zhang Kai , van Horn Linda , Allen Norrina Bai , Greenland Philip , Cohen Sheldon , Gordon-Larsen Penny , Mitchell Colter , McLanahan Sara , Schneper Lisa , Notterman Daniel , Rifas-Shiman Sheryl L , Oken Emily , Hivert Marie-France , Wright Robert , Baccarelli Andrea , Lloyd-Jones Donald , Hou Lifang
Published: September 2021

Background

Both parental and neighbourhood socio-economic status (SES) are linked to poorer health independently of personal SES measures, but the biological mechanisms are unclear. Our objective was to examine these influences via epigenetic age acceleration (EAA)—the discrepancy between chronological and epigenetic ages.

Methods

We examined three USA-based [Coronary Artery Risk Disease in Adults (CARDIA) study, Fragile Families and Child Wellbeing Study (FFCWS) and Programming Research in Obesity, Growth, Environment and Social Stressors (PROGRESS)] and one Mexico-based (Project Viva) cohort. DNA methylation was measured using Illumina arrays, personal/parental SES by questionnaire and neighbourhood disadvantage from geocoded address. In CARDIA, we examined the most strongly associated personal, parental and neighbourhood SES measures with EAA (Hannum’s method) at study years 15 and 20 separately and combined using a generalized estimating equation (GEE) and compared with other EAA measures (Horvath’s EAA, PhenoAge and GrimAge calculators, and DunedinPoAm).

Results

EAA was associated with paternal education in CARDIA [GEEs: βsome college = −1.01 years (−1.91, −0.11) and β<high school = 1.05 (0.09, 2.01) vs college graduates] and FFCWS [GEEs: β<high school = 0.62 (0.00, 1.24)]. We found stronger associations for some paternal education categories among White adults (for GEE, βsome college = −1.39 (−2.41, −0.38)], men (βsome college = −1.76 (−3.16, −0.35)] and women [β<high school = 1.77 (0.42, 3.11)].

Conclusions

These findings suggest that EAA captures epigenetic impacts of paternal education independently of personal SES later in life. Longitudinal studies should explore these associations at different life stages and link them to health outcomes. EAA could be a useful biomarker of SES-associated health and provide important insight into the pathogenesis and prevention of chronic disease.
Azithromycin distribution and childhood mortality in compliance-related subgroups in Niger: complier average causal effect and spillovers in a cluster-randomized, placebo-controlled trial
Authors: O’Brien Kieran S , Arzika Ahmed M , Maliki Ramatou , Amza Abdou , Manzo Farouk , Mankara Alio Karamba , Lebas Elodie , Cook Catherine , Oldenburg Catherine E , Porco Travis C , Arnold Benjamin F , Bertozzi Stefano , Keenan Jeremy D , Lietman Thomas M
Published: September 2021

Background

Biannual azithromycin distribution to children 1–59 months old reduced all-cause mortality by 18% [incidence rate ratio (IRR) 0.82, 95% confidence interval (CI): 0.74, 0.90] in an intention-to-treat analysis of a randomized controlled trial in Niger. Estimation of the effect in compliance-related subgroups can support decision making around implementation of this intervention in programmatic settings.

Methods

The cluster-randomized, placebo-controlled design of the original trial enabled unbiased estimation of the effect of azithromycin on mortality rates in two subgroups: (i) treated children (complier average causal effect analysis); and (ii) untreated children (spillover effect analysis), using negative binomial regression.

Results

In Niger, 594 eligible communities were randomized to biannual azithromycin or placebo distribution and were followed from December 2014 to August 2017, with a mean treatment coverage of 90% [standard deviation (SD) 10%] in both arms. Subgroup analyses included 2581 deaths among treated children and 245 deaths among untreated children. Among treated children, the incidence rate ratio comparing mortality in azithromycin communities to placebo communities was 0.80 (95% CI: 0.72, 0.88), with mortality rates (deaths per 1000 person-years at risk) of 16.6 in azithromycin communities and 20.9 in placebo communities. Among untreated children, the incidence rate ratio was 0.91 (95% CI: 0.69, 1.21), with rates of 33.6 in azithromycin communities and 34.4 in placebo communities.

Conclusions

As expected, this analysis suggested similar efficacy among treated children compared with the intention-to-treat analysis. Though the results were consistent with a small spillover benefit to untreated children, this trial was underpowered to detect spillovers.
Reflection on modern methods: combining weights for confounding and missing data
Authors: Ross Rachael K , Breskin Alexander , Breger Tiffany L , Westreich Daniel
Published: September 2021

Inverse probability weights are increasingly used in epidemiological analysis, and estimation and application of weights to address a single bias are well discussed in the literature. Weights to address multiple biases simultaneously (i.e. a combination of weights) have almost exclusively been discussed related to marginal structural models in longitudinal settings where treatment weights (estimated first) are combined with censoring weights (estimated second). In this work, we examine two examples of combined weights for confounding and missingness in a time-fixed setting in which outcome or confounder data are missing, and the estimand is the marginal expectation of the outcome under a time-fixed treatment. We discuss the identification conditions, construction of combined weights and how assumptions of the missing data mechanisms affect this construction. We use a simulation to illustrate the estimation and application of the weights in the two examples. Notably, when only outcome data are missing, construction of combined weights is straightforward; however, when confounder data are missing, we show that in general we must follow a specific estimation procedure which entails first estimating missingness weights and then estimating treatment probabilities from data with missingness weights applied. However, if treatment and missingness are conditionally independent, then treatment probabilities can be estimated among the complete cases.
Respiratory and cardiovascular condition-related physician visits associated with wildfire smoke exposure in Calgary, Canada, in 2015: a population-based study
Authors: Mahsin M D , Cabaj Jason , Saini Vineet
Published: September 2021

Background

We studied the impact of fine particulate matter (PM2.5) exposure due to a remote wildfire event in the Pacific Northwest on daily outpatient respiratory and cardiovascular physician visits during wildfire (24-31 August, 2015) and post-wildfire period (1-30 September, 2015) relative to the pre-wildfire period (1-23 August, 2015) in the city of Calgary, Canada.

Methods

A quasi-Poisson regression model was used for modelling daily counts of physician visits due to PM2.5 while adjusting for day of the week (weekday versus weekend or public holiday), wildfire exposure period (before, during, after), methane, relative humidity, and wind direction. A subgroup analysis of those with pre-existing diabetes or hypertension was performed.

Results

An elevated risk of respiratory disease morbidity of 33% (relative risk: RR) [95% confidence interval (CI): 10%–59%] and 55% (95% CI: 42%–69%) was observed per 10µg/m3 increase in PM2.5 level during and after wildfire, respectively, relative to the pre-wildfire time period. Increased risk was observed for children aged 0–9 years during (RR = 1.57, 95% CI: 1.21–2.02) and after the wildfire (RR = 2.11, 95% CI: 1.86–2.40) especially for asthma, acute bronchitis and acute respiratory infection. The risk of physician visits among seniors increased by 11% (95% CI: 3%–21%), and 19% (95% CI: 7%–33%) post-wildfire for congestive heart failure and ischaemic heart disease, respectively. Individuals with pre-existing diabetes had an increased risk of both respiratory and cardiovascular morbidity in the post-wildfire period (RR = 1.35, 95% CI: 1.09–1.67; RR = 1.22, 95% CI: 1.01–1.46, respectively).

Conclusions

Wildfire-related PM2.5 exposure led to increased respiratory condition-related outpatient physician visits during and after wildfires, particularly for children. An increased risk of physician visits for congestive heart failure and ischaemic heart disease among seniors in the post-wildfire period was also observed.
Experimental study on cooling feasibility and indoor thermal comfort of multi-connected dry capillary radiant air conditioning system
Authors: Zhang Lina , Tu Qiu , Gong Xuemei , He Yanqiu , Yuan Xiaojun , Ji Chengfan
Published: September 2021

The traditional capillary radiant air conditioning system with water as heat exchange medium in the indoor unit may have defects of water leakage, pipeline freezing in winter and time delay of cooling and heating effect. It can only achieve good cooling or heating comfort, which is related to the installation of radiant capillary or panel in the floor or ceiling. In view of these defects, this work proposes a multi-connected dry capillary radiant (MDCR) air conditioning system with refrigerant as heat exchange medium. For the cooling operation, the fan coil assisted capillary radiant cooling (FCR) is developed. The fan coil bears part of the sensible cooling load to improve cooling effect and undertakes the entire latent cooling load to dehumidify the air to avoid the condensation. Two operation modes including the capillary radiant cooling (CR) and the FCR were comparatively tested. The test results show that the FCR can maintain the indoor temperature at 19–22°C, a comfortable temperature range, and can dehumidify the air to prevent the condensation. The experimental results demonstrate the application feasibility of MDCR for radiant cooling. In addition, the FCR can maintain the comfort relative humidity at 74–80% during the whole process of the refrigeration operation. The thermal comfort indices of predicted mean vote (PMV) and predicted percentage dissatisfied (PPD) can be kept at −0.5 ~ 0.5 and 0–10% at different heights of the indoor room. It can be concluded that FCR can achieve good thermal comfort and the indices of PMV and PPD can reach Class I standard.
The impact of social norms on rice farmers’ behavior of organic fertilizers application: mediating effect of value perception and moderating effect of education level
Authors: Li Xiaoling , Wu Xianrong
Published: September 2021

Existing research on farmers’ behavior of organic fertilizers application usually focuses on individual and household characteristics without considering external social characteristics and potential psychological factors. This paper uses the logistic regression model, mediating effect and moderating effect test method to investigate the influence mechanism of social norms on rice farmers’ behavior of organic fertilizers application. The empirical results show that firstly, social norms can effectively promote rice farmers to apply organic fertilizers. Secondly, the variables of value perception play a mediating role in the relationship between social norms and rice farmers’ behavior of organic fertilizers application. Thirdly, education level plays a significant moderating role in the relationship between social norms and rice farmers’ behavior of organic fertilizers application; the higher the education level of rice farmers, the stronger the positive impact of social norms on their behavior of organic fertilizers application. The results of this study provide an important scientific basis for encouraging rice farmers in developing countries and regions to apply organic fertilizer.
The Exclusivity of Inclusion: Global Construction of Vulnerable and Apolitical Victimhood in Peace Agreements
Authors: Jamar Astrid
Published: September 2021

This article examines the articulation of commitments towards inclusion and victimhood agreed upon within peace processes. It builds on original and comprehensive empirical material to scrutinize provisions for victims’ inclusion in all peace agreements signed from 1990 to 2016. In addition to methodological innovations, this approach offers a global picture and theoretical insights from intersectional, feminist and decolonial perspectives. The article finds that the conceptualizations of ‘victimhood’ and ‘inclusion’ are mostly gender and politically blind; inclusion efforts are often pursued without consideration for political and socio-cultural issues. Still within such conceptual ambiguity, qualifiers and types of efforts provided for inclusion produce the global construction of victimhood as vulnerable, innocent and apolitical. Such conceptual construction negates the complex and fluid political identity of victims; and reproduces sexist, heteronormative and subordinating binaries. The adopted language magnifies vulnerabilities within peace agreements, and provides for actions that do not create space for active participation within these institutional settings. This article contributes to the growing theoretical and policy discussions about inclusion by exposing the ‘inclusion conundrum,’ i.e., inevitable exclusivity – shaped by different forms of sexism, classism and racism – entailed in practices that inquire and decide which victims should be included. Building on these observations, I call for an ontological re-articulation of inclusion by reshaping transitional institutional responses that embrace fluidity rather than reproduce oppression exacerbated by violent conflicts.
Error analysis for space discretizations of quasilinear wave-type equations
Authors: Hochbruck Marlis , Maier Bernhard
Published: September 2021

In this paper we study space discretizations of a general class of first- and second-order quasilinear wave-type problems. We present a rigorous error analysis based on a combination of inverse estimates with semigroup theory for nonautonomous linear Cauchy problems. Moreover, we provide refined results for the special case that the nonlinearities are local in space. As applications of these general results we derive novel error estimates for two prominent examples from nonlinear physics: the Westervelt equation and the Maxwell equations with Kerr nonlinearity. We conclude with a numerical example to illustrate our theoretical findings.
Blaschke–Santaló Inequalities for Minkowski and Asplund Endomorphisms
Authors: Hofstätter Georg C , Schuster Franz E
Published: September 2021

It is shown that each monotone Minkowski endomorphism of convex bodies gives rise to an isoperimetric inequality, which directly implies the classical Urysohn inequality. Among this large family of new inequalities, the only affine invariant one—the Blaschke–Santaló inequality—turns out to be the strongest one. A further extension of these inequalities to merely weakly monotone Minkowski endomorphisms is proven to be impossible. Moreover, for functional analogues of monotone Minkowski endomorphisms, a family of analytic inequalities for log-concave functions is established, which generalizes the functional Blaschke–Santaló inequality.
Vanishing for Hodge Ideals of ℚ-Divisors
Authors: Chen Bingyi
Published: September 2021

Mustaţă and Popa [ 7] introduced the notion of Hodge ideals for an effective $\mathbb{Q}$-divisor $D$ and proved a vanishing theorem for Hodge ideals, which generalizes Nadel vanishing for multiplier ideals. However, their proof needs an extra assumption on the existence of $\ell $-roots of the line bundle $\mathscr{O}_X(\ell D)$, which is not necessary for Nadel vanishing. In this paper, we prove that vanishing for Hodge ideals still holds even without this assumption.
The Effect of Diabetes and Prediabetes on Antituberculosis Treatment Outcomes: A Multicenter Prospective Cohort Study
Authors: Arriaga María B , Araújo-Pereira Mariana , Barreto-Duarte Beatriz , Nogueira Betânia , Freire Maria Vitória C N S , Queiroz Artur T L , Rodrigues Moreno M S , Rocha Michael S , Souza Alexandra B , Spener-Gomes Renata , Carvalho Anna Cristina C , Figueiredo Marina C , Turner Megan M , Durovni Betina , Lapa-e-Silva José R , Kritski Afrânio L , Cavalcante Solange , Rolla Valeria C , Cordeiro-Santos Marcelo , Sterling Timothy R , Andrade Bruno B ,   Regional Prospective Observational Research in Tuberculosis (RePORT)–Brazil Consortium, Andrade Alice M S , Nascimento Vanessa , Malta-Santos Hayna , Rebouças-Silva Jéssica , Costa Alysson G , Silva Jaquelane , de Oliveira Jamile G , Benjamin Aline , Gomes-Silva Adriano , Sant’Anna Flavia M , Ignácio Francine P , Lourenço Maria Cristina , Silva Elisangela C , Moreira Adriana S R , Mello Mayla
Published: September 2021

Background

It is unclear whether diabetes or prediabetes affects unfavorable treatment outcomes and death in people with tuberculosis (PWTB).

Methods

Culture-confirmed, drug-susceptible PWTB, enrolled in the Regional Prospective Observational Research in Tuberculosis (RePORT)–Brazil cohort between 2015 and 2019 (N = 643) were stratified based on glycemic status according to baseline glycated hemoglobin. Unfavorable tuberculosis (TB) outcome was defined as treatment failure or modification, recurrence, or death; favorable outcome was cure or treatment completion. We corroborated the findings using data from PWTB reported to the Brazilian National System of Diseases Notification (SINAN) during 2015–2019 (N = 20 989). Logistic regression models evaluated associations between glycemic status and outcomes.

Results

In both cohorts, in univariate analysis, unfavorable outcomes were more frequently associated with smoking, illicit drug use, and human immunodeficiency virus infection. Diabetes, but not prediabetes, was associated with unfavorable outcomes in the RePORT-Brazil (adjusted relative risk [aRR], 2.45; P < .001) and SINAN (aRR, 1.76; P < .001) cohorts. Furthermore, diabetes was associated with high risk of death (during TB treatment) in both RePORT-Brazil (aRR, 2.16; P = .040) and SINAN (aRR, 1.93; P = .001).

Conclusions

Diabetes was associated with an increased risk of unfavorable outcomes and mortality in Brazilian PWTB. Interventions to improve TB treatment outcomes in persons with diabetes are needed.
Pathogens Associated With Linear Growth Faltering in Children With Diarrhea and Impact of Antibiotic Treatment: The Global Enteric Multicenter Study
Authors: Nasrin Dilruba , Blackwelder William C , Sommerfelt Halvor , Wu Yukun , Farag Tamer H , Panchalingam Sandra , Biswas Kousick , Saha Debasish , Jahangir Hossain M , Sow Samba O , Reiman Robert F B , Sur Dipika , Faruque Abu S G , Zaidi Anita K M , Sanogo Doh , Tamboura Boubou , Onwuchekwa Uma , Manna Byomkesh , Ramamurthy Thandavarayan , Kanungo Suman , Omore Richard , Ochieng John B , Oundo Joseph O , Das Sumon K , Ahmed Shahnawaz , Qureshi Shahida , Quadri Farheen , Adegbola Richard A , Antonio Martin , Mandomando Inacio , Nhampossa Tacilta , Bassat Quique , Roose Anna , O’Reilly Ciara E , Mintz Eric D , Ramakrishnan Usha , Powell Helen , Liang Yuanyuan , Nataro James P , Levine Myron M , Kotloff Karen L
Published: September 2021

Background

The association between childhood diarrheal disease and linear growth faltering in developing countries is well described. However, the impact attributed to specific pathogens has not been elucidated, nor has the impact of recommended antibiotic treatment.

Methods

The Global Enteric Multicenter Study enrolled children with moderate to severe diarrhea (MSD) seeking healthcare at 7 sites in sub-Saharan Africa and South Asia. At enrollment, we collected stool samples to identify enteropathogens. Length/height was measured at enrollment and follow-up, approximately 60 days later, to calculate change in height-for-age z scores (ΔHAZ). The association of pathogens with ΔHAZ was tested using linear mixed effects regression models.

Results

Among 8077 MSD cases analyzed, the proportion with stunting (HAZ below −1) increased from 59% at enrollment to 65% at follow-up (P < .0001). Pathogens significantly associated with linear growth decline included Cryptosporidium (P < .001), typical enteropathogenic Escherichia coli (P = .01), and untreated Shigella (P = .009) among infants (aged 0–11 months) and enterotoxigenic E. coli encoding heat-stable toxin (P < .001) and Cryptosporidium (P = .03) among toddlers (aged 12–23 months). Shigella-infected toddlers given antibiotics had improved linear growth (P = .02).

Conclusions

Linear growth faltering among children aged 0–23 months with MSD is associated with specific pathogens and can be mitigated with targeted treatment strategies, as demonstrated for Shigella.
Spread and Endemicity of Cholera in India: Factors Beyond the Numbers
Authors: Saha Gautam Kumar , Ganguly Nirmal Kumar
Published: September 2021

Cholera outbreaks currently account for 1.3 to 4.0 million cases and cause between 21 000 and 143 000 deaths worldwide. Cholera is preventable by proper sanitization and immunization; however, in many developing nations such as India, cholera disease is endemic.

The surveillance system in India does not adequately capture the actual number of cases. As a result, it is important to utilize limited public health resources correctly in India and other developing counties more effectively to reach vulnerable communities. In this study, we analyze how studies make sense of cholera transmission and spread in India from 1996 to 2015. Furthermore, we analyze how a more sensitive surveillance system can contribute to cholera eradication by giving rise to outbreak preparedness.
Contrasting Epidemiology of Cholera in Bangladesh and Africa
Authors: Sack David A , Debes Amanda K , Ateudjieu Jerome , Bwire Godfrey , Ali Mohammad , Ngwa Moise Chi , Mwaba John , Chilengi Roma , Orach Christopher C , Boru Waqo , Mohamed Ahmed Abade , Ram Malathi , George Christine Marie , Stine O Colin
Published: September 2021

In Bangladesh and West Bengal cholera is seasonal, transmission occurs consistently annually. By contrast, in most African countries, cholera has inconsistent seasonal patterns and long periods without obvious transmission. Transmission patterns in Africa occur during intermittent outbreaks followed by elimination of that genetic lineage. Later another outbreak may occur because of reintroduction of new or evolved lineages from adjacent areas, often by human travelers. These then subsequently undergo subsequent elimination.

The frequent elimination and reintroduction has several implications when planning for cholera’s elimination including: a) reconsidering concepts of definition of elimination, b) stress on rapid detection and response to outbreaks, c) more effective use of oral cholera vaccine and WASH, d) need to readjust estimates of disease burden for Africa, e) re-examination of water as a reservoir for maintaining endemicity in Africa. This paper reviews major features of cholera’s epidemiology in African countries which appear different from the Ganges Delta.
Typhoid in India: An Age-old Problem With an Existing Solution
Authors: Kumar Supriya , Ghosh Raj Shankar , Iyer Harish , Ray Arindam , Vannice Kirsten , MacLennan Calman , Shewchuk Tanya , Steele Duncan
Published: September 2021

Enteric fever continues to impact millions of people who lack adequate access to clean water and sanitation. The typhoid and paratyphoid fever burden in South Asia is broadly acknowledged, but current estimates of incidence, severity, and cost of illness from India are lacking. This supplement addresses this gap in our knowledge, presenting findings from two years of surveillance, conducted at multiple sites between October 2017 and February 2020, in the Surveillance for Enteric Fever in India (SEFI) network. Results provide contemporaneous evidence of high disease burden and cost of illness—the latter borne largely by patients in the absence of universal healthcare coverage in India. Against a backdrop of immediate priorities in the COVID-19 pandemic, these data are a reminder that typhoid, though often forgotten, remains a public health problem in India. Typhoid conjugate vaccines, produced by multiple Indian manufacturers, and recommended for use in high burden settings, ensure that the tools to tackle typhoid are an immediately available solution to this public health problem.
Rotavirus Vaccine Trials in International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) and Future Use of the Vaccine in Bangladesh
Authors: Zaman K , Aziz Asma Binte , Yunus Md , Qadri Firdausi , Ross Allen G , Clemens John D
Published: September 2021

Safe and effective rotavirus vaccines (RVs) are needed to reduce the enormous public health burden of rotavirus illness in developing countries. Vaccination is critical for effective control of rotavirus infection since it cannot be prevented with improvements in water and sanitation. The International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) has completed several groundbreaking RV trials (Phase I–Phase IV). The safety, immunogenicity, efficacy, and effectiveness of different RVs were evaluated among both urban and rural populations. In this study, we present the results, policy implications, and lessons learned for successful implementation of these trials as well as future directions for rotavirus vaccination in Bangladesh.
Typhoid Conjugate Vaccine: An Urgent Tool to Combat Typhoid and Tackle Antimicrobial Resistance
Authors: Saha Samir K , Tabassum Nazifa , Saha Senjuti
Published: September 2021

Typhoid is endemic in many countries in South Asia and sub-Saharan Africa. The high burden of this age-old, preventable disease exacerbates constraints on the health systems of these countries. Currently, most patients are treated effectively in the community or outpatient departments, but with rising antimicrobial resistance and the dearth of novel antimicrobials in the horizon, we risk losing our primary defense against typhoid. Extensively drug-resistant Salmonella Typhi is spreading, and azithromycin is the last oral drug to continue treating typhoid in the community. With increasing azithromycin resistance, emergence of pan-oral drug resistant Salmonella Typhi is imminent. The high burden of typhoid is also an underlying cause of the unnecessary use of antimicrobials. In addition to implementing water sanitation and hygiene interventions to prevent typhoid, it is imperative to rapidly roll out typhoid conjugate vaccines in endemic countries. This will not only reduce the burden of typhoid but will also help interrupt the trend of increasing antimicrobial resistance.
Messenger RNA Vaccine Effectiveness Against Coronavirus Disease 2019 Among Symptomatic Outpatients Aged ≥16 Years in the United States, February–May 2021
Authors: Kim Sara S , Chung Jessie R , Belongia Edward A , McLean Huong Q , King Jennifer P , Nowalk Mary Patricia , Zimmerman Richard K , Balasubramani Goundappa K , Martin Emily T , Monto Arnold S , Lamerato Lois E , Gaglani Manjusha , Smith Michael E , Dunnigan Kayan M , Jackson Michael L , Jackson Lisa A , Tenforde Mark W , Verani Jennifer R , Kobayashi Miwako , Schrag Stephanie J , Patel Manish M , Flannery Brendan
Published: September 2021

Evaluations of vaccine effectiveness (VE) are important to monitor as coronavirus disease 2019 (COVID-19) vaccines are introduced in the general population. Research staff enrolled symptomatic participants seeking outpatient medical care for COVID-19–like illness or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing from a multisite network. VE was evaluated using the test-negative design. Among 236 SARS-CoV-2 nucleic acid amplification test-positive and 576 test-negative participants aged ≥16 years, the VE of messenger RNA vaccines against COVID-19 was 91% (95% confidence interval, 83%–95%) for full vaccination and 75% (55%–87%) for partial vaccination. Vaccination was associated with prevention of most COVID-19 cases among people seeking outpatient medical care.
Effect of a waiting room communication strategy on imaging rates and awareness of public health messages for low back pain
Authors: Sharma Sweekriti , Traeger Adrian C , Tcharkhedian Elise , Middleton Paul M , Cullen Louise , Maher Chris G
Published: September 2021

Background

Few studies have investigated the effects of waiting room communication strategies on health-care behavior.

Objective

We aimed to determine the effect of a waiting room communication strategy, designed to raise awareness of potential harms of unnecessary imaging, on lumbar imaging rates in the emergency department (ED).

Methods

We conducted a controlled experimental study with a replicated time series design. The design included a 6-week run-in time. Following this there were alternating 1-week intervention and control periods. The intervention group received a communication strategy describing the potential harms of unnecessary imaging for low back pain, shown on a 55” LCD screen positioned in the ED waiting room. The communication strategy was designed by a creative innovation agency and included five digital posters and a patient leaflet. The control group received standard messaging for the waiting room at the time, shown on the same 55” LCD screen, and access to the patient leaflet. The primary outcome was the number and proportion of people presenting to ED with low back pain who received at least one lumbar imaging test, measured using routinely collected ED data. Secondary patient-reported outcomes (patient satisfaction and awareness of campaign messages) were collected from a sample of people presenting for any condition who responded to a text-message-based survey.

Results

For the imaging outcome, 337 people presenting to ED with low back pain were included over a 4-month period (intervention n = 99; control n = 238). All had available data on lumbar imaging. Use of lumbar imaging was 25% in those exposed to the communication strategy [95% confidence interval (CI) = 18% to 35%] compared with 29% in those exposed to the standard waiting room messaging [95% CI = 23% to 35%; odds ratio (OR) = 0.83, 95% CI = 0.49 to 1.41]. For the patient-reported outcomes, 349 patients presenting to ED for any condition responded to the survey (intervention n = 170; control n = 179; response rate = 33%). There was uncertain evidence that the intervention increased awareness of the communication strategy leaflet (OR = 2.00, 95% CI = 0.90 to 4.47). Other measures did not suggest between-group differences in patient satisfaction or awareness of the campaign messages.

Conclusion

A communication strategy displayed in the ED waiting room may slightly reduce the proportion of patients with low back pain who receive lumbar imaging, although there is uncertainty due to imprecision. The campaign did not appear to increase awareness of campaign messages or affect patient satisfaction in a sample of patients presenting to the ED for any reason. Larger studies should investigate whether simple, low-cost waiting room communication strategies can raise awareness of unnecessary healthcare and influence health-care quality.

Trial registration

ACTRN12620000300976, 05/03/2020
China’s motives, influence and prospects in Pacific Island countries: views of Chinese scholars
Authors: Zhang Denghua
Published: September 2021

China’s rise in the Pacific has brought the region into the limelight, but research into the views of Chinese scholars of Pacific Studies is limited. Building on a survey and interviews of 39 Chinese scholars, this article analyses China’s motives, influence, and prospects in the Pacific. It finds out that Chinese scholars list China’s diplomatic strategy, the Belt and Road Initiative, and economic interests as the three main causes of China’s Pacific diplomacy. The majority of these scholars rate the performance of China’s Pacific diplomacy as pass/average. Most Chinese scholars are cautiously optimistic about the Belt and Road Initiative in the Pacific, and they expect China to both compete and cooperate with traditional powers in the Pacific in the foreseeable future. Some of these scholars’ views on issues like the China–Taiwan diplomatic competition and the impact of Chinese aid on local corruption contradict the official Chinese line strikingly.
Hedging between the United States and China? South Korea’s ideology-driven behavior and its implications for national security
Authors: Kim Min-hyung
Published: September 2021

Given the limits of the prevailing hedging account for Seoul’s puzzling behavior that is in conformity with the interests of its adversary (i.e. North Korea) and potential threat (i.e. China) rather than those of its principal ally (i.e. the United States) and security cooperation partner (i.e. Japan), this article emphasizes the impact of the progressive ideology on Seoul’s security policy. In doing so, it calls for attention to a domestic source of ideology in explaining the security behaviors of a secondary state, which is under-researched and thus is poorly understood.
Access to Whose Justice? Survivor-Centered Justice for Sexual and Gender-Based Violence in Northern Shan State
Authors: Oo Phyu Phyu , Davies Sara E
Published: September 2021

In 2019, the United Nations (UN) Security Council adopted Resolution 2467. The resolution was to encourage the international system to promote a survivor-centered response to conflict-related sexual violence. The role of local women-led civil society organizations has been identified as the crucial “first-response” mechanism to institute survivor-centered justice. In a situation of ongoing conflict, what agency do civil society organizations have to safely operate “first-response” survivor-centered justice? In this article, we examine the local practices of responding to conflict-related sexual violence in northern Shan State in Myanmar. This article finds that women-led local civil society organizations are indeed crucial first responders and a vital resource for promoting survivor-centered justice-seeking practices. The article also identifies the compromises and risks these civil society organizations experience that limit their agency to deliver survivor-centered justice. Local civil society organizations are constantly navigating local gendered norms, a patriarchal, unrepresentative formal legal system, and a hostile conflict environment. The positionality of local civil society organizations to local armed ethnic organizations and the state itself requires strategic consideration by the international community when recommending local civil society to deliver survivor-centered justice.
Opportunity for Gendering the Responsibility to Protect Agenda at the United Nations?
Authors: Stefan Cristina G
Published: September 2021

Despite its rapid diplomatic rise in the UN setting and global recognition as an established norm, the Responsibility to Protect (R2P) has yet to substantially incorporate gender and directly engage with the complementary Women, Peace, and Security (WPS) agenda. The article discusses this R2P limitation and ways to rectify it through capitalizing on a landmark UN annual report on R2P and cross-cutting areas of engagement with the WPS agenda. To do so, the article proceeds in three sections that mirror the three-pronged classification of overlapping knowledge projects identified for early feminist scholarship. First, the article exposes the extent and effect of masculinist bias in early R2P formulations and R2P's failure to engage explicitly with gender perspectives until the pathbreaking twelfth annual report on R2P. Second, the complementarities between the WPS, gender equality, and R2P are examined in order to highlight the commonalities seen when “adding women” to these agendas. Third, the article examines what gendering the R2P agenda at the United Nations would entail through a reconstruction of R2P that recognizes gender as an analytical and structural category. It is argued that while the progressive 2020 Annual Report on R2P will likely become the reference point for weighing what a gendered R2P agenda should look like, and will hopefully trigger a much-needed reorientation of existing R2P policies as gender-responsive, limitations remain due to three factors: the lack of gender-sensitive analysis at the United Nations, lingering analytical tensions between the WPS and R2P communities, and the current politically resistant climate, which limits a gender audit.
Introduction: WPS 20 Years On: Where Are the Women Now?
Authors: Newby Vanessa F , O'Malley Alanna
Published: September 2021

To commemorate the twentieth anniversary of Resolution 1325, this introduction discusses the state of the field in the women peace and security (WPS) agenda and outlines the challenges to implementation. It begins by introducing the current gaps we see in WPS practice, many of which are driven by insufficient data and lack of funding. The section that follows provides a brief discussion of the global diffusion of the WPS agenda. We highlight the important contribution the Global South has made in implementing the agenda in the absence of great power leadership and the stultified progress of the Global North. We argue that the WPS agenda remains hampered by poor national implementation, a lack of support for civil society initiatives and a failure to recognize the importance of its application in context. The final section introduces the articles in this issue, showing how they advance an emerging human security agenda: integrating WPS into UN-led security initiatives like R2P, and the challenges of the implementation of the WPS agenda in varied local and national contexts. We conclude by arguing that to meet future challenges, the WPS agenda must be broadened to include areas outside traditional conceptions of security and embrace the full remit of evolving security threats; in particular, structural barriers that prevent the empowerment of women across the board.
Practice Theory and the Opening Up of International Organizations
Authors: Holthaus Leonie
Published: September 2021

Scholars researching international organizations’ (IO) inclusion of transnational and local civil society organization (CSO) have provided compelling insights; however, according to their self-evaluation, many of these insights remain at a general level. Against this backdrop, I propose two complementary claims. First, I identify a bias in the literature that has focused on large, Western IOs. What non-Western or small IOs do and how their practices interact with CSO inclusion in different localities is often missed. Second, based on bourgeoning practice theoretical literature on IOs and CSOs, I claim that practice theory can add to research on IO-CSO. In spite of internal pluralism, practice theory refines constructivist methodologies for zooming in on IOs’ internal dynamics, daily practices, and performances of the practice of CSO inclusion, including in IO country offices. On the basis of my own field research, I also suggest that the practice of CSO inclusion interacts with power, gender, and race dynamics. In sum, practice theory can inform research on marginalized and often power-ridden specificities among and within IOs in relation to IO-CSO interaction.
Partisan Technocrats: How Leaders Matter in International Organizations
Authors: Copelovitch Mark , Rickard Stephanie
Published: September 2021

International organizations make policy decisions that affect the lives of people around the world. We argue that these decisions depend, in part, on the political ideology of the organization's chief executive. In this study, we investigate the influence of the leader of one of the most powerful international organizations: the Managing Director of the International Monetary Fund (IMF). We find that when the Managing Director is politically left of center, the IMF requires less labor market liberalization from borrowing countries in exchange for a loan. We also find evidence suggesting that the Managing Director's influence on labor-related loan conditions is independent of the Fund's most powerful members, including the United States. While Managing Directors rarely engage in overtly political behavior, they appear to act as “partisan technocrats” whose ideology influences international financial rescues and specifically the conditions attached to countries’ loans, which shape the distributive consequences of IMF lending.