bluuebunny/crossref_metadata_2025 huggingface dataset:
Electrochemical sensor based on polyamide 6/polypyrrole electrospun nanofibers coated with reduced graphene oxide for malathion pesticide detection
Authors: Migliorini Fernanda L , Sanfelice Rafaela C , Mercante Luiza A , Facure Murilo H M , Correa Daniel S
Published: November 2019

An electrochemical sensor based on polymeric electrospun nanofibers of polyamide 6 (PA6)/polypyrrole (PPy) surface-modified with two forms of graphene was developed for the detection of malathion, an organophosphorus pesticide. The materials were chosen considering the electrospun nanofibers possess large surface area and porosity, while reduced graphene oxide has remarkable electrical conductivity, which is a good strategy to increase sensor sensitivity and improve the limit of detection towards the pesticide. The surface modification of nanofibers with graphene was carried out using chemically (CRGO) and electrochemically reduced graphene oxide (ERGO), in order to demonstrate how the degree of reduction of graphene oxide can influence its electrical conductivity. The influence of the reduction on the conductivity properties of graphene-based films was studied through electrochemical techniques: cyclic voltammetry (CV) and electrochemical impedance spectroscopy (EIS). The platform modified with CRGO, which presented higher electrical conductivity compared to ERGO, was used in the electrochemical detection of the pesticide malathion and exhibited a low detection limit of 0.8 ng ml−1 (S/N = 3). The results indicate that chemically reduced graphene oxide is a potential alternative for modifying electrodes surfaces designed for sensing distinct pollutants of environmental or agricultural interest.
A mechanistic assessment of the potential ecological risk to seagrass meadows posed by marine echosounders
Authors: Alvarez A
Published: November 2019

Motivated by experimental evidence, a mechanistic model is used to investigate the impact of marine echosounder transmissions on seagrass leaves. The interaction of the ultrasonic field with the seagrass is solved within the leaf cross-section. The leaf tissue is assumed to be elastic, homogeneous and isotropic, with embedded cavities representing lacunae. A standard Galerkin finite element method is employed to numerically solve the resulting equations. Natural vibration frequencies are computed for leaves of Halodule wrightii and Syringodium filiforme. Strong perturbations in the leaf structure are expected when natural and echosounder frequencies match. The results reveal that a significant number of natural frequencies are within or near the typical frequency bands of echosounder operations. In addition, stresses in the leaf tissues of seagrass at 20 m depth were computed in a typical scenario for echosounder operations. Leaf-tissue damage in S. filiforme could result under these conditions. Within the framework of the theoretical assumptions, the results highlight the potential and, until now, unnoticed risks to seagrass meadows posed by marine echosounders.
Potential increase in oil and gas well leakage due to earthquakes
Authors: Kang Mary , Dong Yuhan , Liu Yajing , Williams James P , Douglas Peter M J , McKenzie Jeffrey M
Published: November 2019

Earthquakes occurring naturally or induced by human activities can damage surface and subsurface infrastructure. Oil and gas wells represent a category of subsurface infrastructure that can act as leakage pathways connecting oil and gas reservoirs, groundwater aquifers, and the atmosphere. The integrity of these wells can be compromised through a wide range of processes and contribute to groundwater contamination, greenhouse gas emissions, and air quality degradation. We estimate the increase in such subsurface leakage potential due to seismic activity through geospatial analysis of 579,378 oil and gas well and 196,315 earthquake (magnitudes greater than 1.0) locations in Oklahoma, California, and British Columbia. We perform density-based clustering analysis and point density mapping using ArcGIS. We combine the well and earthquake point density maps to identify hot spots of joint high well and earthquake densities. We find that oil and gas wells and earthquakes are clustered in space, with densities reaching ∼60 wells per km2 and ∼40 earthquakes per km2 in California. There are at least two hot spots where these clusters overlap in each state/province. In Oklahoma and British Columbia, the hot spots are more correlated with earthquake densities; while, in California, the hot spots are more correlated with well densities. Our findings indicate the need to investigate the role of earthquakes on wellbore leakage through additional analysis of earthquake characteristics, wellbore attributes, improved data collection, and empirical field studies for all oil and gas wells, including those that are abandoned. In particular, large scale geospatial analysis establishing the scope of the problem and empirical field studies focusing on identified hot spots are needed to understand potential environmental impacts of earthquakes, especially those induced by oil and gas activities.
Bayesian constraint relaxation
Authors: Duan Leo L , Young Alexander L , Nishimura Akihiko , Dunson David B
Published: November 2019

Prior information often takes the form of parameter constraints. Bayesian methods include such information through prior distributions having constrained support. By using posterior sampling algorithms, one can quantify uncertainty without relying on asymptotic approximations. However, sharply constrained priors are not necessary in some settings and tend to limit modelling scope to a narrow set of distributions that are tractable computationally. We propose to replace the sharp indicator function of the constraint with an exponential kernel, thereby creating a close-to-constrained neighbourhood within the Euclidean space in which the constrained subspace is embedded. This kernel decays with distance from the constrained space at a rate depending on a relaxation hyperparameter. By avoiding the sharp constraint, we enable use of off-the-shelf posterior sampling algorithms, such as Hamiltonian Monte Carlo, facilitating automatic computation in a broad range of models. We study the constrained and relaxed distributions under multiple settings and theoretically quantify their differences. Application of the method is illustrated through several novel modelling examples.
A random-perturbation-based rank estimator of the number of factors
Authors: Kong Xinbing
Published: November 2019

We introduce a random-perturbation-based rank estimator of the number of factors of a large-dimensional approximate factor model. An expansion of the rank estimator demonstrates that the random perturbation reduces the biases due to the persistence of the factor series and the dependence between the factor and error series. A central limit theorem for the rank estimator with convergence rate higher than root $n$ gives a new hypothesis-testing procedure for both one-sided and two-sided alternatives. Simulation studies verify the performance of the test.
Genome size evolution and chromosome numbers of species of the cryptanthoid complex (Bromelioideae, Bromeliaceae) in a phylogenetic framework
Authors: Alves Dos Santos Cruz Geyner , Mendonça Filho José Roseno De , Vasconcelos Santelmo , Gitaí Jaílson , Salabert De Campos José Marcello , Facio Viccini Lyderson , Zizka Georg , Leme Elton Martinez Carvalho , Brasileiro-Vidal Ana Christina , Benko-Iseppon Ana Maria
Published: November 2019

We describe the chromosome numbers and genome sizes of species of the cryptanthoid complex of Bromeliaceae in a phylogenetic framework and their relationship with habitat preferences. The 2C DNA contents varied 2.13-fold among species, ranging from 0.76 to 1.66 pg. A significant difference in DNA content was found among Cryptanthus, Hoplocryptanthus and Rokautskyia. Moreover, species from campos rupestres and the Atlantic Forest had lower and higher genome size values, respectively. The smaller genome sizes of Hoplocryptanthus spp. from campos rupestres may be related with the large genome constraint. The species show a highly conserved ploidy (with 2n = 32 and 34), although the genome sizes varied considerably. The observed variation in chromosome numbers seems to be influenced by dysploidy, but additional investigations are needed. Our study demonstrates that the genome size variation in the cryptanthoid complex species is not strictly related to the phylogenetic relationships and has probably been influenced by different evolutionary processes.
MNVPCS: Multinode Virtual-Point–Based Charging Scheme to Prolong the Lifetime of Wireless Rechargeable Sensor Networks
Authors: Chang Hong-Yi , Hang Zih-Huan , Tzang Yih-Jou
Published: November 2019

Wireless-charging technology can utilize a mobile wireless charging vehicle (WCV) to rescue dying nodes by supplementing their remaining energy, and using WCVs in this way forms wireless rechargeable sensor networks (WRSNs). However, a WCV in a WRSN encounters several challenges, collectively called the optimized charging problem. This problem involves a set of sensor nodes randomly distributed on the ground for which the WCV must determine an appropriate travel path to charge the sensor nodes. Because these sensor nodes have different workloads, they exhibit different energy consumption profiles over time. Resolving the above-mentioned problem requires the determination of the priority of charging the sensor nodes based on the order in which they are expected to die and subsequently finding the most efficient path to charge the sensor nodes such that sensor death is avoided for as long as possible. Furthermore, the most efficient placement of the charging point needs to be considered when planning the charging path. To address this, the proposed multinode virtual point-based charging scheme (MNVPCS) considers both the planning of an efficient charging and the best location for the charging point. Experimental results show that MNVPCS can improve the lifetime of the entire WRSN and substantially outperform other methods on this measure.
Acute papillary muscle infarction and rupture in the puerperium complicating Libman–Sacks endocarditis in a patient with systemic lupus erythematosus and antiphospholipid syndrome: a case report
Authors: Curtis Elizabeth , Corkill Michael , Amir Nezar , Haydock David
Published: November 2019

Background

Acute heart failure caused by severe mitral regurgitation (MR) due to papillary muscle rupture has been described in the puerperium by case reports; however, the majority of cases of papillary muscle rupture are caused by myocardial infarction. We describe papillary muscle rupture occurring in the postpartum period in a patient with systemic lupus erythematosus (SLE), antiphospholipid syndrome (APLS), and chronic Libman–Sacks endocarditis and explore the multifactorial nature of the papillary muscle infarction and rupture in the setting of postpartum fluid shifts, chronic myocardial injury from Libman–Sacks, and high thrombotic risk.

Case summary

A 29-year-old woman presented with acute heart failure 2 weeks’ postpartum and was found to have acute MR due to a flail leaflet caused by papillary muscle rupture. She proceeded to emergency surgery with mitral valve (MV) replacement and the histology revealed evidence of chronic Libman–Sacks endocarditis and papillary muscle infarction with thrombi in the intramyocardial arteries.

Discussion

This is the second case report of papillary muscle rupture in the puerperium in a patient with SLE in the literature, the other case was caused by catastrophic APLS. However, in this case, the cause of the rupture is likely to be multifactorial; as a consequence of thrombosis in the microvasculature causing isolated papillary muscle ischaemia, and fibrosis of the muscle due to chronic Libman–Sacks endocarditis resulting in limited pliability which caused rupture of the papillary muscle when faced with the added stress of increased volume that occurs in the puerperium.
Percutaneous closure of an uncommon aortic pseudoaneurysm after arterial switch repair: a case report
Authors: Carmans Lisa , De Meester Pieter , Budts Werner , Troost Els
Published: November 2019

Background

The development of an aortic pseudoaneurysm is a rather rare but potentially fatal complication after cardiac surgery for aortic valve and aorta disease. If a pseudoaneurysm is left untreated, it carries a substantial risk of rupture, thrombosis with subsequently systemic embolization, and compression of the surrounding structures.

Case summary

We describe a case of a transcatheter repair of a more complex and uncommon pseudoaneurysm following aortic valve replacement in a patient with a history of arterial switch repair for transposition of the great arteries. The pseudoaneurysm originated from the aortic wall and connected to the left ventricular outflow tract (LVOT). The connection to LVOT was closed with a duct occluder, the neck to the aortic wall with an atrial septal defect occluder. After 1 month, the complete pseudoaneurysm was successfully thrombosed.

Discussion

Percutaneous closure of a complex pseudoaneurysm after arterial switch repair is feasible and safe. However, lifelong follow-up is needed to determine the late results after transcatheter interventions.
Myocardial bridging in the era of a drug epidemic: a case report addressing the need to revisit donor organ assessment
Authors: Dahiya Garima , McQuade Derek , Alpert Craig
Published: November 2019

Background

Myocardial bridging (MB), though typically a benign finding, may occasionally lead to syncope, myocardial infarction, arrhythmia, or sudden death. Surgical denervation of transplanted hearts complicates the management of such incidentally detected post-transplant coronary anomalies due to the lack of classic ischaemic symptoms.

Case summary

A middle-aged female underwent an uncomplicated cardiac transplantation from a healthy male donor in his early 20s who had suffered a cardiac arrest while using cocaine. Given the young donor age, a pre-transplant coronary angiogram (CAG) was deferred. However, 6-week post-transplant, routine CAG, and intravascular ultrasound revealed an extensive MB spanning a significant portion of the left anterior descending coronary artery with substantial myocardium at risk. A stress test with myocardial perfusion imaging performed to evaluate the functional significance of the bridge did not reveal any perfusion abnormalities in the myocardium at risk.

Discussion

In current practice, younger donors often do not undergo pre-transplantation CAG routinely performed in older donors given the lower prevalence of significant coronary disease. However, post-operatively this young donor was found to have passed on a potentially life-threatening MB to a denervated recipient, who cannot manifest typical anginal symptoms during ischaemia, thereby challenging providers to choose among strategies of watchful waiting, risk stratification, or pre-emptive intervention. In retrospect, the donor’s mode of death may have signalled an underlying structural abnormality that warranted further pre-transplant characterization. In order to ensure optimal quality of transplanted hearts, young donors may warrant pre-transplant CAG despite their age, particularly those with a history of drug use or suspicious mode of death.
Tracheobronchoplasty after a trial with a silicone Y-stent in a patient with Mounier-Kuhn syndrome
Authors: Muñoz Fos Anna , Cosano Javier , Wins Richard , Galán Genaro
Published: November 2019

Tracheobronchomegaly or Mounier-Kuhn syndrome is a rare disorder characterized by the widening of the trachea and the main bronchi. It is a form of tracheomalacia called ‘cartilaginous malacic’ and is characterized by deformation of the tracheal cartilages and intrusion of the redundant membranous wall into the lumen of the airway. We present a patient with Mounier-Kuhn syndrome managed like patients with tracheomalacia of other aetiologies—a tracheobronchoplasty with a reconstructed D-shaped trachea and stabilization of the posterior membranous wall by attaching a polypropylene mesh to the posterior membranous wall of the trachea and the main bronchi after a trial period with a tracheobronchial Y-shaped silicone stent.
Acute myocardial infarction treatments and outcomes in 6.5 million patients with a current or historical diagnosis of cancer in the USA
Authors: Bharadwaj Aditya , Potts Jessica , Mohamed Mohamed O , Parwani Purvi , Swamy Pooja , Lopez-Mattei Juan C , Rashid Muhammad , Kwok Chun Shing , Fischman David L , Vassiliou Vassilios S , Freeman Philip , Michos Erin D , Mamas Mamas A
Published: November 2019

Aims

The aim of this study is to evaluate temporal trends, treatment, and clinical outcomes of patients who present with an acute myocardial infarction (AMI) and have a current or historical diagnosis of cancer, according to cancer type and presence of metastases.

Methods and results

Data from 6 563 255 patients presenting with an AMI between 2004 and 2014 from the US National Inpatient Sample (NIS) database were analysed. A total of 5 966 955 had no cancer, 186 604 had current cancer, and 409 697 had a historical diagnosis of cancer. Prostate, breast, colon, and lung cancer were the four most common types of cancer. Patients with cancer were older with more comorbidities. Differences in invasive treatment were noted, 43.9% received percutaneous coronary intervention (PCI) in patients without cancer, whilst only 21.0% of patients with lung cancer received PCI. Lung cancer was associated with the highest in-hospital mortality [odds ratio (OR) 2.71, 95% confidence interval (CI) 2.62–2.80], major adverse cardiovascular and cerebrovascular complications (OR 2.38, 95% CI 2.31–2.45), and stroke (OR 1.91, 95% CI 1.80–2.02), while colon cancer was associated with highest risk of bleeding (OR 2.82, 95% CI 2.68–2.98). Irrespective of the type of cancer, presence of metastasis was associated with worse in-hospital outcomes, and historical cancer did not adversely impact on survival (OR 0.90, 95% CI 0.89–0.91).

Conclusion

A concomitant cancer diagnosis is associated with a conservative medical management strategy for AMI, and worse clinical outcomes, compared to patients without cancer. Survival and clinical outcomes in the context of AMI vary significantly according to the type of cancer and metastasis status. The management of this high-risk group is challenging and requires a multidisciplinary and patient-centred approach to improve their outcomes.
Adipocytes promote interleukin-18 binding to its receptors during abdominal aortic aneurysm formation in mice
Authors: Liu Cong-Lin , Ren Jingyuan , Wang Yunzhe , Zhang Xian , Sukhova Galina K , Liao Mengyang , Santos Marcela , Luo Songyuan , Yang Dafeng , Xia Mingcan , Inouye Karen , Hotamisligil Gökhan S , Lu Guanyi , Upchurch Gilbert R , Libby Peter , Guo Junli , Zhang Jinying , Shi Guo-Ping
Published: November 2019

Aims

Obesity is a risk factor of abdominal aortic aneurysm (AAA). Inflammatory cytokine interleukin-18 (IL18) has two receptors: IL18 receptor (IL18r) and Na-Cl co-transporter (NCC). In human and mouse AAA lesions, IL18 colocalizes to its receptors at regions rich in adipocytes, suggesting a role of adipocytes in promoting IL18 actions in AAA development.

Methods and results

We localized both IL18r and NCC in human and mouse AAA lesions. Murine AAA development required both receptors. In mouse AAA lesions, IL18 binding to these receptors increased at regions enriched in adipocytes or adjacent to perivascular adipose tissue. 3T3-L1 adipocytes enhanced IL18 binding to macrophages, aortic smooth muscle cells (SMCs), and endothelial cells by inducing the expression of both IL18 receptors on these cells. Adipocytes also enhanced IL18r and IL18 expression from T cells and macrophages, AAA-pertinent protease expression from macrophages, and SMC apoptosis. Perivascular implantation of adipose tissue from either diet-induced obese mice or lean mice but not that from leptin-deficient ob/ob mice exacerbated AAA development in recipient mice. Further experiments established an essential role of adipocyte leptin and fatty acid-binding protein 4 (FABP4) in promoting IL18 binding to macrophages and possibly other inflammatory and vascular cells by inducing their expression of IL18, IL18r, and NCC.

Conclusion

Interleukin-18 uses both IL18r and NCC to promote AAA formation. Lesion adipocyte and perivascular adipose tissue contribute to AAA pathogenesis by releasing leptin and FABP4 that induce IL18, IL18r, and NCC expression and promote IL18 actions.
Quantitative research on health determinants in high-income countries: Systematic literature review
Authors: Varbanova V , Beutels P
Published: November 2019

Background

Identifying determinants of health and understanding their role in health production is an important research theme. In recent decades data have become more accessible and multi-country analyses offer an appealing way to potentially enrich such research.

Methods

We followed the PRISMA guidelines to systematically identify, triage and review literature published between 2013 and early 2018. Forty-three studies that performed cross-national statistical analyses aiming to evaluate the impact of one or more aggregate level determinants on one or more general population health outcomes in high-income countries were selected out of an original yield of 7353. To assess in which combinations and to what extent individual (or thematically linked) determinants had been studied together, we performed multidimensional scaling and cluster analysis.

Results

Life expectancy and overall mortality were the most widely used population health indicators, while determinants came from the broad categories of healthcare, culture, politics, socio-economics, environment, labor, fertility, demographics, life-style, and psychology. The family of regression models was the predominant statistical approach. Results from our multidimensional scaling showed that a relatively tight core of determinants have received much attention, whereas most others were studied in very limited contexts. We consider research findings inconclusive at this time: across a multitude of model specifications, different country samples, and varying time periods, effects fluctuated between statistically significant and not, and between beneficial to health and detrimental.

Conclusions

We conclude that the quest to understand the underlying mechanisms of population health is far from over and the present state of research on the topic leaves much to be desired. It seems essential that future research always considers multiple factors simultaneously and takes advantage of more sophisticated methodology.

Key messages

Provides a broad overview of the current state of research on the topic of determinants of population health in high-income countries. Employs an innovative approach examining the degree to which context has been taken into account, as a basis for future research.
Collecting high-quality survey data on hard-to-reach populations: lessons from Finland
Authors: Rask S , Koponen P , Skogberg N , Kuusio H , Castaneda A
Published: November 2019

Issue

Hard-to-reach populations refer to groups that may be difficult to involve in research. Minorities and persons with migration background (PMB) are often underrepresented in population-based surveys. This may lead to serious bias. Description of the problem: Several surveys on the health and wellbeing of hard-to-reach populations have been conducted in Finland since 2010. Strategies for collecting high-quality data have been identified in five surveys focused on specific migrant groups (Maamu n = 3000), the foreign-origin population (UTH n = 6000; FinMONIK n = 13650), newly-arrived asylum seekers (TERTTU n = 1087) and Finnish Roma (ROOSA n = 365). Also few routinely collected studies include indicators of ethnic background or origin (e.g. School Health Promotion study).

Results

Country of birth and foreign origin can be identified in Finland using register-based sampling. Snowball sampling was needed for the Roma population. Strategies to reach participants included information dissemination, translated questionnaires, multilingual personnel, telephone contacts and door-to-door visits. Stakeholders and participants were involved in planning and reporting. Participation rates as high as 70-80% were reached from register-based samples. Lessons: High-quality survey data can be collected on hard-to-reach populations. This requires adequate resources including multilingual personnel and researcher-participant trust. The cross-cultural validity of survey questions is critical; cognitive interviews can be used to improve cultural sensitivity. Researchers should be sensitive of sense of belonging, e.g. PMB may object being seen as “migrants”. Members of hard-to-reach populations should be involved in research, and not merely objects of a study.

Main messages

High participation rates can be achieved with adequate time, financial resources and established researcher-participant trust. Data collection should be inclusive and clearly benefit the individuals and populations in concern.
“Queer Migrants Welcome” in Public Health Teaching
Authors: Namer Y , Tezcan-Güntekin H
Published: November 2019

Background

People with heterogeneous sexual orientations and gender identities are rarely the focus of public health research or teaching. LGBTQ people (Lesbian, Gay, Bisexual, Transgender, Queer) are particularly at risk of being discriminated against in accessing and using health care. In order to give students of public health a perspective that is sensitive to diversity and which will allow them to consider LGBTQ people in their future research, teaching and practice, these topics must be actively reflected on during their studies.

Methods

A website was built by a team of students of the Bachelor degree program in Health Communication at the School of Public Health, Bielefeld University in Germany. The aim of this course was to learn about the health situation and risks of LGTBQ people. One main emphasis of this project was to develop a medium that focuses on the perspective for newcomers, migrants and refugees in the context of LGTBQ health in a participatory way.

Results

The students developed an understanding of LGBTQ, migration and health largely independently through individual research and group discussion, decided to create an English-language website (https://queermigrantswelcome.jimdofree.com) and present existing findings in blog posts they wrote on their own. The pictures on the homepage were drawn by the students themselves, as they perceived the freely available LGBTQ pictures as too stereotypical. They contacted counselling centres for LGBTQ persons throughout Germany and asked in which language they offer counselling and have included these counselling possibilities on the homepage.

Conclusions

Already at the Bachelor’s level, students can design innovative media that can improve the health care of marginalized people and contribute to the dismantling of discriminatory structures. It is important that the students are given sufficient freedom to make their own decisions and identify with the topic, thus facilitating a major learning process.

Key messages

Desiderates in health communication can be reduced by well accompanied student projects. The topic LGBTQ must be implemented in the curricula of public health study programmes to reduce discrimination in health care.
No UHC without medicines: out-of-pocket payments for non-communicable diseases in 18 countries
Authors: Murphy A , Palafox B , Rangarajan S , Yusuf S , McKee M
Published: November 2019

Background

In 2014 the United Nations agreed on a goal to reduce premature mortality from NCDs by improving financial risk protection. We are far from achieving this: households with NCDs are at an increased risk of catastrophic health spending and impoverishment, particularly in lower middle- and low-income countries. There is a need to better understand the drivers of health spending among households with NCDs, to inform interventions aimed at achieving universal health coverage.

Methods

Using data from the Prospective Urban and Rural Epidemiology Study, we analyse out-of-pocket expenditure (OOP) among households with NCDs (cancer, cardiovascular disease, hypertension, diabetes, respiratory disease or kidney disease) in 18 countries: Canada, Sweden, Brazil, Chile, Malaysia, Poland, South Africa, Turkey, China, the Philippines, Colombia, Iran, the Occupied Palestinian Territory (OPT), Bangladesh, India, Pakistan, Zimbabwe and Tanzania.

Results

The leading driver of OOP on health care in almost all countries included is medicine. For example, the monthly OOP on medicines among NCD households in Iran, where roughly 18% of NCD households experience catastrophic spending, is USD 13.50, representing 36% of OOP on health. In Brazil this figure is USD 25.85, representing 46% of OOP on health. A large proportion of OOP is also made up by consultation fees, particularly in Sub-Saharan African countries. In Poland, 63% of OOP on health is spent on alternative medicine consultation fees.

Conclusions

Our findings echo the message shared by the Director General of the World Health Organization in 2018, that there is “no Universal Health Coverage without access to quality medicines”. Medicine costs impose a significant economic burden on NCD households in countries at all levels of development, highlighting the need to include essential medicines for NCDs in universal health coverage benefit packages.

Key messages

To achieve the goal of improved financial risk protection for NCDs we need to understand drivers of out-of-pocket spending among households with NCDs. Medicines are by far the largest driver of OOP in countries at all levels of development and require urgent attention to ensure universal health coverage.
Expansion of activity-based hospital payment in Israel: evaluation of effects on inpatient activity
Authors: Waitzberg R , Quentin W , Maoz-Breuer R , Busse R , Greenberg D
Published: November 2019

Background

In 2013-14, Israel stepped up the replacement of per-diem payments by Procedure-Related Group (PRG) based hospital payments, a local version of Diagnosis-Related groups (DRGs). PRGs were created for selected procedures in urology, general surgery, gynecology and ophthalmology. We analyzed how did this change affect inpatient activities, measured by the number of discharges, average length of stay (ALoS), and the case-severity Charlson Comorbidity Index (CCI).

Methods

We investigated the impacts of the PRG-payment reform on 15 procedures. Observations covered groups of inpatients, by age and gender, who underwent these procedures in 2005-2016 at all non-profit hospitals. We examined the effect of the payment change on the number of discharges, ALoS and CCI using a multivariable analysis of Ordinary Least Squares controlling for patients, hospital characteristics, and year fixed-effects.

Results

Data on 89,533 patients were examined. During the study period, the ALoS decreased except for one procedure, the number of inpatients increased for most procedures, and case severity remained stable. The multivariable analysis suggests that the transition to PRG-payments contributed to changes in ALoS or case severity for only 3 out of 15 procedures examined. The PRG-reform contributed to changes of 10%-45% in the number of patients, but there was no clear trend: it increased in 9, and decreased in 5. The changes did not follow a clear pattern according to procedures’ price changes after the reform.

Conclusions

Factors that may have hampered the effects of the PRG-reform are conflicting incentives created by other co-existing hospital-payment components, such as revenue caps and retrospective subsidies, and the lack of resources to increase productivity.

Key messages

Provider payment reforms should carefully coordinate the entire payment system, otherwise the incentives may be blurred. Uncoordinated reforms may miss their goals.
The effect of breast cancer on work participation in different sectors. A Danish registry based study
Authors: Jensen L , Bøggild H , Overgaard C , Fonager K
Published: November 2019

Background

A breast cancer diagnosis affects an individual’s affiliation to the labor market, but whether the effect of breast cancer variates in different sectors in a Danish setting has not been examined. The present study investigated the effect of stage IA breast cancer (tumor<20 mm and no lymph nodes involved in six sectors among Danish women being part of the work force. Stage IA breast cancer has a good prognosis, and it would be assumed that the majority have returned to work after 1 year.

Methods

This registry-based cohort study was based on data from linked Danish nationwide registries. We identified 5,543 women (aged 25-63 years) diagnosed with breast cancer (BC) stage IA (exposed) and 65.889 women without breast cancer (unexposed) and included women from the different sectors. We calculated a yearly Work Participation Score (WPS), defined as the proportion of weeks being self-supported during a year. We compared the means of WPS for exposed and unexposed women in six different sectors: 1) teaching, 2) childcare, 3) eldercare, 4) cleaning, 5) administration and 6) hospitality industry.

Results

BC had a negative effect on being self-supporting for women in all six sectors in all three years, although the effect declined. In the first year, the difference in WPS varied between 0.38 and 0.54. During the second year all BC patients had still significantly lower WPS with the largest difference in hospitality industry (0.65 (95% CI 0.50-0.80) for exposed women and 0.86 (95% CI 0.83-0.88) for unexposed women). In the third year, the effect further declined although WPS was still significantly lower for most sectors with the biggest difference in the cleaning sector.

Conclusions

A stage IA BC diagnosis had a negative effect on being self-supportive after 2 and 3 years among women in all six sectors, although the difference was largest among cleaning workers. This may indicate, that individual follow-up in relation to work participation is necessary.

Key messages

Although breast cancer stage IA has a good prognosis, it still affects being self-supporting after three years. A diagnosis of breast cancer affects the affiliation to the labour market, but the effect differs according to different sectors.
We’re making individuals more “health literate” but what about communities?
Authors: Kendir D r , Breton D r
Published: November 2019

Health literacy (HL) is increasingly hailed as a strategy to improve the control individuals have over their health. So much so that HL is now ranked as a determinant of population health. A central critic of HL intervention is its over emphasis on individual level factors something recognised in the 2008 report of the Commission of Social Determinants of Health (SDoH) that recommended expanding the scope of HL to cover the SDoH.

Our objective of our study was to assess the extent to which recent progress on HL captures the need for collective action on the SDoH.

We conducted a scoping review on PubMed looking for review papers, published between 2013-2018 in English and French. The reference lists of the papers were also searched to find other relevant articles. The WHO website was also consulted. The most cited definitions were analysed against two main dimensions (i.e. locus of change of HL strategies and foreseen outcome of HL improvements).

We identified 419 articles. Despite a number of authors calling for more research on HL interventions at the community level and an expansion of the definition to cover the SDoH, we found that the recommendation of the Commission has yet to be implemented. Even when the definitions include the capacities of individuals on distal determinants, both the locus of change and outcomes of HL improvement stayed focused on intra individual factors. It is noteworthy that communities were either framed as a setting outside of health care services or as an aggregate of individuals. We found no instance of HL intervention regarding communities as complex systems of actors sharing a common space and dynamic.

We conclude by drawing attention on the research gap in addressing the upstream SDoH through HL actions. We propose some elements of definition of HL reflecting the need for interventions to build capacities for collective action on the SDoH and develop measurements at the community level.

Key messages

Research and practice have yet to embrace the contribution of HL in addressing the upstream SDoH. There is a large research gap on how HL can build collective capacities on addressing the SDoH.
The association between screen time and psychological distress in Norwegian adolescents
Authors: Kleppang A L , Steigen A M , Finbråten H S
Published: November 2019

Background

The use of screens, especially mobile devices like tablets and smartphones have increased over the last years, and have become an integrated part of modern life. Adolescents today spend a lot of their time using screens both at school and outside school. The concerns about the impact of screens on adolescents are growing, and some expert groups have suggested controlling screen time for children and young adults. Because research is limited and screen-based utilization technologies and their patterns are changing rapidly, it is important to examine their impacts on mental health. This can help to guide public health policy on consequences of, and potential limits on screen time. The purpose of this study is to study the association between screen time and psychological distress among adolescents.

Methods

This study is based on self-reported cross-sectional data from the Ungdata survey conducted in 2018. The target group comprised 6777 adolescents from secondary schools in Norway. Ten items on depression and anxiety symptoms were used to create a composite measure of psychological distress. Binomial logistic regression was used to analyse the association between screen time and psychological distress.

Results

Preliminary results showed that the odds for psychological distress were higher for those who used screens more than 2 hours per day after school (OR: 1.83, 95% CI: 1.60-2.09), compared to those who used screens 2 hours and less per day. Further, the odds of having psychological distress were higher in girls compared to boys (OR: 3.49, 95% CI: 3.14-3.87), and in upper secondary school compared to lower secondary school (OR: 1.41, 95% CI: 1.25-1.58).

Conclusions

Two hours or more used on screens per day was associated with significantly higher odds for psychological distress. Hence, public health policy and practice should pay attention to consequences of screen time use in adolescence. Additional research is needed to further explore these associations.

Key messages

Public health policy and practice should pay attention to screen time in adolescence and its association with psychological distress. This knowledge is important to enhance mental health in adolescence.
Participatory research for developing health promotion campaigns for migrants and host community in Berlin, Germany
Authors: Schouler-Ocak M , Kirkgöze N
Published: November 2019

Background

During the current refugee crisis, hundreds of refugees left their homes and fled to Europe. The country that received the highest rates of refugees was Germany, which above all presented a challenge to the healthcare system. This study aimed to inform the development of a pilot intervention to improve migrants healthcare access in Berlin, Germany.

Methods

A Metaplan© qualitative technique was applied to ensure the community participation, with three sessions with refugee and asylum seeking women and youth in Arabic, Somali and German languages, and one with professionals. With each group, participants identified issues in migrants’ healthcare, then suggested solutions to address these issues and prioritized these solutions.

Results

The migrants (n = 30) were mainly from Syria (n = 4), Somalia (n = 14) and other African countries, mainly females (17-53 yrs) and youth (16-18yrs). The professionals’ group (n = 13) included an interdisciplinary team of a psychiatric day clinic. All groups prioritized language barriers as a crucial problem and suggested to work with interpreters to facilitate the communication. Professionals are additionally confronted with cultural differences in the treatment of refugees. Somali women prioritized raising the awareness about Female Genital Mutilation in the healthcare system and also in their community. Other suggestions included supervisors for unaccompanied minors, multilingual forms, increased intercultural competence of health care providers and reducing waiting time for an appointment.

Conclusions

Future interventions should focus on intercultural competences for professionals and health-promoting information in the specific sociocultural context of migrant communities. This would include the dissemination of multi-lingual doctors’ brochures, interactive training for health care providers as well as informational workshops for migrants to increase their health literacy and promote health-enhancing behaviors.
Could machine learning aid the production of evidence reviews? A retrospective test of RobotAnalyst
Authors: Hookway A , Price S , Knight T
Published: November 2019

Background

The Observatory Evidence Service (OES) at Public Health Wales supports evidence informed decision making by conducting evidence reviews, which follow systematic review methodology, on complex public health topics. Machine-learning technologies have the potential to aid in screening studies for inclusion in reviews, and the OES have undertaken testing of one such system, RobotAnalyst, to assess its accuracy and to determine if it would increase the efficiency of the review process.

Methods

Retrospective testing was undertaken using three previously completed evidence reviews. For each test, references were uploaded into RobotAnalyst and the decisions made by the original reviewers were input in blocks of 25 to form a training set. The “update predictions” function generated a predicted inclusion decision for the remaining references at each test point and these were compared to the original review decisions.

We calculated RobotAnalysts sensitivity, specificity, positive predictive value, false include and exclude rate and the proportion of missed references.

Results

Mixed levels of performance were observed. An overall increase in sensitivity as more studies were added to the training set was detected for two of the three reference sets when screened at title stage, but only in one case did RobotAnalyst produce relatively high levels of sensitivity (over 90%). This was observed in reference test set one (n = 500 references), where sensitivity increased from 51% at the start of testing to 91% after 250 references had been manually marked on the system. Although performance tended to be higher as more studies were added to the training sets, the increases were not always linear.

Conclusions

There may be some promise in using RobotAnalyst as a second screener, especially on larger reference sets when the human resource demands of duplicate screening are considerable. We are continuing to test RobotAnalyst both retrospectively and prospectively.

Key messages

Retrospective testing of RobotAnalyst observed mixed levels of performance. RobotAnalyst could potentially be utilised as a second screener for evidence review.
MS-Diet, a tailored nutrition counselling web-application based on mathematical diet optimization
Authors: Gazan R , Darmon N D , Vieux F V , Maillot M M
Published: November 2019

Background

By definition, messages in tailored approaches are built to reach a given person, based on her/his specific characteristics and needs. Tailored dietary behavior change interventions have a small but significant effect on dietary behavior change. The majority of these interventions target a few food groups or nutrients, without evaluating the overall diet. Diet optimization is a powerful mathematical method to translate nutrient recommendations into individual-specific food choices. This method is increasingly used in nutrition research, in the fields of public health and diet sustainability. Objective: The aim was to combine tailored approaches and diet optimization in a web application of tailored nutrition counselling.

Method and results

The web application, called MS-Diet, was developed based on behavior changes techniques, such as: self-monitoring, self-regulatory, tailored feedback and engaging communication techniques. In a first feature, based on user’s data collected online (including answers to a food frequency questionnaire), the user can obtain a picture of the nutritional quality of her/his diet, the diet cost and the level of physical activity. In a second feature, MS-Diet suggests to the user a list of tailored dietary advices to get a healthier diet (i.e., a nutritionally adequate diet), adapted to her/his specific needs and food preferences. With the application, the user is actor in her/his own dietary changes: she/he specifies her/his food preferences and; chooses dietary suggestions that she/he considers achievable.

Conclusions

This prototype could be a future online health promotion tool which could help individuals to improve their diet or serve as a decision-support tool for health professionals. The evaluation of the tool (e.g. whether the use of the tool results in changes of dietary habits) is warranted before use on health promotion.

Key messages

MS-Diet demonstrates how diet optimization can be used to design dietary advice adapted to user’s needs and food preferences. MS-Diet is a promising tool to help individuals improving their diet but requires qualitative and quantitative evaluation for further improvements.
Telepathology and second opinion for cancer diagnosis in sub-Saharan French-speaking countries
Authors: Petit L , Ilunga J , Foërster F , Traore C , Anani L , Lebwaze B , N’Kegoum B , Hurwitz N , Raphaël M , Gagnepain-Lacheteau A
Published: November 2019

Many healthcare disparities can be described to explain cancer prevalence differences between developed and developing countries. Telepathology, telemedicine declination consisting in the transmission of digital images from a classical optical microscope combined with a digital camera linked to a computer, could offer a healthcare solution by enabling efficient communication between physicians and reinforcing multidisciplinary approaches. This study evaluated a pilot telepathology project using the ‘i-Path’ platform in Sub-Saharan French-speaking countries. This is a descriptive retrospective study. This study was made in two steps: (1) quantitative description of the platform’s use by the pathologists group and (2) qualitative evaluation of the users’ perception of the pilot project. From October 2009 to March 2018, 226 cases were submitted; 86·3% of them (n = 195) were analyzable. More than 30 experts in surgical pathology of 12 different countries were involved in the network. The average turnaround-time was less than one day. The main highlighted obstacles were the lack of time to submit cases and internet connection problems. Discussions on i-Path lead to a useful second opinion for 67·7% (n = 132) of the cases. The major part of second opinion was in favor of lymphoma (32·6%). Regarding children, lymphoma represent half of the second opinion (50·7%). The inter-observers agreement between first interpretation and second opinion was κ = 0·36, and κ = 0·58 after excluding non-diagnosed cases at submission. Even if some improvements can be made, we concluded that the project was satisfying and workable and it could be extended to other applications.

Key messages

Dialogue between expert in multiple LMIC is feasible with telepathology network and, as 1st diagnosis assessment is not always sure, telepathology help for 2nd opinion. Centers’ use of the telepathology system are different but the discussion between experts still provide a 2nd opinion in favor of a precise diagnosis.