bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of brachial artery flow‐mediated dilatation, uterine artery Doppler, and umbilical artery Doppler measurements in obese and normal pregnant women
Authors: Aksin Serif , Andan Cengiz , Tunc Seyhmus , Goklu Mehmet Rifat
Published: November 2021

Objective

In this study, we aimed to compare vascular function at trimesters 1, 2, and 3 between obese and normal pregnant women through brachial artery flow‐mediated dilatation (FMD), uterine artery Doppler, and umbilical artery Doppler measurements.

Methods

Pregnant women between the ages of 18 and 40 who presented to our clinic were included. Brachial artery FMD, uterine and umbilical artery Doppler, and clinical parameters of 40 obese pregnant women from each trimester between 11 and 14 weeks, 24 and 28 weeks, 37 and 40 weeks and control pregnant group in the same number and gestational week were examined.

Results

In all three trimesters, the FMD value was lower in obese pregnant women compared to normal women with adequate weight (p < 0.001). In obese pregnant women, lower FMD values were observed in the second trimester compared to other trimesters (p = 0.011) Cut‐off value of FMD below 14.35 in obese pregnant women was found to be associated with gestational diabetes mellitus. Uterine artery Doppler in obese pregnant women started to increase from the second trimester compared to normal women with adequate weight.

Conclusion

Obese pregnant women have endovascular dysfunction compared to normal pregnant women and this becomes evident from the second trimester.
The effects of a periodontal ligament analogue on occlusal contact forces
Authors: deMoya Adrian V. , Schmidt Evan R. , Eckert George J. , Katona Thomas R.
Published: November 2021

Background

Previous bench‐top studies examined the details of the mechanical environment of rigidly fixed occluding teeth. It was demonstrated that during each chomp, contacting molar teeth experience in‐occlusal‐plane forces (Flateral) that are highly transient in magnitude and direction.

Objectives

The objectives of this study are to identify Flateral behaviours that are attributable to the presence of a visco‐elastic periodontal ligament (PDL) analogue, and to assess the necessity of incorporating it into future studies.

Methods

A weighted maxillary molar denture tooth was lowered onto, and raised from, a matching mandibular molar 10 times. The latter was supported by a load cell that continuously measured Flateral. For statistical purposes, the test was repeated with 21 (n = 21) different occlusal relationships obtained with 0.05 mm incremental shifts of the lower assembly.

Results

Overall, the results are similar to those of rigid attachment but the details of the Flateral profiles are very different.

Conclusion

The PDL plays a major role in the mechanical environment of occlusion, suggesting that, in general (not necessarily always), it should be integrated into studies of occlusion.
Painful and non‐painful comorbidities associated with short‐ and long‐term painful temporomandibular disorders: A cross‐sectional study among adolescents from Brazil, Canada and France
Authors: Velly Ana Miriam , Botros Jack , Bolla Michèle Muller , Khan Khurram , Teixeira Junior Oscar Anacleto , Guimarães Antonio Sergio , Gornitsky Mervyn
Published: November 2021

Background

Temporomandibular disorder (TMD) pain is common among adolescents. The association between painful TMD and other comorbidities has been demonstrated. However, the difference between short‐term (<6 months) and long‐term (≥ 6 months) painful TMD is not yet clear.

Objective

The aim of this study was to assess the association between comorbidities and short‐ and long‐term painful TMD among adolescents.

Methods

In this cross‐sectional study, adolescents were recruited from Montreal (Canada), Nice (France) and Arceburgo (Brazil). Self‐reported painful TMD, comorbidities, school absence and analgesic intake were assessed using reliable instruments. Multivariable logistic regression analyses were conducted to assess the study aims.

Results

The prevalence of short‐ and long‐term painful TMD was estimated at 22.29% and 9.93% respectively. The number of comorbidities was associated with short‐ (OR = 1.71, 95%CI = 1.53–1.90) and long‐term painful TMD (OR = 1.79, 95%CI = 1.55–2.08) compared to controls. Frequent headaches (ORshort‐term = 4.39, 95%CI = 3.23–5.98, ORlong‐term = 3.69, 95%CI = 2.45–5.57) and back pain (ORshort‐term = 1.46, 95%CI = 1.06–2.03, ORlong‐term = 1.69, 95%CI = 1.11–2.59) were associated with both painful TMD groups. Frequent neck pain (OR = 2.23, 95%CI = 1.53–3.26) and allergies were only associated with short‐term painful TMD (OR = 1.54, 95%CI = 1.13–2.10). Frequent stomach pain was related to long‐term (OR = 2.01, 95%CI = 1.35–3.26), and it was the only comorbidity significantly more frequent among the long than short‐term TMD (OR = 1.82, 95%CI: 1.14–2.90). These analyses were adjusted by sex, age and city.

Conclusion

In this multi‐centre study, both short‐ and long‐term painful TMD are associated with frequent headaches and back pain, whereas frequent neck pain and allergies are related to only short‐term and frequent stomach pain with long‐term painful TMD.
Laboratory‐based surveillance of Candida auris in Colombia, 2016–2020
Authors: Escandón Patricia , Cáceres Diego H. , Lizarazo Diana , Lockhart Shawn R. , Lyman Meghan , Duarte Carolina
Published: November 2021

Background

Since the first report of Candida auris in 2016, the Colombian Instituto Nacional de Salud (INS) has implemented a national surveillance of the emerging multidrug‐resistant fungus.

Objectives

This report summarises the findings of this laboratory‐based surveillance from March 2016 to December 2020.

Results

A total of 1720 C. auris cases were identified, including 393 (23%) colonisation cases and 1327 (77%) clinical cases. Cases were reported in 20 of 32 (62%) departments of Colombia and involved hospitals from 33 cities. The median age of patients was 34 years; 317 (18%) cases were children under 16 years, 54% were male. The peak number of cases was observed in 2019 (n = 541). In 2020, 379 (94%) of 404 cases reported were clinical cases, including 225 bloodstream infections (BSI) and 154 non‐BSI. Among the 404 cases reported in 2020, severe COVID‐19 was reported in 122 (30%). Antifungal susceptibility was tested in 379 isolates. Using CDC tentative breakpoints for resistance, 35% of isolates were fluconazole resistant, 33% were amphotericin B resistant, and 0.3% isolates were anidulafungin resistant, 12% were multidrug resistant, and no pan‐resistant isolates were identified.

Conclusion

For five years of surveillance, we observed an increase in the number and geographic spread of clinical cases and an increase in fluconazole resistance. These observations emphasise the need for improved measures to mitigate spread.
The Racial Barriers in U.S. Independent Filmmaking
Authors: Tran Michael T.
Published: November 2021

This study explores the mechanisms of racial discrimination in U.S. independent filmmaking. To answer this question, I combine the theoretical toolkits on Hollywood discrimination and Bourdieu’s theory of cultural production. I employ in‐depth, semi‐structured interviews with 30 U.S.‐based independent filmmakers of color, and observations of public discussions at film festivals in the greater Los Angeles area. I find that despite independent film’s inclusive and non‐commercial discourses, many of the mechanisms of racial exclusion that underlie Hollywood’s lack of diversity also exist in independent film: the economic uncertainty of creative labor, racialized market logics, the economic stigmatization of artists of color, and the reliance on closed social networks for career advancement. Furthermore, I also find that non‐commercial factors in the field of independent film also constrain the ability for filmmakers of color to make art reflective of their experiences, form mutually beneficial collaborations with other artists of color, or invest their time in projects that are culturally innovative. These findings suggest that even at the margins of mainstream cultural production, mechanisms of racialization can still operate where racial prejudice and racialized economics outweigh artistic independence.
Dreams from the Trap: Trap music as a site of liberation
Authors: Crawford Claire B.
Published: November 2021

Objective

This article makes a case for trap music as a form of political engagement and political mobilization for young Black folks. I use the concept of Fanonian freedom to unpack the complex politics of recognition that trap music holds for Black liberation.

Methods

Using a case study of Lil Baby's (2020) “The Bigger Picture” as emblematic of the political possibilities of trap music, I demonstrate how trap music functions as a mode of liberation when seen through Fanon's framework.

Results

Like Black spiritual and political anthems before it, trap music represents a powerful but often dismissed political tool of Black liberation. I suggest that social scientists who study social movements and politics must recognize aurality—in this case, Black Southern aurality—as a communal well of liberatory pursuit and infrapolitical realities.

Conclusion

Mainstream social scientific definitions of “politics” as state‐centered must be expanded to recognize the power of cultural representation and everyday acts, especially by the most dispossessed groups in society, such as young Black folk in the urban South. Such inaccurate social scientific conceptualizations uphold exclusionary logics that can alienate the dispossessed from political engagement and, ultimately, further blame them for this alienation.
Pedagogies of the Senses Multimodal Strategies for Unsettling Visual Anthropology
Authors: Dattatreyan Ethiraj Gabriel , Marrero‐Guillamón Isaac
Published: November 2021

Drawing from our experiences teaching the subdiscipline of visual anthropology, we coin the term pedagogies of the senses to refer to a series of teaching strategies aimed at unsettling anthropology's visual archive through sonic displacements, figure–background reversals, and redactions. We argue for an attention to how experiments with the senses in the visual anthropology classroom have the capacity to actively interrupt colonial visual regimes, disrupt universalizing assumptions regarding the nature of knowledge transmission, and, in so doing, foster opportunities for a more inclusive classroom engagement by centering affects that are often sidelined.
The Regularity of Stress Shielding in Internal Fixation Characterized by Hydromechanics
Authors: Li Yu , Fei Han , Wang Jun , Li Ting , Feng Yihui , Huan Yong
Published: November 2021

Stress shielding is an important factor in the internal fixation of a fracture. To explore the regularity of stress shielding in internal fixation, a simplified model of a comminuted femoral shaft fracture bridged by a locking plate was established and finite element analysis was performed to analyze the load distribution between the plate and femur from the proximal end of the femur to the fracture line and investigate the stress shielding degree of the plate on the bone. The stress, deformation, and axial compressive force distribution of four internal fixation schemes under compression were obtained, and the stress shielding degrees on each section was calculated. To compare the regularity of stress shielding and flow distribution, the relationship between the compressive force increment and stress shielding degree was established. The normalized curves of compressive force increment with the plate section position were compared with the flow distribution in a Z-type manifold, a parallel pipe system similar to an internal fixation system in structure and working characteristics. For quantitative comparison, the similarity between normalized curves of the compressive force increment and simulated flow distribution was calculated. The regularity of load distribution along the section position of the plate was similar to the flow distribution in the Z-type manifold. Therefore, the flow distribution pattern of the Z-type manifold can be used to characterize the regularity of load distribution in internal fixation. This study provided a new method to characterize the stress shielding degree of a locking plate on bone.
Identifying Vulnerable Impact Locations to Reduce the Occurrence of Deadly Commotio Cordis Events in Children's Baseball: A Computational Approach
Authors: Dickey Grant J. , Bian Kewei , Liu Xingyu , Khan Habib R. , Mao Haojie
Published: November 2021

Commotio cordis is the second leading cause of sudden cardiac death in young athletes. Currently available chest protectors on the market are ineffective in preventing cases of commotio cordis in young athletes who play baseball. This study focused on using contour maps to identify specific baseball impact locations to the chest that may result in instances of commotio cordis to children during baseball games. By identifying these vulnerable locations, we may design and develop chest protectors that can provide maximum protection to prevent commotio cordis in young athletes. Simulation cases were run using the validated CHARM-10 chest model, a detailed finite element model representing an average 10-year-old child's chest. A baseball model was developed in company with the chest model, and then used to impact the chest at different locations. A 7 × 8 impact location matrix was designed with 56 unique baseball impact simulations. Left ventricle strain and pressure, reaction force between the baseball and chest, and rib deformations were analyzed. Left ventricle strain was highest from baseball impacts directly over the left ventricle (0.34) as well as impacts slightly lateral and superior to the cardiac silhouette (0.34). Left ventricle pressure was highest with impacts directly over the left ventricle (82.94 kPa). We have identified the most dangerous impact locations resulting in high left ventricle strain and pressure. This novel study provided evidence of where to emphasize protective materials for establishing effective chest protectors that will minimize instances of commotio cordis in young athletes.
Trackability for Discrete-Time Linear Time-Invariant Systems: A Brief Review and New Insights
Authors: Kadam Sujay D. , Palanthandalam-Madapusi Harish J.
Published: November 2021

Trackability is a known system property and has been studied extensively in the literature both from a theoretical standpoint and from the standpoint of constructing inversion-based tracking controllers. There is also a significant body of literature on closely related ideas focusing on existence of tracking control inputs but using varied terminology and tools. In this paper, we start with the existence question, given an linear time-invariant (LTI) discrete-time system, when does there exists control inputs to enable the system to track arbitrary reference commands. We adopt an algebraic approach that then allows us to define the sets of all trackable output reference commands and untrackable output reference commands, and subsequently permitting us to determine conditions for existence of a right inverse of the system based on these sets and a simple rank test. These results permit us to then gain insights into tracking behavior of systems that are not trackable. We discuss in some detail the relationship of these rank tests with other results in the literature. We also define three indices that indicate the expected tracking behavior of any given system (whether trackable or not). Furthermore, we also present a Venn diagram explaining in detail the connections between trackability and other fundamental system properties like controllability, observability and output controllability, while discussing several facts that elaborate these connections. The presented work is expected to provide a framework for receiving new theoretical insights on the topic of tracking control and trackability.
Study on k−ω−Shear Stress Transport Corrections Applied to Airfoil Leading-Edge Roughness Under RANS Framework
Authors: Gutiérrez R. , Llorente E. , Ragni D. , Aranguren P.
Published: November 2021

A computational fluid dynamics study is carried out to model the effects of distributed roughness at the airfoil leading-edge using the equivalent sand grain approach and Reynolds-averaged Navier–Stokes equations. The turbulence model k−ω−shear stress transport (SST) is selected to emulate a fully turbulent flow. Three k and ω boundary conditions are studied to model roughness effects. One refers to Wilcox's boundary condition and the other two refer to Aupoix's boundary conditions. Besides, Hellsten's correction is used to ensure Wilcox's boundary condition compatibility with the shear stress transport limiter. After validating the implementation of these boundary conditions, they are applied to three different airfoils. One of them is a thick airfoil with industrial relevance. For this airfoil, Wilcox's boundary condition significantly underestimates the roughness impact on aerodynamic coefficients. The pressure gradient simplification in Wilcox's boundary condition formulation is the driving factor behind this effect. The pressure gradient effect on Aupoix's boundary condition is minimal.
Diagnostic accuracy of transvaginal ultrasound examination for local staging of cervical cancer: a systematic review and meta-analysis
Authors: Tian Yu , Luo Hong
Published: November 2021

Aim: Transvaginal ultrasonography (TVUS) has shown varying results in the staging of cervical cancer patients around the world. Hence, the current review was done to assess the diagnostic accuracy of TVUS for identifying parametrial, stromal invasion and lymph node metastasis among cervical cancer patients.Material and methods: We conducted a systematic search for all studies reporting the diagnostic accuracy of TVUS for staging of cervical cancer in the databases of PubMed Central, MEDLINE, EMBASE, MEDLINE, SCOPUS and Cochrane library from inception till March 2021. Meta-analysis was performed using STATA software “midas” package.Results: Eleven studies with 760 patients were included. The pooled sensitivity and specificity of TVUS for diagnosing parametrial invasion were 62% (95% CI, 40-80) and 91% (95% CI, 79-97), for stromal invasion were 84% (95% CI, 77-90) and 80% (95% CI, 61-91), for lymph node metastasis were 52% (95% CI, 8-93) and 95% (95% CI, 68-99). There was significant heterogeneity found with all the outcomes with significant chi-square test and I2 statistic >75%.Conclusion: TVUS has limited applicability and use as a screening or diagnostic tool for local staging of cervical cancer patients. Further reviews comparing multiple non-invasive imaging modalities are required to pick the best tool for local staging of cervical cancer.
Role of ultrasound in the diagnosis of very early-onset inflammatory bowel disease in children: a report of three cases
Authors: Hosokawa Takahiro , Tanami Yutaka , Sato Yumiko , Nambu Ryusuke , Iwama Itaru , Oguma Eiji
Published: November 2021

Very early-onset inflammatory bowel disease (VEO-IBD) is defined as IBD onset before 6 years of age and some cases are caused by unique monogenic disorders that require specific treatments such as stem cell transplantation. We identified three children with VEO-IBD of whom two had monogenic disorders. In cases 1 and 2, ultrasound revealed isolated colonic distribution and the loss of wall stratification. In case 3, mesentery inflammation was evident. Bowel ultrasound showed variable findings due to differences in the inflammation distribution within the bowel. In order to diagnose VEO-IBD, sonographersshould carefully evaluate the intestinal wall thickness and stratification and the distribution of inflammation in the intestine and mesentery. These findings may aid the diagnosis of VEO-IBD.
Intra-operative application of ultrasonography combined with limited radiography for the treatment of supracondylar humerus fractures in children: a randomized controlled trial
Authors: Li Yuan , Wu Zongyi , Yi Xianhong , Mao Chenghuang , Yan Guangkui , Fang Mingqiao , Pan Tianlong , Zhu Ruibo , Zhang Jingdong
Published: November 2021

Aims: To introduce a new method of intra-operative application of ultrasonography (US) combined with limited radiography to treat supracondylar humerus fractures in children and evaluate its effect on radiation protection.Material and methods: Fifty patients were randomly divided into the radiography-only group (RO group, n = 22) and the US combined with the limited radiography group (UR group, n = 28). US was performed to evaluate fracture displacement and to guide reduction in the UR group. The primary outcome measures were the average number of radiography instances and the quantitative value of radiation emission. Secondary outcome measures were length of hospital stays, loss of range of motion, loss of carrying angle, loss of Baumann angle, fracture healing time, pin site infection, compartment syndrome, cubitus varus, cubitus valgus, and iatrogenic ulnar nerve injury.Results: Average number of radiography instances and quantitative value of radiation emission in the UR group decreased compared with the RO group (p<0.05). There were no significant differences between the groups regarding mean time to surgery, the average length of hospital stays, average surgery time, radiological union time, Flynn grade, or loss of Baumann angle. Pin site infection was seen in one patient in the RO group and two patients in the UR group. No other complications occurred.Conclusion: Intra-operative application of US combined with limited radiography decreases radiation exposure during treatment of supracondylar humerus fractures in children without compromising the therapeutic effect.
Direct measurement of a non-Hermitian topological invariant in a hybrid light-matter system
Authors: Su Rui , Estrecho Eliezer , Biegańska Dąbrówka , Huang Yuqing , Wurdack Matthias , Pieczarka Maciej , Truscott Andrew G. , Liew Timothy C. H. , Ostrovskaya Elena A. , Xiong Qihua
Published: November 2021

A non-Hermitian topological invariant arising from exceptional points is directly probed in an exciton-polariton system.
Structural snapshots of human PepT1 and PepT2 reveal mechanistic insights into substrate and drug transport across epithelial membranes
Authors: Killer Maxime , Wald Jiri , Pieprzyk Joanna , Marlovits Thomas C. , Löw Christian
Published: November 2021

Structures of PepT1 and PepT2 provide mechanistic insights into substrate and drug translocation across epithelial membranes.
Abyssal Benthic Rover, an autonomous vehicle for long-term monitoring of deep-ocean processes
Authors: Smith K. L. , Sherman A. D. , McGill P. R. , Henthorn R. G. , Ferreira J. , Connolly T. P. , Huffard C. L.
Published: November 2021

Abyssal benthic rover development and proven long-term operation now provide critical data on deep-ocean carbon cycling.
Truncated titin proteins in dilated cardiomyopathy
Authors: McAfee Quentin , Chen Christina Yingxian , Yang Yifan , Caporizzo Matthew A. , Morley Michael , Babu Apoorva , Jeong Sunhye , Brandimarto Jeffrey , Bedi Kenneth C. , Flam Emily , Cesare Joseph , Cappola Thomas P. , Margulies Kenneth , Prosser Benjamin , Arany Zolt
Published: November 2021

Truncating mutations in
TTN
result in both truncated titin proteins and reduced full-length titin in patient hearts.
The Two-Component System FleS/FleR Represses H1-T6SS via Cyclic di-GMP Signaling in Pseudomonas aeruginosa
Authors: Zhou Tian , Huang Jiahui , Liu Zhiqing , Lin Qiqi , Xu Zeling , Zhang Lian-Hui
Published: November 2021

Pseudomonas aeruginosa
is an opportunistic human pathogen distributed widely in the environment. The genome of this pathogen contains three T6SS clusters which contribute significantly to its virulence.
SOSIP Trimer-Specific Antibodies Isolated from a Simian-Human Immunodeficiency Virus-Infected Monkey with versus without a Pre-blocking Step with gp41
Authors: Duggan Natasha N. , Weisgrau Kim L. , Magnani Diogo M. , Rakasz Eva G. , Desrosiers Ronald C. , Martinez-Navio Jose M.
Published: November 2021

Recent advancements in the field have focused on the isolation and use of broadly neutralizing antibodies for both prophylaxis and therapy. Finding a useful probe to isolate broad potent neutralizing antibodies while avoiding non-neutralizing antibodies is important.
Structural Basis of Human Parainfluenza Virus 3 Unassembled Nucleoprotein in Complex with Its Viral Chaperone
Authors: Dong Xiaofei , Wang Xue , Xie Mengjia , Wu Wei , Chen Zhongzhou
Published: November 2021

Human parainfluenza virus 3 (HPIV3) causes annual epidemics of respiratory diseases, especially in newborns and infants. For the replication of HPIV3 and other paramyxoviruses, only three viral proteins are required: phosphoprotein (P), RNA polymerase (L), and nucleoprotein (N).
Dasabuvir Inhibits Human Norovirus Infection in Human Intestinal Enteroids
Authors: Hayashi Tsuyoshi , Murakami Kosuke , Hirano Junki , Fujii Yoshiki , Yamaoka Yoko , Ohashi Hirofumi , Watashi Koichi , Estes Mary K. , Muramatsu Masamichi
Published: November 2021

Although there is an urgent need to develop effective antiviral therapy directed against HuNoV infection, compound screening to identify anti-HuNoV drug candidates has not been reported so far. Using a human HIE culture system, our compound screening successfully identified dasabuvir as a novel anti-HuNoV inhibitor.
Effectiveness of participatory women’s groups scaled up by the public health system to improve birth outcomes in Jharkhand, eastern India: a pragmatic cluster non-randomised controlled trial
Authors: Nair Nirmala , Tripathy Prasanta K , Gope Rajkumar , Rath Shibanand , Pradhan Hemanta , Rath Suchitra , Kumar Amit , Nath Vikash , Basu Parabita , Ojha Amit , Copas Andrew , Houweling Tanja AJ , Haghparast-Bidgoli Hassan , Minz Akay , Baskey Pradeep , Ahmed Manir , Chakravarthy Vasudha , Mahanta Riza , Prost Audrey
Published: November 2021

Introduction

The WHO recommends community mobilisation with women’s groups practising participatory learning and action (PLA) to improve neonatal survival in high-mortality settings. This intervention has not been evaluated at scale with government frontline workers.

Methods

We did a pragmatic cluster non-randomised controlled trial of women’s groups practising PLA scaled up by government front-line workers in Jharkhand, eastern India. Groups prioritised maternal and newborn health problems, identified strategies to address them, implemented the strategies and evaluated progress. Intervention coverage and quality were tracked state-wide. Births and deaths to women of reproductive age were monitored in six of Jharkhand’s 24 districts: three purposively allocated to an early intervention start (2017) and three to a delayed start (2019). We monitored vital events prospectively in 100 purposively selected units of 10 000 population each, during baseline (1 March 2017–31 August 2017) and evaluation periods (1 September 2017–31 August 2019). The primary outcome was neonatal mortality.

Results

We identified 51 949 deliveries and conducted interviews for 48 589 (93.5%). At baseline, neonatal mortality rates (NMR) were 36.9 per 1000 livebirths in the early arm and 39.2 in the delayed arm. Over 24 months of intervention, the NMR was 29.1 in the early arm and 39.2 in the delayed arm, corresponding to a 24% reduction in neonatal mortality (adjusted OR (AOR) 0.76, 95% CI 0.59 to 0.98), including 26% among the most deprived (AOR 0.74, 95% CI 0.57 to 0.95). Twenty of Jharkhand’s 24 districts achieved adequate meeting coverage and quality. In these 20 districts, the intervention saved an estimated 11 803 newborn lives (min: 1026–max: 20 527) over 42 months, and cost 41 international dollars per life year saved.

Conclusion

Participatory women’s groups scaled up by the Indian public health system reduced neonatal mortality equitably in a largely rural state and were highly cost-effective, warranting scale-up in other high-mortality rural settings.

Trial registration

ISRCTN99422435.
Association between built environment and physical activity in Latin American countries: a multicentre cross-sectional study
Authors: Barreno Mishell , Sisa Ivan , Yépez García Martha Cecilia , Shen Hua , Villar Mónica , Kovalskys Irina , Fisberg Mauro , Gomez Georgina , Rigotti Attilio , Cortés Lilia Yadira , Pareja Rossina G , Herrera-Cuenca Marianella , Guajardo Viviana
Published: November 2021

Objective

To assess the association between the physical activity level and the built environment by accessibility, microinfrastructure and security in Latin America (LA).

Design

We conducted a multicentre cross-sectional study to collect physical activity and built environment data. The levels of physical activity were calculated through the International Physical Activity Questionnaire survey. Using the Neighbourhood Environment Walkability Scale-Abbreviated, characteristics of the built environment were measured through three domains: accessibility, microinfrastructure and security. To estimate the association of the built environment and physical activity, we used mixed effects logistic regression analysis. In addition, likelihood ratio test to account for clustered effect within countries and/or cities was used.

Setting

Eight countries in LA.

Participants

Adults aged 15–65 years (n=9218) living in urban areas and consented to participate of the Latin American Study of Nutrition and Health.

Results

Most of the population in LA had access to a grocery store (97.2%), public transport stop (91.5%) and children’s playground (81.6%). Metropolitan parks were more accessible in Ecuador (59.8%) and Colombia (59.2%) than in Venezuela (33.5%). Individuals located within 20 min of walking from sport facilities or children’s playground areas were more likely to perform moderate-to-high physical activity OR 1.20 (95% CI 1.06 to 1.36) and OR 1.25 (95% CI 1.02 to 1.53), respectively. Only 14.5% of the population from the region considered that their neighbourhood had an adequate design for walking or cycling. Likewise, among adults living in LA, only 39.75% had the perception of living in a safe neighbourhood.

Conclusions

This multicentre study shows that currently, LA built environment does not promote physical activity in the region. Our findings provide the rationale to push forward, at regional and national levels, policies and interventions that will help to achieve a safe, healthy and friendly built environment to encourage participation in active recreation and sports in leisure time.

Trial registration number

NCT02226627.
Longitudinal outcomes of gender identity in children (LOGIC): a study protocol for a prospective longitudinal qualitative study of the experiences and well-being of families referred to the UK Gender Identity Development Service
Authors: McKay Kathy , Kennedy Eilis , Lane Chloe , Wright Talen , Young Bridget
Published: November 2021

Introduction

Gender Identity Development Services (GIDS) worldwide have experienced a significant increase in referrals in recent years. However, little is currently known about the experiences of the children and young people (CYP) and their families attending these services and the influences on their well-being. Most published qualitative studies have explored gender identity and gender questioning CYP from either a parental perspective or in an adolescent sample. Consequently, there is a need for research to explore the voices of younger children and adolescents who are referred to GIDS. This study aims to address current gaps in understanding of the experiences of CYP referred to the UK GIDS, specifically regarding the personal, familial, educational, and social contexts in which CYP and their parents/caregivers are navigating gender identity, social and physical transition, and the healthcare system.

Methods and analysis

A prospective longitudinal qualitative study examining the experiences and well-being of CYP referred to the UK GIDS. A purposive sample of up to 40 families will be recruited. Families will be eligible for the study if the child or young person was aged 3–14 years at the time of referral to the GIDS. Semistructured interviews will be conducted with both the child/young person and their parents/caregivers. Analysis of anonymised interview transcripts will be interpretive and pluralistic, informed by both narrative and thematic approaches. This study forms part of a wider programme of research investigating longitudinal outcomes of gender identity in children (the LOGIC Study).

Ethics and dissemination

The proposed study has been approved by the UK Health Research Authority and London–Hampstead Research Ethics Committee as application 19/LO/0857. The study findings will be published in peer-reviewed journals and presented at both conferences and stakeholder events.
I had to leave. I had to leave my clinic, my city, leave everything behind in Syria.Qualitative research of Syrian healthcare workers migrating from the war-torn country
Authors: Kallström Agneta , Al-Abdulla Orwa , Parkki Jan , Häkkinen Mikko , Juusola Hannu , Kauhanen Jussi
Published: November 2021

Objectives

To explore the reasons why healthcare workers migrate from Syria, a country where conflict has been raging for over a decade.

Design

A qualitative study was performed using semistructured interviews. Semistructured questions guided in-depth interviews. Content analysis was used.

Setting

Participants were Syrian healthcare workers who had worked in the country after the conflict started in 2011, but at some point left Syria and settled abroad. The interviews took place in Turkey and Europe in 2016 and 2017.

Participants

We collected data from 20 participants (18 males and 2 females) through snowball sampling method.

Results

Healthcare workers migrated from Syria only because of security reasons. In most cases, the decision to leave resulted from the generalised violence against civilians by different warring parties, mainly the Government of Syria and the Islamic State. Intentional attacks against healthcare workers were also one of the main reasons for leaving. Some participants had a specific notable trigger event before leaving, such as colleagues being detained or killed. Many participants simply grew tired of living under constant fear, with their families also at risk.

Conclusions

This research adds to the body of literature on violence against healthcare workers in Syria. It helps to understand the reasons why healthcare workers leave the country. The study also indicates that the international community has failed to protect Syrian healthcare workers. The intensity of the conflict has left many healthcare workers with no other option than to leave. Understanding this migration will enable the discovery of new solutions for protecting healthcare workers in current and future conflicts.
Cross-sectional study evaluating the seroprevalence of SARS-CoV-2 antibodies among healthcare workers and factors associated with exposure during the first wave of the COVID-19 pandemic in New York
Authors: Bryan Alexander , Tatem Kathleen , Diuguid-Gerber Jillian , Cooke Caroline , Romanoff Anya , Choudhury Nandini , Scanlon Michael , Kishore Preeti , Sydney Elana , Masci Joseph , Bakshi Parampreet , Pemmasani Sahithi , Davis Nichola J , Maru Duncan
Published: November 2021

Objective

Estimate the seroprevalence of SARS-CoV-2 antibodies among New York City Health and Hospitals (NYC H+H) healthcare workers during the first wave of the COVID-19 pandemic, and describe demographic and occupational factors associated with SARS-CoV-2 antibodies among healthcare workers.

Design

Descriptive, observational, cross-sectional study using a convenience sample of data from SARS-CoV-2 serological tests accompanied by a demographic and occupational survey administered to healthcare workers.

Setting

A large, urban public healthcare system in NYC.

Participants

Participants were employed by NYC H+H and either completed serological testing at NYC H+H between 30 April 2020 and 30 June 2020, or completed SARS-CoV-2 antibody testing outside of NYC H+H and were able to self-report results from the same time period.

Primary outcome measure

SARS-CoV-2 serostatus, stratified by key demographic and occupational characteristics reported through the demographic and occupational survey.

Results

Seven hundred and twenty-seven survey respondents were included in analysis. Participants had a mean age of 46 years (SD=12.19) and 543 (75%) were women. Two hundred and fourteen (29%) participants tested positive or reported testing positive for the presence of SARS-CoV-2 antibodies (IgG+). Characteristics associated with positive SARS-CoV-2 serostatus were Black race (25% IgG +vs 15% IgG−, p=0.001), having someone in the household with COVID-19 symptoms (49% IgG +vs 21% IgG−, p<0.001), or having a confirmed COVID-19 case in the household (25% IgG +vs 5% IgG−, p<0.001). Characteristics associated with negative SARS-CoV-2 serostatus included working on a COVID-19 patient floor (27% IgG +vs 36% IgG−, p=0.02), working in the intensive care unit (20% IgG +vs 28% IgG−, p=0.03), being employed in a clinical occupation (64% IgG +vs 78% IgG−, p<0.001) or having close contact with a patient with COVID-19 (51% IgG +vs 62% IgG−, p=0.03).

Conclusions

Results underscore the significance that community factors and inequities might have on SARS-CoV-2 exposure for healthcare workers.
Weight change, cardio-metabolic risk factors and cardiovascular incidence in people with serious mental illness: protocol of a population-based cohort study in the UK from 1998 to 2020
Authors: Lee Charlotte , Waite Felicity , Smith Margaret C , Gao Min , Bankhead Clare , Aveyard Paul , Piernas Carmen
Published: November 2021

Introduction

People with serious mental illness (SMI), which includes people with diagnoses of schizophrenia spectrum and bipolar disorders, face significant health inequality. This includes a life expectancy reduced by 15–20 years mostly due to premature cardiovascular disease (CVD) compared with the general population. Excess weight gain and related comorbidities are preventable risk factors for CVD. To improve the understanding and management of CVD in people with SMI, we will examine the association between SMI and: (1) weight change; (2) cardio-metabolic risk factors for CVD; and (3) incidence of and mortality from CVD. We will also (4) examine the incidence of referral to weight management services for people with SMI compared with people without SMI.

Methods and analysis

In this retrospective cohort study, we will link general practice records from the UK Clinical Practice Research Datalink Aurum database. We will establish a cohort of patients diagnosed with SMI between 1998 and 2020 who are matched with up to four controls on age, sex, general practice and calendar year. We will use multivariable mixed-effects linear regression models and Cox proportional hazard models with sequential adjustment for potential confounders identified by separate directed acyclic graphs.

Ethics and dissemination

This study has been reviewed and approved by the Independent Scientific Advisory Committee for Medicines and Healthcare products Regulatory Agency database research. The results will be published in a peer-reviewed journal.
Establishing best practices in cancer online support groups: protocol for a realist review
Authors: Bender Jacqueline L , Babinski Stephanie , Wong Geoff , Tricco Andrea C , Englesakis Marina , Cyr Alaina B , Potts Henry , Perski Olga , Esplen Mary Jane , Young Colleen , Wassersug Richard , Forster Victoria , Papadakos Janet , Soobiah Charlene , Fox Colleen , Gothard-Huang Alison , Witteman Holly
Published: November 2021

Introduction

Considerable observational evidence suggests that cancer online support groups reduce feelings of isolation, depression and anxiety, enhance coping and self-management, and lead to better informed patients. Other studies indicate that cancer online support groups can increase distress. Yet no studies theorise the complex, context-dependent mechanisms by which cancer online support groups generate their—sometimes contrasting—outcomes.

Methods and analysis

Guided by an integrated knowledge translation approach and the strategy for patient-oriented research, we will conduct a realist review of cancer online support groups in partnership with stakeholders. We will follow Pawson’s five steps and existing quality standards to develop a program theory that explains how cancer online support groups work, for whom and in what circumstances. The specific research questions will be: what positive and negative outcomes have been reported on cancer online support groups? What are the mechanisms that are associated with these outcomes, in which contexts and for whom? Through a rigorous review of relevant scientific and grey literature, as well as ongoing dialogue with stakeholders, a program theory will be developed to explain who benefits from cancer online support groups and who does not, what benefits they derive (or do not), and the factors that affect these outcomes.

Ethics and dissemination

The use of secondary data for this review precludes the need for ethical approval. Dissemination will be informed by the knowledge-to-action framework and will consist of tailored knowledge products that are conceived of collaboratively with stakeholders. These will include peer-reviewed publications on how cancer online support groups can be optimised and best practice recommendations to maximise the benefits experienced by people with cancer. These traditional scientific outputs, along with their respective evidence summaries, will be amplified through strategic social media events hosted and promoted by knowledge users.

PROSPERO registration number

CRD42021250046.
Associations of obesity, physical activity level, inflammation and cardiometabolic health with COVID-19 mortality: a prospective analysis of the UK Biobank cohort
Authors: Hamrouni Malik , Roberts Matthew J , Thackray Alice , Stensel David J , Bishop Nicolette
Published: November 2021

Objectives

To investigate the associations of physical activity level with COVID-19 mortality risk across body mass index (BMI) categories, and to determine whether any protective association of a higher physical activity level in individuals with obesity may be explained by favourable levels of cardiometabolic and inflammatory biomarkers.

Design

Prospective cohort study (baseline data collected between 2006 and 2010). Physical activity level was assessed using the International Physical Activity Questionnaire (high: ≥3000 Metabolic Equivalent of Task (MET)-min/week, moderate: ≥600 MET-min/week, low: not meeting either criteria), and biochemical assays were conducted on blood samples to provide biomarker data.

Setting

UK Biobank.

Main outcome measures

Logistic regressions adjusted for potential confounders were performed to determine the associations of exposure variables with COVID-19 mortality risk. Mortality from COVID-19 was ascertained by death certificates through linkage with National Health Service (NHS) Digital.

Results

Within the 259 397 included participants, 397 COVID-19 deaths occurred between 16 March 2020 and 27 February 2021. Compared with highly active individuals with a normal BMI (reference group), the ORs (95% CIs) for COVID-19 mortality were 1.61 (0.98 to 2.64) for highly active individuals with obesity, 2.85 (1.78 to 4.57) for lowly active individuals with obesity and 1.94 (1.04 to 3.61) for lowly active individuals with a normal BMI. Of the included biomarkers, neutrophil count and monocyte count were significantly positively associated with COVID-19 mortality risk. In a subanalysis restricted to individuals with obesity, adjusting for these biomarkers attenuated the higher COVID-19 mortality risk in lowly versus highly active individuals with obesity by 10%.

Conclusions

This study provides novel evidence suggesting that a high physical activity level may attenuate the COVID-19 mortality risk associated with obesity. Although the protective association may be partly explained by lower neutrophil and monocyte counts, it still remains largely unexplained by the biomarkers included in this analysis.
Manual QT interval measurement with a smartphone-operated single-lead ECG versus 12-lead ECG: a within-patient diagnostic validation study in primary care
Authors: Beers Lisa , van Adrichem Lisa P , Himmelreich Jelle C L , Karregat Evert P M , de Jong Jonas S S G , Postema Pieter G , de Groot Joris R , Lucassen Wim A M , Harskamp Ralf E
Published: November 2021

Objective

To determine the accuracy of QT measurement in a smartphone-operated, single-lead ECG (1L-ECG) device (AliveCor KardiaMobile 1L).

Design

Cross-sectional, within-patient diagnostic validation study.

Setting/participants

Patients underwent a 12-lead ECG (12L-ECG) for any non-acute indication in primary care, April 2017–July 2018.

Intervention

Simultaneous recording of 1L-ECGs and 12L-ECGs with blinded manual QT assessment.

Outcomes of interest

(1) Difference in QT interval in milliseconds (ms) between the devices; (2) measurement agreement between the devices (excellent agreement <20 ms and clinically acceptable agreement <40 ms absolute difference); (3) sensitivity and specificity for detection of extreme QTc (short (≤340 ms) or long (≥480 ms)), on 1L-ECGs versus 12L-ECGs as reference standard. In case of significant discrepancy between lead I/II of 12L-ECGs and 1L-ECGs, we developed a correction tool by adding the difference between QT measurements of 12L-ECG and 1L-ECGs.

Results

250 ECGs of 125 patients were included. The mean QTc interval, using Bazett’s formula (QTcB), was 393±25 ms (mean±SD) in 1L-ECGs and 392±27 ms in lead I of 12L-ECGs, a mean difference of 1±21 ms, which was not statistically different (paired t-test (p=0.51) and Bland Altman method (p=0.23)). In terms of agreement between 1L-ECGs and lead I, QTcB had excellent agreement in 66.9% and clinically acceptable agreement in 93.4% of observations. The sensitivity and specificity of detecting extreme QTc were 0% and 99.2%, respectively. The comparison of 1L-ECG QTcB with lead II of 12L-ECGs showed a significant difference (p=<0.01), but when using a correction factor (+9 ms) this difference was cancelled (paired t-test (p=0.43) or Bland Altman test (p=0.57)). Moreover, it led to improved rates of excellent (71.3%) and clinically acceptable (94.3%) agreement.

Conclusion

Smartphone-operated 1L-ECGs can be used to accurately measure the QTc interval compared with simultaneously obtained 12L-ECGs in a primary care population. This may provide an opportunity for monitoring the effects of potential QTc-prolonging medications.