bluuebunny/crossref_metadata_2025 huggingface dataset:
Multicountry review: developmental surveillance, assessment and care by outpatient paediatricians
Authors: Coscini Nadia , Heyes Priya , Bedford Helen , Cohen Eyal , D’Aprano Anita , Goldfeld Sharon , Hargreaves Dougal , Loveday Sarah , Nejat Sahar , Roberts Gehan , Sarkadi Anna , Saunders Natasha Ruth , Woolfenden Susan , Milner Kate
Published: June 2022

Background

Care of young children with neurodevelopmental disorders (NDD) is a major component of paediatric outpatient practice. However, cross-country practice reviews to date have been limited, and available data demonstrate missed opportunities for early identification, particularly in vulnerable population subgroups.

Methods

Multicountry review of national paediatric body guidance related to developmental surveillance, early identification and early childhood intervention together with review of outpatient paediatrician practices for developmental assessment of children aged 0–5 years with/at risk of NDDs. Review included five countries with comparable nationalised universal child healthcare systems (ie, Australia, Canada, New Zealand, Sweden and the UK). Data were collected using a combination of published and grey literature review, supplemented by additional local sources with descriptive review of relevant data points.

Results

Countries had broadly similar systems for early identification of young children with NDDs alongside universal child health surveillance. However, variation existed in national paediatric guidance, paediatric developmental training and practice, including variable roles of paediatricians in developmental surveillance at primary care level. Data on coverage of developmental surveillance, content and quality of paediatric development assessment practices were notably lacking.

Conclusion

Paediatricians play an important role in ensuring equitable access to early identification and intervention for young children with/at risk of NDDs. However, strengthening paediatric outpatient care of children with NDD requires clearer guidance across contexts; training that is responsive to shifting roles within interdisciplinary models of developmental assessment and improved data to enhance equity and quality of developmental assessment for children with/at risk of NDDs.
Factors that may improve paediatric workplace-based assessments: an exploratory study
Authors: Jefferies Kimberley
Published: June 2022

Objectives

To establish if paediatric trainees are satisfied with the current workplace-based assessment (WBA) process. To identify factors that contribute both positively and negatively to the educational experience during WBAs. To find out if trainees and their supervisors experience any challenges conducting WBAs. To establish potential ways to improve future assessments.

Design

Qualitative semistructured interviews.

Setting

Participants included fifteen trainees (ST1–8) in general paediatric and subspecialty posts and four consultants or equivalent across five hospital sites in the Thames Valley Deanery. All participants had regular exposure to WBAs.

Interventions

Interviews were undertaken between June 2020 and January 2021 via video link. Data collection and analysis were conducted iteratively using constant comparison until theoretical sufficiency was achieved.

Main outcome measure

Using Constructivist Grounded Theory, a theoretical framework, grounded in the data, was developed that depicted the core elements that should be present to optimise WBAs.

Results

A number of key components were reported to affect the educational value of WBAs. A positive departmental culture towards education and training is essential. Chosen cases should be challenging, and direct observation or in-depth discussion, depending on the assessment type, is fundamental. Timely constructive feedback and immediate completion of the assessment form are also imperative.

Conclusion

Some trainees experienced WBAs where these key components aligned, but many did not, and this negatively affected their learning. Three main challenges or future targets for further improvements include increasing time, improving training and optimising technology.
Attitudes and adherence to changes in nutrition and physical activity following surgery for prostate cancer: a qualitative study
Authors: Robles Luke A , Shingler Ellie , McGeagh Lucy , Rowe Edward , Koupparis Anthony , Bahl Amit , Shiridzinomwa Constance , Persad Raj , Martin Richard M , Lane J Athene
Published: June 2022

Objectives

Interventions designed to improve men’s diet and physical activity (PA) have been recommended as methods of cancer prevention. However, little is known about specific factors that support men’s adherence to these health behaviour changes, which could inform theory-led diet and PA interventions. We aimed to explore these factors in men following prostatectomy for prostate cancer (PCa).

Design, setting and participants

A qualitative study using semistructured interviews with men, who made changes to their diet and/or PA as part of a factorial randomised controlled trial conducted at a single hospital in South West England. Participants were 17 men aged 66 years, diagnosed with localised PCa and underwent prostatectomy. Interview transcripts underwent thematic analysis.

Results

Men were ambivalent about the relationship of nutrition and PA with PCa risk. They believed their diet and level of PA were reasonable before being randomised to their interventions. Men identified several barriers and facilitators to performing these new behaviours. Barriers included tolerance to dietary changes, PA limitations and external obstacles. Facilitators included partner involvement in diet, habit formation and brisk walking as an individual activity. Men discussed positive effects associated with brisk walking, such as feeling healthier, but not with nutrition interventions.

Conclusions

The facilitators to behaviour change suggest that adherence to trial interventions can be supported using well-established behaviour change models. Future studies may benefit from theory-based interventions to support adherence to diet and PA behaviour changes in men diagnosed with PCa.
Effects of message framing on self-management behaviour among patients with type 2 diabetes: a randomised controlled trial protocol
Authors: Gao Ruitong , Guo Hui , Liu Yandi , Pang Yue , Zhang Xin , Lian Xiaoqian , Yu Tianyue , Zhu Lanyu , Li Feng
Published: June 2022

Introduction

Accumulating evidence has indicated successful diabetes health education can potentially help to improve blood sugar levels in people with diabetes. However, with a rapid rise in the number of people with diabetes cases and the increasing burden on healthcare, it is often difficult for healthcare providers to find suitable time to provide health education to meet their needs. Thus, more novel and effective ways are needed to conduct education. The message frame provides a new perspective for implementation of a more effective health education in the form of changing information presentation, and the same objective content is described in either positive or negative language or outcomes. Gain framing emphasises the positive consequences of adhering to useful recommendations, while loss framing highlights the negative consequences of the non-adherence. The purpose of our research is to potentially explore the effectiveness of diabetes education based on message framing on the self-management behaviour.

Methods and analysis

A single-blind, three-arm randomised controlled trial involving 84 participants will be conducted. The participants will be assigned into three groups randomly in a 1:1:1 ratio and will receive 12-week intervention. Patients in group 1 will be provided gain framing education videos about the self-management skills for type 2 diabetes, patients in group 2 will be given education videos based on loss framing and patients in group 3 will receive education with no specific message framing. The primary outcome is self-management behaviour. The secondary outcomes will be self-efficacy, patient activation, diabetes-related knowledge and attitude, quality of life and blood glucose level. All outcomes will be measured at baseline and 12 weeks.

Ethics and dissemination

This study was approved by the Ethics Committee of School of Nursing, Jilin University (No. 2020101501). The research results will be published in peer-reviewed publications and presented in international conferences.

Trial registration number

ChiCTR 2100045772; Pre-results.
Towards PErsonalised PRognosis for children with traumatic brain injury: the PEPR study protocol
Authors: Kooper Cece C , Oosterlaan Jaap , Bruining Hilgo , Engelen Marc , Pouwels Petra J W , Popma Arne , van Woensel Job B M , Buis Dennis R , Steenweg Marjan E , Hunfeld Maayke , Königs Marsh
Published: June 2022

Introduction

Traumatic brain injury (TBI) in children can be associated with poor outcome in crucial functional domains, including motor, neurocognitive and behavioural functioning. However, outcome varies between patients and is mediated by complex interplay between demographic factors, premorbid functioning and (sub)acute clinical characteristics. At present, methods to understand let alone predict outcome on the basis of these variables are lacking, which contributes to unnecessary follow-up as well as undetected impairments in children. Therefore, this study aims to develop prognostic models for the individual outcome of children with TBI in a range of important developmental domains. In addition, the potential added value of advanced neuroimaging data and the use of machine learning algorithms in the development of prognostic models will be assessed.

Methods and analysis

210 children aged 4–18 years diagnosed with mild-to-severe TBI will be prospectively recruited from a research network of Dutch hospitals. They will be matched 2:1 to a control group of neurologically healthy children (n=105). Predictors in the model will include demographic, premorbid and clinical measures prospectively registered from the TBI hospital admission onwards as well as MRI metrics assessed at 1 month post-injury. Outcome measures of the prognostic models are (1) motor functioning, (2) intelligence, (3) behavioural functioning and (4) school performance, all assessed at 6 months post-injury.

Ethics and dissemination

Ethics has been obtained from the Medical Ethical Board of the Amsterdam UMC (location AMC). Findings of our multicentre prospective study will enable clinicians to identify TBI children at risk and aim towards a personalised prognosis. Lastly, findings will be submitted for publication in open access, international and peer-reviewed journals.

Trial registration number

NL71283.018.19 and NL9051.
Determining whether ethnic minorities with severe obesity face a disproportionate risk of serious disease and death from COVID-19: outcomes from a Southern California-based retrospective cohort study
Authors: Patel Hemesh Mahesh , Khandwala Shefali , Somani Poonam , Li Qiaowu , Tovar Stephanie , Montano Alejandra
Published: June 2022

Objective

Obesity has been recognised as a risk factor for poor outcomes associated with COVID-19. Ethnic minorities with COVID-19 have been independently found to fare poorly. We aim to determine if ethnic minorities with severe obesity—defined as a body mass index (BMI) above 40 kg/m²—experience higher rates of hospitalisation, invasive ventilation and death.

Design and setting

Retrospective cohort study from 1 March 2020 to 28 February 2021 within an integrated healthcare organisation in Southern California.

Participants

We identified 373 831 patients by COVID-19 diagnosis code or positive laboratory test.

Methods

Multivariable Poisson regression with robust error variance estimated adjusted risks of hospitalisation, invasive ventilator use and death within 30 days. Risks were stratified by ethnicity and BMI.

Results

We identified multiple differences in risk of poor outcomes across BMI categories within individual ethnic groups. Hospitalisation risk with a BMI over 45 kg/m² was greater in Asian (RR 2.31, 95% CI 1.53 to 3.49; p<0.001), Hispanic (RR 3.22, 95% CI 2.99 to 3.48; p<0.001) and Pacific Islander (RR 3.79, 95% CI 2.49 to 5.75; p<0.001) patients compared with White (RR 2.04, 95% CI 1.79 to 2.33; p<0.001) and Black (RR 2.00, 95% CI 1.70 to 2.34; p<0.001) patients. A similar trend was observed with invasive ventilation risk. The risk of death was greater in Asian (RR 3.96, 95% CI 1.88 to 8.33; p<0.001), Hispanic (RR 3.03, 95% CI 2.53 to 3.61; p<0.001) and Pacific Islander (RR 4.60, 95% CI 1.42 to 14.92; p=0.011) patients compared with White (RR 1.47, 95% CI 1.13 to 1.91; p=0.005) and Black (RR 2.83, 95% CI 1.99 to 4.02; p<0.001) patients with a BMI over 45 kg/m².

Conclusions

Ethnic minorities with severe obesity, particularly Asian, Hispanic and Pacific Islander patients, had a statistically significant higher risk of hospitalisation, invasive ventilator use and death due to COVID-19. Potential explanations include differences in adipose tissue deposition, overall inflammation and ACE-2 receptor expression.
Neonatal morbidity after fetal exposure to antipsychotics: a national register-based study
Authors: Heinonen Essi , Forsberg Lisa , Nörby Ulrika , Wide Katarina , Källén Karin
Published: June 2022

Objective

To investigate the admission rate to neonatal care and neonatal morbidity after maternal use of antipsychotics during pregnancy.

Design

A population-based register study.

Setting

Information on all singleton births between July 2006 and December 2017 in Sweden including data on prescription drugs, deliveries and infants’ health was obtained from the Swedish Medical Birth Register, the Prescribed Drug Register and the Swedish Neonatal Quality Register. Exposed infants were compared with unexposed infants and with infants to mothers treated with antipsychotics before or after but not during pregnancy.

Participants

The cohort comprised a total of 1 307 487 infants, of whom 2677 (0.2%) were exposed to antipsychotics during pregnancy and 34 492 (2.6%) had mothers who were treated before/after the pregnancy.

Outcome measures

The primary outcome was admission rate to neonatal care. Secondary outcomes were the separate neonatal morbidities.

Results

Of the exposed infants, 516 (19.3%) were admitted to neonatal care compared with 98 976 (7.8%) of the unexposed infants (adjusted risk ratio (aRR): 1.7; 95% CI: 1.6 to 1.8), with a further increased risk after exposure in late pregnancy. The highest relative risks were seen for withdrawal symptoms (aRR: 17.7; 95% CI: 9.6 to 32.6), neurological disorders (aRR: 3.4; 95% CI: 2.4 to 5.7) and persistent pulmonary hypertension (aRR: 2.1; 95% CI: 1.4 to 3.1) when compared with unexposed infants. The absolute risks for these outcomes were however low among the exposed infants, 1.3%, 1.8% and 1.0%, respectively, and the relative risks were lower when compared with infants to mothers treated before/after the pregnancy.

Conclusion

Fetal exposure to antipsychotics was associated with an increased risk of neonatal morbidity. The effects in the exposed infants seem transient and predominantly mild, and these findings do not warrant discontinuation of a necessary treatment but rather increased monitoring of these infants. The increased risk of persistent pulmonary hypertension requires further studies.
Effect of bortezomib on the treatment of multiple myeloma: a systematic review protocol
Authors: Cantadori Lucas Oliveira , Gaiolla Rafael Dezen , Nunes-Nogueira Vania dos Santos
Published: June 2022

Introduction

Multiple myeloma (MM) is an incurable malignant neoplasm that accounts for approximately 1% of all cancers and 10% of haematological malignancies. Bortezomib is one of the most commonly used medications in first-line treatment and subsequent relapses, either as a single agent or in combination with other therapies. This study aims to assess the effects of bortezomib on the overall survival (OS), progression-free survival, overall response rate, time to next treatment, health-related quality of life, compliance, adverse events and treatment-related death in patients with MM.

Methods and analysis

We have performed a systematic review and meta-analysis and will include both randomised and non-randomised controlled studies where the effect of bortezomib was compared in similar or dissimilar background therapies in each arm. General and adaptive search strategies have been created for the following electronic health databases: Embase, Medline, LILACS and CENTRAL. Two reviewers have independently selected eligible studies, will assess the risk of bias, and will extract data from the included studies. Similar outcomes will be plotted in the meta-analysis using the Stata Statistical Software V.17. The relative risk will be calculated with a 95% CI as the effect size of bortezomib. For the OS and progression-free survival, we calculate the overall OR from the HRs of each included study. Peto’s one-step OR will be calculated for event rates below 1%. We will use the Grading of Recommendations Assessment, Development and Evaluation system to evaluate the certainty of evidence.

Ethics and dissemination

As no primary data collection will be undertaken, formal ethical assessment is not required. We plan to present the results of this systematic review in a peer-reviewed scientific journal, conferences and popular press.

PROSPERO registration number

CRD42020151142.
Objective performance of emergency medical technicians in the use of mechanical cardiopulmonary resuscitation compared with subjective self-evaluation: a cross-sectional, simulation-based study
Authors: Yang Wen-Shuo , Yen Ping , Wang Yao-Cheng , Chien Yu-Chun , Chie Wei-Chu , Ma Matthew Huei-Ming , Chiang Wen-Chu
Published: June 2022

Objective

To evaluate the subjective and objective resuscitation performance of emergency medical technicians (EMTs) using mechanical cardiopulmonary resuscitation (MCPR) devices.

Design and setting

This was a cross-sectional simulation-based study where participants installed the MCPR device on a training manikin.

Participants

We assessed EMT-Intermediates (EMT-Is) and EMT-Paramedics (EMT-Ps) of the Emergency Medical Services (Ambulance) Division of the Taipei City Fire Department.

Primary and secondary outcome measures

The primary outcome was the gap between self-perceived (subjective) and actual (objective) no-flow time during resuscitation, which we hypothesised as statistically insignificant. The secondary outcome was the association between resuscitation performance and personal attributes like knowledge, attitude and self-confidence.

Results

Among 210 participants between 21 and 45 years old, only six were female. There were 144 EMT-Is and 66 EMT-Ps. During a simulated resuscitation lasting between four and a half and 5 min, EMTs had longer actual no-flow time compared with self-perceived no-flow time (subjective, 38 s; objective, 57.5 s; p value<0.001). This discrepancy could cause a 6.5% drop of the chest compression fraction in a resuscitation period of 5 min. Among the EMT personal factors, self-confidence was negatively associated with objective MCPR deployment performance (adjusted OR (aOR) 0.66, 95% CI 0.45 to 0.97, p=0.033) and objective teamwork performance (aOR 0.57, 95% CI 0.34 to 0.97, p=0.037) for EMT-Ps, whereas knowledge was positively associated with objective MCPR deployment performance (aOR 2.15, 95% CI 1.31 to 3.52, p=0.002) and objective teamwork performance (aOR 1.77, 95% CI 1.02 to 3.08, p=0.043) for EMT-Is. Moreover, regarding the self-evaluation of no-flow time, both self-satisfaction and self-abasement were associated with objectively poor teamwork performance.

Conclusions

EMTs’ subjective and objective performance was inconsistent during the MCPR simulation. Self-confidence and knowledge were personal factors associated with MCPR deployment and teamwork performance. Both self-satisfaction and self-abasement were detrimental to teamwork during resuscitation.
Improving mealtimes for patients and staff within an eating disorder unit: the next chapter
Authors: Gardner Lucy , Tillier Kirstie , Marshall-Tyson Kayda , Trueman Hayley , Hunt David Francis
Published: June 2022

Objectives

Mealtimes are an integral part of treatment for patients in an eating disorder inpatient unit. However, they are often distressing and anxiety provoking for both patients and staff. A consequence of patients’ distress is an increase in eating disorder behaviours specific to mealtimes. This is the second paper detailing a quality improvement project following on from an initial paper outlining the first test of change. The aim of this quality improvement project was to decrease the number of eating disorder behaviours at mealtimes in the dining room through the implementation of interventions identified through diagnostic work.

Methods/design

The Model for Improvement was used as the systematic approach for this project. Baseline assessment included observations in the dining room, gathering of qualitative feedback from staff and patients and the development of a form which identifies eating disorder behaviours completed by staff. Interventions in the form of three change ideas have so far been introduced including (1) a host role in the dining room, (2) a guide to the dining room for new staff along with competencies and (3) a dining goals group. The impact of the three interventions is assessed.

Results

The introduction of the interventions has overall reduced the average number of eating disorder behaviours per patient in the dining room by 33%.

Conclusions

This paper reports the challenges and successes of continuing a QI project through the COVID-19 pandemic and the need for multiple tests of change to improve a complex problem. The results demonstrate a consistent reduction in eating disorder behaviours over a period of nearly 2 years.
Predictors of liver cirrhosis and hepatocellular carcinoma among perioperative survivors of the Fontan operation
Authors: Inuzuka Ryo , Nii Masaki , Inai Kei , Shimada Eriko , Shinohara Tokuko , Kogiso Tomomi , Ono Hiroshi , Otsuki Shin-ichi , Kurita Yoshihiko , Takeda Atsuhito , Hirono Keiichi , Takei Kota , Yasukohchi Satoshi , Yoshikawa Tadahiro , Furutani Yoshiyuki , Shinozaki Tomohiro , Matsuyama Yutaka , Senzaki Hideaki , Tokushige Katsutoshi , Nakanishi Toshio
Published: June 2022

Objective

Fontan-associated liver disease (FALD) is widely recognised as a common complication in patients long after the Fontan operation. However, data on the predictors of FALD that can guide its screening and management are lacking. The present study aimed to identify the predictors of liver cirrhosis (LC) and hepatocellular carcinoma (HCC) in post-Fontan patients.

Methods

This was a multi-institutional retrospective cohort study. Clinical data of all perioperative survivors of Fontan operation before 2011 who underwent postoperative catheterisation were collected through a retrospective chart review.

Results

A total of 1117 patients (538 women, 48.2%) underwent their first Fontan operation at a median age of 3.4 years. Postoperative cardiac catheterisation was conducted at a median of 1.0 year. During a median follow-up period of 10.3 years, 67 patients (6.0%) died; 181 (16.2%) were diagnosed with liver fibrosis, 67 (6.0%) with LC, 54 (4.8%) with focal nodular hyperplasia and 7 (0.6%) with HCC. On multivariable analysis, high central venous pressure (CVP) (HR, 1.28 (95% CI 1.01 to 1.63) per 3 mm Hg; p=0.042) and severe atrioventricular valve regurgitation (HR, 6.02 (95% CI 1.53 to 23.77); p=0.010) at the postoperative catheterisation were identified as independent predictors of LC/HCC.

Conclusions

Patients with high CVP and/or severe atrioventricular valve regurgitation approximately 1 year after the Fontan operation are at increased risk of developing advanced liver disease in the long term. Whether therapeutic interventions to reduce CVP and atrioventricular valve regurgitation decrease the incidence of advanced liver disease requires further elucidation.
Mortality and cancer incidence among female Australian firefighters
Authors: Glass Deborah Catherine , Del Monaco Anthony , Pircher Sabine , Vander Hoorn Stephen , Sim Malcolm Ross
Published: June 2022

Objectives

To investigate the mortality and cancer incidence of female firefighters, a group where there are limited published findings.

Methods

Participating fire agencies supplied records of individual firefighters including the number and type of incidents attended. The cohort was linked to the Australian National Death Index and Australian Cancer Database. Standardised mortality ratios and standardised cancer incidence ratios were calculated separately for paid and volunteer firefighters. Volunteer firefighters were grouped into tertiles by the duration of service and by a number of incidents attended and relative mortality ratios and relative incidence ratios calculated.

Results

For volunteer firefighters (n=37 962), the overall risk of mortality and risk from all major causes of death were reduced when compared with the general population whether or not they had ever attended incidents. Volunteer firefighters had a similar cancer incidence when compared with the general population for most major cancer categories. Female volunteer firefighters have usually attended few fires. Of those who had turned out to incidents, only one-third had attended more than 12 fires about half the number for male volunteers. Mortality and cancer incidence for paid female firefighters (n=1682) were similar to the general population but the numbers were small and so power was limited.

Conclusions

Female volunteer firefighters have a cancer incidence similar to the general population but a reduced risk of mortality which is likely to be a result of a ‘healthy volunteer’ effect.

Most of the paid female firefighters were relatively recent recruits and it will be important to monitor the health of this group as more women are recruited to front-line firefighting roles.
Changes in common mental disorders and diagnosis-specific sickness absence: a register-linkage follow-up study among Finnish municipal employees
Authors: Mauramo Elina , Lahti Jouni , Lallukka Tea , Lahelma Eero , Pietiläinen Olli , Rahkonen Ossi
Published: June 2022

Objective

This study examined the associations between changes in common mental disorders (CMD) and subsequent diagnosis-specific sickness absence (SA) among midlife and ageing municipal employees.

Methods

Data from the Helsinki Health Study phase I (2000–2002) and phase II (2007) surveys among employees of the City of Helsinki, Finland, were linked with prospective register data from the Social Insurance Institution of Finland on diagnosis-specific (mental, musculoskeletal, other causes) SA (n=3890). Associations between change in CMD (General Health Questionnaire 12) from phase I to phase II and the first SA event in 2007–2014 were analysed using Cox regression modelling. Sociodemographic, work and health-related covariates from phase I, and SA from the year preceding phase I were controlled for.

Results

Having CMD at one or two time points, that is, favourable and unfavourable change in CMD and repeated CMD, were all associated with a higher risk of SA due to mental, musculoskeletal and other diagnoses compared with women and men with no CMD. Favourable change in CMD reduced the risk of SA when compared with repeated CMD. The strongest associations were observed for repeated CMD (HR range: 1.44 to 5.05), and for SA due to mental diagnoses (HR range: 1.15 to 5.05). The associations remained after adjusting for the covariates.

Conclusions

Changing and repeated CMD increased the risk of SA due to mental, musculoskeletal and other diagnoses. CMD should be tackled to prevent SA and promote work-ability among ageing employees.
Rawlsian reasoning about fairness at the end of life
Authors: Lynøe Niels , Engström Ingemar , Juth Niklas
Published: June 2022

Objectives

The aim of this study was to discuss end-of-life care in the context of Rawls’ and Daniels’ philosophy of justice. The study is based on an empirical survey of Swedish physicians who were asked whether they would want the option of physician-assisted suicide (PAS) for themselves (hereafter called own preferences), what are their attitudes towards PAS in general and whether they were prepared to prescribe PAS drugs to eligible patients. The question is to what extent the physicians’ answers are impartial and consistent in a Rawlsian sense.

Methods

The underlying indicator was the physicians’ own preferences. Kappa score inter-rater agreement was measured between that response and that same physician’s general attitude towards allowing PAS and preparedness to prescribe PAS drugs. The coherence of provided comments and arguments were analysed using content analysis.

Results

Palliative care physicians are the least willing to offer PAS, and surgeons and psychiatrist the most willing. There is a discrepancy between physicians’ general attitudes about allowing PAS, their own wishes to be offered PAS at the end of life and the concrete action of prescribing PAS drugs. Arguments given for not prescribing PAS by those in favour of PAS are seemingly but not truly inconsistent.

Conclusions

Those supporting PAS provided impartial and consistent arguments for their stances in a Rawlsian sense, while those against PAS provided partial arguments. Two specialties, psychiatrists and palliative care physicians, were coherent in their reasoning about PAS for themselves and their willingness to prescribe the needed drugs.
Assisted dying request assessments by trained consultants: changes in practice and quality - Repeated cross-sectional surveys (2008–2019)
Authors: Vissers Stijn , Dierickx Sigrid , Chambaere Kenneth , Deliens Luc , Mortier Freddy , Cohen Joachim
Published: June 2022

Objectives

To study changes in the peer consultation practice of assessing assisted dying requests and its quality among trained ‘Life End Information Forum’ (LEIF) consultants in Belgium between 2008 and 2019.

Methods

Cross-sectional surveys conducted in 2008 (N=132) and 2019 (N=527) among all registered LEIF consultants.

Results

The response rate was 75% in 2008 and 57% in 2019. In 2019 compared with 2008, more LEIF consultants were significantly less than 40 years old (25%/10%, p=0.006) and at least 60 years old (34%/20%, p=0.006). In their activities regarding assessments of assisted dying requests over 12 months, we found a significant increase in the number of patients who did not meet the substantive requirements for assisted dying in 2019 compared with 2008 (1–4 patients: 41.1 %/58.8%, p=0.020). In their most recent assessments of an assisted dying request, LEIF consultants in 2019 made significantly more assessments of patients aged 80 years or older than in 2008 (31%/9%, p<0.001), and significantly fewer assessments for patients with cancer (53%/70%, p=0.034). Regarding adherence to quality criteria for consultation, LEIF consultants discussed unbearable suffering (87%/65%, p=0.003) and alternative treatments (palliative: 48 %/13%, p<0.001; curative: 28%/5%, p=0.002) significantly more often with the attending physician.

Conclusions

Changes in peer consultation practice and its quality among LEIF consultants likely reflect changes in assisted dying practice in general, as well as changes in LEIF consultations on more complex cases for which LEIF consultants’ expertise is required.
Cancer symptoms: do patients, family caregivers and professionals agree?
Authors: Perin Melissa , de Souza Andressa , Boniatti Márcio Manozzo
Published: June 2022

Objectives

To assess the level of agreement among patients, their family caregivers and health professionals regarding the symptoms presented by patients with cancer.

Methods

This is a cross-sectional study carried out in patients with cancer admitted to a hospital in Brazil from December 2019 to July 2020. One family caregiver for each patient was included in the study. In addition, nurses and physicians involved in patient care were included. Patients, family caregivers and health professionals responded to the Palliative Outcome Scale (POS).

Results

Sixty-one patients with their family caregivers, 18 nurses and 8 physicians were included. Physicians reported a lower mean POS score than patients (p=0.008). In general, physicians and nurses underestimated the anxiety of the patient and the anxiety of the family caregivers and how much the patient feels that his or her life is worthwhile. Intraclass correlation coefficient showed moderate and good levels of agreement between patients’ and family caregivers’ responses (0.61). Agreement between patient and nurse (0.02) and physician (0.21) responses was poor.

Conclusions

The level of agreement between patients and healthcare professionals was very poor regarding patients’ symptoms. However, the caregiver’s perception of the patient’s symptoms can be a reliable source of information.
Tobacco industry presence and practices in Mozambique: a ‘chaotic’ but worthy market
Authors: Nguenha Nicole , Bialous Stella , Matavel Joaquim , Lencucha Raphael
Published: June 2022

Background

Mozambique has experienced a series of tobacco industry consolidations both in tobacco leaf buying and processing, and in cigarette manufacturing and marketing. The growth of the tobacco industry presence in Mozambique was followed by an increase in tobacco industry’s Corporate Social Responsibility (CSR) activities. This is the first paper to describe the history of tobacco industry activities in Mozambique, a party to the WHO Framework Convention on Tobacco Control (FCTC).

Methods

We reviewed industry documents and associated web-based information. Industry documents (1990–2021) were identified through University of California San Francisco’s Truth Tobacco Industry Documents Library. We followed with a search of web-based sources pertaining to the tobacco industry in Mozambique. We complemented our analysis with select media sources to identify statements by government officials in relation to the tobacco industry. We mapped major tobacco industry players, industry partnerships and corresponding CSR activities.

Results

Tobacco production increased substantially in Mozambique in the 1990s when tobacco companies began targeting African countries. The increased attention to tobacco production, trade and sales in Mozambique was coupled with greater industry involvement in CSR activities. We identified 10 tobacco industry CSR programmes in Mozambique. Most of the CSR programmes focus on health including HIV/AIDS, social issues and environmental issues.

Conclusions

Similar to other tobacco-growing countries, the industry facilitated an increase in tobacco production and continues efforts to increase the tobacco consumption market while engaging in CSR activities focused on social and environmental issues. As in other countries, CSR initiatives in Mozambique enhance industry’s reputation. Importantly, these CSR programmes and partnerships breach national laws and the provisions of the FCTC. The continuation of these programmes suggests limited attention within government to protect public policy from industry interference in compliance with Article 5.3 of the FCTC.
Wheeze in the time of COVID-19: overcoming obstacles to an unusual diagnosis
Authors: Barclay Mhairi , Buderi Silviu , Bush Andrew , Daniel Mat , Jordan Simon , Rice Alexandra , Ruggins Nigel , Semple Thomas , Smyth Alan Robert
Published: June 2022

This case is an example of a rare cause of a common clinical presentation (persistent lobar collapse with wheeze). We describe patient management from primary care through to a national thoracic referral centre. We highlight the importance of objective testing to support an asthma diagnosis and the need to consider alternative or additional diagnoses if a patient does not respond to treatment or the clinical course is unexpected. We highlight the importance of follow-up X-ray to determine whether atelectasis has resolved, which was significantly delayed in this case due to COVID-19 restrictions. Though rare, an endobronchial tumour should be considered if atelectasis persists and when planning endoscopy for a presumed foreign body, especially if the clinical history and patient factors make a foreign body less likely. Greater awareness of this as a differential may expedite diagnoses for patients in future. We show how virtual, multicentre, multidisciplinary meetings can aid rapid diagnosis, surgical planning and coordination of follow-up across centres.
Twenty-four years of contrasting cropping systems on a brown chernozem in Southern Alberta: crop yields, soil carbon, and subsoil salinity
Authors: Bremer E. , Pauly D. , McKenzie R.H. , Ellert B.H. , Janzen H.H.
Published: June 2022

Cropping systems with perennial forages and reduced fallow frequency generally increase soil organic carbon and thus subsequent soil health and crop yield. We evaluated the impact of prior cropping systems on subsequent yields and soil properties in a semiarid region by using crop yields as a bioassay of soil health following the termination of a 24-year crop rotation study in the Brown soil zone in Alberta. During 24 growing seasons from 1992 to 2015, the study included three fallow-containing rotations, two annual crop rotations that were cropped continuously, and perennial grass hay, each with two to six fertilizer treatments. During the bioassay period from 2016 through 2020, all plots in the study were uniformly cropped. Compared to unfertilized fallow wheat, soil organic C in the fall of 2015 was 54% higher after 24 years of fertilized grass and up to 14% higher following annual crops in rotations without fallow. The most notable impact of the previous cropping system on yield during the bioassay years was low yield following perennial grass in 2016 and 2018. Soil electrical conductivity measurements showed that subsoil salinity was elevated following perennial grass, demonstrating the importance of subsoil characteristics for healthy soils. Crop yields in the fifth year of the crop bioassay were 10%–20% greater due to reduced fallow frequency or increased crop diversity. The long-term impact of the cropping system on crop yield in this study depended on drought intensity due to counteracting changes in soil organic matter and subsoil salinity.
Are you scared yet? Variations to cue indices elicit differential prey behavioral responses even when gape-limited predators are relatively small
Authors: Wagner Madison J. , Moore Paul A.
Published: June 2022

Anti-predator behavior is often evoked based on measurements of risk calculated from sensory cues emanating from predators independent of physical attack. Yet, the exact sensory indices of cues used in risk assessment remain largely unknown. To examine how different predatory cue indices of information are used in risk assessment, we presented prey with various cues from sublethal gape-limited predators. Rusty crayfish ( Faxonius rusticus (Girard, 1852)) were exposed to predatory odors from sublethal-sized largemouth bass ( Micropterus salmoides (Lacepѐde, 1802)) to test effects of changing predator abundance, relative size relationships, and total predator length in flow through mesocosms. Foraging, shelter use, and movement behavior were used to measure cue effects. Foraging time depended jointly upon predator abundance and total predator size ( p = 0.030). Specifically, high predator abundance resulted in decreased foraging efforts as gape ratio increased. Similarly, sheltering time depended on the interaction between predator abundance and gape ratio when predator abundance was highest ( p = 0.020). Crayfish significantly increased exploration time when gape ratio increased ( p = 0.010). Thus, this study shows crayfish can use different indices of predatory cues, namely total predator abundance and relative size ratios, in risk assessment but do so in context-specific ways.
Fundamental length scale and the bending of light in a gravitational field
Authors: Tee Philip , Jafari Nosratollah
Published: June 2022

The canonical approach to quantizing quantum gravity is understood to suffer from pathological non-renomalizability. Nevertheless in the context of effective field theory, a viable perturbative approach to calculating elementary processes is possible. Some non-perturbative approaches, most notably loop quantum gravity and combinatorial quantum gravity imply the existence of a minimal length. To circumvent the seeming contradiction between the existence of a minimum length and the principle of special relativity, Double Special Relativity introduces modified dispersion relationships that reconcile the conflict. In this work, we combine these dispersion relationships with an effective field theory approach to compute the first post Newtonian correction to the bending of light by a massive object. The calculation offers the prospect of a directly measurable effect that rests upon both the existence of a quantized gravitational field and a minimal length. Experimental verification would provide evidence of the existence of a quantum theory of gravity, and the fundamental quantization of spacetime with a bound on the minimal distance.
APPLICATION OF q-SHEHU TRANSFORM ON q-FRACTIONAL KINETIC EQUATION INVOLVING THE GENERALIZED HYPER-BESSEL FUNCTION
Authors: ABUJARAD EMAN S. , JARAD FAHD , ABUJARAD MOHAMMED H. , BALEANU DUMITRU
Published: June 2022

In this paper, we introduce the [Formula: see text]-Shehu transform. Further, we define the generalized hyper-Bessel function. Also, we state the [Formula: see text]-Shehu transform for some elementary functions. The present aim in this paper is to obtain the solutions of the [Formula: see text]-fractional kinetic equations in terms of the established generalized hyper-Bessel function by applying the established [Formula: see text]-Shehu transform. Also, we give some special cases of our main results. At the end of this paper, we give the numerical values and the graphical representations of these solutions by using the software MATLAB.
STUDY ON THE NONLINEAR DEFORMATION MECHANICAL PROPERTIES OF A NEW TYPE OF VENA CAVA FILTER
Authors: FENG HAIQUAN , WANG TIANQI , CHEN SIYUAN , WANG YONGGANG , WANG XIAOTIAN
Published: June 2022

In order to analyze the mechanical properties of a new type of retrievable vena cava filter, the Denali and Aeginsy retrievable filters are selected, and the in vivo and in vitro mechanical properties of the three types of retrievable vena cava filters are compared. The nonlinear deformation process of the filter which is pressed into the transport sheath, flicked and released into the vascular vessel is simulated by using the finite element method, and the mechanical behaviors of the filter and the blood vessel wall are analyzed. During the crimping process, the elastic strain peak value of the filter wall increases with increasing amount of grip. The maximum elastic strain peak value of the three filters is less than 8%, and the safety factor is greater than 2, which meets the strength requirement. Equivalent stress and strain on the vascular wall decreases along the direction of blood flow after the filter is opened. The peak value of equivalent stress and strain on the vascular wall corresponding to Aegisy filter is the largest, and the impact on the vascular wall is the largest. The total displacement of the three filters under the action of thrombus and blood fluids is not more than 80[Formula: see text][Formula: see text]m. The impact of the new filter on the vascular wall is smaller than that of Aegisy filter, and the total displacement after implantation is smaller than that of Denali filter. The results are valuable for the evaluation and clinical application of the new vena cava filter.
Will the Digital Economy Increase Energy Consumption? – An Analysis Based on the ICT Application Research
Authors: WANG Lei , ZHU Tong
Published: June 2022

With the rapid development of digital technologies based on information and communication technology (ICT), some studies suggest that the development of the digital economy is bound to have a significant impact on energy consumption. There are also studies demonstrating from different perspectives that ICT plays an important role in improving energy efficiency. Then, will the rapid development of the digital economy lead to a sharp increase in energy demand (electricity demand), thus affecting China’s socio-economic transition to green and low-carbon development? To this end, it is of great practical significance to explore the relationship between the digital economy and energy consumption from theoretical and practical perspectives. Focusing on the issue of ICT and its impacts on energy consumption, this paper clarifies the internal influencing mechanism between ICT and energy consumption. On this basis, this paper compares and analyzes the models, methods, and data in existing studies from the aspects of measurement of ICT’s direct energy consumption, empirical research on ICT and energy consumption, and discussions on rebound effects. After a brief summary, this paper identifies their shortcomings and explores future research directions.
Cache-related Hardware Capabilities and Their Impact on Information Security
Authors: Branco Rodrigo , Lee Ben
Published: June 2022

Caching is an important technique to speed-up execution, and its implementation and use cases vary. When applied specifically to the memory hierarchy, caching is used to speed up memory accesses and memory translations. Different cache implementations are considered microarchitectural secrets and oftentimes change between generations. The integration of caches in hardware greatly influences security policy enforcement in the platform since caches maintain copies of code and data and their security properties. Examples of attacks due to the existence of caches are side-channels against cryptographic software, recent speculative execution abuses to leak secret data, and usages of cache-based manipulations (e.g., forcing cache splits/incoherence) to hide from security software detection. This survey examines the security issues due to different cache usages in a microarchitecture. The survey also explains the most complicated caching features and their impact on the security of the platform in different scenarios.
Aesthetics in Styles and Variation: A Fresh Flavor
Authors: Meyerhoff Miriam , Mendoza-Denton Norma
Published: June 2022

Speaker attitudes, ascriptions, qualia, and other forms of overt aesthetic commentary function as constraints on language and culture and are central to sociolinguistics and linguistic anthropology. Despite the importance of aesthetics, sociolinguists studying variation and change have largely shied away from the topic. This review suggests that covert aesthetic evaluations play a role in variation and change. We draw on non-Western approaches to aesthetics ( rasa and “everyday aesthetics”) that emphasize the interplay between receiver and the aesthetic stimulus. We present two case studies. One, from fieldwork on Nkep (an Oceanic language spoken in Vanuatu), draws attention to the way aesthetic factors seem to slow language change. The other, from fieldwork on Spanish in California, shows how aesthetic evaluations of linguistic features facilitate the transfer of variation in a situation of language contact.
The Economic Impacts of Walmart Supercenters
Authors: Volpe Richard , Boland Michael A.
Published: June 2022

Our purpose is to review the economic impacts of Walmart's disruption of the food retailing industry. This review synthesizes the extant knowledge and research findings related to the economic impacts of Walmart's entry into, and subsequent domination of, food retailing in the United States and more broadly globally. The findings suggest five broad generalizations: ( a) Walmart's physical growth in the United States has slowed considerably, but the company is growing rapidly in terms of total assets, digital capabilities, international presence, and sales per square foot; ( b) Walmart's entry and presence are associated with lower food prices for households; ( c) Walmart has considerable negative impacts on large competitors, particularly supermarkets, but the evidence for Walmart's deleterious impacts on small businesses is limited; ( d) there is no consensus on the impact of Walmart on local employment, but most studies on the topic point to a modest increase in retail employment; and ( e) Walmart likely increases food access but does not improve dietary quality.