bluuebunny/crossref_metadata_2025 huggingface dataset:
COVID-19 Misinformation Prophylaxis: Protocol for a Randomized Trial of a Brief Informational Intervention (Preprint)
Authors: Agley Jon , Xiao Yunyu , Thompson Esi E , Golzarri-Arroyo Lilian
Published: December 2020

BACKGROUND

As the COVID-19 pandemic continues to affect life in the United States, the important role of nonpharmaceutical preventive behaviors (such as wearing a face mask) in reducing the risk of infection has become clear. During the pandemic, researchers have observed the rapid proliferation of misinformed or inconsistent narratives about COVID-19. There is growing evidence that such misinformed narratives are associated with various forms of undesirable behavior (eg, burning down cell towers). Furthermore, individuals’ adherence to recommended COVID-19 preventive guidelines has been inconsistent, and such mandates have engendered opposition and controversy. Recent research suggests the possibility that trust in science and scientists may be an important thread to weave throughout these seemingly disparate components of the modern public health landscape. Thus, this paper describes the protocol for a randomized trial of a brief, digital intervention designed to increase trust in science.

OBJECTIVE

The objective of this study is to examine whether exposure to a curated infographic can increase trust in science, reduce the believability of misinformed narratives, and increase the likelihood to engage in preventive behaviors.

METHODS

This is a randomized, placebo-controlled, superiority trial comprising 2 parallel groups. A sample of 1000 adults aged ≥18 years who are representative of the population of the United States by gender, race and ethnicity, and age will be randomly assigned (via a 1:1 allocation) to an intervention or a placebo-control arm. The intervention will be a digital infographic with content based on principles of trust in science, developed by a health communications expert. The intervention will then be both pretested and pilot-tested to determine its viability. Study outcomes will include trust in science, a COVID-19 narrative belief latent profile membership, and the likelihood to engage in preventive behaviors, which will be controlled by 8 theoretically selected covariates.

RESULTS

This study was funded in August 2020, approved by the Indiana University Institutional Review Board on September 15, 2020, and prospectively registered with ClinicalTrials.gov.

CONCLUSIONS

COVID-19 misinformation prophylaxis is crucial. This proposed experiment investigates the impact of a brief yet actionable intervention that can be easily disseminated to increase individuals’ trust in science, with the intention of affecting misinformation believability and, consequently, preventive behavioral intentions.

CLINICALTRIAL

ClinicalTrials.gov NCT04557241; https://clinicaltrials.gov/ct2/show/NCT04557241

INTERNATIONAL REGISTERED REPORT

PRR1-10.2196/24383
Design, Development, and Evaluation of a Telemedicine Platform for Patients With Sleep Apnea (Ognomy): Design Science Research Approach (Preprint)
Authors: Mulgund Pavankumar , Sharman Raj , Rifkin Daniel , Marrazzo Sam
Published: December 2020

BACKGROUND

With an aging population and the escalating cost of care, telemedicine has become a societal imperative. Telemedicine alternatives are especially relevant to patients seeking care for sleep apnea, with its prevalence approaching one billion cases worldwide. Increasing awareness has led to a surge in demand for sleep apnea care; however, there is a shortage of the resources and expertise necessary to cater to the rising demand.

OBJECTIVE

The aim of this study is to design, develop, and evaluate a telemedicine platform, called Ognomy, for the consultation, diagnosis, and treatment of patients with sleep apnea.

METHODS

Using the design science research methodology, we developed a telemedicine platform for patients with sleep apnea. To explore the problem, in the analysis phase, we conducted two brainstorming workshops and structured interviews with 6 subject matter experts to gather requirements. Following that, we conducted three design and architectural review sessions to define and evaluate the system architecture. Subsequently, we conducted 14 formative usability assessments to improve the user interface of the system. In addition, 3 trained test engineers performed end-to-end system testing to comprehensively evaluate the platform.

RESULTS

Patient registration and data collection, physician appointments, video consultation, and patient progress tracking have emerged as critical functional requirements. A telemedicine platform comprising four artifacts—a mobile app for patients, a web app for providers, a dashboard for reporting, and an artificial intelligence–based chatbot for customer onboarding and support—was developed to meet these requirements. Design reviews emphasized the need for a highly cohesive but loosely coupled interaction among the platform’s components, which was achieved through a layered modular architecture using third-party application programming interfaces. In contrast, critical findings from formative usability assessments focused on the need for a more straightforward onboarding process for patients, better status indicators during patient registration, and reorganization of the appointment calendar. Feedback from the design reviews and usability assessments was translated into technical improvements and design enhancements that were implemented in subsequent iterations.

CONCLUSIONS

Sleep apnea is an underdiagnosed and undertreated condition. However, with increasing awareness, the demand for quality sleep apnea care is likely to surge, and creative alternatives are needed. The results of this study demonstrate the successful application of a framework using a design science research paradigm to design, develop, and evaluate a telemedicine platform for patients with sleep apnea and their providers.

CLINICALTRIAL
A Smartphone App for Supporting the Self-management of Daytime Urinary Incontinence in Adolescents: Development and Formative Evaluation Study of URApp (Preprint)
Authors: Whale Katie , Beasant Lucy , Wright Anne J , Yardley Lucy , Wallace Louise M , Moody Louise , Joinson Carol
Published: December 2020

BACKGROUND

Daytime urinary incontinence (UI) is common in childhood and often persists into adolescence. UI in adolescence is associated with a range of adverse outcomes, including depressive symptoms, peer victimization, poor self-image, and problems with peer relationships. The first-line conservative treatment for UI is bladder training (standard urotherapy) that aims to establish a regular fluid intake and a timed schedule for toilet visits. The success of bladder training is strongly dependent on good concordance, which can be challenging for young people.

OBJECTIVE

This paper aims to describe the development of a smartphone app (URApp) that aims to improve concordance with bladder training in young people aged 11 to 19 years.

METHODS

URApp was designed by using participatory co-design methods and was guided by the person-based approach to intervention design. The core app functions were based on clinical guidance and included setting a daily drinking goal that records fluid intake and toilet visits, setting reminders to drink fluids and go to the toilet, and recording progress toward drinking goals. The development of URApp comprised the following four stages: a review of current smartphone apps for UI, participatory co-design workshops with young people with UI for gathering user requirements and developing wireframes, the development of a URApp prototype, and the user testing of the prototype through qualitative interviews with 23 young people with UI or urgency aged 10 to 19 years and 8 clinicians. The app functions and additional functionalities for supporting concordance and behavior change were iteratively optimized throughout the app development process.

RESULTS

Young people who tested URApp judged it to be a helpful way of supporting their concordance with a timed schedule for toilet visits and drinking. They reported high levels of acceptability and engagement. Preliminary findings indicated that some young people experienced improvements in their bladder symptoms, including a reduction in UI. Clinicians reported that URApp was clinically appropriate and aligned with the best practice guidelines for bladder training. URApp was deemed age appropriate, with all clinicians reporting that they would use it within their own clinics. Clinicians felt URApp would be of particular benefit to patients whose symptoms were not improving or those who were not engaging with their treatment plans.

CONCLUSIONS

The next stage is to evaluate URApp in a range of settings, including pediatric continence clinics, primary care, and schools. This research is needed to test whether URApp is an effective (and cost-effective) solution for improving concordance with bladder training, reducing bladder symptoms, and improving the quality of life.
Structure and Functioning of Acute Inpatient Psychiatric Units in Spain: Qualitative Study (Preprint)
Authors: Rodriguez-Jimenez Roberto , Corripio Iluminada , Campos Ricardo , Páramo Mario , Franco-Martin Manuel , Segura Estefanía , González Sergio , Martínez-Raga José
Published: December 2020

BACKGROUND

As a consequence of the decentralization of health care provision to the different Regions (called Autonomous Communities) in Spain, different health care models and resources have been developed for psychiatric patients. It would be very useful to obtain comprehensive and comparative data on health care models, resources, and activity of acute inpatient psychiatric units (AIPUs) as a key part of mental health systems.

OBJECTIVE

The aim of this study was to determine the current state of AIPUs in Spain through a national scorecard that allows the current situation to be visualized in terms of resources, processes, and outputs.

METHODS

A 104-item online questionnaire was sent to all the AIPUs of the different Regions in Spain. It was divided into 11 sections, including data on the resources, processes, and outputs of the AIPUs plus general data, an indicator dashboard, and good practices.

RESULTS

The questionnaire was completed by 60.0% (117/195) of the AIPUs invited to participate. The information collected has allowed us to obtain a detailed snapshot of the current situation of AIPUs in Spain at the levels of infrastructure and material resources, staffing, organization and activity of the units, coordination with other units, guidelines, processes and protocols used, participation and communication with patients and their families, teaching activity, and research linked to the units.

CONCLUSIONS

This project aimed to help understand the general situation of AIPUs in Spain and its different Regions, contribute to enhancing the benchmarking and harmonization among Spanish Regions, and provide data for future comparisons with other countries.

INTERNATIONAL REGISTERED REPORT

RR1-10.2196/26214
Factors That Help and Hinder the Implementation of Digital Depression Prevention Programs: School-Based Cross-sectional Study (Preprint)
Authors: Beames Joanne R , Johnston Lara , O'Dea Bridianne , Torok Michelle , Christensen Helen , Boydell Katherine M , Werner-Seidler Aliza
Published: December 2020

BACKGROUND

Digital prevention programs that are delivered in a school environment can inoculate young people against depression. However, little is known about the school-based factors that help and hinder the implementation of these programs. Staff members are integral for supporting mental health programs in schools and are likely to have a wealth of expertise and knowledge about the factors that affect implementation.

OBJECTIVE

The primary objective of this study was to explore the barriers and facilitators to implementing a digital depression prevention program in Australian secondary schools with teachers, counselors, and principals. The secondary objective was to explore variations in these factors across different school contexts, including the school type (government or nongovernment), location (capital city, regional/or rural areas), and socioeconomic status (SES) (low, medium, high).

METHODS

This quantitative cross-sectional survey study assessed the barriers and facilitators to implementing a hypothetical digital prevention program in Australian schools. The survey was taken by 97 teachers (average age 38.3 years), 93 counselors (average age 39.5 years), and 11 principals (average age 50.9 years) across Australia between November 2017 and July 2018.

RESULTS

A range of barriers and facilitators relating to logistics and resources, staff support, and program factors were endorsed by the surveyed staff. Consistent with prior research, common barriers included a lack of time and resources (ie, staff and rooms). These barriers were particularly evident in government, rural/regional, and low socioeconomic schools. Other barriers were specific to digital delivery, including privacy issues and a lack of clarity around staff roles and responsibilities. Facilitators included upskilling staff through training, embedding the program into the curriculum, and other program factors including universal delivery, screening of students’ mental health, and clear referral pathways. Knowledge about the program efficacy was also perceived as important by a large proportion of the respondents.

CONCLUSIONS

The digital depression prevention program was perceived as suitable for use within different schools in Australia, although certain factors need to be considered to enable effective implementation. Logistics and resources, support, and program factors were identified as particularly important for school-based implementation. To maximize the effectiveness in delivering digital programs, implementation may need to be tailored to the staff roles and school types.
Smart Decentralization of Personal Health Records with Physician Apps and Helper Agents on Blockchain: Platform Design and Implementation Study (Preprint)
Authors: Kim Hyeong-Joon , Kim Hye Hyeon , Ku Hosuk , Yoo Kyung Don , Lee Suehyun , Park Ji In , Kim Hyo Jin , Kim Kyeongmin , Chung Moon Kyung , Lee Kye Hwa , Kim Ju Han
Published: December 2020

BACKGROUND

The Health Avatar Platform provides a mobile health environment with interconnected patient Avatars, physician apps, and intelligent agents (termed IoA3) for data privacy and participatory medicine; however, its fully decentralized architecture has come at the expense of decentralized data management and data provenance.

OBJECTIVE

The introduction of blockchain and smart contract technologies to the legacy Health Avatar Platform with a clinical metadata registry remarkably strengthens decentralized health data integrity and immutable transaction traceability at the corresponding data-element level in a privacy-preserving fashion. A crypto-economy ecosystem was built to facilitate secure and traceable exchanges of sensitive health data.

METHODS

The Health Avatar Platform decentralizes patient data in appropriate locations (ie, on patients’ smartphones and on physicians’ smart devices). We implemented an Ethereum-based hash chain for all transactions and smart contract–based processes to guarantee decentralized data integrity and to generate block data containing transaction metadata on-chain. Parameters of all types of data communications were enumerated and incorporated into 3 smart contracts, in this case, a health data transaction manager, a transaction status manager, and an application programming interface transaction manager. The actual decentralized health data are managed in an off-chain manner on appropriate smart devices and authenticated by hashed metadata on-chain.

RESULTS

Metadata of each data transaction are captured in a Health Avatar Platform blockchain node by the smart contracts. We provide workflow diagrams each of the 3 use cases of data push (from a physician app or an intelligent agents to a patient Avatar), data pull (request to a patient Avatar by other entities), and data backup transactions. Each transaction can be finely managed at the corresponding data-element level rather than at the resource or document levels. Hash-chained metadata support data element–level verification of data integrity in subsequent transactions. Smart contracts can incentivize transactions for data sharing and intelligent digital health care services.

CONCLUSIONS

Health Avatar Platform and interconnected patient Avatars, physician apps, and intelligent agents provide a decentralized blockchain ecosystem for health data that enables trusted and finely tuned data sharing and facilitates health value-creating transactions with smart contracts.
Users’ Willingness to Share Health Information in a Social Question-and-Answer Community: Cross-sectional Survey in China (Preprint)
Authors: Li PengFei , Xu Lin , Tang TingTing , Wu Xiaoqian , Huang Cheng
Published: December 2020

BACKGROUND

Social question-and-answer communities play an increasingly important role in the dissemination of health information. It is important to identify influencing factors of user willingness to share health information to improve public health literacy.

OBJECTIVE

This study explored influencing factors of social question-and-answer community users who share health information to provide reference for the construction of a high-quality health information sharing community.

METHODS

A cross-sectional study was conducted through snowball sampling of 185 participants who are Zhihu users in China. A structural equation analysis was used to verify the interaction and influence of the strength between variables in the model. Hierarchical regression was also used to test the mediating effect in the model.

RESULTS

Altruism (β=.264, P<.001), intrinsic reward (β=.260, P=.03), self-efficacy (β=.468, P<.001), and community influence (β=.277, P=.003) had a positive effect on users’ willingness to share health information (WSHI). By contrast, extrinsic reward (β=−0.351, P<.001) had a negative effect. Self-efficacy also had a mediating effect (β=.147, 29.15%, 0.147/0.505) between community influence and WSHI.

CONCLUSIONS

The findings suggest that users’ WSHI is influenced by many factors including altruism, self-efficacy, community influence, and intrinsic reward. Improving the social atmosphere of the platform is an effective method of encouraging users to share health information.
Electronic Loyalty In Social Commerce: Scale Development and Validation
Authors: Khoa Bui Thanh , Nguyen Ha Minh
Published: December 2020

Loyalty is an important key performance indicator to assess a business's success, especially in an online business environment with fierce competition. The explosion of social networking sites has created a new form of business: social commerce. Simultaneously, the scale of loyalty in online transactions has some limitations; hence, this research aims to develop and validate an electronic loyalty scale in the context of social commerce. The study used a mixed research method with two phases of a sequential exploratory strategy. Qualitative research generated the scale and was used in the initial filtering to develop an e-loyalty scale for social commerce. This study conducted two quantitative studies with 715 social commerce shoppers in five developed areas in Vietnam: Ho Chi Minh City, Ha Noi City, Hai Phong City, Da Nang City, and Binh Duong Province. Based on our research survey and literature review, the research results showed that electronic loyalty in social commerce is expressed in three dimensions: preference, interaction, and personal information’s disclosure. Then, the research proposed several relevant implications for other researchers and administrators of online businesses.
The Influence of Visual Merchandising on Store Patronage in the Fast-Fashion Stores in Indonesia: The Role of Shopping Value and Self-Congruity
Authors: Daraninggar Ogi Dhaneswari , Wijaya Serli , Semuel Hatane
Published: December 2020

The study examined direct and indirect effects of visual merchandising on store patronage in a fast-fashion retail context. Adopting the Stimulus-Organism-Response (S-O-R) theory, this study aimed to investigate the relationships of visual merchandising, self-congruity, consumers’ perceived shopping value in determining store patronage. While studies about fast-fashion and store patronage behaviour have been extensively conducted in various market regions, research in an emerging middle-income country like Indonesia is still in its scarcity. The study is therefore among a few attempts to better understand the Indonesian consumers’ buying behaviour of fast-fashion brands. A survey was completed to 250 fast-fashion store shoppers in Surabaya, the second largest city and well-known shopping tourism destination in Indonesia. Partial Least Squares (PLS) path modelling method was utilised to estimate the proposed structural model. The results revealed that visual merchandising, shopping value, and self-congruity had positive and significant effects on store patronage. The study has also found that the indirect effects of consumers’ perceived shopping value and self-congruity as mediating variables as to how visual merchandising affected store patronage, were stronger than the direct ones. Managerial implications based on the findings and recommendations for further research were described.
Bioprecipitation of calcium carbonate by Bacillus subtilis and its potential to self-healing in cement-based materials
Authors: Pérez Héctor Ferral , García Mónica Galicia
Published: December 2020

In recent years, biological mineralization has been implemented as a viable option for the elaboration of new building materials, protection and repair of concrete by self-healing, soil stabilization, carbon dioxide capture, and drug delivery. Biogenic mineralization of calcium carbonate (CaCO3) induced by bacterial metabolism has been proposed as an effective method. The objective of the present study was to characterize the bioprecipitation of CaCO3 crystals by Bacillus subtilis in a semi-solid system. The results show that CaCO3 crystals were produced by day 3 of incubation. The prevalent crystalline polymorph was calcite, and in a minor proportion, vaterite. The presence of amorphous material was also detected (amorphous CaCO3 (ACC)). Finally, the crystallinity index was 81.1%. This biogenic calcium carbonate does not decrease pH and does not yield chloride formation. Contrary, it increases pH values up to 10, which constitutes and advantage for implementations at reinforced concrete. Novel applications for biogenic calcium carbonate derived from Bacillus subtilis addressing self-healing, biocementation processes, and biorestoration of monuments are presented.
El paciente con estado migrañoso en urgencias
Authors: Tan Yuri Takeuchi , Uribe García Bernardo
Published: December 2020

Se presentan dos casos de la práctica diaria, de pacientes con migraña con y sin aura que evolucionan a estado migrañoso (SM) y requieren atención hospitalaria. El manejo hospitalario es necesario luego de que se agotaran todas las medidas de manejo ambulatorio indicadas. Se describen los criterios diagnósticos del SM actuales por la ICDH-3, su fisiopatología y la reciente propuesta del SM episódico. Se ofrecen algunas sugerencias del manejo actual de acuerdo con la evidencia disponible que pueden ser de utilidad en la práctica diaria.
El paciente con estado migrañoso en urgencias que no responde al manejo inicial
Authors: Guerra Carolina , Hernández Natalia
Published: December 2020

El manejo del paciente con estado migrañoso en urgencias incluye un arsenal terapéutico multimodal en búsqueda de la mejoría del dolor y la reducción de la recurrencia. La mayoría de los pacientes responde al manejo inicial, pero en casos no despreciables este resultado no se obtiene con las medicaciones de primera línea y es necesario el uso de otros medicamentos y opciones terapéuticas que incluyen: bloqueos pericraneales, lidocaína, levetiracetam, propofol y, en casos seleccionados, el uso de opiodes. En este escrito se presenta un caso clínico de migraña que no mejora con el manejo inicial en urgencias y requiere el uso de otras opciones.
Hyperbaric oxygen as a treatment for COVID-19 infection? EDITORIAL COMMENTARY Hyperbaric oxygen as a treatment for COVID-19 infection?
Authors:   Medical Director, Center for Hyperbaric Medicine & Environmental Physiology, Duke University Medical Center, Durham, North Carolina, Moon Richard E. , Weaver Lindell K. ,   Medical Director and Division Chief, Hyperbaric Medicine, University of Utah School of Medicine, LDS Hospital, Salt Lake City, Utah
Published: December 2020

Recently the internet has been abuzz with new ideas to treat COVID-19, including hyperbaric oxygen (HBO2) therapy, undoubtedly driven by the fact that until recently there have been few therapeutic options for this highly contagious and often lethal infection. A series of five patients from Wuhan, China, has been reported to the UHMS and their features summarized [1]. Some groups have subsequently promoted HBO2 for COVID-19 infections, largely based upon two possible rationales. The first is treatment of hypoxemia, which is the major indication for endotracheal intubation in this condition. The second proposed rationale for hyperbaric oxygen is its potential anti-inflammatory effect.
Whole-body active heating does not preserve finger temperature or manual dexterity during cold-water immersion
Authors: Wheelock Courtney E. , Hess Hayden W. , Schlader Zachary J. , Johnson Blair D. , Hostler David ,   Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, New York U.S.
Published: December 2020

Background: Cold-water immersion impairs manual dexterity when finger temperature is below 15˚C. This exposes divers to increased risk of error. We hypothesized that whole-body active heating would maintain finger temperatures and dexterity during cold-water immersion. Methods: Twelve subjects (six males) (22±2 years old; BMI 23.9±2.5; body fat 16±6%) completed 60-minute head-out water immersion (HOWI) wearing a 7mm wetsuit and 3mm gloves in thermoneutral water (TN 25˚C) and cold water (CW 10˚C)while wearing a water-perfused suit (WP) with 37˚C water circulated over the torso, arms, and legs. Gross (Minnesota Manual Dexterity Test [MMDT]) and fine (modified Purdue Pegboard [PPT]) dexterity were assessed before, during and after immersion. Core body and skin temperatures were recorded every 10 minutes. Results: MMDT (TN -25±14%; CW -72±23%; WP -67±29%; p<0.05) and PPT (TN -16±9%; CW: -45±10%; WP: -38±13%; p<0.05) performance decreased during immersion. MMDT and PPT did not differ between CW and WP. Immediately following immersion gross dexterity was recovered in all conditions. Post-immersion fine dexterity was still impaired in CW (p<0.01), but not WP or TN. Core and skin temperatures decreased during immersion in CW and WP (p<0.05) but did not differ between CW and WP. Conclusions: Manual dexterity decreased during immersion. Dexterity was further impaired during cold-water immersion and was not maintained by water perfusion active heating. Warm water perfusion did not maintain finger temperature above 15˚C but hand temperature remained above these limits, suggesting a need to reassess thermal thresholds for working divers in cold-water conditions.
Gunshot damage to monoplace hyperbaric chamber acrylic
Authors:   Division of Hyperbaric Medicine Intermountain Medical Center, Murray, Utah U.S. and, Weaver Lindell K. ,   Intermountain LDS Hospital, Salt Lake City, Utah,   Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah, Deru Kayla ,   Division of Hyperbaric Medicine Intermountain Medical Center, Murray, Utah U.S. and,   Intermountain LDS Hospital, Salt Lake City, Utah, Foley John ,   Rocky Mountain Multiple Sclerosis Clinic, Salt Lake City, Utah
Published: December 2020

Introduction: Health care workers are vulnerable to workplace violence, including active shooter incidents. Little is known about how firearms could damage monoplace chamber acrylic and whether a breached pressurized chamber presents additional threat to the patient or bystanders. Methods: In a remote area where firearm discharge is permitted, we tested the durability of sections of monoplace hyperbaric chamber acrylic under various firearm discharges. Firearms were discharged at acrylic sections from a distance of 17 feet at 45 degrees and 10 degrees from perpendicular while wearing protective gear. Firearm calibers ranged from .22 caliber handgun to 5.56 mm AR-15 rifle. We also conducted similar testing on a monoplace hyperbaric chamber pressurized with >99% oxygen to a differential pressure of 14.7 psig (2.0 atmospheres absolute at sea level). Handguns were remotely fired at a distance of 12 feet from the chamber (30 degrees from perpendicular), while the rifles were fired at a distance of 60 feet from the chamber. Results: Higher caliber handguns penetrated or fractured the acrylic sections only after multiple shots. The tested rifles caused full-thickness penetration and fracture with a single shot. However, the pressurized monoplace hyperbaric chamber required two shots from the AR-15 rifle, separated by approximately 60 mm, to penetrate the acrylic, resulting in rapid depressurization. The chamber otherwise remained intact, with no explosion or conflagration observed. Conclusion: An intact or pressurized chamber performs differently than stand-alone acrylic sections under firearms testing. In a worst-case active shooter scenario, the pressurized monoplace chamber tested posed no additional threat to bystanders beyond the significant risk of ricochet.
CCFT Buffer Fringe 2020
Authors: Johan Sandborg  , Duncan Higgins  , Linda H. Lien  , andy d lock  , Ana Souto Galvan  , Susan Brind  , Shauna McMullan  , Yiorgos Hadjichristou  , Jim Harold
Published: December 2020

Creative Centre for Fluid Territories (CCFT), is a peripatetic international research group that contributes to discussions about interdisciplinary practices and how they articulate critical insights about placemaking, belonging, and occupation.

Building on last year’s contribution to buffer fringe 2019 - ‘The Urban Glenti’ - CCFT proposes to create a unique dialogical and negotiated creative exchange to take place on-line within a dedicated exposition: Images, sounds, texts, interviews, moving image are going to be used to contest the idea of fixed documentation in order to acknowledge how our relationship to places are not static and where conflict/tension/uncertainty also defines the creative process itself.

CCFT’s work methodology builds on established mutual respect; track record and insight, rooted in a continued collaborative relationship that has emerged through trust and dialogue. Our focus is on practice-based research methods exploiting the creative intersection between image and text, presented as performance, publication, installation, architectural work, design intervention, music works, and spatial practice. In the intersection of these formulations, we seek to explore the expanded concept of “the atlas” as a dissemination strategy. ATLAS – the order of memory - simultaneously linear and cyclic, ordered and labyrinthine, open to infinite interpretation and analysis — a form of mnemonic iteration – physical and virtual.
Phytotoxicity and phytogenotoxicity of municipal sewage sludge
Authors: Obidoska Grażyna , Karaczun Zbigniew , Żarska Barbara
Published: December 2020

Celem badań była ocena fitotoksyczności i fitogenotok-syczności warszawskich komunalnych osadów ściekowych zmieszanych z dwoma różnymi ro-dzajami gleb przy użyciu standardowych biote-stów roślinnych: Phytotoxkit i Allium cepa Root Tip Assay. Fitotoksyczność mieszanin osadów z glebami była zależna od koncentracji osadu i rodzaju gleby. W przypadku mieszaniny osadu z piaskiem już 3% koncentracja działała fitotok-sycznie, podczas gdy mieszanina z substratem torfowym wywoływała efekt fitotoksyczny dopie-ro przy 25-procentowym stężeniu osadu. Niestety przy tym, a także niższym (6%) stężeniu osadu w mieszaninie z substratem torfowym stwier-dzono silny efekt fitogenotoksyczny. Wydaje sięzatem, iż tak zwane biologiczne wykorzystanie badanego osadu ściekowego jest raczej ryzykow-ne dla roślin, szczególnie w przypadku gleb piasz-czystych, ale także organicznych.
The Development and Implementation of The Wales Multi-Morbidity Electronic Cohort: Prospective and Retrospective Study Designs to Investigate Multi-Morbidity
Authors: Lyons Jane , McCowan Colin , Dezateux Carol , Robson John , Watkins Alan , Rafferty James , Fry Richard , Bailey Rowena , Akbari Ashley , Harper Gill , Agrawal Utkarsh , Lyons Ronan
Published: December 2020

IntroductionMulti-morbidity is a widely recognised but poorly understood global issue that appears to be increasing in prevalence, according to the UK’s Academy of Medical Sciences (AMS) report in 2018. Disease clustering, their determinants and consequences are poorly researched. Better understanding would help drive prevention and improved clinical care, services and patient outcomes.

Objectives and ApproachDevelopment of two comprehensive population-wide e-cohorts, derived utilising data linkage techniques and including multi-sourced anonymised routine health and demographic data held within the SAIL Databank. The objective is to characterise multi-morbidity and its clustering, determinants and outcomes and compare methods using a) prospective cohort design using multiple data sources in Wales and b) retrospective cohort design to examine household level and environment clustering using GP data in demographically diverse populations (Wales and North East London).

The prospective e-cohort focuses on adults living in Wales on 1 st January 2000 and followed up to 2020, including data from the NHS population register, deaths, inpatients, outpatients, Emergency Department, GP, disease registries, laboratory data, and population surveys with QoL measures. This e-cohort will be harmonised with other sites across the UK. The retrospective e-cohort is designed to harmonise with a North East London e-cohort, including all individuals living in Wales on 24 th April 2018 and registered with a GP.

Results2.8 and 2.2 million individuals have been included in the prospective and retrospective cohorts respectively, with 43.6 million person years of follow up. Established comorbidity indices and published phenotypes from libraries are being applied to the data to create initial prevalence and incidence estimates for further analysis. Important clusters will be determined by associations with mortality and excess healthcare utilisation.

Conclusion/ImplicationsBuilding the e-cohorts has involved multiple disciplines across organisations. Multi-morbidity prevalence estimates and study designs will be compared prior to statistical analyses and machine learning methods to evaluate clustering and determinants.
Leveraging Health Administrative Data to Investigate Maternal Vulnerabilities in Early Life Respiratory Syncytial Virus (RSV) Hospitalizations in Ontario, Canada
Authors: Fitzpatrick Tiffany , McNally J Dayre , Kwong Jeffrey , Lu Hong , Fisman David , Guttmann Astrid
Published: December 2020

IntroductionRespiratory syncytial virus (RSV) is the leading cause of hospitalization among infants globally. Several RSV vaccine candidates are currently in trial and the severity of RSV-related illness can be reduced with prophylaxis. To optimize delivery of these programs and reduce inequities, a comprehensive understanding of risk factors for severe RSV-related illness is required.

Objectives and ApproachThe objective of this study was to quantify the risks of severe, early life RSV-related illness in terms of medical conditions, birth characteristics and novel socio-economic factors. We used linked population-based health and socio-demographic administrative data for all children born in Ontario (Apr 1st, 2012-March 31st, 2018), including laboratory viral testing data for a subset of children, to identify all RSV-related hospitalizations occurring in Ontario before a child’s third birthday or end of follow-up (March 31st, 2019). We calculated the relative risk of RSV-related admission, adjusted for several medical complexity and transmission factors. Critically, we leveraged these routinely collected health administrative data to determine the admission risks associated with various novel measures indicative of maternal social vulnerability, such as homelessness and involvement with the criminal justice system.

Results11,279 RSV-related hospitalizations were identified among 789,484 children; 57% of admissions occurred before 6 months of age. We identified several socio-economic factors independently associated with increased risk of severe RSV-related illness, including several maternal factors: young age at first delivery (Relative risk (RR) <20 vs 40+ years: 2.27, 95%CI:(1.89,2.73)), involvement with the criminal justice system [RR:1.34 (1.16,1.55)], social assistance use (RR:1.53 (1.45,1.62)), homelessness [RR:1.69 (1.01,2.83)], mental health/addictions concerns [RR:1.51 (1.36,1.67)] and child apprehension [RR:1.59 (1.29,1.96)].

Conclusion / ImplicationsWe identified several socio-economic factors independently associated with increased risk of severe RSV-related illness, including several novel factors related to maternal vulnerability. This information could inform the selection of high-risk groups for RSV prophylaxis or immunization programs.
Using Linked Administrative Health Databases for An Obesity Case Definition
Authors: Hamm Naomi C , Yan Lin , Lix Lisa M
Published: December 2020

IntroductionCapture of obesity using administrative health data is poor, with many cases being under coded within the data. Linking multiple health data sources may improve case ascertainment and facilitate the use of administrative health data for obesity research and surveillance.

Objectives and ApproachThis research aims to determine if using individual-level linked data from multiple sources can improve case ascertainment for obesity in administrative health data. Data from between April 1, 2001 and March 31, 2015 were obtained from the Manitoba Population Data Repository. Eighteen obesity case definitions were developed with different observation times and combinations of diagnosis, procedure, and prescription codes from physician billing claims, hospitalization abstracts, and prescription drug records. Body mass index (BMI) records from primary care data and the Bone Mineral Density (BMD) registry were used for validation. Sensitivity, specificity, and Cohen’s kappa were calculated.

ResultsIndividuals with a higher BMI class had more physician visits and were more likely to have comorbidities and obese codes in the administrative health data. A higher BMI class was associated with being in a lower income quintile and the age group 40-59. Overall, the case definitions for obesity had high specificity (0.98-0.99) and low sensitivity (0.005-0.19) when validated using primary care data. Case definitions with obesity codes from multiple databases 3 year prior to and including the index date had the highest sensitivity (0.06-0.19) and kappa (0.04-0.23). Results with the BMD data were similar (specificity: 0.97-0.99; sensitivity: 0.007-0.21). Stratified analyses found agreement measures improved slightly for females, those who had chronic conditions and a later index year, and the age group 40-59.

Conclusion / ImplicationsWhen using multiple databases to build a case definition for obesity, sensitivity improves but remains low. Individuals with other chronic conditions and a higher BMI class were more likely to be accurately classified as an obese case.
Sex Differences in Mortality Among People with End-Stage Kidney Disease: Bi-National Data-Linkage Cohort Study
Authors: De La Mata Nicole L , Macleod Grace , Kelly Patrick J , Rosales Brenda , Masson Philip , Morton Rachel L , Webster Angela C
Published: December 2020

IntroductionFemale life expectancies consistently exceed males in the general population. Yet, this survival advantage may not persist in the presence of a chronic disease due to biological differences or healthcare inequities.

Objectives and ApproachWe aimed to explore sex differences in mortality among people with end-stage kidney disease (ESKD). T he entire ESKD population in Australia, 1980-2013, and New Zealand,1988-2012, were included from the Australian and New Zealand Dialysis and Transplant Registry. Data linkage to national death registers was undertaken to ascertain deaths and their causes. We estimated relative measures of survival, including standardized mortality ratios (SMR), relative survival and expected life years lost, using general population data to account for background mortality, adjusting for country, age, sex and year.

ResultsOf 60,823 ESKD patients, there were 25,042 females (41%) and 35,781 males (59%). Mortality sex differences within the ESKD population were minor, but once compared to the general population, female ESKD patients had more excess deaths, worse relative survival and greater life years lost compared to male ESKD patients. Females had 11.5 SMR (95%CI:11.3-11.7) and males had 6.7 SMR (95%CI:6.7-6.8), with greater disparity among younger ages and from certain causes. Relative survival was consistently lower in females, with adjusted excess mortality 9% higher (95%CI:7-12%) in ESKD females. Average life years lost was 4-5 years greater in ESKD females compared to males across all ages. Kidney transplantation reduced the sex differences in excess mortality, with similar relative survival (p=0.42) and average life years lost reduced to 3-4 years for females.

Conclusion / ImplicationsThe impact of ESKD is more profound for women than men with greater excess mortality, however kidney transplantation attenuates these differences. Our findings show that chronic diseases and sex can compound to produce worse outcomes where women lose their survival advantage in the presence of ESKD.
Risks of Squamous Cell Carcinoma of The Lip and Cutaneous Melanoma in Older Australians Using Hydrochlorothiazide (HTCZ)
Authors: Daniels Benjamin , Pearson Sallie-Anne , Vajdic Claire M , Pottegård Anton , Buckley Nicholas A , Zoega Helga
Published: December 2020

IntroductionHCTZ is first-line treatment for hypertension and among the most commonly used medicines in Australia. Recent evidence suggests increased risks of lip and skin cancers in association with HCTZ use.

Objectives and ApproachTo determine the risk of SCC of the lip and melanoma among people prescribed HCTZ in Australia we conducted a case-control study nested within a cohort of Department of Veterans’ Affairs clients 65 years and older in 2004-2015. We identified incident cases of SCC of the lip (lip cancer) and of cutaneous melanoma (malignant melanoma), each matched by sex and age with up to 20 controls through risk-set sampling. We ascertained HCTZ use from dispensing data and classified use according to ever/never use and cumulative use. We estimated odds ratios (ORs) associating HCTZ use with lip cancer and malignant melanoma using conditional logistic regression, adjusting for predefined confounders obtained from dispensing and hospitalisation data.

ResultsFor lip cancer (45 cases) ever-use of HCTZ yielded an OR of 2.6 (95%CI: 1.4–5.0) and high HCTZ use (>25,000mg) an OR of 4.7 (1.61–13.7). For malignant melanoma (659 cases) ever-use of HCTZ resulted in an OR of 1.2 (1.0–1.5) and high HCTZ use in an OR of 1.2 (0.8–1.8).

Conclusion / ImplicationsOur study provides further evidence that the photosensitising properties of HCTZ may promote SCC carcinogenesis, and possibly melanoma, in susceptible sun-exposed tissues. Our findings are the first from the Australian population—already at elevated risk of developing skin cancer—and add to the growing body of data supporting the need for skin cancer prevention advice and behaviours, and potentially heightened surveillance, for individuals prescribed this medication.
Long-Term Morbidity Following IGA Vasculitis in Childhood
Authors: Nossent Johannes , Raymond Warren , Ognjenovic Milica , Keen Helen , Preen David , Inderjeeth Charles
Published: December 2020

Background/ObjectivePatients with IgA vasculitis (IgAV aka Henoch Schonlein) may require aggressive initial treatment, are prone to disease relapses and may have sustained abnormal IgA responsiveness. We investigated whether the relatively rare diagnosis of childhood IgAV is associated with subsequent comorbidity, hospitalisation and interventions.

MethodsUsing linked administrative health data from the Western Australian Rheumatic Disease Registry we performed an observational cohort study comparing hospitalisation and ED visit rates(per 1000 person years), comorbidity accrual (Charlson comorbidity index; CCI) and procedures between 494 IgAV patients < 20 years and 1385 matched controls over a twenty-year period.

ResultsHospitalisation was proportionally (73.5 vs 51.5%) and by rate (21.7 vs 18.9; rate ratio 1.15, p<0.01) increased in IgAV patients. IgAV patients more often underwent diagnostic and medical procedures than controls, who had higher rates of surgical interventions. ED visit frequency (25 vs 16%) and rate (10.8 vs 8.43, rate ratio 1.29, (p<0.01) was also increased in IgAV patients, who more often accrued peptic ulcer and renal disease than controls and had an increased accrual of CCI ≥3.

Conclusions/ImplicationsA diagnosis of IgAV in childhood significantly increases the risk and rate of subsequent hospital admission, ED visits and accrual of severe comorbidity. Although often considered a self-limiting disease, the occurrence of childhood IgAV signifies the presence of a sustained predisposition to illness, likely related to abnormal IgA functioning.
Risk of Overdose-Related Death for People with A History of Incarceration
Authors: Gan Wenqi , Kinner Stuart , Xavier Chloé , Zhao Bin , Slaunwhite Amanda
Published: December 2020

IntroductionEpidemiologic studies have shown that people released from correctional facilities are at substantially increased risk of overdose-related death compared with the general population. However, the reported effect estimates are substantially heterogeneous, and the previous studies have important limitations in relative risk assessment for overdose-related death.

Objectives and ApproachBritish Columbia, Canada, has experienced an unprecedented epidemic of drug overdose, this study aimed to investigate how the overdose epidemic has affected formerly incarcerated persons. A 20% random sample of residents aged 18 years or older in British Columbia was used to conduct this cohort study. During the 5-year exposure period (January 2010 to December 2014), persons with an incarceration history were identified using provincial incarceration records. During the 3-year follow-up period (January 2015 to December 2017), overdose-related deaths were identified using linked administrative health data. Risk of overdose-related death was compared between persons who did and did not have an incarceration history using a Cox regression model.

ResultsOf 765,690 persons in the cohort, 5,743 had an incarceration history during the exposure period, and 634 died from drug overdose during the follow-up period. The mortality rate was 832 and 22 per 100,000 person-years for persons who did and did not have an incarceration history, respectively. Compared with persons without an incarceration history, and adjusting for individual and neighbourhood characteristics, persons who had an incarceration history were 3.67 times (95% confidence interval 2.93 - 4.59) more likely to die from drug overdose. This association was stronger for females, persons who did not have substance use disorder, and persons who were not dispensed opioids for pain or benzodiazepines.

Conclusion/ImplicationsPrevious incarceration is strongly associated with risk of overdose-related death. Specific interventions are needed to better prevent drug overdose for people released from incarceration.