bluuebunny/crossref_metadata_2025 huggingface dataset:
Shortcuts in knowledge mobilization: An ethnographic study of advanced nurse practitioner discharge decision‐making in the emergency department
Authors: King Rachel , Sanders Tom , Tod Angela
Published: March 2021

Aim

To understand how advanced nurse practitioners use knowledge to inform their discharge decision‐making in the emergency department.

Background

Advanced nurse practitioner roles have developed globally in a wide range of healthcare settings, including the emergency department, over the past few years. The scope of practice and training vary widely between countries. Little is known about how they use clinical knowledge in the emergency department.

Design

An ethnographic study was undertaken in an emergency department in the North of England.

Method

Data were collected by observation (n = 5) and semi‐structured interviews (n = 13) between September 2016 and June 2017. Interview transcripts and field notes were coded using Quirkos software. Thematic analysis was used to identify key themes.

Findings

In boundary blurring with medicine, advanced nurse practitioners in the emergency department need to make timely, autonomous discharge decisions. Knowledge mobilization is messy and complex; however, shortcuts facilitate autonomous discharge decision‐making. More experienced advanced nurse practitioners rely less on shortcuts as they draw on experiential knowledge.

Discussion

Boundary blurring in the advanced nurse practitioner role in the emergency department, requires reliable knowledge shortcuts. Support from senior colleagues and accessible smartphone apps enable advanced nurse practitioners to efficiently make discharge decisions. This study adds to previous research on how knowledge is managed in boundary blurring.

Conclusion

Advanced nurse practitioners in the emergency department require timely access to relevant, up to date knowledge. This study has highlighted their preferred knowledge sources to inform discharge decision‐making. In boundary blurring, shortcuts enable ANPs to use knowledge efficiently to inform patient care in the emergency department.

Impact

The findings increase our understanding of how to equip advanced nurse practitioners with knowledge to facilitate clinical decision‐making. Clinical managers should provide mentorship and relevant up to date knowledge shortcuts to ensure efficient, evidence‐based discharge decision‐making.
No More Gouda in Moscow? Distributive Effects of the Imposition of Sanctions
Authors: Onderco Michal , van der Veer Reinout Arthur
Published: March 2021

How do private firms respond when they are hit by economic sanctions? Economic sanctions are a vitally important element of the European Union's foreign policy toolbox. While their importance and frequency of use increased, not much is known about the economic impact of the economic sanctions at the micro level. Yet the sanctions imposition has been recently politicized within the EU, especially in the reaction to the sanctions that EU imposed on Russia, and the counter ‐ sanctions that ensued. Drawing on export data for all Dutch companies over the period 2013 –2016, we examine how Dutch companies responded to Russian counter ‐sanctions imposed on the EU after the annexation of Crimea. Our statistical matching approach suggests that while the companies exposed to the sanctions are more likely to go bankrupt compared to their unexposed counterparts, those who survive are able to weather the impact rather well in the medium ‐long term.
Evaluation of antimicrobial and antioxidant efficacy of hydro ethanol extract of peels of Kufri Chandramukhi, Kufri Chipsona‐3, and Kufri Jyoti potato varieties alone and in combination
Authors: Bhattacharya Abhishek , Purkait Shilpa , Bag Anwesa , Chattopadhyay Rabi Ranjan
Published: March 2021

The potato processing industries generate substantial quantities of phenolic‐rich potato peels as waste by‐products that could be valuable natural sources of antimicrobials and antioxidants in food industry. The present study is aimed to evaluate antimicrobial and antioxidant potential of hydro ethanol extract of peels of three commonly used potato varieties (Kufri Chandramukhi, Kufri Chipsona‐3, and Kufri Jyoti) alone and in combination along with cytotoxicity evaluation. At their individual effect, antimicrobial and antioxidant potential of potato peel extracts were found to be in the following decreasing order: Kufri Chisona‐3 > Kufri Jyoti > Kufri Chandramukhi. In combination, peel extracts of Kufri Chipsona‐3/Kufri Jyoti blend demonstrated synergistic antimicrobial and antioxidant interactions whereas other tested combinations showed additive antimicrobial and antioxidant effects. The peel extracts of Kufri Chipsona‐3/Kufri Jyoti blend did not show any cytotoxic effect up to 1000 μg/ml concentration. Besides, a high positive correlation between total phenolic contents and antimicrobial activity of potato peel extracts was observed. The results provide evidence that hydro ethanol extract of potato peels of Kufri Chipsona‐3/Kufri Jyoti blend may help in designing a more potent safe and effective novel natural antimicrobial and antioxidant agents in food and pharmaceutical industries.
Study on the correlation between vaginal bleeding in first trimester and preterm birth: A birth cohort study in Lanzhou, China
Authors: Liu Sufen , Yu Liqun , Wu Qianfeng , Cui Hongmei , Lin Xiaojuan , Wang Wendi
Published: March 2021

Objects

To investigate the correlation between first trimester vaginal bleeding and preterm birth (PB), and to offer suggestions on the perinatal health care and preterm birth prevention.

Methods

A birth cohort study was conducted on 10 179 pregnant women. Unconditional logistic regression model was used to evaluate the associations between vaginal bleeding and preterm birth in sub‐preterm groups.

Results

Of the 10 179 pregnant women included, a total of 1001 women suffered from vaginal bleeding during the first trimester, of which 119 suffered from PB. Any vaginal bleeding increased the risk of PB. Severe bleeding was a high‐risk factor of PB, associated with 4.8‐fold risk of very PB, 2.7‐fold risk of spontaneous PB without PROM (premature rupture of membrane) and 4.6‐fold risk of medical induced PB. Bleeding prolonged more than 1 week increased 66% risk of PB and 36% risk of PB on initial episode happened in 5–12 weeks of gestation age, especially in moderate PB, in medical‐induced PB and in spontaneous PB with PPROM (preterm premature rupture of membrane which is one cause of PB). Mild bleeding or bleeding within 1 week or initial episode happened within 4 weeks of gestation age possibly had no influence on PB.

Conclusion

Vaginal bleeding in the first‐trimester was an independent risk factor for PB. The severity, duration and initial time of vaginal bleeding had different effects on different subtypes of PB.
Assessment of nutritional status in paediatric outpatients using bioelectrical impedance analysis and anthropometric z‐scores
Authors: Zhu Yuan , Ye Hong , Feng Yi , Pan Li‐ya , Fu Huan‐huan , Liu Yun‐man , Fei Jun , Hong Li
Published: March 2021

Aim

To investigate paediatric outpatients' nutritional status using bioelectrical impedance analysis and anthropometric z‐scores.

Methods

A retrospective data analysis of tertiary paediatric hospital outpatients from 2017 to 2019 was conducted. Patients were categorised into three groups (non‐illness, illness and simple obesity) according to clinical diagnoses. The nutritional status was evaluated using anthropometric and bioelectrical impedance analysis. In addition, body composition measurements of patients in three subgroups of the illness group and age‐ and gender‐matched healthy controls were compared.

Results

A total of 2015 paediatric outpatients were enrolled. According to body mass index z‐scores, undernutrition prevalence among participants was 14.0% (non‐illness group, 21.3%; illness group, 11.4%). Body composition measurements indicated that 41.6% of participants had a low fat‐free mass index, and the proportions of participants with a low fat‐free mass index in the non‐illness, illness and simple obesity groups were 48.4, 47.0 and 10.7%, respectively. Compared with healthy controls, the haematology and oncology subgroup had a significantly lower fat‐free mass index and fat mass index; the nephrology and rheumatology subgroup had significantly lower height‐for‐age z‐scores but higher fat mass index; and the gastroenterology subgroups had lower fat mass index, fat‐free mass index and body mass index z‐scores.

Conclusions

The results suggested the low fat‐free mass index prevalence was greater than the low body mass index z‐score prevalence among paediatric outpatients, and body composition parameters varied across different illnesses. Body composition analysis is recommended in nutrition clinics for accurate paediatric outpatient nutritional assessment, thereby providing timely individualised nutritional interventions.
Convergence stories of post‐socialist Central‐Eastern European countries
Authors: Baksa Dániel , Kónya István
Published: March 2021

This paper views the growth and convergence process of five Central‐Eastern European economies between 1996 and 2019—the Czech Republic, Hungary, Poland, Slovenia and Slovakia—through the lens of an open economy, stochastic neoclassical growth model with simple financial frictions. Our main question is whether shocks to the growth rate of productivity (‘trend’) or shocks to the external interest premium are more important to understand the volatility of GDP growth and its components. We find that while GDP growth fluctuations can be traced back to productivity shocks, the composition of GDP—and consumption in particular—was driven particularly by premium shocks. Investment‐specific and labor market shocks are also important. Our panel estimation allows us to separate global and local components for the productivity‐trend and interest premium shocks. Results indicate that the global trend component is well approximated by the growth rate of the advanced European Union economies, and we also find tentative evidence that recent investment behavior is driven to a large extent by European Union funds.
The effect of chemical exudates of three larvivorous fish species on oviposition preference of Aedes aegypti and Aedes albopictus (Diptera: Culicidae)
Authors: Rathnayaka R. M. G. S. , Jayatunga D. P. W. , Ganehiarachchi G. A. S. M.
Published: March 2021

Mosquito species Aedes aegypti and Aedes albopictus are vectors of dengue worldwide. Mosquito vector control through maintaining larvivorous fish in water bodies is generally suggested, however, its underlying role towards oviposition preference of these dengue vectors is unknown in the Sri Lankan context. The current study investigated the effect of chemical exudates from larvivorous fish species Poecilia reticulata, Rasbora daniconius and Applocheilus dayi on the oviposition preference of Aedes mosquitoes. The number of eggs laid by each mosquito species was determined using ovitraps that contained water conditioned by the fish species both separately and in combination. The ovitraps were placed inside insect cages containing engorged gravid Aedes females. Both the mosquito species had the least preference of oviposition in water conditioned by A. dayi followed by R. daniconius. The highest preference of oviposition was shown for water conditioned by P. reticulata. The current study indicated that oviposition site selection in Ae. aegypti and Ae. albopictus was reduced by A. dayi and R. daniconius, however, it was not influenced by the fish combinations used. Further studies are warranted to understand the chemical cues associated with larvivorous fish towards the oviposition preference in Aedes mosquitoes.
Lozenges with probiotic strains enhance oral immune response and health
Authors: Lin Chiao‐Wen , Chen Yi‐Tzu , Ho Hsieh‐Hsun , Hsieh Pei‐Shan , Kuo Yi‐Wei , Lin Jia‐Hung , Liu Cheng‐Ruei , Huang Yu‐Fen , Chen Ching‐Wei , Hsu Chen‐Hung , Lin Wen‐Yang , Yang Shun‐Fa
Published: March 2021

Objective

Probiotics participate in regulating oral microbiota and reducing the prevalence of oral diseases; however, clinical research on probiotics is insufficient. Therefore, in this study, we performed in vitro screening of potential oral protective probiotic strains and then evaluated the clinical efficacy of the selected strains on maintaining oral health.

Materials and methods

Fifty healthy individuals were recruited and randomly assigned into the placebo group and probiotics group, which included three strains of probiotics, Lactobacillus salivarius subs. salicinius AP‐32, Lactobacillus paracasei ET‐66, and Lactobacillus plantarum LPL28. Each group was blindly administered placebo or probiotics for four weeks.

Results

Next‐generation sequencing results showed that the oral microbiota of Lactobacillus salivarius in the oral cavity were significantly increased in subjects supplemented with mixed probiotic lozenges. The anti‐bacterial activities of viable probiotics were observed within two weeks. Both IgA levels and Lactobacillus and Bifidobacterium abundances in the oral cavity were significantly increased in the experimental groups, along with a reduced formation of plaque. Most participants reported that their oral health conditions and intestinal symptoms had improved.

Conclusions

Overall, our clinical study suggests that oral probiotic lozenges may enhance oral immunity, modulate oral microbiota, and improve oral health.
Managing technical reputation: Regulatory agencies and evidential work in risk assessment
Authors: Demortain David , Borraz Olivier
Published: March 2021

How can regulatory agencies with a technical or scientific mission forge and defend their reputation, when the definition of expertise is subject to countervailing influences and perceptions among a wide array of audiences? In this paper, we tackle this broad question, focusing on a particular episode of the European controversy over the regulatory control of exposure to bisphenol A, during which the European Food Safety Authority altered the method by which it produced an assessment of the risk of BPA, responding to the regulatory controversy surrounding this substance. Building on the literature on organizational reputation and science and technology studies, we shed light on the work that regulatory agencies undertake to gain credibility in particular configurations of audiences. This perspective on the management of audiences and knowledge standards is central for the explanation of the decisions, policies, and strategies of science‐based agencies, and the way in which a technical reputation takes form in controversy‐prone areas of regulation.
Testing for a dietary shift in the Early Cretaceous ceratopsian dinosaur Psittacosaurus lujiatunensis
Authors: Landi Damiano , King Logan , Zhao Qi , Rayfield Emily J. , Benton Michael J.
Published: March 2021

Many dinosaurs may have shown ecological differentiation between hatchlings and adults, possibly because of the great size differential. The basal ceratopsian Psittacosaurus lujiatunensis is known from thousands of specimens from the Lower Cretaceous of China and these include many so‐called ‘juvenile clusters.’ During the early stages of ontogeny, P. lujiatunensis underwent a posture shift from quadrupedal to bipedal, and a dietary shift has also been postulated. In this study, we made a 2D mechanical analysis of the jaws of a hatchling and an adult to determine the differences between the two systems; we found some differences, but these were only modest. The adult was better suited to feeding on tough plant material than the hatchling, based on its higher values of absolute and relative bite forces and higher values of mechanical advantage, but there were no substantial shifts in jaw shape or function.
Methane‐rich water induces bulblet formation of scale cuttings in Lilium davidii var. unicolor by regulating the signal transduction of phytohormones and their levels
Authors: Qi Nana , Hou Xuemei , Wang Chunlei , Li Changxia , Huang Dengjing , Li Yihua , Wang Ni , Liao Weibiao
Published: March 2021

Previous studies have shown that methane (CH4) has promoting roles in the adventitious root (AR) and lateral root (LR) formation in plants. However, whether CH4 could trigger the bulblet formation in scale cutting of Lilium davidii var. unicolor has not been elucidated. To gain insight into the effect of CH4 on the bulblet formation, different concentrations (1, 10, 50, and 100%) of methane‐rich water (MRW) and distilled water were applied to treat the scale cuttings of Lilium. We observed that treatment with 100% MRW obviously induced the bulblet formation in scale cuttings. To explore the mechanism of CH4‐induced bulblet formation, the transcriptome of scales was analyzed. A total of 2078 differentially expressed genes (DEGs) were identified. The DEGs were classified into different metabolic pathways, especially phenylpropanoid biosynthesis, starch and sucrose metabolism, and plant signal transduction. Of these, approximately 38 candidate DEGs involved in the plant signal transduction were further studied. In addition, the expression of AP2‐ERF/ERF, WRKY, GRAS, ARF, and NAC transcription factors (TFs) was changed by MRW treatment, suggesting their potential involvement in bulblet formation. As for hormones, exogenous IAA, GA, and ABA could induce the bulblet formation. Additional experiments suggested that MRW could increase the endogenous IAA, GA, and JA levels, but decrease the levels of ABA during bulblet formation, which showed that higher IAA, GA, JA levels and lower ABA content might facilitate bulblet formation. In addition, the levels of endogenous hormones were consistent with the expression level of genes involved in phytohormone signal transduction. Overall, this study has revealed that CH4 might improve the bulblet formation of cutting scales in Lilium by regulating the expression of genes related to phytohormone signal transduction and TFs, as well as by changing the endogenous hormone levels.
Black Women and the Pleasures of Intellectual Work
Authors: Wall Cheryl
Published: March 2021

What does it mean for a Black woman to choose to do intellectual work? In the twenty‐first century, Black women, either by virtue of their academic careers or their vocations outside of institutional settings, pursue intellectual work for its own sake as well as in pursuit of collective goals. That is to say, they can acknowledge intellectual work as a source of personal fulfillment, indeed a source of joy in ways that earlier generations of Black women could not. At least that should be true. In fact, it remains difficult for Black women to own the joy that their engagement with ideas produces.
Advancing preservice teacher’s science pedagogy beyond the classroom
Authors: Feille Kelly K.
Published: March 2021

The goals of science education include providing students with real‐world learning experiences that connect directly to learning objectives and deepen student interest in science. Learning experiences that occur outside of the science classroom can help science educators respond to these goals. To encourage the use of learning environments beyond the four walls of a classroom, teacher preparation programs should integrate learning experiences for preservice teachers that engage them in learning science and methods for science teaching beyond the classroom. The purpose of this study was to investigate how preservice teachers’ learning and pedagogical experiences in an elementary science methods class that extends beyond the classroom setting may influence the frequency and type of out‐of‐classroom experiences they include in self‐constructed, 5E instructional sequences. Findings in this exploratory, multicase study indicate that preservice teachers who experienced out‐of‐classroom learning in their science methods course may be likely to include similar types of learning in their written lesson plans. However, PSETs who were offered multiple and varied learning experiences beyond the traditional classroom were more likely to include out‐of‐classroom experiences in self‐constructed 5E instructional sequences than those with limited or one‐time experiences.
The Lasting Effects of the COVID‐19 Pandemic on Support for Anti‐Democratic Political Systems: A Six‐Month Longitudinal Study
Authors: Roccato Michele , Russo Silvia , Colloca Pasquale , Cavazza Nicoletta
Published: March 2021

Objectives

We aimed to analyze the enduring effects exerted by COVID‐19 exposure and subjective economic threats on support for anti‐democratic political systems.

Method

We performed a two‐wave longitudinal study on a quota panel of the Italian adult population (N  =  1,073), surveyed first in April 2020, during the first peak of the pandemic (T1) and the first lockdown, and second in October 2020, at the onset of the second peak of the pandemic and of the second lockdown (T2).

Results

A mediation model showed that COVID‐19 exposure and subjective economic threats, measured at T1, fostered a negative evaluation of how the government managed the pandemic, which, in turn, had a positive association with support for anti‐democratic political systems, both measured at T2.

Conclusion

The existential threats related to the COVID‐19 pandemic have enduring political consequences, undermining people's support for democracy, even six months after their onset.
Audit of the provision of nutritional support to mechanically ventilated dogs and cats
Authors: Greensmith Thomas D. , Chan Daniel L.
Published: March 2021

Objectives

To evaluate the use of enteral and parenteral nutrition in a population of mechanically ventilated cats and dogs, identify factors associated with implementation of nutrition, and assess the frequency of nutritional support within 72 hours of absent caloric intake.

Design

Retrospective, single‐center audit from June 2013 to June 2016.

Setting

ICU of a veterinary university teaching hospital.

Animals

Fifty‐eight animals (50 dogs, 8 cats) that underwent mechanical ventilation for ≥6 hours with complete medical records.

Interventions

None.

Measurements and Main Results

Data collected included nutritional provision, time to initiation of nutrition, period of absent caloric intake, percentage of caloric intake obtained, and possible factors contributing to the delay or failure to implement nutrition. Thirty‐one percent of patients (dogs 16/50, 32%; cats 2/8, 25%) received nutritional support during mechanical ventilation with all but 2 dogs receiving parenteral nutrition. Of those patients that did not receive nutrition (dogs 34/50, 68%; cats 6/8, 75%), documented contraindications or notations within the medical record for its omission were present in 16 of 34 dogs (47%) and 4 of 6 cats (66.7%). Thirteen animals (11 dogs, 2 cats) had >72 hours of absent caloric intake with only a small number of these receiving nutrition (dogs 4/11, 36.4%; cats 0/2, 0%).

Conclusions

Only 18 of 58 (31%) mechanically ventilated dogs and cats at our institution received nutritional support, and the majority of these were fed parenterally (16/18, 88.9%). For animals that did not receive nutrition, there was no clear reason for its absence in many cases. Animals with absent caloric intake >72 hours had poor implementation of nutritional support in contrast to current guidelines. A repeat audit after implementing changes to institutional protocols for nutritional provision is warranted to assess the impact on morbidity and mortality.
Computational Simulation and Analysis of Major Control Parameters of Time-Dependent Photovoltaic/Thermal Collectors
Authors: Shi Jimeng , Lin Cheng-Xian
Published: March 2021

In order to improve the transient performance of photovoltaic/thermal (PV/T) collectors, this paper first developed and validated an improved computational thermal model to investigate the effects of the major control parameters on the thermal performance of PV/T collectors, including inlet water temperature and inlet water flowrate. Second, a computational electrical model of PV/T system, coupled with the thermal model, was also introduced to elaborate the relationship of voltage, current, and power of a PV module (MSX60 polycrystalline solar cell) used in an experiment in the literature. The thermal and electrical models were solved simultaneously to predict the transient energy conversion efficiencies of the PV/T system. Simulation results were found to agree with the experimental data very well. The effects of the time-steps from 1 h to 1 min, which is close to real-time, were reported at various conditions. It was found that both thermal and electrical efficiencies are fluctuating with time. There is an optimal water flow rate at which the efficiencies are at the maximum. Suggestions to improve the efficiency of PV/T system were discussed.
Dynamic Modeling of the Double-Nut Planetary Roller Screw Mechanism Considering Elastic Deformations
Authors: Fu Xiaojun , Liu Geng , Li Xin , Ma Shangjun , Qiao Guan
Published: March 2021

With the rising application of double-nut planetary roller screw mechanism (PRSM) into industry, increasing comprehensive studies are required to identify the interactions among motion, forces and deformations of the mechanism. A dynamic model of the double-nut PRSM with considering elastic deformations is proposed in this article. As preloads, inertial forces and elastic deformations have a great influence on the load distribution among threads, the double-nut PRSM is discretized into a spring–mass system. An adjacency matrix is introduced, which relates the elastic displacements of nodes and the deformations of elements in the spring–mass system. Then, the compressive force acting on the spacer is derived and the equations of load distribution are given. Considering both the equilibrium of forces and the compatibility of deformations, nonlinear equations of motion for the double-nut PRSM are developed. The effectiveness of the proposed model is verified by comparing dynamic characteristics and the load distribution among threads with those from the previously published models. Then, the dynamic analysis of a double-nut PRSM is carried out, when the rotational speed of the screw and the external force acting on the nut #2 are changed periodically. The results show that if the external force is increased, the preload of the nut #1 is decreased and that of the nut #2 is increased. Although the nominal radii of rollers are the same, the maximum contact force acting on the roller #2 is much larger than that of the roller #1.
Despite obstacles, WHO unveils plan to distribute vaccine
Authors: Kupferschmidt Kai
Published: March 2021

Nations with nearly two-thirds of world's population have joined, but not the United States, Russia, or China.
Dark skies and bright satellites
Authors: Tyson Anthony , Parriott Joel
Published: March 2021

Most ground-based observatories require a dark night sky to uncover answers to some of the most fundamental questions about the nature of our Universe. However, a number of companies and governments are in various stages of planning or deploying bright satellites in low-Earth orbit (or LEOsats) in greater numbers than ever before. These “megaconstellations” will fundamentally change astronomical observing at visible wavelengths. Nighttime images will be contaminated by streaks caused by the passage of Sun-illuminated satellites. If proposals calling for 100,000 or more LEOsats are realized, no combination of mitigations will be able to fully avoid the negative impact on astronomy.
A Riemerella anatipestifer Metallophosphoesterase That Displays Phosphatase Activity and Is Associated with Virulence
Authors: Niu Pengfei , Chen Zongchao , Ren Xiaomei , Han Wenlong , Dong Hongyan , Shen Ruyu , Ding Chan , Zhu Shanyuan , Yu Shengqing
Published: March 2021

Riemerella anatipestifer
T9SS was recently discovered to be associated with bacterial gliding motility and secretion of virulence factors. Several T9SS genes have been identified, but no effector has been reported in
R. anatipestifer
to date.
Considerations Regarding Activity Determinants of Fungal Polyphenol Oxidases Based on Mutational and Structural Studies
Authors: Nikolaivits Efstratios , Valmas Alexandros , Dedes Grigorios , Topakas Evangelos , Dimarogona Maria
Published: March 2021

PPOs are enzymes of biotechnological interest. They have been extensively studied both biochemically and structurally, with a special focus on the plant-derived counterparts.
North China craton: The conjugate margin for northwestern Laurentia in Rodinia
Authors: Ding Jikai , Zhang Shihong , Evans David A.D. , Yang Tianshui , Li Haiyan , Wu Huaichun , Chen Jianping
Published: March 2021

In the Rodinia supercontinent, Laurentia is placed at the center because it was flanked by late Neoproterozoic rifted margins; however, the conjugate margin for western Laurentia is still enigmatic. In this study, new paleomagnetic results have been obtained from 15 ca. 775 Ma mafic dikes in eastern Hebei Province, North China craton (NCC). Stepwise thermal demagnetization revealed a high-temperature component, directed northeast or southwest with shallow inclinations, with unblocking temperatures of as high as 580 °C. Rock magnetism suggests the component is carried by single-domain and pseudo-single-domain magnetite grains. Its primary origin is supported by a positive reversal test and regional remanence direction correlation test, and the paleomagnetic pole (29.0°S, 64.7°E, A95 = 5.4°) is not similar to any published younger poles of the NCC. Matching the late Mesoproterozoic to early Neoproterozoic (ca. 1110–775 Ma) apparent polar wander paths of the NCC and Laurentia suggests that the NCC could have been the conjugate margin for northwestern Laurentia in Rodinia, rather than sitting off the northeast coast of the main Rodinian landmass. Geological data indicate that breakup of the NCC and Laurentia occurred between ca. 775 and 720 Ma.
Archean geodynamics: Ephemeral supercontinents or long-lived supercratons
Authors: Liu Yebo , Mitchell Ross N. , Li Zheng-Xiang , Kirscher Uwe , Pisarevsky Sergei A. , Wang Chong
Published: March 2021

Many Archean cratons exhibit Paleoproterozoic rifted margins, implying they were pieces of some ancestral landmass(es). The idea that such an ancient continental assembly represents an Archean supercontinent has been proposed but remains to be justified. Starkly contrasting geological records between different clans of cratons have inspired an alternative hypothesis where cratons were clustered in multiple, separate “supercratons.” A new ca. 2.62 Ga paleomagnetic pole from the Yilgarn craton of Australia is compatible with either two successive but ephemeral supercontinents or two long-lived supercratons across the Archean-Proterozoic transition. Neither interpretation supports the existence of a single, long-lived supercontinent, suggesting that Archean geodynamics were fundamentally different from subsequent times (Proterozoic to present), which were influenced largely by supercontinent cycles.
Light Curves of Type Ia Supernovae
Authors: Lyutykh A. V. , Pruzhinskaya M. V. , Blinnikov S. I.
Published: March 2021

We have studied the light curves of type Ia supernovae (SNe Ia) and the physical parameters inferred from them. We have constructed both analytical and numerical light curves of SNe Ia. Using an empirical relation between the SN luminosity and light-curve parameters, we have managed to impose constraints on the hydrodynamic solutions obtained by the STELLA code and to produce a sample of models that describe the observational properties of real SNe maximally accurately. With this sample we have established a relationship between the opacity in SN Ia ejecta and the parameters being determined directly from observations. The method has been tested on two classical SNe Ia as an example: 2011fe and 2012fr. The presented approach allows the opacity to be found without resorting to time-consuming computations.
Management of Crohn’s disease in an immunosuppressed COVID-19-positive patient: safety-driven prioritisation of nutritional therapy as a bridge to restarting immunosuppression
Authors: Harris Clare , Harris Richard James , Downey Louise , Gwiggner Markus
Published: March 2021

Active inflammatory bowel disease (IBD), combined immunosuppression and corticosteroid therapy have all been identified as risk factors for a poor outcome in COVID-19 infection. The management of patients with both COVID-19 infection and active IBD is therefore complex. We present the case of a 31-year-old patient with Crohn’s disease, on dual immunosuppression with infliximab and mercaptopurine presenting with inflammatory small bowel obstruction and COVID-19 infection. The case highlights the use of nutritional therapy, which remains underused in the management of adults with IBD, to manage his flare acutely. Following negative SARS-CoV-2 PCR testing and SARS-CoV-2 IgG testing confirming an antibody response, ustekinumab (anti-interleukin 12/23) was prescribed for long-term maintenance.
Recovery from refractory chronic fatigue syndrome with CBT and modafinil
Authors: Garg Himanshu , Douglas Maggie , Turkington Gordon Douglas , Turkington Douglas
Published: March 2021

Many patients with chronic fatigue syndrome (CFS) fail to derive benefit from evidence-based treatments such as cognitive–behavioural therapy (CBT) and graded exercise therapy leading to permanent disability. To discover whether a repeat prescription of modafinil might potentiate the benefits of CBT leading to social recovery as defined by 2 or more point improvement in energy and muscular pain/concentration and return to work or full-time training. Three patients with treatment-resistant CFS (mean duration 17.66 years) treated with modafinil and CBT in a Liaison Psychiatry clinic were retrospectively reviewed. Progress was reviewed at baseline, 4–6 months and 10–24 months. Patients rated their fatigue, pain and concentration using 10-point Likert scales. 2/3 achieved clinically meaningful improvements in energy and pain/concentration and 3/3 achieved social recovery. Modafinil, when prescribed over the medium term, would appear to be a potentially useful potentiating agent when added to CBT.
Treatment of a rare and complex carotid-cavernous fistula
Authors: Chugh Arunit J S , Duan Yifei , Hu Yin C
Published: March 2021

Carotid-cavernous fistulas (CCFs) are abnormal connections between arteries and the cavernous sinuses. Traditionally, the Barrow Classification system has been used to characterise these fistulas based on their arterial supply from the internal carotid artery (ICA), external carotid artery (ECA) or both. We present a unique case of a patient with a complex CCF with arterial feeders from dural branches of the ECA, ICA and vertebral artery (VA), which, to our knowledge, has not been reported in the literature. Given unique arterial supply pattern involving contribution from the extracranial VA, this CCF falls outside of the traditional Barrow Classification system. The patient ultimately underwent a transfemoral transvenous coil embolisation using multiple dynamic venous routes with obliteration of bilateral CCFs and near complete resolution of her preoperative symptoms.
Temporal variations in the severity of COVID-19 illness by race and ethnicity
Authors: Ebinger Joseph E , Driver Matthew , Ji Hongwei , Claggett Brian , Wu Min , Luong Eric , Sun Nancy , Botting Patrick , Kim Elizabeth H , Hoang Amy , Nguyen Trevor Trung , Diaz Jacqueline , Park Eunice , Davis Tod , Hussain Shehnaz , Cheng Susan , Figueiredo Jane C
Published: March 2021

Introduction

Early reports highlighted racial/ethnic disparities in the severity of COVID-19 seen across the USA; the extent to which these disparities have persisted over time remains unclear. Our research objective was to understand temporal trends in racial/ethnic variation in severity of COVID-19 illness presenting over time.

Methods

We conducted a retrospective cohort analysis using longitudinal data from Cedars-Sinai Medical Center, a high-volume health system in Southern California. We studied patients admitted to the hospital with COVID-19 illness from 4 March 2020 through 5 December 2020. Our primary outcome was COVID-19 severity of illness among hospitalised patients, assessed by racial/ethnic group status. We defined overall illness severity as an ordinal outcome: hospitalisation but no intensive care unit (ICU) admission; admission to the ICU but no intubation; and intubation or death.

Results

A total of 1584 patients with COVID-19 with available demographic and clinical data were included. Hispanic/Latinx compared with non-Hispanic white patients had higher odds of experiencing more severe illness among hospitalised patients (OR 2.28, 95% CI 1.62 to 3.22) and this disparity persisted over time. During the initial 2 months of the pandemic, non-Hispanic blacks were more likely to suffer severe illness than non-Hispanic whites (OR 2.02, 95% CI 1.07 to 3.78); this disparity improved by May, only to return later in the pandemic.

Conclusion

In our patient sample, the severity of observed COVID-19 illness declined steadily over time, but these clinical improvements were not seen evenly across racial/ethnic groups; greater illness severity continues to be experienced among Hispanic/Latinx patients.
Self-reported sick leave following a brief preventive intervention on work-related stress: a randomised controlled trial in primary health care
Authors: Hultén Anna-Maria , Bjerkeli Pernilla , Holmgren Kristina
Published: March 2021

Objectives

To evaluate the effectiveness of a brief intervention about early identification of work-related stress combined with feedback at consultation with a general practitioner (GP) on the number of self-reported sick leave days.

Design

Randomised controlled trial. Prospective analyses of self-reported sick leave data collected between November 2015 and January 2017.

Setting

Seven primary healthcare centres in western Sweden.

Participants

The study included 271 employed, non-sick-listed patients aged 18–64 years seeking care for mental and/or physical health complaints. Of these, 132 patients were allocated to intervention and 139 patients to control.

Interventions

The intervention group received a brief intervention about work-related stress, including training for GPs, screening of patients’ work-related stress, feedback to patients on screening results and discussion of measures at GP consultation. The control group received treatment as usual.

Outcome measures

The number of self-reported gross sick leave days and the number of self-reported net sick leave days, thereby also considering part-time sick leave.

Results

At 6 months’ follow-up, 220/271 (81%) participants were assessed, while at 12 months’ follow-up, 241/271 (89%) participants were assessed. At 6-month follow-up, 59/105 (56%) in the intervention group and 61/115 (53%) in the control group reported no sick leave. At 12-month follow-up, the corresponding numbers were 61/119 (51%) and 57/122 (47%), respectively. There were no statistically significant differences between the intervention group and the control group in the median number of self-reported gross sick leave days and the median number of self-reported net sick leave days.

Conclusions

The brief intervention showed no effect on the numbers of self-reported sick leave days for patients seeking care at the primary healthcare centres. Other actions and new types of interventions need to be explored to address patients’ perceiving of ill health due to work-related stress.

Trial registration number

NCT02480855.
High TG/HDL ratio suggests a higher risk of metabolic syndrome among an elderly Chinese population: a cross-sectional study
Authors: Nie Guqiao , Hou Shukai , Zhang Meng , Peng Wen
Published: March 2021

Objectives

To investigate the relationship between triglyceride/high-density lipoprotein cholesterol (TG/HDL-C) ratio and metabolic syndrome in the elderly population of China, and to determine the best critical value of TG/HDL-C in higher risk of metabolic syndrome in this population.

Design

Cross-sectional study.

Setting

Our study was conducted in a community physical examination centre in Wuhan, China between 1 January 2016 and 31 December 2016.

Participants

The physical examination data from 1267 elderly people (aged over 65 years) in the community were analysed in this study. The average age of the study participants was 71.64±5.605 years.

Primary outcome measures

Correlation between the TG/HDL-C ratio and metabolic syndrome; the optimum cut-off of the TG/HDL-C ratio for the prediction of metabolic syndrome.

Results

The TG/HDL-C ratio showed a significant positive correlation with metabolic syndrome (r=0.420, p<0.001) in the elderly Chinese population. Binary logistic regression analysis showed that the TG/HDL-C ratio was an independent risk factor for metabolic syndrome (OR=3.07 (95% CI: 2.402 to 3.924), p<0.001) after adjusting for blood pressure, blood glucose, age, sex and body mass index. The receiver operating characteristic curves of TG/HDL-C ratio and metabolic syndrome showed that in the elderly population, a TG/HDL-C ratio of 1.49 can be used as the critical value for a higher risk of metabolic syndrome. At this value, the specificity and sensitivity of the measure were optimal (80.8% and 72.4%, respectively).

Conclusion

In this study, we found a significant correlation between TG/HDL-C ratio and metabolic syndrome. And high TG/HDL ratio suggests a higher risk of metabolic syndrome among an elderly Chinese population.
Perspectives of paediatric hospital staff on factors influencing the sustainability and spread of a safety quality improvement programme
Authors: Lachman Peter , Gondek Dawid , Edbrooke-Childs Julian , Deighton Jessica , Stapley Emily
Published: March 2021

Objective

Situation Awareness For Everyone (SAFE) is a quality improvement programme aiming to improve situation awareness in paediatric clinical teams. The aim of our study was to examine hospital staff perceptions of the facilitators and barriers/challenges to the sustaining and subsequent spread of the huddle, the key intervention of the SAFE programme.

Setting

Interviews were held on two wards in two children hospitals and on two children wards in two district general hospitals.

Method

Semistructured interviews were conducted with 23 staff members from four National Health Service paediatric wards. A deductive thematic analysis was conducted, drawing on an existing framework, which groups the factors influencing programme sustainability into four categories: innovation, leadership, process and context.

Participants

23 staff in two children’s hospitals and two children’s wards across four UK hospitals, comprising of nurses and doctors, administration or housekeeping staff, ward managers and matrons, and allied professionals.

Primary outcomes

Understanding factors contributing to the sustaining and spread of a quality improvement intervention.

Results

Perceptions of the benefits, purpose and fit of the huddle, team commitment, sharing learning, adaptation of the method and senior leadership were identified as facilitators. High staff turnover, large multiple specialty medical staff teams, lack of senior leadership and dislike of change were identified as barriers/challenges.

Conclusions

Sustaining and spreading quality improvement interventions in a complex clinical setting requires understanding of the interplay between the actual innovation and existing leadership, process and contextual factors. These must be considered at the planning stage of an innovation to maximise the potential for sustainability and spread to other settings.
Anticipated responses to a hypothetical minimum price for cigarettes and roll-your-own tobacco: an online cross-sectional survey with cigarette smokers and ex-smokers in the UK
Authors: Critchlow Nathan , Moodie Crawford , Best Catherine , Stead Martine
Published: March 2021

Objectives

As tobacco companies can circumvent tax increases, a minimum retail price per-cigarette/per-gram of roll-your-own tobacco presents an additional mechanism for governments to reduce smoking. We examined (1) anticipated responses to a hypothetical minimum price-per-cigarette/per-gram among smokers in the UK; (2) what demographic and smoker characteristics are associated with anticipated responses; and (3) whether minimum pricing may help ex-smokers stay quit.

Design

Cross-sectional survey (May–July 2019).

Setting

UK.

Participants

Adult cigarette smokers (n=2412) and ex-smokers (n=700).

Main outcome measurements

Anticipated responses to a hypothetical minimum price of £10.00 for 20 cigarettes (£0.50 per-cigarette) and £13.50 for 30 grams of roll-your-own tobacco (£0.45 per-gram); approximately £0.10 per-cigarette/per-gram increases on the cheapest prices in leading UK supermarkets (January 2019). Smokers were presented with ten options (eg, ‘Try to quit’) and asked which they would do (Yes/No) and then which they would most likely do. Ex-smokers were asked to what extent the minimum prices would help them stay quit (A lot vs Lesser agreement).

Results

Among smokers, 55.6% said they would most likely smoke the same amount, 10.7% they would smoke less, 9.5% they would try to quit and 5.8% they would use e-cigarettes more often. Anticipated reactions were associated with demography and smoker characteristics, for example, C2DE (lower social grade) smokers were less likely than ABC1 (higher social grade) smokers to say they would smoke the same as they do now (ORAdj=0.74, 95% CI 0.62 to 0.88). Among ex-smokers, 38.5% said the minimum prices would help them stay quit ‘A lot’, more so among C2DE than ABC1 participants (ORAdj=1.80, 95% CI 1.30 to 2.49).

Conclusions

In response to a hypothetical minimum price for cigarettes and roll-your-own tobacco, approximately a fifth of smokers in the UK indicated they would smoke less or quit and almost two-fifths of ex-smokers indicated the prices would help them stay quit.
Videogame intervention to increase advance care planning conversations by hospitalists with older adults: study protocol for a stepped-wedge clinical trial
Authors: Mohan D , O"Malley A James , Chelen Julia , MacMartin Meredith , Murphy Megan , Rudolph Mark , Barnato Amber
Published: March 2021

Introduction

Fewer than half of all people in the USA have a documented advance care plan (ACP). Hospitalisation offers an opportunity for physicians to initiate ACP conversations. Despite expert recommendations, hospital-based physicians (hospitalists) do not routinely engage in these conversations, reserving them for the critically ill.

The objective of this study is to test the effect of a novel behavioural intervention on the incidence of ACP conversations by hospitalists practicing at a stratified random sample of hospitals drawn from 220 US acute care hospitals staffed by a large, nationwide acute care physician practice with an ongoing ACP quality improvement initiative.

Methods and analysis

We developedHopewell Hospitalist, a theory-based adventure video game, to modify physicians" attitudes towards ACP conversations and to increase their motivation for engaging in them. The planned study is a pragmatic stepped-wedge crossover phase III trial, testing the efficacy ofHopewell Hospitalistfor increasing ACP conversations. We will randomise 40 hospitals to the month (step) in which they receive the intervention. We aim to recruit 30 hospitalists from up to eight hospitals each step to complete the intervention, playingHopewell Hospitalistfor at least 2 hours. The primary outcome is ACP billing for patients aged 65 and older managed by participating hospitalists. We hypothesise that the intervention will increase ACP billing in the quarter after dissemination, and have 80% power to detect a 1% absolute increase and 99% power to detect a 3.5% absolute increase.

Ethics and dissemination

Dartmouth’s Committee for the Protection of Human Subjects has approved the study protocol, which is registered on clinicaltrials.gov. We will disseminate the results through manuscripts and the trials website.Hopewell Hospitalistwill be made available on the iOS Application Store for download, free of cost, at the conclusion of the trial.

Trial registration number

NCT04557930.