bluuebunny/crossref_metadata_2025 huggingface dataset:
Ambivalence, Political Consensus and Conditionality: Support for Whistleblowing among Danish Employees
Authors: Olesen Thomas
Published: October 2020

Whistleblower research is understandably focused around the protagonists of the practice. We still know surprisingly little about how whistleblowing is perceived in the wider population. Drawing on a representative survey of Danish employees (N = 1,709), this paper analyses how whistleblower public support is distributed along variables such as political preference, political interest and job type, and tests whether it is conditional on whistleblower motivation and type of wrongdoing. The paper finds that public support is strong but also ambivalent. It shows that support is evenly distributed along party preference. It also demonstrates that support is not uniform but conditional on the characteristics of the whistleblower situation. These insights are important for both social and political reasons in the present situation where whistleblowing seems to be on the rise. From a policy perspective, it offers policymakers an important evidence‐based navigation tool in devising whistleblower legislation.
The effect of polycystic ovary syndrome without hyperandrogenism on pregnancy‐related outcomes: a retrospective cohort study
Authors: Hu Shiqiao , Xu Bei , Long Rui , Jin Lei
Published: October 2020

Objective

To evaluate the effect of polycystic ovary syndrome (PCOS) without hyperandrogenism on pregnancy‐related outcomes.

Design

A retrospective cohort study.

Setting

Reproductive Medicine Centre of Tongji Hospital.

Population

Women without hyperandrogenism undergoing their first single blastocyst transfers in frozen–thawed cycles were divided into a PCOS group and a non‐PCOS group according to the Rotterdam criteria.

Methods

The pregnancy‐related outcomes of women with and without PCOS were compared. Propensity score matching and multiple logistic regression models were used to eliminate essential impacts on pregnancy‐related outcomes.

Main outcome measures

Pregnancy‐related outcomes included pregnancy loss and abnormal perinatal outcomes.

Results

A total of 4083 women without hyperandrogenism met the study criteria, among whom 557 met the diagnostic criteria for PCOS. Women with PCOS had higher rates of clinical pregnancy (P = 0.035) and cumulative live births (P = 0.023). However, there were no significant differences in the rates of biochemical pregnancy, twins and pregnancy loss between the two groups. Among women with singleton pregnancies, the incidences of preterm birth, hypertensive disorders of pregnancy, gestational diabetes, placenta praevia, fetal malformation, macrosomia and low birthweight did not differ significantly between the two groups. The results remained unchanged even after adjustments were made for propensity score matching and multiple logistic regression analyses.

Conclusion

Women with PCOS without hyperandrogenism may achieve higher rates of clinical pregnancy and cumulative live birth than those without PCOS, without increases in their rates of biochemical pregnancy, pregnancy loss or other abnormal perinatal outcomes.

Tweetable abstract

PCOS without hyperandrogenism was not associated with abnormal pregnancy‐related outcomes.
Derivation and validation of a novel comorbidity‐based delirium risk index to predict postoperative delirium using national administrative healthcare database
Authors: Zhong Xiaobo , Lin Jung‐Yi , Li Lihua , Barrett A. M. , Poeran Jashvant , Mazumdar Madhu
Published: October 2020

Objective

To derive and validate a comorbidity‐based delirium risk index (DRI) to predict postoperative delirium.

Data Source/Study Setting

Data of 506 438 hip fracture repair surgeries from 2006 to 2016 were collected to derive DRI and perform internal validation from the Premier Healthcare Database, which provided billing information on 20‐25 percent of hospitalizations in the USA. Additionally, data of 1 130 569 knee arthroplasty surgeries were retrieved for external validation.

Study Design

Thirty‐six commonly seen comorbidities were evaluated by logistic regression with the outcome of postoperative delirium. The hip fracture repair surgery cohort was separated into a training dataset (60 percent) and an internal validation (40 percent) dataset. The least absolute shrinkage and selection operator (LASSO) procedure was applied for variable selection, and weights were assigned to selected comorbidities to quantify corresponding risks. The newly developed DRI was then compared to the Charlson‐Deyo Index for goodness‐of‐fit and predictive ability, using the Akaike information criterion (AIC), Bayesian information criterion (BIC), area under the ROC curve (AUC) for goodness‐of‐fit, and odds ratios for predictive performance. Additional internal validation was performed by splitting the data by four regions and in 4 randomly selected hospitals. External validation was conducted in patients with knee arthroplasty surgeries.

Data Collection

Hip fracture repair surgeries, knee arthroplasty surgeries, and comorbidities were identified by using ICD‐9 codes. Postoperative delirium was defined by using ICD‐9 codes and analyzing billing information for antipsychotics (specifically haloperidol, olanzapine, and quetiapine) typically recommended to treat delirium.

Principal Findings

The derived DRI includes 14 comorbidities and assigns comorbidities weights ranging from 1 to 6. The DRI outperformed the Charlson‐Deyo Comorbidity Index with better goodness‐of‐fit and predictive performance.

Conclusions

Delirium risk index is a valid comorbidity index for covariate adjustment and risk prediction in the context of postoperative delirium. Future work is needed to test its performance in different patient populations and varying definitions of delirium.
The Dessert Flip: Consumer preference for desserts with a high proportion of fruit and nuts
Authors: Kurzer Amalie , Spencer Molly , Cienfuegos Cesar , Guinard Jean‐Xavier
Published: October 2020

American adults consume excess added sugar and saturated fat, and not enough fruit. A possible solution is the “Dessert Flip,” a shift in which the proportions of more sustainable plant‐based garnishes, such as fruit and nuts, are increased, while the proportion of conventional dessert is reduced. We hypothesized that the pleasing properties of fruits and nuts—color, variety, flavor, and texture—would allow the Dessert Flip to be liked as well or better than a conventional dessert by college‐aged students in a dining hall. In a sensory test, participants (n = 118) significantly preferred plated flipped desserts—those containing 80% by weight fruit (strawberries, raspberries, blueberries, and mangoes) and nuts with 20% cake—over the conventional versions of those desserts with 80% cake and 20% fruit and nuts. No significant differences were found in overall liking. In a second experiment, after eating an entrée, participants (n = 150) chose pictures of multiple varieties of flipped cakes with 60% fruit and 40% cake significantly more than pictures of conventional 80% cake for dessert. Based on the U.S. average fruit prices, the Dessert Flip can be equal or lower in price per serving compared to an ungarnished typically sized cake. We conclude that the Dessert Flip offers a feasible option for increasing servings of fruits and nuts in desserts as well as reducing added sugar and saturated fat while maintaining sensory appeal. Future dietary guidelines could include this general strategy as a recommendation for helping adults include more fruits in their diets.

Practical Application

The Dessert Flip offers an appetizing way for foodservice to promote healthier eating by increasing servings of fruits and nuts in their desserts while reducing added sugar and saturated fat. Consumers can try this strategy at home by cutting a smaller piece of cake and adding fruit on the side.
Exploring the Use of Decision Tree Methodology in Hydrology Using Crowdsourced Data
Authors: Wu Di , Del Rosario Elizabeth A. , Lowry Christopher
Published: October 2020

To fill the observations gap on ungauged streams, crowdsourced distributed hydrologic measurements were considered as a potential supplement for observational data networks. However, citizen science data come with uncertainty as they are provided by the general public. In order to investigate this uncertainty, a decision tree methodology was applied to evaluate existing citizen science data of stream stage based on the CrowdHydrology (CH) network. Quality control (QC) flags were developed and applied to CH sites, dividing Level 1 dataset (raw dataset) into Level 2 (flagged dataset) and Level 3 (processed dataset). Error estimates were calculated to determine uncertainty in the citizen science data. The results indicate that the decision tree could provide reliable QC for citizen science data and demonstrate how uncertainty can be quantified in the QC datasets.
Determinants influencing immediate breast reconstruction in an Australian tertiary public hospital
Authors: McCamley Chere , Mills Christopher , Chow Yvonne , Ross David , Fox Jane
Published: October 2020

Background

In Australia, the rate of immediate breast reconstruction (IBR) following breast cancer surgery is highly variable. This study aimed to identify the rate of IBR within an Australian public tertiary breast oncology referral centre and analyse the tumour and demographic factors that impact upon IBR uptake.

Methods

A retrospective cohort study of 288 admissions of women requiring mastectomy between January 2012 and March 2015 was performed. Data collected included demographic data, tumour pathology, operative details and neoadjuvant therapy. Demographic data included a Socioeconomic Index for Area score, based on individual residential postcode, country of birth and need for an interpreter.

Results

Our study demonstrated an IBR rate of 41.3% and included a wide variety of reconstructions. Factors that increased the IBR rate included younger age and negative lymph node status. Our patient population was ethnically and linguistically diverse, with over 50 different countries of birth represented and with 53 patients requiring interpreters in 19 different languages. Our analysis shows that the requirement for an interpreter is negatively correlated with having an IBR.

Conclusions

Our research demonstrates a high rate of IBR that includes a wide range of autologous and alloplastic reconstructions. Our study represents a unique opportunity to identify socioeconomic barriers that influence patient choice for reconstruction following mastectomy. This can lead to improved health care provision for our patients. This is particularly important in tertiary services with a strong multicultural and multi‐linguistic population.
Readability of foot and ankle consent forms in Queensland
Authors: Pastore Giuseppe , Frazer Philip M. , Mclean Andrew , Walsh Tom P. , Platt Simon
Published: October 2020

Background

The aim of this study was to conduct a readability analysis on both patient take‐home information and consent forms for common foot and ankle procedures. Our hypothesis was that the objective reading skills required to read and comprehend the documentation currently in use would exceed the recommendations in place by both national and international bodies.

Methods

The current Queensland Health consent forms are divided into specific subsections. The readability of consent form subsections C and G (sections containing detailed information on risks of the procedure and pertaining to informed patient consent specifically) and patient take‐home information (provided as take‐home leaflet from the consent form which is procedure specific) was assessed by an online readability software program using five validated methods calculated by application of the algorithms for (i) Flesch–Kincaid grade level, (ii) the SMOG (Simple Measure of Gobbledygook), (iii) Coleman–Liau index, (iv) automated readability index and the (v) Linsear Wriste formula.

Results

The mean ± standard deviation reading grade level of risk (section C), grade level of patient consent (section G) and grade level for procedure‐specific take‐home patient information were 8.7 ± 0.9, 11.6 ± 1.2 and 7.5 ± 0.2, respectively.

Conclusion

The readability of sections C and G of the Queensland Health consent form exceeds the recommendations by national and international bodies, but the patient take‐home information appears suitable. Consideration should be given to lower the reading grade level of patient consent forms to better reflect the reading grade of the Australian population.
Hyperactivity is associated with higher fat‐free mass and physical activity in Swedish preschoolers: A cross‐sectional study
Authors: Lundgren Oskar , Henriksson Pontus , Delisle Nyström Christine , Silfvernagel Kristin , Löf Marie
Published: October 2020

Aim

We investigated psychological strengths and difficulties in a Swedish population of preschool children and analysed how these behavioural variables were related to body composition, cardiorespiratory fitness, physical activity levels, sedentary behaviour and diet.

Methods

Three hundred and fifteen boys and girls were recruited during 2014‐2015. Body composition was measured using air‐displacement plethysmography, and anthropometric measures were taken. Parents responded to questions about age, sex and educational attainment, diet, physical activity levels and smoking habits, as well as the Strengths and Difficulties Questionnaire (SDQ). Regression models were created to analyse associations between psychological variables, body composition and health behaviours.

Results

Hyperactivity scores were positively related to fat‐free mass (β = 0.20, P = .001) and moderate‐to‐vigorous physical activity (β = 0.16, P = .003) and negatively associated with sedentary behaviours (β = 0.18, P = .001), but showed no statistically significant associations with fat mass.

Conclusion

Our findings suggest that the adverse health consequences of hyperactivity on obesity and obesity‐related health behaviours may be established after the preschool period. Questions about the time frame of contributing and modulating factors in obesity development are discussed.
Heat treatment significantly increases the sharpness of silcrete stone tools
Authors: Key A. , Pargeter J. , Schmidt P.
Published: October 2020

Humans were regularly heat‐treating stone tool raw materials as early as 130,000 years ago. The late Middle Stone Age (MSA) and Late Stone Age (LSA) of South Africa's Western Cape region provides some of the earliest and most pervasive archaeological evidence for this behaviour. While archaeologists are beginning to understand the flaking implications of raw material heat treatment, its potential functional benefits remain unanswered. Using silcrete from the Western Cape region, we investigate the impact of heat treatment on stone tool cutting performance. We quantify the sharpness of silcrete in its natural, unheated form, before comparing it with silcrete heated in three different conditions. Results show that heat‐treated silcrete can be significantly sharper than unheated alternatives, with cutting forces halving and energy requirements reducing by approximately two‐thirds. The data suggest that silcrete may have been heat treated during the South African MSA and LSA to increase the sharpness and performance of stone cutting edges. This early example of material engineering has implications for understanding Stone Age populations’ technological capabilities, inventiveness and raw material choices. We predict that heat‐treatment behaviours in other prehistoric and ethnographic contexts may also be linked to increases in edge sharpness and concerns about functional performance.
Measuring global bystander intervention and exploring its antecedents for helping refugees
Authors: Albayrak‐Aydemir Nihan , Gleibs Ilka Helene
Published: October 2020

Although the bystander intervention model provides a useful account of how people help others, no previous study has applied it to a global emergency. This research aims to develop a scale for measuring global bystander intervention and investigate its potential antecedents in the Syrian refugee emergency. In Study 1 (N = 80) and Study 2 (N = 205), a 12‐item scale was established through a substantive‐validity assessment and a confirmatory factor analysis, respectively. Study 3 (N = 601) explored the potential antecedents of the global bystander intervention, employing British and German samples. Results show that the global bystander intervention model worked for both samples, but there were significant between‐group differences in terms of the extent to which they notice the emergency, know how to help, show political support, and donate money. Overall, the visibility of the global emergency aftermaths within the context has been deduced as a meaningful driver for between‐group differences. This research provides the first empirical evidence on global bystander intervention and it offers timely suggestions to promote support for refugees or other victims of global disasters, especially among those who are distant to the disaster zone.
Relapse rate and renal prognosis in ANCA-associated vasculitis according to long-term ANCA patterns
Authors: Oristrell J , Loureiro-Amigo J , Solans R , Valenzuela M P , Monsálvez V , Segarra A , Amengual M J , Marín A , Feijoo C , Tolosa C
Published: October 2020

Long-term observation of patients with ANCA-associated vasculitis (AAV) allows the identification of different longitudinal patterns of ANCA levels during follow-up. This study aimed to characterize these patterns and to determine their prognostic significance.

All ANCA determinations performed in two university hospitals during a 2-year period were retrospectively reviewed. Patients were included in the analysis if they had high titers of anti-myeloperoxidase (anti-MPO) or anti-proteinase 3 (anti-PR3) antibodies at least once, ≥ 5 serial ANCA determinations and AAV diagnosed by biopsy or American College of Rheumatology (ACR) classification criteria. Patients’ time–course ANCA patterns were classified as monophasic, remitting, recurrent or persistent. Associations between ANCA patterns and prognostic variables (relapse rate and renal outcome) were analysed by univariate and multivariate statistics. A total of 99 patients [55 with microscopic polyangiitis (MPA), 36 with granulomatosis with polyangiitis (GPA) and eight with eosinophilic granulomatosis with polyangiitis (EGPA)] were included. Median follow-up was 9 years. Among patients diagnosed with MPA or GPA, recurrent or persistent ANCA patterns were associated with a higher risk of clinical relapse [hazard ratio (HR) = 3·7, 95% confidence interval (CI) = 1·5–9·1 and HR = 2·9, 95% CI = 1·1–8·0, respectively], independently of clinical diagnosis or ANCA specificity. In patients with anti-MPO antibodies, the recurrent ANCA pattern was associated with worsening renal function [odds ratio (OR) = 5·7, 95% CI = 1·2–26·0]. Recurrent or persistent ANCA patterns are associated with a higher risk of clinical relapse. A recurrent ANCA pattern was associated with worsening renal function in anti-MPO-associated vasculitis.
A disconnect between upslope shifts and climate change in an Afrotropical bird community
Authors: Neate‐Clegg Montague H. C. , O'Brien Timothy G. , Mulindahabi Felix , Şekercioğlu Çağan Hakkı
Published: October 2020

Climate change threatens to push species to higher elevations and eventual extinction. Birds, in particular, are shown to be shifting upslope in the Neotropics and Southeast Asia. Yet previous studies have lacked the temporal resolution to investigate distributional dynamics over time in relation to climatic fluctuations, especially in the understudied Afrotropics. Here, we used 15 years of point‐count data from across an elevational gradient (1,767–2,940 m) in Rwanda, to assess elevational shift rates and dynamics in a community of Afrotropical birds. In general, species shifted their elevations upslope by 1.9 m/year, especially at their lower elevational limits which shifted by 4.4 m/year. Importantly, these shifts occurred despite the fact that local temperature and precipitation showed little trend over the study period. Moreover, the interannual distributions of few species were associated with temperature, suggesting that temperature played little direct role in determining elevational distributions of birds. Instead, upslope shifts may be more related to incremental shifts in habitat and resources which lag behind decades of increased temperature in the region. Precipitation appeared to have more of an effect than temperature in determining interannual elevational changes, allowing species to expand their ranges in years of higher rainfall. Our results highlight the need to understand the mechanisms driving upslope shifts as they occur throughout the tropics. It will be critical for montane regions of the tropics to preserve contiguous blocks of forest across elevational gradients to allow wildlife to shift unimpeded.
Plantar fasciitis in 19 endurance horses: Diagnosis, treatment and follow‐up
Authors: Paris A. , Beccati F. , Pepe M.
Published: October 2020

Lesions of the peritendinous–periligamentous soft tissues of the tarsus (plantar fasciitis) commonly result in a curb‐like appearance and are considered overrepresented in Standardbred racehorses; however, plantar fasciitis is also quite common in endurance horses. Nineteen endurance horses of different ages (median: 7 years; range: 3–13) and athletic activity level comprising a total number of 25 plantar fasciitis cases were described in this study. In nine cases, injury developed during a training session, and in 16 cases, it developed during competition. In 18 cases, there was swelling, heat and pain on palpation, and in six cases, only swelling was detected. Eight cases were not lame at the time of examination, while in 17 cases, lameness ranged from grades 1–3 on the American Association of Equine Practitioners modified grading scale. The degree of swelling was significantly related to the lameness grade. Ultrasonography revealed differing amounts of thickening of the plantar fascia plantar to the superficial digital flexor tendon and peritendinous–periligamentous oedema of heterogeneous appearance. Horses were treated conservatively with several combinations of rest, controlled exercise, ice‐therapy, corticosteroids, local application of working counterirritants and therapeutic shoeing. Seventeen of 25 cases (68%) did not develop re‐injury after treatment and rehabilitation, whilst eight of 25 (32%) developed one or more re‐injury/injuries. Overall, 21 of 25 cases (84%) returned to the previous or a higher level of competition; in one case (4%), the injury was the cause of retirement from athletic activity. Plantar fasciitis can be considered a sport‐related injury in endurance horses of all ages and athletic activity level. Re‐injury rate is low; however, adequate rest and rehabilitation protocols are important. Plantar fasciitis rarely leads to retirement from athletic activity, but it can result in 2–5 months out of training and competition.
Daphnia performance on diets containing different combinations of high‐quality algae, heterotrophic bacteria, and allochthonous particulate organic matter
Authors: Wenzel Anja , Vrede Tobias , Jansson Mats , Bergström Ann‐Kristin
Published: October 2020

Filter‐feeding zooplankton in lakes feed on a mixture of phytoplankton, bacteria, and terrestrial particles and the proportions and nutritional value of these components can be highly variable. However, the extent to which food quality interacts with food quantity in affecting overall zooplankton performance is not yet fully resolved.

Here we performed laboratory feeding experiments to test how the performance of the unselective filter feeder Daphnia galeata was affected if various quantities of high‐quality food (the phytoplankton Rhodomonas) were diluted with low‐quality food such as heterotrophic bacteria (Pseudomonas) or terrestrial detritus particles (t‐POM) from the riparian zone of a boreal forest stream. We hypothesised: that increased proportions of bacteria and t‐POM in the diet will lead to decreased survival, somatic growth; and reproduction of Daphnia despite the presence of phytoplankton; that these effects are more pronounced for t‐POM than for heterotrophic bacteria; and that this response is stronger when phytoplankton availability is low.

Increasing the concentrations of Pseudomonas affected Daphnia survival, growth, and reproduction negatively when Rhodomonas was available at intermediate (0.37 mgC/L) and high (0.55 mgC/L) quantities. When Rhodomonas quantity was low (0.22 mgC/L), the addition of Pseudomonas generally resulted in better Daphnia performance except at very high concentrations of the bacterium relative to Rhodomonas. In contrast, the addition of t‐POM was detrimental for overall Daphnia performance at all Rhodomonas concentrations.

Daphnia performance was best described by a model including the interaction between food quality and quantity, with stronger negative effects on Daphnia when high‐quality food was supplemented with t‐POM than with Pseudomonas.

The results indicate that the ability of zooplankton to use low‐quality food is affected by the concurrent availability of high‐quality food. Furthermore, food sources that can be used but do not fulfil dietary requirements of grazers (e.g. bacteria), may still provide nutritional benefits as long as other complementary food components are available in sufficient quantities to compensate for biochemical deficiencies.

Therefore, we conclude that heterotrophic bacteria, but not peat layer t‐POM, can be an important component of zooplankton diets in boreal lakes, especially if the concentration of phytoplankton is low.
Trophic interactions will expand geographically but be less intense as oceans warm
Authors: Inagaki Kelly Y. , Pennino Maria Grazia , Floeter Sergio R. , Hay Mark E. , Longo Guilherme O.
Published: October 2020

Interactions among species are likely to change geographically due to climate‐driven species range shifts and in intensity due to physiological responses to increasing temperatures. Marine ectotherms experience temperatures closer to their upper thermal limits due to the paucity of temporary thermal refugia compared to those available to terrestrial organisms. Thermal limits of marine ectotherms also vary among species and trophic levels, making their trophic interactions more prone to changes as oceans warm. We assessed how temperature affects reef fish trophic interactions in the Western Atlantic and modeled projections of changes in fish occurrence, biomass, and feeding intensity across latitudes due to climate change. Under ocean warming, tropical reefs will experience diminished trophic interactions, particularly herbivory and invertivory, potentially reinforcing algal dominance in this region. Tropicalization events are more likely to occur in the northern hemisphere, where feeding by tropical herbivores is predicted to expand from the northern Caribbean to extratropical reefs. Conversely, feeding by omnivores is predicted to decrease in this area with minor increases in the Caribbean and southern Brazil. Feeding by invertivores declines across all latitudes in future predictions, jeopardizing a critical trophic link. Most changes are predicted to occur by 2050 and can significantly affect ecosystem functioning, causing dominance shifts and the rise of novel ecosystems.
The role of SCFSkp2 and SCFβ‐TrCP1/2 in the cerebellar granule cell precursors
Authors: Yamashita Mariko , Owa Tomoo , Shiraishi Ryo , Adachi Toma , Ichijo Kentaro , Taya Shinichiro , Miyashita Satoshi , Hoshino Mikio
Published: October 2020

A proper balance between proliferation and differentiation of cerebellar granule cell precursors (GCPs) is required for appropriate cerebellar morphogenesis. The Skp1‐Cullin1‐F‐box (SCF) complex, an E3 ubiquitin ligase complex, is involved in polyubiquitination and subsequent degradation of various cell cycle regulators and transcription factors. However, it remains unknown how the SCF complex affects proliferation and differentiation of GCPs. In this study, we found that the scaffold protein Cullin1, and F‐box proteins Skp2, β‐TrCP1 and β‐TrCP2 are expressed in the external granule layer (EGL). Knockdown of these molecules in the EGL showed that Cullin1, Skp2 and β‐TrCP2 enhanced differentiation of GCPs. We also observed accumulation of cyclin‐dependent kinase inhibitor p27 in GCPs when treated with a Cullin1 inhibitor or proteasome inhibitor. Furthermore, knockdown of p27 rescued enhancement of differentiation by Cullin1 knockdown. These results suggest that the SCF complex is involved in the maintenance of the proliferative state of GCPs through p27 degradation. In addition, inhibition of Cullin1 activity also prevented cell proliferation and enhanced accumulation of p27 in Daoy cells, a cell line derived from the sonic hedgehog subtype of medulloblastoma. This suggested that excess degradation of p27 through the SCF complex causes overproliferation of medulloblastoma cells.
Public preference for COVID‐19 vaccines in China: A discrete choice experiment
Authors: Dong Dong , Xu Richard Huan , Wong Eliza Lai‐yi , Hung Chi‐Tim , Feng Da , Feng Zhanchun , Yeoh Eng‐kiong , Wong Samuel Yeung‐shan
Published: October 2020

Background

As the coronavirus disease 2019 (COVID‐19) pandemic is sweeping across the globe, there is an urgent need to develop effective vaccines as the most powerful strategy to end the pandemic. This study aimed to examine how factors related to vaccine characteristics, their social normative influence and convenience of vaccination can affect the public's preference for the uptake of the COVID‐19 vaccine in China.

Methods

An online discrete choice experiment (DCE) survey was administered to a sample of China's general population. Participants were asked to make a series of hypothetical choices and estimate their preference for different attributes of the vaccine. A mixed logit regression model was used to analyse the DCE data. Willingness to pay for each attribute was also calculated.

Results

Data of 1236 participants who provided valid responses were included in the analysis. There was strong public preference for high effectiveness of the vaccine, followed by long protective duration, very few adverse events and being manufactured overseas. Price was the least important attribute affecting the public preference in selecting the COVID‐19 vaccine.

Conclusions

The strong public preferences detected in this study should be considered when developing COVID‐19 vaccination programme in China. The results provide useful information for policymakers to identify the individual and social values for a good vaccination strategy.

Patient or Public Contribution

The design of the experimental choices was fully based on interviews and focus group discussions participated by 26 Chinese people with diverse socio‐economic backgrounds. Without their participation, the study would not be possible.
Managing HIV‐associated inflammation and ageing in the era of modern ART
Authors: Bloch M , John M , Smith D , Rasmussen TA , Wright E
Published: October 2020

Objectives

This paper aims to address the concerns around ongoing immune activation, inflammation, and resistance in those ageing with HIV that represent current challenges for clinicians.

Methods

Presentations at a symposium addressing issues of ageing with HIV infection were reviewed and synthesised.

Results

The changing natural history and demographics of human immunodeficiency virus (HIV)‐infected individuals means new challenges in contemporary management. In the early years of the epidemic,management was focussed on acute, potentially life‐threatening AIDS‐related complications. From initial monotherapy with first‐generation antiretroviral therapy (ART), the development of combination highly active ART (HAART) allowed HIV control but ART toxicities, treatment adherence and drug resistance emerged as major issues. Today, the availability of potent and tolerable ART has made viral suppression achievable in most people living with HIV (PLHIV), and clinicians are confronted with managing a chronic condition among an ageing population. The combination of diseases of ageing and the co‐morbidities associated with HIV‐infection, even when well controlled, results in a complex set of challenges for many older PLHIV. There is a growing appreciation that many non‐AIDS‐related co‐morbidities are caused, at least in part, by persistent, low‐grade immune activation, inflammation, and hypercoagulability, despite suppressive ART.

Conclusions

In order to further improve HIV management, it is important to understand the enduring effects of chronically suppressed HIV infection, the potential contribution of these factors to the ageing process, the possibility of drug resistance, and the impact of different treatment strategies, including early ART initiation.
TNFRp75‐dependent immune regulation of alveolar macrophages and neutrophils during early Mycobacterium tuberculosis and Mycobacterium bovis BCG infection
Authors: Walters Avril , Keeton Roanne , Labuschagné Antoinette , Hsu Nai‐Jen , Jacobs Muazzam
Published: October 2020

TNF signalling through TNFRp55 and TNFRp75, and receptor shedding is important for immune activation and regulation. TNFRp75 deficiency leads to improved control of Mycobacterium tuberculosis (M. tuberculosis) infection, but the effects of early innate immune events in this process are unclear. We investigated the role of TNFRp75 on cell activation and apoptosis of alveolar macrophages and neutrophils during M. tuberculosis and M. bovis BCG infection. We found increased microbicidal activity against M. tuberculosis occurred independently of IFNy and NO generation, and displayed an inverse correlation with alveolar macrophages (AMs) apoptosis. Both M. tuberculosis and M. bovis BCG induced higher expression of MHC‐II in TNFRp75−/− AMs; however, M bovis BCG infection did not alter AM apoptosis in the absence of TNFRp75. Pulmonary concentrations of CCL2, CCL3 and IL‐1β were increased in TNFRp75−/− mice during M, bovis BCG infection, but had no effect on neutrophil responses. Thus, TNFRp75‐dependent regulation of mycobacterial replication is virulence dependent and occurs independently of early alveolar macrophage apoptosis and neutrophil responses.
Using network analysis to capture developmental change: An illustration from infants’ postural transitions
Authors: Thurman Sabrina L. , Corbetta Daniela
Published: October 2020

Network analysis is a tool typically used to assess interrelationships between social entities in a system. In this methodological report, we introduce how concepts from network analysis can be utilized to capture, condense, and extract complex developmental changes in individual behaviors over time. Using infant postural‐locomotor development as an example, we demonstrate how network analysis principles can be applied to rich empirical data. We used existing free‐play data from 13 infants followed longitudinally as they progressed from sitting to walking. We documented the range of postures adopted during play, how often infants transitioned between postures in their postural networks, and derived parameters of density and centrality. Analysis revealed that posture network density increased after infants learned to crawl and gained crawling experience as one might expect, but density did not further expand with gains in upright locomotion. Certain postures held different roles in the overall posture network displayed by an infant, and these centrality patterns depended on the time period involved. More central postures in the network were not always postures in which infants spent the most time. We discuss how network analysis might be utilized to better understand infant behaviors in other contexts (e.g., problem‐solving, interventions, humanoid robotics).
Analysis of routine blood markers for predicting amputation/re‐amputation risk in diabetic foot
Authors: Gülcü Anıl , Etli Mustafa , Karahan Oğuz , Aslan Ahmet
Published: October 2020

Diabetic foot is challenging progressive disease which requires multisystemic control. Neuropathy, arteriopathy, and cellular responses should treated collaboratively. Despite all medical advances, diabetic foot can highly resulted with amputation and also re‐amputation can be required because of failed wound healing. In this study, we aimed to investigate the relation between blood parameters and amputation events. Diabetic 323 patients include to the study who referred to orthopaedic clinic for amputation. Amputation levels (amputation levels phalanx, metatarsal, lisfranc, syme, below knee, knee‐disarticulation, above‐knee amputation) and re‐amputations recorded and compared with routine blood parameters. Re‐amputation was observed at 69 patients. The significant difference detected between lower albumin, higher HbA1c, higher CRP levels (P < 0.05) in regards to gross amputation levels, and increased wound depth. Furthermore, lower albumin levels and higher levels of WBC, HbA1c, CRP, and Creatinine were detected in re‐amputation levels. Especially, HbA1c, CRP, and Creatinine levels were found as upper bound of reference line for re‐amputation. The statistically optimal HbA1c cutoff point for diabetes was ≥7.05%, with a sensitivity of 86% and a specificity of 59%. In according to our results, simple blood parameters can be useful for observing the progress of amputation in diabetic foot. Particularly, lower albumin, and higher HbA1c, CRP, and Creatinine levels detected as related with poor prognosis. Besides, screening of HbA1c level seems to be highly sensitive for detecting of re‐amputation possibility.
Clinical and cardiac characteristics of COVID‐19 mortalities in a diverse New York City Cohort
Authors: Abrams Mark P. , Wan Elaine Y. , Waase Marc P. , Morrow John P. , Dizon Jose M. , Yarmohammadi Hirad , Berman Jeremy P. , Rubin Geoffrey A. , Kushnir Alexander , Poterucha Timothy J. , Elias Pierre A. , Rubin David A. , Ehlert Frederick , Biviano Angelo , Uriel Nir , Garan Hasan , Saluja Deepak
Published: October 2020

Introduction

Electrocardiographic characteristics in COVID‐19‐related mortality have not yet been reported, particularly in racial/ethnic minorities.

Methods and Results

We reviewed demographics, laboratory and cardiac tests, medications, and cardiac rhythm proximate to death or initiation of comfort care for patients hospitalized with a positive SARS‐CoV‐2 reverse‐transcriptase polymerase chain reaction in three New York City hospitals between March 1 and April 3, 2020 who died. We described clinical characteristics and compared factors contributing toward arrhythmic versus nonarrhythmic death. Of 1258 patients screened, 133 died and were enrolled. Of these, 55.6% (74/133) were male, 69.9% (93/133) were racial/ethnic minorities, and 88.0% (117/133) had cardiovascular disease. The last cardiac rhythm recorded was VT or fibrillation in 5.3% (7/133), pulseless electrical activity in 7.5% (10/133), unspecified bradycardia in 0.8% (1/133), and asystole in 26.3% (35/133). Most 74.4% (99/133) died receiving comfort measures only. The most common abnormalities on admission electrocardiogram included abnormal QRS axis (25.8%), atrial fibrillation/flutter (14.3%), atrial ectopy (12.0%), and right bundle branch block (11.9%). During hospitalization, an additional 17.6% developed atrial ectopy, 14.7% ventricular ectopy, 10.1% atrial fibrillation/flutter, and 7.8% a right ventricular abnormality. Arrhythmic death was confirmed or suspected in 8.3% (11/133) associated with age, coronary artery disease, asthma, vasopressor use, longer admission corrected QT interval, and left bundle branch block (LBBB).

Conclusions

Conduction, rhythm, and electrocardiographic abnormalities were common during COVID‐19‐related hospitalization. Arrhythmic death was associated with age, coronary artery disease, asthma, longer admission corrected QT interval, LBBB, ventricular ectopy, and usage of vasopressors. Most died receiving comfort measures.
Weak and fragmented regulatory frameworks on the accuracy of blood pressure‐measuring devices pose a major impediment for the implementation of HEARTS in the Americas
Authors: Lombardi Cintia , Sharman James E. , Padwal Raj , Picone Dean , Alcolea Ernesto , Ayala Roberto , Gittens Anselm , Lawrence‐Williams Patrice , Malcolm Taraleen , Neira Carolina , Perez Vivian , Rosende Andres , Tesser Juliano , Villacres Nilda , Campbell Norm R. C. , Ordunez Pedro
Published: October 2020

Global HEARTS is a WHO initiative for cardiovascular disease prevention and control. Accurate blood pressure (BP) measurement is an essential component of the initiative. This study aimed to determine the regulatory frameworks governing the accuracy of BPMDs in countries of the Americas participating in the HEARTS initiative. Quantitative and qualitative analysis of the laws and regulations relevant to ensuring the accuracy of BPMDs were determined from the Ministries of Health/Regulatory Agencies among 13 countries in Latin America and the Caribbean. Analysis included characterizing the scope of regulations (ie, pre‐market approval, sales and promotion, labeling, cuff sizes, and procurement), information systems for monitoring the models of BPMDs used in primary health care (PHC), and systems to enforce compliance with regulations. Ten of the 13 countries had medical device laws, but regulations that specifically address BPMDs only existed in three countries. Only one country (Brazil) had regulations for mandatory accuracy validation testing and only two countries regulated internet sales of BPMDs. Labeling and cuff size regulations existed in four and two countries, respectively. Less than half the countries reported having a data repository on the BPMD models being used in PHC facilities (four countries) or sold (five countries). Weak and fragmented regulatory frameworks on the accuracy of BPMDs exist among countries of the Americas. This will adversely affect the accuracy of blood pressure assessment and hence poses a major impediment for successful implementation of HEARTS initiative.
Perceptions, attitudes and barriers to obesity management: Japanese data from the ACTION‐IO study
Authors: Iwabu Masato , Yamauchi Toshimasa , Shimomura Iichiro , Eguchi Kosei , Ogawa Yoshihiro
Published: October 2020

Aims/Introduction

The prevalence of obesity is rising in Japan and represents a considerable unmet medical need. The Awareness, Care and Treatment in Obesity MaNagement – International Observation (ACTION‐IO) study was designed to identify the perceptions, attitudes and barriers to obesity care among people with obesity (PwO) and healthcare professionals (HCPs) in Japan.

Materials and Methods

An online, cross‐sectional survey was carried out in 11 countries, including Japan.

Results

The survey was completed by 2,001 PwO and 302 HCPs in Japan. Fewer PwO (58%) than HCPs (85%) perceived obesity as a chronic disease. Most PwO (81%) thought that weight loss was their own responsibility, and waited a considerable time before seeking support from their HCP (mean 6 years). Most PwO (64%) had made one or more serious weight loss attempt in the past. In contrast, a serious attempt at losing weight was reported by HCPs for just 21% of their patients. Just 24% of PwO had weight discussions with an HCP in the past 5 years; of those, 56% expressed positive feelings after such a conversation, and just 2% felt offended. Lack of patient motivation (68%) and patient disinterest (61%) were reported by HCPs as barriers to weight management conversations. A higher proportion of obesity specialists (37%) than non‐specialists (22%) thought their patients were motivated to lose weight.

Conclusions

Our Japanese dataset shows a need to raise awareness of the pathophysiological basis and clinical management of obesity among PwO and HCPs. The largely positive feelings expressed by PwO after weight loss conversations should encourage HCPs to initiate earlier discussions before obesity‐related complications occur.
State Actions and Shortages of Personal Protective Equipment and Staff in U.S. Nursing Homes
Authors: Gibson Diane M. , Greene Jessica
Published: October 2020

BACKGROUND

It is crucial that nursing homes have adequate personal protective equipment (PPE) and staff to protect residents and staff from COVID‐19. Some states have taken actions to mitigate shortages of PPE and staffing in nursing homes, including creating dedicated long‐term care (LTC) teams and supporting staffing capacity.

OBJECTIVE

To examine whether state actions and nursing home characteristics are associated with shortages of PPE and staffing.

DESIGN AND SETTING

Facility‐level data, released July 31, 2020, from the Nursing Home COVID‐19 Public File, were combined with data from other sources. Our sample was the 13,445 facilities with information about PPE and staffing shortages for each of the 5 weeks between the week ending June 21, 2020, and the week ending July 19, 2020. Associations between facility characteristics and shortages were examined using descriptive statistics and logistic regression models.

MEASUREMENTS

Outcome variables were whether or not a facility lacked a 1‐week supply of PPE (“PPE shortage”) and whether or not a facility had a staffing shortage during 1 or more weeks over the 5‐week study period.

RESULTS

Over the 5‐week study period, 27.6% of facilities reported 1 or more weeks of PPE shortage, 30.2% of facilities reported at least 1 week of staffing shortage, and 46.5% of facilities lacked PPE and/or staff. Facilities located in states in the Northeast PPE Consortium or with LTC teams were modestly less likely to have had a PPE shortage, and facilities located in states that implemented processes to match job seekers with LTC facilities were marginally significantly less likely to have had a staffing shortage.

CONCLUSION

Given that nearly half of U.S. nursing homes recently faced a shortage of PPE and/or staff, and that state budget deficits may limit further state actions, ongoing federal assistance with PPE and staffing of nursing homes is needed.
Increased cerebral FDG‐PET uptake in type 1 diabetes patients with impaired awareness of hypoglycaemia
Authors: Sampedro Frederic , Stantonyonge Nicole , Martínez‐Horta Saul , Nan Nicoleta , Camacho Valle , Chico Ana
Published: October 2020

Approximately 20% of type 1 diabetes (T1D) patients have an impaired awareness of hypoglyceamia (IAH). IAH represents a risk factor for severe and recurrent hypoglycaemic events, which can lead to brain damage. Because no effective treatments are currently available to prevent IAH in this population, characterising the set of brain alterations associated with IAH may reveal novel preclinical diagnostic or therapeutic strategies. Using state‐of‐the art neuroimaging techniques, we compared 18F‐fluorodeoxyglucose‐positron emission tomography (FDG‐PET) uptake at rest between 10 T1D patients with IAH and nine patients with normal awareness of hypoglycaemia (NAH). T1D‐IAH patients showed a pattern of increased FDG‐PET uptake with respect to NAH patients (P < .05 corrected). Topographically, glucose metabolism was increased in the frontal and precuneus regions. Importantly, within the IAH group, this abnormal hypermetabolism correlated with IAH severity. This hypermetabolic state appeared to be unrelated to compensatory mechanisms as a result of reduced grey matter density or a neuroinflammatory state. We observed an abnormal increase in FDG‐uptake in T1D patients with IAH in brain regions strongly related to cognition. Because this hypermetabolic state correlated with IAH severity, its biological characterisation could reveal new preventive or therapeutic strategies. A possible mechanism could be that glucose transport is increased in hypoglycaemia unawareness to compensate for recurrent hypoglycaemia, although this need to be confirmed in further research.