bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of Prenatal Cannabis Use Disorder on Perinatal Outcomes
Authors: Prewitt Kristin C. , Hayer Sarena , Garg Bharti , Benson Ashley E. , Hedges Madeline A. , Caughey Aaron B. , Lo Jamie O.
Published: December 2022

Objectives

With legislative changes to cannabis legalization and increasing prevalence of use, cannabis is the most commonly used federally illicit drug in pregnancy. Our study aims to assess the perinatal outcomes associated with prenatal cannabis use disorder.

Methods

We conducted a retrospective cohort study using California linked hospital discharge-vital statistics data and included singleton, nonanomalous births occurring between 23 and 42 weeks of gestational age. χ2 Test and multivariable logistic regression were used for statistical analyses.

Results

A total of 2,380,446 patients were included, and 9144 (0.38%) were identified as using cannabis during pregnancy. There was a significantly increased risk for adverse birthing person outcomes, including gestational hypertension (adjusted odds ratio [AOR], 1.19; 95% confidence interval [CI], 1.06–1.34; P = 0.004), preeclampsia (AOR, 1.16; 95% CI, 1.0–1.28; P = 0.006), preterm delivery (AOR, 1.45; 95% CI, 1.35–1.55; P < 0.001), and severe maternal morbidity (AOR, 1.22; 95% CI, 1.02–1.47; P = 0.033). Prenatal cannabis use disorder was also associated with an increased risk of neonatal outcomes including respiratory distress syndrome (AOR, 1.16; 95% CI, 1.07–1.27; P < 0.001), small for gestational age (AOR, 1.47; 95% CI, 1.38–1.56; P < 0.001), neonatal intensive care unit admission (AOR, 1.24; 95% CI, 1.16–1.33; P < 0.001), and infant death (AOR, 1.86; 95% CI, 1.44–2.41; P < 0.001). There was no statistically significant difference in stillbirth (AOR, 0.96; 95% CI, 0.69–1.34; P = 0.80) and hypoglycemia (AOR, 1.22; 95% CI, 1.00–1.49; P = 0.045)

Conclusions

Our study suggests that prenatal cannabis use disorder is associated with increased maternal and neonatal morbidity and mortality. As cannabis use disorder in pregnancy is becoming more prevalent, our findings can help guide preconception and prenatal counseling.
Association Between the Coronavirus Disease 2019 (COVID-19) Pandemic and National Disparities in Postpartum Visit Attendance
Authors: Bellerose Meghan , Steenland Maria W.
Published: December 2022

This study used data from PRAMS (Pregnancy Risk Assessment Monitoring System) between 2016 and 2020 and found that postpartum visit attendance declined by 5.8 (95% CI −6.4 to −5.2) percentage points in the first 9 months of the coronavirus disease 2019 (COVID-19) pandemic. The greatest declines occurred among non-Hispanic Black individuals (−9.9, 95% CI −11.6 to −8.1 percentage points), individuals aged 19 years or younger (−9.9, 95% CI −13.5 to −6.2 percentage points), and individuals without postpartum insurance (−11.4, 95% CI −14.5 to −8.3 percentage points). Although the pandemic was associated with a decrease in reporting common barriers to attendance, including lack of transportation and not being able to leave work, it introduced new barriers that potentially contributed to widened disparities in postpartum care. A combination of health policy and health system approaches are needed to increase postpartum visit attendance and reduce disparities in use.
An Ethical Argument for Health Insurance Coverage of Paternal Prenatal Genetic Testing
Authors: Nguyen Michelle T. , Campo-Engelstein Lisa , Lee Richard H. , Nguyen Brian T.
Published: December 2022

Despite evidence-based recommendations from the American College of Obstetricians and Gynecologists and the American College of Medical Genetics to offer prenatal genetic carrier screening for reproductive partners, partner carrier screening or genetic testing is inconsistently covered by pregnant patients' health insurance plans. Health policies that exclude reproductive partners from insurance coverage for prenatal carrier screening or genetic testing contradict multiple ethical principles and can even contribute to adverse maternal–child health outcomes. Incomplete or missing information regarding partner carrier status can lead to costly, invasive, and potentially risky interventions for the pregnant patient that can be avoided by a simple and less expensive blood test in the reproductive partner. Lack of information regarding carrier status also harms the neonate by obviating an opportunity for early detection and treatment of potential medical complications. Insurance policies that exclude coverage for paternal genetic testing perpetuate the disproportionate burdens of pregnancy care and risk shouldered by pregnant people. To rectify these ethical dilemmas, partner carrier screening and genetic testing should be considered and covered as routine components of obstetric health care that are covered by health insurance.
Incidence, Indications, Risk Factors, and Outcomes of Emergency Peripartum Hysterectomy Worldwide
Authors: Kallianidis Athanasios F. , Rijntjes Douwe , Brobbel Carolien , Dekkers Olaf M. , Bloemenkamp Kitty W. M. , van den Akker Thomas
Published: December 2022

OBJECTIVE:

To describe the incidence, indications, risk factors, outcomes, and management of emergency peripartum hysterectomy globally and to compare outcomes among different income settings.

DATA SOURCES:

PubMed, MEDLINE, EMBASE, ClinicalTrials.gov, Cochrane Library, Web of Science, and Emcare databases up to December 10, 2021.

METHODS OF STUDY SELECTION:

Update of a systematic review and meta-analysis (2016). Studies were eligible if they reported the incidence of emergency peripartum hysterectomy, defined as surgical removal of the uterus for severe obstetric complications up to 6 weeks postpartum. Title and abstract screening and full-text review were performed using Endnote data-management software. Of 8,775 articles screened, 26 were included that were published after 2015, making the total number of included studies 154. A subanalysis was performed for the outcomes of interest per income setting.

TABULATION, INTEGRATION, AND RESULTS:

The meta-analysis included 154 studies: 14,409 emergency peripartum hysterectomies were performed in 17,127,499 births in 42 countries. Overall pooled incidence of hysterectomy was 1.1 per 1,000 births (95% CI 1.0–1.3). The highest incidence was observed in lower middle–income settings (3/1,000 births, 95% CI 2.5–3.5), and the lowest incidence was observed in high-income settings (0.7/1,000 births, 95% CI 0.5–0.8). The most common indications were placental pathology (38.0%, 95% CI 33.9–42.4), uterine atony (27.0%, 95% CI 24.6–29.5), and uterine rupture (21.2%, 95% CI 17.8–25.0). In lower middle–income countries, uterine rupture (44.5%, 95% CI 36.6–52.7) was the most common indication; placental pathology (48.4%, 95% CI 43.5–53.4) was most frequent in high-income settings. To prevent hysterectomy, uterotonic medication was used in 2,706 women (17%): 53.2% received oxytocin, 44.6% prostaglandins, and 17.3% ergometrine. Surgical measures to prevent hysterectomy were taken in 80.5% of women, the most common being compressive techniques performed in 62.6% (95% CI 38.3–81.9). The most common complications were febrile (29.7%, 95% CI 25.4–34.3) and hematologic (27.5%, 95% CI 20.4–35.9). The overall maternal case fatality rate was 3.2 per 100 emergency peripartum hysterectomies (95% CI 2.5–4.2) and was higher in lower middle–income settings (11.2/100 emergency peripartum hysterectomies 95% CI 8.9–14.1) and lower in high-income settings (1.0/100 emergency peripartum hysterectomies 95% CI 0.6–1.6).

CONCLUSION:

Substantial differences across income settings exist in the incidence of emergency peripartum hysterectomy. Women in lower-income settings have a higher risk of undergoing emergency peripartum hysterectomy and suffer more procedure-related morbidity and mortality. The frequency of emergency peripartum hysterectomy is likely to increase in light of increasing cesarean delivery rates.
Pupillary light reflex measured with quantitative pupillometry has low sensitivity and high specificity for predicting neuroworsening after traumatic brain injury
Authors: Trent Tiffany , Vashisht Ayushi , Novakovic Sava , Kanter Giovanni , Nairon Emerson , Lark Amanda , Tucker Amy , Reddy Vamsi , McCreary Morgan , Stutzman Sonja E. , Olson DaiWai M.
Published: December 2022

Background:

Triage and neurological assessment of the 1.7 million traumatic brain injuries occurring annually is often done by nurse practitioners and physician assistants in the emergency department. Subjective assessments, such as the neurological examination that includes evaluation of the pupillary light reflex (PLR), can contain bias. Quantitative pupillometry (QP) standardizes and objectifies the PLR examination. Additional data are needed to determine whether QP can predict neurological changes in a traumatic brain injury (TBI) patient.

Purpose:

This study examines the effectiveness of QP in predicting neurological decline within 24 hours of admission following acute TBI.

Methodology:

This prospective, observational, clinical trial used pragmatic sampling to assess PLR in TBI patients using QP within 24 hours of ED admission. Chi-square analysis was used to determine change in patient status, through Glasgow Coma Scale (GCS), at baseline and within 24 hours of admission, to the QP.

Results:

There were 95 participants included in the analysis; of whom 35 experienced neuroworsening, defined by change in GCS of >2 within the first 24 hours of admission. There was a significant association between an abnormal Neurological Pupil index (NPi), defined as NPi of <3, and neuroworsening (p < .0001). The sensitivity (51.43%) and specificity (91.67%) of abnormal NPi in predicting neuroworsening were varied.

Conclusion:

There is a strong association between abnormal NPi and neuroworsening in the sample of TBI patients with high specificity and moderate sensitivity.

Implications:

NPi may be an early indicator of neurological changes within 24 hours of ED admission in patients with TBI.
New under the sun: ClotPro's ECA-test detects hyperfibrinolysis in a higher number of patients, more frequently and 9 min earlier
Authors: Zátroch István , Dinya Elek , Fazakas János
Published: December 2022

Liver diseases result in a re-balanced state of the haemostatic system with decreased haemostatic reserves. Increased fibrinolytic activity is commonly seen during liver transplants. The aim of this study was to assess whether ClotPro's ECA-test is able to detect hyperfibrinolysis earlier and with higher frequency than ClotPro's conventional viscoelastic assays for the intrinsic and the extrinsic coagulation pathway.

From 25 liver transplant recipients, systemic blood samples were collected during surgery. Viscoelastic haemostatic assays with ClotPro's IN-test, EX-test and ECA-test were performed simultaneously from each blood sample. Hyperfibrinolysis was defined on the basis of the manufacturer's prespecified threshold value (maximal lysis >15%). The incidence of hyperfibrinolysis detected with each test was compared with the McNemar test. For each assay, lysis detection time (LDT) was calculated and analysed with the nonparametric Kruskal–Wallis test.

A total of 125 tests were performed simultaneously. Compared with the IN-test and the EX-test, the ECA-test detected hyperfibrinolysis in significantly (P < 0.001) higher number of patients (9; 11; 14, respectively) and in more measurement points (14; 18; 28, respectively). The analysis of LDT values revealed significant superiority of the ECA-test to the IN-test (P = 0.046) and to the EX-test (P = 0.035), indicating the profibrinolytic state of the haemostasis 8.9 ± 0.65 and 8.7 ± 0.17 min earlier, respectively. These are preliminary results of the study NCT0424637.

ClotPro's ECA-test appeared to detect fibrinolysis in a higher number of patients, more frequently, and the mean time of detection was 9 min earlier than that of the IN-test and the EX-test.
Factors Potential Patients Deem Important for Decision-Making in High-Risk Surgical Scenarios
Authors: Dellen Matthew , Flanagan Mindy , Pfafman Rachel , Drouin Michelle , Pater Jessica , Pei Kevin Y
Published: December 2022

BACKGROUND:

Surgical futility and shared decision-making to proceed with high-risk surgery are challenging for patients and surgeons alike. It is unknown which factors contribute to a patient’s decision to undergo high-risk and potentially futile surgery. The clinical perspective, founded in statistical probabilities of survival, could be misaligned with a patient’s determination of worthwhile surgery. This study assesses factors most important to patients in pursuing high-risk surgery.

STUDY DESIGN:

Via anonymous survey, lay participants recruited through Amazon’s Mturk were presented high-risk scenarios necessitating emergency surgery. They rated factors (objective risk and quality-of-life domains) in surgical decision-making (0 = not at all, 4 = extremely) and made the decision to pursue surgery based on clinical scenarios. Repeated observations were accounted for via a generalized mixed-effects model and estimated effects of respondent characteristics, scenario factors, and likelihood to recommend surgery.

RESULTS:

Two hundred thirty-six participants completed the survey. Chance of survival to justify surgery averaged 69.3% (SD = 21.3), ranking as the highest determining factor in electing for surgery. Other factors were also considered important in electing for surgery, including the average number of days the patient lived if surgery were and were not completed, functional and pain status after surgery, family member approval, and surgery cost. Postoperative independence was associated with proceeding with surgery (p < 0.001). Recommendations by patient age was moderated by respondent age (p = 0.002).

CONCLUSION:

Patients highly value likelihood of survival and postoperative independence in shared decision-making for high-risk surgery. It is important to improve the understanding of surgical futility from a patient’s perspective.
Backcasting COVID-19: a physics-informed estimate for early case incidence
Authors: Kevrekidis G. A. , Rapti Z. , Drossinos Y. , Kevrekidis P. G. , Barmann M. A. , Chen Q. Y. , Cuevas-Maraver J.
Published: December 2022

It is widely accepted that the number of reported cases during the first stages of the COVID-19 pandemic severely underestimates the number of actual cases. We leverage delay embedding theorems of Whitney and Takens and use Gaussian process regression to estimate the number of cases during the first 2020 wave based on the second wave of the epidemic in several European countries, South Korea and Brazil. We assume that the second wave was more accurately monitored, even though we acknowledge that behavioural changes occurred during the pandemic and region- (or country-) specific monitoring protocols evolved. We then construct a manifold diffeomorphic to that of the implied original dynamical system, using fatalities or hospitalizations only. Finally, we restrict the diffeomorphism to the reported cases coordinate of the dynamical system. Our main finding is that in the European countries studied, the actual cases are under-reported by as much as 50%. On the other hand, in South Korea—which had a proactive mitigation approach—a far smaller discrepancy between the actual and reported cases is predicted, with an approximately 18% predicted underestimation. We believe that our backcasting framework is applicable to other epidemic outbreaks where (due to limited or poor quality data) there is uncertainty around the actual cases.
Revisiting the Baltimore–Bullock's Oriole hybrid zone reveals changing plumage colour in Bullock's Orioles
Authors: Suh Young Ha , Ligon Russell A. , Rohwer Vanya G.
Published: December 2022

Hybrid zones are dynamic areas where populations of two or more interbreeding species may change through an influx of novel genetic material resulting from hybridization or selection on standing genetic variation. Documenting changes in populations through time, however, is challenging because repeated samples are often missing or because long-term storage can affect trait morphologies, especially colour traits that may fade through time. We document a change in carotenoid-based orange breast feathers of Bullock's Orioles (Icterus bullockii)from the Great Plains hybrid zone, USA. Contemporary Bullock's Orioles are more orange than historic individuals from the same location sampled approximately 60 years ago. Spectrophotometry revealed that contemporary Bullock's Orioles resemble orange colour profiles of Baltimore Orioles (I. galbula), the species with which they hybridize. Fading or changes in diet hypotheses do not appear to explain the shift in colour we report for Bullock's Orioles. We propose that these changes in colour are facilitated through introgression with Baltimore Orioles, and favoured by females that choose brighter, more orange males. Our study highlights the long memory of natural history collections and how they offer new insights to the dynamic roll of hybrid zones in trait evolution between interacting species.
Array scattering resonance in the context of Foldy’s approximation
Authors: Nethercote M. A. , Kisil A. V. , Thompson I. , Assier R. C.
Published: December 2022

This article provides an overview of resonance phenomena in wave scattering by infinite and semi-infinite periodic arrays of small cylindrical scatterers, in the context of Foldy’s approximation. It briefly summarizes well-known results from the literature. Moreover, for infinite arrays, the asymptotics of the resonant wave amplitudes in the double resonance case is investigated. This leads to the rediscovery of non-uniqueness of the solution in this context, and to a discussion of the validity of Foldy’s approximation for double resonance. For semi-infinite arrays, a new and improved uniform far-field approximation is derived, uniqueness issues are considered and the validity of Foldy’s approximation is discussed.
A cross-sectional study in critically ill patients affected by COVID-19 in an intensive care unit: would Acinetobacter baumannii resistant to carbapenems be the biggest villain?
Authors: Rocha Yamashita Sayuri , Milani Martins Vera Lucia , Pires Maciel Elves Anderson , Azeredo Francine Johansson
Published: December 2022

Aim: to describe cases of co-infection of Acinetobacter baumannii (A. baumannii) in critically ill patients affected by COVID-19, admitted to an intensive care unit (ICU), using dexamethasone. Methodology: Cross-sectional study conducted on patients admitted to the intensive care unit COVID-19 survey among hospitalized patients from November 2020 to March 2021. Setting: large hospital, reference for caring for patients with COVID-19 in Bahia (Brazil). Patients: a convenience sample of 22 patients admitted to the COVID ICU signed the consent form agreeing to participate in the study. Three patients were excluded for having decided to participate without signing the term. Results: Of the 22 patients listed, 45% (10) had blood infection or mechanical ventilation-associated pneumonia by A. baumannii in blood cultures and/or tracheal aspirate secretion. We observed that there is a moderate correlation between the length of stay and infection by A. baumannii (Spearman's ρ; 0.592; p-value<0.005) and a strong correlation between the number of days on mechanical ventilation and infection by these bacteria (Spearman's ρ; 0.740; p-value<0.001). This percentage is higher than the value of 0.62% of infection by A. baumannii in this ICU in the same period of the year before COVID-19 (p-value<0.0001). Conclusions: Hospitals that receive patients with COVID-19 may be vulnerable to outbreaks of multi-drug resistant organisms, such as A. baumannii. It is worth reflecting on the care and operational practices in handling these patients, especially in isolation and restriction measures for those from other nosocomial areas.
Lower Omega-3 Status Associated with Higher Erythrocyte Distribution Width and Neutrophil-Lymphocyte Ratio in UK Biobank Cohort
Authors: McBurney Michael I. , Tintle Nathan L. , Harris William S.
Published: December 2022

High red blood distribution width (RDW) is associated with decreased red blood cell deformability, and high neutrophil-lymphocyte ratio (NLR) is a biomarker of systemic inflammation and innate-adaptive immune system imbalance. Both RDW and NLR are predictors of chronic disease risk and mortality. Omega-3 index (O3I) values have previously been shown to be inversely associated with RDW and NLR levels. Our objective was to determine if total plasma long chain omega-3 fatty acids (Omega3%) measured in the UK Biobank cohort were associated with RDW and NLR values. RDW- and NLR-relationships with Omega3% were characterized in 109,191 adults (58.4% female). RDW- and NLR-Omega3% relationships were inversely associated with Omega3% (both p<0.0001). These cross-sectional associations confirm previous findings that increasing RDW and NLR values are associated with low O3I. The hypothesis that RDW and/or NLR values can be reduced in individuals with less-than optimal long chain omega 3 values need to be tested in randomized controlled intervention trials using EPA and/or DHA.
The survival of the fastest: Reproductive behavior of the Brazilian three-banded armadillo in the wild
Authors: Attias Nina , Araújo Valquíria Cabral , Fragoso Carlos Eduardo , de Melo Amanda , Mourão Guilherme
Published: December 2022

The Brazilian three-banded armadillo,Tolypeutes tricinctusis endemic to Northeastern Brazil and is classified as a “Vulnerable” (A2cd) species according to the IUCN Red List of Threatened Species. During a study of wild carnivores at Fazenda Trijunção, located at the intersection of the Minas Gerais, Goiás and Bahia states, in Cerrado biome, one of our camera traps recorded three individuals ofT. tricinctuschasing a fourth one in an area of savanna woodland. This seems to be the record of multiple males competing for access to a receptive female, as a similar behavior is known to occur in some armadillo species. This is the first video record of the chasing behavior for this species, being an indicative that multiple males physically compete to mate with a single female, benefitting fastest males. Information aboutin situreproductive behavior is essential to contribute to the efficient species conservation planning.
Stress, Genetics and Mood: Impact of COVID-19 on a College Freshman Sample
Authors: Turner Cortney A , Khalil Huzefa , Murphy-Weinberg Virginia , Hagenauer Megan H , Gates Linda , Tang Yu , Weinberg Lauren , Grysko Robert , Floran-Garduno Leonor , Dokas Thomas , Samaniego Catherine , Zhao Zhuo , Fang Yu , Sen ijan , Lopez Juan F , Watson Stanley J , Akil Huda
Published: December 2022

Using a longitudinal approach, we sought to define the interplay between genetic and non-genetic factors in shaping vulnerability or resilience to COVID-19 pandemic stress, as indexed by the emergence of symptoms of depression and/or anxiety. University of Michigan freshmen were characterized at baseline using multiple psychological instruments. Subjects were genotyped and a polygenic risk score for depression (MDD-PRS) was calculated. Daily physical activity and sleep were captured. Subjects were sampled at multiple time points throughout the freshman year on clinical rating scales, including GAD-7 and PHQ-9 for anxiety and depression, respectively. Two cohorts (2019-2021) were compared to a pre-COVID-19 cohort to assess the impact of the pandemic. Across cohorts, 26%-40% of freshmen developed symptoms of anxiety or depression (N=331). Depression symptoms significantly increased in the pandemic years, especially in females. Physical activity was reduced and sleep was increased by the pandemic, and this correlated with the emergence of mood symptoms. While Low MDD-PRS predicted lower risk for depression during a typical freshman year, this apparent genetic advantage was no longer evident during the pandemic. Indeed, females with lower genetic risk accounted for the majority of the pandemic-induced rise in depression. We developed a model that explained approximately half of the variance in follow-up depression scores based on psychological trait and state characteristics at baseline and contributed to resilience in genetically vulnerable subjects. We discuss the concept of multiple types of resilience, and the interplay between genetic, sex and psychological factors in shaping the affective response to different types of stressors.

Significance Statement

Biological and psychological factors that propelled the great rise in mood disorders during the COVID-19 pandemic remain unknown. We used a longitudinal design in three cohorts of college freshmen to parse the variables that contributed to susceptibility vs. resilience to pandemic stress. Low genetic risk (based on a depression polygenic risk score) was protective prior to the pandemic but this “genetic resilience” lost its effectiveness during the pandemic. Paradoxically, female students with low genetic risk showed enhanced vulnerability to depression during the pandemic across two cohorts. By contrast, we defined a baseline Affect Score (AS) comprising psychological variables that were predictive of future stress susceptibility or “psychological resilience” to stress even in the genetically vulnerable subjects.
Polyacrylamide-based Hydrogel Coatings Improve Biocompatibility of Implanted Pump Devices
Authors: Chan Doreen , Maikawa Caitlin L. , d’Aquino Andrea , Raghavan Shyam S. , Troxell Megan L. , Appel Eric A.
Published: December 2022

The introduction of transcutaneous and subcutaneous implants and devices into the human body instigates fouling and foreign body responses that limit their functional lifetimes. Polymer coatings are a promising solution to improve the biocompatibility of such implants, with potential to enhancein vivodevice performance and prolong device lifetime. In this work we sought to develop novel materials that can be used as coatings on devices. We first synthesized a library of polyacrylamide-based copolymer hydrogels and implanted them into the subcutaneous space of mice to evaluate their biocompatibility. We sought to discover copolymer hydrogel formulations eliciting less fibrous capsule formation and lower overall inflammation than gold standard materials such as PEG and polyzwitterions. The top performing copolymer hydrogel materials were then shown to improve the biocompatibility of a commonly used medical material, PDMS. Lastly, we applied the leading hydrogel coating to the catheter tips of insulin pumps. In a rat model of insulin deficient diabetes, the functional lifetime of hydrogel-coated devices was extended over uncoated pumps. These polyacrylamide-based copolymer hydrogel coatings have the potential to improve device function and lifetime, thereby reducing the burden of disease management for people regularly using implanted devices, such as those with diabetes.
Trends in inequalities in avoidable hospitalisations across the COVID-19 pandemic: A cohort study of 23.5 million people in England
Authors: Green Mark A. , McKee Martin , Massey Jon , MacKenna Brian , Mehrkar Amir , Bacon Sebastian , Macleod John , Sheikh Aziz , Shah Syed Ahmar ,   The OpenSAFELY Consortium,   The LH&W NCS Collaborative, Katikireddi Srinivasa Vittal
Published: December 2022

Background

The COVID-19 pandemic and associated national lockdowns created unprecedented disruption to healthcare, with reduced access to services and planned clinical encounters postponed or cancelled. It was widely anticipated that failure to obtain timely treatment would cause progression of illness and increased hospital admissions. Additional concerns were that social and spatial inequalities would widen given the disproportionate impacts of COVID-19 directly. The aim of our study is to determine whether this was observable in England.

Methods

With the approval of NHS England we utilised individual-level electronic health records from OpenSAFELY, which covered ∼40% of general practices in England (mean monthly population size 23.5 million people). We estimated crude and directly age-standardised rates for potentially preventable unplanned hospital admissions: ambulatory care sensitive conditions and urgent emergency sensitive conditions. We considered how trends in these outcomes varied by three measures of social and spatial inequality: neighbourhood socioeconomic deprivation, ethnicity, and geographical region.

Findings

There were large declines in avoidable hospitalisations during the first national lockdown, which then reversed post-lockdown albeit never reaching pre-pandemic levels. While trends were consistent by each measure of inequality, absolute levels of inequalities narrowed throughout 2020 (especially during the first national lockdown) and remained lower than pre-pandemic trends. While the scale of inequalities remained similar into 2021 for deprivation and ethnicity, we found evidence of widening absolute and relative inequalities by geographic region in 2021 and 2022.

Interpretation

The anticipation that healthcare disruption from the COVID-19 pandemic and lockdowns would result in more (avoidable) hospitalisations and widening social inequalities was wrong. However, the recent growing gap between geographic regions suggests that the effects of the pandemic has reinforced spatial inequalities.
Rapid detection of DNA and RNA shrimp viruses using CRISPR-based diagnostics
Authors: Major Samuel R. , Harke Matthew J. , Cruz-Flores Roberto , Dhar Arun K. , Bodnar Andrea G. , Wanamaker Shelly A.
Published: December 2022

Timely detection of persistent and emerging pathogens is critical to controlling disease spread, particularly in high-density populations with increased contact between individuals and limited-to-no ability to quarantine. Standard molecular diagnostic tests for surveying pathogenic microbes have provided the sensitivity needed for early detection, but lag in time-to-result leading to delayed action. On-site diagnostics alleviate this lag, but current technologies are less sensitive and adaptable than lab-based molecular methods. Towards the development of improved on-site diagnostics, we demonstrated the adaptability of a loop-mediated isothermal amplification-CRISPR coupled technology for detecting DNA and RNA viruses that have greatly impacted shrimp populations worldwide; White Spot Syndrome Virus and Taura Syndrome Virus. Both CRISPR-based fluorescent assays we developed showed similar sensitivity and accuracy for viral detection and load quantification to real-time PCR. Additionally, both assays specifically targeted their respective virus with no false positives detected in animals infected with other common pathogens or in certified specific pathogen-free animals.

IMPORTANCE

The Pacific white shrimp (Penaeus vannamei) is one of the most valuable aquaculture species in the world but has suffered major economic losses from outbreaks of White Spot Syndrome Virus and Taura Syndrome Virus. Rapid detection of these viruses can improve aquaculture practices by enabling more timely action to be taken to combat disease outbreaks. Highly sensitive, specific, and robust CRISPR-based diagnostic assays such as those developed here have the potential to revolutionize disease management in agriculture and aquaculture helping to promote global food security.
The structure of tick-borne encephalitis virus determined at X-ray free-electron lasers. Simulations
Authors: Assalauova Dameli , Vartanyants Ivan A.
Published: December 2022

The study of virus structures by X-ray free-electron lasers (XFELs) has attracted increased attention in recent decades. Such experiments are based on the collection of 2D diffraction patterns measured at the detector following the application of femtosecond X-ray pulses to biological samples. To prepare an experiment at the European XFEL, the diffraction data for the tick-borne encephalitis virus (TBEV) was simulated with different parameters and the optimal values were identified. Following the necessary steps of a well established data-processing pipeline, the structure of TBEV was obtained. In the structure determination presented,a prioriknowledge of the simulated virus orientations was used. The efficiency of the proposed pipeline was demonstrated.
Does institutional quality affect the relationship between income inequality and entrepreneurial activity?
Authors: Haini Hazwan , Abdullahi Abubakar Yazid , Wei Loon Pang
Published: December 2022

Purpose

This study examines whether institutional quality affects the relationship between income inequality and entrepreneurial activity. The authors specifically examine whether the greasing or sanding effect holds for the relationship between income inequality and entrepreneurship, while moderating for institutional quality. The greasing effects suggest that income inequality can promote entrepreneurial activity, while the sanding effects disincentivise it.

Design/methodology/approach

The authors examine this relationship using a sample of 100 advanced and developing countries from 2006 to 2018 using a dynamic panel estimator to control endogeneity and simultaneity. Additionally, the authors include an interaction term to estimate the marginal effects of income inequality, while moderating for institutional quality. Furthermore, the authors differentiate between six measures of institutional quality.

Findings

Overall, the authors find that institutional quality and income inequality have a positive and significant impact on entrepreneurial activity. However, when moderating for institutional quality, the findings show that the marginal impact of income inequality is negative for countries with low levels of institutional quality. The authors show that the rule of law and government effectiveness are effective moderators in terms of magnitude. Furthermore, the authors find that the sanding effect of income inequality is observed in developing economies, even when moderating for institutional quality.

Research limitations/implications

The major limitation lies in the estimation of entrepreneurial activity, which is measured using new business formation. While this is commonly used, it focuses on formal entrepreneurial activities and overlooks the informal economy.

Originality/value

This study provides new empirical evidence on whether institutional quality can moderate and explain the puzzling link between entrepreneurial activity and income inequality.
Corporate derivatives use and firm value: conditional role of corporate governance
Authors: Butt Affaf Asghar , Rizavi Sayyid Salman , Nazir Mian Sajid , Shahzad Aamer
Published: December 2022

Purpose

This study aims to examine the effect of corporate derivatives use on firm value and how the corporate governance index modifies this relationship.

Design/methodology/approach

The sample consists of 219 nonfinancial firms on the Pakistan Stock Exchange (PSX) from 2011 to 2019. The study used ordinary least square regression with year and industry dummies for estimations. Multiple estimation models such as fixed/random effect, Fama–MacBeth and two-stage least squares (2SLS) are used for robustness. Finally, the PROCESS macro tool is used to estimate the effect of moderating the role of corporate governance (CG) as robustness.

Findings

The findings show that derivatives use has an inverse influence on firm value. The firms did not use derivatives as a risk management tool but for speculation motives. However, the corporate governance index significantly weakens this relationship. However, strong governance forces the managers to use derivatives for hedging purposes. The firm-specific factors, including size, age, leverage, cash, financial distress cost, dividend and growth opportunities, also significantly influence firm value. The findings are robust to the other estimation models.

Research limitations/implications

The findings indicate that emerging economies like Pakistan are more prone to agency problems. The strong corporate governance structure helps firms turn the speculative motive of derivatives use into hedging purposes and mitigate the agency issues.

Practical implications

This empirical evidence suggests that good governance structures can help improve the impact of derivative usage on firm value.

Originality/value

To the best of the author's knowledge, this is the first study that examines the conditional role of corporate governance on the derivatives–value relationship from the viewpoint of agency problem/speculative motive.
Exploring industrialization and environmental sustainability dynamics in Ghana: a fully modified least squares approach
Authors: Musah Alhassan , Yakubu Ibrahim Nandom
Published: December 2022

Purpose

This paper seeks to provide empirical insight into how industrialization and technology affect environmental quality in Ghana.

Design/methodology/approach

Using Ecological Footprint (ECF) as a measure of environmental degradation, the authors employ annual data from World Development Indicators of the World Bank and the Global Footprint Network spanning from 1970 to 2017 and apply the fully modified least squares (FMOLS) technique.

Findings

The results reveal that industrialization has a negative significant influence on ECF, suggesting that industrialization contributes to environmental sustainability in Ghana. The authors find that technology is harmful to the environment as it has a positive significant effect on ECF. The study also documents that while education and financial development improve environmental sustainability, fossil fuel consumption exacerbates environmental degradation in Ghana.

Originality/value

The environmental impact of industrialization is still being debated, with very scanty empirical evidence in the African context. Based on a detailed review of the literature, this paper provides an initial attempt to investigate the industrialization–environmental sustainability nexus in Ghana. Besides, whereas most extant studies have employed CO2 emission as a proxy of environmental degradation, the authors use ECF to gauge the level of environmental degradation which is regarded as a more inclusive metric.
Psychological safety and emergency department team performance: A mixed‐methods study
Authors: Purdy Eve , Borchert Laura , El‐Bitar Anthony , Isaacson Warwick , Jones Cindy , Bills Lucy , Brazil Victoria
Published: December 2022

Objectives

Team culture underpins team performance. Psychological safety – ‘a shared belief held by members of a team that the team is safe for interpersonal risk taking’ – is a critical component of team culture for high‐performing teams across contexts. However, psychological safety in ED teams has not been well explored. We aimed to explore this core teamwork concept in the ED.

Methods

This was a sequential mixed‐methods study of nursing and medical staff at a large tertiary care ED in Australia from October 2020 to March 2021. First, participants completed the ‘Team Learning and Psychological Safety Survey’ and a narrative questionnaire. These findings informed semi‐structured interviews. We determined median psychological safety and compared results across role and length of time working in the department. Qualitative results were analysed using a deductive thematic analysis using a previously generated framework for enablers of psychological safety at the individual, team and organisational levels.

Results

The survey was completed by 72/410 participants and 19 interviews were conducted. The median psychological safety score was 37/49 (IQR 13). Psychological safety was not experienced universally, with nurses and new staff experiencing lower levels. Individual, team and organisational factors impacted psychological safety. The primary force shaping psychological safety was familiarity with colleagues and leaders.

Conclusion

Familiarity of team members and leaders was critical to the development of psychological safety within the ED. Fostering familiarity should be a focus for frontline leadership each shift and a priority in broader departmental decisions for those seeking to enhance the psychological safety of their teams.
Management of tenosynovial giant cell tumour of the temporomandibular joint: a systematic review
Authors: Kanbour Abdullah , Hurrell Michael , Ricciardo Peter
Published: December 2022

Diffuse type tenosynovial giant cell tumour of the temporomandibular joint (D‐TGCT‐TMJ) is a rare proliferative disorder. The aim of this study was to perform a systematic review of the literature to summarize D‐TGCT‐TMJ management regimes and recurrence rates with at least 12 months of follow‐up. Our secondary aim was to propose a minimum period of post‐operative follow‐up. A medline search for any D‐TGCT‐TMJ case detailing treatment, follow‐up of at least 12 months, and presence of recurrence was undertaken. The following variables were extracted from the studies: patient's age and sex, presence of middle cranial fossa invasion, treatment undertaken, total length of follow‐up, and presence of recurrence. All studies were assessed for bias as per the Joanna Briggs Institute systematic reviews appraisal tool. There were 63 cases reviewed and were predominantly managed with total resection (60.3%). Other modalities included: arthroplasty, subtotal resection with or without postoperative radiotherapy, medical therapy and surveillance. The recurrence rate was 9.52% and the longest follow‐up period where recurrence was observed was at 60 months. Total resection and arthroplasty are common D‐TGCT‐TMJ management regimes. Patients with D‐TGCT‐TMJ should be followed up annually for at least 5 years postoperatively to assess for recurrence.
Effect of meditation music and comedy movie interventions on postoperative kinesiophobia and pain in patients undergoing total knee arthroplasty
Authors: Cici Remziye , Bulbuloglu Semra , Kapikiran Gurkan
Published: December 2022

Background

This study aimed to investigate the effects of music and comedy movie interventions on postoperative pain and kinesiophobia in patients who underwent total knee arthroplasty.

Methods

This randomized‐controlled study was carried out with the participation of patients who underwent total knee arthroplasty. The patients were divided into three groups. To reduce surgical pain and kinesiophobia, the patients in group 1 watched a comedy movie, those in group 2 listened to music, and those in group 3 did not participate in any intervention other than the routine practices of the clinic.

Results

The personal and medical characteristics of the patients in all groups were similar. The patients in all three groups were kinesiophobic, and their surgical pain levels were moderate despite pharmaceutical interventions. Groups 1 and 2 had a statistically significant decrease in kinesiophobia and pain scores after the interventions. The effects of having patients watch a comedy movie and having them listen to meditation music were not significantly different.

Conclusions

The results of the study showed that listening to meditation music or watching comedy movie scenes had significant positive effects in alleviating postoperative pain and kinesiophobia after TKA. Based on the results of this study, it is recommended that patients watch comedy movies and listen to meditation music to alleviate their postoperative pain and kinesiophobia.

Trial Registration

NCT, NCT05471778. The study was registered at ClinicalTrials.gov.
Course of subthreshold manic symptoms and related risk factors in the general population: A three‐year follow‐up study
Authors: Beekman Rosalie A. L. , ten Have Margreet , de Graaf Ron , Kupka Ralph W. , Regeer Eline J.
Published: December 2022

Objectives

Subthreshold manic symptoms (subM) are a risk factor for the onset and recurrence of bipolar disorder (BD). Individuals with subM may benefit from preventive interventions, however, their development is hampered by a lack of knowledge on subM prevalence and subsequent course. This study examines subM characteristics, course, and risk factors for an unfavourable course.

Methods

In a Dutch representative, population‐based sample aged 18–64 (N = 4618), we assessed subM, defined as the occurrence of manic core symptoms (elation/irritability), without meeting full DSM‐IV criteria for BD I or II in the past 3 years. Comparison groups had either no manic symptoms (noM) or hypomania/mania in the context of BD (mBD) in the past 3 years. Furthermore, we differentiated a mild and moderate type of subM, based on the number of manic symptoms. A subsequent three‐year course was assessed prospectively.

Results

SubM had a three‐year prevalence of 4.9%. Its prevalence, characteristics, and course were in between noM and mBD, and there were few differences between mild and moderate subM. Over the 3‐year follow‐up, 25.0% of individuals with subM had persistent subM and another 6.1% transitioned to mBD. Eleven significant risk factors for this unfavourable course were found. The most important were a history of depression/dysthymia (OR 3.75, p ≤ 0.001), living alone (OR 2.61, p ≤ 0.01) and elevated neuroticism score (OR 1.21, p ≤ 0.001).

Conclusions

This study supports the validity and clinical relevance of subM as a BD prodrome. It demonstrates that subM symptoms often persist or increase during follow‐up and identifies 11 risk factors that are associated with an unfavourable course.
Scaling‐up an early childhood parenting intervention by integrating into government health care services in rural Bangladesh: A cluster‐randomised controlled trial
Authors: Mehrin Syeda Fardina , Salveen Nur‐E , Kawsir Masuma , Grantham‐McGregor Sally , Hamadani Jena D. , Baker‐Henningham Helen
Published: December 2022

Aims

We evaluated the feasibility and effectiveness of utilising government health supervisors to train and supervise primary health care workers (HWs) in community clinics to deliver parenting sessions as part of their usual duties.

Methods

We randomly allocated 16 unions in the Mymensing district of Bangladesh 1:1 to an intervention or control group. HWs in clinics in the eight intervention unions (n = 59 health workers, n = 24 clinics) were trained to deliver a group‐based parenting intervention, with training and supervision provided by government supervisors. In each of the 24 intervention clinics, we recruited 24 mothers of children aged 6–24 months to participate in the parenting sessions (n = 576 mother/child dyads). Mother/child dyads attended fortnightly parenting sessions at the clinic in groups of four to five participants for 6 months (13 sessions). We collected data on supervisor and HW compliance in implementing the intervention, mothers' attendance and the observed quality of parenting sessions in all intervention clinics and HW burnout at endline in all clinics. We randomly selected 32 clinics (16 intervention, 16 control) and 384 mothers (192 intervention, 192 control) to participate in the evaluation on mother‐reported home stimulation, measured at baseline and endline.

Results

Supervisors and HWs attended all training, 46/59 health workers (78%) conducted the majority of parenting sessions, (only two HWs [3.4%] refused) and mothers' attendance rate was 86%. However, supervision levels were low: only 32/57 (56.1%) of HWs received at least one supervisory visit. Intervention HWs delivered the parenting sessions with acceptable levels of quality on most items. The intervention significantly benefitted home stimulation (effect size = 0.53SD, 95% confidence interval: 0.50, 0.56, p < 0.001). HW burnout was low in both groups.

Conclusion

Integration into the primary health care service is a promising approach for scaling early childhood development programmes in Bangladesh, although further research is required to identify feasible methods for facilitator supervision.