bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of a blended emergent research training programme for clinical nurses on nursing research competence and critical thinking (Part 2): A quasi‐experimental study
Authors: Chen Qirong , Tang Siyuan , Liu Dan , Zhou Chuyi , Castro Aimee R. , Jiang Shan , Huang Chongmei , Chen Jiarui
Published: July 2021

Aims and objectives

To evaluate the effects of a blended emergent research training programme for clinical nurses on research competence and critical thinking.

Background

With the development of the nursing discipline and evidence‐based nursing practice, nursing research competence is increasingly important for clinical nurses. Current nursing research training programmes cannot meet the needs of clinical nurses.

Design

A quasi‐experimental study.

Methods

A total of 104 clinical nurses from two tertiary hospitals participated in this study. The intervention group received a blended emergent research training programme for clinical nurses, and the control group received no intervention. Nursing research competence and critical thinking were measured at baseline, after the intervention and three months after the intervention. The satisfaction with the training of clinical nurses in the intervention group was also measured after the intervention. Generalised linear mixed models were used to evaluate the effects of the intervention on outcome variables. Qualitative data were analysed by two researchers using the content analysis method. Our reporting complies with the TREND checklist.

Results

The blended emergent research training programme for clinical nurses finally showed positive effects on nursing research competence and critical thinking. The effects lasted until three months after the training programme. ‘Learner‐centred Training’, ‘Skilled Trainers’, ‘Encouraging Training Environment’ and ‘Positive Outcomes’ are the main categories generated from the qualitative data.

Conclusion

The blended emergent research training programme for clinical nurses could be used for clinical nurses’ research education to improve their nursing research competence and critical thinking.

Relevance to clinical practice

The blended emergent teaching method could be considered as an effective method to provide an encouraging learning environment and promote learner‐centred teaching for clinical nurses. The blended emergent research training programme could be used to improve nursing research competence and critical thinking of clinical nurses which are important for evidence‐based nursing practice.
Redistribution under general decision rules
Authors: Parameswaran Giri , Rendleman Hunter
Published: July 2021

We study the political economy of redistribution over a broad class of decision rules. We suggest a simple and elegant procedure to select a robust equilibrium from the multiplicity in the core. Equilibrium policy depends on the full income profile, and, importantly, the preferences of two decisive voters. We show that the effect of increasing inequality depends on the decision rule and the shape of the income distribution; redistribution will increase if both decisive voters are “relatively poor,” and decrease if at least one is sufficiently “rich.” Additionally, redistribution decreases as the polity adopts increasingly stringent super‐majority rules.
Tolerance and Pharmacokinetics of Galliprant™ Administered Orally to Collies Homozygous for MDR1‐1Δ
Authors: Heit Mark C. , Mealey Katrina L. , King Stephen B.
Published: July 2021

The objectives of the study were to evaluate the pharmacokinetics and tolerance of grapiprant, a substrate of the human P‐gp transporter, in collies homozygous for MDR1‐1Δ when administered at the labeled dosage of 2 mg/kg once daily for 28 days. Twelve collie dogs with homozygous for MDR1‐1Δ genotype from a commercial colony were used in the study, eight in the treated group and four as placebo‐treated controls. The only treatment‐related clinical sign was self‐limiting vomiting (in 2/8 treated animals) and the only treatment‐related clinical pathological changes seen were a slight decrease in serum albumin in one dog (2.6 g/dL; reference 2.7 to 3.9 g/dL) and total protein (5.1 g/dL; reference 5.5 to 7.7 g/dL). Absorption of grapiprant was rapid with a median Tmax of 1 h, Cmax of 5.2 μg/mL, AUC0‐24 of 17.3 ± 7.1 h*μg/mL and median terminal t½ of 4.3 h after the first dose. To determine whether MDR1‐1Δ animals handle grapiprant differently from normal dogs, a population pharmacokinetic analysis was performed utilizing data from the collies and historical beagle data. Volume of the peripheral compartment of collies was estimated to be 45% that of beagles, and clearance from the central compartment was 71% less in collies than in beagles. Self‐liming vomiting events occurred at a numerically higher rate (2/8; 25%) in this group of P‐gp‐deficient dogs than seen in a clinical study (17%) composed of various dog breeds but limited numbers in this PK study make comparisons difficult. Grapiprant was otherwise well tolerated in collies homozygous for MDR1‐1Δ despite increased drug exposure compared to dogs without this mutation.
An ultrasound image‐based deep multi‐scale texture network for liver fibrosis grading in patients with chronic HBV infection
Authors: Ruan Dongsheng , Shi Yu , Jin Linfeng , Yang Qiao , Yu Wenwen , Ren Haotang , Zheng Weiyang , Chen Yongping , Zheng Nenggan , Zheng Min
Published: July 2021

Background & Aims

The evaluation of the stage of liver fibrosis is essential in patients with chronic liver disease. However, due to the low quality of ultrasound images, the non‐invasive diagnosis of liver fibrosis based on ultrasound images is still an outstanding question. This study aimed to investigate the diagnostic accuracy of a deep learning‐based method in ultrasound images for liver fibrosis staging in multicentre patients.

Methods

In this study, we proposed a novel deep learning‐based approach, named multi‐scale texture network (MSTNet), to assess liver fibrosis, which extracted multi‐scale texture features from constructed image pyramid patches. Its diagnostic accuracy was investigated by comparing it with APRI, FIB‐4, Forns and sonographers. Data of 508 patients who underwent liver biopsy were included from 4 hospitals. The area‐under‐the ROC curve (AUC) was determined by receiver operating characteristics (ROC) curves for significant fibrosis (≥F2) and cirrhosis (F4).

Results

The AUCs (95% confidence interval) of MSTNet were 0.92 (0.87‐0.96) for ≥F2 and 0.89 (0.83‐0.95) for F4 on the validation group, which significantly outperformed APRI, FIB‐4 and Forns. The sensitivity and specificity of MSTNet (85.1% (74.5%‐92.0%) and 87.6% (78.0%‐93.6%)) were better than those of three sonographers in assessing ≥F2.

Conclusions

The proposed MSTNet is a promising ultrasound image‐based method for the non‐invasive grading of liver fibrosis in patients with chronic HBV infection.
Incidence of liver‐related morbidity and mortality in a population cohort of non‐alcoholic fatty liver disease
Authors: Männistö Ville T. , Salomaa Veikko , Färkkilä Martti , Jula Antti , Männistö Satu , Erlund Iris , Sundvall Jouko , Lundqvist Annamari , Perola Markus , Åberg Fredrik
Published: July 2021

Background & Aims

Non‐alcoholic fatty liver disease (NAFLD) increases morbidity and mortality. However, patients in biopsy‐based cohorts are highly selected and the absolute risks of liver‐ and non‐liver outcomes in NAFLD in population remains undefined. We analysed both liver‐related and non‐liver‐related outcomes in Finnish population cohorts of NAFLD.

Methods

We included 10 993 individuals (6707 men, mean age 53.3 ± 12.6 years) with NAFLD (fatty liver index ≥60) from the Finnish population‐based FINRISK and Health 2000 studies. Liver fibrosis was assessed by the dAAR score, and genetic risk by a recent polygenic risk score (PRS‐5). Incident liver‐related outcomes, cardiovascular disease (CVD), cancer and chronic kidney disease (CKD) were identified through linkage with national registries.

Results

Mean follow‐up was 12.1 years (1128 069 person‐years). The crude incidence rate of liver‐related outcomes in NAFLD was 0.97/1000 person‐years. The cumulative incidence increased with age, being respectively 2.4% and 1.5% at 20 years in men and women aged 60 years at baseline, while the relative risks for CVD and cancer were 9‐16 times higher. The risk of CKD exceeded that of liver outcomes at a baseline age around 50 years. 20‐year cumulative incidence of liver‐related outcomes was 4.3% in the high, and 1.5% in the low PRS‐5 group. The dAAR score associated with liver outcomes, but not with extra‐hepatic outcomes.

Conclusion

The absolute risk of liver‐related outcomes in NAFLD is low, with much higher risk of CVD and cancer, emphasizing the need for more individualized and holistic risk‐stratification in NAFLD.
Heterothermy, body size, and locomotion as ecological predictors of migration in mammals
Authors: Webber Quinn M. R. , McGuire Liam P.
Published: July 2021

Migration is ubiquitous among animals and has evolved repeatedly and independently. Comparative studies of the evolutionary origins of migration in birds are widespread, but are lacking in mammals. Mammalian species have greater variation in functional traits that may be relevant for migration. Interspecific variation in migration behaviour is often attributed to mode of locomotion (i.e. running, swimming, and flying) and body size, but traits associated with the evolutionary precursor hypothesis, including geographic distribution, habitat, and diet, could also be important predictors of migration in mammals. Furthermore, mammals vary in thermoregulatory strategies and include many heterothermic species, providing an alternative strategy to avoid seasonal resource depletion.

We tested the evolutionary precursor hypothesis for the evolution of migration in mammals and tested predictions linking migration to locomotion, body size, geographic distribution, habitat, diet, and thermoregulation. We compiled a dataset of 722 species from 27 mammalian orders and conducted a series of analyses using phylogenetically informed models.

Swimming and flying mammals were more likely to migrate than running mammals, and larger species were more likely to migrate than smaller ones. However, heterothermy was common among small running mammals that were unlikely to migrate. High‐latitude swimming and flying mammals were more likely to migrate than high‐latitude running mammals (where heterothermy was common), and most migratory running mammals were herbivorous. Running mammals and frugivorous bats with high thermoregulatory scope (greater capacity for heterothermy) were less likely to migrate, while insectivorous bats with high thermoregulatory scope were more likely to migrate.

Our results indicate a broad range of factors that influence migration, depending on locomotion, body size, and thermoregulation. Our analysis of migration in mammals provided insight into some of the general rules of migration, and we highlight opportunities for future investigations of exceptions to these rules, ultimately leading to a comprehensive understanding of the evolution of migration.
Gender bias in resident evaluations: Natural language processing and competency evaluation
Authors: Andrews Jane , Chartash David , Hay Seonaid
Published: July 2021

Background

Research shows that female trainees experience evaluation penalties for gender non‐conforming behaviour during medical training. Studies of medical education evaluations and performance scores do reflect a gender bias, though studies are of varying methodology and results have not been consistent.

Objective

We sought to examine the differences in word use, competency themes and length within written evaluations of internal medicine residents at scale, considering the impact of both faculty and resident gender. We hypothesised that female internal medicine residents receive more negative feedback, and different thematic feedback than male residents.

Methods

This study utilised a corpus of 3864 individual responses to positive and negative questions over the course of six years (2012‐2018) within Yale University School of Medicine's internal medicine residency. Researchers developed a sentiment model to assess the valence of evaluation responses. We then used natural language processing (NLP) to evaluate whether female versus male residents received more positive or negative feedback and if that feedback focussed on different Accreditation Council for Graduate Medical Education (ACGME) core competencies based on their gender. Evaluator‐evaluatee gender dyad was analysed to see how it impacted quantity and quality of feedback.

Results

We found that female and male residents did not have substantively different numbers of positive or negative comments. While certain competencies were discussed more than others, gender did not seem to influence which competencies were discussed. Neither gender trainee received more written feedback, though female evaluators tended to write longer evaluations.

Conclusions

We conclude that when examined at scale, quantitative gender differences are not as prevalent as has been seen in qualitative work. We suggest that further investigation of linguistic phenomena (such as context) is warranted to reconcile this finding with prior work.
Use of satellite imagery to identify southern right whales (Eubalaena australis) on a Southwest Atlantic Ocean breeding ground
Authors: Corrêa Audrey A. , Quoos João H. , Barreto André S. , Groch Karina R. , Eichler Patricia P. B.
Published: July 2021

Satellite imagery has been used to improve scientific research worldwide. In this study, the southern right whale (Eubalaena australis) was chosen to test the use of medium, high, and very high resolution (VHR) satellite images, on the Brazilian breeding ground. These images were used to identify the whales and were compared to aerial survey data collected in the same area. The VHR satellite images from the Pleiades‐1A satellite, available on Google Earth, displayed the best results when compared to those from Sentinel 2, Landsat 8, Rapid Eye, and Planet Scope. No significant differences were observed (Mann‐Whitney U test) between the possible whales recorded in the satellite images and of real whales recorded in situ by aerial surveys, while considering either the number of groups (p = .841, n = 5) or the total number of animals (p = .222, n = 5). Further, when using VHR images, the geographical positions of the whales recorded in situ had a positive correlation with the positions generated from the satellite images (Mantel test: r = 0.52, p = .001, n = 13). This technique may represent an important tool for detecting right whales, especially in countries where research funding is scarce.
Amyotrophic lateral sclerosis with speech apraxia, predominant upper motor neuron signs, and prominent iron accumulation in the frontal operculum and precentral gyrus
Authors: Mitani Tomoki T. , Beck Goichi , Kido Kansuke , Yamashita Rika , Yonenobu Yuki , Ogawa Takuya , Saeki Chizu , Okuno Tatsusada , Nagano Seiichi , Morii Eiichi , Hasegawa Masato , Saito Yuko , Murayama Shigeo , Mochizuki Hideki
Published: July 2021

Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease; transactivation response DNA‐binding protein of 43 kDa (TDP‐43) and iron accumulation are supposed to play a crucial role in the pathomechanism of the disease. Here, we report an unusual case of a patient with ALS who presented with speech apraxia as an initial symptom and upper motor neuron deficiencies. In the early clinical stages, single‐photon emission computed tomography visualized focal hypoperfusion of the right frontal operculum, and magnetic resonance imaging identified a hypointense area along the frontal lobe on T2‐weighted images. Neuropathological examination revealed that neuronophagia of Betz cells, gliosis, appearance of phosphorylated TDP‐43 (p‐TDP‐43)‐positive glial and neuronal inclusions, and prominent iron accumulation were frequently visible in the precentral gyrus. TDP‐43 pathology and focal iron accumulation were also visible in the frontal operculum, but only a mild neuronal loss and a few p‐TDP‐43‐positive neuronal and glial inclusions were found in the hypoglossal nucleus of the medulla oblongata and anterior horn of the spinal cord. Immunoblot analysis revealed an atypical band pattern for ALS. In our case, abnormal TDP‐43 and iron accumulation might possibly have caused neurodegeneration of the frontal operculum, in tandem or independently; it might then have spread into the primary motor area. Our results suggest a causative association between TDP‐43 and iron accumulation in the pathomechanisms of ALS presenting with upper motor neuron signs.
Degrees of commensurability and the repugnant conclusion
Authors: Hájek Alan , Rabinowicz Wlodek
Published: July 2021

Two objects of valuation are said to be incommensurable if neither is better than the other, nor are they equally good. This negative, coarse‐grained characterization fails to capture the nuanced structure of incommensurability. We argue that our evaluative resources are far richer than orthodoxy recognizes. We model value comparisons with the corresponding class of permissible preference orderings. Then, making use of our model, we introduce a potentially infinite set of degrees of approximation to better, worse, and equally good, which we interpret as degrees of commensurability.

One payoff is the solution our approach provides to a paradox in population ethics, generated by Parfit's “Continuum Argument”. Parfit imagines a sequence of populations, starting with one consisting of excellent lives and, by a sequence of apparent improvements, reaching a much larger population of lives barely worth living. What he dubs “the Repugnant Conclusion” is that the final population is better than the first. Developing Parfit's response, we argue that some of the populations in the sequence are merely almost better than their immediate predecessors. Almost better is not transitive (unlike better). We offer analogies to other ‘spectrum arguments’, Condorcet's paradox, and to developments in formal epistemology.
To ban or not to ban carbon‐intensive materials: A legal and administrative assessment of product carbon requirements
Authors: Gerres Timo , Haussner Manuel , Neuhoff Karsten , Pirlot Alice
Published: July 2021

By setting near‐zero‐emission requirements for the production of certain products to be sold on the European single market (product carbon requirements, PCRs), the European Union could accelerate the phase‐out of carbon‐intensive production processes. The announcement of such requirements would send a signal to producers, financing institutions and other relevant stakeholders, thus incentivizing them to prepare for the shift to a carbon‐neutral society. This article analyses several European environmental standards and technical regulations to offer insights into the political, legal and technical background for the adoption of PCRs. It shows that PCRs would constitute a new development in technical regulations. Given the relevance of World Trade Organization law for the adoption of standards and technical regulations on products, the article analyses in further detail the compatibility of PCRs under WTO law, and argues that PCRs can be designed in line with the provisions of the General Agreement on Tariffs and Trade and the Agreement on Technical Barriers to Trade.
Rethinking Risk Perception and its Importance for Explaining Natural Hazard Preparedness Behavior
Authors: Scovell Mitchell , McShane Connar , Swinbourne Anne , Smith Daniel
Published: July 2021

Psychological theory suggests there is a positive association between risk perception and protective behavior. Empirical research has, however, found mixed support for the positive link between risk perception and protective behavior. One explanation for the inconsistent link is the way in which risk perception has been conceptualized and/or operationalized in past research. Specifically, few studies acknowledge differences in hazard severity and how it might affect risk perception and protective behavior. Past research has also tended to overlook the importance of emotional appraisal in relation to perceived hazard consequences. To address these inconsistencies in past research, 337 people living in a cyclone‐prone location were recruited to participate in an online study. In this study, respondents were randomly presented with one of five hypothetical cyclone scenarios, which differed in objective severity. Respondents were also presented with a survey, which assessed risk perception, protective action perceptions (or coping appraisal), and intentions to perform short‐term protective behaviors. As hypothesized, risk perception significantly increased preparedness intentions when controlling for hazard severity, hazard probability, and protective action perceptions. Moreover, the degree to which respondents associated negative emotions with predicted damage was also a relatively strong predictor of preparedness intentions. Overall, the findings support the theoretical link between risk perception and protective behavior and provide a new method of assessing risk perception in cross‐sectional research. On a practical level, the results suggest that increasing risk perception should promote protective behavior in response to natural hazards.
Undisclosed HIV status and antiretroviral therapy use among South African blood donors
Authors: van den Berg Karin , Vermeulen Marion , Louw Vernon J. , Murphy Edward L. , Maartens Gary
Published: July 2021

Background

Undisclosed antiretroviral drug (ARV) use among blood donors who tested HIV antibody positive, but RNA negative, was previously described by our group. Undisclosed ARV use represents a risk to blood transfusion safety. We assessed the prevalence of and associations with undisclosed ARV use among HIV‐positive donors who donated during 2017.

Study design and methods

South African National Blood Service (SANBS) blood donors are screened by self‐administered questionnaire, semi‐structured interview, and individual donation nucleic acid amplification testing for HIV. Stored samples from HIV‐positive donations were tested for ARV and characterized as recent/longstanding using lag avidity testing.

Results

Of the 1462 HIV‐positive donations in 2017, 1250 had plasma availability for testing of which 122 (9.8%) tested positive for ARV. Undisclosed ARV use did not differ by gender (p = .205) or ethnicity (p = .505) but did differ by age category (p < .0001), donor (p < .0001), clinic type (p = .012), home province (p = .01), and recency (p < .0001). Multivariable logistic regression found older age (adjusted odds ratio [aOR] 3.73, 95% confidence interval [CI] 1.98–7.04 for donors >40 compared with those <21), first‐time donation (aOR 5.24; 95% CI 2.48–11.11), and donation in a high HIV‐prevalence province (aOR 9.10; 95% CI 2.70–30.72) compared with Northern Rural provinces to be independently associated with undisclosed ARV use.

Discussion

Almost 1 in 10 HIV‐positive blood donors neglected to disclose their HIV status and ARV use. Demographic characteristics of donors with undisclosed ARV use differed from those noted in other study. Underlying motivations for nondisclosure among blood donors remain unclear and may differ from those in other populations with significant undisclosed ARV use.
Experience and market signals in export entry decisions
Authors: Mendoza Beverly
Published: July 2021

Export entry deterrence is a result of export uncertainty, which inhibits the discovery of new exports and prevents a country from realising its true comparative advantage. This paper examines how firms resolve uncertainty through the combination of two learning channels: learning from others and their own export experience. Using Chilean customs data (2007–2016), I find that early entrants have a short export duration and have little export experience. When combining the two learning channels, I find that less experienced exporters are more responsive to new information. Significantly, when observing a 10% increase in average initial export growth, less experience firms have double the entry probability compared with more experienced firms.
Alternative Blade Profile Based on Savonius Concept for Effective Wind Energy Harvesting
Authors: Talukdar Parag K. , Alom Nur , Rathod Umang H. , Kulkarni Vinayak
Published: July 2021

The drag-based vertical-axis Savonius wind rotor is a potential candidate for harvesting renewable energy. It is very simple in design and can be deployed as an off-grid electricity system in remote locations having no access to electricity. The present work aims to develop a novel blade profile for the Savonius rotor in order to improve its performance. In that connection, an arc-elliptical-blade profile has been developed and rotor performance has been assessed through wind tunnel testing at three different Reynolds numbers (Re = 87,039, 107,348, and 131,066). Further, its performance is compared to that of a conventional semicircular-bladed rotor under identical test conditions. The experiments revealed the maximum power coefficient (CPmax) of 0.11, 0.162, 0.213 at Re = 87,039, 107,348, and 131,066, respectively, for the arc-elliptical-bladed rotor. To complement the experimental findings and to examine the flow behavior around the rotor blades, the computational fluid dynamics (CFD) simulations have also been performed using ansys fluent software. The local torque is found to be greater around the advancing arc-elliptical blade than around the advancing semicircular blade. It has also been noticed that the pressure distributions over concave sides are similar regardless of the blade shape.
Towards Mg Based Light Materials of Future: Properties, Applications, Problems, and Their Mitigation
Authors: Maqbool Annayath , Khan Noor Zaman , Siddiquee Arshad Noor
Published: July 2021

The use of lighter materials is one of the efficient means to mitigate the increasing demands on fuel resources, reduce CO2 emissions. Mg is one of the lightest material available and possesses exciting range of properties such as low density and high strength to weight ratio. Despite such exciting properties, the applications of Mg and its alloys were very limited in aerospace, automotive, and biomedical industries but recently the application is picking-up. The restricted application is attributed to anisotropy, poor corrosive resistance, and inflammability of Mg. The current review addresses the barriers limiting the widespread application of Mg based materials. Furthermore, the mitigation of the problems of anisotropy, poor corrosion resistance, ductility, and inflammability of Mg are critically reviewed. The findings of this research provide insights of the processing techniques, properties and how to address the potential barriers of limited applications. The review paper will assist and motivate the researchers to ponder and overcome numerous problems related to Mg and its alloys by understanding the importance of each problem discussed in this review. An attempt has also been made to arrange research status on issues and the mitigation thereof with respect to Mg and its alloys as single reference point.
An Optimization Framework for the Design of Cable Harness Layouts in Planar Interconnected Systems
Authors: Masoudi Nafiseh , Fadel Georges
Published: July 2021

The components of complex systems such as automobiles or ships communicate via connectors, including wires, hoses, or pipes whose weight could substantially increase the total weight of the system. Hence, it is of paramount importance to lay out these connectors such that their overall weight is minimized. In this paper, a computationally efficient approach is proposed to optimize the layout of flexible connectors (e.g., cable harnesses) by minimizing their overall length while maximizing their common length. The approach provides a framework to mathematically model the cable harness layout optimization problem. A Multiobjective Genetic Algorithm (MOGA) solver is then applied to solve the optimization problem, which outputs a set of non-dominated solutions to the bi-objective problem. Finally, the effects of the workspace’s geometric structure on the optimal layouts of cable harnesses are discussed using sample test cases. The overarching objective of this study is to provide insight for designers of cable harnesses when deciding on the final layout of connectors considering aspects such as accessibility to and maintainability of these connectors.
Vascular Ehlers-Danlos syndrome presenting in the ICU as aneurysmal subarachnoid haemorrhage
Authors: Pimenta Inês , Varudo Rita , Castelao Filipa , Gonzalez Filipe André
Published: July 2021

Vascular Ehlers-Danlos syndrome is caused by mutations of COL3A1 gene coding for type III collagen. The main clinical features involve a propensity to arterial tears leading to several life-threatening conditions and intensive care unit admission. We, herein, report the case of a 34-year-old woman presenting with an aneurysmal subarachnoid haemorrhage. Endovascular coil treatment was attempted; however, the procedure was complicated by dissection of the left iliac artery and abdominal aorta. Hospital management was marked by a series of vascular and haemorrhagic complications. These events, together with some distinctive physical features and medical history, raised the suspicion of vascular type of Ehlers-Danlos syndrome. Neurological evolution was not favourable, and the patient evolved to brain death. Genetic testing was available postmortem and identified a mutation in the COL3A1 gene. This case illustrates the importance of medical history and clinical suspicion for diagnosis, which often goes unnoticed until major complications occur.
Ventilator-associated pneumonia due to carbapenem-resistantProvidencia rettgeri
Authors: Patel Nupur B , Jain Gaurav , Chandrakar Saurabh , Walikar Beeraling Ningappa
Published: July 2021

Ventilator-associated pneumonia (VAP) is one of the leading cause of mortality and morbidity in critically ill patients on mechanical ventilation. We report a case of VAP caused byProvidencia rettgeriin a postoperative 58-year-old man with prepyloric perforation. The patient’s ICU stay was complicated by VAP. As the organism was carbapenem resistant, high-dose extended infusion of meropenem along with cefepime was started. Early identification and treatment helped in successful weaning of the patient from the ventilator.Providenciais an emerging nosocomial pathogen with an increase in resistance pattern. This case highlights the rarity and importance ofProvidenciaas a cause of VAP.
Tradition, taste and taboo: the gastroecology of maternal perinatal diet
Authors: Lunkenheimer Hannah G , Burger Oskar , Akhauri Santosh , Chaudhuri Indrajit , Dibbell Lisa , Hashmi Faiz A , Johnson Tracy , Little Emily E , Mondal Sudipta , Mor Nachiket , Saldanha Neela , Schooley Janine , Legare Cristine H
Published: July 2021

Background

Maternal malnutrition is a major source of regional health inequity and contributes to maternal and infant morbidity and mortality. Bihar, a state in eastern India adjacent to Jharkhand and West Bengal, has relatively high neonatal mortality rates because a large portion of infants are born to young mothers. Bihar has the second-highest proportion of underweight children under 3 in India, with infant mortality rates of 48 per 1000 live births. Maternal malnutrition remains a major threat to perinatal health in Bihar, where 58.3% of pregnant women are anaemic.

Methods

We examined dietary beliefs and practices among mothers, mothers-in-law and community members, including Accredited Social Health Activists (ASHAs), using focus group discussions (n=40 groups, 213 participants), key informant interviews (n=50 participants) and quantitative surveys (n=1200 recent mothers and 400 community health workers). We report foods that are added/avoided during the perinatal period, along with stated reasons underlying food choice. We summarise the content of the diet based on responses to the quantitative survey and identify influencers of food choice and stated explanations for adding and avoiding foods.

Key findings

Analyses for all methodologies included gathering frequency counts and running descriptive statistics by food item, recommendation to eat or avoid, pregnancy or post partum, food group and health promoting or risk avoiding. During pregnancy, commonly added foods were generally nutritious (milk, pulses) with explanations for consuming these foods related to promoting health. Commonly avoided foods during pregnancy were also nutritious (wood apples, eggplant) with explanations for avoiding these foods related to miscarriage, newborn appearance and issues with digestion. Post partum, commonly added foods included sweets because they ease digestion whereas commonly avoided foods included eggplants and oily or spicy foods. Family, friends, relatives or neighbours influenced food choice for both mothers and ASHAs more than ASHAs and other health workers.

Perinatal dietary beliefs and behaviours are shaped by localgastroecologiesor systems of knowledge and practice that surround and inform dietary choices, as well as how those choices are explained and influenced. Our data provide novel insight into how health influencers operating within traditional and biomedical health systems shape the perinatal dietary beliefs of both mothers and community health workers.
Early-life famine exposure and rheumatoid arthritis in Chinese adult populations: a retrospective cohort study
Authors: Liu Chunyu , Meng Xiangrui , Zhang Hao , Yang Fan , Pan Xiaoyu , Tang Kun
Published: July 2021

Objective

This study aimed to explore the association between famine exposure in early life and the odds of rheumatoid arthritis (RA) in adulthood.

Design

A population-based retrospective cohort study.

Setting

China.

Participants

A total of 111 706 participants (1775 with RA) born from 1956 to 1964 were selected from the baseline survey of a large cohort in China.

Primary and secondary outcome measures

Four famine exposure groups were generated based on dates of birth, namely prenatal-exposed, infant-exposed, preschool-exposed and non-exposed groups. Logistic regressions were used to explore the association between famine exposure and self-reported RA in adulthood, adjusting for sex, region, monthly income, highest education, alcohol consumption, tobacco use, body mass index (BMI) and metabolic equivalent tasks. Analyses were also performed with stratification for sex (female or male), residing region (urban or rural), famine severity (severe or non-severe) and BMI (≥24 or <24).

Results

The study included 1775 (1.59%) RA cases and 109 931 (98.41%) non-RA controls. Among them, 22 413 (20.06%) were prenatal-exposed, 14 899 (13.34%) were infant-exposed and 34 356 (30.76%) were preschool-exposed. Prenatal exposure to famine was not associated with onset of RA in adulthood. Infant-exposed group and preschool-exposed group had significantly elevated odds of getting RA compared with non-exposed group (infant-exposed: OR=1.44, 95% CI 1.24 to 1.67; preschool-exposed: OR=1.38, 95% CI 1.22 to 1.57, p<0.001), and the relationship was stronger among women, urban residents and participants with BMI ≥24. Similar results were additionally observed when an age-balanced control group was used.

Conclusions

Exposure to the Great Chinese Famine in early life after birth especially in infancy may be associated with a higher risk of RA in adulthood. Strengthening early-life nutrition could be an implication to prevent future RA.
Markers of gastrointestinal permeability and dysbiosis in premenopausal women with PCOS: a case–control study
Authors: Lingaiah Shilpa , Arffman Riikka K , Morin-Papunen Laure , Tapanainen Juha S , Piltonen Terhi
Published: July 2021

Objectives

Altered intestinal permeability and gut barrier dysfunction have been suggested to play a role in the pathogenetic mechanism of polycystic ovary syndrome (PCOS), the most common endocrine and metabolic condition in reproductive-aged women. However, data on intestinal permeability and dysbiosis of the gut microbiota in PCOS is still limited, with conflicting results. To this end, the concentrations of gastrointestinal permeability and gut dysbiosis markers were analysed in women with PCOS.

Design

Case–control study.

Setting

General community.

Participants

104 women with PCOS and 203 body mass index (BMI) matched control women at age 46.

Primary and secondary outcome measures

Serum levels of zonulin, fatty acid-binding protein 2 (FABP2), urinary levels of indican, and hormonal and metabolic parameters.

Results

Serum levels of zonulin (128.0±17.0 vs 130.9±14.0 ng/mL, p=0.13) and FABP2 (1.5±0.9 vs 1.5±0.7 ng/mL, p=0.63) and urinary levels of indican (9.5±5.5 vs 8.4±4.2 mg/dL, p=0.07) were comparable in women with PCOS and controls in the whole study population. Likewise, when the study population was divided into different BMI groups as normal weight, overweight and obese, the levels of the above markers were comparable between the study groups. After BMI adjustment, zonulin levels correlated with the levels of high-sensitivity C reactive protein and homoeostasis model assessment of insulin resistance (p<0.05) both in women with PCOS and controls.

Conclusions

Intestinal permeability markers zonulin and FABP2, and the dysbiosis marker indican do not seem to be altered in women with PCOS at age 46 compared with BMI-matched controls. Serum zonulin levels correlated with BMI, insulin resistance and inflammatory marker levels, but did not segregate women with PCOS and controls. This suggests that metabolic factors, but not PCOS per se, is the driving force of dysbiosis in premenopausal women with PCOS.
Associations of subclinical heart failure and atrial fibrillation with mild cognitive impairment: a cross-sectional study in a subclinical heart failure screening programme
Authors: Potter Elizabeth L , Ramkumar Satish , Wright Leah , Marwick Thomas H
Published: July 2021

Objectives

Effective identification and management of subclinical left ventricular (LV) dysfunction (LVD) and subclinical atrial fibrillation (AF) by screening elderly populations might be compromised by mild cognitive impairment (MCI). We sought to characterise the prevalence and profile of MCI and evaluate associations with LV and left atrial (LA) dysfunction and AF, in a trial of screening for subclinical LVD and AF.

Design

Cross-sectional.

Setting

Australian, community-based intervention trial.

Participants

Adults aged ≥65 years with ≥1 LVD risk factors without ischaemic heart disease (n=337).

Outcome measures

The Montreal cognitive assessment (MoCA) was obtained. Subclinical LVD was defined as echocardiographic global longitudinal strain ≤16%, diastolic dysfunction or LV hypertrophy; abnormal LA reservoir strain (LARS) was defined as <24%. Subclinical AF was detected using a single-lead portable electrocardiographic device in those without pre-existing AF who gave consent (n=293).

Results

Subclinical LVD was found in 155 (46%), abnormal LARS in 9 (3.6%) and subclinical AF in 11 (3.8%). MoCA score consistent with MCI (<26) was found in 101 (30%); executive function (69%) and delayed recall (93%), were the most frequently abnormal domains. Compared with normal cognition, MCI was associated with non-adherence to AF screening (25% vs 40%, p=0.01). In multivariable logistic regression modelling, educational achievement, systolic blood pressure, body mass index and waist-to-hip ratio were independently associated with MCI. However, neither subclinical AF nor any measure of cardiac dysfunction, were associated with MCI.

Conclusions

The 30% prevalence of MCI among elderly subjects with risk factors for subclinical LVD and AF has important implications for screening strategies and management. However, MCI is not associated with subclinical myocardial dysfunction nor subclinical AF.

Trial registration number

Australian New Zealand Clinical Trials Registry (ACTRN12617000116325).
Influence of serum iron test results on the diagnosis of iron deficiency in children: a retrospective observational study
Authors: Sezgin Gorkem , Li Ling , Westbrook Johanna , Wearne Elisabeth , Azar Denise , McLeod Adam , Pearce Christopher , Ignjatovic Vera , Monagle Paul , Georgiou A
Published: July 2021

Background and objective

Serum iron results are not indicative of iron deficiency yet may be incorrectly used to diagnose iron deficiency instead of serum ferritin results. Our objective was to determine the association between serum iron test results and iron-deficiency diagnosis in children by general practitioners.

Design, setting, patients and main outcome measures

A retrospective observational study of 14 187 children aged 1–18 years with serum ferritin and serum iron test results from 137 general practices in Victoria, Australia, between 2008 and 2018. Generalised estimating equation models calculating ORs were used to determine the association between serum iron test results (main exposure measure) and iron-deficiency diagnosis (outcome measure) in the following two population groups: (1) iron-deplete population, defined as having a serum ferritin <12 µg/L if aged <5 years and <15 µg/L if aged ≥5 years and (2) iron-replete population, defined as having a serum ferritin >30 µg/L.

Results

3484 tests were iron deplete and 15 528 were iron replete. Iron-deplete children were less likely to be diagnosed with iron deficiency if they had normal serum iron levels (adjusted OR (AOR): 0.73; 95% CI 0.57 to 0.96). Iron-replete children had greater odds of an iron-deficiency diagnosis if they had low serum iron results (AOR: 2.59; 95% CI 1.72 to 3.89). Other contributors to an iron-deficiency diagnosis were female sex and having anaemia.

Conclusion

Serum ferritin alone remains the best means of diagnosing iron deficiency. Reliance on serum iron test results by general practitioners is leading to significant overdiagnosis and underdiagnosis of iron deficiency in children.
Association of the incidence of atopic dermatitis until 3 years old with birth month and with sunshine duration and humidity in the first 6 months of life: Japan Environment and Children’s Study
Authors: Yokomichi Hiroshi , Mochizuki Mie , Tsuchida Akiko , Kojima Reiji , Horiuchi Sayaka , Ooka Tadao , Akiyama Yuka , Miyake Kunio , Otawa Sanae , Shinohara Ryoji , Inadera Hidekuni , Yamagata Zentaro
Published: July 2021

Objective

To compare the incidence of atopic dermatitis in children aged from 6 months to 3 years across birth seasons and climate conditions.

Design

Cohort study.

Setting

Fifteen regional centres across Japan.

Participants

A total of 100 304 children born from 2011 to 2014.

Exposure

Birth month, and mean sunshine duration (short/long) and humidity (high/low) in the first 6 months of life.

Primary outcome measure

Incidence of atopic dermatitis.

Results

The highest incidence of atopic dermatitis was in children born in the months of October to December. The lowest incidence of atopic dermatitis was in the months of April to June and in periods with a long duration of sunshine and high humidity. Low humidity was significantly associated with a higher incidence of atopic dermatitis. However, this significant difference disappeared when the birth season and parental history of allergic disease were considered in multivariate analysis.

Conclusions

In Japan, being born in the late autumn to early winter months is associated with a risk of developing atopic dermatitis until the age of 3 years. Sunshine duration and humidity from birth to 6 months of age are not associated with the incidence of atopic dermatitis.
Prayer as a pain intervention: protocol of a systematic review of randomised controlled trials
Authors: Ferreira-Valente Alexandra , Jarego Margarida , Queiroz-Garcia Inês , Pimenta Filipa , Costa Rui Miguel , Day Melissa A , Pais-Ribeiro José , Jensen Mark P
Published: July 2021

Background

Pain is a universal experience and the most common reason for seeking healthcare. Inadequate pain management negatively impacts numerous aspects of patient health. Multidisciplinary treatment programmes, including psychosocial interventions, are more useful for pain management than purely biomedical treatment alone. Recently, researchers showed increasing interest in understanding the role of spirituality/religiosity and spiritual/religious practices on pain experience, with engagement in religious practices, such as prayer, showing to positively impact pain experience in religious individuals. This systematic review will seek to summarise and integrate the existing findings from randomised controlled trials assessing the effects of prayer and prayer-based interventions on pain experience.

Methods

The systematic review procedures and its report will follow the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement. Electronic searches in nine databases (Web of Science Core Collection, MEDLINE, SCIELO Citation Index, PubMed, Cochrane Central Register of Controlled Clinical Trial, PsycINFO, Scopus, LILACS and Open-SIGLE) will be performed to identify randomised controlled trials of prayer-based interventions. Two independent researchers will assess studies for inclusion and extract data from each paper. Risk of bias assessment will be assessed independently by two reviewers based on the Consolidated Standards of Reporting Trials statement. Qualitative synthesis of the body of research will be conducted using a narrative summary synthesis method. Meta-analysis will be limited to studies reporting on the same primary outcome. Formal searches are planned to start in June 2021. The final report is anticipated to be completed by September 2021.

Discussion

Findings will be useful to (1) understand the condition of our knowledge in this field and (2) provide evidence for prayer effectiveness in reducing pain intensity and pain-related stress and increasing pain tolerance in adults experiencing acute or chronic pain.

PROSPERO registration number

CRD42020221733.
Pharmacokinetics and complementary evaluation system-based guidance on prophylaxis of paediatric patients with haemophilia A in China with Kovaltry: protocol of the LEAP study
Authors: Kun Huang , Xu Weiqun , Zhou Min , Li Xiaojing , Xu Zhongjin , Fang Yongjun , Li Changgang , Chen Zhenping , Wu Runhui
Published: July 2021

Introduction

Haemophilia A is a rare inherited bleeding disease caused by the deficiency of coagulation factor VIII (FVIII). The main treatment protocol is to administer regular exogenous FVIII concentrate infusions. With the discovery of variability in individualised pharmacokinetics (PK) and bleeding phenotype, the previous weight-based approach needs to be replaced by more advanced PK-tailored prophylaxis with an accurate evaluation system. In this study, we combine individualised PK profiles and a complementary evaluation system to guide prophylaxis in paediatric patients with haemophilia A.

Methods and analysis

This is a single-centre, prospective single-arm study. The aim of this study is to assess the effectiveness of a new strategy combining PK and a complementary evaluation system to treat haemophilia A in Chinese paediatric patients. Sixty paediatric patients with haemophilia will be recruited. After PK testing, they will receive a PK-guided stepup prophylaxis in the next 2 years. The dosing regimen will be determined according to individualised PK profiles and complementary evaluation findings. Related indicators at the end of the study will be compared with the values at treatment initiation to examine the effectiveness of this new strategy. The demographic data of the investigated patients will be summarised by descriptive statistics. Quantitative data will be described by summary statistics, including arithmetic median, range, mean and arithmetic SD. Analyses will use t-test to compare indicators such as bleeding rate and imaging score at both ends of the study as well as during follow-up.

Ethics and dissemination

The study has been approved by the Ethics Committee of Beijing Children’s Hospital (Number 2020-Z-095). The findings will be presented at international meetings such as World Federation of Hemophilia World Congress. Related manuscripts will be submitted to peer-review journals such asBloodandHemophilia.

Trial registration number

ChiCTR2000037821; Pre-results.