bluuebunny/crossref_metadata_2025 huggingface dataset:
Demonic possession: Narratives of domestic abuse and trauma in Malaysia
Authors: Sahdan Zuriatunfadzliah , Pain Rachel , McEwan Cheryl
Published: August 2021

Every society deploys narratives concerning the phenomenon of domestic abuse which serve to downplay and normalise it. Drawing on qualitative research with survivors in Malaysia, and working from a feminist postcolonial framework, this paper explores how the notion of demonic possession is used by survivors and perpetrators as a metaphor for domestic abuse, and a narrative to make sense of and excuse it. The idea of demonic possession has utility because of its close fit both with perpetrators' behaviour and the symptoms experienced by survivors with trauma. The research focuses on the intimate dynamics of abuse, including coercive control and intimate captivity, and the pivotal role of possession and trauma in the successful exertion of control and in extending the damaging effects of abuse. We argue that demonic possession reflects another way in which globally endemic practices of domestic abuse are justified and explained; it provides a means for perpetrators to evade responsibility for abuse, and a way in which the pernicious effects of both abuse and trauma on survivors, their families, and wider society are sometimes dismissed. The paper highlights the significance of culturally sensitive approaches to domestic violence and trauma as a counterpoint to western‐centric understandings. It also stresses the need for locally generated approaches to awareness raising and support services in Malaysia and elsewhere.
Ex vivo comparison ofhand‐suturedversus circular stapled anastomosis in canine large intestine
Authors: Sapora Joseph A. , Hafez Ahmed , Monnet Eric
Published: August 2021

Objective

To compare leakage pressures of colonic anastomoses performed with circular staplers to conventional hand‐sewn techniques in dogs.

Study design

Ex‐vivo study.

Animals

Colon from 11 canine cadavers.

Methods

Thirty‐two colonic anastomoses were performed. Four segments from each colon were randomly assigned to one of four techniques: hand‐sewn colonic anastomoses performed with 4‐0 glycomer 631 (G) and 4‐0 barbed glycomer 631 (BG), and circular stapled colonic anastomoses using 4.8 mm End‐to‐End Anastomosis (EEA C4.8mm) and 3.5 mm End‐to‐End Anastomosis (EEA C3.5mm), 21 mm diameter circular staples in cadaveric canine colon.

Leakage pressure was defined as the pressure at which dye‐containing solution was first observed to leak from the anastomosis site.

Results

Leakage pressures were 49.5 mmHg (range:16‐72) in group G, 45.5 mmHg (range:19‐80) in group BG, 5.3 mmHg (range:0‐31) in group C3.5mm, and 29.5 mmHg (range:23‐50.3) in group C4.8mm. Anastomoses leaked at lower pressures when stapled rather than hand‐sewn (C4.8mm‐Gp = .0313, C4.8mm‐BGp = .0131, C3.5mm‐Gp = .0469, C3.5mm‐BGp = .0313). Two of the C3.5mm constructs leaked immediately after saline infusion with 4/6 leaking at <5.3 mmHg.

Conclusion

End‐to‐end colonic anastomoses closed with circular stapler leaked at lower pressures than hand‐sutured anastomoses. Use of the EEA stapler with a staple height of 3.5 mm did not result in safe colonic anastomoses.

Clinical significance

These results provide evidence to support hand‐suturing colonic anatomoses with G and BG in dogs. The 4.8 mm staples may be considered in anatomical locations difficult to reach.
Effectiveness of an Evidence‐Based Practice Training Program for Nurse Educators: A Cluster‐Randomized Controlled Trial
Authors: D’Souza Preethy , George Anice , Nair Sreekumaran , Noronha Judith , Renjith Vishnu
Published: August 2021

Background

Evidence‐based practice (EBP) endeavors to integrate the best available evidence with clinical expertise and patient preference to enhance clinical outcomes. For nurses to effectively demonstrate EBP, the concepts of EBP should be systematically incorporated into the nursing curriculum, with nurse educators playing a pivotal role in execution. However, the effect of EBP training programs on nurse educators remains largely unexplored.

Aim

To evaluate the effectiveness of an EBP training program on the knowledge, attitude, practice, and competency of nurse educators.

Methods

A pragmatic randomized controlled trial was conducted at a nursing education institution. Fifty‐one nurse educators were cluster randomized into intervention and control groups. A 30‐hour EBP training intervention was provided for nurse educators in the intervention group. The outcome variables were knowledge, attitude, practice, and competency regarding EBP. These outcomes were evaluated using the EBP knowledge and practice questionnaire, EBP attitude scale, and Fresno test. Data were collected at baseline, the end of 5 months, and the end of 10 months.

Results

Fifty‐one eligible participants were enrolled in the study. The intervention and control group had three clusters each with 27 and 24 participants, respectively. Participants in both groups were comparable for variables such as age, years of experience, and educational background (p > .05). Between groups, outcome variables were compared using mixed linear multi‐level modeling. Nurse educators who received the EBP training program demonstrated significant differences in knowledge (p < .05), attitude (p < .05), practice (p < .05), and competency scores (p < .05), than that of the control group, indicating the intervention effectiveness.

Linking Evidence to Action

EBP training programs are effective in improving the knowledge, attitude, practice, and competency of nurse educators.
Contact events in rugby union and the link to reduced cognition: evidence for impaired redox‐regulation of cerebrovascular function
Authors: Owens Thomas S. , Calverley Thomas A. , Stacey Benjamin S. , Iannatelli Angelo , Venables Lucy , Rose George , Fall Lewis , Tsukamoto Hayato , Berg Ronan M. G. , Jones Gareth L. , Marley Christopher J. , Bailey Damian M.
Published: August 2021

New Findings

What is the central question of this study?

How does recurrent contact incurred across a season of professional rugby union impact molecular, cerebrovascular and cognitive function?

What is the main findings and its importance?

A single season of professional rugby union increases systemic oxidative–nitrosative stress (OXNOS) confirmed by a free radical‐mediated suppression in nitric oxide bioavailability. Forwards encountered a higher frequency of contact events compared to backs, exhibiting elevated OXNOS and lower cerebrovascular function and cognition. Collectively, these findings provide mechanistic insight into the possible cause of reduced cognition in rugby union subsequent to impairment in the redox regulation of cerebrovascular function.

Contact events in rugby union remain a public health concern. We determined the molecular, cerebrovascular and cognitive consequences of contact events during a season of professional rugby. Twenty‐one male players aged 25 (mean) ± 4 (SD) years were recruited from a professional rugby team comprising forwards (n = 13) and backs (n = 8). Data were collected across the season. Pre‐ and post‐season, venous blood was assayed for the ascorbate free radical (A•–, electron paramagnetic resonance spectroscopy) and nitric oxide (NO, reductive ozone‐based chemiluminescence) to quantify oxidative–nitrosative stress (OXNOS). Middle cerebral artery velocity (MCAv, Doppler ultrasound) was measured to assess cerebrovascular reactivity (CVR), and cognition was assessed using the Montreal Cognitive Assessment (MoCA). Notational analysis determined contact events over the season. Forwards incurred more collisions (Mean difference [MD] 7.49; 95% CI, 2.58–12.40; P = 0.005), tackles (MD 3.49; 95% CI, 0.42–6.56; P = 0.028) and jackals (MD 2.21; 95% CI, 0.18–4.24; P = 0.034). Forwards suffered five concussions while backs suffered one concussion. An increase in systemic OXNOS, confirmed by elevated A•– (F2,19 = 10.589, P = 0.004) and corresponding suppression of NO bioavailability (F2,19 = 11.492, P = 0.003) was apparent in forwards and backs across the season. This was accompanied by a reduction in cerebral oxygen delivery (, F2,19 = 9.440, P = 0.006) and cognition (F2,19 = 4.813, P = 0.041). Forwards exhibited a greater decline in the cerebrovascular reactivity range to changes in PETCO2 ( compared to backs (MD 1.378; 95% CI, 0.74–2.02; P < 0.001).
Knowledge-Based Adaptation of Product and Process Design in Blisk Manufacturing
Authors: Ganser Philipp , Landwehr Markus , Schiller Sven , Vahl Christopher , Mayer Sebastian , Bergs Thomas
Published: August 2021

Early and efficient harmonization between product design and manufacturing represents one of the most challenging tasks in engineering. Concepts such as simultaneous engineering aim for a product creation process, which addresses both, functional requirements as well as requirements from production. However, existing concepts mostly focus on organizational tasks and heavily rely on the human factor for the exchange of complex information across different domains, organizations, or systems. Nowadays product and process design make use of advanced software tools such as computer-aided design, manufacturing, and engineering systems (CAD/CAM/CAE). Modern systems already provide seamless integration of both worlds in a single digital environment to ensure a continuous workflow. Yet, for the holistic harmonization between product and process design, the following aspects are missing: (i) the digital environment does not provide a complete and data consistent digital twin of the component; this applies especially to the process design and analysis environment, (ii) due to the lack of process and part condition data in the manufacturing environment, an adaptation of product and process design for a balanced functionality and manufacturability is hindered, and (iii) systematic long-term data analytics across different product and process designs with the ultimate goal to transfer knowledge from one product to the next and to accelerate the entire product development process is not considered. This paper presents an exploration concept which couples product design (CAD), process design (CAM), process simulation (CAE), and process adaptation in a single software system. The approach provides insights into correlations and dependencies between input parameters of product/process design and the process output. The insights potentially allow for a knowledge-based adaptation, tackling well-known optimization issues such as parameter choice or operation sequencing. First results are demonstrated using the example of a blade integrated disk (blisk) .
Modeling the initial monolayer formation in thermally localized surface deposition
Authors: de Braaf Bart , Rops Cor M. , Storm Cornelis
Published: August 2021

In atomic layer deposition (ALD), thin layers of materials are deposited on a substrate with atomic layer precision in the vertical direction. The ability to control layer growth in the lateral direction as well is expected to greatly increase the potential of ALD as a path to the bottom-up additive fabrication of electronic devices like solar panels and organic light-emitting diode displays. We explore the possibility of controlling the lateral growth by modifying the temperature profile on the substrate using, for instance, pulsed lasers. This maskless technique keeps the majority of the substrate at a low temperature suppressing one of the chemical half-reactions, while in a small, localized area, the substrate is heated, which allows the reaction to proceed at a higher rate. We test this idea with course-grained computational models that model the control of the temperature by various illumination protocols and simulate the nucleation and growth of the initial monolayer within this inhomogeneous temperature distribution. Our results suggest that the location and the extent of deposition can, in principle, be localized and controlled and address operational regimes in which a thin conducting line may be obtained.
Effect of an Inside–Outside School Alternated Teaching Unit of Knowledge of the Environment for Practicing Physical Activity: A Cluster Randomized Control Trial
Authors: Casado-Robles Carolina , Viciana Jesús , Guijarro-Romero Santiago , Mayorga-Vega Daniel
Published: August 2021

Purpose: To examine the effect of two physical education–based alternated teaching units on students’ environmental knowledge for practicing out-of-school physical activity (PA), perceived autonomy support, self-determined and controlled motivation toward PA, intention to be physically active, self-reported and objective PA levels, and sedentary behavior. Method: A sample of 179 students (94 females) aged 13–15 years old was cluster randomly assigned to the innovative group (two alternated teaching units for practicing PA, with one lesson inside and one outside the school grounds) or the traditional group (a teaching unit for practicing PA, solely inside the school center). Results: The alternated teaching units improved students’ knowledge of their environment for practicing PA, perceived autonomy, autonomous motivation, intention to be physically active, and self-reported PA during the whole week (p < .05). Discussion/Conclusion: The innovative program improved students’ knowledge about their environment for practicing PA and self-reported PA but did not improve objectively measured PA levels.
One Physical Educator’s Struggle to Implement Restorative Practices in an Urban Intensive Environment
Authors: Hemphill Michael A. , Marttinen Risto , Richards K. Andrew R.
Published: August 2021

Purpose: The purpose of this cyclical action research study was to examine the perspectives of Clyde, a first-year physical education teacher working in an urban intensive environment, as he attempted to implement restorative practices. Methods: Data included semistructured interviews, weekly e-mail communication, text messages, photographs, field notes from observations, and artifacts. Data were analyzed using a combination of inductive and deductive analysis. Results: The results are presented in three themes: (a) searching for appropriate discipline procedures, (b) critical incidents inhibited the integration of restorative practices, and (c) lack of preparation to teach in an urban intensive environment. Conclusion: Clyde’s experience suggests that challenges for early career teachers may be further complicated by teaching in urban intensive environments. Teacher educators may consider the different contexts in which teachers work and the influence they can have on both teacher effectiveness and job satisfaction.
Mental Qualities and Techniques in Tactical Populations: A Systematic Review
Authors: Raabe Johannes , Castillo Elmer , Carl Johannes
Published: August 2021

Although applied sport psychology services have traditionally been provided in athletic settings, there has been a trend toward a more general application across different performance domains and, in particular, with tactical populations (i.e., military, law enforcement, and firefighters). The purpose of the current study was to systematically review the existing research on mental qualities and techniques in tactical populations. A database search revealed 7,220 potentially relevant articles, which were screened by two independent reviewers based on predefined inclusion criteria. This systematic screening process helped to identify 49 articles for further analysis. The findings highlight the benefits of developing mental qualities and techniques among tactical populations, as they can help to nurture a range of positive cognitive, affective, and behavioral outcomes. Yet, this review also indicates gaps and limitations that need to be addressed in future research to gain a better understanding of the antecedents, mediators, and consequences of these psychological constructs.
Cellular costs underpin micronutrient limitation in phytoplankton
Authors: McCain J. Scott P. , Tagliabue Alessandro , Susko Edward , Achterberg Eric P. , Allen Andrew E. , Bertrand Erin M.
Published: August 2021

Proteomic allocation modeling coupled with metaproteomics reveals that cellular costs govern micronutrient-controlled growth.
Large slip, long duration, and moderate shaking of the Nicaragua 1992 tsunami earthquake caused by low near-trench rock rigidity
Authors: Sallarès Valentí , Prada Manel , Riquelme Sebastián , Meléndez Adrià , Calahorrano Alcinoe , Grevemeyer Ingo , Ranero César R.
Published: August 2021

Elastic rock properties in the Nicaragua subduction zone explain the anomalous characteristics of tsunami earthquakes.
Programmable self-propelling actuators enabled by a dynamic helical medium
Authors: Ma Ling-Ling , Liu Chao , Wu Sai-Bo , Chen Peng , Chen Quan-Ming , Qian Jia-Xin , Ge Shi-Jun , Wu Yuan-Hang , Hu Wei , Lu Yan-Qing
Published: August 2021

Actuators mimic the unique motion of bacteria, which are realized by self-organizing photoresponsive cholesteric liquid crystals.
Differential H4K16ac levels ensure a balance between quiescence and activation in hematopoietic stem cells
Authors: Pessoa Rodrigues Cecilia , Akhtar Asifa
Published: August 2021

Variable H4K16ac levels are associated with hematopoietic stem cell state heterogeneity.
Nanocapsules modify membrane interaction of polymyxin B to enable safe systemic therapy of Gram-negative sepsis
Authors: Yuk Simseok A. , Kim Hyungjun , Abutaleb Nader S. , Dieterly Alexandra M. , Taha Maie S. , Tsifansky Michael D. , Lyle L. Tiffany , Seleem Mohamed N. , Yeo Yoon
Published: August 2021

Nanocapsules modify membrane interaction of polymyxin B to reduce its toxicity and enable safe systemic therapy of sepsis.
The innate power of PD-1 blockade
Authors: Dhir Aditi , Pillai Asha
Published: August 2021

IL-33 and PD-1 blockade induce melanoma clearance via ILC2 recruitment and expansion.
Supplemental Material: Giant meandering channel evolution, Campos deep-water salt basin, Brazil
Authors: Covault J.A. , al. et
Published: August 2021

File S1: Base channel system horizon in comma-separated values (CSV) format. File S2: Intermediate channel system horizon in CSV format. File S3: Top channel system horizon in CSV format. File S4: Time steps between channel centerlines in Encapsulated PostScript (EPS) format. File S5: Graphics Interchange Format (GIF) animation of channel migration.
Mucinous adenocarcinoma of the lung presenting as pathological humeral fracture: a case report and novel surgical treatment
Authors: Prakash Rohan , Gella Sreenadh , Theivendran Kanthan
Published: August 2021

We present a 73-year-old woman who presented with a pathological fracture of her right humerus. Further imaging and biopsy indicated a mucinous adenocarcinoma of the lung as the primary neoplasm. This represents the first published case of a mucinous adenocarcinoma of the lung presenting as a metastatic lesion of the humerus. Operative management of pathological fractures of the humerus has typically included either intramedullary nailing or the use of single-plating or double-plating techniques. The authors describe a novel technique using both intramedullary fixation augmented with a locking plate, steel cables and bone cement, with good outcome.
Prognostic significance of matrix metalloproteinase 9 in COMET operated chronic ocular Stevens-Johnson syndrome
Authors: Venugopal Renu , Sharma Namrata , Sen Seema , Mohanty Sujata , Kashyap Seema , Agarwal Tushar , Kaur Jasbir , Vajpayee Rasik B
Published: August 2021

Purpose

Molecular pathogenesis underlying persistent ocular surface inflammation in chronic Stevens-Johnson syndrome (SJS) still remains largely unexplored. The present study investigates the expression of matrix metalloproteinase 2 (MMP2), MMP3, MMP9, MMP11 and TIMP1 (tissue inhibittor of matrix metalloproteinase 1) in pannus tissues of chronic ocular SJS undergoing cultivated oral mucosal epithelial transplantation (COMET) and their prognostic relevance.

Methods

In this prospective study, 45 eyes with chronic SJS underwent COMET for visual and anatomical rehabilitation. Preoperative and postoperative clinical parameters were documented. MMP2, MMP3, MMP9, MMP11 and TIMP1 expression were assessed using immunohistochemistry and quantitative real time PCR. Inflammadry MMP9 assay was performed at 1-year follow-up. Kaplan-Meier curves and Cox proportional hazard models were used to correlate protein expression with clinicopathological parameters and COMET graft survival outcomes.

Results

MMP9 and MMP11 positivity was seen in both pannus epithelia (48% and 55%, respectively) and in stromal layer (57% and 33%, respectively) while MMP2 and MMP3 showed only pannus epithelial positivity in 35% and 51% cases, respectively. High MMP9 stromal expression was significantly associated with preoperative corneal keratinisation (p=0.011), conjunctival hyperaemia (p=0.014), symblepharon (p=0.028). High MMP9 and MMP3 epithelial expression were found to be independent risk factors for poor best-corrected visual acuity (BCVA) outcomes post-COMET (p=0.022 and p=0.048). Multivariate analysis revealed MMP9 to be the best prognostic marker (p=0.050).

Conclusion

Our findings suggest that differential expression of MMPs and TIMP1 is seen in SJS in chronic stage. Emergence of MMP9 as a poor prognostic predictor of BCVA post COMET and postoperative MMP9 immunoassay positivity could be a useful tool in further studies to understand the unresolved ocular surface inflammation seen in SJS.
Scoping review of clinical practice guidelines on the management of benign liver tumours
Authors: Haring Martijn P D , Cuperus Frans J C , Duiker Evelien W , de Haas Robbert J , de Meijer Vincent E
Published: August 2021

Objective

Benign liver tumours (BLT) are increasingly diagnosed as incidentalomas. Clinical implications and management vary across and within the different types of BLT. High-quality clinical practice guidelines are needed, because of the many nuances in tumour types, diagnostic modalities, and conservative and invasive management strategies. Yet, available observational evidence is subject to interpretation which may lead to practice variation. Therefore, we aimed to systematically search for available clinical practice guidelines on BLT, to critically appraise them, and to compare management recommendations.

Design

A scoping review was performed within MEDLINE, EMBASE, and Web of Science. All BLT guidelines published in peer-reviewed, and English language journals were eligible for inclusion. Clinical practice guidelines on BLT were analysed, compared, and critically appraised using the Appraisal of Guidelines, Research and Evaluation (AGREE II) checklist regarding hepatic haemangioma, focal nodular hyperplasia (FNH), and hepatocellular adenoma (HCA). Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations (PRISMA) for scoping reviews were adhered to.

Results

The literature search yielded unique 367 papers, 348 were excluded after screening of title/abstract, and 16 after full-text screening. Three guidelines were included: the American College of Gastroenterology (ACG; 2014), Brazilian Society of Hepatology (SBH; 2015), and European Association for the Study of the Liver (EASL; 2016). There was no uniformity in the assessment methods for grading and gravity of recommendations between guidelines. Among observed differences were: (1) indications for biopsy in all three tumours; (2) advices on contraceptive pills and follow-up in FNH and HCA; (3) use of an individualised approach to HCA; (4) absence of recommendations for treatment of HCA in men; and (5) approaches to HCA subtype identification on magnetic resonance imaging.

Conclusion

Recognising differences in recommendations can assist in harmonisation of practice standards and identify unmet needs in research. This may ultimately contribute to improved global patient care.
Value and risk of percutaneous liver biopsy in patients with cirrhosis and clinical suspicion of autoimmune hepatitis
Authors: Sripongpun Pimsiri , Pongpaibul Ananya , Charatcharoenwitthaya Phunchai
Published: August 2021

Objective

The decision regarding whether to perform a liver biopsy in patients with cirrhosis and clinically suspected autoimmune hepatitis (AIH) remains a challenge. This study aimed to assess the utility and complications of percutaneous liver biopsy in cirrhosis for differentiating AIH from other liver conditions.

Methods

A clinicopathological database of patients undergoing percutaneous liver biopsies for suspected AIH (unexplained hepatitis with elevated γ-globulin and autoantibody seropositivity) was reviewed to identify patients presenting with cirrhosis. Biopsy slides were reviewed by an experienced hepatopathologist who was blinded to clinical data.

Results

In 207 patients who underwent liver biopsy for suspected AIH, 59 patients (mean age: 59.0±12.0 years, 83.1% female) had clinically diagnosis of cirrhosis. Mean Child-Turcotte-Pugh score was 6.6±1.6, and 44% of patients had a Child-Turcotte-Pugh score≥7. According to the revised International AIH Group (IAIHG) criteria, histology assessment combined with clinical information facilitated a diagnosis of AIH or overlap syndrome of AIH and primary biliary cholangitis (PBC) in 81.4% of cases. Liver biopsy identified other aetiologies, including PBC (n=2), non-alcoholic steatohepatitis (n=6) and cryptogenic cirrhosis (n=3). A reliable diagnosis of AIH could be made using histological category of the simplified criteria in 69.2% and 81.8% of cases using IAIHG scores before biopsy of <10 and 10–15, respectively. Three patients with cirrhosis (5.1%) experienced bleeding following biopsy, but none of 148 patients with non-cirrhosis had bleeding complication (p=0.022).

Conclusion

Liver biopsy provides important diagnostic information for the management of patients with cirrhosis and suspected AIH, but the procedure is associated with significant risk.
Study designs and outcomes used in evaluation studies of hospital-presenting self-harm: protocol for a methodological systematic review
Authors: Ruane-McAteer Eimear , Corcoran Paul , Browne John , Hursztyn Pawel , Griffin Eve
Published: August 2021

Introduction

Self-harm is the most common risk factor for suicide, and so those who present to hospital following self-harm provide an opportunity for targeted clinical care interventions. Observational studies evaluating such interventions may be useful in overcoming limitations of controlled trials, but study design, statistical analyses and outcomes used must be appropriate. This methodological systematic review will describe, categorise, synthesise and compare the methodological aspects of studies evaluating interventions and aspects of clinical management following hospital-presenting self-harm in both observational and experimental (ie, controlled trials or quasi-experimental studies) study designs.

Methods and analysis

Preferred Reporting Items for Systematic Reviews and Meta-Analysis-Protocol guidelines were followed in drafting this protocol. Search terms were developed (related to self-harm, hospital presentation and evaluation studies) and adapted for MEDLINE, PsycINFO, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials and grey literature databases. Two reviewers will independently screen 100 titles/abstracts until consensus is reached, with the remaining screened by one reviewer. Full-text screening will be conducted independently by two reviewers. Data will be extracted by one reviewer, and a second will check all data extracted. Validated risk of bias tools will be used. Data synthesis will focus on the heterogeneity of outcomes used in individual studies. Descriptive summary statistics of the data (eg, key study characteristics, type and frequency of outcomes) will be provided in categorical format, using frequencies and percentages. Outcomes will be reported separately for trials (both randomised and non-randomised trials), observational and quasi-experimental studies. Categorisation of outcomes will be guided by Cochrane Effective Practice and Organisation of Care resources for reviews of health systems interventions.

Ethics and dissemination

Results will be disseminated at national and international conferences and published in a peer-reviewed journal. Findings will be used to inform future studies in the area of hospital-presenting self-harm. Ethical approval is not required for this review.

PROSPERO registration number

CRD42020208714.
Intersectional stigma and its impact on HIV prevention and care among MSM and WSW in sub-Saharan African countries: a protocol for a scoping review
Authors: Abubakari Gamji M’Rabiu , Dada Debbie , Nur Jemal , Turner DeAnne , Otchere Amma , Tanis Leonne , Ni Zhao , Mashoud Ibrahim Wunpini , Nyhan Kate , Nyblade Laura , Nelson LaRon E
Published: August 2021

Introduction

Research has established that various forms of stigma (HIV stigma, gender non-conforming stigma and same-gender sex stigma) exist across Sub-Saharan Africa and have consequences for the utilisation of HIV prevention and care services. Stigmas are typically investigated in HIV literature individually or through investigating individual populations and the various stigmas they may face. The concept of intersectionality highlights the interconnected nature of social categorisations and their ability to create interdependent systems of discrimination based on gender, race, sexuality and so on. Drawing from perspectives on intersectionality, intersectional stigma denotes the convergence of multiple marginalised identities within an individual or a group, the experiences of stigma associated with these identities as well as the synergistic impact of these experiences on health and well-being. With respect to HIV, public health scholars can examine the impacts of intersectional stigmas on HIV prevention and care utilisation.

Methods and analysis

Reviewers will search systematically through MEDLINE, Global Health, Embase, Scopus, Web of Science Core Collection and Africa Index Medicus and citations for quantitative studies, qualitative studies and grey literature that include data on stigma and HIV among men who have sex with men and women who have sex with women in Sub-Saharan Africa. Eligible studies will include primary or secondary data on stigma related to HIV risk factors experienced by this population. Studies will be written in French or English and be published between January 1991 and November 2020. All screening and data extraction will be performed in duplicate, and if discrepancies arise, they will be settled by GM’RA, LEN, DD or AO. Findings from this study will be reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews.

Ethics and dissemination

Ethics approval is not required as there will be no human participants and no protected data will be used in this study. We will disseminate findings through peer-reviewed manuscripts, conferences and webinars.
Automatic versus manual oxygen titration using a novel nasal high-flow device in medical inpatients with an acute illness: a randomised controlled trial
Authors: Harper James , Kearns Nethmi , Bird Grace , Braithwaite Irene , Eathorne Allie , Shortt Nicholas , Weatherall Mark , Beasley Richard
Published: August 2021

Background

Guideline recommendations state oxygen should be administered to acutely unwell patients to achieve a target oxygen saturation (SpO2) range. The current practice of manual oxygen titration frequently results in SpO2outside of a prescribed range. The aim of this study was to assess the efficacy of automatic oxygen titration using a closed-loop feedback system to achieve SpO2within a prescribed target range

Methods

An open-label randomised parallel group trial was undertaken comparing automatic oxygen titration using a novel nasal high-flow device to manual oxygen titration using nasal high flow. Medical inpatients requiring oxygen therapy in Wellington Regional Hospital, New Zealand with a prescribed target SpO2range of 88%–92% or 92%–96% were recruited and randomised equally between the interventions for a period of 24 hours. The primary outcome was the proportion of time spent with SpO2within the prescribed range.

Results

20 patients were included in the analysis. Automatic oxygen titration resulted in a median (IQR) 96.2% (95.2–97.8) of time within the target range compared with 71% (59.4–88.3) with manual titration; difference (95% CI) 24.2% (7.9% to 35%), p<0.001. There was a reduction in the time spent with SpO2≥2% above and ≥2% below range in the automatic titration group, although the point estimate for the differences were small; −1% (−8.2% to −0.04%), p=0.017 and −2.4% (−11.5% to 0.3%), p=0.05 respectively.

Conclusions

Nasal high-flow with automatic oxygen titration resulted in a greater proportion of time spent with SpO2in target range compared with manual titration.

Trial registration

The trial was registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12619000901101).
Barriers to identifying occupational asthma among primary healthcare professionals: a qualitative study
Authors: Walters Gareth I , Barber Christopher M
Published: August 2021

Introduction

Occupational asthma (OA) accounts for one in six cases of adult-onset asthma and is associated with a large societal cost. Many cases of OA are missed or delayed, leading to ongoing exposure to the causative agent and avoidable lung function loss and poor employment-related outcomes. Enquiry about work-related symptoms and the nature of work by healthcare professionals (HCPs) is limited, evident in primary and secondary care. Potential reasons cited for this are time pressure, lack of expertise and poor access to specialists.

Aim

To understand organisational factors and beliefs and behaviours among primary HCPs that may present barriers to identifying OA.

Methods

We employed a qualitative phenomenological methodology and undertook 20–45 min interviews with primary HCPs in West Midlands, UK. We used purposive and snowball sampling to include general practitioners (GPs) and practice nurses with a range of experience, from urban and rural settings. Interviews were recorded digitally and transcribed professionally for analysis. Data were coded by hand, and thematic analysis was undertaken and determined theoretically until themes were saturated.

Results

Eleven HCPs participated (eight GPs, three nurses). Four themes were identified that were considered to impact on identification of OA: (1) training and experience, (2) perceptions and beliefs, (3) systems constraints, and (4) variation in individual practice. OA-specific education had been inadequate at every stage of training and practice, and clinical exposure to OA had been generally limited. OA-specific beliefs varied, as did clinical behaviour with working-age individuals with asthma. There was a focus on diagnosis and treatment rather than attributing causation. Identified issues regarding organisation of asthma care were time constraints, lack of continuity, referral pressure, use of guidelines and templates, and external targets.

Conclusion

Organisation and delivery of primary asthma care, negative OA-related beliefs, lack of formal education, and exposure to OA may all currently inhibit its identification.
Association between tea consumption and cognitive function in cognitively healthy older adults and older adults with mild cognitive impairment
Authors: Xu Hua , Fiocco Alexandra J , Liu Xiaohua , Wang Tao , Li Guanjun , Xiao Shifu
Published: August 2021

Background

Prospective studies suggest that tea consumption may decrease the risk for cognitive impairment in late life. However, little research has examined the association between tea consumption and cognitive performance across multiple domains. In addition, no research has examined the benefit of tea consumption on cognitive performance among older adults with existing impairment.

Aims

The current study examined the association between tea consumption and performance on tasks of global cognitive function, episodic memory and executive function in cognitively healthy (CH) older adults and older adults with mild cognitive impairment (MCI).

Methods

The analytical sample included 1849 community-dwelling older adults from the Shanghai Brain Aging Study (65.6% female, mean age of 69.50 (8.02) years). Following ascertainment of cognitive function, 816 were categorised as MCI. In addition to completion of a demographics questionnaire, participants reported their tea consumption and completed a battery of tests to measure global cognitive function, episodic memory and working memory.

Results

Independent analyses of covariance revealed a significant association between tea consumption and measures of episodic memory; however, these associations were restricted to CH older adults but not older adults with MCI. Tea consumption was not associated with working memory performance.

Conclusions

The current study suggests that the benefit of tea consumption is restricted to cognitively healthy older adults and does not extend to older adults with MCI.
Diagnostic accuracy of handheld cardiac ultrasound device for assessment of left ventricular structure and function: systematic review and meta-analysis
Authors: Jenkins Sam , Alabed Samer , Swift Andrew , Marques Gabriel , Ryding Alisdair , Sawh Chris , Wardley James , Shah Benoy Nalin , Swoboda Peter , Senior Roxy , Nijveldt Robin , Vassiliou Vassilios S , Garg Pankaj
Published: August 2021

Objective

Handheld ultrasound devices (HUD) has diagnostic value in the assessment of patients with suspected left ventricular (LV) dysfunction. This meta-analysis evaluates the diagnostic ability of HUD compared with transthoracic echocardiography (TTE) and assesses the importance of operator experience.

Methods

MEDLINE and EMBASE databases were searched in October 2020. Diagnostic studies using HUD and TTE imaging to determine LV dysfunction were included. Pooled sensitivities and specificities, and summary receiver operating characteristic curves were used to determine the diagnostic ability of HUD and evaluate the impact of operator experience on test accuracy.

Results

Thirty-three studies with 6062 participants were included in the meta-analysis. Experienced operators could predict reduced LV ejection fraction (LVEF), wall motion abnormality (WMA), LV dilatation and LV hypertrophy with pooled sensitivities of 88%, 85%, 89% and 85%, respectively, and pooled specificities of 96%, 95%, 98% and 91%, respectively. Non-experienced operators are able to detect cardiac abnormalities with reasonable sensitivity and specificity. There was a significant difference in the diagnostic accuracy between experienced and inexperienced users in LV dilatation, LVEF (moderate/severe) and WMA. The diagnostic OR for LVEF (moderate/severe), LV dilatation and WMA in an experienced hand was 276 (95% CI 58 to 1320), 225 (95% CI 87 to 578) and 90 (95% CI 31 to 265), respectively, compared with 41 (95% CI 18 to 94), 45 (95% CI 16 to 123) and 28 (95% CI 20 to 41), respectively, for inexperienced users.

Conclusion

This meta-analysis is the first to establish HUD as a powerful modality for predicting LV size and function. Experienced operators are able to accurately diagnose cardiac disease using HUD. A cautious, supervised approach should be implemented when imaging is performed by inexperienced users. This study provides a strong rationale for considering HUD as an auxiliary tool to physical examination in secondary care, to aid clinical decision making when considering referral for TTE.

Trial registration number

CRD42020182429.
Early adulthood socioeconomic trajectories contribute to inequalities in adult cardiovascular health, independently of childhood and adulthood socioeconomic position
Authors: Winpenny Eleanor M , Howe Laura D , van Sluijs Esther M F , Hardy Rebecca , Tilling Kate
Published: August 2021

Background

Cardiovascular health shows significant socioeconomic inequalities, however there is little understanding of the role of early adulthood in generation of these inequalities. We assessed the contribution of socioeconomic trajectories during early adulthood (16–24 years) to cardiovascular health in mid-adulthood (46 years).

Methods

Participants from the 1970 British Cohort Study with socioeconomic data available in early adulthood were included (n=12 423). Longitudinal latent class analysis identified socioeconomic trajectories, based on patterns of economic activity throughout early adulthood. Cardiometabolic risk factors (46 years) were regressed on socioeconomic trajectory class (16–24 years), testing mediation by adult socioeconomic position (46 years). Models were stratified by sex and adjusted for childhood socioeconomic position (SEP) and adolescent health.

Results

Six early adulthood socioeconomic trajectories were identified: (1) Continued Education (20.2%), (2) Managerial Employment (16.0%), (3) Skilled Non-manual Employment (20.9%), (4) Skilled Manual Employment (18.9%), (5) Partly Skilled Employment (15.8%) and (6) Economically Inactive (8.1%). The ‘Continued Education’ trajectory class showed the best cardiovascular health at age 46 years, with the lowest levels of cardiometabolic risk factors. For example, systolic blood pressure was 128.9 mm Hg (95% CI 127.8 to 130.0) among men in the ‘Continued Education’ class, compared with 131.3 mm Hg (95% CI 130.4 to 132.2) among men in the ‘Skilled Manual’ class. Patterns across classes 2–6 differed by risk factor and sex. The observed associations were largely not mediated by SEP at age 46 years.

Conclusion

Findings suggest an independent contribution of early adulthood socioeconomic trajectories to development of later life cardiovascular inequalities. Further work is needed to understand mediators of this relationship and potential for interventions to mitigate these pathways.
Non-static framework for understanding adaptive designs: an ethical justification in paediatric trials
Authors: Afolabi Michael OS , Kelly Lauren E
Published: August 2021

Many drugs used in paediatric medicine are off-label. There is a rising call for the use of adaptive clinical trial designs (ADs) in responding to the need for safe and effective drugs given their potential to offer efficiency and cost-effective benefits compared with traditional clinical trials. ADs have a strong appeal in paediatric clinical trials given the small number of available participants, limited understanding of age-related variability and the desire to limit exposure to futile or unsafe interventions. Although the ethical value of adaptive trials has increasingly come under scrutiny, there is a paucity of literature on the ethical dilemmas that may be associated with paediatric adaptive designs (PADs). This paper highlights some of these ethical concerns around safety, scientific/social value and caregiver/guardian comprehension of the trial design. Against this background, the paper develops a non-static conceptual lens for understanding PADs. It shows that ADs are epistemically open and reduce some of the knowledge-associated uncertainties inherent in clinical trials as well as fast-track the time to draw conclusions about the value of evaluated drugs/treatments. On this note, the authors argue that PADs are ethically justifiable given they (1) have multiple layers of safety, exposing enrolled children to lesser potential risks, (2) create social/scientific value generally and for paediatric populations in particular, (3) specifically foster the flourishing of paediatric populations and (4) can significantly improve paediatric trial efficiency when properly designed and implemented. However, because PADs are relatively new and their regulatory, ethical and logistical characteristics are yet to be clarified in some jurisdictions, the cooperation of various public and private stakeholders is required to ensure that the interests of children, their caregivers and parents/guardians are best served while exposing paediatric research subjects to the most minimal of risks when they are enrolled in paediatric trials that use ADs.
Elastic and inelastic form factors including 2-body short-range correlation effect
Authors: Abbas Mahmoud A.
Published: August 2021

The charge distributions and elastic electron form factors for 18O, 42,44Ca, 58Ni, and 118Sn nuclei were considered using the cluster expansion of the 1- and 2-body terms. Inelastic electron form factors to 2+ states with core-polarization effects were studied, where the nuclear collective modes were considered alongside the shell model transition density. The influence of short-range correlations (SRCs) was calculated by the parameter β, which was introduced into the ground-state charge distribution and concluded the Jastrow-type function. It is found that the inclusion of 2-body correlations is necessary to describe the observed data of elastic and inelastic form factors at high momentum transfer q > 3 fm–1.
Massive neutron stars with holographic multiquark cores
Authors: Pinkanjanarod Sitthichai , Burikham Piyabut
Published: August 2021

Phases of nuclear matter are crucial in the determination of physical properties of neutron stars (NS). In the core of NS, the density and pressure become so large that the nuclear matter possibly undergoes phase transition into a deconfined phase, consisting of quarks and gluons and their colour bound states. Even though the quark-gluon plasma has been observed in ultra-relativistic heavy-ion collisions (Gyulassy and McLerran, Nucl Phys A 750:30–63, 2005; Andronic et al., Nature 561: 321–330, 2018), it is still unclear whether exotic quark matter exists inside neutron stars. Recent results from the combination of various perturbative theoretical calculations with astronomical observations (Demorest et al., Nature 467:1081–1083, 2010; Antoniadis et al., Science 340:1233232, 2013) shows that (exotic) quark matter could exist inside the cores of neutron stars above 2.0 solar masses ($$M_{\odot }$$

M
⊙

) (Annala et al., Nat Phys, 10.1038/s41567-020-0914-9, arXiv:1903.09121 [astro-ph.HE], 2020). We revisit the holographic model in Refs. (Burikham et al., JHEP 05:006, arXiv:0811.0243 [hep-ph], 2009; Burikham et al., JHEP 06:040, arXiv:1003.5470 [hep-ph], 2010) and implement the equation of states (EoS) of multiquark nuclear matter to interpolate the pQCD EoS in the high-density region with the nuclear EoS known at low densities. For sufficiently large energy density scale ($$\epsilon _{s}$$

ϵ
s

) of the model, it is found that multiquark phase is thermodynamically prefered than the stiff nuclear matter above the transition points. The NS with holographic multiquark core could have masses in the range $$1.96{-}2.23~(1.64{-}2.10) M_{\odot }$$

1.96
-
2.23

(
1.64
-
2.10
)

M
⊙

and radii $$14.3{-}11.8~(14.0{-}11.1)$$

14.3
-
11.8

(
14.0
-
11.1
)

km for $$\epsilon _{s}=26~(28)$$

ϵ
s

=
26

(
28
)

GeV/fm$$^{3}$$

3

respectively. Effects of proton–baryon fractions are studied for certain type of baryonic EoS; larger proton fractions could reduce radius of the NS with multiquark core by less than a kilometer.
Light in dielectric media and scalar fields in a de Sitter spacetime
Authors: Pedrosa I. A. , Ramos B. F. , Bakke K.
Published: August 2021

In the present work we discuss the behavior of light in a linear dielectric medium with a time-varying electric permittivity that increases exponentially at a constant rate and of a scalar field in a de Sitter spacetime, in both the classical and quantum contexts. Notably, we find that the behavior of these two systems are identical and can be described by similar Hamiltonians. By using the Lewis–Riesenfeld invariant method together with Fock states we solve the time-dependent Schrödinger equation for this problem and use its solutions to construct coherent states for the scalar field. Finally, we employ both the Fock and coherent states to evaluate some important properties of the quantized scalar field, such as expectation values of the amplitude and momentum of each mode their variances and the respective uncertainty principle.