bluuebunny/crossref_metadata_2025 huggingface dataset:
Uneven local implementation of federal policy after disaster: Policy conflict and goal ambiguity
Authors: Zarb Stephanie , Taylor Kristin
Published: May 2022

As climate change continues to increase both the frequency and intensity of environmental hazards and disasters, the need for a cohesive national mitigation policy grows. As the environmental federalism scholarship indicates, the inherent tension in federal, state, and local policy implementation highlights that despite a national need, environmental quality is a local public good. To complicate matters, there is disagreement about the optimal level of decision‐making regarding the adoption and implementation of environmental policy. This study addresses this gap by considering the role of policy ambiguity and conflict in policy implementation. The analysis relies on primary qualitative data collected from open‐ended interviews with 22 local government officials in 12 municipalities following Hurricane Harvey. Through the lens of policy ambiguity and conflict, we find confirmatory support for the idea that policies with less ambiguous goals are more likely to be implemented. Furthermore, we find that policy conflict arises when local governments perceive there is little for the community to gain by implementing the federal program. Thus, the level of protection afforded to citizens varies greatly between communities and is influenced heavily by politics. This research supports the Ambiguity‐Conflict Model of policy implementation, an oft‐cited but rarely tested theoretical framework for assessing the intergovernmental politics of policy implementation. It also demonstrates the barriers to local implementation of federal environmental policy in a nested system of government.
Continuous‐time threshold autoregressions with jumps: Properties, estimation, and application to electricity markets
Authors: Lingohr Daniel , Müller Gernot
Published: May 2022

Continuous‐time autoregressive processes have been applied successfully in many fields and are particularly advantageous in the modeling of irregularly spaced or high‐frequency time series data. A convenient nonlinear extension of this model are continuous‐time threshold autoregressions (CTAR). CTAR allow for greater flexibility in model parameters and can represent a regime switching behavior. However, so far only Gaussian CTAR processes have been defined, so that this model class could not be used for data with jumps, as frequently observed in financial applications. Hence, as a novelty, we construct CTAR processes with jumps in this paper. Existence of a unique weak solution and weak consistency of an Euler approximation scheme is proven. As a closed form expression of the likelihood is not available, we use kernel‐based particle filtering for estimation. We fit our model to the Physical Electricity Index and show that it describes the data better than other comparable approaches.
Flow‐through versus static in vitro percutaneous penetration at 50 years: Possible relevance for bioequivalence
Authors: Ajjarapu Krishna , Maibach Howard I.
Published: May 2022

Objective

Compare the relevance of flow‐through versus static diffusion cells data as relates to bioequivalence.

Methods

Search was conducted on PubMed and Google Scholar. Keywords utilized: static cells, flow‐through cells, percutaneous permeation, percutaneous absorption, dermal absorption, and types of permeation.

Results

Fifteen articles were identified with no consistent significant differences between flow‐through and static diffusion cells identified; any differences could exist for two main reasons. (1) Sampling time differences and (2) physical chemistry (lipophilic vs hydrophilic) of the penetrant examined.

Conclusion

Even though there was no consistent significant difference observed, labs have generally adapted to the method they regularly use, which is usually stated in their respective articles. Well‐designed multicentered prospective comparative experiments should clarify potential advantages and disadvantages for each. For flow‐through systems, the flow rate that most approximates to comparable in vivo data for animals and humans may be preferable.
A geospatial workflow for the assessment of public transit system performance using near real‐time data
Authors: Dardas Anastassios , Hall Brent , Salter Jon , Hosseini Hossein
Published: May 2022

This article presents the development of a Geographical Information Systems (GIS) workflow that harvests high‐volume and high‐frequency near real‐time data from a public General Transit Feed Specification (GTFS) and calculates metrics for the assessment of on‐time and route speed performance for a public transit system. The approach is applied to near real‐time and static GTFS data collected over a 9‐month period for the City of Calgary, Alberta, Canada. The workflow uses two Azure Virtual Machines (VMs), one to harvest the data and the other to process observations in parallel using Python and the ArcGIS API libraries. A Web GIS application is described that queries data from MongoDB to visualize the performance results in spatiotemporal form. The purpose of the workflow and Web GIS application is to provide actionable information to transit planners to improve public transportation systems. The data management and analysis workflow is transferable to similar GTFS data from other cities.
Balancing non‐discriminatory donor selection and blood safety in the Netherlands: Evaluation of an individual risk assessment of sexual behavior
Authors: Hahn Brett , Quee Franke , Prinsze Femmeke J. , Gregoire Yves , O'Brien Sheila F. , Germain Marc , van de Laar Thijs , Zaaijer Hans L. , van den Hurk Katja
Published: May 2022

Background

To better balance the safety of the blood supply and the inclusion of men who have sex with men (MSM), further improvements are needed to the risk management strategy employed in the Netherlands to reduce transfusion‐transmissible infections (TTIs). A gender‐neutral individual risk assessment could provide a solution by determining donor eligibility based on sexual behaviors known to increase the risk of TTIs. Our objective is to estimate the proportion of blood donors that would be deferred by such an assessment, as well as their discomfort answering such questions.

Study design and methods

Two surveys were distributed in May 2020 to assess sexual behavior in blood donors in the last 4, 6, and 12 months, as well as their discomfort reporting such information. A combination of both surveys measured the extent to which discomfort was associated with reporting sexual behavior. A high‐risk sexual behavior pattern was defined as having had multiple sexual partners and having engaged in anal sex, without consistent condom use.

Results

Of all 2177 participating whole blood donors, 0.8% report engaging in high‐risk sexual behaviors over the last 4 months and would therefore be ineligible to donate. When accounting for the additional proportion of donors that reported such questions would stop them from donating, 2.0% and 3.2% of female and male donors, respectively, would be lost.

Discussion

Gender‐neutral eligibility criteria based on high‐risk sexual behaviors may reduce the overall number of eligible donors in the Netherlands, but could make blood donation more accessible to a broader group of donors.
Acesso à Justiça e Atuação do Ministério Público na Defesa dos Interesses Sociais
Authors: Da Costa Susana Henriques , De Almeida Ananda Palazzin
Published: April 2022

O presente artigo analisou a atuação do Parquet Paulista na promoção do acesso à justiça. Partiu-se da tipologia dos usuários do sistema de justiça de Marc Galanter e do modelo de Ministério Público de Rogério Arantes, para se questionar qual seria o papel preponderante desempenhado pelo Ministério Público de São Paulo como agente na defesa dos interesses sociais, considerando a sua estrutura e normatização: o de instituição do sistema de justiça, tendencialmente passiva, absorvida pelo desempenho de inúmeras e diferentes funções e adstrita a determinados padrões, herdados do seu desenvolvimento institucional, além de impassível de usufruir de determinadas vantagens estratégicas aventadas por Galanter, ou o de litigante habitual, que atua de forma estratégica em prol de interesses tendencialmente sub-representados. Ao final, a pesquisa, desenvolvida sob os métodos teórico e empírico qualitativo, sem pretensões generalizantes, permitiu confirmar a hipótese traçada, de que há elementos da normatização e estruturação do Ministério Público de São Paulo que favorecem o desenvolvimento do seu papel como instituição do sistema de justiça
Como as Práticas da Repressão à Vadiagem Podem Contribuir para a Compreensão da Hist´ória do Processo Penal Brasileiro?
Authors: Abath Manuela
Published: April 2022

Este artigo objetiva refletir sobre como a prática de repressão à vadiagem e à desordem pública por forças policiais é um elemento fundamental na compreensão da história do sistema punitivo brasileiro em geral e do processo penal em especial. Focando neste último, procuramos afirmar que o seu traço autoritário, comumente mencionado nos estudos de cunho histórico, não se deve apenas ao influxo de ideias fascistas na década que precedeu à publicação do Código de Processo Penal de 1941, mas pode e deve ser encontrado nas práticas punitivas desenvolvidas no Brasil ao longo século XIX e início do século XX, sobretudo no período pós-abolição. Para tanto, tendo como pano de fundo teórico a analítica do poder foucaultina, exploramos dados empíricos sobre a atuação das forças policiais nas primeiras décadas do século XX, na cidade do Recife, demonstrando o quanto as prisõe por vadiagem e desordem, feita pelas polícias sem qualquer controle judicial, ocupavam relevante espaço no cotidiano dessas organizações e tinham como principal alvo pessoas negras. Concluímos que o controle sobre a desordem ergueu as polícias a um patamar de liberdade e autonomia que são elementos presentes até hoje nas práticas do sistema punitivo e que devem ser o ponto de partida para entender o sentido de “autoritário” do processo penal brasileiro.
Ver o Não Visto
Authors: Executivo Comitê , Arrieta Fernández Nohora
Published: April 2022

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Heat Transfer Augmentation With Multiple Jet Impingement Cooling on Dimpled Surface for Gas Turbine Blades
Authors: Nourin Farah Nazifa , Amano Ryoichi S.
Published: May 2022

Multiple jet impingement cooling plays a significant role in the leading-edge cooling of the gas turbine blade. The heat transfer enhancement with this method depends on stand-off distance, nozzle array arrangement, surface roughness, a dimpled surface, a curved surface, etc. This study has developed a numerical simulation model to investigate heat transfer and flow behavior on a dimpled surface. The comparison was made with the conventionally designed dimple and a newly designed-leaf dimple. Computational fluid dynamics plays a significant role in representing the precise flow and heat transfer behavior. This study analyzed the results based on Nusselt number, Reynolds numbers, pressure drop, friction factor, surface roughness of the target plate, and thermal performance. The hemispherical dimpled target plate shows 5–10% more efficiency than the smooth target plate. The leaf target plate shows 2–6% more efficiency compared to the hemispherical dimpled target plate
An Approach to Modeling Percussive Drilling Systems
Authors: Goldman Samuel , Flashner Henryk , Yang Bingen
Published: May 2022

A framework for modeling the transient response of percussive drilling systems is presented. The proposed approach is based on the distributed transfer function method (DTFM), which is a semi-analytical modeling technique. Experimental results obtained from a percussion testbed for the Regolith and ice drill for the exploration of new terrains (TRIDENT) were incorporated into this modeling technique. DTFM is shown to be a convenient, modular modeling approach, capable of handling complex boundary conditions and drill rod geometries. Moreover, this technique is computationally simple and allows for straightforward incorporation of experimentally measured boundary forcing via numerical convolution, as well as control of the frequency content in the transient response. An experimental study is used to demonstrate the ability of the proposed approach to characterize unknown boundary conditions.
Representing and Computing the B-Derivative of the Piecewise-Differentiable Flow of a Class of Nonsmooth Vector Fields
Authors: Council George , Revzen Shai , Burden Samuel A.
Published: May 2022

This paper concerns first-order approximation of the piecewise-differentiable flow generated by a class of nonsmooth vector fields. Specifically, we represent and compute the Bouligand (or B-)derivative of the piecewise-differentiable flow generated by a vector field with event-selected discontinuities. Our results are remarkably efficient: although there are factorially many “pieces” of the derivative, we provide an algorithm that evaluates its action on a tangent vector using polynomial time and space, and verify the algorithm's correctness by deriving a representation for the B-derivative that requires “only” exponential time and space to construct. We apply our methods in two classes of illustrative examples: piecewise-constant vector fields and mechanical systems subject to unilateral constraints.
Computational Study of a Local Fractional Tricomi Equation Occurring in Fractal Transonic Flow
Authors: Dubey Sarvesh , Dubey Ved Prakash , Singh Jagdev , Alshehri Ahmed M. , Kumar Devendra
Published: May 2022

In this paper, we present the application of local fractional methods in combination with the local fractional Sumudu transform (LFST) for a local fractional Tricomi equation (LFTE). The numerical simulations for obtained results are presented for the local fractional Tricomi equation with different initial conditions on the Cantor set. The computational approach shows that the implemented methods are very impressive to derive solutions for a local fractional Tricomi equation. Moreover, the solutions obtained by using these schemes are in quite good agreement with already computed solutions in the literature.
Design and Development of an Open-Source Adl-Compliant Prosthetic Arm for Trans-Radial Amputees
Authors: Timm Lara , Etuket Maureen , Sivarasu Sudesh
Published: May 2022

Presently, open source prosthesis are not optimized to assist the dominant hand in performing bimanual ADL. This research study was thus geared towards the design and experimental validation of an open-source below-elbow prosthetic arm, called the ADL arm, that is functionally optimized for the performance of ADL in the unilateral TR amputee population.

The ADL arm is 3D printed; the design validation involved functional assessment - using the AHAP and simulated use assessment with healthy volunteer participants after obtaining Ethics approval. In accordance with AHAP; the ADL arm presented with an overall GAS of 68% and a partial GAS of >75 % for 4/5 ADL grasps. Usability Assessment involved the performance of ADL tasks coupled with the completion of the SUS. The perceived usability of the device was found to increase with increased device familiarity, yielding an overall score of 84.29.

Through the tests conducted, the ADL arm was found to be functionally competent, relatively acceptable with proven ability to assist in the performance of ADLs in a simulated-use environment. A number of design modifications and clinical tests are however recommended to overcome the limitations of the current design and corroborate the results obtained in this study.
Utilization of Computational Modeling and 3D Printing for Pre-Procedural Planning of an LVAD Exchange Surgery
Authors: DeVos Amanda , Ramirez David A , Gonzalez Celia , Shaffer Andrew , Iaizzo Paul A
Published: May 2022

Computational models and three-dimensional prints were developed to aid in the pre-procedural planning of a LVAD exchange surgery. Clinical imaging was used to model and segment the anatomy and implanted device for computational implantation and 3D printing. The physicians visualized the pre-procedural anatomy in a 3D space to better understand the device-tissue-interface of the current implant and assess the optimal location for surgical entry. The models also contributed to the education of the surgical team by providing hands-on tools to understand the planned steps involved in the procedure.
Letting go of damaged mitochondria
Authors: Wong Wei
Published: May 2022

Thermogenesis requires that macrophages digest damaged mitochondria released by brown adipocytes.
Fomite Transmission Follows Invasion Ecology Principles
Authors: Wang Peihua , Tong Xinzhao , Zhang Nan , Miao Te , Chan Jack P. T. , Huang Hong , Lee Patrick K. H. , Li Yuguo
Published: May 2022

Fomite transmission contributes to the spread of many infectious diseases. However, pathogens in fomite transmission typically are either investigated individually without considering the context of native microbiotas or investigated in a nondiscriminatory way from the dispersal of microbiotas.
Evaluation of a Novel Commercial Real-Time PCR Assay for the Simultaneous Detection of
Cryptosporidium
spp., Giardia duodenalis, and Entamoeba histolytica
Authors: Dashti Alejandro , Alonso Henar , Escolar-Miñana Cristina , Köster Pamela C. , Bailo Begoña , Carmena David , González-Barrio David
Published: May 2022

Thorough independent assessment of the diagnostic performance of novel diagnostic assays is essential to ascertain their true usefulness and applicability in routine clinical practice. This is particularly true for commercially available kits based on multiplex real-time PCR aimed to detect and differentiate multiple pathogens in a single biological sample.
Supplemental Material: Seismic attenuation tomography of the Sn phase beneath the Turkish-Iranian Plateau and the Zagros mountain belt
Authors: Kaviani A. , al. et
Published: April 2022

Figure S1: Maps showing ray coverage per model block.  
Supplemental Material: New age and lake chemistry constraints on the Aptian pre-salt carbonates of the central South Atlantic
Authors: Lawson M. , al. et
Published: May 2022

Methods, models, and all data and supporting figures.
Encephalomyelitis with hearing loss: case report on neurobrucellosis
Authors: Lakhanpal Vikas , Singh Deependra , Bhagwat Kiran , Chakravarthy Kamalesh
Published: May 2022

Neurobrucellosis is a zoonotic infection transmitted by infected animals or by contact with animal products and is an important health problem in resource-limited settings. In this case report, we present the case of a middle-aged man presenting with encephalomyelitis with hearing loss and diagnosed with neurobrucellosis based on imaging and serological tests. Because brucellosis infection is indolent, a high index of suspicion should be maintained in individuals presenting with fever, neurological signs and symptoms so that early management can prevent long-term neurological sequelae such as focal neurological deficits, hydrocephalus and psychiatric sequelae.
Aortic plaque dehiscence caused by rotational atherectomy with Kokeshi phenomenon in a patient with aortic stenosis successfully treated with transcatheter aortic valve replacement
Authors: Haider Syedah Aleena , Jawaid Anas , Stuver Thomas , Naqvi Syed Yaseen
Published: May 2022

Rotational atherectomy (RA) is an important interventional technique to facilitate effective percutaneous coronary intervention of severely calcified lesions. Despite the improved probability of better procedural outcomes during angioplasty, the use of RA is associated with an inherent risk of complications. Here, we present a case of a woman in her mid-90s with severe aortic stenosis (AS) who underwent RA facilitated angioplasty of the right coronary artery (RCA), with the procedure complicated by the Kokeshi phenomenon. Manual traction to retrieve the burr resulted in dehiscence of an aortic plaque near the ostium of the RCA. Unfortunately, the patient’s risk profile precluded surgery. After a multidisciplinary discussion, a self-expanding Core Valve Evolut R prosthesis (Medtronic, Minneapolis, Minnesota, USA) was successfully implanted, with improvement in the AS and stabilisation of the aortic plaque. This is the first reported case of successful non-operative management of a mobile-aortic plaque caused by RA with a transcatheter prosthesis.
Exploratory analyses in aetiologic research and considerations for assessment of credibility: mini-review of literature
Authors: Luijken Kim , Dekkers Olaf M , Rosendaal Frits R , Groenwold Rolf H H
Published: May 2022

Objective

To provide considerations for reporting and interpretation that can improve assessment of the credibility of exploratory analyses in aetiologic research.

Design

Mini-review of the literature and account of exploratory research principles.

Setting

This study focuses on a particular type of causal research, namely aetiologic studies, which investigate the causal effect of one or multiple risk factors on a particular health outcome or disease. The mini review included aetiologic research articles published in four epidemiology journals in the first issue of 2021:American Journal of Epidemiology,Epidemiology,European Journal of Epidemiology, andInternational Journal of Epidemiology, specifically focusing on observational studies of causal risk factors of diseases.

Main outcome measures

Number of exposure-outcome associations reported, grouped by type of analysis (main, sensitivity, and additional).

Results

The journal articles reported many exposure-outcome associations: a mean number of 33 (range 1-120) exposure-outcome associations for the primary analysis, 30 (0-336) for sensitivity analyses, and 163 (0-1467) for additional analyses. Six considerations were discussed that are important in assessing the credibility of exploratory analyses: research problem, protocol, statistical criteria, interpretation of findings, completeness of reporting, and effect of exploratory findings on future causal research.

Conclusions

Based on this mini-review, exploratory analyses in aetiologic research were not always reported properly. Six considerations for reporting of exploratory analyses in aetiologic research were provided to stimulate a discussion about their preferred handling and reporting. Researchers should take responsibility for the results of exploratory analyses by clearly reporting their exploratory nature and specifying which findings should be investigated in future research and how.
Trends in glycemic control in patients with insulin therapy compared with non-insulin or no drugs in type 2 diabetes in Japan: a long-term view of real-world treatment between 2002 and 2018 (JDDM 66)
Authors: Yokoyama Hiroki , Araki Shin-ichi , Yamazaki Katsuya , Kawai Koichi , Shirabe Shin-Ichiro , Oishi Mariko , Kanatsuka Azuma , Yagi Noriharu , Kabata Daijiro , Shintani Ayumi , Maegawa Hiroshi
Published: May 2022

Introduction

We investigated trends in the proportion of diabetes treatment and glycemic control, which may be altered by recent advances in insulin and non-insulin drugs, in Japanese patients with type 2 diabetes.

Research design and methods

A serial cross-sectional study was performed using a multicenter large-population database from the Japan Diabetes Clinical Data Management study group. Patients with type 2 diabetes who attended clinics belonging to the study group between 2002 and 2018 were included to examine trends in glycated hemoglobin A1c (HbA1c) by treatment group using multivariable non-linear regression model.

Results

The proportion of patients with insulin only decreased from 15.0% to 3.6%, patients with insulin+non-insulin drugs increased from 8.1% to 15.1%, patients with non-insulin drugs increased from 50.8% to 67.0%, and those with no drugs decreased from 26.1% to 14.4% from 2002 to 2018, respectively. The HbA1c levels of each group, except for no drugs, continued to decrease until 2014 (unadjusted mean HbA1c (%) from 2002 to 2014: from 7.89 to 7.45 for insulin only, from 8.09 to 7.63 for insulin+non-insulin, and from 7.51 to 6.98 for non-insulin) and remained unchanged thereafter. Among insulin-treated patients, use of human insulin decreased, use of long-acting analog insulin increased, and concomitant use of non-insulin drugs increased (from 35.1% in 2002 to 80.9% in 2018), which included increased use of dipeptidyl peptidase 4 inhibitors, sodium-glucose cotransporter 2 inhibitors, and glucagon-like peptide 1 receptor agonists, and the persistently high use of metformin.

Conclusions

During the past two decades, combined use of insulin and non-insulin drugs increased and glycemic control improved and leveled off after 2014 in Japanese patients with type 2 diabetes. Further studies of the trend in association with age and factors related to metabolic syndrome are necessary to investigate strategies aiming at personalized medicine in diabetes care.
Effectiveness of Ehteraz digital contact tracing app versus conventional contact tracing in managing the outbreak of COVID-19 in the State of Qatar
Authors: Al-Kuwari Mohamed Ghaith , Ali Al Nuaimi Asma , Semaan Sandy , Gibb John Michael , AbdulMajeed Jazeel , Al Romaihi Hamad Eid
Published: May 2022

Introduction

Contact tracing is an integral component of the overall public health strategy for controlling the outbreak of infectious diseases such as COVID-19. In addition to the conventional contact tracing, Qatar has implemented Ehteraz, a proximity-tracing mobile phone App using global positioning system and Bluetooth technologies. In this paper, we aim to evaluate the accuracy of Ehteraz as a contact tracing App based on the WHO contact tracing criteria and compare its effectiveness to the traditional human led case investigation.

Methods

A cross-sectional study was conducted using two databases, including Ehteraz proximity data and swab collection and case investigations reports for the same period.

Results

46.9% of contacts identified by the Ehteraz app did not meet WHO duration and distance criteria. Among the 5650 contacts flagged by Ehteraz during the period, 4973 (88.0%) of contacts did not share any known relation with the index case they are linked to.

Conclusion

The study highlighted the inaccuracy of the Ehteraz tool as its technology enables signals passing through walls, so people in different rooms could be unnecessarily flagged as having had contact. Big segments of the population (eg, Children) do not necessarily use smartphones and are not, therefore, flagged by Ehteraz digital contact tracing App. Similarly, Ehteraz rarely flags close contacts identified by human investigation as Bluetooth is usually turned off in a household or at a workplace. These findings highlight that digital contact tracing would be an efficient public health strategy when integrated to and complementing human investigation.
Maternal over-the-counter analgesics use during pregnancy and adverse perinatal outcomes: cohort study of 151 141 singleton pregnancies
Authors: Zafeiri Aikaterini , Raja Edwin Amalraj , Mitchell Rod Thomas , Hay David C , Bhattacharya Sohinee , Fowler Paul A
Published: May 2022

Objectives

To identify any associations between in utero exposure to five over-the-counter (non-prescription) analgesics (paracetamol, ibuprofen, aspirin, diclofenac, naproxen) and adverse neonatal outcomes.

Design

Retrospective cohort study using the Aberdeen Maternity and Neonatal Databank.

Participants

151 141 singleton pregnancies between 1985 and 2015.

Main outcome measures

Premature delivery (<37 weeks), stillbirth, neonatal death, birth weight, standardised birthweight score, neonatal unit admission, APGAR score at 1 and 5 min, neural tube and amniotic band defects, gastroschisis and, in males, cryptorchidism and hypospadias.

Results

83.7% of women taking over-the-counter analgesics reported first trimester use when specifically asked about use at their first antenatal clinic visit. Pregnancies exposed to at least one of the five analgesics were significantly independently associated with increased risks for premature delivery <37 weeks (adjusted OR (aOR)=1.50, 95% CI 1.43 to 1.58), stillbirth (aOR=1.33, 95% CI 1.15 to 1.54), neonatal death (aOR=1.56, 95% CI 1.27 to 1.93), birth weight <2500 g (aOR=1.28, 95% CI 1.20 to 1.37), birth weight >4000 g (aOR=1.09, 95% CI 1.05 to 1.13), admission to neonatal unit (aOR=1.57, 95% CI 1.51 to 1.64), APGAR score <7 at 1 min (aOR=1.18, 95% CI 1.13 to 1.23) and 5 min (aOR=1.48, 95% CI 1.35 to 1.62), neural tube defects (aOR=1.64, 95% CI 1.08 to 2.47) and hypospadias (aOR=1.27, 95% CI 1.05 to 1.54 males only). The overall prevalence of over-the-counter analgesics use during pregnancy was 29.1%, however it rapidly increased over the 30-year study period, to include over 60% of women in the last 7 years of the study. This makes our findings highly relevant to the wider pregnant population.

Conclusions

Over-the-counter (non-prescription) analgesics consumption during pregnancy was associated with a substantially higher risk for adverse perinatal health outcomes in the offspring. The use of paracetamol in combination with other non-steroidal anti-inflammatory drugs conferred the highest risk. The increased risks of adverse neonatal outcomes associated with non-prescribed, over-the-counter, analgesics use during pregnancy indicate that healthcare guidance for pregnant women regarding analgesic use need urgent updating.
ASSERT (Acute Sacral inSufficiEncy fractuRe augmenTation): randomised controlled, feasibility trial in older people
Authors: Ong Terence , Suazo Di Paola Ana , Brookes Cassandra , Drummond Avril , Hendrick Paul , Leighton Paul , Jones Matthew , Salem Khalid , Quraishi Nasir , Sahota Opinder
Published: May 2022

Objective

To determine the feasibility of designing and conducting a definitive trial to evaluate the effectiveness of sacral fracture fixation compared with non-surgical management among older people admitted with a lateral compression pelvic fragility fracture (PFF).

Design

Single-site, parallel, two-arm randomised controlled feasibility trial.

Setting

A UK tertiary centre hospital.

Participants

Patients aged ≥70 years who were ambulating pre-injury requiring hospital admission (within 28 days of injury) with a type 1 lateral compression PFF.

Interventions

The intervention group received sacral fracture fixation (cement augmentation±screw fixation) within 7 days of randomisation. Routine preoperative and postoperative care followed each surgical intervention. The control group received usual care consisting of analgesia, and regular input from the medical and therapy team.

Primary and secondary outcome measures

The feasibility outcomes were the number of eligible patients, willingness to be randomised, adherence to allocated treatment, retention, data on the completeness and variability of the proposed definitive trial outcome measures, and reported adverse events.

Results

241 patients were screened. 13 (5.4%) were deemed eligible to participate. Among the eligible participants, nine (69.2%) were willing to participate. Five participants were randomised to the intervention group and four to the control group. The clinicians involved were willing to allow their patients to be randomised and adhere to the allocated treatment. One participant in the intervention group and two participants in the control group received their allocated treatment. All participants were followed up until 12 weeks post-randomisation, and had an additional safety follow-up assessment at 12 months. Overall, the proportion of completeness of outcome measures was at least 75%. No adverse events were directly related to the trial.

Conclusions

There were significant challenges in recruiting sufficient participants which will need to be addressed prior to a definitive trial.

Trial registration number

ISRCTN16719542.
Very early invasive angiography versus standard of care in higher-risk non-ST elevation myocardial infarction: study protocol for the prospective multicentre randomised controlled RAPID N-STEMI trial
Authors: Kite Thomas A , Banning Amerjeet S , Ladwiniec Andrew , Gale Chris P , Greenwood John P , Dalby Miles , Hobson Rachel , Barber Shaun , Parker Emma , Berry Colin , Flather Marcus D , Curzen Nick , Banning Adrian P , McCann Gerry P , Gershlick Anthony H
Published: May 2022

Background

There are a paucity of randomised data on the optimal timing of invasive coronary angiography (ICA) in higher-risk patients with non-ST elevation myocardial infarction (N-STEMI). International guideline recommendations for early ICA are primarily based on retrospective subgroup analyses of neutral trials.

Aims

The RAPID N-STEMI trial aims to determine whether very early percutaneous revascularisation improves clinical outcomes as compared with a standard of care strategy in higher-risk N-STEMI patients.

Methods and analysis

RAPID N-STEMI is a prospective, multicentre, open-label, randomised-controlled, pragmatic strategy trial. Higher-risk N-STEMI patients, as defined by Global Registry of Acute Coronary Events 2.0 score ≥118, or >90 with at least one additional high-risk feature, were randomised to either: very early ICA±revascularisation or standard of care timing of ICA±revascularisation. The primary outcome is the proportion of participants with at least one of the following events (all-cause mortality, non-fatal myocardial infarction and hospital admission for heart failure) at 12 months. Key secondary outcomes include major bleeding and stroke. A hypothesis generating cardiac magnetic resonance (CMR) substudy will provide mechanistic data on infarct size, myocardial salvage and residual ischaemia post percutaneous coronary intervention. On 7 April 2021, the sponsor discontinued enrolment due to the impact of the COVID-19 pandemic and lower than expected event rates. 425 patients were enrolled, and 61 patients underwent CMR.

Ethics and dissemination

The trial has been reviewed and approved by the East of England Cambridge East Research Ethics Committee (18/EE/0222). The study results will be submitted for publication within 6 months of completion.

Trial registration number

NCT03707314; Pre-results.
Survey to identify research priorities for primary care in Scotland during and following the COVID-19 pandemic
Authors: Hubbard Gill , Grist Fiona , Pope Lindsey Margaret , Cunningham Scott , Maxwell Margaret , Bennie Marion , Guthrie Bruce , Mercer Stewart W
Published: May 2022

Objectives

To identify research priorities for primary care in Scotland following the COVID-19 pandemic.

Design

Modified James Lind Alliance methodology; respondents completed an online survey to make research suggestions and rank research themes in order of priority.

Setting

Scotland primary care.

Participants

Healthcare professionals in primary care in Scotland and members of primary care patient and public involvement groups. 512 respondents provided research suggestions; 8% (n=40) did not work in health or social care; of those who did work, 68.8% worked in primary care, 16.3% community care, 11.7% secondary care, 4.5% third sector, 4.2% university (respondents could select multiple options). Of those respondents who identified as healthcare professionals, 33% were in nursing and midwifery professions, 25% were in allied health professions (of whom 45% were occupational therapists and 35% were physiotherapists), 20% were in the medical profession and 10% were in the pharmacy profession.

Main outcomes

Suggestions for research for primary care made by respondents were categorised into themes and subthemes by researchers and ranked in order of priority by respondents.

Results

There were 1274 research suggestions which were categorised under 12 themes and 30 subthemes. The following five themes received the most suggestions for research: disease and illness (n=461 suggestions), access (n=202), workforce (n=164), multidisciplinary team (MDT; n=143) and integration (n=108). One hundred and three (20%) respondents to the survey participated in ranking the list of 12 themes in order of research priority. The five most highly ranked research priorities were disease and illness, health inequalities, access, workforce and MDTs. The disease and illness theme had the greatest number of suggestions for research and was scored the most highly in the ranking exercise. The subtheme ranked as the most important research priority in the disease and illness theme was ‘mental health’.

Conclusions

The themes and subthemes identified in this study should inform research funders so that the direction of primary healthcare is informed by evidence.
Sex-disaggregated analysis of the injury patterns, outcome data and trapped status of major trauma patients injured in motor vehicle collisions: a prespecified analysis of the UK trauma registry (TARN)
Authors: Nutbeam Tim , Weekes Lauren , Heidari Shirin , Fenwick Rob , Bouamra Omar , Smith Jason , Stassen Willem
Published: May 2022

Objectives

To identify the differences between women and men in the probability of entrapment, frequency of injury and outcomes following a motor vehicle collision. Publishing sex-disaggregated data, understanding differential patterns and exploring the reasons for these will assist with ensuring equity of outcomes especially in respect to triage, rescue and treatment of all patients.

Design

We examined data from the Trauma Audit and Research Network (TARN) registry to explore sex differences in entrapment, injuries and outcomes. We explored the relationship between age, sex and trapped status using multivariate logistical regression.

Setting

TARN is a UK-based trauma registry covering England and Wales.

Participants

We examined data for 450 357 patients submitted to TARN during the study period (2012–2019), of which 70 027 met the inclusion criteria. There were 18 175 (26%) female and 51 852 (74%) male patients.

Primary and secondary outcome measures

We report difference in entrapment status, injury and outcome between female and male patients. For trapped patients, we examined the effect of sex and age on death from any cause.

Results

Female patients were more frequently trapped than male patients (female patients (F) 15.8%, male patients (M) 9.4%; p<0.0001). Trapped male patients more frequently suffered head (M 1318 (27.0%), F 578 (20.1%)), face, (M 46 (0.9%), F 6 (0.2%)), thoracic (M 2721 (55.8%), F 1438 (49.9%)) and limb injuries (M 1744 (35.8%), F 778 (27.0%); all p<0.0001). Female patients had more injuries to the pelvis (F 420 (14.6%), M 475 (9.7%); p<0.0001) and spine (F 359 (12.5%), M 485 (9.9%); p=0.001). Following adjustment for the interaction between age and sex, injury severity score, Glasgow Coma Scale and the Charlson Comorbidity Index, no difference in mortality was found between female and male patients.

Conclusions

There are significant differences between female and male patients in the frequency at which patients are trapped and the injuries these patients sustain. This sex-disaggregated data may help vehicle manufacturers, road safety organisations and emergency services to tailor responses with the aim of equitable outcomes by targeting equal performance of safety measures and reducing excessive risk to one sex or gender.
Effects of temporarily suspending low-dose methotrexate treatment for 2 weeks after SARS-CoV-2 vaccine booster on vaccine response in immunosuppressed adults with inflammatory conditions: protocol for a multicentre randomised controlled trial and nested mechanistic substudy (Vaccine Response On/Off Methotrexate (VROOM) study)
Authors: Abhishek Abhishek , Boyton RJ , McKnight Áine , Coates Laura , Bluett James , Barber Vicki S , Cureton Lucy , Francis Anne , Appelbe Duncan , Eldridge Lucy , Julier Patrick , Peckham Nicholas , Valdes Ana M , Rombach Ines , Altmann Daniel M , Nguyen-Van-Tam Jonathan , Williams Hywel C , Cook Jonathan Alistair
Published: May 2022

Introduction

It is unknown if a temporary break in long-term immune-suppressive treatment after vaccination against COVID-19 improves vaccine response. The objective of this study was to evaluate if a 2-week interruption in low-dose weekly methotrexate treatment after SARS-CoV-2 vaccine boosters enhances the immune response compared with continuing treatment in adults with autoimmune inflammatory conditions.

Methods and analysis

An open-label, pragmatic, prospective, parallel group, randomised controlled superiority trial with internal feasibility assessment and nested mechanistic substudy will be conducted in rheumatology and dermatology clinics in approximately 25 UK hospitals. The sample size is 560, randomised 1:1 to intervention and usual care arms. The main outcome measure is anti-spike receptor-binding domain (RBD) antibody level, collected at prebooster (baseline), 4 weeks (primary outcome) and 12 weeks (secondary outcome) post booster vaccination. Other secondary outcome measures are patient global assessments of disease activity, disease flares and their treatment, EuroQol 5- dimention 5-level (EQ-5D-5L), self-reported adherence with advice to interrupt or continue methotrexate, neutralising antibody titre against SARS-CoV-2 (mechanistic substudy) and oral methotrexate biochemical adherence (mechanistic substudy). Analysis of B-cell memory and T-cell responses at baseline and weeks 4 and 12 will be investigated subject to obtaining additional funding. The principal analysis will be performed on the groups as randomised (ie, intention to treat). The difference between the study arms in anti-spike RBD antibody level will be estimated using mixed effects model, allowing for repeated measures clustered within participants. The models will be adjusted for randomisation factors and prior SARS-CoV-2 infection status.

Ethics and dissemination

This study was approved by the Leeds West Research Ethics Committee and Health Research Authority (REC reference: 21/HRA/3483, IRAS 303827). Participants will be required to give written informed consent before taking part in the trial. Dissemination will be via peer review publications, newsletters and conferences. Results will be communicated to policymakers.

Trial registration number

ISRCTN11442263.
Returning persons with SARS-CoV-2 to the field of play in professional golf: a risk assessment and risk reduction approach
Authors: Robinson Patrick Gordon , Murray Andrew , Close Graeme , Glover Danny , Du Plessis Wimpie J
Published: May 2022

Objectives

This pilot study aimed to see whether a risk assessment and risk reduction approach was a practical and feasible approach, as compared with standard isolation for fully vaccinated, asymptomatic persons positive for SARS-CoV-2.

Methods

This prospective cohort study included all players and caddies participating in two large professional golf events from 7 to 20 February 2022 in South Africa. Fully vaccinated persons testing positive who were asymptomatic were subject to risk assessment and risk reduction measures to protect the integrity of the event. Asymptomatic individuals who could socially distance in outdoor areas were allowed to participate. Close contacts were subject to daily rapid antigen tests and asked to prioritise outdoor space.

Results

The protocols put in place for the events were practical, feasible, and well accepted by event participants and staff during the study period. There was a total of 378 player-week episodes and 378 caddie-week episodes during the study period. Three persons tested positive while registered at events during the study period (0.4% of person episodes). The positive tests were returned from two players and one caddie, all of which were asymptomatic at the time of testing. There was one high-risk contact who consistently returned negative antigen tests. There was no evidence of transmission.

Conclusions

The approach was practical and feasible. A risk assessment and risk reduction approach allowed fully vaccinated asymptomatic persons with SARS-CoV-2 to participate in golf, an outdoor sport where social distancing is possible, compared with standard isolation.
A decade of hospital costs for firearm injuries in the United States by region, 2005–2015: government healthcare costs and firearm policies
Authors: Spitzer Sarabeth A , Forrester Joseph D , Tennakoon Lakshika , Spain David A , Weiser Thomas G
Published: May 2022

Background

Firearm injuries are a costly, national public health emergency, and government-sponsored programs frequently pay these hospital costs. Understanding regional differences in firearm injury burden may be useful for crafting appropriate policies, especially with widely varying state gun laws.

Objective

To estimate the volume of, and hospital costs for, fatal and non-fatal firearm injuries from 2005 to 2015 for each region of the United States and analyze the proportionate cost by payer status.

Methods

We used the Healthcare Cost and Utilization Project Nationwide Inpatient Sample to identify patients admitted for firearm-related injuries from 2005 to 2015. We converted hospitalization charges to costs, which were inflation-adjusted to 2015 dollars. We used survey weights to create regional estimates. We used the Brady Gun Law to determine significance between firearm restrictiveness and firearm hospitalizations by region.

Results

There were a total of 317 479 firearm related admissions over the study period: 52 829 (16.66%), 66 671 (21.0%), 134 008 (42.2%), and 63 972 (20.2%) for the Northeast, Midwest, South, and West respectively, demonstrating high regional variability. In the Northeast, hospital costs were $1.98 billion (13.9% of total), of which 56.0% was covered by government payers; for the Midwest, costs were $1.53 billion (19.7% of total), 40.4% of which was covered by government payers; in the South costs were highest at $3.2 billion (41.4% of total), but government payers only covered 34.3%; and costs for the West were $1.94 billion (25.0% of total), with government programs covering 41.6% of the cost burden.

Conclusions

Hospital admissions and costs for firearm injuries demonstrated wide variation by region, suggesting opportunities for financial savings. As government insurance programs cover 41.5% of costs, tax dollars heavily subsidize the financial burden of firearm injuries and cost recovery options for treating residents injured by firearms should be considered. Injury control strategies have not been well applied to this national public health crisis.

Level of evidence

Level II, Economic and Value Based Evaluation
Transparency and efficiency in building code review. The case of Ontario, Canada
Authors: Martin Gary , McKay Ruth
Published: May 2022

The paper reports findings from a study of building codes and the code change process in Canada. The context is attempts by insurers to change building codes at the national and Province of Ontario levels to make housing more resilient to high winds. The paper focuses on one code update intended to strengthen the roof-to-wall connection in low-rise wood-framed dwellings. The research began with an extensive review of research and government documents followed by discussions and interviews with key stakeholders in the process. The paper concludes that the process of upgrading residential building codes, especially in Ontario, could be more transparent and efficient by incorporating innovations and technology utilized by the International Code Council in the United States.