bluuebunny/crossref_metadata_2025 huggingface dataset:
Community-level impacts of sanitation coverage on maternal and neonatal health: a retrospective cohort of survey data
Authors: Kmush Brittany L , Walia Bhavneet , Neupane Anushruta , Frances Carolina , Mohamed Idris Ahmed , Iqbal Mahwish , Larsen David A
Published: October 2021

Introduction

Access to sanitation facilities (toilets or latrines) greatly improves human health. Low community sanitation coverage may lead to increased exposure to pathogens for households both with and without a sanitation facility.

Methods

We created a retrospective cohort using Demographic and Health Surveys from 1990 through 2018. Using regression with matched women as a random intercept, we assessed the association between community-level sanitation coverage and neonatal mortality (Poisson model,n=1 254 862 live births, 187 datasets), small birth size (logit model,n=1 058 843 live births, 187 datasets) and anaemia (logit model,n=1 304 626 women, 75 datasets).

Results

Among women with household sanitation, the incidence of neonatal death (incidence rate ratio: 0.85, 95% CI 0.77 to 0.93), the odds of small birth size (OR: 0.81, 95% CI 0.76 to 0.87) and anaemia (OR: 0.82, 95% CI 0.79 to 0.85) were lower for women in communities with 100% sanitation coverage compared with 1%–30% (p≤0.001 for all). There was no difference in neonatal deaths between women in communities with 31%–99% sanitation coverage compared with 1%–30% (p≥0.05). Among women without household sanitation, there were no differences in neonatal mortality by community sanitation (p≥0.05). The odds of small birth size were decreased (OR: 0.91, 95% CI 0.87 to 0.97, p=0.003) for women in communities with 61%–99% sanitation coverage compared with 1%–30%; there was no association with the other community sanitation categories (p≥0.05). The odds of anaemia were increased (OR: 1.08, 95% CI 1.06 to 1.11, p<0.001) for women living in communities with 0% sanitation coverage compared with 1%–30%, but no association with the other community sanitation categories (p≥0.05).

Conclusion

Community sanitation coverage is associated with improved maternal and neonatal outcomes, particularly among women with household sanitation. This suggests that the impact of sanitation coverage on maternal and neonatal health is underestimated unless the community-level effects are considered.
Are there sex differences in completeness of death registration and quality of cause of death statistics? Results from a global analysis
Authors: Adair Tim , Gamage U S H , Mikkelsen Lene , Joshi Rohina
Published: October 2021

Introduction

Recent studies suggest that more male than female deaths are registered and a higher proportion of female deaths are certified as ‘garbage’ causes (ie, vague or ill-defined causes of limited policy value). This can reduce the utility of sex-specific mortality statistics for governments to address health problems. To assess whether there are sex differences in completeness and quality of data from civil registration and vital statistics systems, we analysed available global death registration and cause of death data.

Methods

Completeness of death registration for females and males was compared in 112 countries, and in subsets of countries with incomplete death registration. For 64 countries with medical certificate of cause of death data, the level, severity and type of garbage causes was compared between females and males, standardised for the older age distribution and different cause composition of female compared with male deaths.

Results

For 42 countries with completeness of less than 95% (both sexes), average female completeness was 1.2 percentage points (p.p.) lower (95% uncertainty interval (UI) −2.5 to –0.2 p.p.) than for males. Aggregate female completeness for these countries was 7.1 p.p. lower (95% UI −12.2 to −2.0 p.p.; female 72.9%, male 80.1%), due to much higher male completeness in nine countries including India. Garbage causes were higher for females than males in 58 of 64 countries (statistically significant in 48 countries), but only by an average 1.4 p.p. (1.3–1.6 p.p.); results were consistent by severity and type of garbage.

Conclusion

Although in most countries analysed there was no clear bias against females in death registration, there was clear evidence in a few countries of systematic undercounting of female deaths which substantially reduces the utility of mortality data. In countries with cause of death data, it was only of marginally poorer quality for females than males.
Machine learning for outcome predictions of patients with trauma during emergency department care
Authors: Cardosi Joshua David , Shen Herman , Groner Jonathan I , Armstrong Megan , Xiang Henry
Published: October 2021

Objectives

To develop and evaluate a machine learning model for predicting patient with trauma mortality within the US emergency departments.

Methods

This was a retrospective prognostic study using deidentified patient visit data from years 2007 to 2014 of the National Trauma Data Bank. The predictive model intelligence building process is designed based on patient demographics, vital signs, comorbid conditions, arrival mode and hospital transfer status. The mortality prediction model was evaluated on its sensitivity, specificity, area under receiver operating curve (AUC), positive and negative predictive value, and Matthews correlation coefficient.

Results

Our final dataset consisted of 2 007 485 patient visits (36.45% female, mean age of 45), 8198 (0.4%) of which resulted in mortality. Our model achieved AUC and sensitivity-specificity gap of 0.86 (95% CI 0.85 to 0.87), 0.44 for children and 0.85 (95% CI 0.85 to 0.85), 0.44 for adults. The all ages model characteristics indicate it generalised, with an AUC and gap of 0.85 (95% CI 0.85 to 0.85), 0.45. Excluding fall injuries weakened the child model (AUC 0.85, 95% CI 0.84 to 0.86) but strengthened adult (AUC 0.87, 95% CI 0.87 to 0.87) and all ages (AUC 0.86, 95% CI 0.86 to 0.86) models.

Conclusions

Our machine learning model demonstrates similar performance to contemporary machine learning models without requiring restrictive criteria or extensive medical expertise. These results suggest that machine learning models for trauma outcome prediction can generalise to patients with trauma across the USA and may be able to provide decision support to medical providers in any healthcare setting.
Why are US military personnel prescribed transdermal fentanyl patches?
Authors: Murray Hailey , Gregoriou A N , Lepore A , Booth G J , Goldman A H , Allen M L , Balazs G C
Published: October 2021

Introduction

Transdermal fentanyl is a continuous release opioid delivery system intended for use in opioid-tolerant patients requiring around-the-clock opioid therapy. The purpose of this study is to identify the most common indications for transdermal fentanyl prescriptions in active duty US military personnel, and determine whether these prescriptions meet US Food and Drug Administration (FDA) labelling.

Methods

Active duty US military personnel initiating transdermal fentanyl therapy with prescriptions filled at Military Health System pharmacies between 2015 and 2019 were identified in the Military Data Repository. Electronic health records were searched for patient demographic information, clinical information and prescription data. A total of 225 patients with complete data were identified.

Results

The most common reason for transdermal fentanyl initiation was chronic non-cancer musculoskeletal pain. Among patients with non-cancer pain, 36% received their initial prescription from an internal medicine/primary care provider, and 35% did not meet published US FDA criteria for opioid tolerance prior to treatment initiation. There was an 81% decrease in patients initiating therapy between 2015 and 2019.

Conclusions

While a substantial minority of transdermal fentanyl prescriptions to US military personnel did not meet FDA guidelines on appropriate use, the overall number of prescriptions fell dramatically over the study period. This suggests that automated profile review or additional targeted policies to limit transdermal fentanyl prescribing are unnecessary at this time.
Association of glaucoma with 10-year mortality in a population-based longitudinal study in urban Southern China: the Liwan Eye Study
Authors: Wang Lanhua , Zhu Zhuoting , Huang Wenyong , Scheetz Jane , He Mingguang
Published: October 2021

Objectives

To investigate the association between glaucoma and 10-year mortality rate in an adult population in China.

Design

Population-based cohort study.

Setting

The Liwan Eye Study, China.

Participants

1405 baseline participants aged 50 years and older were invited to attend a 10-year follow-up examination.

Primary and secondary outcome measures

The International Society of Geographic and Epidemiologic Ophthalmology criteria was used to define glaucoma. Detailed information of mortality was confirmed using the Chinese Centre for Disease Control and Prevention. Presenting visual impairment (PVI) was defined as a presenting visual acuity of less than 20/40 in the better-seeing eye. The 10-year mortality rates were compared using the log-rank test. Cox proportional hazards regression models were used to investigate the association between glaucoma and mortality.

Results

A total of 1372 (97.7%) participants with available gonioscopic data were included in the analysis. Of these, 136 (9.9%), 33 (2.4%) and 21 (1.5%) participants had primary angle closure (PAC) suspect (PACS), PAC and PAC glaucoma (PACG), and 29 (2.1%) had primary open angle glaucoma (POAG). After 10 years, 306 (22.3%) participants were deceased. The 10-year mortality was significantly associated with PACG (HR, 2.15, 95% CI 1.14 to 4.04, p=0.018) but not associated with PAC (HR, 1.27, 95% CI 0.67 to 2.39, p=0.463), PACS (HR, 1.32, 95% CI 0.95 to 1.83, p=0.099) and POAG (HR, 0.74, 95% CI 0.36 to 1.49, p=0.395) when age and gender were adjusted for. This association was no longer statistically significant (HR, 1.60, 95% CI 0.70 to 3.61, p=0.263) when covariables, such as income, education, body mass index, PVI, history of diabetes and hypertension, were adjusted for. Larger vertical cup-to-disc ratio (VCDR >0.30) was only a significant risk factor in multivariable analysis (HR, 1.60, 95% CI 1.11 to 2.33, p=0.011).

Conclusions

PACG was significantly associated with higher long-term mortality, but this association was likely to be confounded by other systemic risk factors. VCDR >0.3 was the only independent predictor, implying that it may be a marker of ageing and frailty.
Effects of an isoenergetic low Glycaemic Index (GI) diet on liver fat accumulation and gut microbiota composition in patients with non-alcoholic fatty liver disease (NAFLD): a study protocol of an efficacy mechanism evaluation
Authors: Al-Awadi Amina , Grove Jane , Taylor Moira , Valdes Ana , Vijay Amrita , Bawden Stephen , Gowland Penny , Aithal Guruprasad
Published: October 2021

Introduction

A Low Glycaemic Index (LGI) diet is a proposed lifestyle intervention in non-alcoholic fatty liver diseases (NAFLD) which is designed to reduce circulating blood glucose levels, hepatic glucose influx, insulin resistance and de novo lipogenesis. A significant reduction in liver fat content through following a 1-week LGI diet has been reported in healthy volunteers. Changes in dietary fat and carbohydrates have also been shown to alter gut microbiota composition and lead to hepatic steatosis through the gut-liver axis. There are no available trials examining the effects of an LGI diet on liver fat accumulation in patients with NAFLD; nor has the impact of consuming an LGI diet on gut microbiota composition been studied in this population. The aim of this trial is to investigate the effects of LGI diet consumption on liver fat content and its effects on gut microbiota composition in participants with NAFLD compared with a High Glycaemic Index (HGI) control diet.

Methods and analysis

A 2×2 cross-over randomised mechanistic dietary trial will allocate 16 participants with NAFLD to a 2-week either HGI or LGI diet followed by a 4-week wash-out period and then the LGI or HGI diet, alternative to that followed in the first 2 weeks. Baseline and postintervention (four visits) outcome measures will be collected to assess liver fat content (using MRI/S and controlled attenuation parameter-FibroScan), gut microbiota composition (using 16S RNA analysis) and blood biomarkers including glycaemic, insulinaemic, liver, lipid and haematological profiles, gut hormones levels and short-chain fatty acids.

Ethics and dissemination

Study protocol has been approved by the ethics committees of The University of Nottingham and East Midlands Nottingham-2 Research Ethics Committee (REC reference 19/EM/0291). Data from this trial will be used as part of a Philosophy Doctorate thesis. Publications will be in peer-reviewed journals.

Trial registration number

NCT04415632.
Shingles, Zostavax vaccination and risk of developing dementia: a nested case–control study—results from the UK Biobank cohort
Authors: Lophatananon Artitaya , Mekli Krisztina , Cant Rachel , Burns Alistair , Dobson Curtis , Itzhaki Ruth , Muir Kenneth
Published: October 2021

Objectives

To investigate the association between shingles and dementia, and between Zostavax vaccination and dementia.

Design

Nested case–control study.

Settings

Data were drawn from the UK Biobank cohort study with a total of 228 223 participants with Hospital Episodes Statistics and primary care linkage health records.

Participants

The analyses included 2378 incident dementia cases and 225 845 controls. Inclusion criteria for incident cases were a dementia diagnosis 3 years or more after the first assessment date derived from all sources including International Classification of Diseases (ICD)-10, ICD-9, self-report and primary care linkage records. Subjects with no dementia code from all sources were coded as controls. Both shingles and Zostavax vaccination were investigated for their association with dementia risk.

Results

There was a small but non-significant increase in the risk of dementia in subjects with shingles diagnosed 3 years or more prior to dementia diagnosis (OR: 1.088 with 95% CI: 0.978 to 1.211). In those subjects who had had Zostavax vaccination, the risk of dementia significantly decreased (OR: 0.808 with 95% CI: 0.657 to 0.993).

Conclusion

A history of shingles was not associated with an increased risk of dementia. In subjects who were eligible for the immunisation and vaccinated with Zostavax, we saw reduced risk of developing dementia.
Detection by fluorescence of pituitary neuroendocrine tumour (PitNET) tissue during endoscopic transsphenoidal surgery using bevacizumab-800CW (DEPARTURE trial): study protocol for a non-randomised, non-blinded, single centre, feasibility and dose-finding trial
Authors: Vergeer Rob A , Postma Mark R , Schmidt Iris , Korsten-Meijer Astrid GW , Feijen Robert A , Kruijff Schelto , Nagengast Wouter B , van Dijk J Marc C , den Dunnen Wilfred F A , van Beek André P , Kuijlen Jos M A , van den Berg Gerrit
Published: October 2021

Introduction

Achieving gross total resection and endocrine remission in pituitary neuroendocrine tumours (PitNET) can be challenging, especially in PitNETs with cavernous sinus (CS) invasion, defined as a Knosp grade of 3 or 4. A potential target to identify PitNET tissue is vascular endothelial growth factor A (VEGF-A), which expression is known to be significantly higher in PitNETs with CS invasion.

Methods and analysis

The aim of this non-randomised, non-blinded, single centre, feasibility and dose-finding phase 1 trial is to determine the feasibility of intraoperative fluorescence imaging detection of PitNET tissue during endoscopic transsphenoidal surgery using the VEGF-A targeting optical agent bevacizumab-800CW (4, 5, 10 or 25 mg). Nine to fifteen patients with a PitNET with a Knosp grade of 3 or 4 will be included. Secondary objectives are: (1) To identify the optimal tracer dose for imaging of PitNET tissue during transsphenoidal surgery for further development in a phase 2 fluorescence molecular endoscopy trial. (2) To quantify fluorescence intensity in vivo and ex vivo with multidiameter single-fibre reflectance, single-fibre fluorescence (MDSFR/SFF) spectroscopy. (3) To correlate and validate both the in vivo and ex vivo measured fluorescence signals with histopathological analysis and immunohistochemical staining. (4) To assess the (sub)cellular location of bevacizumab-800CW by ex vivo fluorescence microscopy. Intraoperative, three imaging moments are defined to detect the fluorescent signal. The tumour-to-background ratios are defined by intraoperative fluorescence in vivo measurements including MDSFR/SFF spectroscopy data and by ex vivo back-table fluorescence imaging. After inclusion of three patients in each dose group, an interim analysis will be performed to define the optimal dose.

Ethics and dissemination

Approval was obtained from the Medical Ethics Review Board of the University Medical Centre Groningen. Results will be disseminated through national and international journals. The participants and relevant patient support groups will be informed about the results.

Trial registration number

NCT04212793
Relationship between medical students’ negative perceptions of colleagues’ work–life and burn-out during clerkships: a longitudinal observational cohort study
Authors: Lin Yung Kai , Lin Blossom Yen-Ju , Lin Chia-Der , Chen Der-Yuan
Published: October 2021

Objective

Because work and educational environments are closely related and can affect each other, this study examined whether medical students’ negative perceptions of their colleagues’ work–life balance (NWLB) during their clinical rotations would be related to burn-out in clerkships and investigated the effect of students’ gender on this relationship.

Design

A longitudinal, prospective 2-year cohort study conducted between September 2013 and April 2015.

Setting

Medical students from a university school of medicine in Taiwan.

Participants

One voluntary cohort of undergraduate medical students in clerkships was invited to participate. Among 190 medical students recruited in September 2013, a total of 124 students provided written informed consent. Participants were free to decide whether to complete each survey; therefore, varying numbers of responses were obtained during the study period. Those who responded to our survey for more than 6 months were included in our analyses. Overall, 2128 responses from 94 medical students were analysed, with each student providing an average of 23 responses for 2 years.

Primary outcome measure

Burn-out was measured using the Professional Quality of Life Scale.

Results

Our study found that a strong NWLB was related to high burn-out levels among medical students during their clerkships (p<0.001). However, the gender of the student had no effect on this relationship (p>0.05). In addition, our study indicated that medical students living with a companion had decreased burn-out levels than did those living alone during their clerkships.

Conclusions

The significance of policies promoting employee work–life balance should be emphasised because of the potential for social contagion effects on medical students. Clerkship trainees might be vulnerable to such negative contagion effects during the transition to their early clinical workplace training and may, therefore, require advanced socialisation and mentoring.
Impacts of clinical academic activity: qualitative interviews with healthcare managers and research-active nurses, midwives, allied health professionals and pharmacists
Authors: Newington Lisa , Alexander Caroline M , Wells Mary
Published: October 2021

Objectives

To explore the perceived impacts of clinical academic activity among the professions outside medicine.

Design

Qualitative semistructured interviews.

Setting and participants

There were two groups of interviewees: Research-active nurses, midwives, allied health professionals, healthcare scientists, psychologists and pharmacists (NMAHPPs) and managers of these professions. All participants were employed in a single, multisite healthcare organisation in the UK.

Analysis

Interview transcripts were analysed using the framework method to identify key themes, subthemes and areas of divergence.

Results

Four themes were identified. The first, cultural shifts, described the perceived improvements in the approach to patient care and research culture that were associated with clinical academic activity. The second theme explored visibility and included the positive reputation that clinical academics were identified as bringing to the organisation in contrast with perceived levels of invisibility and inaccessibility of these roles. The third theme identified the impacts of the clinical academic pathways, including the precarity of these roles. The final theme explored making impact tangible, and described interviewees’ suggestions of possible methods to record and demonstrate impact.

Conclusions

Perceived positive impacts of NMAHPP clinical academic activity focused on interlinked positive changes for patients and clinical teams. This included delivery of evidence-based healthcare, patient involvement in clinical decision making and improved staff recruitment and retention. However, the positive impacts of clinical academic activity often centred around individual clinicians and did not necessarily translate throughout the organisation. The current clinical academic pathway was identified as causing tension between the perceived value of clinical academic activity and the need to find sufficient staffing to cover clinical services.
Factors related to the adoption and adherence of physical activity mobile applications by older people: a scoping review protocol
Authors: Lorenzi Lorena Jorge , Belo Letícia Fernanda , Frohlich David Mark , Dourado Victor Zuniga , Castro Paula Costa , Gomes Grace Angélica de Oliveira
Published: October 2021

Introduction

Ageing is a natural process marked by physiological changes and declines in functional capacity. One strategy to encourage healthy habits in older people is the use of applications on mobile devices to promote physical activity (PA). An immediate challenge is for these applications to be accessible to older people themselves, while a second challenge is to retain their interest and engagement in connection with PA itself. Therefore, the purpose of this review is to map the factors related to the adoption and adherence of PA mobile applications by older people.

Methods and analysis

Five databases will be searched where articles and reviews, available between 2010 and present, in English, Portuguese or Spanish, at full text, will be included. In addition, two additional strategies will be performed, including grey literature. The search terms adoption, adherence, factors, mobile application, PA, older people and other terms related to them will be used in the search strategy. This review will include studies that identify factors related to the adoption and adherence to PA mobile applications by people over 60 years. The selection of studies will be carried out by two reviewers in five stages: identification of studies and duplicate removal; pilot test; selection by reading abstracts; inclusion by reading the full text and search in additional sources. Disagreements will be resolved by a third reviewer. Data will be extracted using a data extraction tool. Quantitative data will be described in a narrative manner and qualitative data will be categorised through inductive thematic analysis.

Ethics and dissemination

Ethical approval is not required for this scoping review. Plans for the dissemination of the review include the presentation of the results at relevant scientific conferences and the submission and publication in significant journals.
Development and field testing of primary care screening tools for harms of long-term opioid therapy continuation and tapering to discontinuation: a study protocol
Authors: Timko Christine , Kroenke Kurt , Nevedal Andrea , Lor Mai Chee , Oliva Elizabeth , Drexler Karen , Sandbrink Friedhelm , Hoggatt Katherine
Published: October 2021

Introduction

Despite calls for screening tools to help providers monitor long-term opioid therapy (LTOT) harms, and identify patients likely to experience harms of discontinuation, such screening tools do not yet exist. Current assessment tools are infeasible to use routinely in primary care and focus mainly on behaviours suggestive of opioid use disorder to the exclusion of other potential harms. This paper describes a study protocol to develop two screening tools that comprise one integrated instrument,Screen toEvaluate andTreat (SET). SET1 will indicate if LTOT may be harmful to continue (yes or no), and SET2 will indicate if tapering to discontinue opioids may be harmful to initiate (yes or no). Patients receiving LTOT who screen positive on the SET tools should receive subsequent additional assessment. SET will give providers methods that are feasible to implement routinely to facilitate more intensive and comprehensive monitoring of patients on LTOT and decision-making about discontinuation.

Methods and analysis

We will develop the screening tools, SET1 and SET2, concurrently. Tool development will be done in stages: (1) comprehensive literature searches to yield an initial item pool for domains covered by each screening tool; (2) qualitative item analyses using interviews, expert review and cognitive interviewing, with subsequent item revision, to yield draft versions of each tool; and (3) field testing of the draft screening tools to assess internal consistency, test–retest reliability and convergent and discriminant validity.

Ethics and dissemination

Ethical approval was obtained from the Institutional Review Boards of Stanford University and the University of California, San Francisco for the VA Palo Alto Health Care System, and the VA San Francisco Healthcare System, respectively. Findings will be disseminated through peer-reviewed manuscripts and presentations at research conferences.
Acceptance of COVID-19 vaccines in Palestine: a cross-sectional online study
Authors: Zawahrah Hassan J , Saca-Hazboun Hanan , Melhem Shatha S , Adwan Rabee , Sabateen Ali , Abu-Rmeileh Niveen M E
Published: October 2021

Introduction

In Palestine (West Bank and Gaza), there have been more than 320 890 known cases of COVID-19, resulting in 3452 deaths. The detrimental effects of the virus can be seen in the nation’s health, economy and government operations, leading to radical uncertainty that is exacerbated by the absence of any definitive treatment or vaccines. The level of knowledge about and trust in treatment and vaccination varies worldwide. This study aims to assess the willingness of Palestinians to receive a COVID-19 vaccine and their knowledge about such vaccines.

Methods

An online survey of adults over 18 years old (n=1080) was conducted in Palestine in October 2020. Using multivariate logistic regression, we identified correlates of participants’ willingness to get a COVID-19 vaccine.

Results

We found that about 63% of participants were willing to get a COVID-19 vaccine. However, acceptance varied with the specific demographic variables that were investigated. Women, married participants and those aged 18–24 years are more likely to take the vaccine. Further, participants with good knowledge about the vaccine and its side effects are more willing to get the vaccine.

Conclusion

The availability of a safe and effective COVID-19 vaccine in Palestine is crucial to decrease the burden of COVID-19 morbidity and mortality. In addition, to ensure a high vaccination rate, health awareness campaigns should target those who are not willing to get the vaccine, especially those who are more vulnerable and the elderly.
Risk of pneumothorax in pneumoconiosis patients in Taiwan: a retrospective cohort study
Authors: Pan Jo-Hui , Cheng Chih-Hung , Wang Chao-Ling , Dai Chia-Yen , Sheu Chau-Chyun , Tsai Ming-Ju , Hung Jen-Yu , Chong Inn-Wen
Published: October 2021

Objectives

This study was conducted to explore the association between pneumoconiosis and pneumothorax.

Design

Retrospective cohort study.

Setting

Nationwide population-based study using the Taiwan National Health Insurance Database.

Participants

A total of 2333 pneumoconiosis patients were identified (1935 patients for propensity score (PS)-matched cohort) and matched to 23 330 control subjects by age and sex (7740 subjects for PS-matched cohort).

Primary and secondary outcome measures

The incidence and the cumulative incidence of pneumothorax.

Results

Both incidence and the cumulative incidence of pneumothorax were significantly higher in the pneumoconiosis patients as compared with the control subjects (p<0.0001). For multivariable Cox regression analysis adjusted for age, sex, residency, income level and other comorbidities, patients with pneumoconiosis exhibited a significantly higher risk of pneumothorax than those without pneumoconiosis (HR 3.05, 95% CI 2.18 to 4.28, p<0.0001). The male sex, heart disease, peripheral vascular disease, chronic pulmonary disease and connective tissue disease were risk factors for developing pneumothorax in pneumoconiosis patients.

Conclusions

Our study revealed a higher risk of pneumothorax in pneumoconiosis patients and suggested potential risk factors in these patients. Clinicians should be aware about the risk of pneumothorax in pneumoconiosis patients.
How does implementation of an electronic medical record system impact nurses’ work motivation, engagement, satisfaction and well-being? A realist review protocol
Authors: Jedwab Rebecca M , Redley Bernice , Manias Elizabeth , Dobroff Naomi , Hutchinson Alison M
Published: October 2021

Introduction

Electronic medical record (EMR) systems are used worldwide as repositories for patients’ clinical information, providing clinical decision support and increasing visibility of and access to clinical information. While EMR systems facilitate improved healthcare delivery, emerging reports suggest potential detrimental effects on clinician well-being. EMR system implementation influences on nurses’ work motivation, engagement, satisfaction and well-being (including burnout) are not well understood, nor have they been examined in relation to contextual factors and mechanisms of action. This paper presents a realist review protocol to examine causal explanations to address the question: How, why and under what circumstances does the implementation of a new hospital EMR system or similar technology impact nurses’ work motivation, engagement, satisfaction or well-being?

Methods and analysis

The five-step method for realist review will be used to identify causal relationships, how the relationships work, for whom and under what circumstances: (1) defining the review scope; (2) developing initial program theories; (3) searching the evidence; (4) selecting and appraising the evidence; (5) extracting and synthesising the data. Initial program theories were developed using scoping review findings and qualitative data collected from nurses pre-EMR and post-EMR. Five databases will be systematically searched from 1 January 2000 to 31 October 2021 (APA PsycInfo, CINAHL, Embase, IEEE Xplore and MEDLINE Complete), and forward and backward citation searching, grey literature searching and literature recommended by the research team. Search results will be screened by two research team members. Data extracted will assist in refining program theories to develop a conceptual model that synthesises how work motivation, engagement, satisfaction and well-being may influence, or be influenced by, an EMR implementation.

Ethics and dissemination

The larger project has previously obtained low-risk ethics approval. The review will be published in a peer-reviewed journal and reported as per RAMESES guidelines.

PROSPERO registration number

CRD42020131875.
Increased coexpression of PD-L1 and TIM3/TIGIT is associated with poor overall survival of patients with esophageal squamous cell carcinoma
Authors: Wang Peipei , Chen Yueyun , Long Qingqin , Li Qing , Tian Jiangfang , Liu Ting , Wu Yong , Ding Zhenyu
Published: October 2021

Background

Immune checkpoint (IC) blockades (ICBs) significantly improve patients’ clinical outcomes with solid tumors. Because the objective response rate of single-agent ICB is limited, it is meaningful to explore the combination of ICs for immunotherapy.

Methods

RNA sequencing data of 95 newly diagnosed patients with esophageal squamous cell carcinoma (ESCC) from The Cancer Genome Atlas (TCGA) database were used to explore the prognostic significance of ICs. The results were validated by immunohistochemistry of 58 ESCC tissue samples from our clinical center.

Results

The results of both TCGA and validation data suggested that high expression of programmed cell death 1 ligand 1 (PD-L1), T-cell immunoglobulin and mucin-domain-containing-3 (TIM3), and T-cell immunoglobulin and immunoreceptor tyrosine-based inhibitory motif domain (TIGIT) was associated with poor overall survival (OS) of patients with ESCC. Importantly, PD-L1/TIM3 or PD-L1/TIGIT was the optimal combination for predicting poor OS and short restricted mean survival time of patients with ESCC and was an independent prognostic factor. Moreover, a nomogram model constructed by PD-L1, TIM3, and TIGIT together with the primary tumor, regional lymph node, distant metastasis stage could provide a concise and precise prediction of 1-year and 2-year OS rates and median survival time. PD-L1/TIM3 or PD-L1/TIGIT had a positive correlation with CD8+ T cells. Notably, PD-1 and TIM3/TIGIT were primarily coexpressed on CD8+ tumor-infiltrating lymphocyte in patients with ESCC by multiplexed immunofluorescence.

Conclusion

High expression of ICs was associated with poor OS of patients with ESCC. PD-L1/TIM3 and PD-L1/TIGIT were the optimal combinations for predicting OS, which might be potential targets for future ICBs therapy of ESCC.
Acute kidney injury in patients treated with immune checkpoint inhibitors
Authors: Gupta Shruti , Short Samuel A P , Sise Meghan E , Prosek Jason M , Madhavan Sethu M , Soler Maria Jose , Ostermann Marlies , Herrmann Sandra M , Abudayyeh Ala , Anand Shuchi , Glezerman Ilya , Motwani Shveta S , Murakami Naoka , Wanchoo Rimda , Ortiz-Melo David I , Rashidi Arash , Sprangers Ben , Aggarwal Vikram , Malik A Bilal , Loew Sebastian , Carlos Christopher A , Chang Wei-Ting , Beckerman Pazit , Mithani Zain , Shah Chintan V , Renaghan Amanda D , Seigneux Sophie De , Campedel Luca , Kitchlu Abhijat , Shin Daniel Sanghoon , Rangarajan Sunil , Deshpande Priya , Coppock Gaia , Eijgelsheim Mark , Seethapathy Harish , Lee Meghan D , Strohbehn Ian A , Owen Dwight H. , Husain Marium , Garcia-Carro Clara , Bermejo Sheila , Lumlertgul Nuttha , Seylanova Nina , Flanders Lucy , Isik Busra , Mamlouk Omar , Lin Jamie S , Garcia Pablo , Kaghazchi Aydin , Khanin Yuriy , Kansal Sheru K , Wauters Els , Chandra Sunandana , Schmidt-Ott Kai M , Hsu Raymond K , Tio Maria C , Sarvode Mothi Suraj , Singh Harkarandeep , Schrag Deborah , Jhaveri Kenar D , Reynolds Kerry L , Cortazar Frank B , Leaf David E
Published: October 2021

Background

Immune checkpoint inhibitor-associated acute kidney injury (ICPi-AKI) has emerged as an important toxicity among patients with cancer.

Methods

We collected data on 429 patients with ICPi-AKI and 429 control patients who received ICPis contemporaneously but who did not develop ICPi-AKI from 30 sites in 10 countries. Multivariable logistic regression was used to identify predictors of ICPi-AKI and its recovery. A multivariable Cox model was used to estimate the effect of ICPi rechallenge versus no rechallenge on survival following ICPi-AKI.

Results

ICPi-AKI occurred at a median of 16 weeks (IQR 8–32) following ICPi initiation. Lower baseline estimated glomerular filtration rate, proton pump inhibitor (PPI) use, and extrarenal immune-related adverse events (irAEs) were each associated with a higher risk of ICPi-AKI. Acute tubulointerstitial nephritis was the most common lesion on kidney biopsy (125/151 biopsied patients [82.7%]). Renal recovery occurred in 276 patients (64.3%) at a median of 7 weeks (IQR 3–10) following ICPi-AKI. Treatment with corticosteroids within 14 days following ICPi-AKI diagnosis was associated with higher odds of renal recovery (adjusted OR 2.64; 95% CI 1.58 to 4.41). Among patients treated with corticosteroids, early initiation of corticosteroids (within 3 days of ICPi-AKI) was associated with a higher odds of renal recovery compared with later initiation (more than 3 days following ICPi-AKI) (adjusted OR 2.09; 95% CI 1.16 to 3.79). Of 121 patients rechallenged, 20 (16.5%) developed recurrent ICPi-AKI. There was no difference in survival among patients rechallenged versus those not rechallenged following ICPi-AKI.

Conclusions

Patients who developed ICPi-AKI were more likely to have impaired renal function at baseline, use a PPI, and have extrarenal irAEs. Two-thirds of patients had renal recovery following ICPi-AKI. Treatment with corticosteroids was associated with improved renal recovery.
Thick braneworld model in nonmetricity formulation of general relativity and its stability
Authors: Fu Qi-Ming , Zhao Li , Xie Qun-Ying
Published: October 2021

In this paper, we study the thick brane system in the so-called f(Q) gravity, where the gravitational interaction was encoded by the nonmetricity Q like scalar curvature R in general relativity. With a special choice of $$f(Q)=Q-b Q^n$$

f

(
Q
)

=
Q
-
b

Q
n

, we find that the thick brane system can be solved analytically with the first-order formalism, where the complicated second-order differential equation is transformed to several first-order differential equations. Moreover, the stability of the thick brane system under tensor perturbation is also investigated. It is shown that the tachyonic states are absent and the graviton zero mode can be localized on the brane. Thus, the four-dimensional Newtonian potential can be recovered at low energy. Besides, the corrections of the massive graviton Kaluza–Klein modes to the Newtonian potential are also analyzed briefly.
Neutron stars in Palatini $$R+\alpha R^2$$ and $$R+\alpha R^2+\beta Q$$ theories
Authors: Herzog Georg , Sanchis-Alepuz Hèlios
Published: October 2021

We study solutions of the stellar structure equations for spherically symmetric objects in modified theories of gravity, where the Einstein-Hilbert Lagrangian is replaced by$$f(R)=R+\alpha R^2$$f(R)=R+αR2and$$f(R,Q)=R+\alpha R^2+\beta Q$$f(R,Q)=R+αR2+βQ, withRbeing the Ricci scalar curvature,$$Q=R_{\mu \nu }R^{\mu \nu }$$Q=RμνRμνand$$R_{\mu \nu }$$Rμνthe Ricci tensor. We work in the Palatini formalism, where the metric and the connection are assumed to be independent dynamical variables. We focus on stellar solutions in the mass-radius region associated to neutron stars. We illustrate the potential impact of the$$R^2$$R2andQterms by studying a range of viable values of$$\alpha $$αand$$\beta $$β. Similarly, we use different equations of state (SLy, FPS, HS(DD2) and HS(TMA)) as a simple way to account for the equation of state uncertainty. Our results show that for certain combinations of the$$\alpha $$αand$$\beta $$βparameters and equation of state, the effect of modifications of general relativity on the properties of stars is sizeable. Therefore, with increasing accuracy in the determination of the equation of state for neutron stars, astrophysical observations may serve as discriminators of modifications of General Relativity.
Many accelerating distorted black holes
Authors: Astorino Marco , Viganò Adriano
Published: October 2021

An analytical solution of four-dimensional General Relativity, representing an array of collinear and accelerating black holes, is constructed with the inverse scattering method. The metric can be completely regularised from any conical singularity, thanks to the presence of an external gravitational field. Therefore the multi-black hole configuration can be maintained at equilibrium without the need of strings or struts. Some notable subcases such as the accelerating distorted Schwarzschild black hole and the distorted double C-metric are explicitly presented. The Smarr law and the thermodynamics of these systems is studied. The Bonnor–Swaminarayan and the Bičák–Hoenselaers–Schmidt particle metrics are recovered, through appropriate limits, from the multi-black holes solutions.
Quantum teleportation of a tripartite entangled coherent state
Authors: Kumar Shivani A.
Published: October 2021

The present work proposes a scheme to teleport a tripartite coherent state using an unparalleled four-component state as a quantum channel. The scheme involves linear optical devices like beam splitters and phase shifters. It is shown that, even by taking an uncompromising quantum model, almost a complete teleportation can be achieved with an impressive number of photons. It is also shown that the teleportation fails only if zero photons are found in all the three output modes or zero in two output modes and a nonzero even/odd photon in one mode. However, the probability of getting these output modes is almost negligible.
Set-valued perturbation to second-order evolution problems with time-dependent subdifferential operators
Authors: Saïdi Soumia
Published: October 2021

The main purpose of this work is to study the existence of solutions for a perturbed second-order evolution inclusion involving time-dependent subdifferential operators. Under suitable conditions on the set-valued perturbation, the main result of the paper is proved in the context of a separable Hilbert space. A second-order evolution quasi-variational inequality is also investigated.
Seroprevalence of Taenia solium and Trichinella spiralis among Humans and Pigs in Ghana
Authors: Addo Henry Ofosu , Majekodunmi Ayodele O. , Sampane-Donkor Eric , Ofosu-Appiah Lawrence Henry , Opare David , Owusu-Okyere Godfred , Amegah Kingsley Ebenezer , Bimi Langbong
Published: October 2021

In this study, the seroprevalence of the intestinal worms Taenia solium and Trichinella spiralis in humans and pigs was assessed. A cross‐sectional serological study design was performed. Blood samples were collected from 322 humans and 245 pigs used in the study. These were tested for markers of antibodies for Taenia solium and Trichinella spp. Demographic data such as sex, age, education, pig farming practices, and water source used were also obtained. An overall seroprevalence of 3.1% was recorded for Taenia solium in humans. There was also a statistical association between pig management system employed by pig farmers and seropositivity to Taenia solium (p = 0.005). Factors such as mode of waste disposal (p = 0.003) and water source used statistically correlated with Taenia solium seroprevalence among humans. For the pig samples, a Taenia solium seroprevalence of 24.9% was recorded. All the pig samples which tested positive for Taenia solium were reared on the free‐ranged system. This study also recorded a seroprevalence of 0.31% for Trichinella spp. for humans and a seroprevalence of 4.5% for Trichinella spp. for pigs. Again, all the samples that showed serological evidence of Trichinella spp. among pigs came from those pigs which were raised on the free‐ranged system. Proper pig management practice is a very important tool for controlling these intestinal parasites in both humans and animals. This study recommends public health education among the general public and good pig farming practices.
Multiplicative Watermarking Method with the Visual Saliency Model Using Contourlet Transform
Authors: Liu Jinhua , Huang Jiawen , Huang Yuanyuan
Published: October 2021

We have proposed an image adaptive watermarking method by using contourlet transform. Firstly, we have selected high-energy image blocks as the watermark embedding space through segmenting the original image into nonoverlapping blocks and designed a watermark embedded strength factor by taking advantage of the human visual saliency model. To achieve dynamic adjustability of the multiplicative watermark embedding parameter, the relationship between watermark embedded strength factor and watermarked image quality is developed through experiments with the peak signal-to-noise ratio (PSNR) and structural similarity index measure (SSIM), respectively. Secondly, to detect the watermark information, the generalized Gaussian distribution (GGD) has been utilized to model the contourlet coefficients. Furthermore, positions of the blocks selected, watermark embedding factor, and watermark size have been used as side information for watermark decoding. Finally, several experiments have been conducted on eight images, and the results prove the effectiveness of the proposed watermarking approach. Concretely, our watermarking method has good imperceptibility and strong robustness when against Gaussian noise, JPEG compression, scaling, rotation, median filtering, and Gaussian filtering attack.
Degree-Based Topological Properties of Molecular Polymeric Networks Composed by Sierpinski Networks
Authors: Rauf Abdul , Ishtiaq Muhammad , Faraz Qaiser Hafiz , Aslam Adnan , Anoh Yannick Kraidi
Published: October 2021

Sierpinski graphs are a widely observed family of fractal-type graphs relevant to topology, Hanoi Tower mathematics, computer engineering, and around. Chemical implementations of graph theory establish significant properties, such as chemical activity, physicochemical properties, thermodynamic properties, and pharmacological activities of a molecular graph. Specific graph descriptors alluded to as topological indices are helpful to predict these properties. These graph descriptors have played a key role in quantitative structure-property/structure-activity relationships (QSPR/QSAR) research. The objective of this article is to compute Randic index (

R

−
1

/
2

), Zagreb index

M

1

, sum-connectivity index

SCI

, geometric-arithmetic index

GA

, and atom-bond connectivity

ABC

index based on ev-degree and ve-degree for the Sierpinski networks

S

n
,
m

.
MATrix LABoratory Algorithm in Ultrasound Image-Guided General Drug Anesthesia along with Lumbar and Sacral Plexus Block in Hip Replacement under
Authors: Wang Nana , Chen Lingyang , Wang Hongzhu , Wang Yibing , Ruan Binhao
Published: October 2021

Objective. The study aimed to explore the application of ultrasound image-guided general drug anesthesia combined with lumbar and sacral plexus block based on MATrix LABoratory (MATLAB) algorithm in hip arthroplasty and to study its clinical effect. Methods. The classic geodesic active contour (GAC) algorithm and the improved fuzzy clustering level set algorithm were used to segment ultrasound images of waist plexus, and then their segmentation effects were compared. Both algorithms are from the MATrix LABoratory (MATLAB) platform. A total of 60 patients undergoing hip arthroplasty were selected and randomly enrolled into control and experimental groups. The control group accepted general drug anesthesia, and the experimental group accepted ultrasound-guided lumbar and sacral plexus block combined with general anesthesia. The mean arterial pressure and heart rate at t0 (before anesthesia), t1 (before ventilation), t2 (when the skin was incised), t3 (when the prosthesis was implanted), t4 (when the incision was closed), and t5 (at the end of ventilation) were observed, and the intraoperative sufentanil dosage and 24 h analgesic dosage, the incidence of postoperative delirium, and the incidence of cognitive dysfunction were recorded. Results. The improved fuzzy clustering level set algorithm was better than the GAC model algorithm in image segmentation and running time. In contrast with the control group, the average arterial pressure and heart rate of the experimental group at the four time points of t1, t2, t3, and t5 were obviously reduced (

P

 < 0.05). In contrast with the control group, the amount of sufentanil and analgesics in the experimental group was obviously reduced (

P

 < 0.05), and the incidence of postoperative cognitive dysfunction and delirium was obviously reduced (

P

 < 0.05). Conclusion. The improved fuzzy clustering level set algorithm is superior to the GAC model in image segmentation and running time. Under its guidance, the lumbar and sacral plexus block combined with general anesthesia has a good clinical effect in hip arthroplasty, which is better than simple general anesthesia.