bluuebunny/crossref_metadata_2025 huggingface dataset:
Hume on Nonhuman Animals, Causal Reasoning, and General Thoughts
Authors: Tanaka Ryo
Published: February 2021

In both theTreatiseand theEnquiry, as a naturalist philosopher Hume is committed to recognizing continuity between humans’ and other animals’ cognitive capacities. In particular, Hume maintains that humans share with other intelligent animals the basic psychological mechanism that underlies their capacities for causal reasoning. In this article, I will address the question whether Hume’s philosophical system can coherently attribute to animals the ability to engage in causal reasoning as he intends. First, I formulate an apparent problem for Hume that his views on causal reasoning and general thinking may seem to yield the following inconsistent triad: (1) causal reasoning requires general thinking; (2) general thinking requires language; (3) nonhuman animals lack language but can engage in causal reasoning. Then, I will develop a Humean solution to the problem by distinguishing two kinds of general thinking, which I call “level‐1” and “level‐2” general thinking, respectively. Level‐1 general thinking does not require language and must play the foundational role in Hume’s account of causal reasoning, as well as his account of language acquisition. Level‐2 general thinking, on the other hand, requires language, and it presupposes the capacity for level‐1 general thinking in several important ways.
Beyond ‘Borderism’: Overcoming Discriminative B/Ordering and Othering
Authors: van Houtum Henk
Published: February 2021

Now, 20 years after our article “Bordering, Ordering and Othering”, the editorial team ofTESGhas asked me to look back on its formation, and to comment on the appraisals of its continued relevance and influence offered by Anssi Paasi, Bastian Vollmer, James Scott and Chiara Brambilla in this Forum. To this end, I will first explain what the inspiration was for our essay and will shortly revisit the geopolitical triadic frame that we proposed; then, I will discuss the reflections of the commentators while briefly analyzing how the field of border studies has developed; and lastly, I will look ahead and offer, also using their reflections, a brief research agenda to address present and upcoming b/ordering and othering challenges.
Information extraction from Murphy–Good plots of tungsten field electron emitters
Authors: Madanat Mazen , Al Share Mohammad , Allaham Mohammad M. , Mousa Marwan S.
Published: February 2021

This study introduces an easy methodology to test and analyze experimental field electron emission current-voltage data from metallic single-tip emitters; this novel and easy methodology is called the Murphy–Good plots. Tungsten electron emitters were used as an example and were prepared by the electrochemical etching process. The current-voltage characteristics are obtained in high vacuum levels and using a traditional field emission microscope. Murphy–Good plots are used to apply the well-known field electron emission orthodoxy test to the experimental data and then to extract the emitters’ characterization parameters if the test is passed. The novelty in using this type of plots lies in its independency on any correction factors, unlike the traditional Fowler–Nordheim and Millikan–Lauritsen plots, in addition to its simple theoretical form. The results are calculated using a simple web tool that applies the field electron emission orthodoxy test to any type of the current-voltage analysis plots and then to extract the characterization parameters of the emitters.
Frequency-difference autoproduct cross-term analysis and cancellation for improved ambiguity surface robustness
Authors: Geroski David J. , Worthmann Brian M.
Published: February 2021

Frequency-differencing, or autoproduct processing, techniques are one area of research that has been found to increase the robustness of acoustic array signal processing algorithms to environmental uncertainty. Previous studies have shown that frequency differencing techniques are able to mitigate problems associated with environmental mismatch in source localization techniques. While this method has demonstrated increased robustness compared to conventional methods, many of the metrics, such as ambiguity surface peak values and dynamic range, are lower than would typically be expected for the observed level of robustness. These previous studies have suggested that such metrics are reduced by the inherent nonlinearity of the frequency-differencing method. In this study, simulations of simple multi-path environments are used to analyze this nonlinearity and signal processing techniques are proposed to mitigate the effects of this problem. These methods are used to improve source localization metrics, particularly ambiguity surface peak value and dynamic range, in two experimental environments: a small laboratory water tank and in a deep ocean (Philippine Sea) environment. The performance of these techniques demonstrates that many source localization metrics can be improved for frequency-differencing methods, which suggests that frequency-differencing methods may be as robust as previous studies have shown.
Modeling the thermal behavior of an acoustically driven gas bubble
Authors: Zhou Guangzhao
Published: February 2021

Numerical simulation of an acoustically driven gas bubble is usually achieved by solving a Rayleigh-Plesset-type equation, in which the time-dependent pressure of the gas inside the bubble needs to be appropriately modeled. This is done in most existing methods by assuming a polytropic relation between the gas pressure and the bubble volume, which sometimes oversimplifies the thermal interaction between the bubble and the ambient liquid. In this paper, a model is developed aiming to perform an accurate and efficient calculation of the pressure variation in the bubble. The approach is different from that in the recent paper by the author and his collaborator which used a combination of an integral and a collocation method to solve the energy equation in the gas [Zhou and Prosperetti (2020). J. Fluid Mech. 901, R3]. The starting point of the proposed method in this paper is the gas continuity equation which is manipulated to lead to three ordinary differential equations. In this way, the thermal behavior of an oscillating gas bubble is captured at a modest coding and computational cost.
The Sleep of Elite Australian Rules Footballers During Preseason: A Comparison of Men and Women
Authors: Roberts Spencer S.H. , Falkenberg Emma , Stevens Alysha , Aisbett Brad , Lastella Michele , Condo Dominique
Published: February 2021

Purpose: Australian football has elite men’s (Australian Football League; AFL) and women’s (Australian Football League Women’s; AFLW) competitions. This study compared AFL and AFLW players’ sleep and characterized players’ sleep in the context of current sleep recommendations. Methods: A total of 70 players (36 AFL, 34 AFLW) had their sleep monitored via actigraphy over a 10-day preseason period. Sleep outcomes and their intraindividual variation, were compared between AFL and AFLW players using linear mixed models. Proportions of players sleeping ≥7 and ≥8 hours per night, and achieving ≥85% sleep efficiency, were compared using chi-square analyses. Results: Compared with AFL players, AFLW players slept less (7.9 [0.5] vs 7.1 [0.6] h, P = .000), had lower sleep efficiency (89.5% [2.8%] vs 84.0% [4.4%], P = .000), and greater intraindividual variation in sleep efficiency (3.1% [0.9%] vs 5.1% [2.1%], P = .000). A total of 47% of AFLW versus 3% of AFL players averaged <7 hours sleep (χ2 = 18.6, P = .000). A total of 88% of AFLW versus 50% of AFL players averaged <8 hours sleep (χ2 = 11.9, P = .001). A total of 53% of AFLW versus 14% of AFL players averaged <85% sleep efficiency (χ2 = 12.1, P = .001). Conclusions: AFLW players slept less and had poorer sleep quality than AFL players. Many AFLW players do not meet current sleep duration or sleep quality recommendations. Research should test strategies to improve sleep among Australian rules footballers, particularly among elite women.
Athlete–Coach Conflict and a Sport Psychologist Caught in the Middle: A Case Study of Consultancy During Athlete Preparation and Performance in Olympic Games Athletics
Authors: Males Jonathan R. , Kerr John H. , Hudson Joanne
Published: February 2021

This case study examines the personal experiences of an elite athlete, coach, and sport psychology consultant (SPC) during the athlete’s preparation and performance in a recent Olympic Games. The qualitative research details how the consultancy process was affected by the athlete’s late admission of the deteriorating relationship with his coach. The concepts of closeness, commitment, complementarity, and co-orientation provided a theoretical perspective to the SPC’s interpretation of athlete performance and the interpersonal conflict that developed between athlete and coach. The basic performance demand model provided an applied perspective. The SPC’s commentary adopts a reflexive discursive style that also focuses on the SPC’s role in the consultancy process and the effectiveness of the performance demand model materials. Five important recommendations arise from the case study, and these might inform other SPCs’ future athlete–coach consultancies and interventions.
“Women Are Cancer, You Shouldn’t Be Working in Sport”: Sport Psychologists’ Lived Experiences of Sexism in Sport
Authors: Goldman Aura , Gervis Misia
Published: February 2021

Though sexism has been recognized as problematic in sport, its impact on female sport psychologists in the United Kingdom has not yet been investigated. The purpose of this research was to explore the impact of sexism and its influence on practice. Four semistructured focus groups were conducted, comprising 11 sport psychologists who worked in the United Kingdom. Thematic analysis revealed four general themes: the environment, privileging masculinity, acts of sexism, and the feminine. Participants’ discourse suggests that female sport psychologists are impacted by sexism in their workplaces. Gendered power differentials, coupled with the low status of sport psychology within sport, exacerbated the challenges faced by female sport psychologists. This study contributes to making up for the dearth of research on the impact of sexism on sport psychologists. Suggestions are made with regard to implications for practice.
Genomes arising
Authors: Pennisi Elizabeth
Published: February 2021

Africans have begun to study their continent's rich human diversity—but what comes after current grants end?
HSP70 chaperones RNA-free TDP-43 into anisotropic intranuclear liquid spherical shells
Authors: Yu Haiyang , Lu Shan , Gasior Kelsey , Singh Digvijay , Vazquez-Sanchez Sonia , Tapia Olga , Toprani Divek , Beccari Melinda S. , Yates John R. , Da Cruz Sandrine , Newby Jay M. , Lafarga Miguel , Gladfelter Amy S. , Villa Elizabeth , Cleveland Don W.
Published: February 2021

The makings of anisosomes

Phase separation of proteins within the cell can produce a liquid-inside-a-liquid phase resembling oil droplets in water. Yu
et al.
now report that an RNA-binding protein called TDP-43, in which mutation and aggregation are linked to amyotrophic lateral sclerosis and frontotemporal dementia, phase separates into complex droplets, which they named anisosomes. This process occurred when TDP-43 lost its ability to bind RNA through disease-causing mutation or posttranslational acetylation. Anisosomes have spherical shells of TDP-43 (with properties of a liquid crystal) surrounding centers of the protein chaperone HSP70. Chaperone activity was required to maintain liquidity. Anisosomes formed in neurons in vivo when proteasome activity was inhibited and were converted into aggregates when adenosine triphosphate (ATP) levels fell.

Science
, this issue p.
eabb4309
Solvent molecules form surface redox mediators in situ and cocatalyze O
2
reduction on Pd
Authors: Adams Jason S. , Chemburkar Ashwin , Priyadarshini Pranjali , Ricciardulli Tomas , Lu Yubing , Maliekkal Vineet , Sampath Abinaya , Winikoff Stuart , Karim Ayman M. , Neurock Matthew , Flaherty David W.
Published: February 2021

Solvents forming redox mediators

The role of solvents participating directly in thermal catalytic reactions is clearer for homogeneous catalysis than for heterogeneous catalysis. Adams
et al.
studied the formation of hydrogen peroxide from hydrogen and oxygen on palladium nanoparticles by measuring the kinetic isotope effect and performing density functional theory simulations in aqueous and organic solvents. Methanol formed chemisorbed hydroxymethyl intermediates. These surface redox mediators transferred electrons and protons to adsorbed oxygen species and were regenerated by oxidizing chemisorbed hydrogen atoms. However, water molecules heterolytically oxidized hydrogen to generate solvated protons and surface electrons that reduced oxygen.

Science
, this issue p.
626
CARD8 is an inflammasome sensor for HIV-1 protease activity
Authors: Wang Qiankun , Gao Hongbo , Clark Kolin M. , Mugisha Christian Shema , Davis Keanu , Tang Jack P. , Harlan Gray H. , DeSelm Carl J. , Presti Rachel M. , Kutluay Sebla B. , Shan Liang
Published: February 2021

Eradicating the last vestiges of HIV

After treatment with antiretroviral therapy, HIV-1 wild-type and escape variants can persist in a latent form, especially within CD4
+
T cells, hindering efforts to eradicate the virus. Q. Wang
et al.
found that human CARD8, a member of the caspase recruitment domain (CARD)–containing family of innate immune sensors, is activatable by direct proteolysis of its N-terminus by HIV-1 protease. This cleavage should result in the programmed cell death of infected cells, but HIV-1 protease remains inactive and undetected as a subunit of the unprocessed Gag-Pol polyprotein. However, when infected cells were treated with non-nucleoside reverse transcriptase inhibitors, intracellular Gag-Pol dimerization was enhanced, resulting in CARD8-mediated caspase activation and pyroptosis. Targeting this pathway may be a promising way to eliminate residual HIV-1 in patients.

Science
, this issue p.
eabe1707
Modulating gut microbiota to treat cancer
Authors: Woelk Christopher H. , Snyder Alexandra
Published: February 2021

Fecal microbiota transplantation is evaluated in melanoma patients resistant to immunotherapy
Complicated legacies: The human genome at 20
Authors: Jones Kathryn Maxson , Cook-Deegan Robert , Rotimi Charles N. , Callier Shawneequa L. , Bentley Amy R. , Stevens Hallam , Phillips Kathryn A. , Jansen Jeroen P. , Weyant Christopher F. , Roberts Dorothy E. , Zielinski Dina , Erlich Yaniv , Garrison Nanibaa’ A. , Carroll Stephanie Russo , Ossorio Pilar N. , Moreau Yves , Wang Maya
Published: February 2021

Millions of people today have access to their personal genomic information. Direct-to-consumer services and integration with other “big data” increasingly commoditize what was rightly celebrated as a singular achievement in February 2001 when the first draft human genomes were published. But such remarkable technical and scientific progress has not been without its share of missteps and growing pains.
Science
invited the experts below to help explore how we got here and where we should (or ought not) be going.
The Complex Link between the Female Genital Microbiota, Genital Infections, and Inflammation
Authors: Dabee Smritee , Passmore Jo-Ann S. , Heffron Renee , Jaspan Heather B.
Published: February 2021

The female genital tract microbiota is part of a complex ecosystem influenced by several physiological, genetic, and behavioral factors. It is uniquely linked to a woman’s mucosal immunity and plays a critical role in the regulation of genital inflammation.
Finding Order in the Chaos: Outstanding Questions in Klebsiella pneumoniae Pathogenesis
Authors: Gonzalez-Ferrer Shekina , Peñaloza Hernán F. , Budnick James A. , Bain William G. , Nordstrom Hayley R. , Lee Janet S. , Van Tyne Daria
Published: February 2021

Klebsiella pneumoniae
are Gram-negative facultative anaerobes that are found within host-associated commensal microbiomes, but they can also cause a wide range of infections that are often difficult to treat. These infections are caused by different pathotypes of
K. pneumoniae
, called either classical or hypervirulent strains.
Clinical Evaluation of a Real-Time PCR Assay for Simultaneous Detection of Helicobacter pylori and Genotypic Markers of Clarithromycin Resistance Directly from Stool
Authors: Marrero Rolon Rebecca , Cunningham Scott A. , Mandrekar Jayawant N. , Polo Erin T. , Patel Robin
Published: February 2021

Helicobacter pylori
infection is mainly diagnosed noninvasively, with susceptibility testing traditionally requiring endoscopy. Treatment is empirical, with clarithromycin-based triple therapy recommended where resistance rates are below 15%. Rising rates of clarithromycin resistance, resulting in high therapy failure rates, are seen worldwide, but U.S. data are limited.
Depression preceding the diagnosis of pancreatic cancer
Authors: Ferreira Mafalda , Moreira Hélder , Esperto Helder , Carvalho Armando
Published: February 2021

Pancreatic cancer is the tumour related to higher rates of depression. Several papers have validated the association between pancreatic cancer and depression. It was noticed that in some cases the psychiatric symptoms precede the somatic ones. We present a case of a progressive and incapacitating diffuse abdominal pain, initially attributed to psychosomatic disorder. This hindered a timely correct diagnosis leading to a poor outcome. A pancreatic adenocarcinoma in an unresectable stage was confirmed by histopathology. The patient underwent chemotherapy.
Unusual presentation of chronic eosinophilic pneumonia with mild peripheral eosinophilia
Authors: Meena Rishikesh , Goyal Abhishek , Keshri Shashwat Kirti , Khurana Alkesh Kumar
Published: February 2021

Chronic eosinophilic pneumonia (CEP) is a rare disorder of unknown aetiology which comes under the class of diffuse parenchymal lung diseases with eosinophilia. It is classically characterised by blood and pulmonary eosinophilia, peripheral consolidation on chest radiograph and prompt response to corticosteroid therapy. We report a case of CEP in a 66-year-old man, smoker showing bilateral pulmonary infiltrates with mild peripheral eosinophilia. Our study shows that CEP can be kept as a possibility if radiological pictures are consistent, even if peripheral blood eosinophilia is mild.
Novel compound heterozygous variants in theNBASgene in a child with osteogenesis imperfecta and recurrent acute liver failure
Authors: Krishnan Sowmya , Rughani Ankur , Tsai Anne , Palle Sirish
Published: February 2021

Osteogenesis imperfecta (OI) consists of a group of genetically and phenotypically heterogeneous diseases characterised by bone fragility. Recent improvement in gene sequencing methods has helped us identify rare forms of OI that are inherited in an autosomal recessive manner. Paediatric endocrinology was consulted on a newborn girl with multiple fractures and wavy thin ribs noted on X-rays. In addition to the bone phenotype, she also has short stature and recurrent acute liver failure (ALF) episodes triggered by intercurrent illness. Whole exome sequencing revealed two novel compound heterozygous variants in neuroblastoma amplified sequence (NBAS) gene.NBASgene codes for a protein that is involved in nonsense-mediated decay pathway and retrograde transport of proteins from Golgi to endoplasmic reticulum. Recognition of pathogenic variants in this gene as a rare cause of autosomal recessive OI and recurrent ALF has important therapeutic implications.
Patent foramen ovale presenting with platypnoea-orthodeoxia syndrome and stroke after multi-organ resection
Authors: Elenizi Khaled , Alharthi Rasha
Published: February 2021

Platypnoea-orthodeoxia syndrome (POS) is defined by oxygen desaturation and dyspnoea in upright position that improves by lying down. It results from a right to left shunt at the intracardiac or intrapulmonary level. A 53-year-old ovarian cancer patient presented with POS that was refractory to oxygen therapy. The symptoms began after an extensive abdominal and pelvic surgery as treatment of her cancer with a complex hospital course. A patent foramen ovale was found with the use of transoesophageal echocardiography. A percutaneous closure was done with positive outcome and dyspnoea disappearance. In this case with its challenging clinical setting, we present a unique clinical scenario of an immediate postoperative POS syndrome. We address the different therapeutic modalities and the need for a multidisciplinary medical approach.
Cerebellar ataxia as a primary manifestation of neuropsychiatric systemic lupus erythematosus
Authors: Sy Marie Charmaine C , Reyes Nikolai Gil D , Zamora Geraldine T , Fernandez Marc Laurence L
Published: February 2021

Acute cerebellar ataxia is a rare primary manifestation of neuropsychiatric systemic lupus erythematosus (NPSLE). We report a case of a 22-year-old woman who presented with gait instability, behavioural changes and new-onset seizures. The tempo of disease progression was explained by an autoimmune cause, eventually fulfilling the criteria for systemic lupus erythematosus. The patient’s neurological symptoms improved markedly following administration of steroids and immunomodulators. A review of literature on cerebellar ataxia in NPSLE and a summary of all reported cases to date are also presented.
Mycobacterium mageritenseinfection following mastectomy and breast reconstruction requiring triple antibiotic therapy and surgical debridement
Authors: Joya Christie Alyce , Deegan Cara , Gleeson Todd D
Published: February 2021

A 40-year-old woman was referred to infectious disease specialists for aMycobacterium mageritenseskin infection following mastectomy and bilateral reconstruction with deep inferior epigastric perforator flap. Her case demonstrates the difficulty in treating non-tuberculosis mycobacterial infections, especially the rarely seen species. She failed to respond to dual antibiotic therapy containing imipenem-cilastin despite reported sensitivity. Additionally, her course was complicated by intolerance to various regimens, including gastrointestinal distress, a drug rash with eosinophilia and systemic symptoms, and tendinopathy. With few published data, no treatment guidelines, and limited medications from which to choose forM. mageritense,her treatment posed a challenge. She ultimately required aggressive surgical intervention and a triple therapy antibiotic regimen. The duration of our patient’s treatment and the extent of her complications suggest a potential need for early surgical intervention in postsurgical wounds infected withM. mageritensethat do not respond to conventional treatment.
Prospective validation of Canadian TIA Score and comparison with ABCD2 and ABCD2i for subsequent stroke risk after transient ischaemic attack: multicentre prospective cohort study
Authors: Perry Jeffrey J , Sivilotti Marco L A , Émond Marcel , Stiell Ian G , Stotts Grant , Lee Jacques , Worster Andrew , Morris Judy , Cheung Ka Wai , Jin Albert Y , Oczkowski Wieslaw J , Sahlas Demetrios J , Murray Heather E , Mackey Ariane , Verreault Steve , Camden Marie-Christine , Yip Samuel , Teal Philip , Gladstone David J , Boulos Mark I , Chagnon Nicolas , Shouldice Elizabeth , Atzema Clare , Slaoui Tarik , Teitlebaum Jeanne , Abdulaziz Kasim E , Nemnom Marie-Joe , Wells George A , Sharma Mukul
Published: February 2021

Objective

To validate the previously derived Canadian TIA Score to stratify subsequent stroke risk in a new cohort of emergency department patients with transient ischaemic attack.

Design

Prospective cohort study.

Setting

13 Canadian emergency departments over five years.

Participants

7607 consecutively enrolled adult patients attending the emergency department with transient ischaemic attack or minor stroke.

Main outcome measures

The primary outcome was subsequent stroke or carotid endarterectomy/carotid artery stenting within seven days. The secondary outcome was subsequent stroke within seven days (with or without carotid endarterectomy/carotid artery stenting). Telephone follow-up used the validated Questionnaire for Verifying Stroke Free Status at seven and 90 days. All outcomes were adjudicated by panels of three stroke experts, blinded to the index emergency department visit.

Results

Of the 7607 patients, 108 (1.4%) had a subsequent stroke within seven days, 83 (1.1%) had carotid endarterectomy/carotid artery stenting within seven days, and nine had both. The Canadian TIA Score stratified the risk of stroke, carotid endarterectomy/carotid artery stenting, or both within seven days as low (risk ≤0.5%; interval likelihood ratio 0.20, 95% confidence interval 0.09 to 0.44), medium (risk 2.3%; interval likelihood ratio 0.94, 0.85 to 1.04), and high (risk 5.9% interval likelihood ratio 2.56, 2.02 to 3.25) more accurately (area under the curve 0.70, 95% confidence interval 0.66 to 0.73) than did the ABCD2 (0.60, 0.55 to 0.64) or ABCD2i (0.64, 0.59 to 0.68). Results were similar for subsequent stroke regardless of carotid endarterectomy/carotid artery stenting within seven days.

Conclusion

The Canadian TIA Score stratifies patients’ seven day risk for stroke, with or without carotid endarterectomy/carotid artery stenting, and is now ready for clinical use. Incorporating this validated risk estimate into management plans should improve early decision making at the index emergency visit regarding benefits of hospital admission, timing of investigations, and prioritisation of specialist referral.
Effects of physical fitness training on metabolic syndrome among military personnel in Taiwan
Authors: Chang Che-Fu , Wu Y-C , Lai C-H , Chen P-C , Guo Y-L
Published: February 2021

Introduction

Metabolic syndrome (MS) is strongly associated with cardiovascular diseases and diabetes but can be prevented with regular physical activity. This study aimed to assess the impact of a physical fitness training programme on MS among military personnel.

Methods

This retrospective observational study included volunteer army soldiers who underwent annual health examinations between 2011 and 2014. In 2011, the reformed physical fitness training programme and physical fitness test were introduced to the participants. MS evaluation and physical fitness performances were evaluated before and after implementing the training programme using a mixed-effects model and generalised estimating equation, adjusted for sex, age and smoking.

Results

From 2011 to 2014, 1720 soldiers underwent the annual health examination. In 2011, before the fitness programme, 246 soldiers (14.3%) had MS. After implementation, decreases in blood pressure and fasting glucose levels were observed and maintained for 3 years. Running performance was negatively correlated to triglycerides (ß=−11.37; p<0.001) and waist circumference (ß=−0.42; p<0.001) and positively correlated to high-density lipoprotein cholesterol levels (ß=2.14; p<0.001). The severity of MS was reduced following introduction of the physical fitness programme.

Conclusions

MS and its components improved after introducing the reformed fitness programme, with running performance proving to be most relevant to MS. Clinicians should encourage increased physical activity to prevent MS among military personnel.
Investigation to identify individual socioeconomic and health determinants of suicidal ideation using responses to a cross-sectional, community-based public health survey
Authors: Mulholland Helen , McIntyre Jason C , Haines-Delmont Alina , Whittington Richard , Comerford Terence , Corcoran Rhiannon
Published: February 2021

Objectives

To address a gap in knowledge by simultaneously assessing a broad spectrum of individual socioeconomic and potential health determinants of suicidal ideation (SI) using validated measures in a large UK representative community sample.

Design

In this cross-sectional design, participants were recruited via random area probability sampling to participate in a comprehensive public health survey. The questionnaire examined demographic, health and socioeconomic factors. Logistic regression analysis was employed to identify predictors of SI.

Setting

Community setting from high (n=20) and low (n=8) deprivation neighbourhoods across the North West of England, UK.

Participants

4319 people were recruited between August 2015 and January 2016. There were 809 participants from low-deprivation neighbourhoods and 3510 from high-deprivation neighbourhoods. The sample comprised 1854 (43%) men and 2465 (57%) women.

Primary outcome measures

SI was the dependent variable which was assessed using item 9 of the Patient Health Questionnaire-9 instrument.

Results

454 (11%) participants reported having SI within the last 2 weeks. Model 1 (excluding mental health variables) identified younger age, black and minority ethnic (BME) background, lower housing quality and current smoker status as key predictors of SI. Higher self-esteem, empathy and neighbourhood belonging, alcohol abstinence and having arthritis were protective against SI. Model 2 (including mental health variables) found depression and having cancer as key health predictors for SI, while identifying as lesbian, gay, bisexual, transgender or queer (LGBTQ) and BME were significant demographic predictors. Alcohol abstinence, having arthritis and higher empathy levels were protective against SI.

Conclusions

This study suggests that it could be useful to increase community support and sense of belonging using a public health approach for vulnerable groups (e.g. those with cancer) and peer support for people who identify as LGBTQ and/or BME. Also, interventions aimed at increasing empathic functioning may prove effective for reducing SI.
Novel approach to meta-analysis of tests and clinical prediction rules with three or more risk categories
Authors: Ebell Mark H , Walsh Mary E , Boland Fiona , McKay Brian , Fahey Tom
Published: February 2021

Objective

Multichotomous tests have three or more outcome or risk categories, and can provide richer information and a better fit with clinical decision-making than dichotomous tests. Our objective is to present a fully developed approach to the meta-analysis of multichotomous clinical prediction rules (CPRs) and tests, including meta-analysis of stratum specific likelihood ratios.

Study design

We have developed a novel approach to the meta-analysis of likelihood ratios for multichotomous tests that avoids the need to dichotomise outcome categories, and demonstrate its application to a sample CPR. We also review previously reported approaches to the meta-analysis of the area under the receiver operating characteristic curve (AUROCC) and meta-analysis of a measure of calibration (observed:expected) for multichotomous tests or CPRs.

Results

Using data from 10 studies of the Cancer of the Prostate Risk Assessment (CAPRA) risk score for prostate cancer recurrence, we calculated summary estimates of the likelihood ratios for low, moderate and high risk groups of 0.40 (95% CI 0.32 to 0.49), 1.24 (95% CI 0.99 to 1.55) and 4.47 (95% CI 3.21 to 6.23), respectively. Applying the summary estimates of the likelihood ratios for each risk group to the overall prevalence of cancer recurrence in a population allows one to estimate the likelihood of recurrence for each risk group in that population.

Conclusion

An approach to meta-analysis of multichotomous tests or CPRs is presented. A spreadsheet for data preparation and code for R and Stata are provided for other researchers to download and use. Combined with summary estimates of the AUROCC and calibration, this is a comprehensive strategy for meta-analysis of multichotomous tests and CPRs.
SOS! Summer of Smoke: a retrospective cohort study examining the cardiorespiratory impacts of a severe and prolonged wildfire season in Canada’s high subarctic
Authors: Howard Courtney , Rose Caren , Dodd Warren , Kohle Katherine , Scott Craig , Scott Patrick , Cunsolo Ashlee , Orbinski James
Published: February 2021

Objectives

To determine healthcare service utilisation for cardiorespiratory presentations and outpatient salbutamol dispensation associated with 2.5 months of severe, unabating wildfire smoke in Canada’s high subarctic.

Design

A retrospective cohort study using hospital, clinic, pharmacy and environmental data analysed using Poisson regression.

Setting

Territorial referral hospital and clinics in Yellowknife, Northwest Territories, Canada.

Participants

Individuals from Yellowknife and surrounding communities presenting for care between 2012 and 2015.

Main outcome measures

Emergency room (ER) presentations, hospital admissions and clinic visits for cardiorespiratory events, and outpatient salbutamol prescriptions

Results

The median 24-hour mean particulate matter (PM2.5) was fivefold higher in the summer of 2014 compared with 2012, 2013 and 2015 (median=30.8 µg/m3), with the mean peaking at 320.3 µg/m3. A 10 µg/m3 increase in PM2.5 was associated with an increase in asthma-related (incidence rate ratio (IRR) (95% CI): 1.11 (1.07, 1.14)) and pneumonia-related ER visits (IRR (95% CI): 1.06 (1.02, 1.10)), as well as an increase in chronic obstructive pulmonary disease hospitalisations (IRR (95% CI): 1.11 (1.02, 1.20). Compared with 2012 and 2013, salbutamol dispensations in 2014 increased by 48%; clinic visits for asthma, pneumonia and cough increased; ER visits for asthma doubled, with the highest rate in females, in adults aged ≥40 years and in Dene people, while pneumonia increased by 57%, with higher rates in males, in individualsaged <40 years and in Inuit people. Cardiac variables were unchanged.

Conclusions

Severe wildfires in 2014 resulted in extended poor air quality associated with increases in health resource utilization; some impacts were seen disproportionately among vulnerable populations, such as children and Indigenous individuals. Public health advisories asking people to stay inside were inadequately protective, with compliance possibly impacted by the prolonged exposure. Future research should investigate use of at-home air filtration systems, clean-air shelters and public health messaging which addresses mental health and supports physical activity.
Cost analysis of a mobile medical unit programme in Andhra Pradesh: a microcosting study protocol
Authors: Raikwar Aakash Ashok , Dogra Vishal , Giri Ashish , Rathnam Nitin , Hegde Shailendra Kumar
Published: February 2021

Introduction

Offering primary healthcare through mobile medical units is an innovative way to reach the rural and the vulnerable population. With 292 mobile medical units, the Andhra Pradesh mobile medical unit (APMMU) programme is one of the largest health outreach programmes in rural India. However, India lacks reliable cost estimates for the health services delivered through mobile medical platforms. This study aims to estimate the unit cost of providing primary care services through mobile medical units in rural and tribal areas of Andhra Pradesh.

Method and analysis

Cost analysis of 12 mobile medical units will be undertaken. We will use the activity-based microcosting technique from the providers’ perspective. A bottom-up approach will be used for cost estimation. Standardised tools will be used to collect data on activities and resources, and on the costs. Capital investments and recurrent costs will be measured and evaluated. Average unit costs, along with 95% CIs, will be reported. Sensitivity analysis will assess the cost estimate uncertainties and other cost assumptions.

Ethics and dissemination

Piramal Swasthya Management Research Institute’s ethics committee approved the study. The findings of the study will be disseminated through conference presentations, publications in peer-reviewed journals and advocacy with the national and state governments. This study will provide first-hand comprehensive cost estimates of provisioning primary healthcare services using mobile medical units in India.
Association among age, gender, menopausal status and small dense low-density lipoprotein cholesterol: a cross-sectional study
Authors: Izumida Toshihide , Nakamura Yosikazu , Sato Yukihiro , Ishikawa Shizukiyo
Published: February 2021

Objectives

Small dense low-density lipoprotein cholesterol (sdLDL-C) might be a better cardiovascular disease (CVD) indicator than low-density lipoprotein cholesterol (LDL-C); however, details regarding its epidemiology remain elusive. The present study aimed at evaluating the association between the demographic factors, such as age, gender and menopausal status, and sdLDL-C levels and sdLDL-C/LDL-C ratio in the Japanese population.

Design

This was a cross-sectional study.

Setting

13 rural districts in Japan, 2010–2017.

Participants

This study included 5208 participants (2397 men and 2811 women), who underwent the health mass screening that was conducted in accordance with the medical care system for the elderly and obtained informed consent for this study.

Results

In total, 517 premenopausal women (mean age ±SD, 45.1±4.2 years), 2294 postmenopausal women (66.5±8.8 years) and 2397 men (64.1±11.2 years) were analysed. In men, the sdLDL-C levels and sdLDL-C/LDL-C ratio increased during younger adulthood, peaked (36.4 mg/dL, 0.35) at 50–54 years, and then decreased. In women, relatively regular increasing trends of sdLDL-C level and sdLDL-C/LDL-C ratio until approximately 65 years (32.7 mg/dL, 0.28), followed by a downward or pleated trend. Given the beta value of age, body mass index, fasting glucose and smoking and drinking status by multiple linear regression analysis, standardised sdLDL-C levels and sdLDL-C/LDL-C ratio in 50-year-old men, premenopausal women and postmenopausal women were 26.6, 22.7 and 27.4 mg/dL and 0.24, 0.15 and 0.23, respectively. The differences between premenopausal and postmenopausal women were significant (p<0.001).

Conclusions

SdLDL-C and sdLDL-C/LDL-C ratios showed different distributions by age, gender and menopausal status. A subgroup-specific approach would be necessary to implement sdLDL-C for CVD prevention strategies, fully considering age-related trends, gender differences and menopausal status.
Country-level determinants of the severity of the first global wave of the COVID-19 pandemic: an ecological study
Authors: Pana Tiberiu A , Bhattacharya Sohinee , Gamble David T , Pasdar Zahra , Szlachetka Weronika A , Perdomo-Lampignano Jesus A , Ewers Kai D , McLernon David J , Myint Phyo K
Published: February 2021

Objective

We aimed to identify the country-level determinants of the severity of the first wave of the COVID-19 pandemic.

Design

Ecological study of publicly available data. Countries reporting >25 COVID-19 related deaths until 8 June 2020 were included. The outcome was log mean mortality rate from COVID-19, an estimate of the country-level daily increase in reported deaths during the ascending phase of the epidemic curve. Potential determinants assessed were most recently published demographic parameters (population and population density, percentage population living in urban areas, population >65 years, average body mass index and smoking prevalence); economic parameters (gross domestic product per capita); environmental parameters (pollution levels and mean temperature (January–May); comorbidities (prevalence of diabetes, hypertension and cancer); health system parameters (WHO Health Index and hospital beds per 10 000 population); international arrivals; the stringency index, as a measure of country-level response to COVID-19; BCG vaccination coverage; UV radiation exposure; and testing capacity. Multivariable linear regression was used to analyse the data.

Primary outcome

Country-level mean mortality rate: the mean slope of the COVID-19 mortality curve during its ascending phase.

Participants

Thirty-seven countries were included: Algeria, Argentina, Austria, Belgium, Brazil, Canada, Chile, Colombia, the Dominican Republic, Ecuador, Egypt, Finland, France, Germany, Hungary, India, Indonesia, Ireland, Italy, Japan, Mexico, the Netherlands, Peru, the Philippines, Poland, Portugal, Romania, the Russian Federation, Saudi Arabia, South Africa, Spain, Sweden, Switzerland, Turkey, Ukraine, the UK and the USA.

Results

Of all country-level determinants included in the multivariable model, total number of international arrivals (beta 0.033 (95% CI 0.012 to 0.054)) and BCG vaccination coverage (−0.018 (95% CI −0.034 to –0.002)), were significantly associated with the natural logarithm of the mean death rate.

Conclusions

International travel was directly associated with the mortality slope and thus potentially the spread of COVID-19. Very early restrictions on international travel should be considered to control COVID-19 outbreaks and prevent related deaths.
Neonatal mortality and leading causes of deaths: a descriptive study in China, 2014–2018
Authors: Liu Yuxi , Kang Leni , He Chunhua , Miao Lei , Qiu Xiaoqiong , Xia Weipeng , Zhu Jun , Liang Juan , Li Qi , Wang Yanping , Liu Hanmin
Published: February 2021

Objective

The present study estimated the national and urban–rural levels and causes of neonatal deaths in China annually between 2014 and 2018 to provide data support for the further end of preventable neonatal deaths for China and other low-income and middle-income countries.

Methods

The study was based on data from the National Maternal and Child Health Surveillance System. All neonates of surveillance districts (gestational week: ≥28 weeks) who died after delivery have been involved in the study. The mortality rate and the leading causes of death for neonates were analysed.

Results

The neonatal mortality rate (NMR) of China has steadily decreased from 5.9 deaths per 1000 live births in 2014 to 3.9 deaths per 1000 live births in 2018. The NMR in 2018 of urban and rural areas was 2.2 deaths per 1000 live births and 4.7 deaths per 1000 live births, respectively. The leading preventable causes of neonatal deaths are the same in the urban and rural areas were same, which were preterm birth, intrapartum complications and pneumonia. Mortality rates of these three causes fell significantly between 2014 and 2018 but contributed to a higher proportion of deaths in rural areas than urban areas. The proportion of preventable deaths accounted for 74.6% in 2018.

Conclusions

The NMR of China has decreased steadily from 2014 to 2018. However, the inequality between urban and rural areas still exists. The goal of government interventions should be to reduce the health inequality of neonates and further take targeted measures to eliminate preventable neonatal death.
Clinical and cost-effectiveness of an online-delivered group-based pain management programme in improving pain-related disability for people with persistent pain—protocol for a non-inferiority randomised controlled trial (iSelf-help trial)
Authors: Hale Leigh , Devan Hemakumar , Davies Cheryl , Dean Sarah Gerard , Dowell Anthony , Grainger Rebecca , Gray Andrew R , Hempel Dagmar , Ingham Tristram , Jones Bernadette , Leung William , Mills Jessica , Saipe Barbara , Shipton Edward , Perry Meredith
Published: February 2021

Introduction

Persistent non-cancer pain affects one in five adults and is more common in Māori—the Indigenous population of New Zealand (NZ), adults over 65 years, and people living in areas of high deprivation. Despite the evidence supporting multidisciplinary pain management programmes (PMPs), access to PMPs is poor due to long waiting lists. Although online-delivered PMPs enhance access, none have been codesigned with patients or compared with group-based, in-person PMPs. This non-inferiority trial aims to evaluate the clinical and cost-effectiveness of a cocreated, culturally appropriate, online-delivered PMP (iSelf-help) compared with in-person PMP in reducing pain-related disability.

Methods and analysis

Mixed-methods, using a modified participatory action research (PAR) framework, involving three phases. Phase I involved cocreation and cultural appropriateness of iSelf-help by PAR team members. Phase II: The proposed iSelf-help trial is a pragmatic, multicentred, assessor-blinded, two-arm, parallel group, non-inferiority randomised controlled trial. Adults (n=180, age ≥18 years) with persistent non-cancer pain eligible for a PMP will be recruited and block randomised (with equal probabilities) to intervention (iSelf-help) and control groups (in-person PMP). The iSelf-help participants will participate in two 60-minute video-conferencing sessions weekly for 12 weeks with access to cocreated resources via smartphone application and a password-protected website. The control participants will receive group-based, in-person delivered PMP. Primary outcome is pain-related disability assessed via modified Roland Morris Disability Questionnaire at 6 months post intervention. Secondary outcomes include anxiety, depression, stress, pain severity, quality of life, acceptance, self-efficacy, catastrophising and fear avoidance. Data will be collected at baseline, after the 12-week intervention, and at 3 and 6 months post intervention. We will conduct economic analyses and mixed-method process evaluations (Phase IIA).

Ethics and dissemination

The Health and Disability Ethics Committee approved the study protocol (HDEC18/CEN/162). Phase III involves dissemination of findings guided by the PAR team as outcomes become apparent.

Trial registration number

ACTRN 12619000771156.
Closing schools for SARS-CoV-2: a pragmatic rapid recommendation
Authors: Bekkering Geertruida , Delvaux Nicolas , Vankrunkelsven Patrik , Toelen Jaan , Aertgeerts Sigrid , Crommen Sofie , Bruyckere Pedro De , Devisch Ignaas , Lernout Tinne , Masschalck Katrien , Milissen Nore , Molenberghs Geert , Pascal Annelies , Plomteux Oscar , Raes Marc , Rans Lise , Seghers Alexandra , Sweldens Lode , Vandenbussche Jeroen , Vanham Guido , Wollants Elke , Aertgeerts Bert
Published: February 2021

Background

In Belgium, schools closed during the first lockdown in March 2020, with a partial reopening in May. They fully reopened in September. During the summer, infections started to increase in the general population, speeding up in September. Some measures were taken to limit social contacts but those were insufficient to mitigate the exponential rise of infections in October. Children were still receiving all lessons at school at that time and it was questioned whether this position was tenable. We systematically compared the benefits and harms of closing primary and secondary schools and developed a recommendation.

Methods

A multidisciplinary panel, including school pupils and teachers, educational experts, clinicians and researchers, produced this recommendation in compliance with the standards for trustworthy rapid guidelines. The recommendation is based on data collected through national surveillance or studies from Belgium, and supported by a rapid literature review.

Results

Closing schools during the first lockdown probably resulted in a large learning delay and possibly led to more cases of child abuse. We are uncertain about the effect on the infection rate, hospitalisations, transmission rates, mental health of children, teachers and parents. The panel concluded that the balance of benefits and harms of closing schools clearly shifts against closing schools. Detrimental effects are even worse for vulnerable children. This recommendation is affected by the local virus circulation.

Conclusion

The guideline panel issues a strong recommendation against closing schools when the virus circulation is low to moderate, and a weak recommendation against closing schools when the virus circulation is high. It does not apply when the school system cannot function due to lack of teachers, too many children who are at home or a shortage of support services. As the results of international studies are consistent with Belgian study results, this recommendation may also be relevant internationally.