bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluating the implementation of interdisciplinary patient-centred care intervention for people with multimorbidity in primary care: a qualitative study
Authors: Ngangue Patrice , Brown Judith Belle , Forgues Catherine , Ag Ahmed Mohamed Ali , Nguyen Tu Ngoc , Sasseville Maxime , Loignon Christine , Gallagher Frances , Stewart Moira , Fortin Martin
Published: September 2021

Objective

A patient-centred care interdisciplinary pragmatic intervention to support self-management for patients with multimorbidity was implemented in one region of Quebec, Canada. This embedded study aimed to evaluate the process of implementation.

Design

A descriptive qualitative study was conducted in 2016–2017 using semistructured individual interviews. The Consolidated Framework for Implementation Research (CFIR) was used to guide the data coding, analysis and reporting of the findings.

Setting

The study took place in seven Family Medicine Groups in one region (Saguenay-Lac-Saint-Jean) of Quebec, Canada.

Participants

Ten managers (including two family physicians) and 19 healthcare professionals (HCPs), nurses, kinesiologists, nutritionists and a respiratory therapist, were interviewed.

Results

Many key elements within the five CFIR domains were identified as impacting the implementation of the intervention : (1) intervention characteristics—evidence strength and quality, design quality and packaging, relative advantage and complexity; (2) outer setting—patients’ needs and resources, external policies and incentives; (3) inner setting—structural characteristics, networks and communication, culture, compatibility, readiness for implementation and leadership engagement; (4) characteristics of the managers and HCPs—knowledge and belief about the intervention; (5) process—planning, opinion leaders, formally appointed internal implementation leaders, reflecting and evaluating.

Conclusion

This study revealed the organisational and contextual aspects of the implementation based on different and complementary perspectives. With the growing demand for interdisciplinary teams in primary care, we believe that our insights will be helpful for practices, researchers, and policymakers interested in the implementation of disease prevention and management programmes for people with multiple chronic conditions in primary care.

Trial registration number

NCT02789800.
Prehospital major incident management: how do training and real-life situations relate? A qualitative study
Authors: Hugelius Karin , Edelbring Samuel , Blomberg Karin
Published: September 2021

Objective

To explore the relationship between preparations and real-life experiences among prehospital major incident commanders.

Design

An explorative, qualitative design was used.

Setting

Prehospital major incidents in Sweden. Data were collected between December 2019 and August 2020.

Participants

Prehospital major incident commanders (n=15) with real-life experiences from major events, such as fires, bus accidents, a bridge collapse and terrorist attacks, were included. All but one had participated in 2-day training focusing on the prehospital management of major incidents. In addition, about half of the participants had participated in simulation exercises, academic courses and other training in the management of major incidents.

Methods

Data from two-session individual interviews were analysed using inductive thematic analysis.

Results

The conformity between real-life major incidents and preparations was good regarding prehospital major incident commanders’ knowledge of the operational procedures applied in major incidents. However, the preparations did not allow for the complexities and endurance strategies required in real-life incidents. Personal preparations, such as mental preparedness or stress management, were not sufficiently covered in the preparations. To some extent, professional experience (such as training) could compensate for the lack of formal preparations.

Conclusions

This study identified perceived gaps between preparations and real-life experiences of being a prehospital major incident commander. To minimise the gaps between demands and expectations on perceived control and to better prepare individuals for being prehospital major incident commanders, the training and other preparations should reflect complexities of real-life incidents. Preparations should develop both technical skills required, such as principles and methodology used, and personal preparedness. Personal preparations should include improving one’s mental preparedness, self-knowledge and professional self-confidence required to successfully act as a prehospital incident commander. Since little is known about what pedagogical methods that should be used to enhance this, further research is needed.
Preferences for pre-exposure prophylaxis (PrEP) among men who have sex with men and transgender women at risk of HIV infection: a multicentre protocol for a discrete choice experiment in Brazil
Authors: Pereira Claudia Cristina de Aguiar , Torres Thiago Silva , Luz Paula Mendes , Hoagland Brenda , Farias Alessandro , Brito Jose David Urbaez , Guimarães Lacerda Marcus Vinícius , da Silva Daila Alena Raenck , Benedetti Marcos , Pimenta Maria Cristina , Grinsztejn Beatriz , Veloso Valdilea Gonçalves
Published: September 2021

Introduction

Pre-exposure prophylaxis (PrEP) is an important and well-established prevention strategy for sexual acquisition of HIV. In Brazil, transgender women (TGW) and men who have sex with men (MSM) bear the largest burden among key populations. Little is known about preferences for PrEP characteristics in these vulnerable populations in Latin America. The goal of this study is to investigate preferences of TGW and MSM with respect to PrEP characteristics, whether current user or not, and to assess any attributes and levels that may improve the decision to start using PrEP (uptake) and optimal continuity of use (adherence), which are important dimensions for PrEP success.

Methods and analysis

We hereby outline the protocol of a discrete choice experiment (DCE) to be conducted among TGW and MSM in Brazil. The study will be carried out in two phases. The first phase involves literature review and qualitative approaches including in-depth interviews to inform the development of the DCE (attributes and levels). The second phase entails the DCE survey and supporting questions pertaining to sociodemographic and risk behaviour information. The survey is aimed at current PrEP users and non-users, consisting of two modes of administration: face to face in five Brazilian capitals (Rio de Janeiro, Brasília, Manaus, Porto Alegre and Salvador) and online targeting the entire country. A D-efficient zero-prior blocked experimental design will be used to select 60 paired-profile DCE choice tasks, in which participants will be randomly assigned to one of four groups and presented with a set of 15 choice tasks. The planned sample size is 1000 volunteers.

Ethics, timeline and dissemination

The study was approved by Comitê de Ética em Pesquisa—Instituto Nacional de Infectologia Evandro Chagas—INI/FIOCRUZ, CEP/INI, CAAE 28416220.2.1001.5262, approval number 3.979.759 in accordance with the Comissão Nacional de Ética em Pesquisa (CONEP—Brazilian National Board of Research Ethics). The study will be conducted between 2020 and 2021. The results will be disseminated to the scientific community and to the public in general through publications in published in peer-reviewed journals and in scientific conferences.
Temocillin versus meropenem for the targeted treatment of bacteraemia due to third-generation cephalosporin-resistantEnterobacterales(ASTARTÉ): protocol for a randomised, pragmatic trial
Authors: Marín-Candón Alicia , Rosso-Fernández Clara M , Bustos de Godoy Natalia , López-Cerero Lorena , Gutiérrez-Gutiérrez Belén , López-Cortés Luis Eduardo , Barrera Pulido Lydia , Borreguero Borreguero Irene , León María José , Merino Vicente , Camean-Fernández Manuel , Retamar Pilar , Salamanca Elena , Pascual Alvaro , Rodriguez-Baño Jesús
Published: September 2021

Introduction

Alternatives to carbapenems are needed in the treatment of third-generation cephalosporin-resistantEnterobacterales(3GCR-E). Temocillin is a suitable candidate, but comparative randomised studies are lacking. The objective is to investigate if temocillin is non-inferior to carbapenems in the targeted treatment of bacteraemia due to 3GCR-E.

Methods and analysis

Multicentre, open-label, randomised, controlled, pragmatic phase 3 trial. Patients with bacteraemia due to 3GCR-E will be randomised to receive intravenously temocillin (2 g three times a day) or carbapenem (meropenem 1 g three times a day or ertapenem 1 g once daily). The primary endpoint will be clinical success 7–10 days after end of treatment with no recurrence or death at day 28. Adverse events will be collected; serum levels of temocillin will be investigated in a subset of patients. For a 10% non-inferiority margin, 334 patients will be included (167 in each study arm). For the primary analysis, the absolute difference with one-sided 95% CI in the proportion of patients reaching the primary endpoint will be compared in the modified intention-to-treat population.

Ethics and dissemination

The study started after approval of the Spanish Regulatory Agency and the reference institutional review board. Data will be published in peer-reviewed journals.

Trial registration number

NCT04478721.
Assessing knowledge, attitude, practice and training related to COVID-19: a cross-sectional survey of frontline healthcare workers in Nigeria
Authors: Iheanacho Theddeus , Stefanovics Elina , Okoro Ugochi Genevieve , Anyaehie Udo Ego , Njoku Paschal Okuchi , Adimekwe Anthony Ikenna , Ibediro Kingsley , Stefanovics Glenn A , Haeny Angela , Jackson Asti , Unamba Norbert Ndubuisi , Isiguzo Godsent , Chukwu Chinedu Chukwukiro , Anyaehie Ugochukwu Bond , Mbam Thomas Terence , Osy-Eneze Chinyere , Ibezim Ebere Otuomasirichi
Published: September 2021

Objectives

Healthcare workers (HCWs) are at the frontline of efforts to treat those affected by COVID-19 and prevent its continued spread. This study seeks to assess knowledge, attitude and practice (KAP) as well as training needs and preferences related to COVID-19 among frontline HCWs in Nigeria.

Setting

A cross-sectional survey was carried out among 1852 HCWs in primary, secondary and tertiary care settings across Nigeria using a 33-item questionnaire.

Participants

Respondents included doctors, nurses, pharmacy and clinical laboratory professionals who have direct clinical contact with patients at the various healthcare settings.

Analysis

Exploratory factor analysis (EFA) was used to establish independent factors related to COVID-19 KAP. Analysis of variance was used to identify any differences in the factors among different categories of HCWs.

Results

EFA identified four factors: safety and prevention (factor 1), practice and knowledge (factor 2), control and mitigation (factor 3) and national perceptions (factor 4). Significant group differences were found on three factors: Factor 1 (F(1,1655)=5.79, p=0.0006), factor 3 (F(1,1633)=12.9, p<0.0.0001) and factor 4 (F(1,1655)=7.31, p<0.0001) with doctors scoring higher on these three factors when compared with nurses, pharmaceutical workers and medical laboratory scientist. The most endorsed training need was how to reorganise the workplace to prevent spread of COVID-19. This was chosen by 61.8% of medical laboratory professionals, 55.6% of doctors, 51.7% of nurses and 51.6% of pharmaceutical health workers. The most preferred modes of training were webinars and conferences.

Conclusion

There were substantial differences in KAP regarding the COVID-19 pandemic among various categories of frontline HCWs surveyed. There were also group differences on COVID-19 training needs and preferences. Tailored health education and training aimed at enhancing and updating COVID-19 KAP are needed, particularly among non-physician HCWs.
Assessment of time-related deficits in older adults: a scoping review protocol
Authors: Dsouza Sebestina Anita , Ramachandran Meena , Nishiura Yuko , Venkatesh Bhumika Tumkur , Dahlberg Lena
Published: September 2021

Introduction

People with cognitive impairments often have difficulties in managing their time for daily activities. In older adults with cognitive impairments such as dementia and stroke, these may present as disorientation, poor time awareness, time perception, daily time management and so on. Time-related deficits and associated behaviours impede independent living and add considerably to caregiver strain. Several interventions are being investigated to help people with cognitive impairments orient and navigate time and do their daily activities. The provision of interventions requires the use of sound assessment tools. However, it is not clear how time-related concepts are specifically evaluated in practice, what are the available assessments and how these assessments should be selected.

Method and analysis

This protocol follows the Joanna Briggs Institute Reviewer’s Manual (2020) for scoping reviews and is registered with the Open Science Framework (https://osf.io/4ptgy/). We will include the following databases: PubMed, CINAHL, Scopus, Web of Science and PsycINFO. Two reviewers will independently screen eligible studies for inclusion against the selection criteria and then review the full-text of the selected studies. We will extract the bibliographic data, study design and setting, and details of assessments used in the studies to evaluate time-related concepts including format, mode and duration of administration, psychometric properties and so on. The identified assessments will be mapped with regard to time-related concepts being evaluated and described using narrative synthesis.

Ethics and dissemination

As secondary data analysis, ethics approval is not required for this scoping review. We plan to disseminate the results through peer-reviewed journals and conferences targeting health professionals working with older adults.
Predicting muscle loss during lung cancer treatment (PREDICT): protocol for a mixed methods prospective study
Authors: Kiss Nicole K , Denehy Linda , Edbrooke Lara , Prado Carla M , Ball David , Siva Shankar , Abbott Gavin , Ugalde Anna , Fraser Steve F , Everitt Sarah , Hardcastle Nicholas , Wirth Andrew , Daly Robin M
Published: September 2021

Introduction

Low muscle mass and low muscle attenuation (radiodensity), reflecting increased muscle adiposity, are prevalent muscle abnormalities in people with lung cancer receiving curative intent chemoradiation therapy (CRT) or radiation therapy (RT). Currently, there is a limited understanding of the magnitude, determinants and clinical significance of these muscle abnormalities in the lung cancer CRT/RT population. The primary objective of this study is to identify the predictors of muscle abnormalities (low muscle mass and muscle attenuation) and their depletion over time in people with lung cancer receiving CRT/RT. Secondary objectives are to assess the magnitude of change in these parameters and their association with health-related quality of life, treatment completion, toxicities and survival.

Methods and analysis

Patients diagnosed with lung cancer and planned for treatment with CRT/RT are invited to participate in this prospective observational study, with a target of 120 participants. The impact and predictors of muscle abnormalities (assessed via CT at the third lumbar vertebra) prior to and 2 months post CRT/RT on the severity of treatment toxicities, treatment completion and survival will be assessed by examining the following variables: demographic and clinical factors, weight loss, malnutrition, muscle strength, physical performance, energy and protein intake, physical activity and sedentary time, risk of sarcopenia (Strength, Assistance in walking, Rise from a chair, Climb stairs, Falls history (SARC-F) score alone and with calf-circumference) and systemic inflammation. A sample of purposively selected participants with muscle abnormalities will be invited to take part in semistructured interviews to understand their ability to cope with treatment and explore preference for treatment strategies focused on nutrition and exercise.

Ethics and dissemination

The PREDICT study received ethics approval from the Human Research Ethics Committee at Peter MacCallum Cancer Centre (HREC/53147/PMCC-2019) and Deakin University (2019-320). Findings will be disseminated through peer review publications and conference presentations.
Public acceptability of the UK Soft Drinks Industry Levy: repeat cross-sectional analysis of the International Food Policy Study (2017–2019)
Authors: Adams Jean , Pell David , Penney Tarra L , Hammond David , Vanderlee Lana , White Martin
Published: September 2021

Objectives

To determine whether public acceptability, in terms of both support for and perceived effectiveness of, the UK Soft Drinks Industry Levy (SDIL) changed between 4 months prior to, and 8 and 20 months after, implementation.

Design

Repeat cross-sectional online survey.

Setting

The UK.

Participants

UK respondents to the International Food Policy Study aged 18–64 years who provided information on all variables of interest in November–December 2017 (4 months prior to SDIL implementation), 2018 (8 months after) or 2019 (20 months after; n=10 284).

Outcome measures

Self-reported support for, and perceived effectiveness of, the SDIL.

Results

The adjusted logistic regression model predicted that 70% (95% CI: 68% to 72%) of participants supported the SDIL in 2017, 68% (95% CI: 67% to 70%) in 2018 and 68% (95% CI: 66% to 70%) in 2019. There was no evidence of a difference in support in 2018 vs 2017 (OR: 0.93; 95% CI: 0.81 to 1.05); or in 2019 vs 2017 (OR: 0.90; 95% CI: 0.78 to 1.03). The adjusted logistic regression model predicted that 72% (95% CI: 70% to 74%) of participants perceived the SDIL to be effective in 2017, 67% (95% CI: 65% to 69%) in 2018 and 67% (95% CI: 64% to 69%) in 2019. There was evidence that perceived effectiveness decreased a small amount in 2018 vs 2017 (OR: 0.78; 95% CI: 0.69 to 0.88). The difference in 2019 vs 2017 was similar.

Conclusions

We found high support for the SDIL among UK adults and this did not change between 4 months before implementation and 8 or 20 months after. While perceived effectiveness remained high, there was evidence that this decreased slightly after implementation in 2018, but no further in 2019. Greater understanding of influences on public acceptability of effective structural public health interventions is required.
Cross-sectional assessment of tuberculosis and HIV prevalence in 13 correctional facilities in Zambia
Authors: Kagujje Mary , Somwe Paul , Hatwiinda Sisa , Bwalya Joel , Zgambo Tamala , Thornicroft Moomba , Bozzani Fiammetta Maria , Moonga Clement , Muyoyeta Monde
Published: September 2021

Objective

To determine the prevalence of tuberculosis (TB) and HIV in 13 Zambian correctional facilities.

Methods

Cross-sectional study.

Setting

13 correctional facilities in seven of the 10 provinces in Zambia.

Participants

All incarcerated individuals were eligible for TB and HIV screening and testing. Of the total study population of 9695 individuals, which represent 46.2% of total correctional population at the beginning of the study, 8267 and 8160 were screened for TB and HIV, respectively.

Interventions

TB and HIV screening and testing was done between July 2018 and February 2019.

Primary outcome measures

All forms of TB, bacteriologically confirmed TB, drug-resistant TB, HIV.

Results

Prevalence of all forms of TB and bacteriologically confirmed TB was 1599 (1340–1894) per 100 000 population and 1056 (847–1301) per 100 000 population, respectively. Among those with bacteriologically confirmed TB, 4.6% (1.3%–11.4%) had drug-resistant TB.

There was no statistically significant difference in the prevalence of all forms of TB, bacteriologically confirmed TB and drug resistant TB between adults and juveniles: (p=0.82), (p=0.23), (p=0.68) respectively. Of the bacteriologically confirmed TB cases, 28.7% were asymptomatic. The prevalence of HIV was 14.3% (13.6%–15.1%). The prevalence of HIV among females was 1.8 times the prevalence of HIV among males (p=0.01).

Conclusion

Compared with the study in 2011 which screened inmates representing 30% of the country’s inmate population, then the prevalence of all forms of TB and HIV in correctional facilities has reduced by about 75% and 37.6%, respectively. However, compared with the general population, the prevalence of all forms of TB and HIV was 3.5 and 1.3 times higher, respectively. TB/HIV programmes in correctional facilities need further strengthening to include aspects of juvenile-specific TB programming and gender responsive HIV programming.
Music and dance in respiratory disease management in Uganda: a qualitative study of patient and healthcare professional perspectives
Authors: Philip Keir EJ , Cartwright Lucy L , Westlake Debra , Nyakoojo Grace , Kimuli Ivan , Kirenga Bruce , Brakema Evelyn A , Orme Mark W , Fancourt Daisy , Hopkinson Nicholas S , Jones Rupert , Katagira Winceslaus
Published: September 2021

Introduction

Music and dance are increasingly used as adjunctive arts-in-health interventions in high-income settings, with a growing body of research suggesting biopsychosocial benefits. Such low-cost, low-resource interventions may have application in low-resource settings such as Uganda. However, research on perceptions of patients and healthcare professionals regarding such approaches is lacking.

Methods

We delivered sample sessions of music and dance for chronic respiratory disease (CRD) to patients and healthcare professionals. Seven participants took part in one singing and dance sample session. One patient completed only the dance session. We then conducted an exploratory qualitative study using thematic analysis of semistructured interviews with healthcare professionals and patients regarding (1) the role of music and dance in Ugandan life and (2) the perceived acceptability and feasibility of using music and dance in CRD management in Uganda.

Results

We interviewed 19 participants, made up of 11 patients with long-term respiratory conditions and 8 healthcare professionals, who were selected by purposeful convenience sampling. Four key themes were identified from interview analysis: music and dance (1) were central components of daily life; (2) had an established role supporting health and well-being; and (3) had strong therapeutic potential in respiratory disease management. The fourth theme was (4) the importance of modulating demographic considerations of culture, religion and age.

Conclusion

Music and dance are central to life in Uganda, with established roles supporting health and well-being. These roles could be built on in the development of music and dance interventions as adjuncts to established components of CRD disease management like pulmonary rehabilitation. Through consideration of key contextual factors and codevelopment and adaptation of interventions, such approaches are likely to be well received.
Implementation and use of mHealth home telemonitoring in adults with acute COVID-19 infection: a scoping review protocol
Authors: Dauletbaev Nurlan , Kuhn Sebastian , Holtz Svea , Waldmann Susanne , Niekrenz Lukas , Müller Beate S , Bellinghausen Carla , Dreher Michael , Rohde Gernot G U , Vogelmeier Claus
Published: September 2021

Introduction

mHealth refers to digital technologies that, via smartphones, mobile apps and specialised digital sensors, yield real-time assessments of patient’s health status. In the context of the COVID-19 pandemic, these technologies enable remote patient monitoring, with the benefit of timely recognition of disease progression to convalescence, deterioration or postacute sequelae. This should enable appropriate medical interventions and facilitate recovery. Various barriers, both at patient and technology levels, have been reported, hindering implementation and use of mHealth telemonitoring. As systematised and synthesised evidence in this area is lacking, we developed this protocol for a scoping review on mHealth home telemonitoring of acute COVID-19.

Methods and analysis

We compiled a search strategy following the PICO (Population, Intervention, Comparator, Outcome) and PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendation for Scoping Reviews) guidelines. MEDLINE, Embase and Web of Science will be searched from 1 March 2020 to 31 August 2021. Following the title and abstract screening, we will identify, systematise and synthesise the available knowledge. Based on pilot searches, we preview three themes for descriptive evidence synthesis. The first theme relates to implementation and use of mHealth telemonitoring, including reported barriers. The second theme covers the interactions of the telemonitoring team within and between different levels of the healthcare system. The third theme addresses how this telemonitoring warrants the continuity of care, also during disease transition into deterioration or postacute sequelae.

Ethics and dissemination

The studied evidence is in the public domain, therefore, no specific ethics approval is required. Evidence dissemination will be via peer-reviewed publications, conference presentations and reports to the policy makers.
Informed consent in cluster randomised trials: a guide for the perplexed
Authors: Nix Hayden P , Weijer Charles , Brehaut Jamie C , Forster David , Goldstein Cory E , Taljaard Monica
Published: September 2021

In a cluster randomised trial (CRT), intact groups—such as communities, clinics or schools—are randomised to the study intervention or control conditions. The issue of informed consent in CRTs has been particularly challenging for researchers and research ethics committees. Some argue that cluster randomisation is a reason not to seek informed consent from research participants. In fact, systematic reviews have found that, relative to individually randomised trials, CRTs are associated with an increased likelihood of inadequate reporting of consent procedures and inappropriate use of waivers of consent. The objective of this paper is to clarify this confusion by providing a practical and useful framework to guide researchers and research ethics committees through consent issues in CRTs. In CRTs, it is the unit of intervention—not the unit of randomisation—that drives informed consent issues. We explicate a three-step framework for thinking through informed consent in CRTs: (1) identify research participants, (2) identify the study element(s) to which research participants are exposed, and (3) determine if a waiver of consent is appropriate for each study element. We then apply our framework to examples of CRTs of cluster-level, professional-level and individual-level interventions, and provide key lessons on informed consent for each type of CRT.
Associations of statin adherence and lipid targets with adverse outcomes in myocardial infarction survivors: a retrospective cohort study
Authors: Brown Rosemary , Lewsey Jim , Wild Sarah , Logue Jennifer , Welsh Paul
Published: September 2021

Objectives

To examine associations between statin adherence and lipid target achievement in myocardial infarction (MI) survivors, and their associations with mortality and recurrent MIs.

Design

Retrospective cohort study using linked clinical records within the National Health Service Greater Glasgow and Clyde (NHS GGC) Data Safe Haven.

Setting

Routine clinical practice in the NHS GGC area between January 2009 and July 2017.

Participants

Patients ≥18 years who experienced a non-fatal MI hospital admission (ICD10: I21, I22) between January 2009 and July 2014 (n=11 031), followed up from the date of MI admission until July 2017 or death, whichever occurred first.

Primary and secondary outcome measures

Statin adherence was estimated using encashed prescriptions and lipid results from routine biochemistry data. Primary lipid and statin adherence targets were LDL ≤1.8 mmol/L and adherence ≥50%, and were related to all-cause death, deaths due to cardiovascular disease (CVD) (ICD10: I00–I99 as the underlying cause), and recurrent MI in unadjusted models and models adjusting for age, sex, socioeconomic deprivation and year of MI.

Results

Over 4.5 years follow-up, 76% achieved LDL ≤1.8 mmol/L, and 84.5% had average adherence ≥50%. Patients with adherence <50% had an increased risk of not meeting LDL ≤1.8 mmol/L, in adjusted models (OR 2.03, 95% CI 1.78 to 2.31, p<0.0001). In univariable models, not meeting LDL ≤1.8 mmol/L was associated with increased risks of all-cause mortality (HR 1.27, 95% CI 1.16 to 1.39, p<0.0001) and CVD mortality (HR 1.29, 95% CI 1.11 to 1.51, p=0.0013). Adherence <50% was associated with increased risks of all-cause mortality (HR 1.58, 95% CI 1.44 to 1.74, p<0.0001) and CVD mortality (HR 1.60, 95% CI 1.36 to 1.88, p<0.0001). Adjustment for confounders did not abrogate these associations. Neither exposure was associated with recurrent MIs.

Conclusions

Non-achievement of lipid and adherence targets are associated with increased risks of all-cause and CVD mortality. Further work is required to optimise their use to improve outcomes in clinical practice.
Evaluating the efficacy of intranasal oxytocin on pain and function among individuals who experience chronic pain: a protocol for a multisite, placebo-controlled, blinded, sequential, within-subjects crossover trial
Authors: Rash Joshua A. , Campbell Tavis S. , Cooper Lynn , Flusk David , MacInnes Aaron , Nasr-Esfahani Maryam , Mekhael Anastasia A. , Poulin Patricia A. , Robert Magali , Yi Yanqing
Published: September 2021

Introduction

Current treatments for chronic pain (eg, opioids) can have adverse side effects and rarely result in resolution of pain. As such, there is a need for adjuvant analgesics that are non-addictive, have few adverse side effects and are effective for pain management across several chronic pain conditions. Oxytocin is a naturally occurring hormone that has gained attention for its potential analgesic properties. The objective of this trial is to evaluate the efficacy of intranasal oxytocin on pain and function among adults with chronic pain.

Methods and analysis

This is a placebo-controlled, triple-blind, sequential, within-subject crossover trial. Adults with chronic neuropathic, pelvic and musculoskeletal pain will be recruited from three Canadian provinces (British Columbia, Alberta and Newfoundland and Labrador, respectively). Enrolled patients will provide one saliva sample pretreatment to evaluate basal oxytocin levels and polymorphisms of the oxytocin receptor gene before being randomised to one of two trial arms. Patients will self-administer three different oxytocin nasal sprays twice daily for a period of 2 weeks (ie, 24 IU, 48 IU and placebo). Patients will complete daily diaries, including standardised measures on day 1, day 7 and day 14. Primary outcomes include pain and pain-related interference. Secondary outcomes include emotional function, sleep disturbance and global impression of change. Intention-to-treat analyses will be performed to evaluate whether improvement in pain and physical function will be observed posttreatment.

Ethics and dissemination

Trial protocols were approved by the Newfoundland and Labrador Health Research Ethics Board (HREB #20227), University of British Columbia Clinical Research Ethics Board (CREB #H20-00729), University of Calgary Conjoint Health Research Ethics Board (REB20 #0359) and Health Canada (Control # 252780). Results will be disseminated through publication in peer-reviewed journals and presentations at scientific conferences.

Trial registration number

NCT04903002; Pre-results.
Asthma, rhinitis and eczema symptoms in Quito, Ecuador: a comparative cross-sectional study 16 years after ISAAC
Authors: Cabrera Angelita , Picado Cesar , Rodriguez Alejandro , Garcia-Marcos Luis
Published: September 2021

Background

In 2003, the International Study of Asthma and Allergies in Childhood (ISAAC) estimated the prevalence of asthma, rhinitis and eczema symptoms in Quito, Ecuador. Since then, no update of this study has been done in the last years. This study examined changes in the prevalence of asthma–rhinitis–eczema symptoms over a 16 years period in Quito and explored possible risk factors.

Methods

We conducted a comparative cross-sectional study in an adolescent population following the Global Asthma Network (GAN) methodology. A written questionnaire was used to explore symptoms of asthma–rhinitis–eczema. We calculated the prevalence and 95% CIs for each of the symptoms and compared them with the ISAAC results. We conducted bivariate and multivariate analysis using logistic regression to identify possible risk factors for recent wheeze, rhinitis and eczema.

Results

A total of 2380 adolescents aged between 13 and 14 years were evaluated. The prevalence of doctor diagnosis for asthma, rhinitis and eczema was 3.4%, 8.5% and 2.2%, respectively. Compared with ISAAC results, we found a lower prevalence of wheeze and eczema symptoms: wheeze ever (37.6% vs 12.7%), recent wheeze (17.8% vs 6.5%), asthma ever (6.9% vs 4.6%), recent rush (22.4% vs 13.9%) and eczema ever (11.7% vs 3.6%). The prevalence of rhinitis symptoms in the GAN study was higher than the ISAAC results: nose symptoms in the past 12 months (36.6% vs 45.8%) and nose and eye symptoms in the past 12 months (23.1% vs 27.9). Significant associations were observed between symptoms of asthma–rhinitis–eczema and sex, race/ethnicity, smoking habit, physical exercise and sedentary activities.

Conclusions

In the last two decades, the prevalence of asthma and eczema symptoms in adolescent population in the city of Quito has significantly declined; however, the prevalence of rhinitis symptoms has increased. The reduction in asthma symptoms could be related to better managing the disease and changes in local environmental risk factors in the last years. Further studies must be conducted in the country to evaluate the change in trends in asthma and other related allergic diseases.
‘I JUST WANT TO RUN’: how recreational runners perceive and deal with injuries
Authors: Verhagen Evert , Warsen Marit , Silveira Bolling Caroline
Published: September 2021

Running injuries impact the health gains achieved through running and are linked to drop-out from this otherwise healthy activity. The need for effective prevention is apparent, however, implementation of preventive measures implies a change in runners’ behaviour. This exploratory qualitative study aimed to explore Dutch recreational runners’ perception on injuries, injury occurrence and prevention. An interpretative paradigm underpins this study. We conducted 12 individual semistructured interviews with male (n=6) and female runners (n=6). Through a constant comparative data analysis, we developed a conceptual model to illustrate the final product of the analysis and represent the main themes’ connection. We present a framework that describes the pathway from load to injury and the self-regulatory process controlling this pathway. Runners mentioned that pain is not necessarily an injury, and they usually continue running. Once complaints become unmanageable and limit the runner’s ability to participate, an injury was perceived. Based on our outcomes, we recommend that preventive strategies focus on the self-regulation by which runners manage their complaints and injuries—providing information, advice and programmes that support the runner to make well-informed, effective decisions.
Migraine: beyond pain
Authors: Karsan Nazia , Goadsby Peter J
Published: September 2021

Most people who see, treat or experience migraine will be aware that its clinical manifestations exceed the symptom of head pain. However, available acute treatments so far have targeted migraine symptoms only in the context of the pain phase of an attack. The associated disability clearly involves more than just these symptoms, and the phenotype can include additional painless features, including alterations in mood, cognition and homeostasis and sensory sensitivities. Recognising these symptoms, understanding their neurobiological basis and systematically recording them prospectively in clinical therapeutic trials are likely to offer valuable pathophysiological and therapeutic insights into this complex brain disorder, ultimately helping to improve the quality of lives of sufferers. We aim to explore the multifaceted disorder that is migraine, with a particular focus on the non-painful non-aura symptoms.
Downregulation of acylglycerol kinase suppresses high-glucose-induced endothelial-mesenchymal transition in human retinal microvascular endothelial cells through regulating the LPAR1/TGF-β/Notch signaling pathway
Authors: Wang Haijing , Feng Zhuolei , Han Xue , Xing Yue , Zhang Xiaomei
Published: September 2021

The endothelial-mesenchymal transition (EndMT) participates in the progression of diabetic retinopathy (DR), but cell-intrinsic factors modulating this process remain elusive. In this study, we explored the role of lysophosphatidic acid (LPA) – producing enzyme, acylglycerol kinase (AGK), in the EndMT of human retinal microvascular endothelial cells (HRECs) under high-glucose (HG) conditions. We found that AGK was significantly elevated in HG-treated cells. In addition, AGK knockdown reversed the HG-induced EndMT in HRECs, which was evidenced by the increased endothelial markers (CD31 and VE-cadherin) and decreased mesenchymal markers (FSP1 and α-SMA). Furthermore, downregulation of AGK inhibited the HG-induced activation of transforming growth factor β (TGF-β)/Notch pathways, whereas exogenous TGF-β1 (10 ng/mL) impeded the inhibitory effects of AGK knockdown on HG-induced EndMT in HRECs. Additionally, the silencing of AGK abolished the HG-induced upregulation of LPA and its receptor, LPA receptor 1 (LPAR1), and overexpression of LPAR1 further rescued the AGK knockdown-mediated inhibition of the EndMT process. In conclusion, we demonstrate that downregulation of AGK suppresses HG-induced EndMT in HRECs through regulating the LPAR1/TGF-β/Notch signaling pathway, indicating that AGK might be a potential therapeutic target for the treatment of DR.
Baryon number in proton-proton and proton-nucleus high energy collisions
Authors: Jeżabek Marek , Rybicki Andrzej
Published: September 2021

New analyses of baryon spectra in proton-proton and proton-carbon collisions at $$\sqrt{s}_\mathrm {_{NN}}=17.3$$

s

NN

=
17.3

GeV, made in the framework of two phenomenological models are presented. The first model in question is the classic Dual Parton Model by Capella and Tran Thanh Van, the second is the Gluon Exchange Model very recently proposed by the authors. For both studies, the usage of modern experimental data from the CERN SPS eliminates several of the most important limitations inherent to earlier studies of this type. In both studies, the standard mechanism of baryon stopping with preservation of the diquark, proposed by Capella and Tran Thanh Van fails to describe the distribution of non-strange baryons in collisions of the projectile proton with more than one nucleon from the carbon target obtained from experimental data, and the upper limit for the contribution of this mechanism can be established. In both cases, the conclusion is that the projectile diquark must be very often disintegrated. This opens new diagrams not available in proton-proton collisions which lead to the transport of baryon number over long distances in rapidity. The present limitations, and possibility of improvement in both approaches are discussed. The implications of our findings for new measurements are addressed, in particular using antiproton beams.
A Novel Feasibility Test for Energy Minimization of Real-Time Mixed Task Sets for DVS-Enabled Uniprocessor System
Authors: Manohara H. T. , Harish B. P.
Published: September 2021

With advancements in computing and communication technologies on mobile devices, the performance requirements of embedded processors have significantly increased, resulting in a corresponding increase in its energy consumption. Dynamic scaling of operating voltage and operating frequency has a strong correlation to energy minimization in CMOS real-time circuits. Simultaneous optimization of ([Formula: see text], [Formula: see text] pairs under dynamic activity levels is thus extensively investigated over several years. The supply voltage is tuned dynamically during runtime (DVS), with a fixed threshold voltage, to achieve energy minimization. This work addresses the issue of maximizing the energy efficiency of real-time periodic, aperiodic and mixed task sets, in a uniprocessor system, by developing a novel task feasibility methodology, with a novel processor performance-based constraint, to generate the optimal operating supply voltage to the individual task of task sets. The energy minimization of real-time mixed task sets is formulated as Geometric Programming (GP) problem, by varying frequency for periodic tasks sets and keeping fixed frequency for aperiodic tasks set, over a range of task sets and hence computing optimal operating voltages. Simulation experiments show energy savings on the cumulative basis of 50%, 38% and 29% for periodic, aperiodic and mixed task sets, respectively, based on the processing timing constraints of task sets.
Stochastic Bifurcations of a Fractional-Order Vibro-Impact Oscillator Subjected to Colored Noise Excitation
Authors: Sun Ya-Hui , Yang Yong-Ge , Hong Ling , Xu Wei
Published: September 2021

A stochastic vibro-impact system has triggered a consistent body of research work aimed at understanding its complex dynamics involving noise and nonsmoothness. Among these works, most focus is on integer-order systems with Gaussian white noise. There is no report yet on response analysis for fractional-order vibro-impact systems subject to colored noise, which is presented in this paper. The biggest challenge for analyzing such systems is how to deal with the fractional derivative of absolute value functions after applying nonsmooth transformation. This problem is solved by introducing the Fourier transformation and deriving the approximate probabilistic solution of the fractional-order vibro-impact oscillator subject to colored noise. The reliability of the developed technique is assessed by numerical solutions. Based on the theoretical result, we also present the critical conditions of stochastic bifurcation induced by system parameters and show bifurcation diagrams in two-parameter planes. In addition, we provide a stochastic bifurcation with respect to joint probability density functions. We find that fractional order, coefficient of restitution factor and correlation time of colored noise excitation can induce stochastic bifurcations.
Global Bifurcation of Periodic Solutions in Symmetric Reversible Second Order Systems with Delays
Authors: Balanov Zalman , Burnett Joseph , Krawcewicz Wiesław , Xiao Huafeng
Published: September 2021

Global bifurcation and spatio-temporal patterns of periodic solutions (with prescribed period) to second order reversible equivariant autonomous systems with commensurate delays are studied using the Brouwer/Leray–Schauder [Formula: see text]-equivariant degree theory. Here, [Formula: see text] is related to the reversal symmetry combined with the autonomous form of the system, [Formula: see text] reflects extra spacial symmetries of the system, and [Formula: see text] is related to the oddness of the right-hand side. Abstract results are supported by a concrete example with [Formula: see text] — the dihedral group of order 12.
Parametric Frequency Analysis of Mathieu–Duffing Equation
Authors: Azimi Mohsen
Published: September 2021

The classic linear Mathieu equation is one of the archetypical differential equations which has been studied frequently by employing different analytical and numerical methods. The Mathieu equation with cubic nonlinear term, also known as Mathieu–Duffing equation, is one of the many extensions of the classic Mathieu equation. Nonlinear characteristics of such equation have been investigated in many papers. Specifically, the method of multiple scale has been used to demonstrate the pitchfork bifurcation associated with stability change around the first unstable tongue and Lie transform has been used to demonstrate the subharmonic bifurcation for relatively small values of the undamped natural frequency. In these works, the resulting bifurcation diagram is represented in the parameter space of the undamped natural frequency where a constant value is allocated to the parametric frequency. Alternatively, this paper demonstrates how the Poincaré–Lindstedt method can be used to formulate pitchfork bifurcation around the first unstable tongue. Further, it is shown how higher order terms can be included in the perturbation analysis to formulate pitchfork bifurcation around the second tongue, and also subharmonic bifurcations for relatively high values of parametric frequency. This approach enables us to demonstrate the resulting global bifurcation diagram in the parameter space of parametric frequency, which is beneficial in the bifurcation analysis of systems with constant undamped natural frequency, when the frequency of the parametric force can vary. Finally, the analytical approximations are verified by employing the numerical integration along with Poincaré map and phase portraits.
Image De-Speckling Based on the Coefficient of Variation, Improved Guided Filter, and Fast Bilateral Filter
Authors: Salehi Hadi
Published: September 2021

Images are widely used in engineering. Unfortunately, medical ultrasound images and synthetic aperture radar (SAR) images are mainly degraded by an intrinsic noise called speckle. Therefore, de-speckling is a main pre-processing stage for degraded images. In this paper, first, an optimized adaptive Wiener filter (OAWF) is proposed. OAWF can be applied to the input image without the need for logarithmic transform. In addition its performance is improved. Next, the coefficient of variation (CV) is computed from the input image. With the help of CV, the guided filter converts to an improved guided filter (IGF). Next, the improved guided filter is applied on the image. Subsequently, the fast bilateral filter is applied on the image. The proposed filter has a better image detail preservation compared to some other standard methods. The experimental outcomes show that the proposed denoising algorithm is able to preserve image details and edges compared with other de-speckling methods.
Braided Frobenius algebras from certain Hopf algebras
Authors: Saito Masahico , Zappala Emanuele
Published: September 2021

A braided Frobenius algebra is a Frobenius algebra with a Yang–Baxter operator that commutes with the operations, that are related to diagrams of compact surfaces with boundary expressed as ribbon graphs. A heap is a ternary operation exemplified by a group with the operation [Formula: see text], that is ternary self-distributive. Hopf algebras can be endowed with the algebra version of the heap operation. Using this, we construct braided Frobenius algebras from a class of certain Hopf algebras that admit integrals and cointegrals. For these Hopf algebras we show that the heap operation induces a Yang–Baxter operator on the tensor product, which satisfies the required compatibility conditions. Diagrammatic methods are employed for proving commutativity between Yang–Baxter operators and Frobenius operations.