bluuebunny/crossref_metadata_2025 huggingface dataset:
Post‐operative colonic manometry in children with Hirschsprung disease: A systematic review
Authors: Evans‐Barns Hannah M. E. , Swannjo Justina , Trajanovska Misel , Safe Mark , Hutson John M. , Teague Warwick J. , Dinning Phil G. , King Sebastian K.
Published: July 2021

Background

A significant proportion of children experience bowel dysfunction (including constipation and fecal incontinence) following surgical repair of Hirschsprung disease (HD). Persistent symptoms are thought to relate to underlying colonic and/or anorectal dysmotility. Manometry may be used to investigate the gastrointestinal motility patterns of this population.

Purpose

To (1) evaluate the colonic manometry equipment and protocols used in the assessment of the post‐operative HD population and (2) summarize the available evidence regarding colonic motility patterns in children with HD following surgical repair.

Data Sources

We performed a systematic review of the Cochrane Library, Embase, MEDLINE, and PubMed databases (January 1, 1980 and March 9, 2020). Data were extracted independently by two authors.

Study Selection

This systematic review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA). Studies reporting the post‐operative assessment of children with HD using colonic manometry were considered for inclusion.

Results

Five studies satisfied selection criteria, providing a combined total of 496 children. Of these, 184 children with repaired HD underwent colonic manometry. Studies assessed heterogeneous populations, utilized variable manometry equipment and protocols, and reported limited baseline symptom characteristics, thus restricting comparability. All studies used low‐resolution colonic manometry.

Conclusions

This systematic review highlighted the paucity of evidence informing the understanding of colonic dysmotility in the post‐operative HD cohort. Current literature is limited by variable methodologies, heterogeneous cohorts, and the lack of high‐resolution manometry.
Left ventricular lead placement using inner guiding catheter alone in cardiac resynchronization therapy device implantation
Authors: Hayasaka Kazuto , Sasaki Takeshi , Akimoto Ko , Yabe Kento , Toya Chisashi , Yamashita Shu , Suzuki Masahito , Sugiyama Koji , Goya Masahiko , Sasano Tetsuo
Published: July 2021

Background

Subselection inner catheters (Inner‐Cath) are used adjunctively with outer guiding catheters (Outer‐Cath) during cardiac resynchronization therapy (CRT) device implantation. This study aims to investigate the feasibility and efficacy of left ventricular lead placement (LV‐LP) guided by Inner‐Cath alone.

Methods

A total of 74 patients undergoing de novo CRT implantation were investigated. LV‐LP was initially guided by Inner‐Cath in 42 patients (Inner‐Cath group) and Outer‐Cath in 32 patients (Outer‐Cath group). In the Inner‐Cath group, a 7Fr Inner‐Cath was advanced to the coronary sinus through a 7 Fr sheath inserted in a subclavian vein. In the Outer‐Cath group, 9Fr or 10Fr Outer‐Caths were used. Success rate of LV‐LP, additional use of inner or outer catheters and procedure‐related complications were compared between groups.

Results

LV‐LP was successful in all patients in the Inner‐Cath group, while LV‐LP had to be abandoned in two patients (6.3%) of the Outer‐Cath group due to CS perforation caused by Outer‐Cath manipulation. Procedure time was significantly shorter in the Inner‐Cath group (148 vs. 168 min; p = .024). Deployment of both an inner and outer cath became necessary less frequently for the Inner‐Cath group (4.8% vs. 56.3%; p < .001). Mechanical CS injuries due to guiding catheter manipulation were only observed in the Outer‐Cath group (0% vs. 15.6%, p = .013).

Conclusion

LV‐LP guided by Inner‐Cath alone was feasible in over 95% of the patients without severe complications. This methodology for LV‐LP may be preferable in CRT candidates with severe LV dysfunction in terms of shorter procedure time, smaller guiding sheath, and less procedure‐related complications.
An Appalachian population of neochoristoderes (Diapsida, Choristodera) elucidated using fossil evidence and ecological niche modelling
Authors: Dudgeon Thomas W. , Landry Zoe , Callahan Wayne R. , Mehling Carl M. , Ballwanz Steven
Published: July 2021

Four neochoristoderan vertebral centra are described from the latest Cretaceous of New Jersey, USA. One specimen was recovered from the basal transgressive lag of the Navesink Formation in the area of Holmdel, New Jersey, and two others were recovered nearby and probably were derived from the same horizon. The fourth was recovered from the Marshalltown sequence in the vicinity of the Ellisdale Dinosaur Site. These vertebrae expand the geographical range of Late Cretaceous neochoristoderes in North America by over 2000 km further east, and represent the first neochoristoderan remains from the Atlantic coastal plain. To discern whether neochoristodere remains are to be expected in New Jersey, and elucidate why neochoristoderes are apparently so rare in Appalachia, we implemented ecological niche modelling to predict the range of suitable habitat for Champsosaurus, the only known genus of Late Cretaceous neochoristoderes. We found that in Appalachia, the ideal habitat of Champsosaurus probably existed slightly further north and west than the Atlantic coastal plain, and New Jersey is probably on or near the margin of this suitable habitat space. These results suggest that the occurrence of neochoristoderes in New Jersey is consistent with the habitat requirements of known Late Cretaceous neochoristoderes. These vertebrae may therefore represent the southern margin of a population of neochoristoderes that lived further inland, where latest Cretaceous sediments are not preserved. The continued recovery of material from Late Cretaceous deposits along the Atlantic coast, and review of existing collections, is encouraged to clarify the true distribution of neochoristoderes in Appalachia.
Current situation of children with disabilities in low‐ and middle‐income countries
Authors: Kamiya Yasuhiko
Published: July 2021

Global child mortality has more than halved for the last three decades. Without a decrease in morbidity corresponding to that in mortality, this increased survival is likely to increase the number of children with disabilities, especially in low‐ and middle‐income countries (LMICs). While population‐based data on children with disabilities have been scarce in LMICs, it is estimated that among 52.9 million children with disabilities under 5 years worldwide, 95% live in LMICs. Sequelae of postnatal disease continue to be the major cause of child disability in LMICs; however, disability is increasingly the result of perinatal conditions. The Convention on the Rights of the Child and the Convention on the Rights of Persons with Disabilities promote the rights of children with disabilities, but limited resources in LMICs have prevented the translation of policies reflecting these Conventions into practice. Because health care for children with disabilities is limited in LMICs, most of them are cared for at home. This places heavy physical and mental burden on family caregivers and affects the allocation of time and financial resources in the family. Simple interventions can dramatically improve the clinical condition of disabled children and should be applied in care at home. Legally recognized members of society, children with disabilities remain excluded from public support. Disabled children must be empowered to overcome this inequity. This is the focus of the “Nothing About Us Without Us” campaign. Society, including professionals, can further redistribute power by “putting the first last” to empower individuals with disability.
Values, Partisan Interest, and the Voting Age: Lessons from Australia
Authors: Miragliotta Narelle , Murray Sarah , Drum Martin
Published: July 2021

The decline in youth participation in elections has been an ongoing concern in Australia, in spite of the requirement for compulsory turnout. In 2018, and in response to these concerns, the Australian parliament debated an electoral amendment that would lower the national voting age to 16 years. The Bill, however, did not succeed even though two opposition parties—the Australian Labor Party and the Australian Greens—supported the reform and the Morrison Government accepted the premise that youth electoral disengagement was a troubling phenomenon. Drawing on veto player theory, this article examines how the legislative dynamics intersected with partisan self‐interest and party value priorities to undercut the case for lowering the voting age to 16. The Australian case highlights the ways in which latent ideological differences among parties can serve to divide them on the inclusiveness of franchise, and the democratic goals to be served by voting.

Related Articles

Cormack, Lindsey. 2019. “Leveraging Peer‐to‐Peer Connections to Increase Voter Participation in Local Elections.” Politics & Policy 47 (2): 248‐266. https://doi.org/10.1111/polp.12297

Fisher, Patrick. 2020. “Generational Replacement and the Impending Transformation of the American Electorate.” Politics & Policy 48 (1): 38‐68. https://doi.org/10.1111/polp.12340

Ike, Vivian. 2020. “The Impact of Veto Players on Incremental and Drastic Policy Making: Australia's Carbon tax Policy and its Repeal.” Politics & Policy 48 (2): 232‐264. https://doi.org/10.1111/polp.12346
Mobile capital, optimal tariff, and tariff war
Authors: Takatsuka Hajime , Zeng Dao‐Zhi
Published: July 2021

Using an intra‐industry trade model with mobile/immobile capital, we revisit the characteristics of optimal tariffs and tariff wars. In contrast to folk wisdom on optimal tariffs, we show that when capital is freely mobile across countries, smaller countries impose higher tariffs, and they can win tariff wars. This occurs because tariffs have a strong impact on output expansion. Even if capital import taxes are available, small countries can win tariff wars, although larger countries may apply higher tariff rates.
Generating Poisson-Distributed Differentially Private Synthetic Data
Authors: Quick Harrison
Published: July 2021

The dissemination of synthetic data can be an effective means of making information from sensitive data publicly available with a reduced risk of disclosure. While mechanisms exist for synthesizing data that satisfy formal privacy guarantees, these mechanisms do not typically resemble the models an end-user might use to analyse the data. More recently, the use of methods from the disease mapping literature has been proposed to generate spatially referenced synthetic data with high utility but without formal privacy guarantees. The objective for this paper is to help bridge the gap between the disease mapping and the differential privacy literatures. In particular, we generalize an approach for generating differentially private synthetic data currently used by the US Census Bureau to the case of Poisson-distributed count data in a way that accommodates heterogeneity in population sizes and allows for the infusion of prior information regarding the underlying event rates. Following a pair of small simulation studies, we illustrate the utility of the synthetic data produced by this approach using publicly available, county-level heart disease-related death counts. This study demonstrates the benefits of the proposed approach’s flexibility with respect to heterogeneity in population sizes and event rates while motivating further research to improve its utility.
Xenophobia during the pandemic: A Lacanian perspective
Authors: Dempsey Owen Philip
Published: July 2021

The aim of this article is: (a) to argue that the UK governments’ authoritarian response to the COVID‐19 pandemic is inciting a qualitative shift in discourse structures that are transforming xenophobia into a radically totalitarian force; and (b) to demonstrate that even ostensibly voluntarist libertarian discourse also creates conditions for the psyche that incite the same totalitarian xenophobic transformation. I use two approaches to the relation between authoritarianism and xenophobia in the context of the COVID‐19 pandemic in the UK and the debates over the benefits and harms of ‘lockdowns’ (state‐enforced, legally binding restrictions on social interaction to reduce infection transmission). First, I use Lacanian theory in a socio‐cultural critique to explain the on‐going shift, during the pandemic, towards an increasingly totalitarian psyche, that is intensifying and transforming xenophobia. The anti‐democratic imposition of new laws induces agencies and civilians to over‐zealously report and punish violators. I present xenophobic activities that are signs of a developing totalitarian psyche that over‐represses and ultimately negates the humanity of the other and feels a duty to punish the ‘other’ as a moral good. Second, I use Lacanian discourse analysis to analyse an example of ostensibly libertarian anti‐lockdown discourse. The analysis disorganises and disentangles the underlying non‐sensical symbolic values and structure of words or signifiers. This reveals how these signifiers: (a) create discrete identities for social groups of ‘minority’ non‐sensible others; who are (b) blamed as the cause of harm to the sensible ‘majority’; and (c) function socially to effectively demand that the ‘minority’ groups isolate themselves, as if voluntarily, and are to be isolated, actually and metaphorically, by the xenophobic ‘majority’. The apparently liberal democratic discourse is shown to be performative of a totalitarian system of mastery and xenophobic attitudes and behaviours.
Washing transplants with Sepax 2 reduces the incidence of side effects associated with autologous transplantation and increases patients' comfort
Authors: Huvarová Lucie , Kořístek Zdeněk , Jelínek Tomáš , Černá Lucie , Smejkalová Jana , Navrátil Milan , Grebeníček Lukáš , Tvrdá Ivana , Michalíková Magda , Hájek Roman
Published: July 2021

Background

High‐dose chemotherapy followed by autologous hematopoietic stem cell transplantation (ASCT) is routinely used in various hematologic malignancies. However, dimethylsulfoxide contained in cryopreserved grafts can cause adverse events (AEs).

Study design and methods

Forty‐three ASCTs were performed with Sepax 2 washed grafts between 7/2016 and 10/2019. The aim of this study was to determine whether washing out dimethyl sulfoxide (DMSO) from transplants using the Sepax 2 (S‐100) device is safe and reduces the incidence of DMSO‐associated AEs.

Results

The washing procedure was automated and that resulted in the satisfactory recovery of total nucleated cells, CD34+ cells, and colony forming units of granulocyte and macrophages (85%, 80%, and 84%, medians). Time to engraftment of leukocytes, granulocytes, and platelets as well as the number of neutropenic days did not differ when compared to 20 consecutive ASCTs without washing. The AE occurrence was lower compared to unwashed grafts: 81% versus 78% during and shortly after grafts administration, 76% versus 69% in the following day.

Conclusion

We conclude that the washing of cryopreserved transplants using Sepax 2 was feasible with a high recovery of hematopoietic cells, did not influence time to engraftment, and resulted in the satisfactory reduction of AEs and improved tolerance of the procedure.
Canine pedal papilloma identification and management: a retrospective series of 44 cases
Authors: Gould Alexandra P. , Coyner Kimberly S. , Trimmer Ann M. , Tater Kathy , Rishniw Mark
Published: July 2021

Background

Papillomavirus infections in dogs have a variety of manifestations and involve multiple viral genera. Canine pedal papillomas have been infrequently studied and reported in the literature.

Objective

To report the signalment, history, treatment and outcome of biopsy‐confirmed cases of canine pedal papillomatosis, collected from veterinarians across the United States and Canada

Animals

Medical records from 44 dogs were submitted by North American veterinarians.

Methods and materials

Surveys were submitted through the Veterinary Information Network for biopsy‐confirmed cases of canine pedal papillomatosis. Submissions included information on patient signalment, history, biopsy report, treatment and outcome.

Results

Forty‐four cases were reviewed. The median age of presentation was four years old. Dogs most commonly presented with lameness and/or paw licking/chewing. Only one paw was affected in 35 cases, and front paws were more often affected than back paws. Twenty‐eight dogs presented with one mass. Histopathological evaluation documented 33 cases of noninverted papillomas and 11 cases of inverted papillomas. Thirty‐four papillomas resolved in total; 25 resolved within three weeks after biopsy collection. Twenty‐one dogs received no additional treatment and 15 of those cases resolved. Azithromycin was the most commonly reported treatment initiated after biopsy was collected.

Conclusions and clinical importance

The biological behaviour of canine pedal papillomas in this case series was similar to oral papillomas, and most lesions resolved with or without additional treatment. Further research is needed to better characterise the causative papillomavirus types and genera involved in the development of canine pedal papillomas.
Role of AMPA receptor desensitization in short term depression – lessons from retinogeniculate synapses
Authors: von Engelhardt Jakob
Published: July 2021

Repetitive synapse activity induces various forms of short‐term plasticity. The role of presynaptic mechanisms such as residual Ca2+ and vesicle depletion in short‐term facilitation and short‐term depression is well established. On the other hand, the contribution of postsynaptic mechanisms such as receptor desensitization and saturation to short‐term plasticity is less well known and often ignored. In this review, I will describe short‐term plasticity in retinogeniculate synapses of relay neurons of the dorsal lateral geniculate nucleus (dLGN) to exemplify the synaptic properties that facilitate the contribution of AMPA receptor desensitization to short‐term plasticity. These include high vesicle release probability, glutamate spillover and, importantly, slow recovery from desensitization of AMPA receptors. The latter is strongly regulated by the interaction of AMPA receptors with auxiliary proteins such as CKAMP44. Finally, I discuss the relevance of short‐term plasticity in retinogeniculate synapses for the processing of visual information by LGN relay neurons.

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Cuidados paliativos en la época de infección por SARS-CoV-2/COVID-19
Authors: Ariza Galindo Carlos José , Castiblanco Bautista Angela Patricia
Published: July 2021

La nueva pandemia por coronavirus 2019 (COVID-19) está generando desafíos en los sistemas de salud a nivel mundial y planteando dilemas éticos que derivan tanto en la adecuación terapeútica de cada individuocomo en la toma de decisiones en contexto de recursos limitados donde la capacidad de brindar atención médica es insuficiente, así como en aquellos pacientes con múltiples comorbilidades o enfermedad avanzada sin voluntades anticipadas respecto a las medidas de reanimación e intervenciones invasivas como intubación orotraqueal, niveles de asistencia (UCI, sala general, domicilio) y sus preferencias de atención al final de vida.Así mismo, ha evidenciado la necesidad universal del acceso a los cuidados paliativos, el alivio de sintomas y la importancia de la capacitación del personal de salud en cuidados paliativos en los centros y niveles de atención en salud.
Cost-Effectiveness and Resiliency Evaluation of Net-Zero Energy U.S. Residential Communities
Authors: Thompson Jordan , Krarti Moncef
Published: July 2021

In this paper, a resiliency analysis is carried out to assess the energy, economic, and power outage survivability benefits of efficient and net-zero energy communities. The analysis addresses the appropriate steps to designing an energy-efficient and net-zero energy community using Phoenix, Arizona, as a primary location for weather and utility inputs. A baseline home is established using International Energy Conservation Code (IECC) 2018 code requirements. Three occupancy levels are evaluated in BEopt to provide diversity in the community’s building stock. The loads from the baseline, energy-efficient optimum, and net-zero energy optimum single-family homes are utilized to determine energy use profiles for various residential community types using occupancy statistics for Phoenix. Then, REopt is used to determine the photovoltaic (PV) and battery storage system sizes necessary for the community to survive a 72-hour power outage. The analysis results indicated that the baseline community requires a 544-kW PV system and 375-kW/1,564 kWh battery storage system to keep all electrical loads online during a 72-hour power outage. The energy-efficient community requires a 291-kW PV system and a 202-kW/820 kWh battery storage system while the net-zero energy community requires a 291-kW PV system and a 191-kW/880 kWh battery storage system. In this study, the economic analysis indicates that it is 31% more cost-effective to install a shared PV plus storage system than to install individual PV plus storage systems in an energy-efficient community. After analyzing the system sizes and costs required to survive various outage durations, it is found that only a 4% difference in net present cost exists between a system sized for a 24-hour outage and a 144-hour outage. In the event of a pandemic or an event that causes a community-wide lockdown, the energy-efficient community would only survive 6 h out of a 72-hour power outage during a time where plug loads are increased by 50% due to added laptops, monitors, and other office electronics. Finally, a climate sensitivity analysis is conducted for efficient communities in Naperville, Illinois, and Augusta, Maine. The analysis suggests that for a 72-hour power outage starting on the peak demand day and time of the year, the cost of resiliency is higher in climates with more heating and cooling needs as heating, ventilation, air conditioning, and cooling (HVAC) is consistently the largest load in a residential building.
Regime change in the recorder: Using Navier–Stokes modeling to design a better instrument
Authors: Thacker J. W. , Giordano N.
Published: July 2021

Blowing a recorder at a low to moderate blowing speed with the toneholes all closed yields the lowest note in the range of the instrument. As the blowing speed is increased, the tone abruptly changes to the tone an octave higher. This “jump” in the frequency of the dominant spectral component of the tone is referred to as “regime change.” Interestingly, in conversations with recorder players, several have mentioned that regime change seems to occur at a significantly lower blowing speed for bass recorders than for instruments that sound an octave or more higher. In this paper we study regime change in the recorder and use Navier–Stokes modeling to confirm and study differences in the behavior of different instruments in the recorder family. We show, using modeling, how the regime change threshold in a model of the bass recorder can be increased by changing the geometry in the vicinity of the labium. These results are then confirmed through experimental studies of real recorders with designs inspired by the modeling results. The insights gained from these results suggest new recorder designs that may produce instruments that in some respects are more playable than current instruments.
Specular reflection contributions to dynamic radiation forces on highly reflecting spheres (L)
Authors: Marston Philip L. , Daniel Timothy D. , Fortuner Auberry R.
Published: July 2021

Specular reflection contributions to dynamic radiation forces were recently mentioned for highly reflecting spheres to facilitate comparison with forces on cylinders [Marston, Daniel, Fortuner, Kirsteins, and Abawi, J. Acoust. Soc. Am. 149, 3042–3051 (2021)]. Both shapes of reflectors were taken to be illuminated by short-wavelength plane wave double-sideband suppressed-carrier ultrasound. Here, the geometric method of evaluating dynamic forces on spheres is illustrated along with an analysis of the phase of the modulated radiation force. Comparison with partial wave series solutions supports the relevance of the specular reflection analysis for insight into forces on highly reflecting objects in water.
Supplemental Material: Bringing sedimentology and stratigraphy into the StraboSpot data management system
Authors: Duncan C.J. , al. et
Published: July 2021

File A which outlines results from a fall 2019 post-GSA Annual Meeting field workshop. File B which outlines the results from a summer 2020 online workshop/app launch.
Acceptance and commitment therapy meets peer-support. Development of a supportive self-care intervention for patients with rare diseases: a multistage development process
Authors: Depping Miriam K , Uhlenbusch Natalie , Löwe Bernd
Published: July 2021

Objective

We aimed at developing a patient-centred self-help programme, tailored to the needs of patients with rare chronic diseases.

Design

Multistage, multimethod development process including a survey with validated self-report scales and open-ended questions (phase 1) and focus groups (phase 2) for needs assessment and, consolidating the first phases and the literature, the intervention development (phase 3).

Setting

Phase 1: nationwide online survey in Germany, phase 2: four separate and diagnostically homogeneous focus groups. The focus groups took place at a university medical centre in Germany.

Participants

Target group were patients with rare diseases that occur at a prevalence <1:2000. Phase 1: n=300 participants with different rare diseases. Phase 2: Individuals with neurofibromatosis type 1 (n=4), primary sclerosing cholangitis (n=5), pulmonary arterial hypertension (n=4) and Marfan syndrome (n=5).

Results

The central results of phases 1 and 2 were requests for more information about the disease and contact with other affected persons. Patients also expressed support needs in dealing with difficult emotions and identified acceptance of the disease as a turning point for quality of life. In phase 3, we identified acceptance and commitment therapy (ACT) as a suitable therapeutic approach and determined details about implementation and execution of self-management programmes. A 6-week self-help concept led by peer counsellors was developed, which includes disease-specific information and ACT-based exercises.

Conclusion

Based on a multistage needs assessment, we developed a peer-guided self-help intervention for patients with rare chronic diseases. Combining self-management, peer-counselling and ACT may help living with a rare condition. Further research needs to test the programme’s efficacy.

Trial registration number

ISRCTN13738704.
Ability of plasma-based or serum-based assays of D-dimer and FDP for diagnosing periprosthetic joint infection: protocol for a prospective single-centre, parallel comparative study
Authors: Xu Hong , Xie Jinwei , Zhou Jing , Wang Xing , Wang Duan , Huang Zeyu , Zhou Zongke
Published: July 2021

Introduction

Several studies have evaluated the diagnostic values of D-dimer and fibrin degradation product (FDP) for detecting periprosthetic joint infection (PJI), but their conclusions have been inconsistent. More importantly, whether the diagnostic value of these two biomarkers differs depending on whether they are assayed in plasma or serum is unclear.

Methods and analysis

This prospective single-centre, parallel comparative study will involve patients planning to undergo revision hip or knee arthroplasty due to an aseptic mechanical failure or PJI. After the patients provide written informed consent, their serum and plasma will be sampled and assayed for D-dimer and FDP. The diagnostic value of these two biomarkers in plasma and serum will be compared with one another and with the value of two traditional inflammatory markers (C reactive protein and erythrocyte sedimentation rate) used to diagnose PJI according to the 2013 International Consensus Meeting criteria. Diagnostic value will be assessed in terms of area under receiver operating characteristic curves, sensitivity, specificity, as well as positive and negative predictive values, all calculated based on the optimal cut-off determined from the Youden index.

Ethics and dissemination

This study was approved by the Ethics Committee of our hospital (approval no. 2020-859). Written informed consent will be obtained from all patients before enrollment. Study findings will be disseminated widely through peer-reviewed publications and conference presentations.

Trial registration number

This study was registered in the Chinese Clinical Trial Registry (ChiCTR2000038547), and it is ongoing.

Title:
Process evaluation of an implementation strategy to support uptake of a tuberculosis treatment adherence intervention to improve TB care and outcomes in Malawi
Authors: Puchalski Ritchie Lisa M , Kip Esther C , Mundeva Hayley , van Lettow Monique , Makwakwa Austine , Straus Sharon E , Hamid Jemila S , Zwarenstein Merrick , Schull Michael J , Chan Adrienne K , Martiniuk Alexandra , van Schoor Vanessa
Published: July 2021

Objective

To assess implementation and to identify barriers and facilitators to implementation, sustainability and scalability of an implementation strategy to provide lay health workers (LHWs) with the knowledge, skills and tools needed to implement an intervention to support patient tuberculosis (TB) treatment adherence.

Design

Mixed-methods design including a cluster randomised controlled trial and process evaluation informed by the RE-AIM framework.

Setting

Forty-five health centres (HCs) in four districts in the south east zone of Malawi, who had an opportunity to receive cascade training.

Participants

Forty-five peer-trainers (PTs), 23 patients and 20 LHWs.

Intervention

Implementation strategy employing peer-led educational outreach, a clinical support tool and peer support network to implement a TB treatment adherence intervention.

Outcome measures

Process data were collected from study initiation to the end-of-study PT meeting, and included: LHW and patient interviews, quarterly PT meeting notes, training logs and study team observations and meeting notes. Data sources were first analysed in isolation, followed by method, data source and analyst triangulation. Analyses were conducted independently by two study team members, and themes revised through discussion and involvement of additional study team members as needed.

Results

Forty-one HCs (91%) trained at least one LHW. Of 256 LHWs eligible to participate at study start 152 (59%) completed training, with the proportion trained per HC ranging from 0% to 100% at the end of initial cascade training. Lack of training incentives was the primary barrier to implementation, with intrinsic motivation to improve knowledge and skills, and to improve patient care and outcomes the primary facilitators of participation.

Conclusion

We identified important challenges to and potential facilitators of implementation, scalability and sustainability, of the TB treatment adherence intervention. Findings provide guidance to scale-up, and use of the implementation strategies employed, to address LHW training and supervision in other areas.

Trial registration number

NCT02533089.
Digital acoustic surveillance for early detection of respiratory disease outbreaks in Spain: a protocol for an observational study
Authors: Gabaldon-Figueira Juan Carlos , Brew Joe , Doré Dominique Hélène , Umashankar Nita , Chaccour Juliane , Orrillo Virginia , Tsang Lai Yu , Blavia Isabel , Fernández-Montero Alejandro , Bartolomé Javier , Grandjean Lapierre Simon , Chaccour C
Published: July 2021

Introduction

Cough is a common symptom of COVID-19 and other respiratory illnesses. However, objectively measuring its frequency and evolution is hindered by the lack of reliable and scalable monitoring systems. This can be overcome by newly developed artificial intelligence models that exploit the portability of smartphones. In the context of the ongoing COVID-19 pandemic, cough detection for respiratory disease syndromic surveillance represents a simple means for early outbreak detection and disease surveillance. In this protocol, we evaluate the ability of population-based digital cough surveillance to predict the incidence of respiratory diseases at population level in Navarra, Spain, while assessing individual determinants of uptake of these platforms.

Methods and analysis

Participants in the Cendea de Cizur, Zizur Mayor or attending the local University of Navarra (Pamplona) will be invited to monitor their night-time cough using the smartphone app Hyfe Cough Tracker. Detected coughs will be aggregated in time and space. Incidence of COVID-19 and other diagnosed respiratory diseases within the participants cohort, and the study area and population will be collected from local health facilities and used to carry out an autoregressive moving average analysis on those independent time series. In a mixed-methods design, we will explore barriers and facilitators of continuous digital cough monitoring by evaluating participation patterns and sociodemographic characteristics. Participants will fill an acceptability questionnaire and a subgroup will participate in focus group discussions.

Ethics and dissemination

Ethics approval was obtained from the ethics committee of the Centre Hospitalier de l’Université de Montréal, Canada and the Medical Research Ethics Committee of Navarre, Spain. Preliminary findings will be shared with civil and health authorities and reported to individual participants. Results will be submitted for publication in peer-reviewed scientific journals and international conferences.

Trial registration number

NCT04762693.
Child abuse in children living with special guardians, a service evaluation of child protection medical examinations
Authors: Garstang Joanna , Hallett Nutmeg , Cropp Gabrielle , Kenyon-Blair Davina , Morgans Clare , Taylor Julie
Published: July 2021

Objective

To determine difference in frequency of referral for child protection medical examination (CPME) in children subject to special guardianship order (SGO), subject to child protection plan (CPP) or neither.

Design

Service evaluation analysing data from CPME reports.

Setting

Acute and community healthcare providers in Birmingham UK, during 2018.

Patients

All children aged 0–18 years requiring CPME.

Main outcome measures

Details were obtained from CPME reports on: age, SGO status, CPP status, reason for CPME, injuries sustained, presence of non-accidental injury.

Population data were obtained from the local children’s safeguarding board and national statistics.

Results

Reports were available for 292/298 (98%) CPME, relating to 288 children. 5 children were subject to SGO, 39 were subject to CPP, none subject to both. Non-accidental injury was substantiated in 189/288 (66%). The child population was 288 000. 1665 children were subject to CPP and approximately 750 subject to SGO. The relative risk (RR) for children subject to SGO requiring a CPME compared with children not subject to SGO or CPP is 7.86, p<0.0001 with 95% CI (3.26 to 19.02). The RR for children subject to a CPP requiring CPME compared with children not subject to SGO or CPP is 27.65, p<0.0001 with 95% CI (19.78 to 38.63).

Conclusions

This is a small study and findings need interpreting cautiously. Children subject to SGO may potentially be at higher risk of abuse than the general population despite living with carers who have passed social care parenting assessments. There is no register of children subject to SGO so professionals may be unable to offer families additional support. SGO families should be offered enhanced support and monitoring routinely. Children subject to CPP are not being adequately protected from further abuse.
Psychopathological outcomes and defence mechanisms in clinically healed adults with a paediatric cancer history: an exploratory study
Authors: Petralia Antonino , Bisso Emanuele , Concas Ilaria , Maglitto Antonino , Bucolo Nunzio , Alaimo Salvatore , Di Cataldo Andrea , Signorelli Maria Salvina , Pulvirenti Alfredo , Aguglia Eugenio
Published: July 2021

Background

The incidence of paediatric cancers has increased in recent years; however, with advances in the treatment of paediatric cancer, almost 80% of children and adolescents who receive a diagnosis of cancer become long-term survivors. Given the high stress levels associated with cancer, it becomes important to ascertain the risk and likelihood of psychiatric disorders in adult paediatric cancer survivors.

Aims

This study aims to investigate the relationship between defence styles and predisposition to psychiatric diseases in adults with a history of paediatric cancer.

Methods

We performed an explorative study on a sample of 66 clinically healed adults with a history of paediatric cancer (survivors) during follow-up visits at the University Hospital ‘Policlinico G Rodolico’ of Catania (Italy) and 98 healthy controls among medicine students. We administered the Defence Mechanism Inventory (DMI) to assess defence styles. The Symptom Checklist-90-Revised (SCL-90-R) and the Davidson Trauma Scale (DTS) were administered to assess psychopathological indices. We conducted comprehensive statistical analysis based on correlation analysis and mediation analysis to investigate the relationship between defence styles and psychopathological outcomes in survivors compared with controls.

Results

The survivors obtained statistically significant lower values in TAO, PRO and TAS defence styles and a higher value in REV. Both groups showed non-pathlogical mean scores in DTS and SCL-90-R (with an exception of the obsessive-compulsive subscale), with lower mean values among survivors. The results of mediation analysis showed that TAS had mediation effects on interpersonal sensitivity, anxiety, PSDI, GSI and avoidance, while TAO had mediation effects on DTS total score and intrusivity. Thus, for these psychopathological indices, the effect of the oncological pathology was indirect and mediated by TAO or TAS. Our analysis exlcluded mediation effects between the remaining variables and defence styles.

Conclusion

Integrating data from mediation and correlation analysis, we found how the decreasing of TAS utilization in survivors as the consequence of cancer history, has decreased interpersonal sensitivity, anxiety and GSI score in these subjects compared with controls. Similary, the decrease of TAO utilization played a role in lower values of DTS total score and intrusivity subscale. Unexpectedly, our analysis excluded relationships between cancer history, other defence styles and psycopathological scores as we initially assumed.
Whole-exome sequencing reveals a monogenic cause in 56% of individuals with laterality disorders and associated congenital heart defects
Authors: Bolkier Yoav , Barel Ortal , Marek-Yagel Dina , Atias-Varon Danit , Kagan Maayan , Vardi Amir , Mishali David , Katz Uriel , Salem Yishay , Tirosh-Wagner Tal , Jacobson Jeffrey M , Raas-Rothschild Annick , Chorin Odelia , Eliyahu Aviva , Sarouf Yarden , Shlomovitz Omer , Veber Alvit , Shalva Nechama , Javasky Elisheva , Ben Moshe Yishay , Staretz-Chacham Orna , Rechavi Gideon , Mane Shrikant , Anikster Yair , Vivante Asaf , Pode-Shakked Ben
Published: July 2021

Background

The molecular basis of heterotaxy and congenital heart malformations associated with disruption of left–right asymmetry is broad and heterogenous, with over 25 genes implicated in its pathogenesis thus far.

Objective

We sought to elucidate the molecular basis of laterality disorders and associated congenital heart defects in a cohort of 30 unrelated probands of Arab–Muslim descent, using next-generation sequencing techniques.

Methods

Detailed clinical phenotyping followed by whole-exome sequencing (WES) was pursued for each of the probands and their parents (when available). Sanger sequencing was used for segregation analysis of disease-causing mutations in the families.

Results

Using WES, we reached a molecular diagnosis for 17 of the 30 probands (56.7%). Genes known to be associated with heterotaxy and/or primary ciliary dyskinesia, in which homozygous pathogenic or likely pathogenic variants were detected, included CFAP53 (CCDC11), CFAP298 (C21orf59), CFAP300, LRRC6, GDF1, DNAAF1, DNAH5, CCDC39, CCDC40, PKD1L1 and TTC25. Additionally, we detected a homozygous disease causing mutation in DAND5, as a novel recessive monogenic cause for heterotaxy in humans. Three additional probands were found to harbour variants of uncertain significance. These included variants in DNAH6, HYDIN, CELSR1 and CFAP46.

Conclusions

Our findings contribute to the current knowledge regarding monogenic causes of heterotaxy and its associated congenital heart defects and underscore the role of next-generation sequencing techniques in the diagnostic workup of such patients, and especially among consanguineous families.
Characterization of Stable 12T SRAM with Improved Critical Charge
Authors: Sachdeva Ashish , Tomar V. K.
Published: July 2021

With the aggressive growth of the internet of things-based applications in the domestic and industrial domain, the embedded static memory is also under renovation stage to eliminate classical barriers such as soft errors, poor stability, and mediocre performance. In this work, a novel twelve transistors (12T) SRAM cell is presented that replaces the conventional inverter with Schmitt trigger-based inverter in core latch. The proposed SRAM circuit has been compared with four formerly reported designs for investigating the improvement in terms of various performance metrics. These designs include conventional six transistors (6T), tunable transistor 8T (T8T), PPN inverter-based 10T (PP10T), and stable low read power 11T (S11T) cells. The presented cell effectively minimizes the soft errors attributed to [Formula: see text]/[Formula: see text]/[Formula: see text]/[Formula: see text] enhancement of critical charge compared to 6T/T8T/PP10T/S11T cells. Also, the proposed bit-cell effectively mitigates multi-bit-cell upsets because it allows bit interleaving array structure. The presented bit-cell also shows reduction in leakage power by [Formula: see text]/[Formula: see text]/[Formula: see text]/[Formula: see text] in comparison to 6T/T8T/PP10T/S11T cells, respectively. The read and write stability of proposed bit-cell circuit is enhanced by [Formula: see text]/[Formula: see text]/[Formula: see text]/[Formula: see text] and [Formula: see text]/[Formula: see text]/[Formula: see text]/[Formula: see text], respectively, in comparison to 6T/T8T/PP10T/S11T cells, respectively. In addition to this, proposed cell exhibits improvement in dynamic power, data retention voltage, and overall electrical quality matrix. Variability comparison of key design metrics such as read power and read current of the proposed SRAM circuit with 6T cell has also been presented in this work.
Performance Enhancement of Current Follower Transconductance Amplifier (CFTA) and its Application as Filter
Authors: Tasneem Sadaf , Ranjan Rajeev Kumar , Paul Sajal K.
Published: July 2021

This paper presents a modified Current Follower Transconductance Amplifier (CFTA). It provides the essential features of high transconductance, wide bandwidth besides a wide linear range. It records the highest transconductance of 18.2[Formula: see text]mS and power dissipation of 1.12[Formula: see text]mW. Moreover, the linear range ([Formula: see text] versus [Formula: see text]) of CFTA is found as [Formula: see text][Formula: see text][Formula: see text]A. All these essential performance parameters are found much better than the available literature. As an application, a novel second-order universal filter is implemented using the proposed CFTA. It is found that the performance of the filter improves with the use of the proposed CFTA.
Wavelet packets associated with linear canonical transform on spectrum
Authors: Bhat M. Younus , Dar Aamir H.
Published: July 2021

The linear canonical transform (LCT) provides a unified treatment of the generalized Fourier transforms in the sense that it is an embodiment of several well-known integral transforms including the Fourier transform, fractional Fourier transform, Fresnel transform. Using this fascinating property of LCT, we, in this paper, constructed associated wavelet packets. First, we construct wavelet packets corresponding to nonuniform Multiresolution analysis (MRA) associated with LCT and then those corresponding to vector-valued nonuniform MRA associated with LCT. We investigate their various properties by means of LCT.
The geochemical evolution of the Logan Igneous Suite, Ontario, Canada: new insights from the Logan Basin and implications for the genesis of the Mesoproterozoic Midcontinent Rift System
Authors: Cundari Robert , Hollings Pete , Smyk Mark , Carl Christian
Published: July 2021

The 1.1 Ga Midcontinent Rift System (MRS) of North America comprises a series of Mesoproterozoic flood basalts and intrusive rocks emplaced in the Lake Superior region. The mafic rocks preserved on the NW flank of Lake Superior offer insights into the early development of the rift. New geochemical data collected from intrusive rocks in the Logan Basin, coupled with improved constraints on timing relationships between units, allow for a better understanding of the geochemical evolution of intrusive rocks therein. The extensive dataset suggests many previously unrecognized relationships between MRS intrusive rocks, indicating multiple, distinct mantle-source characteristics with highly variable crustal contamination histories, implying a complicated magma plumbing system. The data presented here suggest that five geochemically distinct mantle source regions were involved in the emplacement of the Logan Igneous Suite, each with its own distinct contamination history and perhaps different degrees of partial melting. The geochemical variations could suggest either a progressive, relative depletion in the mantle source over time or heterogeneity of the source region. However, based on the model for MRS magmatism presented here, we suggest that units related to the Logan Igneous Suite were tapping a heterogeneous mantle source that varied over time.
[Retracted] Construction and Simulation of Financial Audit Model Based on Convolutional Neural Network
Authors: Zhang Xiaoyi
Published: July 2021

Big data has brought a new round of information revolution. Faced with the goal of full coverage of audit and supervision, making full use of big data is the main method to promote the realization of the goal of full coverage of audit and supervision. Data analysis and utilization is an indispensable task of auditing. Actively exploring multidimensional and intelligent data analysis methods and developing big data audit cases are the new development direction of auditing. The convolutional neural network’s excellent ability to extract data features well meets the relevant requirements of financial auditing. However, in practical applications, convolutional neural networks often encounter various problems such as disappearance of gradients and difficulty in convergence, which reduces its expected performance in financial audit applications. In order to make the performance of the financial audit model based on convolutional neural network more excellent, after summarizing the characteristics of genetic algorithm, this article applies genetic algorithm to the optimization of the convolutional neural network model. We applied genetic algorithm to optimize the initial weights of the convolutional neural network. The error sensitivity and learning rate changes of different hidden layers are discussed, the influence of different learning rates on the convergence speed of convolutional neural networks is analyzed, and the recognition performance of other algorithms on financial audit data sets is simulated and compared. We conducted experiments on the network structure and parameter optimization on the financial audit database. The results show that the recognition error rate of the convolutional neural network model with improved learning rate algorithm in the financial audit data set is lower than that of the multilayer feedforward network, so it has better performance.