bluuebunny/crossref_metadata_2025 huggingface dataset:
What can postcolonial theory contribute to the study of social equity?
Authors: Bhati Abhishek
Published: May 2022

There is a unanimous agreement among scholars that social equity scholarship is essential to the study of public administration. One area of weakness in the social equity literature is its inability to develop a theoretical understanding of the complexities of race, gender, and ethnicity. This viewpoint addresses the call of Pandey, Bearfield, and Hall (2022), arguing “concept of race in public administration remains woefully undertheorized” by exploring key tenets of Postcolonial theory. Postcolonial theory can bolster social equity literature by providing a much‐needed theoretical framework to systematically understand the marginalization and subordination of people of color for centuries through representation, production of knowledge, and power. The postcolonial theory also challenges the portrayal of all non‐White minorities as one collective hegemonic identity and, therefore, can provide a sound theoretical grounding to social equity scholarship.

Evidence for Practice

There is a growing call among scholars and practitioners to conceptualize race in public administration using more complex historical foundations capturing nuances of gender, ethnicity, and skin‐tone rather than simplifying race as binary (White vs. non‐White).

Postcolonial theory provides a strong theoretical foundation to understand race and intersectional identity and provides a firm capacity to understand race relationships using the historical lens.

Postcolonial theory also provides insights into the exploitation and subjugation of colonial subjects (citizens once colonized by European empires) and how their identity is forever molded by the slave trade and exploitation of natural resources of countries in Asia, Africa, and Latin America.

Finally, the postcolonial theory provides a strong parallel between the colonial representation of the colonized subjects as the “Other” and the portrayal of poor people from the global South as stereotypical and helpless and refugees and immigrants as dangerous or “bad hombres.”
Association of linear type pelvic traits with testicular characteristics and reproductive capability of breeding dairy bulls
Authors: Mandal Dilip Kumar , Kumar Mahesh , Tyagi Shrikant
Published: May 2022

Associations of pelvic linear type traits (PLT) on production and reproduction of cows were widely documented; in contrast, importance of PLT on bulls’ reproductive ability, semen quality, semen cryo‐preservability, frozen semen doses (FSD) production etc. was inadequately reported. The present study was conducted on Frieswal bulls (N = 378, age: 6–91 months, m) to assess age‐wise growth dynamics of pelvic dimensions, classifying age into 6 groups (6 m, 7–12 m, 13–24 m, 25–36 m, 37–48 m, >48 m). Iso‐age group bulls’ (N = 100; 25–36 m) records were analysed after classifying seasons (summer/rainy/winter) of semen collection, if pelvic morphometric traits had any practical associations with testicular traits, semen quality and FSD production or not. A discriminant function was developed based on PLT, which showed poor predictive ability to distinguish FSD/non‐FSD category bulls. Age significantly influenced growth and dimensions of gonadal and external pelvic morphometry traits. The dimensions of PLT increased at higher rate up to 36 m age and thereafter enhancement became insignificant. Pelvic linear type traits were positively (p < .01) associated with testicular/scrotal traits. Among PLT studied, pelvic triangle area (PTA) was the strongest discriminating variable to distinguish between good and poor breeding bulls. Bulls of larger PTA (≥1000 cm2), at average 30 m age, produced relatively inferior‐quality semen, viz. lower volume (−3%), sperm concentration (−48 × 106/mL), motility, semen quality index, total sperm counts/ejaculate (−601 × 106), motile sperm counts/ejaculate (−474 × 106) and total post‐thaw motile sperm counts (−226 106), than bulls of lesser PTA (<1000 cm2). It was concluded that external PTA could be a useful addition to the bulls’ breeding soundness evaluation.
A critical contribution in a time of crisis: Examining motivations and deterrents to COVID‐19 convalescent plasma donation and future donation intentions among prospective Canadian donors
Authors: Holloway Kelly , Campbell Chantal , Ali Ridwaanah , Huyer Larkin Davenport , Hart Dana , Haw Jennie , Brennenstuhl Sarah , Grundy Quinn
Published: May 2022

Objectives

To understand motivations and deterrents to donate COVID‐19 convalescent plasma for a clinical trial and determine whether they predict intention to donate source plasma.

Background

During the COVID‐19 pandemic, Canadian Blood Services was involved in three nationally coordinated convalescent plasma clinical trials, requiring the recruitment of several thousand prospective convalescent plasma donors. Understanding the motivations and deterrents of donors in the unique context of a clinical trial and ongoing pandemic can inform recruitment for source plasma donation beyond a clinical trial.

Methods and Materials

We invited 2785 Canadians who had registered interest in donating COVID‐19 convalescent plasma to participate in an online survey containing a 42‐item scale on motivators of and deterrents to donation. Between April 26th and May 19th, 2021, 979 responded (35.1%). We included a final sample of 820 participants with sufficient data across all scales. Exploratory and confirmatory factor analysis determined the factor structure of the scale. Regression analysis assessed the extent to which the factors predicted intention to donate.

Results

Four factors were identified: ‘helping relationally’, ‘deterrents to donation’, ‘social facilitators’, and ‘access to the donation centre’, each with good internal consistency (α = 0.78–95). Higher scores on the helping relationally scale were associated with higher odds of intention to donate, whereas higher scores on the deterrents scale were associated with lower odds of intention to donate.

Conclusion

Participants were motivated by an interest in helping people who are ill and contributing to research committed to finding treatments in a time of crisis. Outside the crisis context, blood service operators seeking to recruit source plasma donors should emphasise its lifesaving potential and the impact of donation on the community.
Cold storage alters the immune characteristics of platelets and potentiates bacterial‐induced aggregation
Authors: Winskel‐Wood Ben , Padula Matthew P. , Marks Denese C. , Johnson Lacey
Published: May 2022

Background and Objectives

Cold‐stored platelets are currently under clinical evaluation and have been approved for limited clinical use in the United States. Most studies have focused on the haemostatic functionality of cold‐stored platelets; however, limited information is available examining changes to their immune function.

Materials and Methods

Two buffy‐coat‐derived platelet components were combined and split into two treatment arms: room temperature (RT)‐stored (20–24°C) or refrigerated (cold‐stored, 2–6°C). The concentration of select soluble factors was measured in the supernatant using commercial ELISA kits. The abundance of surface receptors associated with immunological function was assessed by flow cytometry. Platelet aggregation was assessed in response toEscherichia coliandStaphylococcus aureus, in the presence and absence of RGDS (blocks active conformation of integrin α2β3).

Results

Cold‐stored platelet components contained a lower supernatant concentration of C3a, RANTES and PF4. The abundance of surface‐bound P‐selectin and integrin α2β3in the activated conformation increased during cold storage. In comparison, the abundance of CD86, CD44, ICAM‐2, CD40, TLR1, TLR2, TLR4, TLR3, TLR7 and TLR9 was lower on the surface membrane of cold‐stored platelets compared to RT‐stored components. Cold‐stored platelets exhibited an increased responsiveness toE. coli‐andS. aureus‐induced aggregation compared to RT‐stored platelets. Inhibition of the active conformation of integrin α2β3using RGDS reduced the potentiation of bacterial‐induced aggregation in cold‐stored platelets.

Conclusion

Our data highlight that cold storage changes the in vitro immune characteristics of platelets, including their sensitivity to bacterial‐induced aggregation. Changes in these immune characteristics may have clinical implications post transfusion.
Multi-Objective Optimization of an Axial Flow Turbine Design Using Surrogate Modeling and Genetic Algorithm
Authors: Abraham Aji M. , Anil Lal S.
Published: May 2022

A surrogate model-based multi-objective design optimization methodology using a nondominated sorting genetic algorithm is used to maximize the power output and efficiency of an axial flow turbine. A set of high-fidelity data obtained from ANSYS-CFD simulations on space-filling samples is used for developing a surrogate model. The methodology uses (i) a Latin hypercube experimental design for selecting space-filling samples, (ii) a genetic algorithm for determining parameters of a Kriging model, and (iii) axial gap, tip clearance, and rotation angle of nozzle profile of turbine as predictor variables. Flow in the turbine is characterized by the presence of jet and wake flow, shock in the rotor blade flow passage, and tip clearance vortex. Study shows that (i) the axial gap controls the mixing of the jet and the wake flows and provides proper blade incidence which reduces the shock strength in the rotor blade flow passages and (ii) an optimum sized tip clearance vortex controls tip clearance leakage. The optimization provided a set of Pareto-optimal solutions that are nondominated in terms of power and efficiency. Verification of a selected design configuration from the Pareto-optimal solution using computational fluid dynamics (CFD) analysis showed that the process of optimization has been able to fine-tune the axial gap and the tip clearance.
Evaluating Tradeoffs for Swarm Reconnaissance With Autonomous Ground Vehicles
Authors: Goodin Christopher , Cagle Lucas , Henley Greg , Fereday Rhett , Carrillo Justin , Song Peilin , McInnis David
Published: May 2022

Autonomous ground vehicles (AGVs) operating collaboratively have several advantages over vehicles operating alone. An AGV team may be more resilient and efficient than a single AGV. Other advantages of AGV teams include increased coverage and multiple viewing angles of terrain features as well as resistance to failure from any single AGV. Additionally, AGV teams can explore large terrains more quickly and thoroughly than a single system. In this work, the feasibility of using a team of high-mobility AGV to explore a navigation corridor, map the terrain, and autonomously flag obstacles for future navigation is evaluated. Focusing on negative obstacles, the value of using multiple vehicles to map a navigation corridor is quantified. This study is the first to evaluate large teams of AGV collaborating in realistic off-road, 3D environments. The feasibility of the large-scale AGV team is demonstrated while avoiding the high cost of purchasing and testing large numbers of vehicles using the Mississippi State University autonomous vehicle simulator (MAVS), a high-fidelity, physics-based simulation tool. The cost and benefits of increasing the AGV team size are evaluated. The simulation results show how factors like fuel use, map coverage, and obstacle detection are influenced by increasing numbers of AGV in the team. The simulation architecture is presented and experiments quantifying the performance of the simulator are shown. Finally, a model for evaluating the tradeoff between mission effectiveness and fuel use is developed and presented to demonstrate the utility of this approach.
Axial Static Stiffness of Ball Screw Feed Drive System Incorporating Flexibility of Ball Screw and Rolling Bearing
Authors: Jiang Shuyun , Zhu Yongjin
Published: May 2022

Axial static stiffness is a main technical indicator for the ball screw feed drive system, and the elastic deformation outside the Hertz contact zone of the system affects its axial static stiffness. However, the influence of elastic deformation outside the Hertz contact zone on the axial stiffness has not been studied thoroughly. This study was to establish a flexible model of axial stiffness for the feeding system with considering the elastic deformation outside the Hertz contact zone. The axial stiffness of the feeding system was calculated using the proposed flexible model, and the model was verified by measuring the axial stiffness of the feeding system. The results show that the proposed flexible model can be more accurate compared with the conventional rigid model, and the method to analyze the elastic deformation outside the Hertz contact zone is practicable.
Tunable emission from Eu:SiOxNy thin films prepared by integrated magnetron sputtering and plasma enhanced chemical vapor deposition
Authors: Azmi Fahmida , Gao Yuxuan , Khatami Zahra , Mascher Peter
Published: May 2022

This paper reports tunable emission of trivalent (Eu3+) and divalent (Eu2+) europium (Eu) from SiOxNy films fabricated by integrated electron cyclotron plasma enhanced chemical vapor deposition and magnetron sputtering. The photoluminescence (PL) spectra of intense red emission from Eu3+ around 600 nm and blue (cyan) broadband emission from 400 to 750 nm of Eu2+ are observed under daylight conditions with the naked eye. The spectra reveal a strong dependency of the PL on the atomic concentration of the dopant and the silicon/nitrogen ratio. The atomic composition of the films is investigated by Rutherford backscattering spectrometry and elastic recoil detection analysis. Values of the refractive indices are obtained by variable angle spectroscopic ellipsometry. To confirm the presence of crystalline phases of europium silicate Eu4.67(SiO4)3O [Eu2(Si2O7)] and europium silicon oxynitride (EuSi2N2O2) distributed in the amorphous host matrix of SiOxNy, high-resolution x-ray diffraction is used. The findings of this work are promising toward the realization of europium-doped Si-based materials for photonics and lighting technologies.
Effective Delivery of Pressure Training: Perspectives of Athletes and Sport Psychologists
Authors: Low William R. , Butt Joanne , Freeman Paul , Stoker Mike , Maynard Ian
Published: May 2022

Pressure training (PT) strategically increases pressure in training to prepare athletes to perform under pressure. Although research has studied how to create pressure during training, PT’s effectiveness may depend on more than creating pressure. A practitioner’s delivery of sport psychology interventions can moderate their effectiveness, so the current study explored perspectives of sport psychologists and athletes on the characteristics of effective PT delivery in applied settings. Eight international-level athletes and eight sport psychologists participated in semistructured qualitative interviews in which they described their experience participating in or conducting PT, respectively. Thematic analysis produced four themes relating to effective delivery: (a) collaboration with athletes and coaches: “with,” not “to”; (b) integration into training; (c) upfront transparency; and (d) promoting learning before and after PT. The themes provide guidance for planning, conducting, and following up on PT sessions in applied settings. The best practices discussed could increase athletes’ receptiveness to PT.
Metagenomic Shotgun Sequencing of Endocervical, Vaginal, and Rectal Samples among Fijian Women with and without Chlamydia trachomatis Reveals Disparate Microbial Populations and Function across Anatomic Sites: a Pilot Study
Authors: Bommana Sankhya , Richards Gracie , Kama Mike , Kodimerla Reshma , Jijakli Kenan , Read Timothy D. , Dean Deborah
Published: May 2022

Chlamydia trachomatis
is the primary cause of bacterial sexually transmitted infections worldwide, with a disturbing increase in annual rates. While there is a plethora of data on healthy and pathogenic vaginal microbiomes—defining microbial profiles and associations with sexually transmitted infections (STIs)—far fewer studies have similarly examined the endocervix or rectum.
Super Dominant Pathobiontic Bacteria in the Nasopharyngeal Microbiota Cause Secondary Bacterial Infection in COVID-19 Patients
Authors: Qin Tian , Wang Yajie , Deng Jianping , Xu BaoHong , Zhu Xiong , Wang Jitao , Zhou Haijian , Zhao Na , Jin Fangfang , Ren Hongyu , Wang Huizhu , Li Qun , Xu Xinmin , Guo Yumei , Li Ruihong , Xiong Yanwen , Wang XiaoXia , Guo Jiane , Zheng Han , Hou Xuexin , Wan Kanglin , Zhang Jianzhong , Lu Jinxing , Kan Biao , Xu Jianguo
Published: May 2022

The nasopharyngeal microbiota is composed of a variety of not only the true commensal bacterial species but also the two-face pathobionts, which are one a harmless commensal bacterial species and the other a highly invasive and deadly pathogen. In a previous study, we found that the diversity of nasopharyngeal microbiota was lost in severe influenza patients.
The EnvZ/OmpR Two-Component System Regulates the Antimicrobial Activity of TAT-RasGAP
317-326
and the Collateral Sensitivity to Other Antibacterial Agents
Authors: Georgieva Maria , Heinonen Tytti , Hargraves Simone , Pillonel Trestan , Widmann Christian , Jacquier Nicolas
Published: May 2022

Antimicrobial peptides (AMP) are promising alternatives to classical antibiotics in the fight against antibiotic resistance. Resistance toward antimicrobial peptides can occur, but little is known about the mechanisms driving this phenomenon.
Co-Occurrence of Multidrug Resistant Klebsiella pneumoniae Pathogenic Clones of Human Relevance in an Equine Pneumonia Case
Authors: Venturini Carola , Bowring Bethany , Partridge Sally R. , Ben Zakour Nouri L. , Fajardo-Lubian Alicia , Lopez Ayala Ariana , Qin Jilong , Totsika Makrina , van Galen Gaby , Norris Jacqueline , Iredell Jonathan
Published: May 2022

Multidrug resistant
Klebsiella pneumoniae
are agents of life-threatening infections in animals and humans, with several multidrug resistant clones causing outbreaks of disease worldwide. It is generally accepted that only one clone will be dominant in an infection episode.
Sodalis ligni Strain 159R Isolated from an Anaerobic Lignin-Degrading Consortium
Authors: Chaput Gina , Ford Jacob , DeDiego Lani , Narayanan Achala , Tam Wing Yin , Whalen Meghan , Huntemann Marcel , Clum Alicia , Spunde Alex , Pillay Manoj , Palaniappan Krishnaveni , Varghese Neha , Mikhailova Natalia , Chen I-Min , Stamatis Dimitrios , Reddy T. B. K , O’Malley Ronan , Daum Chris , Shapiro Nicole , Ivanova Natalia , Kyrpides Nikos C. , Woyke Tanja , Glavina del Rio Tijana , DeAngelis Kristen M.
Published: May 2022

Currently, in the paper industry, paper mill pulping relies on unsustainable and costly processes to remove lignin from lignocellulosic material. A greener approach is biopulping, which uses microbes and their enzymes to break down lignin.
Gut Microbiota of Obese Children Influences Inflammatory Mucosal Immune Pathways in the Respiratory Tract to Influenza Virus Infection: Optimization of an Ideal Duration of Microbial Colonization in a Gnotobiotic Pig Model
Authors: Renu Sankar , Deblais Loic , Patil Veerupaxagouda , Schrock Jennifer , Kathayat Dipak , Srivastava Vishal , Feliciano-Ruiz Ninoshkaly , Han Yi , Ramesh Anikethana , Lakshmanappa Yashavanth S. , Ghimire Shristi , Dhakal Santosh , Rajashekara Gireesh , Renukaradhya Gourapura J.
Published: May 2022

The diversity of gut microbiome of obese people differs markedly from that of lean healthy individuals which, in turn, influences the severity of inflammatory diseases because of differential maturation of immune system. The mouse model provides crucial insights into the mechanism(s) regulating the immune systems mediated by the gut microbiota but its applicability to humans is questionable because immune cells in mice are poorly activated in microbiota humanized mice. Several important strains of
Bifidobacterium
,
Lactobacillus
, and
Clostridium
fails to colonize the murine gut.
Supplemental Material: Gouge fabrics reset by thermal pressurization record stress on faults after earthquakes
Authors: Kuo Li-Wei , al. et
Published: May 2022

 Methods and supplemental figures. 
Supplemental Material: Protogenetic clinopyroxene inclusions in diamond and Nd diffusion modeling—Implications for diamond dating
Authors: Pasqualetto Leonardo , al. et
Published: May 2022

Data for the reciprocal orientations between diamonds/clinopyroxene (cpx) and the Sm diffusion model. 
Supplemental Material: Volcano-pluton connections at the Lake City magmatic center (Colorado, USA)
Authors: Pamukçu A.S. , al. et
Published: May 2022

Includes files containing detailed descriptions of CA-ID-TIMS-TEA sample preparation and data reduction procedures used; figures comparing TIMS ages calculated from different values of Th/Umagma, REEs determined from the Plešovice zircon solution analyzed by ICPMS, CL images of zircon grains, zircon REE from TIMS-TEA and trace-element modeling from trachyte and HREE-trachyte parents; reduced TIMS-TEA data; and the code used for trace-element modeling.  
Hospital-wide SARS-CoV-2 antibody screening of 4840 staff members in a University Medical Center in France: a cross-sectional study
Authors: Pierson-Marchandise Marion , Castelain Sandrine , Chevalier Cassandra , Brochot Etienne , Schmit Jean-Luc , Diouf Momar , Ganry Olivier , Gignon Maxime
Published: May 2022

Objectives

Healthcare workers are more likely to be infected by SARS-CoV-2. In order to assess the infectious risk associated with working in a hospital, we sought to estimate the proportion of healthcare professionals infected with SARS-CoV-2 by screening staff in a University Medical Center in France.

Setting

A hospital-wide screening campaign (comprising a serological test and a questionnaire) ran from 18 May to 26 July 2020.

Primary and secondary outcome measures

The seroprevalence rate was analysed in a multivariate analysis according to sociodemographic variables (age, sex and profession), exposure to SARS-CoV-2 and symptoms.

Results

A total of 4840 professionals were included, corresponding to 74.5% of the centre’s staff. The seroprevalence rate (95% CI) was 9.7% (7.0% to 12.4%). Contact with a confirmed case of COVID-19 was significantly associated with seropositivity (OR (95% CI: 1.43, (1.15 to 1.78)). The seroprevalence rate was significantly higher among nursing assistants (17.6%) than among other healthcare professionals. The following symptoms were predictive of COVID-19: anosmia (OR (95% CI): 1.55, (1.49 to 1.62)), ageusia (1.21, (1.16 to 1.27)), fever (1.15, (1.12 to 1.18)), myalgia (1.03, (1.01 to 1.06)) and headache (1.03, (1.01 to 1.04)).
Study protocol: the TRAnsplant BIOpsies (TRABIO) study – a prospective, observational, multicentre cohort study to assess the treatment of kidney graft rejections
Authors: von Samson-Himmelstjerna Friedrich Alexander , Esser Grit , Schulte Kevin , Kolbrink Benedikt , Krautter Markus , Schwenger Vedat , Weinmann-Menke Julia , Matschkal Julia , Schraml Florian , Pahl Anne , Braunisch Matthias , Amann Kerstin , Feldkamp Thorsten , Kunzendorf Ulrich , Renders Lutz , Heemann Uwe
Published: May 2022

Introduction

Despite continued efforts, long-term outcomes of kidney transplantation remain unsatisfactory. Kidney graft rejections are independent risk factors for graft failure. At the participating centres of the TRAnsplant BIOpsies study group, a common therapeutic standard has previously been defined for the treatment of graft rejections. The outcomes of this strategy will be assessed in a prospective, observational cohort study.

Methods and analysis

A total of 800 kidney transplantation patients will be enrolled who undergo a graft biopsy because of deteriorating kidney function. Patients will be stratified according to the Banff classification, and the influence of the treatment strategy on end points will be assessed using regression analysis. Primary end points will be all-cause mortality and graft survival. Secondary end points will be worsening of kidney function (≥30% decline of estimated Glomerular Filtration Rate [eGFR] or new-onset large proteinuria), recurrence of graft rejection and treatment response. Baseline data and detailed histopathology data will be entered into an electronic database on enrolment. During a first follow-up period (within 14 days) and subsequent yearly follow-ups (for 5 years), treatment strategies and clinical course will be recorded. Recruitment at the four participating centres started in September 2016. As of August 2020, 495 patients have been included.

Ethics and dissemination

Ethical approval for the study has been obtained from the ethics committee of Kiel (AZ B 278/16) and was confirmed by the committees of Munich, Mainz and Stuttgart. The results will be reported in a peer-reviewed journal, according to the Strengthening the Reporting of Observational Studies in Epidemiology criteria.

Trial registration number

ISRCTN78772632; Pre-results.
Cohort profile: The Xinjiang Multiethnic Cohort (XMC) study
Authors: Tao Luo , Tian Tian , Liu Lirong , Zhang Zewen , Sun Qi , Sun Gaofeng , Dai Jianghong , Yan Hong
Published: May 2022

Purpose

To investigate the potential causal link between heredity, geographical environment, diet and other lifestyle factors with long-term health consequences, we established the Xinjiang Multiethnic Cohort Study (XMC), the first large-scale prospective cohort in Xinjiang, China.

Participants

XMC commenced in 2018 and enrolled participants from three study sites (Urumqi, Hotan and Ili) in Xinjiang, China. Data collected include standard baseline questionnaire, physical measurement, biological specimen. In addition, about one-third of participants were assessed habitual diet by a more detailed semiquantitative food frequency questionnaire which included 127 foods items at baseline

Findings to date

Finally, a total of 30 949 participants, with 32.37% from Urumqi, 41.75% from Hotan, and 25.88% from Ili were recruited in XMC. The average age of participants was 56.21 years for men, and 54.75 years for women. More than 60% of participants in all three survey sites reported an average consumption of fruit and vegetable three or more times per week. In Hotan and Ili, the staple food was wheaten food, whereas, in Urumqi, rice and wheaten food was the food staples. Consumption of white meat, such as fish and poultry, was lower in the three survey locations. Based on self-reported disease from study participants, the five most common chronic diseases among participants across all three survey locations were dyslipidaemia, hypertension, cholecystitis, diabetes, ischaemic heart disease.

Future plans

First, we will collect all health-related records of the study participants in January each year for the previous year. Second, 10% of subjects were randomly selected for telephone follow-up in the final year of cohort building. Finally, as planned, we will revisit the study subjects on site every 2–3 years. Again, we will conduct face-to-face questionnaires and collect biological specimens such as blood and urine from the study subjects.
Socioeconomic differences in recruitment and sickness absence in a large NHS health organisation: a cross-sectional study
Authors: Daras Konstantinos , Baker Wesam , Rafferty Joe , Oates Amanda , Edwards Louise , Wyatt Steven , Barr Benjamin
Published: May 2022

Objective

This study investigates the distribution of the workforce of one large National Health Service (NHS) employer in relation to socioeconomic deprivation and how sickness absence rates varied across these levels of deprivation.

Design

Share of the working age population that was employed at the NHS organisation mapped by area deprivation. The study used negative binomial regression models to investigate the extent to which wage level, occupational group and area deprivation were associated with sickness absence among employees.

Setting

The study used electronic staff records (2018–2019) of a large NHS organisation in the North West of England.

Results

In the most deprived areas, an additional person per 1000 working age population were employed at this NHS organisation compared with the most affluent areas. Employees from the most deprived quintile had 1.41 (95% CI 1.16 to 1.70) times the higher sickness rates than the employees from the least deprived quintile, when adjusting for age and sex. These differences were largely explained by differences in wage levels and occupation groups, with the lowest wage employees having 2.5 (95% CI 1.87 to 3.42) times the sickness absence rate as the highest wage group and the nursing and midwifery employees having 1.8 (95% CI 1.50 to 2.24) times the sickness absence rate as the administrative and clerical group.

Conclusion

This large NHS organisation employed people disproportionately from deprived areas. They were considerably more likely to experience sickness absence compared with people from affluent areas. This appears to be because they were more likely to be in lower wage employment and employed in nursing and nursing assistant. Workplace health policies need to target these workers, adapting to their needs while enabling improvements in their working conditions, pay and career progression.
Continuity of community-based healthcare provision during COVID-19: a multicountry interrupted time series analysis
Authors: Ballard Madeleine , Olsen Helen E , Millear Anoushka , Yang Jane , Whidden Caroline , Yembrick Amanda , Thakura Dianne , Nuwasiima Afra , Christiansen Molly , Ressler Daniele J , Omwanda Wycliffe Okoth , Lassala Diego , Palazuelos Daniel , Westgate Carey , Munyaneza Fabien
Published: May 2022

Background

Pandemics often precipitate declines in essential health service utilisation, which can ultimately kill more people than the disease outbreak itself. There is some evidence, however, that the presence of adequately supported community health workers (CHWs), that is, financially remunerated, trained, supplied and supervised in line with WHO guidelines, may blunt the impact of health system shocks. Yet, adequate support for CHWs is often missing or uneven across countries. This study assesses whether adequately supported CHWs can maintain the continuity of essential community-based health service provision during the COVID-19 pandemic.

Methods

Interrupted time series analysis. Monthly routine data from 27 districts across four countries in sub-Saharan Africa were extracted from CHW and facility reports for the period January 2018–June 2021. Descriptive analysis, null hypothesis testing, and segmented regression analysis were used to assess the presence and magnitude of a possible disruption in care utilisation after the earliest reported cases of COVID-19.

Results

CHWs across all sites were supported in line with the WHO Guideline and received COVID-19 adapted protocols, training and personal protective equipment within 45 days after the first case in each country. We found no disruptions to the coverage of proactive household visits or integrated community case management (iCCM) assessments provided by these prepared and protected CHWs, as well as no disruptions to the speed with which iCCM was received, pregnancies were registered or postnatal care received.

Conclusion

CHWs who were equipped and prepared for the pandemic were able to maintain speed and coverage of community-delivered care during the pandemic period. Given that the majority of CHWs globally remain unpaid and largely unsupported, this paper suggests that the opportunity cost of not professionalising CHWs may be larger than previously estimated, particularly in light of the inevitability of future pandemics.
Interventions for the prevention of spontaneous preterm birth: a scoping review of systematic reviews
Authors: Campbell Fiona , Salam Shumona , Sutton Anthea , Jayasooriya Shamanthi Maya , Mitchell Caroline , Amabebe Emmanuel , Balen Julie , Gillespie Bronwen M , Parris Kerry , Soma-Pillay Priya , Chauke Lawrence , Narice Brenda , Anumba Dilichukwu O
Published: May 2022

Background

Globally, 11% of babies are born preterm each year. Preterm birth (PTB) is a leading cause of neonatal death and under-five mortality and morbidity, with lifelong sequelae in those who survive. PTB disproportionately impacts low/middle-income countries (LMICs) where the burden is highest.

Objectives

This scoping review sought to the evidence for interventions that reduce the risk of PTB, focusing on the evidence from LMICs and describing how context is considered in evidence synthesis.

Design

We conducted a scoping review, to describe this wide topic area. We searched five electronic databases (2009–2020) and contacted experts to identify relevant systematic reviews of interventions to reduce the risk of PTB. We included published systematic reviews that examined the effectiveness of interventions and their effect on reducing the risk of PTB. Data were extracted and is described narratively.

Results

139 published systematic reviews were included in the review. Interventions were categorised as primary or secondary. The interventions where the results showed a greater effect size and consistency across review findings included treatment of syphilis and vaginal candidiasis, vitamin D supplementation and cervical cerclage. Included in the 139 reviews were 1372 unique primary source studies. 28% primary studies were undertaken in LMIC contexts and only 4.5% undertaken in a low-income country (LIC) Only 10.8% of the reviews sought to explore the impact of context on findings, and 19.4% reviews did not report the settings or the primary studies.

Conclusion

This scoping review highlights the lack of research evidence derived from contexts where the burden of PTB globally is greatest. The lack of rigour in addressing contextual applicability within systematic review methods is also highlighted. This presents a risk of inappropriate and unsafe recommendations for practice within these contexts. It also highlights a need for primary research, developing and testing interventions in LIC settings.
Comorbidities in osteoarthritis (ComOA): a combined cross-sectional, case–control and cohort study using large electronic health records in four European countries
Authors: Swain Subhashisa , Kamps Anne , Runhaar Jos , Dell'Isola Andrea , Turkiewicz Aleksandra , Robinson Danielle , Strauss V , Mallen Christian , Kuo Chang-Fu , Coupland Carol , Doherty Michael , Sarmanova Aliya , Prieto-Alhambra Daniel , Englund Martin , Bierma-Zeinstra Sita M A , Zhang Weiya
Published: May 2022

Introduction

Osteoarthritis (OA) is one of the leading chronic conditions in the older population. People with OA are more likely to have one or more other chronic conditions than those without. However, the temporal associations, clusters of the comorbidities, role of analgesics and the causality and variation between populations are yet to be investigated. This paper describes the protocol of a multinational study in four European countries (UK, Netherlands, Sweden and Spain) exploring comorbidities in people with OA.

Methods and analysis

This multinational study will investigate (1) the temporal associations of 61 identified comorbidities with OA, (2) the clusters and trajectories of comorbidities in people with OA, (3) the role of analgesics on incidence of comorbidities in people with OA, (4) the potential biomarkers and causality between OA and the comorbidities, and (5) variations between countries.

A combined case–control and cohort study will be conducted to find the temporal association of OA with the comorbidities using the national or regional health databases. Latent class analysis will be performed to identify the clusters at baseline and joint latent class analysis will be used to examine trajectories during the follow-up. A cohort study will be undertaken to evaluate the role of non-steroidal anti-inflammatory drugs (NSAIDs), opioids and paracetamol on the incidence of comorbidities. Mendelian randomisation will be performed to investigate the potential biomarkers for causality between OA and the comorbidities using the UK Biobank and the Rotterdam Study databases. Finally, a meta-analyses will be used to examine the variations and pool the results from different countries.

Ethics and dissemination

Research ethics was obtained according to each database requirement. Results will be disseminated through the FOREUM website, scientific meetings, publications and in partnership with patient organisations.
Impact of employing primary healthcare professionals in emergency department triage on patient flow outcomes: a systematic review and meta-analysis
Authors: Jeyaraman Maya M , Alder Rachel N , Copstein Leslie , Al-Yousif Nameer , Suss Roger , Zarychanski Ryan , Doupe Malcolm B , Berthelot Simon , Mireault Jean , Tardif Patrick , Askin Nicole , Buchel Tamara , Rabbani Rasheda , Beaudry Thomas , Hartwell Melissa , Shimmin Carolyn , Edwards Jeanette , Halas Gayle , Sevcik William , Tricco Andrea C , Chochinov Alecs , Rowe Brian H , Abou-Setta Ahmed M
Published: May 2022

Objectives

To identify, critically appraise and summarise evidence on the impact of employing primary healthcare professionals (PHCPs: family physicians/general practitioners (GPs), nurse practitioners (NP) and nurses with increased authority) in the emergency department (ED) triage, on patient flow outcomes.

Methods

We searched Medline (Ovid), EMBASE (Ovid), Cochrane Library (Wiley) and CINAHL (EBSCO) (inception to January 2020). Our primary outcome was the time to provider initial assessment (PIA). Secondary outcomes included time to triage, proportion of patients leaving without being seen (LWBS), length of stay (ED LOS), proportion of patients leaving against medical advice (LAMA), number of repeat ED visits and patient satisfaction. Two independent reviewers selected studies, extracted data and assessed study quality using the National Institute for Health and Care Excellence quality assessment tool.

Results

From 23 973 records, 40 comparative studies including 10 randomised controlled trials (RCTs) and 13 pre–post studies were included. PHCP interventions were led by NP (n=14), GP (n=3) or nurses with increased authority (n=23) at triage. In all studies, PHCP-led intervention effectiveness was compared with the traditional nurse-led triage model. Median duration of the interventions was 6 months. Study quality was generally low (confounding bias); 7 RCTs were classified as moderate quality. Most studies reported that PHCP-led triage interventions decreased the PIA (13/14), ED LOS (29/30), proportion of patients LWBS (8/10), time to triage (3/3) and repeat ED visits (5/6), and increased the patient satisfaction (8/10). The proportion of patients LAMA did not differ between groups (3/3). Evidence from RCTs (n=8) as well as other study designs showed a significant decrease in ED LOS favouring the PHCP-led interventions.

Conclusions

Overall, PHCP-led triage interventions improved ED patient flow metrics. There was a significant decrease in ED LOS irrespective of the study design, favouring the PHCP-led interventions. Evidence from well-designed high-quality RCTs is required prior to widespread implementation.

PROSPERO registration number

CRD42020148053.
Comparative safety and efficacy of cognitive enhancers for Alzheimer’s dementia: a systematic review with individual patient data network meta-analysis
Authors: Veroniki Areti Angeliki , Ashoor Huda M , Rios Patricia , Seitidis Georgios , Stewart Lesley , Clarke Mike , Tudur-Smith Catrin , Mavridis Dimitris , Hemmelgarn Brenda R , Holroyd-Leduc Jayna , Straus Sharon E , Tricco Andrea C
Published: May 2022

Objective

To examine the comparative efficacy and safety of cognitive enhancers by patient characteristics for managing Alzheimer’s dementia (AD).

Design

Systematic review and individual patient data (IPD) network meta-analysis (NMA) based on our previously published systematic review and aggregate data NMA.

Data sources

MEDLINE, Embase, Cochrane Methodology Register, CINAHL, AgeLine and Cochrane Central Register of Controlled Trials up to March 2016.

Participants

80 randomised controlled trials (RCTs) including 21 138 adults with AD, and 12 RCTs with IPD including 6906 patients.

Interventions

Cognitive enhancers (donepezil, rivastigmine, galantamine and memantine) alone or in any combination against other cognitive enhancers or placebo.

Data extraction and synthesis

We requested IPD from authors, sponsors and data sharing platforms. When IPD were not available, we used aggregate data. We appraised study quality with the Cochrane risk-of-bias. We conducted a two-stage random-effects IPD-NMA, and assessed their findings using CINeMA (Confidence in Network Meta-Analysis).

Primary and secondary outcomes

We included trials assessing cognition with the Mini-Mental State Examination (MMSE), and adverse events.

Results

Our IPD-NMA compared nine treatments (including placebo). Donepezil (mean difference (MD)=1.41, 95% CI: 0.51 to 2.32) and donepezil +memantine (MD=2.57, 95% CI: 0.07 to 5.07) improved MMSE score (56 RCTs, 11 619 participants; CINeMA score: moderate) compared with placebo. According to P-score, oral rivastigmine (OR=1.26, 95% CI: 0.82 to 1.94, P-score=16%) and donepezil (OR=1.08, 95% CI: 0.87 to 1.35, P-score=30%) had the least favourable safety profile, but none of the estimated treatment effects were sufficiently precise when compared with placebo (45 RCTs, 15 649 patients; CINeMA score: moderate to high). For moderate-to-severe impairment, donepezil, memantine and their combination performed best, but for mild-to-moderate impairment donepezil and transdermal rivastigmine ranked best. Adjusting for MMSE baseline differences, oral rivastigmine and galantamine improved MMSE score, whereas when adjusting for comorbidities only oral rivastigmine was effective.

Conclusions

The choice among the different cognitive enhancers may depend on patient’s characteristics. The MDs of all cognitive enhancer regimens except for single-agent oral rivastigmine, galantamine and memantine, against placebo were clinically important for cognition (MD larger than 1.40 MMSE points), but results were quite imprecise. However, two-thirds of the published RCTs were associated with high risk of bias for incomplete outcome data, and IPD were only available for 15% of the included RCTs.

PROSPERO registration number

CRD42015023507.
What is the suitability of clinical vignettes in benchmarking the performance of online symptom checkers? An audit study
Authors: El-Osta Austen , Webber Iman , Alaa Aos , Bagkeris Emmanouil , Mian Saba , Taghavi Azar Sharabiani Mansour , Majeed Azeem
Published: May 2022

Objective

Assess the suitability of clinical vignettes in benchmarking the performance of online symptom checkers (OSCs).

Design

Observational study using a publicly available free OSC.

Participants

Healthily OSC, which provided consultations in English, was used to record consultation outcomes from two lay and four expert inputters using 139 standardised patient vignettes. Each vignette included three diagnostic solutions and a triage recommendation in one of three categories of triage urgency. A panel of three independent general practitioners interpreted the vignettes to arrive at an alternative set of diagnostic and triage solutions. Both sets of diagnostic and triage solutions were consolidated to arrive at a final consolidated version for benchmarking.

Main outcome measures

Six inputters simulated 834 standardised patient evaluations using Healthily OSC and recorded outputs (triage solution, signposting, and whether the correct diagnostic solution appeared first or within the first three differentials). We estimated Cohen’s kappa to assess how interpretations by different inputters could lead to divergent OSC output even when using the same vignette or when compared with a separate panel of physicians.

Results

There was moderate agreement on triage recommendation (kappa=0.48), and substantial agreement on consultation outcomes between all inputters (kappa=0.73). OSC performance improved significantly from baseline when compared against the final consolidated diagnostic and triage solution (p<0.001).

Conclusions

Clinical vignettes are inherently limited in their utility to benchmark the diagnostic accuracy or triage safety of OSC. Real-world evidence studies involving real patients are recommended to benchmark the performance of OSC against a panel of physicians.
Association between platelets and in-hospital mortality in critically ill patients with tumours: a retrospective cohort study
Authors: Zhao Chaofen , Qin Zuoan , Tang Yaxue , Liu Lina , Li Yuanyuan , He Qianyong , Jiang Jieqing , Chen Yue , Li Yuxin , Zhu Shaoyuan , Xu Xinyu , Zhou Ding’an , Jin Feng
Published: May 2022

Objectives

Platelet count is an independent predictor of mortality in patients with cancer. It remains unknown whether the platelet count is related to in-hospital mortality in severely ill patients with tumours.

Design

A retrospective study based on a dataset from a multicentre cohort.

Setting

This was a secondary analysis of data from one Electronic Intensive Care Unit Collaborative Research Database survey cycle (2014–2015).

Participants

The data pertaining to severely ill patients with tumours were collected from 208 hospitals located across the USA. This study initially a total of 200 859 participants. After the population was limited to patients with combined tumours and platelet deficiencies, the remaining 2628 people were included in the final data analysis.

Primary and secondary outcome measures

The main measure was the platelet count, and the main outcome was in-hospital mortality.

Results

After adjustment for the covariates, the platelet count had a curvilinear relationship with in-hospital mortality (p<0.001). The first inflection point was 18.4 (per 10 change). On the left side of the first inflection point (platelet count ≤184 'x10ˆ9/L), an increase of 10 in the platelet count was negatively associated with in-hospital mortality (OR 0.92, 95% CI 0.89 to 0.95, p<0.001). The second inflection point was 44.5 (per 10 change). Additional increases of 10 in the platelet count thereafter were positively associated with hospital mortality (OR 1.13, 95% CI 1.00 to 1.28, p=0.0454). The baseline platelet count was in the range of 184 'x10ˆ9/L–445 'x10ˆ9/L(p=0.0525), and the hospital mortality was lower than the baseline platelet count in other ranges.

Conclusions

The relationship between platelet count and in-hospital mortality in critically ill patients with tumours was curvilinear. The lowest in-hospital mortality was associated with platelet count between 184 'x10ˆ9/Land 445 'x10ˆ9/L. This indicates that both high and low platelet count should receive attention in clinical practice.