bluuebunny/crossref_metadata_2025 huggingface dataset:
Temporal trends in respiratory care and bronchopulmonary dysplasia in very preterm infants over a 10-year period in Spain
Authors: Avila-Alvarez Alejandro , Zozaya Carlos , Pértega-Diaz Sonia , Sanchez-Luna Manuel , Iriondo-Sanz Martin , Elorza Maria Dolores , García-Muñoz Rodrigo Fermín
Published: July 2021

Objective

To evaluate trends in respiratory care practices and bronchopulmonary dysplasia (BPD) among very preterm infants born in Spain between 2010 and 2019.

Study design

This was a retrospective cohort study of data obtained from a national population-based database (SEN1500 network). Changes in respiratory care and BPD-free survival of infants with gestational age (GA) of 230–316 weeks and <1500 g were assessed over two 5-year periods. Temporal trends were examined by joinpoint and Poisson regression models and expressed as the annual per cent change and adjusted relative risk (RR) for the change per year.

Results

A total of 17 952 infants were included. In the second period, infants were less frequently intubated in the delivery room and during neonatal intensive care unit stay. This corresponded with an increase in use of non-invasive ventilation techniques. There were no significant differences between the periods in BPD-free survival or survival without moderate-to-severe BPD. After adjusting for covariates, the RR for the change per year was significant for the following variables: never intubated (RR 1.03, 95% CI 1.02 to 1.04); intubation in the delivery room (RR 0.98, 95% CI 0.97 to 0.99); use of nasal intermittent positive pressure ventilation (RR 1.08, 95% CI 1.05 to 1.11); and BPD-free survival (only in the group with the lowest GA; RR 0.98, 95% CI 0.97 to 0.99).

Conclusion

Our findings reveal significant changes in respiratory care practices between 2009 and 2019. Despite an increase in use of non-invasive respiratory strategies, BPD-free survival did not improve and even worsened in the group with the lowest GA (230–256).
Adult nasal chondromesenchymal hamartoma: a rare and benign tumour with aggressive malignant transformation
Authors: Collins Rachael , Lafford George , Meghji Sheneen , Burrows Stuart
Published: July 2021

Nasal chondromesenchymal hamartoma (NCMH) is an extremely rare benign tumour of the nasal cavity predominantly described in infants. We report a case involving a 48-year-old woman who had been diagnosed with NCMH a year earlier and now re-presented with a short history of progressive nasal blockage, recurrent epistaxis and orbital apex syndrome. Histopathology was suggestive of malignant transformation into sinonasal sarcoma. However, following multidisciplinary team (MDT) discussions, including second and third opinions from external departments, the histological diagnosis was revised to ‘NCMH with bizarre stromal cells’. Despite this, the lesion demonstrated malignant features of rapid, invasive growth and was treated with palliative radiotherapy. The patient later developed radiological evidence of lung and liver metastases with subsequent pulmonary emboli. Shortly after this, she passed away. This case is unique in its diagnostic challenge, with ambiguous histopathological findings, and highlights the importance of an MDT approach when managing complex sinonasal tumours.
Multiorgan thrombosis as a complication of COVID-19 pneumonia
Authors: Ceci Bonello Etienne , Casha Ramon , Xerri Thelma , Bonello John , Fsadni Claudia , Mallia Azzopardi Charles
Published: July 2021

A 47-year-old man, positive for SARS-CoV-2, was diagnosed with acute coronary syndrome (ACS) complicated by myocarditis on a background of COVID-19 pneumonia. He was medically treated for ACS; however, 3 days into his admission, the patient developed neurological complications confirmed on MRI of the brain. MRI showed established infarcts involving a large part of the left temporal lobe and right occipital lobe, with minor foci of micro-haemorrhagic transformation in the left temporal lobe. A left ventricular mural thrombus was then confirmed on echocardiogram, and this was attributed as the cause of his neurological infarct. Further infarctions in the kidneys and spleen, and thrombi in the superior mesenteric and left femoral artery were also identified on imaging of the abdomen. The left ventricular mural thrombus was removed surgically via a midline sternotomy incision under general anaesthesia. Surgery was successful and the patient was discharged to a rehabilitation centre.
Spatial clustering and contextual factors associated with hospitalisation and deaths due to COVID-19 in Sweden: a geospatial nationwide ecological study
Authors: Fonseca-Rodríguez Osvaldo , Gustafsson Per E , San Sebastián Miguel , Connolly Anne-Marie Fors
Published: July 2021

Introduction

In Sweden, thousands of hospitalisations and deaths due to COVID-19 were reported since the pandemic started. Considering the uneven spatial distribution of those severe outcomes at the municipality level, the objective of this study was, first, to identify high-risk areas for COVID-19 hospitalisations and deaths, and second, to determine the associated contextual factors with the uneven spatial distribution of both study outcomes in Sweden.

Methods

The existences of spatial autocorrelation of the standardised incidence (hospitalisations) ratio and standardised mortality ratio were investigated using Global Moran’sItest. Furthermore, we applied the retrospective Poisson spatial scan statistics to identify high-risk spatial clusters. The association between the contextual demographic and socioeconomic factors and the number of hospitalisations and deaths was estimated using a quasi-Poisson generalised additive regression model.

Results

Ten high-risk spatial clusters of hospitalisations and six high-risk clusters of mortality were identified in Sweden from February 2020 to October 2020. The hospitalisations and deaths were associated with three contextual variables in a multivariate model: population density (inhabitants/km2) and the proportion of immigrants (%) showed a positive association with both outcomes, while the proportion of the population aged 65+ years (%) showed a negative association.

Conclusions

Our study identified high-risk spatial clusters for hospitalisations and deaths due to COVID-19 and the association of population density, the proportion of immigrants and the proportion of people aged 65+ years with those severe outcomes. Results indicate where public health measures must be reinforced to improve sustained and future disease control and optimise the distribution of resources.
Global burden of post-traumatic stress disorder and major depression in countries affected by war between 1989 and 2019: a systematic review and meta-analysis
Authors: Hoppen Thole H , Priebe Stefan , Vetter Inja , Morina Nexhmedin
Published: July 2021

Objective

Extensive research has demonstrated high prevalences of post-traumatic stress disorder (PTSD) and major depression (MD) in war-surviving populations. However, absolute estimates are lacking, which may additionally inform policy making, research and healthcare. We aimed at estimating the absolute global prevalence and disease burden of adult survivors of recent wars (1989–2019) affected by PTSD and/or MD.

Methods

We conducted a systematic literature search and meta-analysis of interview-based epidemiological surveys assessing the prevalence of PTSD and/or MD in representative samples from countries with a recent war history (1989–2019). Drawing on the war definition and geo-referenced data of the Uppsala Conflict Database Programme and population estimates of the United Nations for 2019, we extrapolated the meta-analytic results to absolute global numbers of affected people. Drawing on disability-adjusted life years (DALYs) data of the Global Burden of Diseases Study 2019, we further calculated the PTSD-associated and MD-associated DALYs.

Results

Twenty-two surveys (N=15 420) for PTSD, 13 surveys for MD (N=9836) and six surveys on the comorbidity of PTSD and MD (N=1131) were included. Random effects meta-analyses yielded point prevalences of 26.51% for PTSD and 23.31% for MD. Of those affected by PTSD, 55.26% presented with comorbid MD. Prevalence rates were not significantly associated with war intensity and length, time since war, response rate or survey quality. The extrapolation yielded 316 million adult war-survivors globally who suffered from PTSD and/or MD in 2019. War-survivors were almost exclusively living in low/middle-income countries (LMICs) and carried a burden of 3 105 387 and 4 083 950 DALYs associated with PTSD and MD, respectively.

Conclusions

Since LMICs lack sufficient funding and qualified professionals to provide evidence-based psychological treatments for such large numbers of affected people, alternative and scalable strategies using existing resources in primary care and communities are required. Research is required to assist upscaling.
Adopting an ethical approach to migration health policy, practice and research
Authors: Onarheim Kristine Husøy , Wickramage Kolitha , Ingleby David , Subramani Supriya , Miljeteig Ingrid
Published: July 2021

Migration health is affected by decision making at levels ranging from global to local, both within and beyond the health sector. These decisions impact seeking, entitlements, service delivery, policy making and knowledge production on migration health. It is key that ethical challenges faced by decision makers are recognised and addressed in research and data, clinical practice and policy making on migration health. An ethical approach can provide methods to identify ethical issues, frameworks for systematising information and suggesting ethically acceptable solutions, and guidance on procedural concerns and legitimate decision making processes. By unpacking dilemmas, conflicts of interests and values at stake, an ethical approach is relevant for all who make decisions about migration health policy and practice. Adopting an ethical approach to migration health benefits governments, organisations, policy makers, health workers, data managers, researchers and migrants themselves. First, it highlights the inherent normative questions and trade-offs at stake in migration health. Second, it assists decision makers in deciding what is the ethically justifiable thing to do through an ‘all things considered’ approach. Third, ethical frameworks and technical guidance set normative and practical standards for decision makers facing ethical questions – from ‘bedside rationing’ to collection of big data or in policy making – that can ensure that migrants’ interests are considered. Fourth, there is a need for greater transparency and accountability in decision making, as well as meaningful participation of migrant groups. An ethical approach connects to public health, economic and human rights arguments and highlights the urgent need to mainstream concerns for migrants in global and national health responses.
Are interventions to improve cardiovascular disease risk factors in premenopausal women effective? A systematic review and meta-analysis
Authors: Gao Lan , Faller Jan , Majmudar Ishani , Nguyen Phuong , Moodie Marj
Published: July 2021

Objectives

Non-traditional risk factors place young women at increased risk of cardiovascular disease (CVD) over their lifetime. The current study undertakes a systematic review and meta-analysis of randomised controlled trials (RCTs) that examined the effectiveness of primary prevention interventions for CVD in premenopausal women.

Methods

An electronic literature search was performed in key databases in July 2018 and updated in May 2020. RCTs that recruited predominately female participants with a proportion aged under 55 years and that compared primary prevention interventions of CVD with usual practice were included. Two reviewers undertook the selection process for study inclusion. Meta-analysis was conducted for studies based on the same intervention in order to synthesise the results.

Results

14 RCTs with sample size ranging from 49 to 39 876 were included. Interventions included diet (2), vitamin E/antioxidants (3), lifestyle modification programme (7) and aspirin (2). The meta-analysis results indicated that diet nor vitamin E/antioxidant did not significantly lower the CVD risk profiles, while lifestyle modification programme involving components of lifestyle education, counselling and multiple follow-ups showed great potential to improve risk profiles. The lifestyle modification intervention improved blood pressure (−2.11 mm Hg, 95% CI −4.32 to 0.11, for systolic and −3.31 mm Hg (95% CI −4.72 to −1.91, for diastolic), physical activity (30.72 MET-min/week, 95% CI 23.57 to 37.87, for moderate physical activity 12.70 MET-min/week, 95% CI 8.27 to 17.14, for vigorous physical activity) and fasting blood glucose (−0.37 mmol/L, 95% CI −0.58 to −0.15). Subgroup meta-analysis in studies with a mean age under 51 years old suggested that lifestyle modification intervention remained to be effective in improving physical activity and fasting blood glucose.

Conclusion

The effective interventions identified in this review although with a small sample size and short duration could potentially inform future design of primary prevention of CVD in premenopausal women.
Retrospective cohort study of androgen deprivation therapy and the risk of diabetes in men with prostate cancer in Lithuania
Authors: Drevinskaite Mingaile , Patasius Ausvydas , Kincius Marius , Urbonas Vincas , Smailyte Giedre
Published: July 2021

Objectives

To examine the risk of type 2 diabetes in patients with prostate cancer and its association with androgen deprivation therapy (ADT).

Design and participants

We performed a retrospective cohort study of patients diagnosed with prostate cancer in the Lithuanian male population between 1 January 2003 and 31 December 2012 who were identified through the Lithuanian Cancer registry. All prostate cancer cases were linked to the National Health Insurance Fund database to obtain information regarding the diagnosis of diabetes mellitus and information on prescriptions of antiandrogens and gonadotropin-releasing hormone (GnRH) agonists. Patients with prostate cancer were followed up until the diagnosis of type 2 diabetes, or 31 December 2017, or date of death, whichever came first. Cox proportional hazard models were used to estimate the risk of type 2 diabetes in patients with prostate cancer with or without ADT exposure.

Results

27 580 men were diagnosed with prostate cancer, out of whom 14 502 (52.6%) did not receive ADT and 13 078 (47.4%) were treated with ADT. The incidence of type 2 diabetes for all patients with prostate cancer was 7.4/1000 person-years, for men on GnRH agonists 9.0/1000 person-years and 5.8/1000 person-years for men on antiandrogens. There was an increased risk of developing type 2 diabetes comparing ADT users and non-users (HR=1.49, 95% CI 1.34 to 1.66).

Conclusion

This study showed an increased risk of diabetes in patients with prostate cancer treated with ADT in comparison to ADT-free patient cohort. GnRH agonist users showed higher susceptibility, while the group on antiandrogen monotherapy showed no such increase.
Poliovirus excretion among children with primary immune deficiency in Pakistan: a pilot surveillance study protocol
Authors: Pethani Asma Sadruddin , Kazi Zaubina , Nayyar Ujala , Shafiq-ur-Rehman Muhammad , Yousafzai Muhammad Tahir , Ondrej Mach , Saleem Ali Faisal
Published: July 2021

Introduction

Children with primary immunodeficiency disorders (PID) are more susceptible to developing viral infections and are at a substantially increased risk of developing paralytic poliomyelitis. Such children, if given oral polio vaccines tend to excrete poliovirus chronically that may lead to the propagation of highly divergent vaccine-derived poliovirus (VDPV). Consequently, they may act as a reservoir for the community by introducing an altered virus potentially imposing a risk to global polio eradication. However, the risks of chronic and prolonged excretion are not well characterised in the study context. This study seeks to establish a pilot surveillance system for successful identification and monitoring of VDPV excretion among children with PID. It will assess whether the Jeffrey Modell warning signs of PID can be used as an appropriate screening tool for PID in Pakistan.

Methods and analysis

In this pilot surveillance, recruitment of PID cases is currently done at participating hospitals in Pakistan. Potential children are screened and tested against the Jeffrey Modell Foundation (JMF) warning signs for immunodeficiency and their stool is collected to test for poliovirus excretion. Cases excreting poliovirus are followed until the two consecutive negative stool samples are obtained over a period of 6 months. The data will be analysed to calculate hospital-based proportions of total Immunodeficiency-related vaccine-derived poliovirus (iVDPV) cases over a 2-year period and to determine the sensitivity and specificity of the JMF signs.

Ethics and dissemination

This protocol was reviewed and approved by the WHO (WHO Reference-2018/811124-0), Aga Khan University (AKU ERC-2018-0380-1029) and National Bioethics Committee (Ref No. 4-87 NBC-308-Y2). The results will be published in an open access peer-reviewed scientific journal and presented to the iVDPV Working Group members, policy-makers, paediatric consultants and fellow researchers with the same domain interest. It may be presented in scientific conferences and seminars in the form of oral or poster presentations.
Use of complexity theory in health and social care: a scoping review protocol
Authors: Carroll Aine , Stokes Diarmuid , Darley Andrew
Published: July 2021

Introduction

Despite the use of a wide variety of improvement tools and approaches, healthcare organisations continue to struggle in several key areas. Complexity-informed approaches have the potential to offer health and social care a new paradigm for understanding, designing, implementing and evaluating solutions, yet so far has failed to gain the traction anticipated some years ago. There is a growing need for high quality syntheses of the existing knowledge base in this area and given the diversity of theory and approaches, a scoping review is the best approach to curate this knowledge.

Methods

A scoping review of relevant literature from January 2000 to present, using the refined Arksey and O’Malley six-stage framework will be conducted. This protocol will follow the Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols Extension for Scoping Reviews. A three-step search strategy will be used. An initial search of databases will be undertaken to identify key search terms followed by an analysis of retrieved papers title and abstract text words, and of index terms used to describe the articles. A second search using all identified keywords and index terms will then be undertaken across all included databases. Third, the reference lists of identified reports and articles will be searched. Authors of primary articles will be contacted and a search for grey material performed. Finally, a complete search strategy of one major database will be included.

Ethics and dissemination

As this is a scoping review, ethical approval is not required. The results of the scoping review will be published in a peer-reviewed journal and presented at national and international conferences and will guide a large research project investigating teamwork. All data will be stored in accordance with best General Data Protection Regulation practice.

Registration

This scoping review protocol has been registered with Open Science Framework.
Single-arm, open-label, multicentre first in human study to evaluate the safety and performance of dural sealant patch in reducing CSF leakage following elective cranial surgery: the ENCASE trial
Authors: Van Doormaal Tristan , Germans Menno R , Sie Mariska , Brouwers Bart , Carlson Andrew , Dankbaar Jan Willem , Fierstra Jorn , Depauw Paul , Robe Pierre , Regli Luca
Published: July 2021

Objective

The dural sealant patch (DSP) is designed for watertight dural closure after cranial surgery. The goal of this study is to assess, for the first time, safety and performance of the DSP as a means of reducing cerebrospinal fluid (CSF) leakage in patients undergoing elective cranial intradural surgery with a dural closure procedure.

Design

First in human, open-label, single-arm, multicentre study with 360-day (12 months) follow-up.

Setting

Three large tertiary reference neurosurgical centres, two in the Netherlands and one in Switzerland.

Participants

Forty patients undergoing elective cranial neurosurgical procedures, stratified into 34 supratentorial and six infratentorial trepanations.

Intervention

Each patient received one DSP after cranial surgery and closure of the dura mater with sutures.

Outcome measures

Primary composite endpoint was occurrence of one of the following events: postoperative percutaneous CSF leakage, intraoperative leakage at 20 cm H2O positive end-expiratory pressure or postoperative wound infection. Overall success was defined as achieving the primary endpoint in no more than two patients. Secondary endpoints were device-related serious adverse events or adverse events (AEs), pseudomeningocele and thickness of dura+DSP. Additional endpoints were reoperation in 30 days and user satisfaction.

Results

No patients met the primary endpoint. No device-related (serious) AEs were observed. There were two incidences of self-limiting pseudomeningocele as confirmed on MRI. Thickness of dura and DSP were (mean±SD) 3.5 mm±2.0 at day 7 and 2.1 mm±1.2 at day 90. No patients were reoperated within 30 days. Users reported a satisfactory design and intuitive application.

Conclusions

DSP, later officially named Liqoseal, is a safe and potentially efficacious device for reducing CSF leakage after intracranial surgery, with favourable clinical handling characteristics. A randomised controlled trial is needed to assess Liqoseal efficacy against the best current practice for reducing postoperative CSF leakage.

Trial registration number

NCT03566602.
Study protocol to develop a core outcome set for thyroid dysfunction to bridge the unmet needs of patient-centred care
Authors: Ooi Cheow Peng , Yusof Khan Abdul Hanif Khan , Abdul Manaf Rosliza , Mustafa Norlaila , Sukor Norlela , Williamson Paula R , Kamaruddin Nor Azmi
Published: July 2021

Introduction

Thyroid dysfunctions (TD) are common medical conditions affecting all global populations. Improved healthcare leading to increasing survival rates and delayed diagnosis rendered significant burden of the disease in the increasing number of patients with TD with comorbid illnesses. Therefore, reducing the burden of TD and improving the quality of care are crucial. Existing poor-quality data that guide evidence-based decisions only provide a fragmented picture of clinical care. The different outcomes across studies assessing the effectiveness of treatments impede our ability to synthesise results for determining the most efficient treatments. This project aims to produce a core outcome set (COS), which embeds the multiple complex dimensions of routine clinical care for the effectiveness studies and clinical care of adult patients with TD.

Methods and analysis

This mixed-method project has two phases. In phase 1, we will identify a list of patient-reported and clinical outcomes through qualitative research and systematic reviews. In phase 2, we will categorise the identified outcomes using the Core Outcome Measures in Effectiveness Trials taxonomy of core domains and the International Classification of Functioning, Disability and Health. We will develop questionnaires from the list of outcomes identified from each domain for the two-round online Delphi exercise, aiming to reach a consensus on the COS. The Delphi process will include patients, carers, researchers and healthcare participants. We will hold an online consensus meeting involving representatives of all key stakeholders to establish the final COS.

Ethics and dissemination

The study has been reviewed and approved by the Ethics Committee for Research Involving Human Subjects, Universiti Putra Malaysia and the Research Ethics Committee, National University of Malaysia. This proposed COS in TD will improve the value of data, facilitate high-quality evidence synthesis and evidence-based decision-making. Furthermore, we will present the results to participants, in peer-reviewed academic journals and conferences.

Registration details

Core Outcome Measures in Effectiveness Trials (COMET) Initiative database registration:http://www.comet-initiative.org/studies/details/1371
DEveloping Tests for Endometrial Cancer deTection (DETECT): protocol for a diagnostic accuracy study of urine and vaginal samples for the detection of endometrial cancer by cytology in women with postmenopausal bleeding
Authors: Jones Eleanor R , Carter Suzanne , O"Flynn Helena , Njoku Kelechi , Barr Chloe E , Narine Nadira , Shelton David , Rana Durgesh , Crosbie Emma J
Published: July 2021

Introduction

Postmenopausal bleeding (PMB), the red flag symptom for endometrial cancer, triggers urgent investigation by transvaginal ultrasound scan, hysteroscopy and/or endometrial biopsy. These investigations are costly, invasive and often painful or distressing for women. In a pilot study, we found that voided urine and non-invasive vaginal samples from women with endometrial cancer contain malignant cells that can be identified by cytology. The aim of theDEvelopingTests forEndometrialCancer deTection (DETECT) Study is to determine the diagnostic test accuracy of urine and vaginal cytology for endometrial cancer detection in women with PMB.

Methods and analysis

This is a multicentre diagnostic accuracy study of women referred to secondary care with PMB. Eligible women will be asked to provide a self-collected voided urine sample and a vaginal sample collected with a Delphi screener before routine clinical procedures. Pairs of specialist cytologists, blinded to participant cancer status, will assess and classify samples independently, with differences settled by consensus review or involving a third cytologist. Results will be compared with clinical outcomes from standard diagnostic tests. A sample size of 2000 women will have 80% power to establish a sensitivity of vaginal samples for endometrial cancer detection by cytology of ≥85%±7%, assuming 5% endometrial cancer prevalence. The primary objective is to determine the diagnostic accuracy of urogenital samples for endometrial cancer detection by cytology. Secondary objectives include the acceptability of urine and vaginal sampling to women.

Ethics and dissemination

This study has been approved by the North West–Greater Manchester West Research Ethics Committee (16/NW/0660) and the Health Research Authority. Results will be disseminated through publication in peer-reviewed scientific journals, presentation at conferences and via charity websites.

Trial registration number

ISRCTN58863784.
Risk of all-cause mortality associated with chronic obstructive pulmonary disease and the role of healthy ageing trajectories: a population-based study of middle-aged and older adults
Authors: Bayes-Marin Ivet , Sanchez-Niubo Albert , Fernández Daniel , Haro Josep Maria , Olaya Beatriz
Published: July 2021

Objectives

The aims were to study the risk of all-cause mortality associated with chronic obstructive pulmonary disease (COPD) and healthy ageing trajectories (HAT) in three birth cohorts and to determine the moderating role of HAT in the association between COPD and all-cause mortality.

Design

Prospective cohort study.

Setting

Data from waves 1 to 5 of The Survey of Health, Ageing and Retirement in Europe.

Participants

The total sample was 28 857 community-dwelling individuals aged 50+ years.

Main outcome

All-cause mortality associated with COPD and HAT adjusting for covariates. We performed Aalen additive hazards models to explore these associations. Interactions between COPD and HAT were also explored. Analyses were conducted separately in three birth cohorts (>1945, 1936–1945 and ≤1935). Latent class growth analysis was used to classify participants into HAT.

Results

Three parallel HAT were found in the three birth cohorts (‘low’, ‘medium’ and ‘high’ healthy ageing). Participants with COPD had an increased mortality risk, but this effect was no longer significant after adjusting for covariates. The ‘low’ HAT was associated with increased mortality risk in the three subsamples, although this effect was lower after adjustment. The interaction between COPD and HAT was significant only in the ≤1935 birth cohort, indicating that those with COPD and a ‘low’ trajectory had a greater risk of mortality.

Conclusions

The healthy ageing scale may be a suitable tool to identify patients at higher risk to mitigate disease burden and improve patients’ quality of life.
Mental health crisis in healthcare providers in the COVID-19 pandemic: a cross-sectional facility-based survey
Authors: Sung Chih-Wei , Chen Chi-Hsin , Fan Cheng-Yi , Chang Jia-How , Hung Chia Chun , Fu Chia-Ming , Wong Li Ping , Huang Edward Pei-Chuan , Lee Tony Szu-Hsien
Published: July 2021

Objectives

During a pandemic, healthcare providers experience increased mental and physical burden. Burnout can lead to treatment errors, patient mortality, increased suicidal ideation and substance abuse as well as medical malpractice suits among medical staff. This study aimed to investigate the occurrence of burnout, acute stress disorder, anxiety disorder and depressive disorder among healthcare providers at the third month of the COVID-19 pandemic.

Design

A cross-sectional facility-based survey.

Setting

Hospitals around the country with different levels of care.

Participants

A total of 1795 respondents, including 360 men and 1435 women who participated in the survey.

Primary outcome measures

Burnout was assessed using the Physician Work Life Study. A score of ≥3 implied burnout.

Results

Of the 1795 respondents, 723 (40.3%) reported burnout, and 669 (37.3%) cared for patients with COVID-19. Anxiety levels were mild in 185 (10.3%) respondents, moderate in 209 (11.6%) and severe in 1401 (78.1%). The mean Center for Epidemiologic Studies Depression Scale-10 score was 9.5±6.3, and 817 (45.5%) respondents were classified as having depression. Factors associated with burnout were working in acute and critical care (ACC) divisions (adjusted OR (aOR)=1.84, 95% CI 1.20 to 3.39, p=0.019), caring for patients with COVID-19 (aOR=3.90, 95% CI 1.14 to 13.37, p=0.031) and having depressive disorder (aOR=9.44, 95% CI 7.44 to 11.97, p<0.001).

Conclusions

Physicians and nurses are vulnerable to burnout during a pandemic, especially those working in ACC divisions. Anxiety disorder, depressive disorder and care of patients with COVID-19 may be factors that influence the occurrence of burnout among healthcare providers.
Diverse experts’ perspectives on ethical issues of using machine learning to predict HIV/AIDS risk in sub-Saharan Africa: a modified Delphi study
Authors: Nichol Ariadne A , Bendavid Eran , Mutenherwa Farirai , Patel Chirag , Cho Mildred K
Published: July 2021

Objective

To better understand diverse experts’ views about the ethical implications of ongoing research funded by the National Institutes of Health that uses machine learning to predict HIV/AIDS risk in sub-Saharan Africa (SSA) based on publicly available Demographic and Health Surveys data.

Design

Three rounds of semi-structured surveys in an online expert panel using a modified Delphi approach.

Participants

Experts in informatics, African public health and HIV/AIDS and bioethics were invited to participate.

Measures

Perceived importance of or agreement about relevance of ethical issues on 5-point unipolar Likert scales. Qualitative data analysis identified emergent themes related to ethical issues and development of an ethical framework and recommendations for open-ended questions.

Results

Of the 35 invited experts, 22 participated in the online expert panel (63%). Emergent themes were the inclusion of African researchers in all aspects of study design, analysis and dissemination to identify and address local contextual issues, as well as engagement of communities. Experts focused on engagement with health and science professionals to address risks, benefits and communication of findings. Respondents prioritised the mitigation of stigma to research participants but recognised trade-offs between privacy and the need to disseminate findings to realise public health benefits. Strategies for responsible communication of results were suggested, including careful word choice in presentation of results and limited dissemination to need-to-know stakeholders such as public health planners.

Conclusion

Experts identified ethical issues specific to the African context and to research on sensitive, publicly available data and strategies for addressing these issues. These findings can be used to inform an ethical implementation framework with research stage-specific recommendations on how to use publicly available data for machine learning-based predictive analytics to predict HIV/AIDS risk in SSA.
Travelling for abortion services in Mexico 2016–2019: community-level contexts of Mexico City public abortion clients
Authors: Jacobson Laura E , Saavedra-Avendano Biani , Fuentes-Rivera Evelyn , Schiavon Raffaela , Darney Blair G
Published: July 2021

Objective

To describe the community context of women who travel to access Mexico City’s public sector abortion programme and identify factors associated with travelling from highly marginalised settings.

Methods

We used data from the Interrupción Legal de Embarazo (ILE) programme (2016–2019) and identified all abortion clients who travelled from outside Mexico City. We merged in contextual information at the municipality level and used descriptive statistics to describe ILE clients’ individual characteristics and municipalities on several measures of vulnerability. We also compared municipalities that ILE clients travelled from with those where no one travelled from. We used logistic regression to identify factors associated with travelling to access ILE services from highly marginalised versus less marginalised municipalities.

Results

Our sample included 21 629 ILE clients who travelled to Mexico City from 491 municipalities within all 31 states outside Mexico City. The majority of clients travelled from the least marginalised (81.9%) and most populated (over 100 000 inhabitants; 91.3%) municipalities. Most (91.2%) ILE clients came from municipalities with adolescent fertility rates in the bottom three quintiles. Clients with a primary or secondary education (vs high school or more) and those from a municipality with a high adolescent fertility rate (top two quintiles) had higher odds of travelling from a highly marginalised (vs less) municipality (adjusted odds ratio (aOR) 1.46, 95% CI 1.35 to 1.58 and aOR 1.89, 95% CI 1.68 to 2.12, respectively).

Conclusion

ILE clients travel from geographically and socioeconomically diverse communities. There is an unmet need for legal abortion across Mexico.
Effect of small vs large muscle mass endurance training on maximal oxygen uptake in organ transplanted recipients
Authors: del Torto Alessio , Capelli Carlo , Peressutti Roberto , di Silvestre Adriana , Livi Ugolino , Nalli Chiara , Sponga Sandro , Amici Gianpaolo , Baccarani Umberto , Lazzer Stefano
Published: July 2021

Maximal oxygen consumption (V̇O2max) is impaired in heart (HTx), kidney (KTx), and liver (LTx) transplanted recipients and the contribution of the cardiovascular, central, and peripheral (muscular) factors in affecting V̇O2max improvement after endurance training (ET) has never been quantified in these patients. ET protocols involving single leg cycling (SL) elicit larger improvements of the peripheral factors affecting O2 diffusion and utilization than the double leg (DL) cycling ET. Therefore, this study aimed to compare the effects of SL-ET vs DL-ET on V̇O2max. We determined the DL-V̇O2max and maximal cardiac output before and after 24 SL-ET vs DL-ET sessions on 33 patients (HTx = 13, KTx = 11 and LTx = 9). The DL-V̇O2max increased by 13.8% ± 8.7 (p < 0.001) following the SL-ET, due to a larger maximal O2 systemic extraction; meanwhile, V̇O2max in DL-ET increased by 18.6% ± 12.7 (p < 0.001) because of concomitant central and peripheral adaptations. We speculate that in transplanted recipients, SL-ET is as effective as DL-ET to improve V̇O2max and that the impaired peripheral O2 extraction and/or utilization play an important role in limiting V̇O2max in these types of patients.

Novelty: SL-ET increases V̇O2max in transplanted recipients because of improved peripheral O2 extraction and/or utilization. SL-ET is as successful as DL-ET to improve the cardiorespiratory fitness in transplanted recipients. The model of V̇O2max limitation indicates the peripheral factors as a remarkable limitation to the V̇O2max in these patients.
Fighting off field dependence in MSSM Higgs-mass corrections of order $$\alpha _t\,\alpha _s$$ and $$\alpha _t^2$$
Authors: Domingo Florian , Paßehr Sebastian
Published: July 2021

The connection between gauge and Higgs sectors makes supersymmetric extensions of the Standard Model predictive frameworks for the derivation of Higgs masses. In this paper, we study the contamination of such predictions by field-renormalization constants, in the MSSM with two-loop gaugeless corrections of $$\mathcal {O}\big (\alpha _{t,b}\,\alpha _s,\,\alpha _{t,b}^2\big )$$

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b

2

)

and full momentum dependence, and demonstrate how strict perturbative expansions allow to systematically neutralize the dependence on such unphysical objects. On the other hand, the popular procedure consisting in an iterative pole search remains explicitly dependent on field counterterms. We then analyze the magnitude of the intrinsic uncertainty that this feature implies for the iterative method, both in non-degenerate and near-degenerate regimes, and conclude that this strategy does not improve on the predictions of the more straightforward expansion. We also discuss several features related to the inclusion of the orders $$\alpha _{t,b}\,\alpha _s$$

α

t
,
b

α
s

and $$\alpha _{t,b}^2$$

α

t
,
b

2

in the so-called ‘fixed-order’ approach, such as the resummation of UV-logarithms for heavy supersymmetric spectra.
Conformal Higgs model: Gauge fields can produce a 125 GeV resonance
Authors: Nesbet Robert K.
Published: July 2021

Recent cosmological observations and compatible theory offer an understanding of long-mysterious dark matter and dark energy. The postulate of universal conformal local Weyl scaling symmetry, without dark matter, modifies action integrals for both Einstein–Hilbert gravitation and the Higgs scalar field by gravitational terms. Conformal theory accounts for both observed excessive external galactic orbital velocities and for accelerating cosmic expansion. SU(2) symmetry-breaking is retained by the conformal scalar field, which does not produce a massive Higgs boson, requiring an alternative explanation of the observed LHC 125 GeV resonance. Conformal theory is shown here to be compatible with a massive neutral particle or resonance [Formula: see text] at 125 GeV, described as binary scalars [Formula: see text] and [Formula: see text] interacting strongly via quark exchange. Decay modes would be consistent with those observed at LHC. Massless scalar field [Formula: see text] is dressed by the [Formula: see text] field to produce Higgs Lagrangian term [Formula: see text] with the empirical value of [Formula: see text] known from astrophysics.
Japan and Changes of International Order: Concepts and Countermeasures
Authors: Yang Bojiang
Published: July 2021

The issue of order is the core of international relations. Both the dimensions of history and reality should be explored in order that the relationship between Japan and the world should be acknowledged in a scientific way. This paper analyzes Japan’s cognition and practice from such three aspects as the evolution of Japan’s view of international orders from a historical perspective, the post-war international order and “the crisis of liberal international order” and Japan’s responses to the international order under the ongoing unprecedented changes in the world. Based on principles of pragmatism, Japan strove to maintain its independence while expressing its respect with the order within the framework of the Hua-Yi Order. In face of the impact of rising Western civilization, Japan attempted to extricate itself from and overthrew the Hua-Yi Order and achieve the objective of “leaving Asia and embracing Europe,” and then turned from a follower of the Western dominant order into a challenger. After being defeated in WWII, the US occupation and the democratic transformation, Japan chose to accept and integrate into the liberal international order dominated by the US and gradually formed a unique view of international order through constantly sizing up the international situation, maintaining dynamic adjustment and making efforts to seek advantages and avoid disadvantages. Faced with the changing international relations nowadays, Japan has been committed to enhancing the “comprehensive strategic activity” and repairing the liberal international order in crisis. The relationship between Japan and the international order not only reflects historical continuity but also presents newly emerging characteristics.
Ruthenium-Exsolution Catalyst for Dry Reforming of Biogas
Authors: Frantz Cedric , Rumpf Lionel , López Solá Alex , Wang Ligang , Naeem Muhammad Awais , Müller Christoph R. , Van herle Jan
Published: July 2021

Solid oxide fuel cells have a proven efficiency for the direct conversion of biogas into electricity, and their full potential from European agricultural and waste-water sites still has to be fully evaluated and harnessed. Biogases are methane-rich mixtures whose composition and trace contaminants, especially of sulfur compounds, can vary greatly.

To avoid carbon deposition from the carbon-rich CH4-CO2 mixtures, some amount of steam and/or extra CO2 needs to be added to process the biogas. Ideally this can be recovered from the SOFC exhaust. In a preparatory work, biogas/SOFC integrated systems were studied and compared using Aspen Plus[1]. Best performances are reached with a catalytic methane pre-reformer when a fraction of the anode off-gas is recirculated for mixing with the biogas feed. This work provided the guidelines for the present catalytic study and predicted thermodynamic equilibria of gas mixtures.

Here, the overall performance of a ruthenium exsolution catalyst[2] for the reforming of methane was evaluated for these different biogas compositions at various gas hourly space velocities. Gas chromatography and material balance calculations enabled the full measurement of inlet and outlet gas compositions which, in turn, permitted to calculate precise conversion rates, reforming ratio, and the deviation from thermodynamic equilibrium. Methane conversion reached >95 % for a dry-dominant reforming mixture, which simplifies the overall system. The longer-term stability of the catalyst as well as its tolerance towards different sulfur traces that occur in biogas was then evaluated and analyzed.

[1] Shuai Ma, Gabriele Loreti, Ligang Wang, Andrea L. Facci, Stefano Ubertini, Changqing Dong, François Maréchal, and Jan Van herle, E3S Web of Conferences 2021 238:04002

DOI:
10.1051/e3sconf/202123804002

[2] Muhammad A. Naeem, Paula M. Abdala, Andac Armutlulu, Sung Min Kim, Alexey Fedorov, and Christoph R. Müller, ACS Catalysis 2020 10 (3), 1923-1937

DOI: 10.1021/acscatal.9b04555
Examination of Gadolinium Doped Ceria Mixed with Yttrium Stabilized Zirconia Mixed Ionic Electronic Conducting Solid Electrolytes for Use As Reversible High Temperature Cells
Authors: Dale Olivia R. , Virkar Anil , Simpson Michael
Published: July 2021

Reversible cells can be used as solid oxide fuel cells (SOFC) and solid oxide electrolyzer cells (SOEC). The solid electrolytes used for such cells frequently have pure ionic conduction with insignificant electronic conduction. A previous study (Virkar and Tao, 2015) has shown that cells made of ceria doped yttrium stabilized zirconia (YSZ), a mixed ionic electronic conducting (MIEC) material, can be made to operate at the same efficiency level and with superior stability compared to a pure ionic conductor, like pure YSZ. This work is a continuation of that study, examining the use of gadolinium doped ceria (GDC) mixed with YSZ. The MIEC cell, 8mol%GDC+YSZ, will be further tested and designed to consume fuel or water vapor, generate power or hydrogen, and release heat at the same rate as the pure ionic conducting cell, YSZ, when operating in SOFC or SOEC mode. Future testing will also determine if the GDC MIEC cell can match or exceed the durability of the ceria doped YSZ.

The electrolyte layer, made of either pure 8YSZ or 8YSZ doped with 8mol%GDC, was die pressed and sintered at 1400oC (2oC/min) for five hours. On one side of the electrolyte, the anode interlayer is mixed with isopropyl alcohol and painted on the electrolyte's surface. The anode interlayer is composed of 50wt% NiO and 50wt% 8YSZ. The cell was heated to 950oC (2oC/min) for one hour. The anode functional layer, 70wt% NiO and 30wt% 8YSZ, was painted on top of the anode interlayer. The sample was then again heated to 950oC (2oC/min) for one hour to burn off any organic compounds. A cathode interlayer was then painted on the other side of the electrolyte layer. The cathode interlayer was also painted on and consists of 50wt% lanthanum strontium manganite (LSM) and 50wt% YSZ. The cell is heated to 1200oC (2oC/min) for two hours. Finally, a pure LSM layer is painted on top as the cathode current collector material and heated to 1100oC (2oC/min) for one hour to ensure good porosity. The cells were then sealed by compression-loading at the edges using glass-mica seals.

Results of tests will be reported for both SOEC and SOFC modes at 800oC. Data to be reported include open-circuit voltage, area-specific resistance, corresponding ionic currents based on an applied voltage, and long-term durability of the two cells in both SOFC and SOEC modes.