bluuebunny/crossref_metadata_2025 huggingface dataset:
Essayism as a form of writing and a form of life
Authors: Zambito Pascal F.
Published: July 2021

As Wittgenstein still eludes classification as either an analytic or a poetic philosopher, this article considers his work under the perspective of essayism as a hybrid intellectual attitude that combines elements from both modes of thinking. Drawing on Adorno’s and Musil’s accounts, I present four characteristics of essayism that can be applied to Wittgenstein’s writing: (a) essayism does not claim access to primal knowledge or an absolute starting point of thought, but typically reacts to given ideas; (b) it is systematic insofar as it is concerned with words, things, and events in systemic contexts rather than in isolation; (c) it is anti‐systematic insofar as it neither accepts the given conceptual system nor strives for an ultimate system in which all things are in their place and all problems ultimately solved; (d) it is aware of, and emphasizes, the mediatedness of its objects and warns of any equation of the conceptual ordering with the order of reality. As a consequence, essayism goes beyond a particular text form, but concerns an attitude towards the world that manifests itself in various forms. It thus turns out to be not merely a form of writing but ultimately a form of life.
Four subtypes of childhood allergic rhinitis identified by latent class analysis
Authors: Yavuz Suleyman Tolga , Oksel Karakus Ceyda , Custovic Adnan , Kalayci Ömer
Published: July 2021

Background

Childhood allergic rhinitis (AR) is clinically heterogenous. We aimed to identify distinct phenotypes among children with AR using data‐driven techniques and to ascertain their association with patterns of symptoms, allergic sensitization, and comorbidities.

Methods

We recruited 510 children with physician‐diagnosed AR, of whom 205 (40%) had asthma. Latent class analysis (LCA) was performed to identify latent structure within the data set using 17 variables (allergic conjunctivitis, eczema, asthma, family history of asthma, family history of allergic rhinitis, skin sensitization to 8 common allergens, tonsillectomy, adenoidectomy).

Results

A four‐class solution was selected as the optimal model based on statistical fit. We labeled latent classes as: (1) AR with grass mono‐sensitization and conjunctivitis (n = 361, 70.8%); (2) AR with house dust mite sensitization and asthma (n = 75, 14.7%); (3) AR with pet and grass polysensitization and conjunctivitis (n = 35, 6.9%); and (4) AR among children with tonsils and adenoids removed (n = 39, 7.6%). Perennial AR was significantly more common among children in Class 2 (OR 5.83, 95% CI 3.42–9.94, p < .001) and Class 3 (OR 2.88, 95% CI 1.36–6.13, p = .006). Mild and intermittent AR symptoms were significantly more common in children in Class 2 compared to those in Class 1. AR was more severe in Class 1 compared to other 3 classes, indicating that upper respiratory symptoms are more severe among children with isolated seasonal rhinitis, than in those with rhinitis and coexisting asthma.

Conclusion

We have identified 4 phenotypes in school‐age children with AR, which were associated with different patterns of clinical symptoms and comorbidities.
Propofol‐induced uric acid crystals: A case of cloudy urine
Authors: Baumgarten Alexandra , Newton Mark
Published: July 2021

Propofol is an intravenous anesthetic agent commonly used intraoperatively as well as in the intensive care unit. Known short‐term effects of propofol can include apnea, hypotension, and bradycardia. In children, the rarer adverse sequelae of intravenous anesthetics have received little attention. We present the case of a thirteen‐year‐old male who incidentally developed uric acid crystals in his urine following a short‐duration propofol infusion.
Characterization of physiological traits during development of the recalcitrant seeds of Quercus serrata
Authors: Xia K. , Zhu Z.‐Q.
Published: July 2021

We investigated how developmental stage affects seed traits, including the relative level of desiccation tolerance of Quercus serrata. We tested the hypothesis that the relative level of desiccation tolerance is a quantitative trait associated with seed development and that a maximum relative level of desiccation tolerance is reached during development.

Seed growth and physiological traits of Q. serrata from a subtropical forest were examined in detail during the developmental process.

During seed development, the relative level of desiccation tolerance and other seed traits of Q. serrata varied. Dry matter accumulation in seed components increased rapidly beginning in mid‐August, and moisture content declined. At the peak period of seed dispersal in late September, seeds were fully mature, with 100% germination. Relative level of desiccation tolerance increased up to the point of peak dispersal; however, at this time seeds were still recalcitrant. Post‐mature development was accompanied by further increases in seed dry matter and decreases in moisture content, which led to a decrease in seed germination and relative level of desiccation tolerance.

Our results suggest that in species with recalcitrant seeds, the relative level of desiccation tolerance and other seed traits are quantitative at the intraspecific level. The relative level of desiccation tolerance for recalcitrant seeds does not increase infinitely during phase II of development. There is a maximum relative level of desiccation tolerance in recalcitrant seeds within a species.
Loneliness, Love, and the Limits of Language
Authors: Tietjen Ruth Rebecca , Furtak Rick Anthony
Published: July 2021

In this article, we illuminate the affective phenomenon of loneliness by exploring the question of how it relates to love and other forms of friendship. We reflect in particular on the question of how different forms of loneliness are relevant to human existence. Distinguishing three forms of loneliness, we first introduce two border cases of loneliness: unfelt loneliness in which one’s individuality is denied and one thereforecannotfeel lonely; and existential loneliness in which the possibility of intimacy and existential communication are denied and one thereforecannot butfeel lonely. We then turn to loneliness that occurs within intimate friendships—even the most intimate ones. In our analysis, we pay attention especially to the role of communication. In order to do so, we repeatedly turn to poetic expressions of loneliness. We argue that loneliness cannot reflect only the absence or partial failure of communication but also the inherent limits of communication. These limits in turn point back to the nature of human existence and love itself.
Meeting physical activity and screen time among Colombian adolescents with or without sensory‐related problems
Authors: López‐Gil José Francisco , Ramírez‐Vélez Robinson , Flórez‐López María Eugenia , Izquierdo Mikel , García‐Hermoso Antonio
Published: July 2021

The aim of this study was to assess the extent to which adolescents with and without visual and hearing‐related problems meet physical activity (PA) and recreational screen time (ST) recommendations in a representative Colombian sample. A total of 35,404 adolescents aged 13–17 years were included from the Encuesta Nacional de Salud Escolar (ENSE) (Colombia). Sociodemographic‐related information, anthropometric variables, PA, ST, and both visual‐ and hearing‐related problems were collected by self‐administered questionnaires. The prevalence of adolescents meeting with PA, ST, and both recommendations was 14.8%, 53.4%, and 7.8%, respectively. Both sexes with visual‐ (males: OR=0.70, 95%CI 0.59–0.83; females: OR=0.73, 95%CI 0.61–0.88) and hearing‐related problems (males, OR=0.75, 95%CI 0.61–0.93; females, OR=0.76, 95%CI 0.61–0.94) are less likely to meet combined recommendations. Sensory problems such as vision‐ and hearing‐related problems could be considered key barriers to engagement in PA and facilitators of recreational ST in Colombian adolescents.
Linking the Pleiades to a reawakened Black Duck Songline in Southeastern Australia
Authors: Fuller Robert S. , Bursill Leslie W.
Published: July 2021

This article presents an analysis of an Aboriginal songline in South‐eastern Australia that has not been previously recorded. As part of a project examining the astronomy and songline connections of the Saltwater Aboriginal peoples of the New South Wales coast, the Black Duck Songline was identified that may have links to the Pleiades star cluster. The Pleiades, known by many peoples as the Seven Sisters, is one of the most important elements of Aboriginal cosmologies across Australia, and features in songlines and oral traditions, as well as being a resource calendar identifier. Aboriginal songlines are a unique development of Aboriginal culture that celebrate the travels of the Creator Ancestors as they shaped the landscape. The identification of the Black Duck Songline and its possible connection to the Pleiades is an example of the potential reawakening of other long‐distance songlines in Australia and their connection to the cosmology of their communities.
A review of minimally invasive fracture stabilization in dogs and cats
Authors: Pozzi Antonio , Lewis Daniel D. , Scheuermann Logan M. , Castelli Emanuele , Longo Federico
Published: July 2021

Objective

To summarize and discuss peer‐reviewed studies on minimally invasive osteosynthesis (MIO) of long bone, physeal, and articular fractures in dogs and cats.

Study Design

Invited review.

Methods

A critique of literature was performed to assess MIO feasibility, outcomes, and complications through PubMed, Scopus, and CAB abstracts research databases (2000–2020).

Results

More than 40 MIO articles have been published in the last 15 years, but most studies had small numbers, lacked control groups, and used limited outcome measures. Studies generally showed that MIO was feasible in dogs and cats with low complication rates. The current evidence does not demonstrate superior bone healing or functional outcomes with MIO when compared to standard methods. Although treatment principles, case selection, and techniques varied depending on the anatomical location, there were no salient differences in complication rates among long bones, physeal, and articular fractures treated by MIO.

Conclusion

The current available evidence and the personal experience of the authors support MIO as a promising fracture management modality. MIO can yield excellent outcomes when applied in carefully selected cases, performed by surgeons experienced in the technique. We cannot, however, conclude that MIO is superior to open fracture stabilization based on the available evidence in veterinary literature. Randomized controlled studies are warranted to prospectively compare MIO with other osteosynthesis techniques and thereby validate its role in fracture management for dogs and cats.
Altered central and peripheral haemodynamics during rhythmic handgrip exercise in young adults with SARS‐CoV‐2
Authors: Stute Nina L. , Stickford Abigail S. L. , Stickford Jonathon L. , Province Valesha M. , Augenreich Marc A. , Bunsawat Kanokwan , Alpenglow Jeremy K. , Wray D. Walter , Ratchford Stephen M.
Published: July 2021

New Findings

What is the central question of this study?

Are central and peripheral haemodynamics during handgrip exercise different in young adults 3–4 weeks following infection with of SARS‐CoV‐2 compared with young healthy adults.

What is the main finding and its importance?

Exercising heart rate was higher while brachial artery blood flow and vascular conductance were lower in the SARS‐CoV‐2 compared with the control group. These findings provide evidence for peripheral impairments to exercise among adults with SARS‐CoV‐2, which may contribute to exercise limitations.

The novel severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) can have a profound impact on vascular function. While exercise intolerance may accompany a variety of symptoms associated with SARS‐CoV‐2 infection, the impact of SARS‐CoV‐2 on exercising blood flow (BF) remains unclear. Central (photoplethysmography) and peripheral (Doppler ultrasound) haemodynamics were determined at rest and during rhythmic handgrip (HG) exercise at 30% and 45% of maximal voluntary contraction (MVC) in young adults with mild symptoms 25 days after testing positive for SARS‐CoV‐2 (SARS‐CoV‐2: n = 8M/5F; age: 21 ± 2 years; height: 176 ± 11 cm; mass: 71 ± 11 kg) and were cross‐sectionally compared with control subjects (Control: n = 8M/5F; age: 27 ± 6 years; height: 178 ± 8 cm; mass: 80 ± 25 kg). Systolic blood pressure, end systolic arterial pressure and rate pressure product were higher in the SARS‐CoV‐2 group during exercise at 45% MVC compared with controls. Brachial artery BF was lower in the SARS‐CoV‐2 group at both 30% MVC (Control: 384.8 ± 93.3 ml min–1; SARS‐CoV‐2: 307.8 ± 105.0 ml min–1; P = 0.041) and 45% MVC (Control: 507.4 ± 109.9 ml min–1; SARS‐CoV‐2: 386.3 ± 132.5 ml min–1; P = 0.002). Brachial artery vascular conductance was lower at both 30% MVC (Control: 3.93 ± 1.07 ml min–1 mmHg–1; SARS‐CoV‐2: 3.11 ± 0.98 ml min–1 mmHg–1; P = 0.022) and 45% MVC (Control: 4.74 ± 1.02 ml min–1 mmHg–1; SARS‐CoV‐2: 3.46 ± 1.10 ml min–1 mmHg–1; P < 0.001) in the SARS‐CoV‐2 group compared to control group. The shear‐induced dilatation of the brachial artery increased similarly across exercise intensities in the two groups, suggesting the decrease in exercising BF may be due to microvascular impairments. Brachial artery BF is attenuated during HG exercise in young adults recently diagnosed with mild SARS‐CoV‐2, which may contribute to diminished exercise capacity among those recovering from SARS‐CoV‐2 like that seen in severe cases.
Key Components Related to Pressure Injury Formation: An Initial Investigation Into Pressure Distribution and Blood Perfusion Responses in Wheelchair Users
Authors: Scott Justin , Bush Tamara Reid
Published: July 2021

Soft tissue around bony prominences in the buttocks and back are high-risk areas prone to the development of pressure injuries. From a clinical perspective, prevention of pressure injuries all together is the ideal situation. Unfortunately, prevalence rates still reach 47% with recurrence rates even higher. The goals of this study were to evaluate the effects of a series of wheelchair movements, some that currently exist in commercial wheelchairs and some new, on interface pressures and perfusion under the buttocks. Twenty-seven chair positions were obtained by varying back recline, seat pan tilt, and articulation of two supports along the back. Although back recline is commonly taught by therapists to be used as a pressure relieving posture, results indicated an increase in pressures under the ischial tuberosities and sacral areas in reclined positions. Articulation of the back supports produced changes in posture moving from an “erect” to “slouched” position. These movements successfully shifted pressures across back regions. Seat pan tilt was effective in shifting pressures off the ischial tuberosity regions. Additionally, in a portion of the participants, seat pan tilt consistently increased perfusion under the ischial tuberosity region. The findings of this research suggest that movements other than back recline should be considered to more effectively alter interface pressures, particularly in high-risk regions like the sacrum and ischial tuberosities.
Temperature dependence of the optical phonon reflection band in GaP
Authors: Samarasingha Nuwanjula S. , Zollner Stefan
Published: July 2021

We explore the effect of temperatures between 80 and 720 K on the energy and linewidth of zone-center transverse (TO) and longitudinal (LO) optical phonons in bulk gallium phosphide (GaP) using Fourier transform infrared ellipsometry from 0.03 to 0.60 eV. We extract the optical phonon parameters of GaP by fitting the ellipsometric angles with the Lowndes–Gervais model, which applies two different broadening parameters to the TO and LO phonons. In GaP, the two-phonon density of states is larger for the decay of TO phonons than for LO phonons. Therefore, we observed a larger TO phonon broadening (compared to the LO phonon) and an asymmetric reststrahlen line shape. This would lead to a negative imaginary part of the dielectric function just above the LO phonon energy but the addition of two-phonon absorption avoids this. We find a temperature-dependent redshift and broadening of TO and LO phonons with increasing temperature due to thermal expansion and anharmonic phonon-phonon scattering, involving three and four phonon decay processes. We also investigate the temperature dependence of the high-frequency dielectric constant. Its variation is explained by thermal expansion and the temperature dependence of the Penn gap.
Population Pharmacokinetics of Diethylcarbamazine in Patients with Lymphatic Filariasis and Healthy Individuals
Authors: Bala Veenu , Chhonker Yashpal S. , Alshehri Abdullah , Edi Constant , Bjerum Catherine M. , Koudou Benjamin G. , King Christopher L. , Murry Daryl J.
Published: July 2021

Diethylcarbamazine (DEC) is a drug of choice to treat lymphatic filariasis (LF) either used alone or in combination as mass drug administration (MDA) preventive strategies. The objective of this study was to develop a population pharmacokinetics (PK) model for DEC in subjects infected with lymphatic filariasis (LF) compared to healthy individuals, and to evaluate the effect of covariates on the volume of distribution (
V
/
F
) and oral clearance (CL/
F
) of DEC. This was an open-label cohort study of treatment-naive
Wuchereria bancrofti
-infected (
n
 = 32) and uninfected (
n
 = 24) adults residing in the Agboville District of Côte d’Ivoire.
Point Mutation or Overexpression of Aspergillus fumigatus
cyp51B,
Encoding Lanosterol 14α-Sterol Demethylase, Leads to Triazole Resistance
Authors: Handelman Mariana , Meir Zohar , Scott Jennifer , Shadkchan Yona , Liu Wei , Ben-Ami Ronen , Amich Jorge , Osherov Nir
Published: July 2021

Aspergillus fumigatus
is the most common cause of invasive fungal mold infections in immunocompromised individuals. Current antifungal treatment relies heavily on the triazole antifungals which inhibit fungal Erg11/Cyp51 activity and subsequent ergosterol biosynthesis.
Central nervous system of a 310-m.y.-old horseshoe crab: Expanding the taphonomic window for nervous system preservation
Authors: Bicknell Russell D.C. , Ortega-Hernández Javier , Edgecombe Gregory D. , Gaines Robert R. , Paterson John R.
Published: July 2021

The central nervous system (CNS) presents unique insight into the behaviors and ecology of extant and extinct animal groups. However, neurological tissues are delicate and prone to rapid decay, and thus their occurrence as fossils is mostly confined to Cambrian Burgess Shale–type deposits and Cenozoic amber inclusions. We describe an exceptionally preserved CNS in the horseshoe crab Euproops danae from the late Carboniferous (Moscovian) Mazon Creek Konservat-Lagerstätte in Illinois, USA. The E. danae CNS demonstrates that the general prosomal synganglion organization has remained essentially unchanged in horseshoe crabs for >300 m.y., despite substantial morphological and ecological diversification in that time. Furthermore, it reveals that the euarthropod CNS can be preserved by molding in siderite and suggests that further examples may be present in the Mazon Creek fauna. This discovery fills a significant temporal gap in the fossil record of euarthropod CNSs and expands the taphonomic scope for preservation of detailed paleoneuroanatomical data in the Paleozoic to siderite concretion Lagerstätten of marginal marine deposits.
Unusual case of recurrent hypoglycaemia in multiple bee sting envenomation
Authors: Pillur Tamilarasu Kumaresh , Shankar Takshak , Kabi Ankita
Published: July 2021

A bee sting can result in allergic and toxin-mediated local manifestations like pain, swelling, redness and itching to serious systemic effects like acute kidney injury (AKI), pancreatitis, Kounis syndrome and stroke. Melittin and phospholipase A2, which make up 62% of honeybee venom, have vasoactive, haemolytic properties causing severe AKI. Its role in lowering blood glucose in diabetics is an interesting research topic. We report an elderly herdsman, a known diabetic on irregular oral hypoglycaemic drugs, who presented with altered mental status due to hypoglycaemia. On further prodding, a recent multiple bee sting attack 5 days ago was found which was followed by altered coloured urine for 2 days for which no medical attention was sought. Additional analyses revealed reticulocytosis, azotemia and high serum creatine phosphokinase. The patient was treated with dextrose infusion, antihistamines, fluids and haemodialysis. Renal failure resolved completely and the patient was discharged in a stable condition.
Early space-occupying cerebellar oedema requiring decompressive craniectomy following a clinically minor stroke
Authors: Borojevic Branko , Choi Philip M C
Published: July 2021

We describe a patient presented with clinically a small cerebellar ischaemic stroke but required emergency decompression within 24 hours of symptoms onset after incidental finding of severe mass effect on imaging without any change in her mild clinical symptoms. Her initial multimodal acute stroke imaging, non-contrast CT of the brain and CT angiography from aortic arch to vertex were normal. CT perfusion showed a very small deficit only. The malignant mass effect was picked on an MRI scan performed routinely as part of a clinical trial, 32 hours after stroke. Our case highlights stroke evolution, and mass effect may be insidious and faster than anticipated in the posterior fossa. Cerebellar stroke of any severity diagnosed clinically and radiologically may benefit from routine follow-up imaging at 24 hours from onset.
Driving digital transformation of comprehensive primary health services at scale in India: an enterprise architecture framework
Authors: Nadhamuni Sunita , John Oommen , Kulkarni Mallari , Nanda Eshan , Venkatraman Sethuraman , Varma Devesh , Balsari Satchit , Gudi Nachiket , Samantaray Shantidev , Reddy Haritha , Sheel Vikas
Published: July 2021

In its commitment towards Sustainable Development Goals, India envisages comprehensive primary health services as a key pillar in achieving universal health coverage. Embedded in siloed vertical programmes, their lack of interoperability and standardisation limits sustainability and hence their benefits have not been realised yet. We propose an enterprise architecture framework that overcomes these challenges and outline a robust futuristic digital health infrastructure for delivery of efficient and effective comprehensive primary healthcare. Core principles of an enterprise platform architecture covering four platform levers to facilitate seamless service delivery, monitor programmatic performance and facilitate research in the context of primary healthcare are listed. A federated architecture supports the custom needs of states and health programmes through standardisation and decentralisation techniques. Interoperability design principles enable integration between disparate information technology systems to ensure continuum of care across referral pathways. A responsive data architecture meets high volume and quality requirements of data accessibility in compliance with regulatory requirements. Security and privacy by design underscore the importance of building trust through role-based access, strong user authentication mechanisms, robust data management practices and consent. The proposed framework will empower programme managers with a ready reference toolkit for designing, implementing and evaluating primary care platforms for large-scale deployment. In the context of health and wellness centres, building a responsive, resilient and reliable enterprise architecture would be a fundamental path towards strengthening health systems leveraging digital health interventions. An enterprise architecture for primary care is the foundational building block for an efficient national digital health ecosystem. As citizens take ownership of their health, futuristic digital infrastructure at the primary care level will determine the health-seeking behaviour and utilisation trajectory of the nation.
Ten lessons learnt: scaling and transitioning one of the largest mobile health communication programmes in the world to a national government
Authors: Chamberlain Sara , Dutt Priyanka , Godfrey Anna , Mitra Radharani , LeFevre Amnesty Elizabeth , Scott Kerry , Mendiratta Jai , Chauhan Vinod , Arora Salil
Published: July 2021

There has been exponential growth in the numbers of ‘digital development’ programmes seeking to leverage technology to solve systemic challenges. However, despite promising results and a shift from pilots to scale-ups, many have failed to realise their full potential. This paper reflects on lessons learnt from scaling and transitioning one of the largest mobile health programmes in the world to the Indian government. The complementary suite of services was designed by BBC Media Action to strengthen families’ reproductive, maternal, neonatal and child health behaviours. Mobile Academy was a training course to refresh frontline health workers’ (FLHWs) knowledge and improve their interpersonal communication skills. MobileKunjiwas a job aid to support FLHWs’ interactions with families.Kilkaridelivered weekly audio information to families’ phones to reinforce FLHWs’ counselling. As of April 2019, when Mobile Academy andKilkariwere transitioned to the government, 206 000 FLHWs had graduated andKilkarihad reached 10 million subscribers. Lessons learnt include the following: (1) private sector business models are challenging in low-resource settings; (2) you may pilot ‘apples’ but scale ‘oranges’; (3) trade-offs are required between ideal solution design and affordability; (4) programme components should be reassessed before scaling; (5) operational viability at scale is a prerequisite for sustainability; (6) consider the true cost of open-source software; (7) taking informed consent in low-resource settings is challenging; (8) big data offer promise, but social norms and SIM change constrain use; (9) successful government engagements require significant capacity; (10) define governance structures and roadmaps up front.
Healthcare utilisation, cancer screening and potential barriers to accessing cancer care in rural South West Nigeria: a cross-sectional study
Authors: Sharma Avinash , Alatise Olusegun Isaac , O'Connell Kelli , Ogunleye Samson Gbenga , Aderounmu Adewale Abdulwasiu , Samson Marquerite L , Wuraola Funmilola , Olasehinde Olalekan , Kingham T Peter , Du Mengmeng
Published: July 2021

Background/aims

Cancer burden is predicted to double by 2030 in sub-Saharan Africa; access to healthcare services for cancer management is a priority in the region. In Nigeria, National Cancer Control Plan aims to ensure >50% cancer screening of eligible populations by 2022 for all Nigerians. We describe healthcare utilisation, cancer screening activities and potential barriers to accessing cancer care within an understudied rural community-based adult population in South West Nigeria.

Methods

In April 2018, we conducted a cross-sectional study of community-based adults (>18 years) ~130 km east of Ibadan, 250 km from Lagos in Osun State, South West Nigeria. Participants completed a face-to-face survey in local dialect. We used a questionnaire to assess demographics, health status, income, medical expenditures, doctor visits and cancer screening history.

Results

We enrolled 346 individuals: with median age of 52 years and 75% women. Of the entire cohort, 4% had medical insurance. 46% reported a major medical cost in the last year. Cancer screening activities were infrequent in eligible participants: 1.5% reported having had cervical cancer screening, 3.3% mammogram and 5% colonoscopy screening. Cancer screening assessment was less frequent in those with less income and lower education levels. Using a multivariable logistic regression model including personal income, insurance status and education, higher personal income was associated with more cancer screening activity (OR 2.7, 95% CI 1.3 to 5.7, p<0.01). Despite this, most individuals had contact with a primary healthcare doctor (52% in the last year), and over 70% access to radio and TV suggesting the opportunity to expand community-based screening interventions and awareness exists.

Conclusions

Despite national increases in cancer cases, we highlight a deficiency in cancer screening and universal healthcare coverage within a community-based adult Nigerian population. Subject to availability of governmental resources, increasing financial risk protection, awareness and targeted resource allocation may help expand access in Nigeria.
Adolescent mental health difficulties and educational attainment: findings from the UK household longitudinal study
Authors: Smith Neil R , Marshall Lydia , Albakri Muslihah , Smuk Melanie , Hagell Ann , Stansfeld Stephen
Published: July 2021

Objective

This study examines whether there is an independent association between mental difficulties in adolescence and educational attainment at age 16.

Design

Longitudinal study.

Setting

Nationally representative data from the UK Household Longitudinal Study (UKHLS) were linked to the National Pupil Database for England.

Participants

Respondents (N=1100) to the UKHLS between 2009 and 2012 were linked to the National Pupil Database to investigate longitudinal associations between mental difficulties at ages 11–14 and educational attainment at age 16 (General Certificate of Secondary Education (GCSE)).

Primary outcome measure

Not gaining five or more GCSE qualifications at age 16, including English and maths at grade A*–C.

Results

An atypical total mental health difficulty score measured using the Strengths and Difficulties Questionnaire at ages 11–14 predicted low levels of educational attainment at age 16 (OR: 3.11 (95% CI: (2.11 to 4.57)). Controlling for prior attainment and family sociodemographic factors, happiness with school (/work) and parental health, school engagement and relationship with the child partially attenuated the association, which was significant in the fully adjusted model (2.05, 95% CI (1.15 to 3.68)). The association was maintained in the fully adjusted model for males only (OR: 2.77 (95% CI (1.24 to 6.16)) but not for females. Hyperactivity disorder strongly predicted lower attainment for males (OR: 2.17 (95% CI: (1.11 to 4.23)) and females (OR: 2.85 (95% CI (1.30 to 6.23)).

Conclusion

Mental difficulties at ages 11–14 were independently linked to educational success at age 16, highlighting an important pathway through which health in adolescence can determine young people’s life chances.
Development of a healthcare system COVID Hotspotting Score in California: an observational study with prospective validation
Authors: Liu Vincent X , Thai Khanh K , Galin Jessica , Gerstley Lawrence David , Myers Laura C , Parodi Stephen M , Chen Yi-Fen Irene , Goler Nancy , Escobar Gabriel J , Kipnis Patricia
Published: July 2021

Objective

To examine the value of health systems data as indicators of emerging COVID-19 activity.

Design

Observational study of health system indicators for the COVID Hotspotting Score (CHOTS) with prospective validation.

Setting and participants

An integrated healthcare delivery system in Northern California including 21 hospitals and 4.5 million members.

Main outcome measures

The CHOTS incorporated 10 variables including four major (cough/cold calls, emails, new positive COVID-19 tests, COVID-19 hospital census) and six minor (COVID-19 calls, respiratory infection and COVID-19 routine and urgent visits, and respiratory viral testing) indicators assessed with change point detection and slope metrics. We quantified cross-correlations lagged by 7–42 days between CHOTS and standardised COVID-19 hospital census using observational data from 1 April to 31 May 2020 and two waves of prospective data through 21 March 2021.

Results

Through 30 September 2020, peak cross-correlation between CHOTS and COVID-19 hospital census occurred with a 28-day lag at 0.78; at 42 days, the correlation was 0.69. Lagged correlation between medical centre CHOTS and their COVID-19 census was highest at 42 days for one facility (0.63), at 35 days for nine facilities (0.52–0.73), at 28 days for eight facilities (0.28–0.74) and at 14 days for two facilities (0.73–0.78). The strongest correlation for individual indicators was 0.94 (COVID-19 census) and 0.90 (new positive COVID-19 tests) lagged 1–14 days and 0.83 for COVID-19 calls and urgent clinic visits lagged 14–28 days. Cross-correlation was similar (0.73) with a 35-day lag using prospective validation from 1 October 2020 to 21 March 2021.

Conclusions

Passively collected health system indicators were strongly correlated with forthcoming COVID-19 hospital census up to 6 weeks before three successive COVID-19 waves. These tools could inform communities, health systems and public health officials to identify, prepare for and mitigate emerging COVID-19 activity.
Play interventions for paediatric patients in hospital: a scoping review
Authors: Gjærde Line Klingen , Hybschmann Jane , Dybdal Daniel , Topperzer Martha Krogh , Schrøder Morten Arnborg , Gibson Jenny Louise , Ramchandani Paul , Ginsberg Elisabeth Ida , Ottesen Bent , Frandsen Thomas Leth , Sørensen Jette Led
Published: July 2021

Objective

Play is a non-invasive, safe and inexpensive intervention that can help paediatric patients and their families manage difficult aspects of being ill or hospitalised. Although play has existed in hospitals for decades, research on hospital play interventions is scarce. This review aimed to categorise and synthesise the last 20 years of research on hospital play interventions.

Design

Scoping review.

Data sources

PubMed, CINAHL, CENTRAL, ERIC and PsycINFO (1 January 2000– 9 September 2020).

Study selection and data extraction

We systematically searched for original peer-reviewed articles, written in English, on hospital play interventions in paediatric patients (0–18 years) in non-psychiatric settings. Two reviewers independently screened titles and abstracts, reviewed full text of relevant articles and extracted data. We thematically synthesised the data from the included studies, and a descriptive analysis, based on a developed framework, is presented.

Results

Of the 297 included articles, 78% came from high-income countries and 56% were published within the last 5 years. Play interventions were carried out across all ages by various healthcare professionals. Play interventions served different roles within four clinical contexts: A) procedures and diagnostic tests, B) patient education, C) treatment and recovery and D) adaptation. Across these contexts, play interventions were generally facilitated and purpose-oriented and had positive reported effects on pain, stress, and anxiety.

Conclusions

Play in hospitals is an emerging interdisciplinary research area with a significant potential benefit for child and family health. Future research should further describe principles for play in hospitals. High-quality studies investigating short-term and long-term effects are needed to guide when and how to best integrate play in hospitals.
Structures of paediatric pain management: a PERUKI service evaluation study
Authors: Durnin Sheena , Barrett Michael J , Lyttle Mark D , Hartshorn Stuart
Published: July 2021

Background

Pain is very common in childhood emergency department (ED) attendances, but is under-recognised and undertreated. Sequential national paediatric analgesia audits demonstrate suboptimal outcomes in several domains. The Donabedian framework examines the structures, processes and outcomes to evaluate quality of care. To date there has been no network-level exploration of structures supporting analgesic practices or attempts to address failure to attain national standards.

Objective

To benchmark current variation in assessment and management of childhood pain at network level.

Methods

Online survey distributed between December 2016 and January 2017 exploring health system structures including pain score tools, pain assessment/protocols, training, practice guidelines and analgesic agent usage. We explored structures, processes and outcomes to identify interventions, and their potential effectiveness and feasibility.

Results

In total 95% (38/40 sites) responded, including 25 tertiary (66%) and 13 secondary hospitals (34%), with a total annual paediatric ED census of 1 225 000 (range 11 500–65 000). Availability of analgesics varied included topical wound anaesthesia in 29/38 sites (76%), oral diclofenac sodium in 22/38 sites (58%) and tramadol in 16/38 sites (42%). Pain assessment was mandatory in initial assessment in 34/38 sites (89%), and 18/38 sites had a policy on frequency of pain assessment (47%). Local guidance aligned with national guidance in 21/38 sites (55%). There was no staff training at induction/orientation in 14/38 sites (37%) and no mandatory competencies in pain management in 23/38 sites (61%). Play specialist services were available in 21/38 sites (55%).

Conclusion

Despite national guidance and recommendations from multiple audits, there are substantial variations in structures relating to pain assessment and management across sites. The lack of uniformity is a likely root cause for the persistent suboptimal practices identified by serial national audits. A whole system and person-centred approach to improving pain outcomes by utilising effective interventions seeks to improve paediatric pain outcomes.
Impact of COVID-19 on the lives of vulnerable young people in New Delhi, India: a mixed method study
Authors: Napier-Raman Sharanya , Rattani Ananya , Qaiyum Yawar , Bose Vijayluxmi , Seth Rajeev , Raman Shanti
Published: July 2021

Background

India is home to the largest child population in the world. India also has faced a devastating burden of COVID-19 infections. During the first wave of COVID-19, the Indian government’s lockdown measures brought loss of livelihoods for millions. We aimed to explore the social, psychological and health impacts of the government’s pandemic measures on children and young people (CYP), and their families.

Methods

Bal Umang Drishya Sanstha (BUDS) is a non-profit organisation providing child health and welfare services to marginalised urban slum communities in New Delhi, India. As part of formative evaluation of BUDS’s COVID-19 pandemic relief efforts, the team conducted a rapid survey of 60 children (10–17 years) and 62 young adults (18–25 years) who were beneficiaries of the relief programme. The team also undertook semi-structured interviews with nine young women attending BUDS’s second-chance education programme.

Results

Almost all respondents had some understanding of COVID-19 (54 children (90%) and 53 young adults (85%)) and the reasons for public health measures (59 children (98%) and 56 young adults (90%)). Over 80% of girls and 60% of boys experienced financial strains and food shortages. Gender discrepancies were particularly evident in areas of family stress, with girls and young women disproportionately experiencing distress and family violence. Girls were more likely to be fearful of contracting the disease, while boys were more concerned about getting back to school. In-depth interviews with young women revealed that government ration schemes were insufficient to support vulnerable families; there were interesting cultural understandings of and responses to the pandemic. Young women reported high rates of anxiety and distress.

Conclusions

The lockdown had a multitude of adverse social, health and psychosocial effects on marginalised CYP, disproportionately affecting girls and young women. A tailored response based on equity and child rights is urgently required to address concerns voiced by CYP.
Peripheral neuropathy in systemic lupus erythematosus: what can neuromuscular ultrasonography (NMUS) tell us? A cross-sectional study
Authors: Mahran Safaa A , Galluccio Felice , Khedr Tayseer Mohamed , Elsonbaty Amira , Allam Abdallah El-Sayed , Garcia Martos Alvaro , Osman Doaa M M , Matucci-Cerinic Marco , Guiducci Serena , Galal Marwa A A
Published: July 2021

Objective

To evaluate peripheral nerve involvement in patients with SLE with neuromuscular ultrasonography (NMUS) and understand its role in investigating SLE-related peripheral neuropathy.

Methods

This is an observational cross-sectional study on patients with SLE and healthy controls. Five nerves in each patient were examined bilaterally with NMUS, and the cross-sectional area (CSA) of each nerve at certain sites was estimated. The mean CSA at each site, for each nerve, in each group was statistically analysed and compared between groups.

Results

370 nerves were evaluated in 37 patients. By nerve conduction study (NCS), 36 patients had polyneuropathy (80.6% mixed type, 19.4% sensory). Significant mean CSA enlargement was present among the ulnar nerve at the Guyon’s canal and mid-humerus (both p=0.001); tibial nerve at the distal leg and proximal to the tarsal tunnel (p=0.003 and p=0.001, respectively); and peroneal nerve at the popliteal fossa (p=0.042). The mean CSA showed high specificity compared with NCS.

Conclusion

Our study shows that CSA could be a complementary tool to NCS for studying peripheral neuropathy in SLE. Furthermore, NMUS provides data on the different pathophysiological aspects of nerve involvement in SLE. Future studies using more than one sonographic parameter in combination with NCS and nerve histopathology are recommended to further investigate SLE-related neuropathy.

Trial registration numberNCT04527172.
Clustering the World Currency Exchange Rates Using Hierarchical Methods Based on Dynamic Time Warping
Authors: Pimentel Jonatha Sousa , Rodrigues Paulo Canas
Published: July 2021

The analysis of currency exchange rates is of great importance to analyze the economic health of a country. In this paper, we collect and analyze the historical data on exchange rates of all available currencies, considering the US dollar as reference. In particular, we are interested in clustering the collected daily time series by using a similarity measure based on dynamic time warping. In total, the observations of 150 currencies, between January 3, 2005 and April 30, 2020, are analyzed. The results show that the use of dynamic time warping as a distance measure results in the improvement of the interpretability of the dendrograms, when compared with standard similarity measures such as the Euclidean distance.
Graphical Minimax Game and Off-Policy Reinforcement Learning for Heterogeneous MASs with Spanning Tree Condition
Authors: Dong Wei , Wang Jianan , Wang Chunyan , Qi Zhenqiang , Ding Zhengtao
Published: July 2021

In this paper, the optimal consensus control problem is investigated for heterogeneous linear multi-agent systems (MASs) with spanning tree condition based on game theory and reinforcement learning. First, the graphical minimax game algebraic Riccati equation (ARE) is derived by converting the consensus problem into a zero-sum game problem between each agent and its neighbors. The asymptotic stability and minimax validation of the closed-loop systems are proved theoretically. Then, a data-driven off-policy reinforcement learning algorithm is proposed to online learn the optimal control policy without the information of the system dynamics. A certain rank condition is established to guarantee the convergence of the proposed algorithm to the unique solution of the ARE. Finally, the effectiveness of the proposed method is demonstrated through a numerical simulation.
Fixing the internet
Authors: Kirkpatrick Keith
Published: July 2021

Internet security was once based on trust and needs to be updated.
Divide and Conquer
Authors: Neville-Neil George V.
Published: July 2021

Bisection is of no use if you have a heisenbug that fails only from time to time. These subtle bugs are the hardest to fix and the ones that cause us to think critically about what we are doing. Timing bugs, bugs in distributed systems, and all the difficult problems we face in building increasingly complex software systems can't yet be addressed by simple bisection. It's often the case that it would take longer to write a usable bisection test for a complex problem than it would to analyze the problem whilst at the tip of the tree.
Experimental Study on the Damage Characteristics of Polymer Slabs Subjected to Air Contact and Close‐In Explosions
Authors: Liu Zhidong , Zhao Xiaohua , Fang Hongyuan , Du Xueming , Xue Binghan , Li Zhaonan
Published: July 2021

As a new antiseepage reinforcement material, polyurethane grouting material has been widely studied in terms of its static mechanical properties. However, research on its dynamic mechanical properties is relatively rare. In this research, considering the influence of the explosive charge weight, the air contact and close‐in explosion experiments of polymer slabs were carried out. The failure mode and damage spatial distribution characteristics of polymer slabs were explored. Pressure time history curve of air shock wave was obtained using an air shock wave tester. The influence of polymer slabs on the propagation of air explosion shock wave was compared and analyzed. The results show that, under the air contact explosion, the polymer slab mainly suffers local damage, while under close‐in explosion, overall damage is the main damage mode. With the increase of the explosive charge weight, the failure mode of the polymer slab transits from surface crack and slight spalling to local and whole crushing.
Magnetic Resonance Imaging Features of Cerebral Infarction in Critical Patients Based on Convolutional Neural Network
Authors: Bo Yi , Xie Junli , Zhou Jianguo , Li Shikun , Zhang Yuezhan , Zhou Zhenjiang
Published: July 2021

The clinical application of the artificial intelligence-assisted system in imaging was investigated by analyzing the magnetic resonance imaging (MRI) influence characteristics of cerebral infarction in critically ill patients based on the convolutional neural network (CNN). Fifty patients with cerebral infarction were enrolled and examined by MRI. Besides, a CNN artificial intelligence system was established for learning and training. The features were extracted from the MRI image results of the patients, and then, the data were calculated by computer technology. The gray-level cooccurrence matrix (GLCM) of T1-weighted images was 0.872 ± 0.069; the reasonable prediction (ALL) result was 0.766 ± 0.112; the gray-level run-length matrix (GLRLM) was 0.812 ± 0.101; the multigray-level area size matrix (MGLSZM) result was 0.713 ± 0.104; and the result of gray-scale area size matrix (GLSZM) was 0.598 ± 0.099. The GLCM, ALL, GLRLM, MGLSZM, and GLSZM of enhanced T1-weighted images were 0.710 ± 0.169, 0.742 ± 0.099, 0.778 ± 0.096, 0.801 ± 0.104, and 0.598 ± 0.099, respectively. The GLCM, ALL, GLRLM, MGLSZM, and GLSZM of T2-weighted images were 0.780 ± 0.096, 0.798 ± 0.087, 0.888 ± 0.086, 0.768 ± 0.112, and 0.767 ± 0.100, respectively. In short, the image diagnosis method that could reduce the subjective visual judgment error to a certain extent was found by analyzing the characteristics of MRI images of critically ill patients with cerebral infarction based on CNN.