bluuebunny/crossref_metadata_2025 huggingface dataset:
Why do patients with chronic hepatitis C drink alcohol? An examination of pain, depression and drinking motives
Authors: Wilder Julius M. , Evon Donna M. , Proeschold‐Bell Rae Jean , Yao Jia , Sohail Malik Muhammed , Niedzwiecki Donna , Makarushka Christina , Hodge Terra , Muir Andrew J.
Published: January 2021

Alcohol consumption in the setting of chronic HCV is associated with accelerated progression towards cirrhosis, increased risk of hepatocellular carcinoma and higher mortality. This analysis contextualizes how sociodemographic factors, chronic pain and depression relate to the motivations of individuals with chronic HCV to consume alcohol. We conducted a secondary analysis of baseline data from the Hep ART trial of behavioural interventions on alcohol use among patients with HCV. Alcohol consumption was measured using the Drinking Motives Questionnaire and a novel 6‐item measure of pain‐related drinking motives. Statistical analyses performed included ANOVA for bivariate analyses and multivariable ordinary least‐squares linear regression. At study baseline, 181 participants had an average age of 55 years; the majority (66.7%) reported beyond‐minor pain; and a third (37%) met criteria for depression; drinking motives were higher for individuals with beyond‐minor pain (means 9.9 vs. 4.6, p < .001) and who met criteria for depression (means 10.9 vs. 6.4, p < .001) when using the pain‐related drinking motives items. Average pain(coef = 1.0410067141 < .001) was significantly associated with increased motives to drink to relieve pain in the full baseline model specification controlling for all covariates using ordinary at least squares; depression (coef = 7.06; 95% CI 1.32, 12.81; p = .016) was significantly associated with increased non‐pain‐related motives to drink. From baseline to 3‐month follow‐up, compared to participants who had mean average pain scores among the sample, motives to drink to relieve pain decreased in participants who had higher average pain scores (coef = −0.30; 95% CI −0.59, −0.01; p = .40). Physical pain and depression are associated with increased motives to consume alcohol. Patients with chronic liver disease should be screened for chronic pain and depression and, if present, referred to pain specialists or co‐managed in partnership with pain specialists in hepatology clinics.
Effects of the upwelling system on the assessment of reproductive parameters of the caridean shrimp Nematopalaemonschmitti (Holthuis, 1950) in the Western Atlantic
Authors: Herrera Daphine R. , Davanso Thiago Maia , Costa Rogerio C.
Published: January 2021

Costal upwelling and other oceanographic features exert important effects on neritic and benthic communities, causing variations in the reproduction and survival of organisms. Here, we assessed the population structure, sex ratio, recruitment, and reproduction of the caridean shrimp Nematopalaemon schmitti near the Cabo Frio upwelling area in southeastern Brazil. In total, 759 individuals were captured. N. schmitti exhibited a unimodal size–frequency distribution pattern with larger females, and the binomial test indicated a significantly female‐biased sex ratio. The time‐series analysis showed synchrony between ovigerous females and juveniles that revealed continuous reproduction and the possible existence of recruitment areas. Our findings indicate that reproductive parameters are influenced by the environmental factors of the region studied here. We advocate that the influence of the sedimentary composition of the soft bottom and upwelling system of Cabo Frio is the predominant factors influencing the reproductive parameters in N. schmitti.
Genomic signatures of selection in bats surviving white‐nose syndrome
Authors: Gignoux‐Wolfsohn Sarah A. , Pinsky Malin L. , Kerwin Kathleen , Herzog Carl , Hall MacKenzie , Bennett Alyssa B. , Fefferman Nina H. , Maslo Brooke
Published: January 2021

Rapid evolution of advantageous traits following abrupt environmental change can help populations recover from demographic decline. However, for many introduced diseases affecting longer‐lived, slower reproducing hosts, mortality is likely to outpace the acquisition of adaptive de novo mutations. Adaptive alleles must therefore be selected from standing genetic variation, a process that leaves few detectable genomic signatures. Here, we present whole genome evidence for selection in bat populations that are recovering from white‐nose syndrome (WNS). We collected samples both during and after a WNS‐induced mass mortality event in two little brown bat populations that are beginning to show signs of recovery and found signatures of soft sweeps from standing genetic variation at multiple loci throughout the genome. We identified one locus putatively under selection in a gene associated with the immune system. Multiple loci putatively under selection were located within genes previously linked to host response to WNS as well as to changes in metabolism during hibernation. Results from two additional populations suggested that loci under selection may differ somewhat among populations. Through these findings, we suggest that WNS‐induced selection may contribute to genetic resistance in this slowly reproducing species threatened with extinction.
HOMEODOMAIN PROTEIN8 mediates jasmonate‐triggered trichome elongation in tomato
Authors: Hua Bing , Chang Jiang , Xu Zhijing , Han Xiaoqian , Xu Mengyuan , Yang Meina , Yang Changxian , Ye Zhibiao , Wu Shuang
Published: January 2021

Plant hormones can adjust the physiology and development of plants to enhance their adaptation to biotic and abiotic challenges. Jasmonic acid (JA), one of the immunity hormones in plants, triggers genome‐wide transcriptional changes in response to insect attack and wounding. Although JA is known to affect the development of trichomes, epidermal appendages that form a protective barrier against various stresses, it remains unclear how JA interacts with developmental programs that regulate trichome development.

In this study, we show that JA affects trichome length in tomato by releasing the transcriptional repression mediated by Jasmonate ZIM (JAZ) proteins. We identified SlJAZ4, a negative regulator preferentially expressed in trichomes, as the critical component in JA signaling in tomato trichomes.

We also identified a homeodomain‐leucine zipper gene, SlHD8, as the downstream regulator of JA signaling that promotes trichome elongation. SlHD8 is also highly expressed in trichomes and physically interacts with SlJAZ4. Loss‐of‐function mutations in SlHD8 caused shorter trichomes, a phenotype that was only partially rescued by methyl jasmonate treatment.

Our dual‐luciferase and chromatin immunoprecipitation–quantitative PCR assays revealed that SlHD8 regulates trichome elongation by directly binding to the promoters of a set of cell‐wall‐loosening protein genes and activating their transcription. Together, our findings define SlHD8‐SlJAZ4 as a key module mediating JA‐induced trichome elongation in tomato.
Role of a vacuolar iron transporter OsVIT2 in the distribution of iron to rice grains
Authors: Che Jing , Yamaji Naoki , Ma Jian Feng
Published: January 2021

Iron (Fe) from rice grains is an important source of dietary intake; however, the molecular mechanisms responsible for loading of Fe to the grains are poorly understood.

We functionally characterized a vacuolar iron transporter gene, OsVIT2 in terms of expression pattern, cellular localization, and mutant phenotypes.

OsVIT2 was expressed in the parenchyma cell bridges of nodes, in the mestome sheath of leaf sheath and aleurone of the caryopsis. Mutation of OsVIT2 resulted in decreased Fe distribution to the leaf sheath, nodes, and aleurone, but increased Fe to the leaf blade and grains. Furthermore, Fe was heavily deposited in the parenchyma cell bridges, mestome sheath and aleurone in the wild‐type rice, but this accumulation was decreased in the knockout lines. Conversely, heavier deposition of Fe was observed in the embryo and endosperm of the grains of knockout lines compared with the wild‐type rice, resulting in increased Fe accumulation in the polished rice without yield penalty.

These results indicate that OsVIT2 is involved in the distribution of Fe to the grains through sequestering Fe into vacuoles in mestome sheath, nodes, and aleurone layer and that knockout of this gene provides a potential way for Fe biofortification without yield penalty.
The effects of verbal cueing for high intended movement velocity on power, neuromuscular activation, and performance
Authors: Rheese Michael , Drinkwater Eric J. , Leung Hans , Andrushko Justin W. , Tober Jacob , Hendy Ashlee M.
Published: January 2021

It is widely believed that lifting heavy loads slowly, but with a conscious intention to move at high velocity, can produce resistance training (RT) adaptations indicative of rapid movements. This study investigated the effects of verbally cued high “intended” movement velocity (HIMV) during RT on neuromuscular and performance outcomes. 20 untrained volunteers (aged 24.2 ± 3.9 years) participated in 3 weeks of knee extension training. Participants were randomly allocated to receive verbal cues focusing on high intended movement velocity, HIMV, or steady and controlled movement, TRAD (traditional training). All other training variables, including actual movement velocity (30° s−1), remained constant. Increase in mean power output at 30° s−1 was greater for TRAD than HIMV (76% and 33%, respectively, P = 0.027). There were main effects for time (but no between‐group differences) for maximal isometric force (+14%, P = 0.003), peak torque at 180° s−1 (+22%, P = 0.006), peak torque at 30° s−1 (+29%, P < 0.001), 3‐repetition maximum (+20%, P < 0.001), and resting corticospinal excitability (+43%, P = 0.017). There were no differences between groups or across time for voluntary activation (P = 0.793), spinal excitability (P = 0.686), or intracortical inhibition (all P > 0.05). HIMV verbal cueing did not produce additional neurophysiological or performance benefits when compared to traditional cueing. Overall, our results demonstrated that verbal cueing did not alter the principle of velocity‐specific adaptation. Cueing that increases the duration of maximal effort may be optimal for maximizing average power output at low speeds.
Identification of the novel HLA‐C*03:04:79 allele in a Chinese bone marrow donor
Authors: Fu Rui , He Yizhen , Zhang Wei , He Ji , Zhu Faming
Published: January 2021

HLA‐C*03:04:79 differs from HLA‐C*03:04:01:01 by a single nucleotide substitution at position 834 G>A.
Export quality dynamics: Multidimensional evidence of financial development
Authors: Nguyen Canh Phuc , Su Thanh Dinh
Published: January 2021

This study examines the impact of financial development on export quality. Financial development is proxied by the overall financial development index, its two sub‐indices (financial institutions index and financial markets index) and three dimensions of each sub‐index. The study begins by examining the causality between financial development indicators and export quality. The influences of financial development indicators on export quality are then investigated. Econometric techniques are applied for 49 low‐ and lower‐middle‐income economies (LMEs), 31 upper‐middle‐income economies (UMEs) and 48 high‐income economies (HIEs) over the period 2002–14, which was chosen on account of data availability. The predominant finding is significant bidirectional causality between financial development indicators, as well as their dimensions, and export quality. Notably, most financial development indicators and their dimensions are found to have significant positive effects on export quality for both HIEs and LMEs, while two dimensions of the financial institutions indicator have no significant impacts in the case of UMEs.
Acute effects of increased gut microbial fermentation on the hypoxic ventilatory response in humans
Authors: Seredyński Rafał , Pawłowska‐Seredyńska Katarzyna , Ponikowska Beata , Paleczny Bartłomiej
Published: January 2021

New Findings

What is the central question of this study?

Is there a link between gut microbial fermentation and ventilatory responsiveness to hypoxia in humans?

What is the main finding and its importance?

Increased gut microbial fermentation is associated with augmented ventilatory (but not haemodynamic) responses to transient hypoxia. These findings imply a capacity for gut microbiota to modulate the peripheral chemoreflex response to hypoxia in humans.

Recent animal data indicate the presence of a bidirectional link between gut microbial activity and respiratory control. Nevertheless, the presence of a similar association between gut microbiota and peripheral chemoreceptor responsiveness to hypoxia in humans has not been reported to date. Therefore, we performed a within subject, placebo‐controlled study in a group of 16 healthy individuals (eight men; mean ± SD age 25.9 ± 5.2 years). Participants underwent two tests (in a random order), receiving lactulose, which stimulates gut fermentation, or placebo. Ventilatory and haemodynamic responses to transient hypoxia were evaluated before and 2 h after the test meal. The magnitude of these responses was related to the net hydrogen content in the exhaled air, reflecting gut fermentation intensity. A lactulose meal, compared to placebo, caused an increase in the minute ventilation (Hyp‐VI; l/min/) and breathing rate (Hyp‐BR; breaths/min/) responses to hypoxia (for Hyp‐VI, mean ± SD −0.03 ± 0.059 in placebo test vs. 0.05 ± 0.116 in lactulose test, P = 0.03; for Hyp‐BR, −0.015 ± 0.046 vs. 0.034 ± 0.054, P = 0.01). The magnitude of these responses was positively correlated with the lactulose‐induced hydrogen excretion (for Hyp‐VI, r = 0.62, P = 0.01; for Hyp‐BR, r = 0.73, P = 0.001). Changes in the resting parameters during normoxia did not differ significantly between the tests. Our results demonstrate that the increased gut microbial fermentation is associated with augmented ventilatory (but not haemodynamic) responses to the transient hypoxia, which implies a capacity for gut microbiota to modulate the peripheral chemoreflex in humans.
Hierarchical Nano/Micro-Structured Surfaces With High Surface Area/Volume Ratios
Authors: Lichade Ketki M. , Jiang Yizhou , Pan Yayue
Published: January 2021

Recently, many studies have investigated additive manufacturing (AM) of hierarchical surfaces with high surface area/volume (SA/V) ratios, and their performance has been characterized for applications in next-generation functional devices. Despite recent advances, it remains challenging to design and manufacture high SA/V ratio structures with desired functionalities. In this study, we established the complex correlations among the SA/V ratio, surface structure geometry, functionality, and manufacturability in the two-photon polymerization (TPP) process. Inspired by numerous natural structures, we proposed a 3-level hierarchical structure design along with the mathematical modeling of the SA/V ratio. Geometric and manufacturing constraints were modeled to create well-defined three-dimensional hierarchically structured surfaces with a high accuracy. A process flowchart was developed to design the proposed surface structures to achieve the target functionality, SA/V ratio, and geometric accuracy. Surfaces with varied SA/V ratios and hierarchy levels were designed and printed. The wettability and antireflection properties of the fabricated surfaces were characterized. It was observed that the wetting and antireflection properties of the 3-level design could be easily tailored by adjusting the design parameter settings and hierarchy levels. Furthermore, the proposed surface structure could change a naturally hydrophilic surface to near-superhydrophobic. Geometrical light trapping effects were enabled and the antireflection property could be significantly enhanced (> 80% less reflection) by the proposed hierarchical surface structures. Experimental results implied the great potential of the proposed surface structures for various applications such as microfluidics, optics, energy, and interfaces.
The Effect of Thermal Barrier Coating Surface Temperature on the Adhesion Behavior of CMAS Deposits
Authors: Clark Robert A. , Plewacki Nicholas , Gnanaselvam Pritheesh , Bons Jeffrey P. , Viswanathan Vaishak
Published: January 2021

The interaction of thermal barrier coating’s surface temperature with calcium magnesium aluminosilicate (CMAS) like deposits in gas turbine hot flowpath hardware is investigated. Small Hastelloy X coupons were coated in thermal barrier coatings (TBC) using the air plasma spray (APS) method and then subjected to a thermal gradient via backside impingement cooling and frontside impingement heating using the High-Temperature Deposition Facility (HTDF) at The Ohio State University (OSU). A one-dimensional (1D) heat transfer model was used to estimate TBC surface temperatures and correlate them to intensity values taken from infrared (IR) images of the TBC surface. TBC frontside surface temperatures were varied by changing backside mass flow (kept at a constant temperature) while maintaining a constant hot-side gas temperature and jet velocity representative of modern commercial turbofan high-pressure turbine (HPT) inlet conditions (approximately 1600 K and 200 m/s, or Mach 0.25). In this study, Arizona Road Dust (ARD) was utilized to mimic the behavior of CMAS attack on TBC. To identify the minimum temperature at which particles adhere, the backside cooling mass flow was set to the maximum amount allowed by the test setup, and trace amounts of 0–10 µm ARD particles were injected into the hot-side flow to impinge on the TBC surface. The TBC surface temperature was increased through coolant reduction until noticeable deposits formed, as evaluated through an IR camera. Accelerated deposition tests were then performed where approximately 1 g of ARD was injected into the hot side flow while the TBC surface temperature was held at various points above the minimum observed deposition temperature. Surface deposition on the TBC coupons was evaluated using an infrared camera and a backside thermocouple. Coupon cross-sections were also evaluated under a scanning electron microscope for any potential CMAS ingress into the TBC. Experimental results of the impact of surface temperature on CMAS deposition, and deposit evolution and morphology are presented. In addition, an Eulerian–Lagrangian solver was used to model the hot-side impinging jet with particles at four TBC surface temperatures and deposition was predicted using the OSU deposition model. Comparisons to experimental results highlight the need for more sophisticated modeling of deposit development through a conjugate heat transfer and mesh morphing of the target surface. These results can be used to improve physics-based deposition models by providing valuable data relative to CMAS deposition characteristics on TBC surfaces, which modern commercial turbofan high-pressure turbines use almost exclusively.
Approach for Importance–Performance Analysis of Product Attributes From Online Reviews
Authors: Joung Junegak , Kim Harrison M.
Published: January 2021

The importance–performance analysis (IPA) is a widely used technique to guide strategic planning for the improvement of customer satisfaction. Compared with surveys, numerous online reviews can be easily collected at a lower cost. Online reviews provide a promising source for the IPA. This paper proposes an approach for conducting the IPA from online reviews for product design. Product attributes from online reviews are first identified by latent Dirichlet allocation. The performance of the identified attributes is subsequently estimated by the aspect-based sentiment analysis of IBM Watson. Finally, the importance of the identified attributes is estimated by evaluating the effect of sentiments of each product attribute on the overall rating using an explainable deep neural network. A Shapley additive explanation-based method is proposed to estimate the importance values of product attributes with a low variance by combining the effect of the input features from multiple optimal neural networks with a high performance. A case study of smartphones is presented to demonstrate the proposed approach. The performance and importance estimates of the proposed approach are compared with those of previous sentiment analysis and neural network-based method, and the results exhibit that the former can perform IPA more reliably. The proposed approach uses minimal manual operation and can support companies to take decisions rapidly and effectively, compared with survey-based methods.
Lost in Translation: Examining the Complex Relationship Between Prototyping and Communication
Authors: Krishnakumar Sandeep , Berdanier Catherine , McComb Christopher , Menold Jessica
Published: January 2021

Prototyping plays a pivotal role in the engineering design process. Prototypes represent physical or digital manifestations of design ideas, and as such act as effective communication tools for designers. While the benefits of prototyping are well-documented in research, the fundamental ways in which the construction of a prototype affects designers' reflection on and evaluation of their design outcomes and processes are not well understood. The relationships between prototypes, designers' communication strategies, and recollection of design processes is of particular interest in this work, as preliminary research suggests that novice designers tend to struggle to clearly articulate the decisions made during the design process. This work serves to extend prior work and build foundational knowledge by exploring the evaluation of design outcomes and decisions, and communication strategies used by novice designers during prototyping tasks. A controlled in situ study was conducted with 45 undergraduate engineering students. Results from qualitative analyses suggest that a number of rhetorical patterns emerged in students' communications, suggesting that a complicated relationship exists between prototyping and communication.
Silicon field emitters fabricated by dicing-saw and wet-chemical-etching
Authors: Edler Simon , Schels Andreas , Biba Josef , Hansch Walter , Bachmann Michael , Düsberg Felix , Werber Marinus , Langer Christoph , Meyer Manuel , von Bergen David , Pahlke Andreas
Published: January 2021

Silicon field emitter arrays (FEAs) with different tip sizes and quantities were fabricated by saw dicing and anisotropic wet chemical etching by tetramethylammonium hydroxide. The tip is formed by the different etching rates of the crystal facets leading to a sharp pyramid based on {103} planes on the top and a hexadecagon based on {331} and {221} planes on the bottom. Electrical measurements at 10−5 mbar up to 10 μA show good reproducibility for FEAs with the same process parameters and higher uniformity and stability with an increasing number of tips. Constant current measurements at the same conditions and 10 μA show a mean electric field increase of about 0.06(3) V/(μm h) for p-type FEAs with a tip quantity of 3600. The shift increases with lower tip quantity and is higher for n-type FEAs compared to p-type. The degradation during the constant current measurement of n-type samples is found to be partly reversible by heating to 200 °C during emission. In contrast, heating of p-type FEAs induced further degradation instead of a regeneration effect.
Uncertainty about amplitude eliminates negative masking in a pure-tone amplitude discrimination experiment
Authors: Conroy Christopher , Kidd Gerald
Published: January 2021

The role of uncertainty and its reduction in producing the “negative masking” of amplitude increments that is often observed in pure-tone amplitude discrimination experiments using circathreshold pedestals was investigated. It was found that negative masking is eliminated by uncertainty induced by roving the pedestal level across trials. On the basis of this finding, as well as those from a previous study, it is argued that, consistent with a longstanding theory of negative masking based on the notion of “intrinsic uncertainty,” negative masking requires near-optimal stimulus conditions, under which uncertainty about increment parameters is more or less absent.
Validating a psychoacoustic model of voice quality
Authors: Kreiman Jody , Lee Yoonjeong , Garellek Marc , Samlan Robin , Gerratt Bruce R.
Published: January 2021

No agreed-upon method currently exists for objective measurement of perceived voice quality. This paper describes validation of a psychoacoustic model designed to fill this gap. This model includes parameters to characterize the harmonic and inharmonic voice sources, vocal tract transfer function, fundamental frequency, and amplitude of the voice, which together serve to completely quantify the integral sound of a target voice sample. In experiment 1, 200 voices with and without diagnosed vocal pathology were fit with the model using analysis-by-synthesis. The resulting synthetic voice samples were not distinguishable from the original voice tokens, suggesting that the model has all the parameters it needs to fully quantify voice quality. In experiment 2 parameters that model the harmonic voice source were removed one by one, and the voice tokens were re-synthesized with the reduced model. In every case the lower-dimensional models provided worse perceptual matches to the quality of the natural tokens than did the original set, indicating that the psychoacoustic model cannot be reduced in dimensionality without loss of fit to the data. Results confirm that this model can be validly applied to quantify voice quality in clinical and research applications.
Expression of E8^E2 Is Required for Wart Formation by Mouse Papillomavirus 1
In Vivo
Authors: Stubenrauch Frank , Straub Elke , Klein Katrin , Kramer Daniela , Iftner Thomas , Wong Margaret , Roden Richard B. S.
Published: January 2021

HPV encodes an E8^E2 protein which acts as repressors of viral gene expression and genome replication. In cultured normal keratinocytes, E8^E2 is essential for long-term episomal maintenance of HPV 31 (HPV31) genomes, but not for that of HPV16.
Supplemental Material: No ring fracture in Mono Basin, California
Authors: Hildreth Wes , Fierstein Judy , al. et
Published: January 2021

Table S1: Chemical data for the three plutons in the area investigated.
Supplemental Material: Stratigraphy, age, and provenance of the Eocene Chumstick basin, Washington Cascades; implications for paleogeography, regional tectonics, and development of strike-slip basins
Authors: Donaghy Erin E. , al. et
Published: January 2021

(1) Descriptions of spatial and temporal stratigraphic thickness variations in the Chumstick basin and methods for sediment accumulation rate calculations, (2) Detailed descriptions and photographs of each lithofacies association of the Chumstick Formation defined in the text of the manuscript, (3) Tables of raw and summary conglomerate clast count data for each member of the Chumstick Formation, (4) Summary tables of conglomerate detrital modes for each member of the Chumstick Formation, (5) Summary tables and age probability plots of detrital zircon ages from each sandstone sample collected within the Chumstick Formation, (6) Conglomerate clast raw data from LaCasse (2013) and (7) Tables of detrital zircon raw data from each individual sandstone sample within the Chumstick Formation (Donaghy, 2015).
Impact of transcatheter aortic valve implantation on left ventricular function recovery, mass regression and outcome in patients with aortic stenosis: protocol of the TAVI-NOR prospective study
Authors: Mohamed Ali Abukar , Wasim Daanyaal , Løland Kjetil Halvorsen , Rotevatn Svein , Bleie Øyvind , Saeed Sahrai
Published: January 2021

Introduction

Transcatheter aortic valve implantation (TAVI) is a widely used treatment option as an alternative to surgical aortic valve replacement in patients with severe aortic stenosis (AS) at high or intermediate surgical risk. TAVI improves symptoms, induces reverse left ventricular (LV) remodelling and increases overall survival. However, a careful patient selection is essential to achieve better outcome. Evidence on LV functional recovery and LV mass regression after TAVI based on contemporary registry data is scarce. The impact of TAVI on the arterial vasculature is also less explored.

Method and analyses

This is a study of 600 consecutive patients with AS who underwent a TAVI at Haukeland University Hospital, Bergen, Norway. Demographics, clinical data, arterial haemodynamics and echocardiographic parameters were prospectively collected. In the present paper, we describe the design, major scientific objectives and echocardiography imaging protocol of the TAVI-NOR (TAVI in western NORway) study. The main objectives are: To explore the impact of TAVI on cardiac structure and function in patients with severe AS, identify the echocardiographic predictors of reverse LV remodelling, assess survival benefits according to baseline risk profile, evaluate long-term therapeutic success as reflected by reduction in valvular-arterial impedance and to investigate the impact of various types of blood pressure response immediately after TAVI on clinical outcome.

Ethics and dissemination

The study was approved by the Regional Committees for Medical and Health Research Ethics (REK vest, ref. number 33814) and the Institutional Data Protection Services. Patients’ consent was waived. The study findings will be disseminated via peer-reviewed publications and presentation in national and international scientific meetings and conferences.

Trail registration number

The study was registered in the international database: ClinicalTrials.gov, Identifier:NCT04417829.
Effective coverage of nutrition interventions across the continuum of care in Bangladesh: insights from nationwide cross-sectional household and health facility surveys
Authors: Nguyen Phuong Hong , Khương Long Quỳnh , Pramanik Priyanjana , Billah Sk Masum , Menon Purnima , Piwoz Ellen , Leslie Hannah H
Published: January 2021

Introduction

Improving the impact of nutrition interventions requires adequate measurement of both reach and quality of interventions, but limited evidence exists on advancing coverage measurement. We adjusted contact-based coverage estimates, taking into consideration the inputs required to deliver quality nutrition services, to calculate input-adjusted coverage of nutrition interventions across the continuum of care from pregnancy through early childhood in Bangladesh.

Methods

We used data from the 2014 Bangladesh Demographic and Health Surveys to assess use of maternal and child health services and the 2014 Service Provision Assessment to determine facility readiness to deliver nutrition interventions. Service readiness captured availability of nutrition-specific inputs (including human resources and training, equipment, diagnostics and medicines). Contact coverage was combined with service readiness to create a measure of input-adjusted coverage at the national and regional levels, across place of residence, and by maternal education and household socioeconomic quintiles.

Results

Contact coverage varied from 28% for attending at least four ANC visits to 38% for institutional delivery, 35% for child growth monitoring and 81% for sick child care. Facilities demonstrated incomplete readiness for nutrition interventions, ranging from 48% to 51% across services. Nutrition input-adjusted coverage was suboptimal (18% for ANC, 23% for institutional delivery, 20% for child growth monitoring and 52% for sick child care) and varied between regions within the country. Inequalities in input-adjusted coverage were large during ANC and institutional delivery (14–17 percentage points (pp) between urban and rural areas, 15 pp between low and high education, and 28-34 pp between highest and lowest wealth quintiles) and less variable for sick child care (<2 pp).

Conclusion

Nutrition input-adjusted coverage was suboptimal and varied subnationally and across the continuum of care in Bangladesh. Special efforts are needed to improve the reach as well as the quality of health and nutrition services to achieve the Sustainable Development Goals.
Effectiveness of pretend medical play in improving children’s health outcomes and well-being: a systematic review
Authors: Rashid Aneesa Abdul , Cheong Ai Theng , Hisham Ranita , Shamsuddin Nurainul Hana , Roslan Dalila
Published: January 2021

Background

The healthcare setting is stressful for many people, especially children. Efforts are needed to mitigate children’s healthcare-related anxiety. Medical play using the Teddy Bear Hospital (TBH) concept can expose children to healthcare settings and help them develop positive experiences in these settings. In this role-playing game, children bring their soft toys and act as parents to the ‘sick’ teddies in a pretend hospital or clinic play setting. The objective of this systematic review is to evaluate the effectiveness of the TBH in improving children’s health outcomes and well-being.

Methods

We searched the reference lists of included studies from four electronic databases (PubMed, CINAHL, Scopus and Google Scholar) from inception until November 2020. We included pre-post, quasiexperimental and case–control studies, as well as randomised controlled trials (RCTs) that discussed medical play using the TBH concept as an intervention. Studies that involved sick patients and used interventions unlike the TBH were excluded. We assessed the quality of the included studies using the Cochrane Collaboration’s ‘Risk of bias’ tool.

Results

Ten studies were included in this systematic review. Five specifically investigated the TBH method, while the others involved the same concept of medical play. Only three studies were RCTs. All of the studies report more than one outcome—mostly positive outcomes. Two report lower anxiety levels after intervention. Two found better healthcare knowledge, with one reporting increased feelings of happiness regarding visiting a doctor. Two studies found no change in anxiety or feelings, while another two found increased levels of fear and lowered mood after the medical play (which involved real medical equipment).

Conclusions

The practice of TBH has mostly positive outcomes, with lower anxiety levels and improved healthcare knowledge. Its effectiveness should be verified in future studies using a more robust methodology.

PROSPERO registration number

CRD42019106355.
REACT study protocol: resilience after the COVID-19 threat (REACT) in adolescents
Authors: Smith Alicia Joanne , Moreno-López Laura , Davidson Eugenia , Dauvermann Maria , Orellana Sofia , Soneson Emma , Ioannidis Konstantinos , Kaser Muzaffer , van Harmelen Anne-Laura
Published: January 2021

Introduction

COVID-19-related social isolation and stress may have significant mental health effects, including post-traumatic stress, anxiety and depression. These factors are thought to disproportionately affect populations at risk of psychopathology, such as adolescents with a history of childhood adversity (CA). Therefore, examining which factors may buffer the impact of COVID-19-related stress and isolation in vulnerable adolescents is critical. The Resilience After the COVID-19 Threat (REACT) study assesses whether emotion regulation capacity, inflammation and neuroimmune responses to stress induced in the laboratory prior to the pandemic predict responses to COVID-19-related social isolation and stress in adolescents with CA. We aim to elucidate the mechanisms that enable vulnerable adolescents to maintain or regain good mental health when confronted with COVID-19.

Methods and analysis

We recruited 79 adolescents aged 16–26 with CA experiences from the Resilience After Individual Stress Exposure study in which we assessed emotion regulation, neural and immune stress responses to an acute stress task. Our sample completed questionnaires at the start of the UK lockdown (‘baseline’; April 2020) and three (July 2020) and 6 months later (October 2020) providing crucial longitudinal information across phases of the pandemic progression and government response. The questionnaires assess (1) mental health, (2) number and severity of life events, (3) physical health, (4) stress perception and (5) loneliness and friendship support. We will use multilevel modelling to examine whether individual differences at baseline are associated with responses to COVID-19-related social isolation and stress.

Ethics and dissemination

This study has been approved by the Cambridge Psychology Research Ethics Committee (PRE.2020.037). Results of the REACT study will be disseminated in publications in scientific peer-reviewed journals, presentations at scientific conferences and meetings, publications and presentations for the general public, and through social media.
Effect of stroke early supported discharge on length of hospital stay: analysis from a national stroke registry
Authors: Fisher Rebecca J , Byrne Adrian , Chouliara Niki , Lewis Sarah , Paley Lizz , Hoffman Alex , Rudd Anthony , Robinson Thompson , Langhorne Peter , Walker Marion
Published: January 2021

Objective

The first observational study to investigate the impact of early supported discharge (ESD) on length of hospital stay in real-world conditions.

Design

Using historical prospective Sentinel Stroke National Audit Programme (SSNAP) data (1 January 2013–31 December 2016) and multilevel modelling, cross-sectional (2015–2016; 30 791 patients nested within 55 hospitals) and repeated cross-sectional (2013–2014 vs 2015–2016; 49 266 patients nested within 41 hospitals) analyses were undertaken.

Setting

Hospitals were sampled across a large geographical area of England covering the West and East Midlands, the East of England and the North of England.

Participants

Stroke patients whose data were entered into the SSNAP database by hospital teams.

Interventions

Receiving ESD along the patient care pathway.

Primary and secondary outcome measures

Length of hospital stay.

Results

When adjusted for important case-mix variables, patients who received ESD on their stroke care pathway spent longer in hospital, compared with those who did not receive ESD. The percentage increase was 15.8% (95% CI 12.3% to 19.4%) for the 2015–2016 cross-sectional analysis and 18.8% (95% CI 13.9% to 24.0%) for the 2013–2014 versus 2015–2016 repeated cross-sectional analysis. On average, the increased length of hospital stay was approximately 1 day.

Conclusions

This study has shown that by comparing ESD and non-ESD patient groups matched for important patient characteristics, receiving ESD resulted in a 1-day increase in length of hospital stay. The large reduction in length of hospital stay overall, since original trials were conducted, may explain why a reduction was not observed. The longer term benefits of accessing ESD need to be investigated further.

Trial registration number

http://www.isrctn.com/ISRCTN15568163.
Athlete medicine applied in a pandemic: disparities among athletes and performers reveal the need for a true ‘revolution’ in health care
Authors: Tucker Clea , Antoniak Katherine , Edison Bianca
Published: January 2021

While society watches athletes and artists on a screen during the COVID-19 pandemic, some proponents tout ‘normalcy’ as the moment live in-action play resumes again. However, when we ‘see’ these athletes, are we truly seeing them? Failing to understand and address athletes’ adversity faced during this pandemic amidst social pressures to return to play under a preconceived notion of ‘normal’ commoditises athletes; instead, we must humanise them while recognising additional burdens they bear amidst unmet healthcare needs. Athletes and performers represent a unique population; they stand at the intersection of racial and socioeconomic health inequity and societal expectations for entertainment. Returning to the field or stage suddenly, unscathed by effects of global viral and racial pandemics, is impossible. Instead, athletes face resuming play with a sobering realisation the pursuit of health is not fulfilled with the same tenacity for everyone. This editorial is to raise awareness to disparities that exist for athletes and performing artist athletes during the COVID-19 pandemic and beyond.
301 CAN news2 be used to predict A&E re-attendances during the covid-19 pandemic?
Authors: Gopalakrishna Pillai Krishna Prasad , Naing Zeyar Win , Muniswamy Hemavathi , Pathan Abdul Sajjad
Published: January 2021

Aims/Objectives/Background

The NEWS2 (National Emergency Warning Score 2) is a widely used tool in Emergency Departments (ED) to identify patients who may be at increased risk of deterioration. NEWS2 is based on a simple aggregate scoring system in which a score is allocated to physiological measurements, already recorded in routine practice, when patients present to, or are being monitored in hospital. Currently there are no predictive scoring systems to evaluate ED re-attendances. The objective of this study was to investigate whether calculated NEWS2 had any influence on the ED re-attendances during the COVID-19 pandemic.

Methods/Design

Data for the study was compiled from Symphony, the department’s electronic patient records. Data was retrospectively compiled for the month of April 2020 and was subsequently followed up to 28 days for re-attendances. Patients aged 18 years and older, presenting with COVID-19 symptoms who were discharged from ED were only included (n=310). Case definitions for COVID-19 symptomatology were in accordance to the Public Health England guidance. Correlation was made between NEWS2 and the total number of re-attendances within 28 days using regression analysis.

Results/Conclusions

Simple linear regression analyses the influence of NEWS2 and the total number of re-attendances within 28 days and gives us the value of R2 as 0.007, which suggests that 0.7 percent of variation of NEWS2 is attributable to regression (figure 1).The regression line is almost flat which tells us that there is no relationship between the two variables. NEWS2 alone is not a useful tool to predict re-attendances to ED for patients presenting with COVID-19 symptoms.

Abstract 301 Figure 1
93 Acute magnetic resonance imaging for mild traumatic brain injury
Authors: Richter Sophie , Winzeck Stefan , Kornaropoulos Evgenios , Das Tilak , Williams Guy B , Correia Marta M , Menon David , Newcombe Virginia
Published: January 2021

Aims/Objectives/Background

Mild traumatic brain injury (mTBI) accounts for one million emergency department attendances in the UK every year. Whilst 30–50% of patients suffer from persistent symptoms, unselected follow up would overwhelm the health care system. Magnetic resonance imaging (MRI), may help to stratify patients for clinical follow up and interventional trials. We therefore aimed to identify:

Neuroanatomical features of concussion on MRI and

the optimal timing for magnetic resonance imaging (<72h or 2–3 weeks after injury).

This is the largest study to date using serial scanning acutely in patients with mTBI.

Methods/Design

Data originated from two prospective cohorts: the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study (2014–2017) and a local cohort (2012–2013). Eligible patients presented to hospital within 24h of a mTBI (Glasgow Coma Score 13–15), satisfied local criteria for computed tomography scanning and received two MRIs: one within 72h (MR1) and one 2–3 weeks after injury (MR2). In addition, 104 controls were enrolled. Volumes and diffusion parameters for brain regions of interest were extracted via automated pipelines. Symptoms were measured using the Rivermead Post-Concussion Questionnaire acutely and the extended Glasgow Outcome Score at three months.

Results/Conclusions

The study included 81 patients (73 from CENTER-TBI, 8 local) with a median age of 44 years (range 14–85) and 57 (70%) men. Within patients, cerebral white matter volume decreased (MR1/MR2 0.98, p=0.001) and ventricular volume increased (MR1/MR2 1.06, p<0.001). Compared to controls, white matter volume was normal on MR1 (patient/control 1.00, p=0.277) but reduced on MR2 (patient/control 0.97, p<0.001). Diffusion changes followed one of three trajectories: progressive injury, minimal change, or pseudonormalisation. Concussion symptoms worsened, improved and were variable in the three groups respectively (delta [IQR] + 5.00 [+2.00-+5.00], -4.5 [-9.25-+1.75], 0.00 [-6.25 to +9.00], p=0.018). MR1 predicted three-month outcome better than MR2 (AUC [95% CI]: 0.93 [0.83–1.00] vs 0.72 [0.51–0.92]).
106 The types and effects of feedback received by emergency ambulance staff: A systematic mixed studies review with narrative synthesis
Authors: Wilson Caitlin , Benn Jonathan , Janes Gillian , Lawton Rebecca
Published: January 2021

Aims/Objectives/Background

The phenomenon of feedback is well-researched within the wider healthcare context, where it is suggested that feedback can improve patient care and patient safety by enhancing clinical performance and staff mental health. Within prehospital care, reviews have been conducted for automated feedback from defibrillators and debrief after simulation, but not on the wider concept of feedback. The aim of this systematic review is to identify, describe and synthesize the published literature on the types and effects of feedback received by emergency ambulance staff. PROSPERO CRD42020162600.

Methods/Design

The search strategy consisted of three facets: ambulance staff synonyms, feedback synonyms and feedback content. Databases searched from inception were MEDLINE, EMBASE, AMED, PsycInfo, HMIC, CINAHL and Web of Science. Studies were included if they were qualitative or quantitative empirical research exploring the concept of feedback, i.e. the systematised provision of information to emergency ambulance staff regarding their performance within prehospital practice. Study quality was appraised using the Mixed Methods Appraisal Tool and data analysed using narrative synthesis.

Results/Conclusions

The search strategy yielded 2424 articles excluding duplicates. 94 studies met the inclusion criteria after full-text review, of which 36 fleetingly mentioned increased feedback as a solution to improving specific circumstances (e.g. decision-making, burnout). The remaining 58 studies consisted of 48 interventional prehospital feedback studies, 8 non-interventional studies and 2 feasibility studies. Narrative synthesis revealed a wide range of prehospital feedback types with the majority of studies focusing on performance or patient outcome feedback. The effects of feedback encompassed both personal and professional development, such as improved decision-making, reflection and closure. Mechanisms of providing prehospital feedback varied from electronic dashboards to case reviews and performance appraisals. Further empirical research is required to explore whether the published literature reflects current prehospital practice, as well as to determine the when, what, how and why of ambulance staff desiring feedback.