bluuebunny/crossref_metadata_2025 huggingface dataset:
Influences of exercise interventions on overweight and obesity in children and adolescents
Authors: Lee Junga
Published: February 2021

Purpose

Conflicting findings of the effects of exercise on body fat, free fat mass, insulin, insulin resistance, and physical fitness for overweight and obesity in children and adolescents. The purpose of this meta‐analysis was to investigate the effects of exercise interventions in children and adolescents with overweight and obesity depending on exercise type and to build effective exercise interventions to reduce risks of metabolic disorders.

Methods

Databases were used to find eligible studies regarding the effects of exercise interventions on overweight and obesity in children and adolescents in randomized controlled trails. Effect size was calculated using the standardized mean difference statistic and heterogeneity across studies was estimated using the Q statistic.

Results

A total of 27 studies met the inclusion criteria. Children and adolescents with overweight and obesity who participated in aerobic exercise had reduced body mass index, % body fat, fasting insulin, free fat mass, TNF‐α, and IL‐6, and increased physical fitness compared with control groups. Reduced free fat mass in resistance exercise was not found. Glucose, insulin resistance, blood pressure, C‐reactive protein (CRP), and blood markers including total cholesterol (TC), triglyceride, LDL, and HDL did not have significant change. Average exercise interventions were aerobic exercise, 3 times/week, 60 min, and 36 weeks of exercise period.

Conclusions

Aerobic exercise may be beneficial to reduce body fat, fasting insulin, and inflammatory markers, and increased physical fitness for overweight and obesity in childhood and adolescence, but resistance exercise may be added, which can help avoid muscle loss in children and adolescents with overweight and obesity.
Overview of human papillomavirus vaccination policy changes and its impact in the United States: Lessons learned and challenges for the future
Authors: Kim Deogwoon , Lee Haeok , Kim Minjin
Published: February 2021

Background

The HPV vaccination is effective and safe for preventing HPV infection and HPV attributable cancers. Despite this fact, the uptake rate of the vaccination in the United States has remained below the national target of 80%. Health policy focused on allocating resources and creating vaccine‐promoting environments can influence HPV vaccination coverage rates. There is a scarcity of information about the HPV vaccination‐related health policy and its impact on the outcome of vaccine uptake.

Method

We conducted a comprehensive review of HPV vaccination‐related health policies at the federal, state, and professional organization levels and examined their impact on population health by reviewing national data on HPV vaccination uptake rates.

Results

The review revealed that (a) HPV vaccination recommendations, which serve as the federal‐level HPV vaccination policy, have changed frequently in terms of gender, age criteria, and dosing schedule, and (b) the frequent changes of the policy have resulted in low uptake rates among male and young adult populations.

Discussion

The uptake rate should be continuously followed to evaluate the impact of recent changes to the federal‐level HPV vaccination policy. State‐level policies and healthcare professionals, including nurses, are important to the promotion of HPV vaccinations and decreasing HPV vaccination disparities.
Characteristics of an Impaired PDT Response
Authors: Kessel David , Cho Won Jin , Rakowski Joseph , Kim Harold E. , Kim Hyeong‐Reh C.
Published: February 2021

A concurrent human papilloma virus (HPV) infection potentiates the efficacy of ionizing radiation for treatment of head and neck cancer by promoting apoptosis. Studies in cell culture indicated an opposite effect for photodynamic therapy (PDT) when this leads to mitochondrial and ER photodamage. The explanation for this difference in PDT efficacy remains to be established. While apoptosis was impaired in HPV(‐) cells, such cells can be killed via photodamage directed at the ER: this leads to a nonapoptotic death pathway termed paraptosis. No differences in photosensitizer uptake or reactive oxygen species (ROS) production were observed in HPV(+) vs. HPV(‐) tumors. We now provide evidence that death pathways initiated by ER/mitochondrial photodamage leading to either paraptosis or apoptosis are impaired in an HPV(+) head and neck cell line. These results illustrate the complex determinants of PDT efficacy, a topic that has yet to be fully explored.
K–Ar geochronology of orogenic gold mineralization in the Vangtat gold belt, southeastern Laos: Effect of excess argon in hydrothermal quartz
Authors: Bounliyong Patthana , Itaya Tetsumaru , Arribas Antonio , Watanabe Yasushi , Wong Henry , Echigo Takuya
Published: February 2021

The Thongkai‐Ok gold deposit is one of several actively mined deposits in a newly discovered orogenic gold belt in southeastern Laos. At a district scale, gold mineralization occurs within the Vangtat shear zone, one of the tectonic structures of the Poko suture zone that marks the collision between the Indochina Terrane and the Kontum Massif in southern Laos‐central Vietnam. High grade gold mineralization is associated with quartz–pyrite–white mica veins and silicified zones up to 10 m thick, hosted by strongly deformed and sheared pelitic schist. Lower‐grade gold mineralization occurs in a graphite–carbonate–quartz–sulfide hydrothermal alteration envelope that grades into sub‐economic/barren altered pelitic schist. The objective of this study is to establish the age of mineralization in the Vangtat orogenic gold belt by K–Ar dating of hydrothermal white mica in the gold‐bearing quartz‐sulfide veins in order to better understand its spatial and temporal relation to other gold deposits in Southeast Asia and to regional tectonic events. Three‐white mica bearing quartz–pyrite samples were collected from the open pit at Thongkai‐Ok. The dominant white mica phase in the samples is 2M1 muscovite and the K2O content measured by electron microprobe techniques in individual white mica crystals ranged between 8.61 and 9.79 wt%. Two of the three vein samples were separated by gravity settling into four size fractions, <2, 2–4, 4–10, and 10–40 μm, respectively. The results of potassium measurements by flame photometry in the K–Ar sample aliquots show a range in potassium content which reflects the amount of quartz present in each sample as an impurity. With one exception, a correlation was observed between potassium concentration in the samples, including the size fraction separates, and the calculated K–Ar age. The large range of calculated ages, from 348 to 206 Ma, is interpreted to reflect excess argon contained in fluid inclusions in the hydrothermal quartz present in the analyzed samples. We interpret the youngest age of the quartz‐free samples, 206 ± 4 Ma, as closest to the age of mineralization in the Vangtat gold belt. The age could be as young as ~170 Ma if the age versus potassium content relation is extrapolated to the average potassium content of white mica in the samples analyzed.
Between affordable welfare and affordable food: Internationalized food subsidy reforms in Egypt and Tunisia
Authors: Thyen Kressen , Karadag Roy
Published: February 2021

The public subsidization of food is an important element of North African welfare states, guaranteeing access to affordable nutrition and maintaining food security even in times of economic downturns. Since the 1970s, universal food subsidy schemes have come under growing international pressure, and North African countries have selectively adopted policy recommendations and adjusted their subsidy schemes. Comparing the empirical cases of Egypt and Tunisia before and after the 2010/11 uprisings, we analyze the linkages between international organizations, national governments and local welfare demands and explain what kinds of reform alliances emerge between these actors. We find that until 2010, internationalized social policy reform was structured by governments' brokerage of international and domestic pressure and adaptation of reform aims. Since then, two modes have unfolded: in militarized Egypt, coercive closure secured an alliance and the respective subsidy reforms, whereas in Tunisia, polarization disconnected domestic and international policy goals.
Ultraconserved element phylogenomics and biogeography of the agriculturally important mason bee subgenus Osmia (Osmia)
Authors: Branstetter Michael G. , Müller Andreas , Griswold Terry L. , Orr Michael C. , Zhu Chao‐Dong
Published: February 2021

One of the most important non‐Apis groups of bees for agriculture is the mason bee subgenus Osmia Panzer (Osmia), or Osmia s.s. (Hymenoptera: Megachilidae). Out of the 29 known species, four have been developed as managed pollinators of orchards. In addition, the group is important as a source of non‐native pollinators, given that several species have been introduced into new areas. Osmia s.s. occurs naturally throughout the northern temperate zone with greatest species richness in Europe and Asia. Here, we integrate phylogenomic data from ultraconserved elements (UCEs), near complete taxon sampling, and a diversity of analytical approaches to infer the phylogeny, divergence times and biogeographic history of Osmia s.s. We also demonstrate how mitochondrial sequence data can be extracted from ultraconserved element data and combined with sequences from public repositories in order to test the phylogeny, examine species boundaries and identify specimen‐associated, non‐bee DNA. We resolve the phylogeny of Osmia s.s. and show strong support that Nearctic Osmia ribifloris is the sister group to the rest of the subgenus. Biogeographic analyses indicate that the group originated during the Late Miocene in the West Nearctic plus East Palearctic region following dispersal from the East Palearctic to the West Nearctic across the Bering land bridge prior to its closure 5.5–4.8 Ma. The mitochondrial DNA results reveal potential taxonomic synonymies involving Osmia yanbianensis and Osmia opima, and Osmia rufina, Osmia rufinoides and Osmia taurus.
Characterization of the novel HLA‐C*14:124 allele by next generation sequencing
Authors: Ulrich Silvia , Lang Johanna , Posch Ursula , Schlenke Peter
Published: February 2021

HLA‐C*14:124 differs from C*14:02:01:01 by one nucleotide substitution at position 757 in exon 4.
The Middle East respiratory syndrome coronavirus (MERS‐CoV) nucleic acids detected in the saliva and conjunctiva of some naturally infected dromedary camels in Saudi Arabia ‐2019
Authors: Hemida Maged Gomaa , Ali Ali Mohamed , Alnaeem Abdelmohsen
Published: February 2021

Dromedary camels are playing essential roles in the evolution and transmission of MERS‐CoV. MERS‐CoV shedding in some dromedary camel secretions, particularly nasal swabs, were studied in more detail. However, the roles of viral shedding in saliva and ocular secretions are still required further detailed studies. We performed a longitudinal study on a farm of dromedary camel herd from 10th March until 7th April, 2019, in eastern Saudi Arabia. This is a closed management herd including a large number of colour‐based breed animals and include animals of both sexes. We collected saliva and ocular swabs from 18% of the target animal population. Detection of the MERS‐CoV‐RNAs in these samples was conducted by the real‐time PCR technique. We detected the viral RNAs in the saliva of and conjunctival swabs of some of the tested animals at 33%, 77% and 88% during the three‐time points, respectively. Moreover, we also detected the viral RNAs in the conjunctival swabs at 11%, 22% and 33% at similar time intervals. Our results are suggesting the possibility of MERS‐CoV shedding in the saliva and the ocular discharges of the infected dromedary camels. This explains, at least in part, the mechanism of transmission of MERS‐CoV from animals to humans. More studies are needed for a better understanding of the transmission of MERS‐CoV from animals to humans; thus, the risk of virus spread can be mitigated.
Efecto del Seguimiento a la Gestión Estratégica sobre las Funciones Sustantivas en las Instituciones de Educación Superior en Colombia
Authors: González-Campo Carlos Hernán , Vásquez Rivera Oscar Iván , Cifuentes-Madrid Jairo Humberto
Published: February 2021

¿Cuál es el efecto que tiene el seguimiento a la gestión estratégica sobre las funciones sustantivas de investigación, docencia y extensión en las Instituciones de Educación Superior –IES– en Colombia? El objetivo de esta investigación es responder al interrogante, por medio del uso de una metodología cuantitativa sobre una muestra compuesta por 83 instituciones. La hipótesis plantea que el seguimiento a la gestión estratégica genera un efecto positivo en las funciones sustantivas. Los resultados respaldan el planteamiento, siendo significativo sólo para la docencia y la investigación. Esto permite concluir que las IES pueden centrar su gestión estratégica hacia las variables del seguimiento que lo componen, dado los impactos positivos de este proceso sobre las funciones sustantivas de docencia, investigación y extensión.
Numerical Characterization of the Performance Curve of a Regenerative Pump-as-Turbine
Authors: Cantini Giulio , Salvadori Simone
Published: February 2021

Energy companies in the power generation field are continuously searching for green technologies to reduce pollutant emissions. In that context, small hydropower plants represent an attractive solution for distributed electricity generation. Reverse-running centrifugal pumps (also known as “pump-as-turbines,” PaT) are increasingly selected in that field. Amongst the existing type of pumps, drag-type regenerative pumps (RP) can perform similarly to radial centrifugal pumps in terms of head and efficiency for low specific speed values. For a fixed rotational speed, RPs with linear blades work as pumps or turbines only depending on the flow rate. Such peculiarity makes it particularly intriguing to evaluate RPs working characteristics in the turbine operating mode. In this paper, the performance of three regenerative pump-as-turbines (RPaT) is analyzed using computational fluid dynamics (CFD). The numerical approach is validated using experimental data for both an RP (in the pump working region) and a regenerative turbine (RT) (in the turbine working region). Finally, the numerical simulation of a small-scale RP allows for characterizing both the pump and the turbine regions. Results show that for an RPaT it is possible to find a “switch region” where the machine turns from behaving as a pump to behaving as a turbine, the losses not being overcome by the turbine power output. The analysis of the RPaT also shows the inversion of the flow pattern and the constant positioning of the pivot around which the flow creates the typical helical structure that characterizes RPs.
One Hundred Years Later, Introductory Labs Are Poised for Change
Authors: Carter Ashley R.
Published: February 2021

Introductory lab courses have been a staple of the physics curriculum for over 100 years. Yet these courses are now poised for change as recent research shows that they do not meet a frequent goal of enhancing student understanding of lecture content. In thinking about how to move forward, a look back at experiment courses in history seems wise. Here, I take a quick look at our historical record and describe three interesting experiment courses from different time periods: Adolphe Ganot’s demonstration-style experiment course of the mid-1800s, Fredrich Kohlrausch’s research-grade experiment course in the late 1800s, and Newton Henry Black’s concept-exercise experiment course of the early 1900s. In looking back at these three courses, I find that instructors throughout history have had to face the same questions we do today. Specifically, what is the role of the introductory lab course in teaching experimental or theoretical concepts, and how much preparation, instruction, authenticity, and complexity are required? It seems that even if the introductory lab course is poised for change, that change may not be meaningful unless we answer these questions.
From Pressure Maps and Wind Velocity to Northern Lights and Other Fascinating Phenomena on the Rotating Earth
Authors: Gróf Andrea
Published: February 2021

Owing to the presence of the Coriolis effect, the rotation of Earth has a multitude of surprising consequences that make the mechanics of the atmosphere or the oceans different from that of a fluid in a container. Since the Coriolis effect also captures the imagination of screenwriters, contributing to the continual exposure of students to bogus science, it is important to address these ideas in the physics classroom. This paper assumes that students are familiar with the Coriolis force acting on moving bodies in a rotating reference frame, and suggests a possible algebra-based approach. The information encoded in pressure maps is used to obtain wind velocity, and the result is applied in various contexts to learn about tilting sea surfaces, northern lights, and fluids flowing around phantom obstacles.
Systematic Problem Authoring: Constant Acceleration and Projectile Motion
Authors: Forringer Edward
Published: February 2021

When authoring physics problems, professors may develop an intuition for how much information they need to provide such that the problem has a unique answer and is not over constrained. It is an open question as to whether using intuition leads to a sufficiently broad range of problems. In this paper we discuss a systematic way of authoring problems to guarantee that problems are fully constrained and that all possible variations of certain classes of problems are explored.
The flashing light bulb: A quantitative introduction to the theory of alternating current
Authors: Vogt Patrik , Küchemann Stefan , Kuhn Jochen
Published: February 2021

In this column, several previous articles focused on mechanics experiments that can be analyzed using a mobile video motion analysis. However, the use of this method is also possible in completely different areas, which is the focus of this article.
Color temperature in digital photography and the blackbody spectrum
Authors: Lincoln James , Wetrich Steven
Published: February 2021

As an application of the blackbody spectrum outside of pure physics, we present how the phenomenon applies to digital photography. While shooting the AAPT Films series, the authors often would discuss how the names of “warm” and “cool” light sources strikingly mismatch their temperature values. Indeed, the so-called “cool tones” are over 7000 K, while the “warm tones” are at a much lower 3000 K. In this article, we discuss a few demonstrations of blackbody radiation and explain how the concept applies to photography and astronomy, and even dare to utilize the camera’s white balance feature as a thermometer.
Deep learning assisted sound source localization using two orthogonal first-order differential microphone arrays
Authors: Liu Nian , Chen Huawei , Songgong Kunkun , Li Yanwen
Published: February 2021

Sound source localization in noisy and reverberant rooms using microphone arrays remains a challenging task, especially for small-sized arrays. Recent years have seen promising advances on deep learning assisted approaches by reformulating the sound localization problem as a classification one. A key to the deep learning-based approaches lies in extracting sound location features effectively in noisy and reverberant conditions. The popularly adopted features are based on the well-established generalized cross correlation phase transform (GCC-PHAT), which is known to be helpful in combating room reverberation. However, the GCC-PHAT features may not be applicable to small-sized arrays. This paper proposes a deep learning assisted sound localization method using a small-sized microphone array constructed by two orthogonal first-order differential microphone arrays. An improved feature extraction scheme based on sound intensity estimation is also proposed by decoupling the correlation between sound pressure and particle velocity components in the whitening weighting construction to enhance the robustness of the time-frequency bin-wise sound intensity features. Simulation and real-world experimental results show that the proposed deep learning assisted approach can achieve higher spatial resolution and is superior to its state-of-the-art counterparts using the GCC-PHAT or sound intensity features for small-sized arrays in noisy and reverberant environments.
Caffeine Use or Napping to Enhance Repeated Sprint Performance After Partial Sleep Deprivation: Why Not Both?
Authors: Romdhani Mohamed , Souissi Nizar , Moussa-Chamari Imen , Chaabouni Yassine , Mahdouani Kacem , Sahnoun Zouheir , Driss Tarak , Chamari Karim , Hammouda Omar
Published: February 2021

Purpose: To compare the effect of a 20-minute nap opportunity (N20), a moderate dose of caffeine (CAF; 5 mg·kg−1), or a moderate dose of caffeine before N20 (CAF+N) as possible countermeasures to the decreased performance and the partial sleep deprivation–induced muscle damage. Methods: Nine male, highly trained judokas were randomly assigned to either baseline normal sleep night, placebo, N20, CAF, or CAF+N. Test sessions included the running-based anaerobic sprint test, from which the maximum (Pmax), mean (Pmean), and minimum (Pmin) powers were calculated. Biomarkers of muscle, hepatic, and cardiac damage and of enzymatic and nonenzymatic antioxidants were measured at rest and after the exercise. Results: N20 increased Pmax compared with placebo (P < .01, d = 0.75). CAF+N increased Pmax (P < .001, d = 1.5; d = 0.94), Pmin (P < .001, d = 2.79; d = 2.6), and Pmean (P < .001, d = 1.93; d = 1.79) compared with placebo and CAF, respectively. Postexercise creatine kinase increased whenever caffeine was added, that is, after CAF (P < .001, d = 1.19) and CAF+N (P < .001, d = 1.36). Postexercise uric acid increased whenever participants napped, that is, after N20 (P < .001, d = 2.19) and CAF+N (P < .001, d = 2.50) and decreased after CAF (P < .001, d = 2.96). Conclusion: Napping improved repeated-sprint performance and antioxidant defense after partial sleep deprivation. Contrarily, caffeine increased muscle damage without improving performance. For sleep-deprived athletes, caffeine before a short nap opportunity would be more beneficial for repeated sprint performance than each treatment alone.
Seismic crustal imaging using fin whale songs
Authors: Kuna Václav M. , Nábělek John L.
Published: February 2021

Structure from a whale song

Probing the structure of the ocean crust requires a wave source. The most common source is an air gun, which is effective but potentially harmful for ocean life and not easy to use everywhere. Kuna and Nábělek found that fin whale songs can also be used as a seismic source for determining crustal structure. Fin whale vocalizations can be as loud as large ships and occur at frequencies useful for traveling through the ocean floor. These properties allow fin whale songs to be used for mapping out the density of ocean crust, a vital part of exploring the seafloor.

Science
, this issue p.
731
Asking the right questions about race and policing
Authors: Goff Phillip Atiba
Published: February 2021

When is policing the right tool, and when is it the problem?
Mosaic nanoparticles elicit cross-reactive immune responses to zoonotic coronaviruses in mice
Authors: Cohen Alexander A. , Gnanapragasam Priyanthi N. P. , Lee Yu E. , Hoffman Pauline R. , Ou Susan , Kakutani Leesa M. , Keeffe Jennifer R. , Wu Hung-Jen , Howarth Mark , West Anthony P. , Barnes Christopher O. , Nussenzweig Michel C. , Bjorkman Pamela J.
Published: February 2021

Fighting zoonotic coronaviruses

In the past 20 years, three betacoronaviruses thought to have originated in bats have caused devastating disease in humans. The global pandemic caused by the latest such virus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), highlights the need to protect against other strains that could present a threat to humans. Cohen
et al.
constructed nanoparticles displaying the protein domain that binds the host cell receptor (receptor-binding domain or RBD), either a homotypic SARS-CoV-2 particle or mosaic particles displaying RBDs from four or eight different betacoronaviruses. In mice, antibodies to the SARS-CoV-2 RBD were elicited just as well by mosaic particles as by homotypic nanoparticles. The mosaic nanoparticles elicited antibodies that, beyond recognizing the strains displayed, also recognized mismatched strains.

Science
, this issue p.
735
Tracking the UK SARS-CoV-2 outbreak
Authors: Nelson Martha I.
Published: February 2021

The UK epidemic was seeded by more than 1000 imported viruses from Europe
Yin Yang 1 protein ameliorates diabetic nephropathy pathology through transcriptional repression of TGFβ1
Authors: Gao Pan , Li Liliang , Yang Liu , Gui Dingkun , Zhang Jiarong , Han Junfeng , Wang Jiajia , Wang Niansong , Lu Junxi , Chen Suzhen , Hou Liping , Sun Honglin , Xie Liping , Zhou Jian , Peng Chao , Lu Yan , Peng Xuemei , Wang Cunchuan , Miao Ji , Ozcan Umut , Huang Yu , Jia Weiping , Liu Junli
Published: February 2021

YY1 transcriptionally represses
TGFB1
in mice and may be a potential drug target for treating diabetic nephropathy.
Verification and Validation of SARS-CoV-2 Assay Performance on the Abbott
m
2000 and Alinity
m
Systems
Authors: Hirschhorn Julie W. , Kegl April , Dickerson Tanisha , Glen W. Bailey , Xu Gang , Alden Jay , Nolte Frederick S.
Published: February 2021

We verified the analytical performance of the Abbott RealTi
m
e SARS-CoV-2 assay on the
m
2000 system and compared its clinical performance to the CDC 2019-nCoV real-time PCR diagnostic panel and the Thermo Fisher TaqPath RT-PCR COVID-19 kit. We also performed a bridging study comparing the RealTi
m
e SARS-CoV-2 assay with the new Abbott Alinity
m
SARS-CoV-2 assay.
CD8 Lymphocyte Depletion Enhances the Latency Reversal Activity of the SMAC Mimetic AZD5582 in ART-Suppressed Simian Immunodeficiency Virus-Infected Rhesus Macaques
Authors: Mavigner Maud , Liao Laura E. , Brooks Alyssa D. , Ke Ruian , Mattingly Cameron , Schoof Nils , McBrien Julia , Carnathan Diane , Liang Shan , Vanderford Thomas H. , Paiardini Mirko , Kulpa Deanna , Lifson Jeffrey D. , Dunham Richard M. , Easley Kirk A. , Margolis David M. , Perelson Alan S. , Silvestri Guido , Chahroudi Ann
Published: February 2021

A favored approach to curing HIV infection aims at inducing viral expression using latency-reversing agents (LRAs) to allow the elimination of infected cells. Here, we tested a combination of two recently identified LRAs, the SMAC mimetic/IAP inhibitor AZD5582, which activates the noncanonical NF-κB pathway, and the antibody (Ab) MT807R1, which depletes CD8α
+
cells, in SIV-infected rhesus macaques (RMs) on ART.
Quantifying and Modeling the Acquisition and Retention of Lumpy Skin Disease Virus by Hematophagus Insects Reveals Clinically but Not Subclinically Affected Cattle Are Promoters of Viral Transmission and Key Targets for Control of Disease Outbreaks
Authors: Sanz-Bernardo Beatriz , Haga Ismar R. , Wijesiriwardana Najith , Basu Sanjay , Larner Will , Diaz Adriana V. , Langlands Zoë , Denison Eric , Stoner Joanne , White Mia , Sanders Christopher , Hawes Philippa C. , Wilson Anthony J. , Atkinson John , Batten Carrie , Alphey Luke , Darpel Karin E. , Gubbins Simon , Beard Philippa M.
Published: February 2021

Lumpy skin disease virus (LSDV) causes a severe systemic disease characterized by cutaneous nodules in cattle. LSDV is a rapidly emerging pathogen, having spread since 2012 into Europe and Russia and across Asia.
Association of first trimester prescription opioid use with congenital malformations in the offspring: population based cohort study
Authors: Bateman Brian T , Hernandez-Diaz Sonia , Straub Loreen , Zhu Yanmin , Gray Kathryn J , Desai Rishi J , Mogun Helen , Gautam Nileesa , Huybrechts Krista F
Published: February 2021

Objective

To evaluate the risk of first trimester exposure to prescription opioids for major congenital malformations, previously reported to be associated with such exposure.

Design

Population based cohort study.

Setting

Nationwide sample of publicly and commercially insured pregnant women linked to their liveborn infants, nested in the Medicaid Analytic eXtract (MAX, 2000-14) and the MarketScan Research Database (MarketScan, 2003-15).

Participants

1 602 580 publicly insured (MAX) and 1 177 676 commercially insured (MarketScan) pregnant women with eligibility from at least three months before pregnancy to one month after delivery; infants with eligibility for at least three months after birth.

Interventions

Use of prescription opioids was ascertained by requiring two or more dispensations of any opioid during the first trimester.

Main outcomes measures

Major malformations overall, cardiac malformations overall, ventricular septal defect, secundum atrial septal defect/patent foramen ovale, neural tube defect, clubfoot, and oral cleft, defined based on validated algorithms. Propensity score stratification was used to adjust for potential confounders and/or proxies for confounders. Estimates from each database were combined using meta-analysis.

Results

70 447 (4.4%) of 1 602 580 publicly insured and 12 454 (1.1%) of 1 177 676 commercially insured pregnant women had two or more dispensations of an opioid during the first trimester. Absolute risk of malformations overall was 41.0 (95% confidence interval 39.5 to 42.5) per 1000 pregnancies exposed to opioids versus 32.0 (31.7 to 32.3) per 1000 unexposed pregnancies in the MAX cohort, and 42.6 (39.0 to 46.1) and 37.3 (37.0 to 37.7) per 1000, respectively, in the MarketScan cohort. Pooled unadjusted relative risk estimates were raised for all outcomes but shifted substantially toward the null after adjustment; for malformations overall (relative risk 1.06, 95% confidence interval 1.02 to 1.10), cardiovascular malformations (1.09, 1.00 to 1.18), ventricular septal defect (1.07, 0.95 to 1.21), atrial septal defect/patent foramen ovale (1.04, 0.88 to 1.24), neural tube defect (0.82, 0.53 to 1.27), and clubfoot (1.06, 0.88 to 1.28). The relative risk for oral clefts remained raised after adjustment (1.21, 0.98 to 1.50), with a higher risk of cleft palate (1.62, 1.23 to 2.14).

Conclusions

Prescription opioids used in early pregnancy are not associated with a substantial increase in risk for most of the malformation types considered, although a small increase in the risk of oral clefts associated with their use is possible.
Availability and funding of clinical genomic sequencing globally
Authors: Phillips Kathryn A , Douglas Michael P , Wordsworth Sarah , Buchanan James , Marshall Deborah A
Published: February 2021

The emergence of next-generation genomic sequencing (NGS) tests for use in clinical care has generated widespread interest around the globe, but little is known about the availability and funding of these tests worldwide. We examined NGS availability across world regions and countries, with a particular focus on availability of three key NGS tests—Whole-Exome Sequencing or Whole-Genome Sequencing for diagnosis of suspected genetic diseases such as intellectual disability disorders or rare diseases, non-invasive prenatal testing for common genetic abnormalities in fetuses and tumor sequencing for therapy selection and monitoring of cancer treatment. We found that these NGS tests are available or becoming available in every major region of the world. This includes both high-income countries with robust genomic programmes such as the USA and the UK, and growing availability in countries with upper-middle-income economies. We used exploratory case studies across three diverse health care systems (publicly funded/national (UK), publicly funded/provincial (Canada) and mixed private/public system (USA)) to illustrate the funding challenges and approaches used to address those challenges that might be adopted by other countries. We conclude by assessing what type of data and initiatives will be needed to better track and understand the use of NGS around the world as such testing continues to expand.
Protocol for a randomised clinical trial of multimodal postconcussion symptom treatment and recovery: the Concussion Essentials study
Authors: Anderson Vicki , Rausa Vanessa C , Anderson Nicholas , Parkin Georgia , Clarke Cathriona , Davies Katie , McKinlay Audrey , Crichton Ali , Davis Gavin A , Dalziel Kim , Dunne Kevin , Barnett Peter , Hearps Stephen JC , Takagi Michael , Babl Franz E
Published: February 2021

Introduction

While most children recover from a concussion shortly after injury, approximately 30% experience persistent postconcussive symptoms (pPCS) beyond 1-month postinjury. Existing research into the treatment of pPCS have evaluated unimodal approaches, despite evidence suggesting that pPCS likely represent an interaction across various symptom clusters. The primary aim of this study is to evaluate the effectiveness of a multimodal, symptom-tailored intervention to accelerate symptom recovery and increase the proportion of children with resolved symptoms at 3 months postconcussion.

Methods and analysis

In this open-label, assessor-blinded, randomised clinical trial, children with concussion aged 8–18 years will be recruited from The Royal Children’s Hospital (The RCH) emergency department, or referred by a clinician, within 17 days of initial injury. Based on parent ratings of their child’s PCS at ~10 days postinjury, symptomatic children (≥2 symptoms at least 1-point above those endorsed preinjury) will undergo a baseline assessment at 3 weeks postinjury and randomised into either Concussion Essentials (CE, n=108), a multimodal, interdisciplinary delivered, symptom-tailored treatment involving physiotherapy, psychology and education, or usual care (UC, n=108) study arms. CE participants will receive 1 hour of intervention each week, for up to 8 weeks or until pPCS resolve. A postprogramme assessment will be conducted at 3 months postinjury for all participants. Effectiveness of the CE intervention will be determined by the proportion of participants for whom pPCS have resolved at the postprogramme assessment (primary outcome) relative to the UC group. Secondary outcome analyses will examine whether children receiving CE are more likely to demonstrate resolution of pPCS, earlier return to normal activity, higher quality of life and a lower rate of utilisation of health services, compared with the UC group.

Ethics and dissemination

Ethics were approved by The RCH Human Research Ethics Committee (HREC: 37100). Parent, and for mature minors, participant consent, will be obtained prior to commencement of the trial. Study results will be disseminated at international conferences and international peer-reviewed journals.

Trial registration number

ACTRN12617000418370; pre-results.
What drives general practitioners in the UK to improve the quality of care? A systematic literature review
Authors: Ahmed Kanwal , Hashim Salma , Khankhara Mariyam , Said Ilhan , Shandakumar Amrita Tara , Zaman Sadia , Veiga Andre
Published: February 2021

Background

In the UK, the National Health Service has various incentivisation schemes in place to improve the provision of high-quality care. The Quality Outcomes Framework (QOF) and other Pay for Performance (P4P) schemes are incentive frameworks that focus on meeting predetermined clinical outcomes. However, the ability of these schemes to meet their aims is debated.

Objectives

(1) To explore current incentive schemes available in general practice in the UK, their impact and effectiveness in improving quality of care and (2) To identify other types of incentives discussed in the literature.

Methods

This systematic literature review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Six databases were searched: Cochrane, PubMed, National Institute for Health and Care Excellence Evidence, Health Management Information Consortium, Embase and Health Management. Articles were screened according to the selection criteria, evaluated against critical appraisal checklists and categorised into themes.

Results

35 articles were included from an initial search result of 22087. Articles were categorised into the following three overarching themes: financial incentives, non-financial incentives and competition.

Discussion

The majority of the literature focused on QOF. Its positive effects included reduced mortality rates, better data recording and improved sociodemographic inequalities. However, limitations involved decreased quality of care in non-incentivised activities, poor patient experiences due to tick-box exercises and increased pressure to meet non-specific targets. Findings surrounding competition were mixed, with limited evidence found on the use of non-financial incentives in primary care.

Conclusion

Current research looks extensively into financial incentives, however, we propose more research into the effects of intrinsic motivation alongside existing P4P schemes to enhance motivation and improve quality of care.
Validation of a new method for saliva cortisol testing to assess stress in first responders
Authors: Smeets Math MJ , Vandenbossche Piet , Duijst Wilma LJM , Mook Walther NKA van , Leers Mathie P.G.
Published: February 2021

Background

Acute or chronic stress can lead to physical and mental disorders. Measuring cortisol can objectify the degree of stress. Cortisol is traditionally measured in serum, but recently the relevant fraction of free cortisol can be reliably measured in saliva, using the very sensitive liquid chromatography tandem mass spectrometry (LC-MS/MS) method. The use of saliva is non-invasive and allows easy serial testing around stressful events. The main objective of this study is to investigate whether serial saliva cortisol determinations using the LC-MS/MS method can be used to assess the stress response that first responders may experience during moments of acute professional deployment in their daily work.

Methods

Healthy first responders (police officers, firefighters, rapid response team, ambulance personnel, first aid and emergency medical personnel) were recruited to participate in a Euregional high-reliability simulation training (‘Be Aware’-scenario training, 19 April 2018). At three time points, simultaneous venous blood samples and saliva samples were obtained. These time points were 1 hour before, immediately after and 10 hours after the simulation training. The correlation between changes in saliva cortisol measured by LC-MS/MS and serum cortisol at all three time points was determined. Results were compared with spectators not directly participating in the simulation.

Results

70 subjects participated in the simulation. There was a strong correlation between the changes in saliva and blood cortisol at the three time points. A significant increase in blood and saliva cortisol was shown 1 hour after the experienced stress moments. The levels had almost completely returned to baseline in all healthy volunteers 10 hours later. Cortisol in spectators was unaffected.

Conclusion

Serial saliva cortisol measurements using LC-MS/MS is a reliable and fast non-invasive functional stress assay, which can be easily collected in daily practice and used for investigation and monitoring of stress response in front line responders.
Systemic lupus erythematosus presenting as Guillain-Barré syndrome
Authors: Kopanidis Paul Christopher , Kane Alisa , Nguyen Minh Anh , Markus Romesh
Published: February 2021

A 37-year-old woman developed progressive symmetrical weakness with areflexia, consistent with Guillain-Barré syndrome. After initially briefly responding to intravenous immunoglobulin, her weakness progressed markedly. Further investigation identified a new diagnosis of systemic lupus erythematosus with lupus nephritis. Following additional plasma exchange and corticosteroids, the lupus activity remitted and she made a complete neurological recovery.
Prevalence of burnout and its relationship to health status and social support in more than 1000 subspecialty anesthesiologists
Authors: Hyman Steve A , Card Elizabeth Borg , De Leon-Casasola Oscar , Shotwell Matthew S , Shi Yaping , Weinger Matthew B
Published: February 2021

Background

Physician burnout may be at ‘epidemic’ proportions due to factors associated with modern healthcare practice and technology. Practice attributes vary appreciably among subspecialists. Understanding burnout incidence and its associated factors could illuminate potential causes and interventions. We evaluated burnFout, mental and physical health, and social support and coping skills in acute and chronic pain physicians and pediatric and cardiac anesthesiologists.

Methods

We administered the Maslach Burnout Inventory Human Services Survey (MBI-HSS), a two-item self-identified burnout measure, the Veterans RAND 12-item Health Survey and the Social Support and Personal Coping Survey to subspecialty society members practicing acute and chronic pain management, pediatric anesthesiology and cardiac anesthesiology. Multivariable regression analysis compared the groups, and adjusted burnout prevalence was compared with an all-physician and an employed general population sample.

Results

Among 1303 participants (response rates 21.6%–35.6% among the subspecialty groups), 43.4% met established burnout criteria (range 30.0%–62.3%). Chronic pain physicians had significantly worse scores (unadjusted) than the other three groups of subspecialty anesthesiologists, the all-physician comparator group and the general population comparator group. Mental health inversely correlated with emotional exhaustion and depersonalization in all groups. Self-identified burnout correlated with the full MBI-HSS (R=0.54; positive predictive value of 0.939 (0.917, 0.955)). Physicians’ scores for personal accomplishment were higher than population norms.

Conclusions

This study provides data on burnout prevalence and associated demographic, health and social factors in subspecialist anesthesiologists. Chronic pain anesthesiologists had significantly greater burnout than the other groups. The self-identified burnout metric performed well and may be an attractive alternative to the full MBI-HSS.
Respiratory exacerbations are associated with muscle loss in current and former smokers
Authors: Mason Stefanie Elizabeth , Moreta-Martinez Rafael , Labaki Wassim W , Strand Matthew , Baraghoshi David , Regan Elizabeth A , Bon Jessica , San Jose Estepar Ruben , Casaburi Richard , McDonald Merry-Lynn N , Rossiter Harry , Make Barry J , Dransfield Mark T , Han MeiLan K , Young Kendra A , Kinney Greg , Hokanson John E , San Jose Estepar Raul , Washko George R
Published: February 2021

Objectives

Muscle wasting is a recognised extra-pulmonary complication in chronic obstructive pulmonary disease and has been associated with increased risk of death. Acute respiratory exacerbations are associated with reduction of muscle function, but there is a paucity of data on their long-term effect. This study explores the relationship between acute respiratory exacerbations and long-term muscle loss using serial measurements of CT derived pectoralis muscle area (PMA).

Design and setting

Participants were included from two prospective, longitudinal, observational, multicentre cohorts of ever-smokers with at least 10 pack-year history.

Participants

The primary analysis included 1332 (of 2501) participants from Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) and 4384 (of 10 198) participants from Genetic Epidemiology of COPD (COPDGene) who had complete data from their baseline and follow-up visits.

Interventions

PMA was measured on chest CT scans at two timepoints. Self-reported exacerbation data were collected from participants in both studies through the use of periodic longitudinal surveys.

Main outcome measures

Age-related and excess muscle loss over time.

Results

Age, sex, race and body mass index were associated with baseline PMA. Participants experienced age-related decline at the upper end of reported normal ranges. In ECLIPSE, the exacerbation rate over time was associated with an excess muscle area loss of 1.3% (95% CI 0.6 to 1.9, p<0.001) over 3 years and in COPDGene with an excess muscle area loss of 2.1% (95% CI 1.2 to 2.8, p<0.001) over 5 years. Excess muscle area decline was absent in 273 individuals who participated in pulmonary rehabilitation.

Conclusions

Exacerbations are associated with accelerated skeletal muscle loss. Each annual exacerbation was associated with the equivalent of 6 months of age-expected decline in muscle mass. Ameliorating exacerbation-associated muscle loss represents an important therapeutic target.
Age of thawed plasma does not affect clinical outcomes or biomarker expression in patients receiving prehospital thawed plasma: a PAMPer secondary analysis
Authors: Reitz Katherine M , Gruen Danielle S , Guyette Frances , Brown Joshua B , Yazer Mark H , Vodovotz Yoram , Johanssen Pär I , Stensballe Jakob , Daley Brian , Miller Richard S , Harbrecht Brian G , Claridge Jeffrey , Phelan Herb A , Neal Matthew D , Zuckerbraun Brian S , Sperry Jason L
Published: February 2021

Background

Prehospital plasma administration during air medical transport reduces the endotheliopathy of trauma, circulating pro-inflammatory cytokines, and 30-day mortality among traumatically injured patients at risk of hemorrhagic shock. No clinical data currently exists evaluating the age of thawed plasma and its association with clinical outcomes and biomarker expression post-injury.

Methods

We performed a secondary analysis from the prehospital plasma administration randomized controlled trial, PAMPer. We dichotomized the age of thawed plasma creating three groups: standard-care, YOUNG (day 0–1) plasma, and OLD (day 2–5) plasma. We generated HRs and 95% CIs for mortality. Among all patients randomized to plasma, we compared predicted biomarker values at hospital admission (T0) and 24 hours later (T24) controlling for key difference between groups with a multivariable linear regression. Analyses were repeated in a severely injured subgroup.

Results

Two hundred and seventy-one patients were randomized to standard-care and 230 to plasma (40% YOUNG, 60% OLD). There were no clinically or statistically significant differences in demographics, injury, admission vital signs, or laboratory values including thromboelastography between YOUNG and OLD. Compared with standard-care, YOUNG (HR 0.66 (95% CI 0.41 to 1.07), p=0.09) and OLD (HR 0.64 (95% CI 0.42 to 0.96), p=0.03) plasma demonstrated reduced 30-day mortality. Among those randomized to plasma, plasma age did not affect mortality (HR 1.04 (95% CI 0.60 to 1.82), p=0.90) and/or adjusted serum markers by plasma age at T0 or T24 (p>0.05). However, among the severely injured subgroup, OLD plasma was significantly associated with increased adjusted inflammatory and decreased adjusted endothelial biomarkers at T0.

Discussion

Age of thawed plasma does not result in clinical outcome or biomarker expression differences in the overall PAMPer study cohort. There were biomarker expression differences in those patients with severe injury. Definitive investigation is needed to determine if the age of thawed plasma is associated with biomarker expression and outcome differences following traumatic injury.

Level of evidence

II.