bluuebunny/crossref_metadata_2025 huggingface dataset:
Case of fetal ovarian juvenile granulosa cell tumor: Complications and management
Authors: Ben David Yehuda , Sela Nitzan , Ben David Chen , Dujovni Tal
Published: March 2021

A prenatal ovarian juvenile granulosa cell tumor (JGCT) is a rare entity which may present as an intra‐abdominal cyst. Due to its low incidence, optimal management and timing for intervention remain uncertain. This report presents a case of an intra‐abdominal cystic structure in a female fetus, one of the two fetuses in a dichorionic‐diamniotic twin pregnancy, detected during routine fetal sonographic surveillance at 30 weeks of gestation. Further fetal evaluation detected the sonographic triad of an ovarian cystic mass, polyhydramnios and signs of fetal virilizations, requiring us to consider the presence of an atypical, ovarian androgen secreting tumor. Following delivery, acute ovarian torsion and intracystic hemorrhage required emergent surgical intervention, confirming the diagnosis of JGCT. Following surgical treatment, laboratory, clinical, and morphological features improved progressively.
Frequency, breed predisposition and demographic risk factors for overweight status in dogs in theUK
Authors: Pegram C. , Raffan E. , White E. , Ashworth A. H. , Brodbelt D. C. , Church D. B. , O'Neill D. G.
Published: March 2021

Objectives

To evaluate the prevalence and risk factors for overweight status in dogs under primary veterinary care in the UK.

Materials and Methods

A retrospective study design was used to estimate the 1‐year (2016) period prevalence of overweight status. The clinical records were randomly ordered and manually validated for dogs with overweight status during 2016. Univariable and multivariable logistic regression modelling were used to evaluate associations between risk factors (breed, brachycephalic status, adult bodyweight, bodyweight relative to breed‐sex mean, age, sex‐neuter and insurance) and overweight status.

Results

There were 1580 of 22,333 dogs identified as overweight during 2016. The estimated 1‐year period prevalence for overweight status recorded in dogs under veterinary care was 7.1% (95% confidence interval 6.7–7.4). After accounting for confounding factors, eight breeds showed increased odds of overweight status compared with crossbred dogs. The breeds with the highest odds included the Pug (OR 3.12, 95% confidence interval 2.31 to 4.20), Beagle (OR 2.67, 1.75 to 4.08), Golden Retriever (OR 2.58, 1.79 to 3.74) and English Springer Spaniel (OR 1.98, 1.31 to 2.98). Being neutered, middle‐aged and insured were additionally associated with overweight status.

Clinical Significance

Targeted overweight prevention strategies should be prioritised for predisposed breeds, such as Pugs and Beagles. The findings additionally raise questions about further preventative efforts following neutering. The prevalence estimate suggests veterinary professionals are underreporting overweight status and therefore could be missing key welfare opportunities.
Combining population genomics and ecological niche modeling to assess taxon limits between Carex jemtlandica and C. lepidocarpa
Authors: Nygaard Malene , Kemppainen Petri , Speed James D. M. , Elven Reidar , Flatberg Kjell Ivar , Galten Leif P. , Yousefi Narjes , Solstad Heidi , Bendiksby Mika
Published: March 2021

Carex section Ceratocystis (Cyperaceae) is a group of recently evolved plant species, in which hybridization is frequent, introgression is documented, taxonomy is complex, and morphological boundaries are vague. Within this section, a unified taxonomic treatment of the Carex jemtlandica–Carex lepidocarpa species complex does not exist, and Norway may currently be the sole country accepting species rank for both. Carex jemtlandica is mainly confined to Fennoscandia and is thus a Fennoscandian conservation responsibility. This motivated us to test the principal hypothesis that both C. jemtlandica and C. lepidocarpa represent evolutionary significant units, and that both deserve their current recognition at species level. We investigated their evolutionary distinctiveness in Norway, using restriction site‐associated DNA sequencing and ecological niche modeling. Our genomic results reveal two genetic clusters, largely corresponding to C. jemtlandica and C. lepidocarpa that also remain distinct in sympatry, despite clear indications of ongoing hybridization and introgression. The ecological niche modeling suggests that they occupy different environmental niches. Jointly, our results clearly show that C. jemtlandica and C. lepidocarpa represent separately evolving entities that should qualify recognition as evolutionary significant units. Given the high level of introgression compared to other hybridizing species pairs in Carex we recommend treating C. jemtlandica as a subspecies of C. lepidocarpa.
Shifting community composition determines the biodiversity–productivity relationship under increasing precipitation and N deposition
Authors: Zhang Ruiyang , Schellenberg Michael P. , Tian Dashuan , Ma Fangfang , Zhang Tianyou , Wang Hu , Wu Qian , Bai Yuting , Han Guodong , Niu Shuli
Published: March 2021

Questions

The relationships between biodiversity and ecosystem functioning (BEF) vary largely across natural ecosystems, with a unimodal, monotonous linear or no relationship. However, it remains unclear how BEF relationships vary under global change. Given future predicted changes in precipitation and nitrogen (N) deposition, it is crucial to determine how precipitation change and N deposition affect grassland biodiversity and productivity, and regulate their relationships.

Location

A Dry Mixed‐Grass Prairie of western Canada.

Methods

We established a manipulative field experiment of increased precipitation (water addition with approximately 15% and 30% more monthly precipitation) and N addition (10 g/m2) using a randomized complete block design, including six treatments, each replicated five times (30 plots). We conducted vegetation sampling with a 1 m × 1 m quadrat in each plot from 2016 to 2017, to examine the individual and interactive effects of water and N addition on plant diversity, functional group composition, above‐ and below‐ground productivity, and the diversity–productivity relationships.

Results

We found a positive linear diversity–above‐ground biomass (AGB) relationship under increased precipitation, which was attributed to the water‐induced increase in the abundance of forbs in the plant community, further promoting the positive effect of plant diversity on AGB. However, N addition caused a negative linear diversity–AGB relationship by increasing AGB and reducing plant diversity. The effects of N on diversity and productivity can be further strengthened under increased precipitation, which was due to the increase of C3rhizomatous grasses with high above‐ and below‐ground biomass and the decrease of forbs with high richness.

Conclusions

Our results suggest that changes in functional group composition determine the plant species’ diversity, productivity, and their relationships under increasing precipitation and N deposition, which has significant implications for understanding and modelling ecosystem productivity in the context of global change.
Linking membrane fluidity with defective antigen presentation in leishmaniasis
Authors: Pradhan Supratim , Ghosh Souradeepa , Hussain Shahbaj , Paul Joydeep , Mukherjee Budhaditya
Published: March 2021

Hampering‐surface presentation of immunogenic peptides by class I/II MHCs is a key strategy opted by several intracellular protozoan pathogens including Leishmania to escape CD8/CD4 mediated host‐protective T‐cell response. Although Leishmania parasites (LP) primarily hijack/inhibit host lysosomal/proteasomal pathways to hamper antigen‐processing/presentation machinery, recent pieces of evidence have linked host‐membrane fluidity as a major cause of defective antigen presentation in leishmaniasis. Increased membrane fluidity severely compromised peptide‐MHC stability in the lipid raft regions, thereby abrogating T‐cell mediated‐signalling in the infected host. LP primarily achieves this by quenching host cholesterol, which acts as cementing material in maintaining the membrane fluidity. In this review, we have particularly focused on several strategies opted by LP to hijack‐host cholesterol resulting in lipid droplets accumulation around leishmania‐containing parasitophorous vacuole favouring intracellular survival of LP. In fact, LP infection can result in altered cholesterol and lipid metabolism in the infected host, thereby favouring the establishment and progression of the infection. From our analysis of two genome‐wide transcriptomics data sets of LP infected host, we propose a possible molecular network that connects these interrelated events of altered lipid metabolism with eventual compromised antigen presentation, still existing as a gap in our current understanding of Leishmania infection.
Reduced early fearful face processing during perceptual distraction in high trait anxious participants
Authors: Steinweg Anna‐Lena , Schindler Sebastian , Bruchmann Maximilian , Moeck Robert , Straube Thomas
Published: March 2021

Fearful facial expressions are prioritized across different stages of information processing as reflected by early, mid‐latency, and late components of event‐related brain potentials (ERP). Trait anxiety has been proposed to modulate these responses, but it is yet unclear how such modulations depend on feature‐based attention. In this preregistered study (N = 80), we investigated the effects of trait anxiety on ERP differences between fearful and neutral faces across three different tasks. Participants had to discriminate either the orientation of lines overlaid onto the faces, the gender of the face, or the emotional expression, thus increasing attention to emotionally relevant facial features across the tasks. Fearful versus neutral faces elicited increased P1 and N170 amplitudes across tasks and potentiated amplitudes when attention was directed to faces (early posterior negativity [EPN]) or the expression (EPN and late positive potential). Higher trait anxiety was related to smaller EPN differences between fearful and neutral faces during the perceptual discrimination task. This early relationship suggests reduced instead of amplified processing of fearful faces for high trait anxious participants under perceptual distraction.
Active restoration leads to rapid recovery of aboveground biomass but limited recovery of fish diversity in planted mangrove forests of the North Brazil Shelf
Authors: Ram Mark A. , Caughlin T. Trevor , Roopsind Anand
Published: March 2021

Coastal degradation has spurred active restoration of mangrove ecosystems, from local initiatives to global commitments to increase mangrove forest area by 20% over the next decade. Mangrove restoration projects typically have multiple objectives, including carbon storage, coastal resilience, and fisheries recovery. How planting seedlings, the most common form of active restoration, can promote recovery of mangrove ecosystem functions remains an urgent research need. We quantified multiple ecosystem outcomes of Guyana's national mangrove restoration program, approximately a decade after seedling planting, and compared restoration outcomes with conditions in intact and degraded mangrove forests. Multivariate analyses indicate that intact and restored sites' environmental conditions were similar to each other but different from degraded sites. Aboveground biomass in restored sites (103 Mg ha−1) was 13 and 99% greater than intact (89.4 Mg ha−1) and degraded (0.12 Mg ha−1) sites, respectively. Active restoration successfully increased seedling abundance of both planted and unplanted species, with similar abundance between intact and restored sites. In contrast, fish communities in restored sites remained similar to degraded sites. Restored sites were dominated by a single algivorous fish species, with lower species diversity and commercially valuable fisheries than intact sites. Our results demonstrate that active restoration is a viable option to restore mangrove forest tree biomass and tree species composition in this region. However, even under a best‐case scenario for mangrove forest restoration, fisheries did not recover during our study's timespan. Long‐term monitoring and controlled experiments will be essential to further understand restoration outcomes for multiple ecosystem services in mangrove forests.
Acoustic Resonance in an Axial Multistage Compressor Leading to Non-Synchronous Blade Vibration
Authors: Fiquet Anne-Lise , Aubert Stéphane , Brandstetter Christoph , Buffaz Nicolas , Vercoutter Agathe
Published: March 2021

Significant non-synchronous blade vibrations (NSVs) have been observed in an experimental three-stage high-speed compressor at part-speed conditions. High-amplitude acoustic modes, propagating around the circumference and originating in the highly loaded stage-3, have been observed in coherence with the structural vibration mode. In order to understand the occurring phenomena, a detailed numerical study has been carried out to reproduce the mechanism. Unsteady full-annulus Reynolds-averaged Navier–Stokes simulations of the whole setup have been performed using the solver elsA. The results revealed the development of propagating acoustic modes which are partially trapped in the annulus and are in resonance with an aerodynamic disturbance in rotor-3. The aerodynamic disturbance is identified as an unsteady separation of the blade boundary layer in rotor-3. The results indicate that the frequency and phase of the separation adapt to match those of the acoustic wave and are therefore governed by acoustic propagation conditions. Furthermore, the simulations clearly show the modulation of the propagating wave with the rotor blades, leading to a change of circumferential wave numbers while passing the blade row. To analyze if the effect is self-induced by the blade vibration, a non-coherent structural mode has been imposed in the simulations. Even at high vibration amplitude, the formerly observed acoustic mode did not change its circumferential wave number. This phenomenon is highly relevant to modern compressor designs, since the appearance of the axially propagating acoustic waves can excite blade vibrations if they coincide with a structural eigenmode, as observed in the presented experiments.
Experimental and Numerical Study of Laminar-Turbulent Transition on a Low-Pressure Turbine Outlet Guide Vane
Authors: Jonsson Isak , Deshpande Srikanth , Chernoray Valery , Thulin Oskar , Larsson Jonas
Published: March 2021

This work presents an experimental and numerical investigation of the laminar-turbulent transition and secondary flow structures in a turbine rear structure (TRS). The study was executed at engine representative Reynolds number and inlet conditions at three different turbine load cases. Experiments were performed in an annular rotating rig with a shrouded low-pressure turbine upstream of the TRS test section. The numerical results were obtained using the shear stress transport k − ω turbulence model and the Langtry–Menter γ − θ transition model. The boundary layer transition location at the entire vane suction side is investigated. The location of the onset and the transition length are measured using IR-thermography along the entire vane span. The IR-thermography approach was validated using hot-wire boundary layer measurements. Both experiments and computational fluid dynamics (CFD) show large variations of transition location along the vane span with strong influences from endwalls and turbine outlet conditions. Both agree well with traditional transition onset correlations near midspan and show that the transition onset Reynolds number is independent of the acceleration parameter. However, CFD tends to predict an early transition onset in the midspan vane region and a late transition is present in the hub region. Furthermore, in the hub region, CFD is shown to overpredict the transverse flow and related losses.
Binder Jetting of Silicon Steel, Part I: Process Map of Green Density
Authors: Rishmawi Issa , Vlasea Mihaela
Published: March 2021

This study focuses on developing and demonstrating a straightforward workflow for identifying pathways to increase green part density in binder jetting additive manufacturing (BJAM) using statistically driven process maps. The workflow was applied to investigate the effects of process parameters toward improving green part density, with a direct application in manufacturing of Fe-Si components. Specifically, a half-factorial experimental design was used to study the effects of four key parameters—layer thickness, powder spreading speed, roller rotational speed, and binder saturation—on Fe-Si spherical powder with D50 of 32.40 µm. Relative bulk density was estimated via three methods: geometrical and mass measurements, the Archimedes test, and CT imaging. The study discusses relative bulk density as well as localized density variation in the printed parts, which is attributed to both parameter selection and inherent process variability. A regression analysis was used to reveal the significance of main effects and second-order interactions. The regression model (R2 = 0.915) was used to derive an expression for green density as a function of the parameters and had a prediction error of 0.96%. Based on the regression model, an optimized set of parameters was obtained that would maximize green density up to 57.96% for the machine and material system.
Assessment of Turbulence Models for Low Reynolds Number Flows and Their Computational Costs, Part 2: Square Prism in Cross Flow
Authors: Mancuso Thomas , Mukherjee Abhijit
Published: March 2021

The accuracy of six turbulent flow modeling techniques in an unsteady solution is evaluated against experimental data for a square prism in cross flow. The selected models, shear stress transport (SST), SST-SAS, Reynolds stress model (RSM), partially averaged Navier–Stokes (PANS)-SST, detached eddy simulation (DES), and large eddy simulations (LES), models are the same as those presented in Part 1 of this study, which focused on flow in a staggered tube bank. For this geometry, the SST model proved to be effective at capturing the averaged Nusselt values per side of the square with relatively low computational costs. The SST model, however, showed poorer fidelity to the local Nusselt number profile compared to the experimental data. The LES approach provided a more accurate representation of the local Nusselt number but the computational cost was significantly higher. The PANS modification to the SST model did provide a noticeable improvement in accuracy at a reasonable cost while the SAS modification did not see the same improvement. These conclusions are generally consistent with those found for the staggered tube bank in Part 1 of this study. This study can be used as a guide for the industrial user to select a turbulence model for a similar problem with a low Reynolds number and significant flow separation.
Surface reaction of the hafnium precursor with a linked amido-cyclopentadienyl ligand: A density functional theory study
Authors: Hidayat Romel , Kim Hye-Lee , Kim Hohoon , Byun Younghun , Lee Jongsoo , Lee Won-Jun
Published: March 2021

We studied heteroleptic Hf precursors with a linked amido-cyclopentadienyl ligand by density functional theory (DFT) calculation to enable high-temperature atomic layer deposition processes. The thermolysis and hydrolysis of Hf precursors were simulated to expect thermal stability and reactivity with hydroxyl groups. The effects of alkyl groups in the precursors were also investigated. We constructed the hydroxylated HfO2 surface and then simulated the surface reactions of the precursors. The precursors with the linked ligand showed higher activation energies for thermolysis and lower activation energies for hydrolysis as compared with CpHf(NMe2)3. The precursors with the linked ligand also showed low activation energies for the serial ligand exchange reactions on the HfO2 surface, significantly lower than those of CpHf(NMe2)3. Therefore, the DFT calculation suggests that the Hf precursors with the linked ligand are promising due to their thermal stability and reactivity better than CpHf(NMe2)3.
A study on tracheoesophageal phonation based on a collapsible channel model
Authors: Tourinho André Miazaki da Costa , da Silva Andrey Ricardo , dos Santos Luiz Roberto Medina , Thomaz Fabiana Barroso , Vieira Elisa Gomes
Published: March 2021

Laryngeal cancer afflicts a large number of people worldwide, and some will need surgery to contain the disease. Currently, tracheoesophageal (TE) speech is a common method of voice rehabilitation for patients who have had their larynges excised. However, despite the relatively high success rate, not everyone is capable of producing the TE voice, usually due to the tonicity of the pharyngoesophageal segment (PES). The present work studies how the tonicity of the muscles of the PES affects TE phonation, focusing mainly on hypotonicity. A simplified collapsible channel model is used. Steady-state solutions are obtained and a linear stability analysis is performed. It is then shown that the steady-state solutions of the model are similar to the wide variety of possible PES configurations that are reported in the literature. The linear stability analysis results provide a simple expression for the estimation of the minimum tonicity required for self-sustained oscillations of the PES.
PrkC, a Transmembrane Serine/Threonine Protein Kinase, Regulates Bacterial Chain Length in Bacillus anthracis
Authors: Dhasmana Neha , Kumar Nishant , Gangwal Aakriti , Keshavam Chetkar Chandra , Singh Lalit K. , Sangwan Nitika , Nashier Payal , Biswas Sagarika , Pomerantsev Andrei P. , Leppla Stephen H. , Singh Yogendra , Gupta Meetu
Published: March 2021

Chaining phenotype acts as a virulence factor in
Bacillus anthracis
. This is the first study that identifies a signal transduction protein with an ability to regulate the chaining phenotype in
Bacillus anthracis
.
Photochromic Fluorophores Enable Imaging of Lowly Expressed Proteins in the Autofluorescent Fungus Candida albicans
Authors: Van Genechten Wouter , Demuyser Liesbeth , Duwé Sam , Vandenberg Wim , Van Dijck Patrick , Dedecker Peter
Published: March 2021

Understanding the spatial and temporal organization of proteins of interest is key to unraveling cellular processes and identifying novel possible antifungal targets. Only a few therapeutic targets have been discovered in
Candida albicans
, and resistance mechanisms against these therapeutic agents are rapidly acquired.
Engineering High-Yield Biopolymer Secretion Creates an Extracellular Protein Matrix for Living Materials
Authors: Orozco-Hidalgo Maria Teresa , Charrier Marimikel , Tjahjono Nicholas , Tesoriero Robert F. , Li Dong , Molinari Sara , Ryan Kathleen R. , Ashby Paul D. , Rad Behzad , Ajo-Franklin Caroline M.
Published: March 2021

Engineered living materials (ELM) aim to mimic characteristics of natural occurring systems, bringing the benefits of self-healing, synthesis, autonomous assembly, and responsiveness to traditional materials. Previous research has shown the potential of replicating the bacterial extracellular matrix (ECM) to mimic biofilms.
Linking Bacterial-Fungal Relationships to Microbial Diversity and Soil Nutrient Cycling
Authors: Jiao Shuo , Peng Ziheng , Qi Jiejun , Gao Jiamin , Wei Gehong
Published: March 2021

The relationships between soil biodiversity and ecosystem functions are an important yet poorly understood topic in microbial ecology. This study presents an exploratory effort to gain predictive understanding of the factors driving the relationships between microbial diversity and potential soil nutrient cycling in complex terrestrial ecosystems.
Premature thelarche in an infant girl with failure to thrive related to dietary soy exposure
Authors: Chang Serena Su Ying , Nagarajan Nandhakumar , Tan Joanne Mui Ching
Published: March 2021

A 7-month-old female infant presented with failure to thrive. She was breastfed till 3 months of age, thereafter switched to soy-based milk formula. There was no history to suggest excess energy losses, recurrent infections or chronic diarrhoea. Three months after switching to exclusive soy-based milk formula, parents noticed significant enlargement of both breasts. Clinical examination was unremarkable except for enlargement of both breasts. None of the other secondary sexual characteristics were present. Initial blood investigations showed hyponatraemic hypokalaemic hypochloraemic metabolic alkalosis, which corrected after 2 days with intravenous hydration. The patient subsequently maintained normal electrolyte balance with recommended intake of cow’s milk-based standard formula milk.

Further exploration of her soy-based milk revealed that it was low in sodium and calories, unsuitable for children. This was not a standard and approved infant soy-based formula milk. She achieved excellent weight gain and reduction of breast size on cessation of soy-based milk formula.
Unusual aetiology of respiratory compromise in a patient with AIDS
Authors: Maaliki Naji , Ali Aleem Azal , Isache Carmen Liliana , Aung Win
Published: March 2021

A 36-year-old African American man with no medical history presented with a recent history of cough and dyspnoea. Initial chest imaging revealed diffuse bilateral lung infiltrates. A subsequent HIV test resulted positive, and he was presumptively diagnosed with AIDS, later confirmed by a CD4 of 88 cells/mm3. Empiric therapy with trimethoprim–sulfamethoxazole was initiated for presumedPneumocystis jiroveciipneumonia. The patient’s clinical status deteriorated despite treatment. Further workup with chest CT, bronchoscopy and skin biopsy led to a diagnosis of Kaposi sarcoma with pulmonary involvement. Highly active antiretroviral therapy therapy was initiated, along with plans to start chemotherapy. However, the patient’s clinical status rapidly declined, leading to respiratory failure and eventual death. This case underlines the importance of maintaining a broad differential in immunocompromised patients presenting with respiratory symptoms.
Endourological management of multiple large bladder calculi over eroded mesh in an adult with augmented bladder and catheterisable continent appendicovesicostomy
Authors: Bitran Joshua Nissim , Katz Jonathan E , Bhat Abhishek , Shah Hemendra N
Published: March 2021

Migration of abdominal wall mesh in an augmented bladder is a rarely encountered complication leading to formation of bladder stones causing recurrent urinary tract symptoms. The usual management of this condition involves either open surgical or a percutaneous approach for removal of the stone and migrated portion of mesh. Diagnosis of a migrated mesh is usually made intraoperatively during cystolitholapaxy. Appropriate management results in symptomatic improvement. Endoscopic management through catheterisable continent appendicovesicostomy has not been described to manage this challenging condition. To the best of our knowledge, we describe herewith the first report of endoscopic management of a large bladder stone formed over migrated mesh which involved removal of migrated mesh with holmium laser via a Mitrafanoff.
Age dependent associations of risk factors with heart failure: pooled population based cohort study
Authors: Tromp Jasper , Paniagua Samantha M A , Lau Emily S , Allen Norrina B , Blaha Michael J , Gansevoort Ron T , Hillege Hans L , Lee Douglas E , Levy Daniel , Vasan Ramachandran S , van der Harst Pim , van Gilst Wiek H , Larson Martin G , Shah Sanjiv J , de Boer Rudolf A , Lam Carolyn S P , Ho Jennifer E
Published: March 2021

Objective

To assess age differences in risk factors for incident heart failure in the general population.

Design

Pooled population based cohort study.

Setting

Framingham Heart Study, Prevention of Renal and Vascular End-stage Disease Study, and Multi-Ethnic Study of Atherosclerosis.

Participants

24 675 participants without a history of heart failure stratified by age into young (<55 years; n=11 599), middle aged (55-64 years; n=5587), old (65-74 years; n=5190), and elderly (≥75 years; n=2299) individuals.

Main outcome measure

Incident heart failure.

Results

Over a median follow-up of 12.7 years, 138/11 599 (1%), 293/5587 (5%), 538/5190 (10%), and 412/2299 (18%) of young, middle aged, old, and elderly participants, respectively, developed heart failure. In young participants, 32% (n=44) of heart failure cases were classified as heart failure with preserved ejection fraction compared with 43% (n=179) in elderly participants. Risk factors including hypertension, diabetes, current smoking history, and previous myocardial infarction conferred greater relative risk in younger compared with older participants (P for interaction <0.05 for all). For example, hypertension was associated with a threefold increase in risk of future heart failure in young participants (hazard ratio 3.02, 95% confidence interval 2.10 to 4.34; P<0.001) compared with a 1.4-fold risk in elderly participants (1.43, 1.13 to 1.81; P=0.003). The absolute risk for developing heart failure was lower in younger than in older participants with and without risk factors. Importantly, known risk factors explained a greater proportion of overall population attributable risk for heart failure in young participants (75%
v
53% in elderly participants), with better model performance (C index 0.79
v
0.64). Similarly, the population attributable risks of obesity (21%
v
13%), hypertension (35%
v
23%), diabetes (14%
v
7%), and current smoking (32%
v
1%) were higher in young compared with elderly participants.

Conclusions

Despite a lower incidence and absolute risk of heart failure among younger compared with older people, the stronger association and greater attributable risk of modifiable risk factors among young participants highlight the importance of preventive efforts across the adult life course.
Developing more detailed taxonomies of tobacco industry political activity in low-income and middle-income countries: qualitative evidence from eight countries
Authors: Matthes Britta Katharina , Lauber Kathrin , Zatoński Mateusz , Robertson Lindsay , Gilmore Anna B
Published: March 2021

Introduction

Historical evidence, predominantly from high-income countries (HICs), shows that the tobacco industry uses a recurring set of arguments and techniques when opposing tobacco control policies. This data formed the basis of a model of tobacco industry political activity known as the policy dystopia model (PDM). The PDM has been widely used in tobacco control research and advocacy and has subsequently been shown relevant to other unhealthy commodities industries in both HICs and low-income and middle-income countries (LMICs). Before it can be validated as a generic tool for researching corporate influence on policy, one needs to determine whether the PDM successfully captures contemporary corporate political activities in LMICs.

Method

We conducted semistructured interviews with 22 LMIC-based advocates and used the transcripts as the primary data source. The discursive and instrumental taxonomies constituting the PDM served as the starting point for the coding framework. Using thematic analysis, we combined deductive and inductive coding to ensure we captured all strategies from the PDM and the interviews.

Results

This study found that the tobacco industry uses a set of discursive and instrumental strategies that is largely consistent across LMICs and with the PDM. We identified several minor contextual nuances absent from the PDM. Some of these nuances were characteristic to individual countries, while others to LMICs more broadly. They included the argument that tobacco control policies unfairly punish reputable tobacco industry actors, and an emphasis on instrumental strategies centred around maintaining a good image, rather than rehabilitating a tarnished image as emphasised in the PDM.

Conclusions

Allowing for the nuances identified in this study, the PDM has been found to be fit for purpose. The revised model should now be tested through in-depth LMIC case studies and could be used to facilitate comparative studies of unhealthy commodity industries’ political activities.
Which came first, obstructive sleep apnoea or hypertension? A retrospective study of electronic records over 10 years, with separation by sex
Authors: An Eunjoo , Irwin Michael R , Doering Lynn V , Brecht Mary-Lynn , Watson Karol E , Aysola Ravi S , Aguila Andrea P , Harper Ronald M , Macey Paul M
Published: March 2021

Objectives

Obstructive sleep apnoea (OSA) is a risk factor for hypertension (HTN), but the clinical progression of OSA to HTN is unclear. There are also sex differences in prevalence, screening and symptoms of OSA. Our objective was to estimate the time from OSA to HTN diagnoses in females and males.

Design

Retrospective analysis of electronic health records (EHR) over 10 years (2006–2015 inclusive).

Setting

University of California Los Angeles (UCLA) Health System in Los Angeles, California, USA.

Participants

4848 patients: females n=2086, mean (SD) age=52.8 (13.2) years; males n=2762, age=53.8 (13.5) years. These patients were selected from 1.6 million with diagnoses in the EHR who met these criteria: diagnoses of OSA and HTN; in long-term care defined by ambulatory visits at least 1 year prior and 1 year subsequent to the first OSA diagnosis; no diagnosis of OSA or HTN at intake; and a sleep study performed at UCLA.

Primary and secondary outcome measures

The primary outcome measure in each patient was time from the first diagnosis of OSA to the first diagnosis of HTN (OSA to HTN days). Since HTN and OSA are progressive disorders, a secondary measure was the relationship between OSA to HTN time and age (OSA to HTN=β1×Age+β0).

Results

The median (lower and upper quartiles) days from OSA to HTN were: all −532 (−1439, –3); females −610 (−1579, –42); and males −451 (−1358, 0). Older age in both sexes was associated with less time to a subsequent HTN diagnosis or more time from a prior HTN diagnosis (β1 days/year: all −16.9, females −18.3, males −15.9).

Conclusions

HTN was on average diagnosed years prior to OSA, with a longer separation in females. Our findings are consistent with underscreening of OSA, more so in females than males. Undiagnosed OSA may delay treatment for the sleep disorder and perhaps affect the development and progression of HTN.
Trends in known and undiagnosed diabetes, HbA1c levels, cardiometabolic risk factors and diabetes treatment target achievement in repeated cross-sectional surveys: the population-based Tromsø Study 1994–2016
Authors: Langholz Petja Lyn , Wilsgaard Tom , Njølstad Inger , Jorde Rolf , Hopstock Laila Arnesdatter
Published: March 2021

Objectives

The aim of this study was to investigate time trends in known and undiagnosed diabetes, glycated haemoglobin (HbA1c) levels and other cardiometabolic risk factors in the general population as well as treatment target achievement among those with diabetes.

Design and setting

Repeated cross-sectional surveys in the population-based Tromsø Study.

Methods

We used age-adjusted generalised estimating equation models to study trends in self-reported and undiagnosed (HbA1c ≥6.5%) diabetes, cardiometabolic risk factors and the metabolic syndrome in 27 281 women and men aged 40–84 years examined in up to four surveys of the Tromsø Study between 1994 and 2016. Further, we analysed trends in diabetes treatment target achievement.

Results

During 1994–2016, diabetes prevalence increased in women (2.3% to 4.6%) and men (2.4% to 5.8%) and in all age groups, while the proportion of undiagnosed diabetes in women (32% to 17%) and men (37% to 24%) decreased. Blood pressure and total cholesterol decreased, while waist circumference increased in participants with and without diabetes, leading to a relatively stable prevalence of the metabolic syndrome throughout the study period. There was a marginal increase in HbA1c levels among participants without diabetes. Only half of those with diabetes achieved the treatment target of HbA1c ≤7.0%.

Conclusion

In the last two decades, diabetes prevalence increased, while the proportion of undiagnosed diabetes declined. The prevalence of the metabolic syndrome remained stable throughout, driven by opposing trends with an increase in obesity and a decrease in other cardiometabolic risk factors. HbA1c treatment target achievement did not improve.
Training general practitioners in melanoma diagnosis: a scoping review of the literature
Authors: Harkemanne Evelyne , Baeck Marie , Tromme Isabelle
Published: March 2021

Background

General practitioners (GPs) play a key role in early melanoma detection. To help GPs deal with suspicious skin lesions, melanoma diagnostic training programmes have been developed. However, it is unclear whether these programmes guarantee the acquisition of skills that will be applied by GPs in their daily clinical practice and maintained over time.

Objectives

This scoping review aimed to examine and compare educational programmes designed to train GPs in melanoma diagnosis using clinical (naked eye) examination alone or dermoscopy±clinical examination, and sought to inform on the long-term sustainability of the GPs’ acquired skills.

Eligibility criteria

Studies eligible for inclusion evaluated educational programmes for teaching diagnosis of melanoma to GPs. MEDLINE, EMBASE and Cochrane databases were searched for relevant articles from 1995 to May 2020.

Results

Forty-five relevant articles were found assessing 31 educational programmes. Most programmes that improved the diagnostic accuracy and long-term performances of the GPs, that is, increase in confidence, decrease in dermatologist referral for benign skin lesions and improvement in the benign/malignant ratio of excised skin lesions, trained the GPs in clinical diagnosis, followed by dermoscopy. To maintain long-term performances, these programmes provided refresher training material.

Conclusion

This review shows that studies generally report positive outcomes from the training of GPs in melanoma diagnosis. However, refresher training material seemed necessary to maintain the acquired skills. The optimal form and ideal frequency for these updates have yet to be defined.
Model-based estimation of the economic burden of cholera in Africa
Authors: Mogasale Vittal , Ngogoyo Samuel Mwaura , Mogasale Vijayalaxmi V
Published: March 2021

Objectives

To estimate the economic burden of cholera in Africa.

Settings

Cholera affected 44 countries in Africa.

Participants

The analysis used data from public sources in Africa published until September 2019.

Methods

Based on existing data from field-based cost-of-illness studies, estimated cholera incidence rates, and reported cholera cases to WHO, this research estimates the economic burden of cholera in Africa from a societal perspective with 2015 as the base year. The estimate included out-of-pocket costs, public health system costs, productivity loss related to illness and an optional productivity loss related to premature deaths valued by the human capital approach. As various input data such as cholera incidence, hospitalisation rates and the number of workdays lost were not well defined, a series of scenario analyses and uncertainty analyses, accounting for unknowns and data variability, was conducted. Similarly, the value of time lost due to illness and deaths using the human capital approach was explored through scenario analyses.

Results

In 2015, an estimated 1 008 642 cases in 44 African countries resulted in an economic burden of US$130 million from cholera-related illness and its treatment. When the estimated 38 104 cholera deaths were included in the analysis, the economic burden increased to US$1 billion or international $2.4 billion for the same year. At the same time, when only the 71 126 cases and 937 deaths reported to the WHO are considered, the economic burden was only US$68 million for the year 2015. The estimates of economic burden are thus heavily dependent on the cholera incidence rate, how time lost due to illness and deaths are calculated, hospitalisation rates and hospitalisation costs.

Conclusion

The findings can be used as an economic justification for cholera control in Africa and for generating value-for-money evidence to underpin Ending Cholera—A Global Roadmap to 2030 with considerations to study limitations.
Change in prevalence of psychological and economic abuse, and controlling behaviours against women by an intimate partner in two cross-sectional studies in New Zealand, 2003 and 2019
Authors: Fanslow Janet , Malihi Zarintaj , Hashemi Ladan , Gulliver Pauline , McIntosh Tracey
Published: March 2021

Objectives

Changes in reported lifetime prevalence of psychological abuse, controlling behaviours and economic abuse between 2003 and 2019, and past 12-month prevalence of psychological abuse by an intimate partner were examined.

Design

Cross-sectional analysis.

Setting and participants

Data came from two surveys of family violence in New Zealand, conducted in 2003 and 2019. Respondents were ever partnered women aged 18–64 years old (2003 n=2673; 2019 n=935).

Main outcome measures

Prevalence rates for psychological abuse, controlling behaviours and economic abuse were compared between the two study years using logistic regression. Sociodemographic and economic correlates of each abuse subtype were investigated. Interactions were examined between sociodemographic factors and the study year for reported prevalence rates.

Results

There was a reduction in reported past 12-month experience of two or more acts of psychological intimate partner violence (IPV) from 8.4% (95% CI 7.3 to 9.6) in 2003 to 4.7% (95% CI 3.2 to 6.2) in 2019. The reported lifetime prevalence of two or more acts of controlling behaviours increased from 8.2% in 2003 (95% CI 7.0 to 9.5) to 13.4% in 2019 (95% CI 11.0 to 15.7). Lifetime prevalence of economic IPV also increased from 4.5% in 2003 (95% CI 3.5 to 5.5) to 8.9% in 2019 (95% CI 6.7 to 11.1). Those who were divorced/separated or cohabiting, and those living in the most deprived areas were more likely to report past year psychological IPV, lifetime controlling behaviours and economic abuse. A higher proportion of women who were married or cohabiting reported controlling behaviours in 2019 compared with 2003.

Conclusion

While the reduction in reported past year psychological IPV is encouraging, the increase in the lifetime prevalence of controlling behaviours and economic abuse from 2003 to 2019 is worth critical evaluation. Results highlight potential gaps in current IPV prevention programmes, the need to identify and address underlying drivers of abusive behaviour and the importance of measuring multiple forms of IPV independently.
Interpregnancy intervals and child development at age 5: a population data linkage study
Authors: Dhamrait Gursimran Kaur , Taylor Catherine Louise , Pereira Gavin
Published: March 2021

Objective

To investigate the associations between interpregnancy intervals (IPIs) and developmental vulnerability in children’s first year of full-time school (age 5).

Design

Retrospective cohort study using logistic regression. ORs were estimated for associations with IPIs with adjustment for child, parent and community sociodemographic variables.

Setting

Western Australia (WA), 2002–2015.

Participants

34 574 WA born singletons with a 2009, 2012 or 2015 Australian Early Development Census (AEDC) record.

Main outcome measure

The AEDC measures child development across five domains; Physical Health and Wellbeing, Social Competence, Emotional Maturity, Language and Cognitive Skills (school-based) and Communication Skills and General Knowledge. Children with scores <10th percentile were classified as developmentally vulnerable on, one or more domains (DV1), or two or more domains (DV2).

Results

22.8% and 11.5% of children were classified as DV1 and DV2, respectively. In the adjusted models (relative to the reference category, IPIs of 18–23 months), IPIs of <6 months were associated with an increased risk of children being classified as DV1 (adjusted OR (aOR) 1.17, 95% CI 1.08 to 1.34), DV2 (aOR 1.31, 95% CI 1.10 to 1.54) and an increased risk of developmental vulnerability for the domains of Physical Health and Wellbeing (aOR 1.25, 95% CI 1.06 to 1.48) and Emotional Maturity (aOR 1.36, 95% CI 1.12 to 1.66). All IPIs longer than the reference category were associated with and increased risk of children being classified as DV1 and DV2 (aOR >1.15). IPIs of 60–119 months and ≥120 months, were associated with an increased risk of developmental vulnerability on each of the five AEDC domains, with greater odds for each domain for the longer IPI category.

Conclusions

IPIs showed independent J-shaped relationships with developmental vulnerability, with short (<6 months) and longer (≥24 months) associated with increased risks of developmental vulnerability.
Predictors of clinical deterioration in patients with suspected COVID-19 managed in a ‘virtual hospital’ setting: a cohort study
Authors: Francis Nick A , Stuart Beth , Knight Matthew , Vancheeswaran Rama , Oliver Charles , Willcox Merlin , Barlow Andrew , Moore Michael
Published: March 2021

Objective

Identify predictors of clinical deterioration in a virtual hospital (VH) setting for COVID-19.

Design

Real-world prospective observational study.

Setting

VH remote assessment service in West Hertfordshire NHS Trust, UK.

Participants

Patients with suspected COVID-19 illness enrolled directly from the community (postaccident and emergency (A&E) or medical intake assessment) or postinpatient admission.

Main outcome measure

Death or (re-)admission to inpatient hospital care during VH follow-up and for 2 weeks post-VH discharge.

Results

900 patients with a clinical diagnosis of COVID-19 (455 referred from A&E or medical intake and 445 postinpatient) were included in the analysis. 76 (8.4%) of these experienced clinical deterioration (15 deaths in admitted patients, 3 deaths in patients not admitted and 58 additional inpatient admissions). Predictors of clinical deterioration were increase in age (OR 1.04 (95% CI 1.02 to 1.06) per year of age), history of cancer (OR 2.87 (95% CI 1.41 to 5.82)), history of mental health problems (OR 1.76 (95% CI 1.02 to 3.04)), severely impaired renal function (OR for eGFR <30=9.09 (95% CI 2.01 to 41.09)) and having a positive SARS-CoV-2 PCR result (OR 2.0 (95% CI 1.11 to 3.60)).

Conclusions

These predictors may help direct intensity of monitoring for patients with suspected or confirmed COVID-19 who are being remotely monitored by primary or secondary care services. Further research is needed to confirm our findings and identify the reasons for increased risk of clinical deterioration associated with cancer and mental health problems.