bluuebunny/crossref_metadata_2025 huggingface dataset:
One step at a time to feel lighter: Understanding the impact of sound and smell on body image perception
Authors: Brianza Giada , Memoli Gianluca
Published: December 2020

How people mentally represent their body image does not always match their actual body. A negative body image perception (i.e., BIP) can cause risks of eating disorders, isolation, and emotional disease. Thus, being able to manipulate this perception through technology can open up the opportunity to increase healthy behaviours. Previous works showed that technology can be used to change people’s BIP combining visual and tactile stimulation. However, can other senses make the difference? Can audio and smell impact on our BIP? We based our work on a well-established link between walking sounds and the perceived walker’s weight: heavier bodies produce lower spectral mode sounds than lighter bodies. We ran a multisensory user-study in which we altered in real-time the frequency spectra of the sound of participants' footstep. In the meantime, we delivered previously selected scents. Our results show that the combination of audio and scent stimuli can be used to make participants feel lighter or heavier and that highly arousing scents (e.g., lemon) enhance the effect of sound. We discuss limitations (e.g., the use of headphones and wired devices) and potentials of our findings (e.g., the use of multisensory to overcome BIP misperception). With this work, we want to make the community aware of the power of audio on BIP, and inform future research towards the creation of novel virtual multisensory experiences and devices that can positively impact the way we feel about ourselves.
Vibro-acoustic analysis and optimization of hearing aids
Authors: Priyadarshinee Prachee
Published: December 2020

This work presents the vibro-acoustic analysis and optimization of behind-the-ear(BTE) hearing aids. The aim was to improve the overall performance and reduce the feedback caused by the vibrations transmitted due to the tranducer. The vibro-acoustic model also improved the vibration isolation mounts to reduce the vibrations transmitted through the hearing aid, while keeping the packaging compact and without sacrificing the performance accuracy.
The role of resonance in the extreme value statistics of flow-induced response
Authors: McCluskey Connor J. , Guers Manton J. , Conlon Stephen C.
Published: December 2020

Extreme value statics (EVS) are used to predict outlying loads that greatly damage structures. EVS are commonly applied to random environmental loads, such as sea states. However, the output response from structure’s transfer function has different statistics from the input load. Accurate prediction of maximum loads require analysis of the random response, which includes considering worst-case conditions such as resonance. This work aims to investigate the EVS of the flow-induced response from the applied load and the resonance of the first bending mode. In a water tunnel, an upstream cylinder was used to shed a wake onto a cantilever fin. The tunnel flow speed was increased to allow harmonics of the cylinder’s vortex shedding frequency to excite the fin’s first bending mode. The measured response was band-pass filtered to separate stiffness-controlled and resonance frequency bands. Extreme values of each record were modeled with the Generalized Extreme Value distribution. The experimental results are investigated to provide insight on how resonance impacts EVS and the consideration of resonance in accounting for extreme responses.
Using praat for high-quality speech manipulation and illustration: Recommended practices and demonstrations
Authors: Winn Matthew B.
Published: December 2020

Praat is widely used and freely available software that is designed with speech acoustics in mind. Despite its popularity, there is little standardization on the development of features and scripts, causing duplication of work across labs. This presentation has two goals: (1) highlighting a number of features that could be useful to kickstart such standardization, and (2) demonstration of scripts that could be useful for experimenters looking to create high-quality perceptual stimuli or classroom demonstrations. Recommendations will be given for variable assignment, documentation, increasing stimulus naturalness, and incorporating auditory scaling rather than linear interpolation for both frequency and intensity. Demonstrations will include manipulations of vowel formant contours, voice onset time, pitch contour, and fricative spectra, all using natural speech. Additionally, resources will be highlighted that allow users to easily compare outputs of sound modifications like spectral filtering. Examples will be given of data visualization within Praat to verify clean manipulations, as well as creating publication-quality images using R while handling objects from Praat.
Persistent scatterers detection from phase statistics of multi-view synthetic aperture sonar imaging
Authors: Xenaki Angeliki , Pailhas Yan , Sabatini Roberto
Published: December 2020

Persistent scatterers (PS) refer to stationary point reflectors that exhibit strong phase stability, irrespective of their amplitude. Synthetic aperture sonar (SAS) systems provide high-resolution seafloor imaging by adding coherently the backscattered waves from multiple views along the synthetic antenna. Traditionally, PS detection relies on the magnitude of the resulting image, thus it is susceptible to high levels of speckle noise. This study demonstrates that PS can be detected more reliably from pixel-wise phase statistics of multi-view complex SAS images. Phase-based feature extraction aims to facilitate automatic target recognition tasks without training data.
A sub-band filter design approach for sound field reproduction
Authors: Zhuang Yongjie , Song Guochenhao , Liu Yangfan
Published: December 2020

The purpose of sound field reproduction is to use loudspeakers to produce desired sound at particular locations in a given environment, which has a wide range of applications such as virtual reality, etc. The computational load required to design and implement filters involved in sound reproduction systems can be significant, especially when the desired sound has rich information over a wide frequency band. To reduce the computational load, sub-band filtering approaches are usually used in sound reproduction systems. In the present work, an approach is proposed to design the sub-band filters used in sound reproduction systems in a more convenient way, where the filter design problem is formulated into a convex optimization problem. A detailed analysis has been conducted on how to specify the response characteristics of each sub-band and how different sub-band filters can be combined into one full band filter in the design and implementation of the system. Results also show that even if the sub-band filter structure is not necessary, this approach can also be applied to reduce the computational load in designing inverse filters when the plant responses involve relatively large differences in delay time among different frequency bands.
Influence of the warping time parameters on dedopplerization efficiency in the case of a rotating source in cavitation tunnel
Authors: Boucheron Romuald
Published: December 2020

Cavitation tunnels are hydrodynamic facilities used mainly to observe cavitation and to analyze the performances of maritime devices likes propellers or foils. These experimental approaches, consisting in a model scale measurements extrapolated to full scale with similitude laws, are nowadays the preferred methods to predict the underwater noise radiated by a vessel at sea. The characterization of the different acoustic sources (localization and strength mainly) is one of the key point to better understand the whole mechanism that generates the total underwater noise. The particular case of a rotating source imposes a Doppler effect that disturbs the frequency content of the signal measured by a fixed hydrophone. The communication presents the results obtained by simulation of the measured signal generated by a rotating source. A warping time function is defined with geometrical parameters and used to perform a dedopplerization of the measured signal. The influence of each of those parameters is presented focusing on the performance of the expected dedopplerization. Consequently, different strategies are proposed to define an adapted criterion representing the accuracy of the dedopplerization effect.
Investigation of ultrasound exposure in the presence of microbubbles on a LumeNEXT blood-brain barrier model
Authors: Osborn Jenna , Bender-Bier Sara , Lopez Asis , Suite Loren , Lam Johnny , Sung Kyung , Skoog Shelby , Sarkar Kausik , Myers Matthew R. , Clement Gregory T.
Published: December 2020

The blood-brain barrier (BBB) is notoriously difficult to penetrate for the delivery of drugs and therapeutic compounds due to the unique nature of the tight junctions between endothelial cells. Ultrasound in the presence of microbubbles has been discovered to transiently open the BBB, however, little is known about the mechanism and the effects of excitation parameters at a cellular level. In this study, a static vascular lumen in vitro model, LumeNEXT, was utilized to investigate the excitation parameters in a controlled manner. Fibrin lumen hydrogels were lined with human cerebral microvessel endothelial and astrocyte cells. Cells were exposed to ultrasound with and without the presence of microbubbles. The devices were exposed to ultrasound parameters ranging in frequency from 0.5 to 1.55MHz, duty factor from 0.0001–0.001 and pulse repetition frequency of 1–10 Hz. Acoustic and thermal characterization of the device was performed. Effects of microbubble size and composition on the endothelial permeability were also investigated. The transepithelial electrical resistance (TEER) and cell morphology were monitored post-ultrasound exposure to investigate endothelial permeability duration and extent. Understanding the fundamentals of ultrasound-induced permeability in a controlled manner can lead to further investigations and optimization for in vivo and clinical settings.
Comparison of hearing protector ratings for statistically significant differences
Authors: Murphy William J.
Published: December 2020

During the development of the American National Standards Institute S12.68 standard for estimating effective A-weighted sound pressure levels when hearing protector device (HPD) are worn, the need to provide a mechanism to compare HPD ratings was identified. The current Noise Reduction Rating (NRR) is a single number that describes the potential of a product to reduce noise at the user’s ears. The Noise Reduction Statistic for A-weighting (NRSA) describes a range of protection performance and estimates the uncertainty associated with the rating. The uncertainty for NRSA is estimated using a bootstrap procedure. This method can be applied to current ratings and comparisons between rating evaluations from different laboratories. This paper will discuss NRR and NRSA error bars ratings and present a modification of the bootstrap method to estimate directly the statistical significance of differences. Results from two different studies of hearing protector attenuation measurements and training protocols will be examined. The studies’ results will also be compared against the manufacturers’ published attenuation values.
Image-based estimation of hearing protection attenuation and fit
Authors: Smalt Christopher J. , Ciccarelli Gregory , Rodriguez Aaron , Murphy William J.
Published: December 2020

Dangerous acoustic noise levels are encountered occupationally by 22 million workers annually (Tak et al., 2009). Occupational and recreational noise is known to cause permanent hearing damage and reduced quality of life, which suggests the importance of noise controls including hearing protection devices (HPDs). While HPDs can provide adequate protection for many noise exposures, it is often a challenge to properly train and maintain compliance. Fit-testing systems are commercially available to ensure proper attenuation is achieved, but they either require specific facilities (e.g., ANSI S12.6) or special equipment and hearing protection devices designed formicrophone-in-the-ear (MIRE) testing. In this study, we estimated the adequacy of fit for a foam hearing protector using only a photograph of the inserted foam plug. Our initial dataset was photographs of a single type of foam hearing protector, broken up into a 200-image training set and 40 image test set, where individual subjects were not mixed across the two datasets. We achieved 73% classification accuracy if the fit was greater or less than the median measured attenuation (35 dB averaged across frequency). Ultimately, this algorithm could be used as part of a smartphone app for training as well as for automated compliance monitoring in noisy environments for preventing hearing loss.
Far-field acoustic subwavelength imaging with structured illumination
Authors: Lin Jinuan , Ma Chu
Published: December 2020

In the past decade, subwavelength imaging technologies have attracted a lot of interest for breaking the diffraction limit. While localization-based methods are able to image isolated subwavelength objects, differentiating objects with subwavelength distances in the far field is still challenging. To solve this problem, it has been proposed in optical microscopy to exploit structured or blind structured illumination, where the spatial frequency mixing between the objects and the illumination converts evanescent waves to propagating waves that can reach far field. Here, we propose an acoustic analogy and demonstrate a framework, both theoretically and experimentally, for performing far-field acoustic subwavelength imaging using structured illumination generated by scattering media with subwavelength features. A scattering medium is placed behind subwavelength objects. The excitation wave is first diffracted by the scattering medium before it further passes through the objects and reaches the receiver in the far field. By utilizing a compressive sensing reconstruction algorithm, the image of the objects can be reconstructed with multiple measurements that are obtained by shifting or rotating the scattering medium. The proposed framework has great potential in medical imaging, non-destructive testing, and underwater acoustic imaging for improving imaging resolution of objects far away from the sensors.
Production and perception of a merger: The case of [l] and [n] in Eastern Min Chinese
Authors: Cheng Ruoqian , Jongman Allard
Published: December 2020

We identified six acoustic correlates to the phonemic contrast between word-initial [l] and [n] in both English and Mandarin (Cheng and Jongman, 2019, JASA). All six cues suggested the phonemic contrast between prescriptive L and N (phonemes in the unmerged system) disappeared in Eastern Min (EM) in production. The current study investigated the phonological and social factors that modulate the merger-in-progress. In production, a classifier was trained with acoustic parameters from Mandarin (F3, F1 bandwidth, A1-P0) to categorize EM tokens. Linear discriminant results illustrated acoustically distinct [l] and [n] tokens as the phonetic realizations of the merger. Both prescriptive L and N were variably realized as acoustic [l] or [n] in production. Low vowels correlated with acoustically more nasal-like onsets. Speakers of all ages and genders leaned toward [l]. Perceptually, AX discrimination results (ISI = 750 ms) suggested EM speakers did not distinguish prescriptive L from N (mean A′ = 0.46), providing converging evidence of the merger. EM listeners did not perceive the difference between acoustic [l] and [n] either (mean A′ = 0.47). However, lower vowels with nasal codas illustrated a higher degree of sensitivity than other phonological conditions, which was an effect of the larger acoustic distance between stimuli.
Self-perception and vowel inherent spectral change
Authors: Jibson Jonathan
Published: December 2020

Speakers self-correct vowels with deviant formants: tokens whose onsets are farther from the average midpoint move toward that average, while nearer tokens move randomly (Niziolek et al., 2013). The method used to establish this finding typically groups tokens based on onset formants relative to midpoint formants, and the midpoint is taken as the target. But vowel inherent spectral change research has shown that vowels are best modelled as contours rather than midpoints. The present study asks whether speakers self-correct toward trajectories rather than static midpoints. Seventeen female speakers provided 20 tokens of each stressed non-rhotic monophthong in English in [hVd] (heed, hid, etc.). Formants were sampled at 3% and 50% of vowel duration, and each speaker’s average formant position was calculated at both samples. Sample-matched Euclidean distances were calculated—each 3% token to the 3% average, each 50% token to the 50% average—rather than comparing to the midpoint sample in both cases. Tokens were grouped based on onset distance. Far tokens showed a larger decrease in distance by the midpoint than Near tokens, and regression to the mean was ruled out as the reason. This study suggests that speakers use dynamic spectral information for online self-correction.
Adaptation in vowels for real-time temporal perturbation
Authors: Karlin Robin , Naber Chris , Parrell Benjamin
Published: December 2020

Real-time altered auditory feedback has demonstrated a key role for auditory feedback in both online feedback control and in updating feedforward control for future utterances. Much of this research has examined control in the spectral domain, and has found that speakers compensate for perturbations to vowel formants, intensity, and fricative center of gravity (Houde and Jordan, 1998; Jones and Munhall 2000; Patel et al. 2015, inter alia). However, there is just one study that examines the regulation of temporal control via auditory feedback (Mitsuya et al., 2014). In the current study we introduced a real-time perturbation of speech timing to examine control of relative timing between two distinct actions (VOT for /g, k/) and inherent timing of a single action (fricative duration for /s, z/). The introduced acoustic perturbation increased the duration of the target consonant and decreased the duration of the following vowel. Overall, speakers do not compensate for lengthened consonants. However, speakers do lengthen vowel productions in response to shortening, effectively decreasing the proportion of the syllable occupied by the consonant. Vowel lengthening effects persist after perturbation has ceased. These results indicate that speakers actively monitor duration and update upcoming plans accordingly.
The role of somatosensory feedback in the production of English vowels
Authors: Al-Zanoon Noor , Cullum Angela , Cummine Jacqueline , Jeffery Caroline , Hodgetts Bill , Aalto Daniel
Published: December 2020

Speech involves the complex coordination of motor, auditory and somatosensory systems. Perturbing feedback in speech has been shown to impact both vowels and consonants. The present study sought to investigate the role of somatosensory feedback in the production of four English vowels (/i, æ, u/, and /ɑ/). Thirty-three female, native English speakers were randomly assigned to control and experimental groups. The experimental group received 15 ml of 2% lidocaine mouthwash, whereas the control group received a visually comparable solution without anesthetic. Participants produced 10 repetitions of four words (/bit, bæt, but, bɑt/) in random order. Formant frequencies (F1, F2) of all four vowels were extracted and analyzed using eight linear mixed effects models. Significant effects were found for F1 in the experimental group for the single vowel /u/. The results suggest that the articulatory system is robust against somatosensory feedback perturbation in learned articulations.
Native English speakers’ pre-existing sensitivity to the Hindi dental-retroflex contrast
Authors: Hayes-Harb Rachel , Barrios Shannon
Published: December 2020

Native English speakers’ pre-existing perceptual sensitivity to Mandarin lexical tone contrasts is associated with the ability to distinguish newly learned minimal pairs (Wong and Perrachione, 2007). Perrachione et al. (2011) further demonstrated that degree of pre-existing sensitivity predicts whether learners subsequently benefit more from single- or multiple-talker training. Together these findings point to the importance of pre-existing sensitivity in second language learning, yet the role of sensitivity to consonant contrasts has not been explored. We investigated variability in pre-existing sensitivity among native English speakers perceiving Hindi voiced and voiceless dental-retroflex stop contrasts. Fifty-two participants completed a web-based AXB task involving the four contrasts produced by four native Hindi speakers. Participants varied widely in their discrimination accuracy, ([t̪]-[ʈ], mean proportion correct = 0.59, min = 0.31, median = 0.59, max = .84; [t̪ʰ]-[ʈʰ], mean = 0.53, min = 0.31, median = 0.53, max = 0.75; [d̪]-[ɖ], mean = 0.56, min = 0.25, median = 0.56, max = 0.75; [d̪ɦ]-[ɖɦ], mean = 0.64, min = 0.38, median = 0.63, max = 0.81). In addition, the relative difficulty of the contrasts differed across speakers, complicating the construct of pre-existing sensitivity. We conclude that listeners exhibit variability in their pre-existing sensitivity to Hindi consonant contrasts, warranting further investigation into how this ability relates to their word learning success.
Perceptual discrimination measure of non-native phoneme perception in early and late Spanish-English and Japanese-English bilinguals
Authors: Hisagi Miwako , Higby Eve , Zandona Mike , Kent Justin , Castillo Daniela , Davidovich Ingrid , Shafer Valerie
Published: December 2020

This study examined speech discrimination of English vowels /ɑ/ (as in “hot”), /ʌ/ (as in “hut”), and /æ/ (as in “hat”) by non-native English speakers, using an AXB discrimination task. Previous research shows that a person’s first language (L1) changes how speech is perceived in a second learned language (L2). Spanish and Japanese were chosen for this study because both languages share the same five spectrally different vowels, but Japanese additionally distinguishes between short and long versions of those five vowels. L2 proficiency and/or amount of L2 input were used as additional predictor variables. The target populations were early and late Spanish-English bilinguals and early and late Japanese-English bilinguals, which were compared to a control group of monolingual American English speakers. We are currently collecting data and based on previous studies (Shafer et al., under review), we predict: (1) monolinguals and early-bilinguals will show better performance than late-bilinguals; (2) discrimination of /ʌ/ vs. /æ/ contrast will be easier than other contrasts, /ʌ/ vs. /ɑ/ and /ɑ/ vs. /æ/. Our findings will address how L1 spectral-temporal cues and L2 age of acquisition affect L2 speech perception.
The perception and production of Mandarin-accented English: The role of degree of accentedness in the interlanguage speech intelligibility benefit for talkers and the interlanguage speech intelligibility benefit for listeners
Authors: Fishero Sheyenne , Sereno Joan , Jongman Allard
Published: December 2020

The Interlanguage Speech Intelligibility Benefit for talkers (ISIB-T) claims non-native learners are better at understanding talkers with a shared L1 than they are at understanding native talkers, and the ISIB for listeners (ISIB-L) claims non-native learners are better at understanding talkers with a shared L1 than native speakers are (Hayes-Harb et al., 2008). In the present study, a lexical decision task (including words with shared phonemes in both Mandarin and English, as well as words with phonemes that only occur in English) was used, with accentedness ratings of talkers and listeners collected to investigate whether ISIB is manifested differently for listeners and speakers of different proficiency levels. Accuracy scores and reaction time measures were compared for both L1 (native English) and L2 (high proficiency, low proficiency) groups when listening to strongly Mandarin-accented, weakly Mandarin-accented, and native English speech. Amount of Mandarin-accented English input was also measured. Results showed some gradience in accuracy by degree of accentedness, with trends in the predicted direction suggestive of ISIB-T and ISIB-L effects. In addition, participants were more accurate when listening to words with phonemes shared in Mandarin and English than English-specific phoneme words, an advantage that increased as the strength of speaker accent increased.
Self-Selecting the Number of Repetitions in Potentiation Protocols: Enhancement Effects on Jumping Performance
Authors: Dello Iacono Antonio , Beato Marco , Halperin Israel
Published: December 2020

Purpose: To investigate whether providing athletes with a choice regarding the number of repetitions to complete in a potentiation protocol would enhance jumping performance compared with protocols in which the number of repetitions is predetermined. Methods: Fifteen male basketball players completed 4 testing sessions separated by 72 hours. In the first session, individual optimum power loads in the barbell jump squat were determined. In the following 3 sessions, the athletes completed 3 sets of 3 potentiation protocols using optimum power load jump squats in a partly randomized order: (1) The traditional condition included 6 repetitions per set, (2) the self-selected condition included a choice regarding the number of repetitions to complete per set, and (3) the imposed condition included the same number of repetitions per set as the self-selected condition, but the number was imposed on the athletes beforehand. The jumping performance was determined as jump squat test height and measured using a force platform before and 30 seconds, 4 minutes, and 8 minutes after completing the protocols. Results: The self-selected condition led to superior jumping performance compared with the 2 other conditions across all post measures (P < .05; range: 0.3–1.3 cm). Compared with the traditional condition, the imposed condition led to superior jumping performance across all post measures (range: 0.2–0.45 cm), although not statistically significant at post 4 minutes and post 8 minutes. Conclusions: Choice provision concerning how many repetitions to complete in a potentiation protocol is a useful performance-enhancing strategy. Improved potentiation–fatigue ratio and motivational factors are sought to explain these effects.
Landscapes of bacterial and metabolic signatures and their interaction in major depressive disorders
Authors: Yang Jian , Zheng Peng , Li Yifan , Wu Jing , Tan Xunmin , Zhou Jingjing , Sun Zuoli , Chen Xu , Zhang Guofu , Zhang Hanping , Huang Yu , Chai Tingjia , Duan Jiajia , Liang Weiwei , Yin Bangmin , Lai Jianbo , Huang Tingting , Du Yanli , Zhang Peifen , Jiang Jiajun , Xi Caixi , Wu Lingling , Lu Jing , Mou Tingting , Xu Yi , Perry Seth W. , Wong Ma-Li , Licinio Julio , Hu Shaohua , Wang Gang , Xie Peng
Published: December 2020

Major depressive disorder is linked with disturbances of gut bacterial, viral, and metabolic signatures.
Potassium isotopic heterogeneity in subducting oceanic plates
Authors: Hu Yan , Teng Fang-Zhen , Plank Terry , Chauvel Catherine
Published: December 2020

High-precision K isotopic measurements identify crustal inputs to the mantle and controls on oceanic K cycle.
Matrix Protein 2 Extracellular Domain-Specific Monoclonal Antibodies Are an Effective and Potentially Universal Treatment for Influenza A
Authors: Bimler Lynn , Ronzulli Sydney L. , Song Amber Y. , Johnson Scott K. , Jones Cheryl A. , Kim Teha , Le Duy T. , Tompkins S. Mark , Paust Silke
Published: December 2020

Despite a seasonal vaccine and multiple therapeutic treatments, influenza A remains a significant threat to human health. The biggest obstacle in producing a vaccine or treatment for influenza A is their universality or efficacy against not only seasonal variances in the influenza virus but also all human, avian, and swine serotypes and, therefore, potential pandemic strains.
A framework for identifying and learning from countries that demonstrated exemplary performance in improving health outcomes and systems
Authors: Carter Austin , Akseer Nadia , Ho Kevin , Rothschild Oliver , Bose Niranjan , Binagwaho Agnes , Hirschhorn Lisa R , Price Matthew , Muther Kyle , Panjabi Raj , Freeman Matthew C , Bednarczyk Robert A , Bhutta Zulfiqar Ahmed
Published: December 2020

This paper introduces a framework for conducting and disseminating mixed methods research on positive outlier countries that successfully improved their health outcomes and systems. We provide guidance on identifying exemplar countries, assembling multidisciplinary teams, collecting and synthesising pre-existing evidence, undertaking qualitative and quantitative analyses, and preparing dissemination products for various target audiences. Through a range of ongoing research studies, we illustrate application of each step of the framework while highlighting key considerations and lessons learnt. We hope uptake of this comprehensive framework by diverse stakeholders will increase the availability and utilisation of rigorous and comparable insights from global health success stories.
Targeting anticorruption interventions at the front line: developmental governance in health systems
Authors: Hutchinson Eleanor , Naher Nahitun , Roy Pallavi , McKee Martin , Mayhew Susannah H , Ahmed Syed Masud , Balabanova Dina
Published: December 2020

In 2008, Vian reported an increasing interest in understanding how corruption affects healthcare outcomes and asked what could be done to combat corruption in the health sector. Eleven years later, corruption is seen as a heterogeneous mix of activity, extensive and expensive in terms of loss of productivity, increasing inequity and costs, but with few examples of programmes that have successfully tackled corruption in low-income or middle-income countries. The commitment, by multilateral organisations and many governments to the Sustainable Development Goals and Universal Health Coverage has renewed an interest to find ways to tackle corruption within health systems. These efforts must, however, begin with a critical assessment of the existing theoretical models and approaches that have underpinned action in the health sector in the past and an assessment of the potential of innovations from anticorruption work developed in sectors other than health. To that end, this paper maps the key debates and theoretical frameworks that have dominated research on corruption in health. It examines their limitations, the blind spots that they create in terms of the questions asked, and the capacity for research to take account of contextual factors that drive practice. It draws on new work from heterodox economics which seeks to target anticorruption interventions at practices that have high impact and which are politically and economically feasible to address. We consider how such approaches can be adopted into health systems and what new questions need to be addressed by researchers to support the development of sustainable solutions to corruption. We present a short case study from Bangladesh to show how such an approach reveals new perspectives on actors and drivers of corruption practice. We conclude by considering the most important areas for research and policy.
Use of social media platforms by manufacturers to market breast-milk substitutes in South Africa
Authors: Pereira-Kotze Catherine , Doherty Tanya , Swart Elizabeth C
Published: December 2020

In South Africa (SA), exclusive breast feeding remains rare, with breast-milk substitutes (BMS) commonly being used in ways that are detrimental to infant and young child nutrition, health and survival. The use of internet, digital and mobile platforms has increased, including in low-income and middle-income countries, like SA and these platforms are avenues for BMS marketing. SA has national legislation (Regulation R991) to enforce the International Code of Marketing of BMS. This paper aims to provide pertinent examples of how BMS manufacturers in SA use social media to market their products thus violating national regulations. A digital (and social media) ethnography approach was used to study BMS organisations’ activity on Facebook and Instagram. Purposively selected examples of social media posts observed (from 2015 to 2019) were included, and content analysed in terms of national legislation. Several examples of BMS social media marketing are presented and interpreted according to provisions of national regulations that they violate. BMS manufacturers have found ways on social media to market their products in a media space that is complex to regulate, and where it is difficult to enforce national regulations. It is necessary to engage with stakeholders, notably social media companies, to alert them to relevant regulations applicable to their platforms. Monitoring the marketing of products for infants and young children by national governments needs to include online and digital platforms especially social media.
District-level health system strengthening for universal health coverage: evidence from a longitudinal cohort study in rural Madagascar, 2014-2018
Authors: Garchitorena Andres , Miller Ann C , Cordier Laura F , Randriamanambintsoa Marius , Razanadrakato Hery-Tiana R , Randriamihaja Mauricianot , Razafinjato Benedicte , Finnegan Karen E , Haruna Justin , Rakotonirina Luc , Rakotozafy Germain , Raharimamonjy Laliarisoa , Atwood Sidney , Murray Megan B , Rich Michael , Loyd Tara , Solofomalala Gaêtan Duval , Bonds Matthew H
Published: December 2020

Introduction

Despite renewed commitment to universal health coverage and health system strengthening (HSS) to improve access to primary care, there is insufficient evidence to guide their design and implementation. To address this, we conducted an impact evaluation of an ongoing HSS initiative in rural Madagascar, combining data from a longitudinal cohort and primary health centres.

Methods

We carried out a district representative household survey at the start of the HSS intervention in 2014 in over 1500 households in Ifanadiana district, and conducted follow-up surveys at 2 and 4 years. At each time point, we estimated maternal, newborn and child health coverage; economic and geographical inequalities in coverage; and child mortality rates; both in the HSS intervention and control catchments. We used logistic regression models to evaluate changes associated with exposure to the HSS intervention. We also estimated changes in health centre per capita utilisation during 2013 to 2018.

Results

Child mortality rates decreased faster in the HSS than in the control catchment. We observed significant improvements in care seeking for children under 5 years of age (OR 1.23; 95% CI 1.05 to 1.44) and individuals of all ages (OR 1.37, 95% CI 1.19 to 1.58), but no significant differences in maternal care coverage. Economic inequalities in most coverage indicators were reduced, while geographical inequalities worsened in nearly half of the indicators.

Conclusion

The results demonstrate improvements in care seeking and economic inequalities linked to the early stages of a HSS intervention in rural Madagascar. Additional improvements in this context of persistent geographical inequalities will require a stronger focus on community health.
The compatibility of reductionistic and complexity approaches in a sociomedical innovation perspective
Authors: Naaldenberg Jenneken , Aarts Noelle
Published: December 2020

Medical technologies, e-health and personalised medicine are rapidly changing the healthcare landscape. Successful implementation depends on interactions between the technology, the actors and the context. More traditional reductionistic approaches aim to understand isolated factors and linear cause–effect relations and have difficulties in addressing inter-relatedness and interaction. Complexity theory offers a myriad of approaches that focus specifically on behaviour and mechanisms that emerge from interactions between involved actors and the environment. These approaches work from the assumption that change does not take place in isolation and that interaction and inter-relatedness are central concepts to study. However, developments are proceeding fast and along different lines. This can easily lead to confusion about differences and usefulness in clinical and healthcare research and practice. Next to this, reductionistic and complexity approaches have their own merits and much is to be gained from using both approaches complementary. To this end, we propose three lines in complexity research related to health innovation and discuss ways in which complexity approaches and reductionistic approaches can act compatibly and thereby strengthen research designs for developing, implementing and evaluating health innovations.
Gut microbiota-derived metabolites as central regulators in metabolic disorders
Authors: Agus Allison , Clément Karine , Sokol Harry
Published: December 2020

Metabolic disorders represent a growing worldwide health challenge due to their dramatically increasing prevalence. The gut microbiota is a crucial actor that can interact with the host by the production of a diverse reservoir of metabolites, from exogenous dietary substrates or endogenous host compounds. Metabolic disorders are associated with alterations in the composition and function of the gut microbiota. Specific classes of microbiota-derived metabolites, notably bile acids, short-chain fatty acids, branched-chain amino acids, trimethylamine N-oxide, tryptophan and indole derivatives, have been implicated in the pathogenesis of metabolic disorders. This review aims to define the key classes of microbiota-derived metabolites that are altered in metabolic diseases and their role in pathogenesis. They represent potential biomarkers for early diagnosis and prognosis as well as promising targets for the development of novel therapeutic tools for metabolic disorders.
Sensitivity and specificity of loss of heterozygosity analysis for the classification of rare germline variants inBRCA1/2: results of the observational AGO-TR1 study (NCT02222883)
Authors: Hauke Jan , Harter Philipp , Ernst Corinna , Burges Alexander , Schmidt Sandra , Reuss Alexander , Borde Julika , De Gregorio Nikolaus , Dietrich Dimo , El-Balat Ahmed , Kayali Mohamad , Gevensleben Heidrun , Hilpert Felix , Altmüller Janine , Heimbach André , Meier Werner , Schoemig-Markiefka Birgid , Thiele Holger , Kimmig Rainer , Nürnberg Peter , Kast Karin , Richters Lisa , Sehouli Jalid , Schmutzler Rita K , Hahnen Eric
Published: December 2020

Variant-specific loss of heterozygosity (LOH) analyses may be useful to classifyBRCA1/2germline variants of unknown significance (VUS). The sensitivity and specificity of this approach, however, remains unknown. We performed comparative next-generation sequencing analyses of theBRCA1/2genes using blood-derived and tumour-derived DNA of 488 patients with ovarian cancer enrolled in the observational AGO-TR1 trial (NCT02222883). Overall, 94 pathogenic, 90 benign and 24 VUS were identified in the germline. A significantly increased variant fraction (VF) of a germline variant in the tumour indicates loss of the wild-type allele; a decreased VF indicates loss of the variant allele. We demonstrate that significantly increased VFs predict pathogenicity with high sensitivity (0.84, 95% CI 0.77 to 0.91), poor specificity (0.63, 95% CI 0.53 to 0.73) and poor positive predictive value (PPV; 0.71, 95% CI 0.62 to 0.79). Significantly decreased VFs predict benignity with low sensitivity (0.26, 95% CI 0.17 to 0.35), high specificity (1.0, 95% CI 0.96 to 1.00) and PPV (1.0, 95% CI 0.85 to 1.00). Variant classification based on significantly increased VFs results in an unacceptable proportion of false-positive results. A significantly decreased VF in the tumour may be exploited as a reliable predictor for benignity, with no false-negative result observed. When applying the latter approach, VUS identified in four patients can now be considered benign.Trial registration numberNCT02222883.
Do subtle findings on chest X-ray predict worse outcomes for paediatric asthma?
Authors: Abeles Michael , Akerman Meredith , Halaby Claudia , Pirzada Melodi
Published: December 2020

Background

Asthma, a common childhood condition, often presents with chronic cough. While evaluating for chronic cough, many specialists obtain a baseline chest radiograph (CR) to assess for other causes. Usually read as ‘normal’, sometimes CRs will reveal evidence of airway inflammation in the form of subtle findings, such as ‘increased interstitial markings’ or ‘peribronchial thickening’. There is sparse literature in the outpatient setting correlating findings on baseline CRs with adverse outcomes such as systemic steroid use, emergency department (ED) visit or hospitalisation.

Methods

This was a retrospective study of patients seen at our institution's Pediatric Pulmonology outpatient clinic. We reviewed the charts of all new patients aged 0–18 years who presented between January 2015 and December 2017. Patients were included if they were diagnosed with asthma, had a CR after the initial visit and were followed up at least twice. Adverse outcomes include systemic steroid use, ED visit or hospitalisation.

Results

130 subjects were included. 89 subjects had clear CRs and 41 subjects had CRs with airway inflammation. Overall events were higher in the airway inflammation group (22.5% vs 46.3%, respectively, p<0.0058). There were no significant differences between in terms of oral corticosteroid use or hospitalisations. There was a significant difference between the two groups in terms of ED visits (2.2% vs 14.6%, respectively, p=0.0121).

Conclusion

This study shows a positive correlation between airway inflammation findings on baseline CR and subsequent ED visits in patients with asthma.
Patient outcomes after hospitalisation with COVID-19 and implications for follow-up: results from a prospective UK cohort
Authors: Arnold David T , Hamilton Fergus W , Milne Alice , Morley Anna J , Viner Jason , Attwood Marie , Noel Alan , Gunning Samuel , Hatrick Jessica , Hamilton Sassa , Elvers Karen T , Hyams Catherine , Bibby Anna , Moran Ed , Adamali Huzaifa I , Dodd James William , Maskell Nicholas A , Barratt Shaney L
Published: December 2020

The longer-term consequences of SARS-CoV-2 infection are uncertain. Consecutive patients hospitalised with COVID-19 were prospectively recruited to this observational study (n=163). At 8–12 weeks postadmission, survivors were invited to a systematic clinical follow-up. Of 131 participants, 110 attended the follow-up clinic. Most (74%) had persistent symptoms (notably breathlessness and excessive fatigue) and limitations in reported physical ability. However, clinically significant abnormalities in chest radiograph, exercise tests, blood tests and spirometry were less frequent (35%), especially in patients not requiring supplementary oxygen during their acute infection (7%). Results suggest that a holistic approach focusing on rehabilitation and general well-being is paramount.
Is the tobacco ‘footfall’ argument justified for tobacco purchases in New Zealand convenience stores?
Authors: Marsh Louise , Cameron Claire , Quigg Robin , Wood Sarah , Blank Mei-Ling , Venter Noeleen , Thomas Lathan , Robertson Lindsay , Hoek Janet , Sullivan Trudy
Published: December 2020

Introduction

New Zealand’s Smokefree 2025 goal aims to greatly decrease the availability of tobacco. One option is to cease the sale of tobacco from convenience stores. However, tobacco companies and retail trade associations oppose this move and have argued that customers who purchase tobacco drive footfall and spend more than non-tobacco customers. The aim of this study is to test the validity of industry claims about the importance of tobacco to convenience stores.

Methods

During November and December 2019, immediate postpurchase surveys were undertaken with customers on exit from a random sample of 100 convenience stores in two New Zealand cities. We estimated the mean number of items purchased, including tobacco and non-tobacco items, and mean expenditure on non-tobacco items.

Results

Of the 3399 transactions recorded, 13.8% included tobacco, of which 8.3% comprised tobacco only and 5.5% included tobacco and non-tobacco items. The mean number of transactions containing both tobacco and non-tobacco items was 1.98, and 1.87 for those containing non-tobacco items only. Customers who purchased tobacco and non-tobacco items spent on average NZ$6.99 on non-tobacco items, whereas customers who purchased non-tobacco items only, spent on average NZ$5.07.

Conclusions

Our results do not support claims that tobacco drives one-quarter of footfall into stores or that customers who purchase tobacco spend almost twice as much as non-tobacco customers. Combined purchases of tobacco and non-tobacco items constituted 5.5% of transactions; the impact on a store’s profitability of removing tobacco sales is unknown and could be the focus of future research.
Potential impact of sub-structure on the determination of neutrino mass hierarchy at medium-baseline reactor neutrino oscillation experiments
Authors: Cheng Zhaokan , Raper Neill , Wang Wei , Wong Chan Fai , Zhang Jingbo
Published: December 2020

In the past decade, the precise measurement of the lastly known neutrino mixing angle $$\theta _{13}$$

θ
13

has enabled the resolution of neutrino mass hierarch (MH) at medium-baseline reactor neutrino oscillation (MBRO) experiments. Recent calculations of the reactor neutrino flux predict percent-level sub-structures in the $$\bar{\nu }_e$$

ν

¯

e

spectrum due to Coulomb effects in beta decay. Such fine structure in the reactor spectrum has been an issue of concern for efforts to determine the neutrino MH for the MBRO approach, the concern being that the sub-dominant oscillation pattern used to discriminate different hierarchies will be obscured by fine structure. The energy resolutions of current reactor experiments are not sufficient to measure such fine structure, and therefore the size and location in energy of these predicted discontinuities has not been confirmed experimentally. There has been speculation that a near detector is required with sufficient energy resolution to resolve the fine structure. This article studies the impact of fine structure on the resolution of MH, based on predicted reactor neutrino spectra, using the measured spectrum from Daya Bay as a reference. We also investigate how a near detector could improve the sensitivity of neutrino MH resolution based on various assumptions of near detector energy resolution.