bluuebunny/crossref_metadata_2025 huggingface dataset:
White spot syndrome virus host range and impact on transmission
Authors: Desrina  , Prayitno Slamet B. , Verdegem Marc C. J. , Verreth Johan A. J. , Vlak Just M.
Published: April 2022

White spot syndrome virus (WSSV), the etiological agent of white spot disease (WSD), is a significant pathogen affecting shrimp farming industry worldwide. White spot syndrome virus is a generalist virus mainly infecting decapod crustaceans. The aims of this review were to: (1) Re‐evaluate and update the status of reported WSSV host and vector species based on the methods used when detecting replication and transmission to shrimp and 2) make a critical evaluation of existing literature on the presence of WSSV in aquatic organisms and the potential role these organisms might play in the transmission of WSSV in pond systems and the wild. An evaluation of literature about WSSV reported host and vector species showed an increase from 33 families to 50 families including 11 families of non‐crustacean hosts, proved the virus continues to spread beyond farmed shrimp and the shrimp pond environment. White spot syndrome virus transmission in the aquatic environment is complex as depicted in our model. Containment of WSSV in ponds and the natural environment is challenging, mainly because of its generalist nature and a lack of understanding about (1) WSSV transmission in the aquatic setting, (2) the route of WSSV transmission among species exist in the aquatic environment and (3) information on the transmission dynamics between WSSV in farmed crustaceans and non‐farmed animals. Information presented in this review provides the research direction on methods to control WSSV.
BRI as cognitive empire: Epistemic violence, ethnonationalism and alternative imaginaries in Zomian highlands
Authors: Sims Kearrin
Published: April 2022

China's Belt and Road Initiative (BRI) has become the lodestar of Beijing's efforts to increase its global political and economic influence. This article interrogates BRI discourse, arguing that the normative adoption of BRI narratives as a means for making sense of connectivities between China and other places risks producing new forms of epistemic violence against subaltern populations. The empirical focus of this paper is on China‐Laos relations, and the epistemic positioning of highland ethnic minority groups in northern Laos. This context offers a valuable case study for examining BRI discourse due to: (a) the profound effects of Chinese investment in Laos; (b) the geostrategic importance of Laos as a BRI ‘gateway’ between China and Southeast Asia; (c) the deep histories of ethnic minority engagements across China and Laos; and (d) the limited extant research on both China‐Laos relations and the more localized effects of Chinese actors within the highland border regions.
Non‐response to questions about suicide ideation and attempts among veterans: Results from the National Health and Resilience in Veterans Study
Authors: Stanley Ian H. , Marx Brian P. , Nichter Brandon , Pietrzak Robert H.
Published: April 2022

Objectives

Veterans who decline to provide information on their history of self‐injurious thoughts and behaviors (SITBs) may be at elevated suicide risk. We examined associations between non‐response to a question assessing lifetime SITBs and proxy variables of suicide risk.

Methods

In this population‐based cross‐sectional study of 4069 US veterans, responses to the Suicidal Behaviors Questionnaire‐Revised were examined to group veterans into one of three categories: (1) denied lifetime SITBs, (2) reported lifetime SITBs, or (3) declined to respond.

Results

Overall, 69.5% of veterans denied a SITB history, 29.5% reported a SITB history, and 1.0% declined to provide information regarding SITBs. In adjusted analyses, veterans who declined to provide information on SITBs were significantly more likely than veterans who explicitly denied lifetime SITBs to screen positive for posttraumatic stress disorder; report lifetime non‐suicidal self‐injury; and report elevated levels of total trauma burden, externalizing behaviors, loneliness, received social support, and provided social support. Across these constructs, veterans who declined to provide SITB information were statistically indistinguishable from veterans who explicitly reported lifetime SITBs.

Conclusions

Veterans who decline to provide information about suicidal thoughts and behaviors may represent a covert group at elevated risk for suicide.
Party over preference? Strategic primary voting in the age of outsiders*
Authors: Kelly Jarrod T. , Loepp Eric
Published: April 2022

Objective

Some primary voters cast their ballot for a candidate they do not most prefer in hopes that doing so will increase their party's chances of winning the general election. However, the emergence of party “outsider” candidates challenges prevailing assumptions about the persuasive pull of electability arguments on voter decision making. In this project, we analyze whether and when supporters of “outsider” candidates resolve strategic dilemmas relative to supporters of “insider” candidates.

Methods

We administer survey experiments to Republicans and Democrats immediately before the 2016 and 2020 primaries, respectively.

Results

Although voters in both parties are willing to vote strategically, there are critical differences when it comes to the loyalty primary voters feel to outsider primary candidates like Donald Trump and Bernie Sanders.

Conclusion

Strategic voting decisions are not based merely on electability, particularly in the case of “outsider” candidates. Scholars should integrate additional factors into future work on voter behavior in primaries.
Virtual and face-to-face team collaboration comparison through an agent-based simulation
Authors: Singh Harshika , Cascini Gaetano , McComb Christopher
Published: April 2022

The ongoing COVID-19 pandemic has accelerated the acceptance of virtual team collaboration as a replacement for face-to-face collaboration. Unlike face-to-face collaboration, virtual collaboration is influenced by unique factors, such as technology mediation. However, there is a lack of rigorous research that assesses the impact of virtual collaboration on the engineering design process. Therefore, the current study investigates the effect of virtual team collaboration on design outcomes by means of the MILANO (Model of Influence, Learning, and Norms in Organizations) framework. To tailor MILANO for virtual collaboration, this paper first presents an empirical study of human design teams, which shows how model parameter values for face-to-face collaboration (like self-efficacy, perceived influencers, perceived degree of influence, trust and familiarity) differ from appropriate parameter values for virtual collaboration. The simulation results for both virtual and face-to-face collaboration show how design outcomes differ with collaboration mode. Unlike teams with a few well-defined influential individuals, the mode of collaboration does not have a significant impact on teams where all individuals are equally influential. Virtual collaboration also results in lower exploration and variety than face-to-face collaboration.
Bioinspiration of Product Architecture: Trading-Off System Effectiveness for System Robustness
Authors: Bhasin Devesh , Staack David , McAdams Daniel A.
Published: April 2022

This work analyzes the role of bioinspired product architecture in facilitating the design of robust engineering systems. Prior works have proposed design guidelines to facilitate the implementation of bioinspired product architectures for engineered systems. This work shows that implementing a bioinspired product architecture may improve a system’s robustness to random module failures, but may degrade the system’s effectiveness in the absence of any module failure. To demonstrate such a trade-off between the robustness and the undisrupted effectiveness of a system, this study quantitatively compares biological systems to their functionally equivalent modular systems. The modular equivalents of biological systems are first derived by utilizing Functional Modeling. The application of the bioinspired product architecture guidelines is then modeled as a transition from the modular product architecture of the modular equivalents to the actual product architecture of the biological systems. The effectiveness and the robustness of the systems are analyzed after the application of each guideline by modeling the systems as multi-flow directed networks. Such an analysis is performed by introducing metrics that quantify a system’s expected effectiveness and the degradation in the system’s expected effectiveness with increasing severity of random disruptions. The findings are validated by designing and analyzing a COVID-19 breathalyzer as an engineering case study.
Predicting the Erosion Rate of Uni-Directional Glass Fiber Reinforced Polymer Composites Using Machine-Learning Algorithms
Authors: Deliwala Ajaz Ahmed , Dubey Koshlendra , Yerramalli Chandra Sekher
Published: April 2022

The wind turbine and helicopter rotor blades when exposed to dust borne environment are subjected to leading edge erosion because of the impact of dust particles. These blades are manufactured from fiber reinforced polymer (FRP) composites and therefore, it is important to predict the erosion rate of FRP composites. In this paper, the main aim is to accurately predict the erosion rate of uni-directional FRP composites using machine-learning algorithms like artificial neural networks (ANNs) and extreme gradient boosting (XGB) and compare between the algorithms. The model uses input parameters like erodent impact angle, velocity of erodent particle, fiber orientation, and fiber volume fraction as the input and erosion rate as the output variable. The total dataset considered for training and testing the model is obtained from two parts. The first part of the dataset is obtained from the literature and the other part is collected from performing in-house experiments on uni-directional glass fiber reinforced polymer (GFRP) composites. The crater profiles of the tested specimens are characterized using 3D Alicona imaging microscopy. The machine-learning models considered in this study provide accurate results on the dataset. However, the XGB method is more robust, reliable, and faster to train and more accurate than the ANN model in the case of an unknown dataset (dataset not used for training). The feature importance from the XGB model suggests that impact particle velocity, impact angle, and fiber orientation are the most important input features. The model predictions by taking into account the three input features provide accurate results without affecting the accuracy of the model.
Sleep Dysfunction in Adolescents With Prolonged Postconcussion Symptoms: A Reciprocal Coupling of Traumatic Brain Injury and Sleep-Related Problems
Authors: Hughes Carter , Hunt Kevin , Cox Brian , Raybon John , Lopez Rebecca M.
Published: April 2022

Clinical Scenario: Concussions are often neglected injuries that affect children and adolescents. Two physiological responses to a concussion are an ionic flux and an increased indiscriminate release of glutamate, which leads to an increase of intracellular calcium and extracellular potassium. This can ultimately result in sleep dysfunction, which often occurs after concussion and has long been thought of as simply another concussion symptom. Focused Clinical Question: Does the likelihood of prolonged postconcussion symptoms increase with reported sleep-related problems (SRPs) in young athletes (8–18 y) compared to concussed young athletes without SRPs and healthy controls? Summary of Key Findings: Four cohort studies with level 2/3 evidence measured subjective and objective sleep dysregulations in concussed and healthy populations. Overall, there was a difference in subjective SRPs between concussed and healthy patients. This correlated with other studies where worse sleep scores during the acute phase of concussion and increased SRPs led to worse ImPACT scores in patients 3 to 12 months postconcussion and longer overall recovery. Objective sleep dysfunction measures were significantly worse in concussed patients than in healthy controls, but no significant difference existed in melatonin measures. Clinical Bottom Line: There is strong evidence that sleep dysfunction is both a symptom of concussion as well as a causal factor of prolonged postconcussion symptoms. These studies show that sleep dysregulation is not always evident in objective measurements, leading to the strong possibility of a functional dysregulation of the sleep–wake cycle that is evident solely from subjective reports. Strength of Recommendation: While there are strong cohort studies researching the role of sleep in those with postconcussion symptoms, the nature of sleep studies prevents the production of strong, high-level evidence studies such as randomized control trials. Thus, there is level B evidence that the likelihood of prolonged postconcussion symptoms is increased by a higher amount of SRPs.
Is Tecar Therapy Effective on Biceps Femoris and Quadriceps Rehabilitation? A Cadaveric Study
Authors: Rodríguez-Sanz Jacobo , López-de-Celis Carlos , Hidalgo-García César , González-Rueda Vanessa , Ragazzi Paolo , Bueno-Gracia Elena , Llurda-Almuzara Luis , Pérez-Bellmunt Albert
Published: April 2022

Background: Capacitive-resistive electric transfer therapy is an interesting rehabilitation treatment to use in musculoskeletal injuries. The purpose is to analyze the temperature change and current flow in superficial and deep biceps femoris and quadriceps tissues when applying different protocols of capacitive-resistive electric transfer therapy. Methods: Five cryopreserved cadavers (10 legs) were included in this study. Four interventions (high/low power) were performed for 5 minutes. Dynamic movements were performed to the biceps femoris and quadriceps. Superficial, middle, and deep temperature were recorded at 1-minute intervals and 5 minutes after the treatment using invasive temperature meters placed with ultrasound guidance. Results: Low-power applications have generated a very low thermal effect and an important current flow. The high-power capacitive application achieves a greater increase in superficial temperature compared with low power (P < .001). The high-power resistive application recorded a greater increase in superficial, middle, and deep temperatures with a greater current flow compared with the other applications (P < .001). Conclusion: This study could serve as basic science data to justify the acceleration of the processes of muscle recovery, improving cell proliferation without increasing the temperature in acute muscle injuries and increasing the temperature and viscoelasticity of the tissues in chronic processes with this therapy.
Recruitment and organization of ESCRT-0 and ubiquitinated cargo via condensation
Authors: Banjade Sudeep , Zhu Lu , Jorgensen Jeffrey R. , Suzuki Sho W. , Emr Scott D.
Published: April 2022

The general mechanisms by which ESCRTs (Endosomal Sorting Complexes Required for Transport) are specifically recruited to various membranes, and how ESCRT subunits are spatially organized remain central questions in cell biology. At the endosome and lysosomes, ubiquitination of membrane proteins triggers ESCRT-mediated substrate recognition and degradation. Using the yeast lysosome/vacuole, we define the principles by which substrate engagement by ESCRTs occurs at this organelle. We find that multivalent interactions between ESCRT-0 and polyubiquitin are critical for substrate recognition at yeast vacuoles, with a lower-valency requirement for cargo engagement at endosomes. Direct recruitment of ESCRT-0 induces dynamic foci on the vacuole membrane and forms fluid condensates in vitro with polyubiquitin. We propose that self-assembly of early ESCRTs induces condensation, an initial step in ESCRT assembly/nucleation at membranes. This property can be tuned specifically at various organelles by modulating the number of binding interactions.
Nanoscale flexible organic thin-film transistors
Authors: Zschieschang Ute , Waizmann Ulrike , Weis Jürgen , Borchert James W. , Klauk Hagen
Published: April 2022

Direct-write electron-beam lithography has been used to fabricate low-voltage p-channel and n-channel organic thin-film transistors with channel lengths as small as 200 nm and gate-to-contact overlaps as small as 100 nm on glass and on flexible transparent polymeric substrates. The p-channel transistors have on/off current ratios as large as 4 × 109and subthreshold swings as small as 70 mV/decade, and the n-channel transistors have on/off ratios up to 108and subthreshold swings as low as 80 mV/decade. These are the largest on/off current ratios reported to date for nanoscale organic transistors. Inverters based on two p-channel transistors with a channel length of 200 nm and gate-to-contact overlaps of 100 nm display characteristic switching-delay time constants between 80 and 40 ns at supply voltages between 1 and 2 V, corresponding to a supply voltage–normalized frequency of about 6 MHz/V. This is the highest voltage-normalized dynamic performance reported to date for organic transistors fabricated by maskless lithography.
Primary non-gestational mediastinal choriocarcinoma metastatic to the brainstem
Authors: De Jesus Orlando , Pellot Cestero Joel E , Gómez-González Frances M , Vélez Román
Published: April 2022

Choriocarcinoma is a highly malignant tumour emerging from the syncytiotrophoblast divided into gestational and non-gestational presentations. Primary choriocarcinoma of the mediastinum is rare. Metastases to the brain often occur; however, brainstem involvement has not been reported for non-gestational choriocarcinoma. We described a middle-aged man who developed a complete left oculomotor nerve paralysis secondary to a brainstem tumour at the midbrain. The workup for the primary source of the brainstem tumour included a chest CT scan, which revealed a mediastinal mass. A mediastinal mass needle biopsy confirmed the diagnosis of primary mediastinal choriocarcinoma. Despite aggressive chemotherapy, the patient died 6 months after the initial presentation from neurological complications and multiorgan failure.
Body mass index and all-cause mortality in patients with newly diagnosed type 2 diabetes mellitus in South Korea: a retrospective cohort study
Authors: Hong Jae-Seok , Kang Hee-Chung
Published: April 2022

Objectives

The lower risk of death in overweight or obese patients, compared with normal-weight individuals, has caused confusion for patients with diabetes and healthcare providers. This study investigated the relationship between body mass index (BMI) and mortality in patients with type 2 diabetes.

Design

A retrospective cohort study.

Setting

We established a national population database by merging the Korea National Health Insurance (KNHI) claims database, the National Health Check-ups Database and the KNHI Qualification Database of South Korea.

Participants

A total of 53 988 patients who were newly diagnosed with type 2 diabetes (E11 in International Classification of Diseases, 10th Edition) in 2007, had available BMI data, lacked a history of any serious comorbidity, received diabetes medication and did not die during the first 2 years were followed up for a median of 8.6 years.

Primary outcome measures

All-cause mortality.

Results

The mean BMI was 25.2 (SD 3.24) kg/m2, and the largest proportion of patients (29.4%) had a BMI of 25–27.4 kg/m2. Compared with a BMI of 27.5–29.9 kg/m2(the reference), mortality risk continuously increased as BMI decreased while the BMI score was under 25 (BMI <18.5 kg/m2: adjusted HR (aHR) 2.71, 95% CI 2.24 to 3.27; BMI 18.5–20.9 kg/m2: aHR 1.94, 95% CI 1.70 to 2.22; BMI 21–22.9 kg/m2: aHR 1.51, 95% CI 1.34 to 1.70; and BMI 23–24.9 kg/m2: aHR 1.14, 95% CI 1.01 to 1.28). For patients aged ≥65 years, the inverse association was connected up to a BMI ≥30 kg/m2group (aHR 0.76, 95% CI 0.59 to 0.98). However, the associations for men, patients aged <65 years and ever smokers resembled a reverse J curve, with a significantly greater risk of death in patients with a BMI ≥30 kg/m2.

Conclusions

This study suggests that, for patients with type 2 diabetes at a normal weight, distinct approaches are needed in terms of promoting muscle mass improvement or cardiorespiratory fitness, rather than maintaining weight status. Improved early diagnosis considering the inverse association between BMI and mortality is also needed.
Prevalence of blindness and its determinants in Bangladeshi adult population: results from a national cross-sectional survey
Authors: Shakoor Shawkat Ara , Rahman Mustafizur , Hossain A H M Enayet , Moniruzzaman Mohammad , Bhuiyan Mahfuzur Rahman , Hakim Ferdous , Zaman M Mostafa
Published: April 2022

Objective

The objective of this study was to determine the prevalence of blindness and its determinants in Bangladeshi adult population.

Study design

A cross-sectional population-based survey conducted at household level with national representation. Samples were drawn from the 2011 national census frame using a multistage stratified cluster sampling method.

Setting and participants

The survey was done in urban and rural areas in 2013 using a probability proportionate to size sampling approach to locate participants from 72 primary sampling units. One man or one woman aged ≥40 years was randomly selected from their households to recruit 7200. In addition to sociodemographic data, information on medication for hypertension and diabetes was obtained. Blood pressure and capillary blood glucose were measured. Eyelids, cornea, lens, and retina were examined in addition to visual acuity and refraction testing.

Primary outcome measures

The following definition was used to categorise subjects having (1) blindness: visual acuity <3/60, (2) low vision: ≥3/60 to <6/60 and (3) normal vision: ≥6/12 after best correction.

Results

We could recruit 6391 (88.8%) people among whom 2955 (46.2%) were men. Among them, 1922 (30.1%) were from urban and 4469 (69.9%) were from rural areas. The mean age was 54.3 (SD 11.2) years. The age-standardised prevalence, after best correction, of blindness and low vision was 1.0% (95% CI 0.5% to 1.4%) and 12.1% (95% CI 10.5% to 13.8%), respectively. Multivariable logistic regression indicated that cataract, age-related macular degeneration and diabetic retinopathy were significantly associated with low vision and blindness after adjustment for age and sex. Population attributable risk of cataract for low vision and blindness was 79.6%.

Conclusions

Low vision and blindness are common problems in those aged 40 years or older. Extensive screening and eye care services are necessary for wider coverage engaging all tiers of the healthcare system especially focusing on cataract.
Assessment of mental health trajectories before and after myocardial infarction, atrial fibrillation or stroke: analysis of a cohort study in Tromsø, Norway (Tromsø Study, 1994–2016)
Authors: Lorem Geir Fagerjord , Opdal Ida Marie , Wilsgaard Tom , Schirmer Henrik , Løchen Maja-Lisa , Olsen Ingrid Petrikke , Steigen Terje , Rognmo Kamilla
Published: April 2022

Objectives

The increased survival rate of cardiovascular disease (CVD) implies a higher proportion of individuals who live with CVD. Using data from the Tromsø Study, we aimed to investigate mental health symptom trajectories before and after myocardial infarction, atrial fibrillation or stroke in a general population and to explore factors that contribute to the association.

Design

Cohort study.

Setting

Sample drawn from inhabitants of the municipality of Tromsø, Norway, who participated in the Tromsø Study (1994–2016).

Participants

A total of 18 719 participants (52.3% women) were included, and of these 2098 (32.9% women) were diagnosed with myocardial infarction, 1896 (41.9% women) with atrial fibrillation and 1263 (42.9% women) with stroke.

Primary outcome measures

Mental health symptoms were assessed using the Hopkins Symptom Checklist-10 and the Conor Mental Health Index.

Results

The participants who were diagnosed with either myocardial infarction or stroke had a significant monotonous increase in mental health symptoms before myocardial infarction (p=0.029) and stroke (p=0.029) that intensified at the time of diagnosis. After the event, the study found a higher prevalence of mental health symptoms with a decline in symptom levels over time for myocardial infarction (p<0.001) and stroke (p=0.004), but not for atrial fibrillation (before: p=0.180, after: p=0.410). The risk of elevated mental health symptoms with myocardial infarction, atrial fibrillation and stroke was associated with sex (p<0.001), age (p<0.01), physical activity (p<0.001), diabetes (p<0.05) and other comorbidities (p<0.001).

Conclusion

The study indicates that mental health problems among individuals with myocardial infarction, atrial fibrillation and stroke may have started to develop several years before the cardiovascular event and suggests that successful CVD rehabilitation may need to consider previous life factors. Future research is recommended to examine whether health promotion measures in a general population also create mental health resilience after a CVD event.
Approaches and outcomes of community health worker’s interventions for hypertension management and control in low-income and middle-income countries: systematic review
Authors: Mbuthia Grace Wambura , Magutah Karani , Pellowski Jennifer
Published: April 2022

Objectives

To critically appraise the scope, content and outcomes of community health worker (CHW) interventions designed to reduce blood pressure (BP) in low-income and middle-income countries (LMICs).

Method

We performed a database search (PUBMED, EMBASE, CINAHL, PsycINFO, OpenGrey, Cochrane Central Trials Register and Cochrane Database of Systematic Reviews) to identify studies in LMICs from 2000 to 2020. Eligible studies were interventional studies published in English and reporting CHW interventions for management of BP in LMICs. Two independent reviewers screened the titles, abstracts and full texts of publications for eligibility and inclusion. Relevant information was extracted from these studies using a tailored template. Risk of bias was assessed using the Cochrane collaboration risk of bias tool. Qualitative synthesis of results was done through general summary of the characteristics and findings of each study. We also analysed the patterns of interventions and their outcomes across the studies. Results were presented in form of narrative and tables.

Results

Of the 1557 articles identified, 14 met the predefined criteria. Of these, 12 were cluster randomised trials whereas two were pretest/post-test studies. The CHW interventions were mainly community-based and focused on behaviour change for promoting BP control among hypertensive patients as well as healthy individuals. The interventions had positive effects in the BP reduction, linkage to care, treatment adherence and in reducing cardivascular-disease risk level.

Discussion and conclusion

The current review is limited in that, a meta-analysis to show the overall effect of CHW interventions in the management of hypertension was not possible due to the diversity of the interventions, and outcomes of the studies included in the review. Summarised outcomes of individual studies showed CHW enhanced the control and management of hypertension. Further studies are needed to indicate the impact and cost-effectiveness of CHW-led interventions in the control and management of hypertension in LMICs.
Optimising diagnostics to discriminate complicated from uncomplicated appendicitis: a prospective cohort study protocol
Authors: Bom Wouter J , Scheijmans Jochem C G , Ubels Sander , van Geloven Anna A W , Gans Sarah L , Tytgat Kristien M A J , van Rossem Charles C , Koens Lianne , Stoker Jaap , Bemelman Willem A , Dijkgraaf Marcel G W , Boermeester Marja A
Published: April 2022

Introduction

Growing evidence is showing that complicated and uncomplicated appendicitis are two different entities that may be treated differently. A correct diagnosis of the type of appendicitis is therefore essential. The Scoring system of Appendicitis Severity (SAS) combines clinical, laboratory and imaging findings. The SAS rules out complicated appendicitis in 95% (negative predictive value, NPV) and detects 95% (sensitivity) of patients with complicated appendicitis in adults suspected of acute appendicitis. However, this scoring system has not yet been validated externally. In this study, we aim to provide a prospective external validation of the SAS in a new cohort of patients with clinical suspicion of appendicitis. We will optimise the score when necessary.

Methods and analysis

The SAS will be validated in 795 consecutive adult patients diagnosed with acute appendicitis confirmed by imaging. Data will be collected prospectively in multiple centres. The predicted diagnosis based on the SAS score will be compared with the combined surgical and histological diagnosis. Diagnostic accuracy for ruling out complicated appendicitis will be calculated. If the SAS does not reach a sensitivity and NPV of 95% in its present form, the score will be optimised. After optimisation, a second external validation will be performed in a new group of 328 patients. Furthermore, the diagnostic accuracy of the clinical perspective of the treating physician for differentiation between uncomplicated and complicated appendicitis and the patient’s preferences for different treatment options will be assessed.

Ethics and dissemination

Ethical approval was granted by the Amsterdam UMC Medical Ethics Committee (reference W19_416 # 19.483). Because of the observational nature of this study, the study does not fall under the scope of the Medical Research Involving Human Subjects Act. Results will be presented in peer-reviewed journals. This protocol is submitted for publication before analysis of the results.
Sex differences in neurology: a scoping review protocol
Authors: Moores Ginette , Wolff Elena , Pikula Aleksandra , Bui Esther
Published: April 2022

Introduction

Sex and gender are independently important in health and disease but have been incompletely explored in neurology. This is in part contributed to by the pre-existing male bias in scientific literature that results in fewer females being included in clinical research and the often interchangeable use of sex and gender in the literature. This scoping review intends to identify the advances as well as under-explored aspects of this field to provide a road map for future research. This paper outlines the methods for a scoping review of published, peer-reviewed literature on sex and gender differences in four subspecialty areas of neurology: demyelination, stroke, epilepsy and headache.

Methods and analysis

A detailed search strategy will be used to search five databases pertaining only to sex differences. Specific inclusion and exclusion criteria will be applied to capture relevant literature published from 2014 to 2020. Data will be collected and synthesised to provide an overview of information retrieved, a narrative synthesis of each subspecialty area and map of results.

Ethics and dissemination

Research ethics board approval was not required for this study. This study will aid in mapping recent trends in sex differences in four major neurological conditions and will help identify areas for further research. A manuscript will be compiled for publication and presentations of findings.

Registration details

The final protocol is registered with the Open Science Framework (https://osf.io/n937x/).
Associations between fibrinogen levels and the risk of cardiovascular disease and all-cause death: a cohort study from the Chin-Shan community in Taiwan
Authors: Hsieh Cheng-Tzu , Chien Kuo-Liong , Hsu Hsiu-Ching , Lin Hung-Ju , Su Ta-Chen , Chen Ming-Fong , Lee Yuan-Teh
Published: April 2022

Objectives

Although several studies have investigated the association between fibrinogen level and the risk of cardiovascular disease (CVD), few studies have been conducted in Asia.

Setting

We conducted a community-based prospective cohort study in the Chin-Shan community, Taiwan.

Participants

A total of 2222 participants (54.6±11.9 years, 53.4% women, and 22.4 years of follow-up) who underwent plasma fibrinogen measurements and were without CVD at baseline were recruited, among which 735 participants with available C reactive protein (CRP) were included in the joint analysis of the association of fibrinogen and CRP levels with the risk of CVD.

Primary and secondary outcome measures

Fibrinogen and CRP levels were measured by clotting and high-sensitivity immunoturbidimetric assays, respectively. The study outcomes were CVD events and all-cause death. Our definition of CVD included both coronary artery disease (CAD) and stroke cases. Cox proportional hazards regression models were used to estimate the HRs and 95% CIs.

Results

Compared with the lowest quartile, participants with higher fibrinogen levels tended to have a higher risk of CAD (adjusted HR for the highest quartile=1.48 (95% CI 0.90 to 2.44); test for trend p=0.037) regardless of CRP level (adjusted HR=2.12 (95% CI 1.24 to 3.63) and 2.17 (95% CI 1.06 to 4.44) for high fibrinogen/low CRP and high fibrinogen/high CRP, respectively). The association was not observed for stroke (adjusted HR for the highest quartile=0.99 (95% CI 0.62 to 1.60); test for trend p=0.99) and was only observed for all-cause death among participants <65 years of age (adjusted HR for the highest quartile=1.47 (95% CI 1.11 to 1.95); test for trend p=0.004).

Conclusions

Fibrinogen may be a potential risk factor for CAD but not for stroke. Further studies are necessary to clarify the differences in the role of fibrinogen levels on the risk of CVD between Asian and Western countries.
Trends in outcomes following COVID-19 symptom onset in Milan: a cohort study
Authors: Jackson Christopher H , Grosso Francesca , Kunzmann Kevin , Corbella Alice , Gramegna Maria , Tirani Marcello , Castaldi Silvana , Cereda Danilo , De Angelis Daniela , Presanis Anne
Published: April 2022

Background

For people with symptomatic COVID-19, the relative risks of hospital admission, death without hospital admission and recovery without admission, and the times to those events, are not well understood. We describe how these quantities varied with individual characteristics, and through the first wave of the pandemic, in Milan, Italy.

Methods

A cohort study of 27 598 people with known COVID-19 symptom onset date in Milan, Italy, testing positive between February and June 2020 and followed up until 17 July 2020. The probabilities of different events, and the times to events, were estimated using a mixture multistate model.

Results

The risk of death without hospital admission was higher in March and April (for non-care home residents, 6%–8% compared with 2%–3% in other months) and substantially higher for care home residents (22%–29% in March). For all groups, the probabilities of hospitalisation decreased from February to June. The probabilities of hospitalisation also increased with age, and were higher for men, substantially lower for healthcare workers and care home residents, and higher for people with comorbidities. Times to hospitalisation and confirmed recovery also decreased throughout the first wave. Combining these results with our previously developed model for events following hospitalisation, the overall symptomatic case fatality risk was 15.8% (15.4%–16.2%).

Conclusions

The highest risks of death before hospital admission coincided with periods of severe burden on the healthcare system in Lombardy. Outcomes for care home residents were particularly poor. Outcomes improved as the first wave waned, community healthcare resources were reinforced and testing became more widely available.
Intended versus actual delivery location and factors associated with change in delivery location among pregnant women in Southern Province, Zambia: a prespecified secondary observational analysis of the ZamCAT
Authors: Solomon Hiwote , Henry Elizabeth G , Herlihy Julie , Yeboah-Antwi Kojo , Biemba Godfrey , Musokotwane Kebby , Bhutta Afsah , Hamer Davidson H , Semrau Katherine E A
Published: April 2022

Objectives

This prespecified, secondary analysis of the Zambia Chlorhexidine Application Trial (ZamCAT) aimed to determine the proportion of women who did not deliver where they intended, to understand the underlying reasons for the discordance between planned and actual delivery locations; and to assess sociodemographic characteristics associated with concordance of intention and practice.

Design

Prespecified, secondary analysis from randomised controlled trial.

Setting

Recruitment occurred in 90 primary health facilities (HFs) with follow-up in the community in Southern Province, Zambia.

Participants

Between 15 February 2011 and 30 January 2013, 39 679 pregnant women enrolled in ZamCAT.

Secondary outcome measures

The location where mothers gave birth (home vs HF) was compared with their planned delivery location.

Results

When interviewed antepartum, 92% of respondents intended to deliver at an HF, 6.1% at home and 1.2% had no plan. However, of those who intended to deliver at an HF, 61% did; of those who intended to deliver at home, only 4% did; and of those who intended to deliver at home, 2% delivered instead at an HF. Among women who delivered at home, women who were aged 25–34 and ≥35 years were more likely to deliver where they intended than women aged 20–24 years (adjusted OR (aOR)=1.31, 95% CI=1.11 to 1.50 and aOR=1.32, 95% CI=1.12 to 1.57, respectively). Women who delivered at HFs had greater odds of delivering where they intended if they received any primary schooling (aOR=1.34, 95% CI=1.09 to 1.72) or more than a primary school education (aOR=1.54, 95% CI=1.17 to 2.02), were literate (aOR=1.33, 95% CI=1.119 to 1.58), and were not in the lowest quintile of the wealth index.

Conclusion

Discrepancies between intended and actual delivery locations highlight the need to go beyond the development of birth plans and exposure to birth planning messaging. More research is required to address barriers to achieving intentions of a facility-based childbirth.

Trial registration number

ClinicalTrials.gov Registry (NCT01241318).
‘Striving for freedom or remaining with what is well-known’: a focus-group study of self-management among people with type 1 diabetes who have suboptimal glycaemic control despite continuous subcutaneous insulin infusion
Authors: Persson Margareta , Leksell Janeth , Ernersson Åsa , Rosenqvist Ulf , Hörnsten Åsa
Published: April 2022

Introduction

Continuous subcutaneous insulin infusion (CSII) treatment is beneficial for obtaining glycaemic control for many persons with type 1 diabetes mellitus (T1DM). Still, some individuals do not obtain improved HbA1C levels despite CSII treatment, and there is a lack of evidence regarding how psychosocial factors may influence glycaemic control. Thus, we aimed to explore the attitudes and experiences of self-management among people with T1DM and suboptimal glycaemic control despite CSII treatment.

Research design and methods

A qualitative inductive design was applied, and four FGDs were performed with 37 adult men and women of various ages and duration of T1DM. All participants had suboptimal glycaemic control despite CSII treatment. Transcripts were analysed using qualitative manifest and latent content analysis.

Results and conclusion

The themesSearching for freedom and flexibilityandPreferring safety and the well-knownillustrated the divergent psychosocial strategies adapted, which both resulted in suboptimal glycaemic control. The technical devices and their effects on glycaemic levels may be challenging to understand and adjust to fit people’s lifestyles. The rapid advances of technology devices in diabetes care can potentially change peoples’ lives, but is the educational support developing as fast? Multifaceted web-based education of high quality, including tailored support with a person-centred focus, is more important than ever before as the need for technical knowledge and understanding may put further disease burdens to patients with T1DM on CSII treatment.
Antibiotic use attributable to specific aetiologies of diarrhoea in children under 2 years of age in low-resource settings: a secondary analysis of the MAL-ED birth cohort
Authors: Brennhofer Stephanie A , Platts-Mills James A , Lewnard Joseph A , Liu Jie , Houpt Eric R , Rogawski McQuade Elizabeth T
Published: April 2022

Objective

To quantify the frequency of antibiotic treatments attributable to specific enteric pathogens due to the treatment of diarrhoea among children in the first 2 years of life in low-resource settings.

Design

Secondary analysis of a longitudinal birth cohort study, Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development (MAL-ED).

Setting

This study was conducted at eight sites in Bangladesh, Brazil, India, Nepal, Peru, Pakistan, South Africa and Tanzania.

Participants

We analysed 9392 reported diarrhoea episodes, including 6677 with molecular diagnostic test results, as well as 31 408 non-diarrhoeal stools from 1715 children aged 0–2 years with 2 years of complete follow-up data.

Primary and secondary outcome measures

We estimated incidence rates and the proportions of antibiotic use for diarrhoea and for all indications attributable to the top 10 aetiologies of diarrhoea. We estimated associations between specific aetiologies and antibiotic treatment, and assessed whether clinical characteristics of the diarrhoea episodes mediated these relationships.

Results

Shigella and rotavirus were the leading causes of antibiotic treatment, responsible for 11.7% and 8.6% of diarrhoea treatments and 14.8 and 10.9 courses per 100 child-years, respectively. Shigella and rotavirus-attributable diarrhoea episodes were 46% (RR: 1.46; 95% CI: 1.33 to 1.60), and 19% (RR: 1.19; 95% CI: 1.09 to 1.31) more likely to be treated with antibiotics, respectively, compared with other aetiologies. Considering antibiotic uses for all indications, these two pathogens accounted for 5.6% of all antibiotic courses, 19.3% of all fluoroquinolone courses and 9.5% of all macrolide courses. Among indicated treatments for dysentery, Shigella and Campylobacter jenjui/Campylobacter coli were responsible for 27.5% and 8.5% of treated episodes, respectively.

Conclusions

The evidence that Shigella and rotavirus were disproportionately responsible for antibiotic use due to their high burden and severity further strengthens the value of interventions targeted to these pathogens. Interventions against Campylobacter could further prevent a large burden of indicated antibiotic treatment for dysentery, which could not be averted by antibiotic stewardship interventions.
Public risk perception and behaviours towards COVID-19 during the first and second waves in Nigeria: a secondary data analysis
Authors: Ochu Chinwe Lucia , Onoja Michael , Olatunji David , Okusanya Babasola O , Usuwa Ifeoma Sophia , Akeju David O , Disu Yahya , Adejo Samuel Ojima , Eziechina Sunday , Nwiyi Gloria , Okediran James Olatunde , Elimian Kelly Osezele , Akande Oluwatosin Wuraola , Dunkwu Lauryn , Fagbemi Babafunke , Aisiri Adolor , Agogo Emmanuel A , Ebenso Bassey , Oke David Adewale , Igumbor Ehimario , Ihekweazu Chikwe
Published: April 2022

Objectives

To describe changes in public risk perception and risky behaviours during the first wave (W1) and second wave (W2) of COVID-19 in Nigeria, associated factors and observed trend of the outbreak.

Design

A secondary data analysis of cross-sectional telephone-based surveys conducted during the W1 and W2 of COVID-19 in Nigeria.

Setting

Nigeria.

Participants

Data from participants randomly selected from all states in Nigeria.

Primary outcome

Risk perception for COVID-19 infection categorised as risk perceived and risk not perceived.

Secondary outcome

Compliance to public health and social measures (PHSMs) categorised as compliant; non-compliant and indifferent.

Analysis

Comparison of frequencies during both waves using χ2 statistic to test for associations. Univariate and multivariate logistic regression analyses helped estimate the unadjusted and adjusted odds of risk perception of oneself contracting COVID-19. Level of statistical significance was set at p<0.05.

Results

Triangulated datasets had a total of 6401 respondents, majority (49.5%) aged 25–35 years. Overall, 55.4% and 56.1% perceived themselves to be at risk of COVID-19 infection during the W1 and W2, respectively. A higher proportion of males than females perceived themselves to be at risk during the W1 (60.3% vs 50.3%, p<0.001) and the W2 (58.3% vs 52.6%, p<0.05). Residing in the south-west was associated with not perceiving oneself at risk of COVID-19 infection (W1—AOdds Ratio (AOR) 0.28; 95% CI 0.20 to 0.40; W2—AOR 0.71; 95% CI 0.52 to 0.97). There was significant increase in non-compliance to PHSMs in the W2 compared with W1. Non-compliance rate was higher among individuals who perceived themselves not to be at risk of getting infected (p<0.001).

Conclusion

Risk communication and community engagement geared towards increasing risk perception of COVID-19 should be implemented, particularly among the identified population groups. This could increase adherence to PHSMs and potentially reduce the burden of COVID-19 in Nigeria.
Diabetes mellitus and its associated factors among patients with tuberculosis attending directly observed treatment centres in Oyo State, Nigeria: a cross-sectional evaluation
Authors: Anyanwu Maureen Odochi , Ajumobi Olufemi O , Afolabi Nathanael B , Usman Aishat , Kehinde Aderemi
Published: April 2022

Objective

Diabetes mellitus (DM) and tuberculosis (TB) comorbidity is evolving into an emerging epidemic globally. In Nigeria, a high burden of both diseases, respectively, exists with limited information on tuberculosis-diabetes mellitus (TB-DM) comorbidity. We determined the fasting blood glucose (FBG) level among patients with TB and factors associated with TB-DM comorbidity in Oyo State, South-west Nigeria.

Methods

A cross-sectional study was conducted among patients with TB aged 15 years and above, who were selected using multistage sampling. Data were collected on patients’ biodata, anthropometric measurements and FBG levels using a pretested semistructured questionnaire. The FBG test was conducted on patients with confirmed pulmonary TB (old and newly diagnosed patients with TB) at any stage of anti-TB treatment. Background characteristics and FBG level were summarised using descriptive statistics and factors associated with TB-DM comorbidity were examined at bivariate and multivariable analyses.

Results

Of the 404 patients with TB, 30 (7.4%) had impaired fasting glucose and 32 (7.9%) were diagnosed with diabetes. The mean age of the male and female respondents was 41 (±14.2) and 36.8 (±15.0), respectively. Females were more likely than males to have diabetes (10.6% vs 6.3%). Median FBG level for the patients was 88 (IQR: Q1: 99, Q3: 79) mg/dL. Age, marital status and educational level were not associated with TB-DM comorbidity. In the multivariable model, only normal body mass index was independently and significantly associated with diabetes.

Conclusion

TB-DM was prevalent among the studied population in South-west Nigeria. We recommend the integration of DM screening within the continuum of care for TB management.