bluuebunny/crossref_metadata_2025 huggingface dataset:
The Determinants of Non-COVID-19 Excess Deaths During the COVID-19 Pandemic: A Cross-country Panel Study
Authors: Dey Subhasish , Davidson Jessie
Published: October 2021

This paper examines the determinants of non-COVID excess deaths during the COVID pandemic between January and June 2020. These are the extra deaths occurring during the pandemic which are not directly attributable to COVID. While emerging literature examines the determinants of COVID deaths, few look at non-COVID excess deaths, though early estimates suggest they are enough to be seen as a pandemic in their own count. We investigate the impact of factors including COVID deaths and cases, lockdown stringency, economic support and search intensity for non-COVID conditions on excess deaths, using Fixed Effects and GMM estimations. We also use quantile regression to assess the differential impacts of the variables at different stages of the excess death distribution. First, we find that excess deaths are increasing and concave in COVID deaths, and that the rate of growth, as well as the level, of COVID deaths has a significant and positive impact. Second, we find some evidence that stringency of lockdown increases excess deaths by a maximum of 16 extra per-million population. Third, we find a reduction in search intensity for other conditions significantly increases excess deaths, implying that policymakers should ensure public health messaging for other conditions during a pandemic.

JEL Classifications: I12, I18, I11
When You “Can’t See” a Case of Relapsing Polychondritis
Authors: Contreras David , Dhillon Navpreet , Sharma Rupam , Bali Varun , Katayon Sabetian , Quynh Bao , Heidari Arash
Published: October 2021

Relapsing polychondritis (RP) is a rare and, if not treated, potentially lethal autoimmune disorder. Involvement of central nervous system (CNS) in RP is rare and, when present, makes it extremely difficult to diagnose. In this report, we present a case of a 22-year-old Hispanic woman who presented with sudden onset of headache and blurred vision. Magnetic resonance imaging (MRI) of her brain and orbit showed leptomeningeal enhancements in addition to asymmetrical thickening and enhancement of globes. Her lumbar puncture was consistent with aseptic meningitis picture, and she was placed on empirical treatment for presumptive CNS tuberculosis. Her vision deteriorated, and she was diagnosed with RP with CNS and ocular involvement and placed on high-dose steroids with dramatic rapid response. She has been on immunosuppressive treatment, including Sulfasalazine and Methotrexate, since then and her disease has been under control with decreased need for ophthalmic steroid drops. There have been only 19 previous cases found in literature reporting an association of RP with CNS involvement.
Education Data Science: Past, Present, Future
Authors: McFarland Daniel A. , Khanna Saurabh , Domingue Benjamin W. , Pardos Zachary A.
Published: October 2021

This AERA Open special topic concerns the large emerging research area of education data science (EDS). In a narrow sense, EDS applies statistics and computational techniques to educational phenomena and questions. In a broader sense, it is an umbrella for a fleet of new computational techniques being used to identify new forms of data, measures, descriptives, predictions, and experiments in education. Not only are old research questions being analyzed in new ways but also new questions are emerging based on novel data and discoveries from EDS techniques. This overview defines the emerging field of education data science and discusses 12 articles that illustrate an AERA-angle on EDS. Our overview relates a variety of promises EDS poses for the field of education as well as the areas where EDS scholars could successfully focus going forward.
Opening the Public Accessibility to the Wreckage of the RMS Titanic: Some Ethical Reflections
Authors: Frigerio Alberto
Published: October 2021

In 2021, Ocean Gate Expeditions allowed people to visit the remains of the RMS Titanic. While this is not the first time that the site has been accessed for touristic aims, this case has, once again, opened the debate about the ethics of such experiences. The key dilemma is if permitting the public access to a natural graveyard, such as the wreck of the Titanic, should be considered as an acceptable practice or an immoral act that must be banned. Notwithstanding the sensitive arguments raised against the organization of similar initiatives, the visit to the RMS Titanic seems to be a valuable and legitimate practice according to diverse ethical approaches.
Clinical symptoms of androgen deficiency in men with migraine or cluster headache: a cross-sectional cohort study
Authors: Verhagen Iris E. , Brandt Roemer B. , Kruitbosch Carlijn M. A. , MaassenVanDenBrink Antoinette , Fronczek Rolf , Terwindt Gisela M.
Published: October 2021

Background

To compare symptoms of clinical androgen deficiency between men with migraine, men with cluster headache and non-headache male controls.

Methods

We performed a cross-sectional study using two validated questionnaires to assess symptoms of androgen deficiency in males with migraine, cluster headache, and non-headache controls. Primary outcome was the mean difference in androgen deficiency scores. Generalized linear models were used adjusting for age, BMI, smoking and lifetime depression. As secondary outcome we assessed the percentage of patients reporting to score below average on four sexual symptoms (beard growth, morning erections, libido and sexual potency) as these items were previously shown to more specifically differentiate androgen deficiency symptoms from (comorbid) anxiety and depression.

Results

The questionnaires were completed by n = 534/853 (63%) men with migraine, n = 437/694 (63%) men with cluster headache and n = 152/209 (73%) controls. Responders were older compared to non-responders and less likely to suffer from lifetime depression.

Patients reported more severe symptoms of clinical androgen deficiency compared with controls, with higher AMS scores (Aging Males Symptoms; mean difference ± SE: migraine 5.44 ± 0.90, p <  0.001; cluster headache 5.62 ± 0.99, p <  0.001) and lower qADAM scores (quantitative Androgen Deficiency in the Aging Male; migraine: − 3.16 ± 0.50, p <  0.001; cluster headache: − 5.25 ± 0.56, p <  0.001). Additionally, both patient groups more often reported to suffer from any of the specific sexual symptoms compared to controls (18.4% migraine, 20.6% cluster headache, 7.2% controls, p = 0.001).

Conclusion

Men with migraine and cluster headache more often suffer from symptoms consistent with clinical androgen deficiency than males without a primary headache disorder.
Complete Terahertz Polarization Control with Broadened Bandwidth via Dielectric Metasurfaces
Authors: Wang Dacheng , Sun Song , Feng Zheng , Tan Wei
Published: October 2021

We demonstrate terahertz dielectric metasurfaces with anisotropic multipoles within the framework of the generalized Huygens principle, in which the interference among these multipoles achieves giant phase shift with broadened bandwidth and high transmission coefficients. More importantly, owing to the anisotropic design, various phase delays between π/2 and 3π/2 are obtained, which convert the incident linearly polarized terahertz wave into right/left-handed circularly polarized light, elliptically polarized light and cross-polarized light. Both simulation and experimental results verify complete terahertz polarization control with the ellipticity ranging from 1 to − 1, which paves a way for polarization-related applications of terahertz meta-devices.
Humoral and cellular response to SARS-CoV-2 BNT162b2 mRNA vaccine in hemodialysis patients
Authors: Melin Jan , Svensson Maria K. , Albinsson Bo , Winqvist Ola , Pauksens Karlis
Published: October 2021

Background

Hemodialysis (HD) patients have an increased risk of acquiring infections due to many health care contacts and may, in addition, have a suboptimal response to vaccination and a high mortality from Covid-19 infection.

Methods

In 50 HD patients (mean age 69.4 years, 62% men) administration of SARS-CoV-2BNT162b2 mRNA vaccine began in Dec 2020 and the immune response was evaluated 7–15 weeks after the last dose. Levels of Covid-19 (SARS-CoV-2) IgG antibody against the nucleocapsid antigen (anti-N) and the Spike antigen (anti-S) and T-cell reactivity testing against the Spike protein using ELISPOT technology were evaluated.

Results

Out of 50 patients, anti-S IgG antibodies indicating a vaccine effect or previous Covid-19 infection, were detected in 37 (74%), 5 (10%) had a borderline response and 8 (16%) were negative after two doses of vaccine. T-cell responses were detected in 29 (58%). Of the 37 patients with anti-S antibodies, 25 (68%) had a measurable T-cell response. 2 (40%) out of 5 patients with borderline anti-S and 2 (25%) without anti-S had a concomitant T-cell response. Twenty-seven (54%) had both an antibody and T-cell response. IgG antibodies to anti-N indicating a previous Covid-19 disease were detected in 7 (14%) patients.

Conclusions

Most HD patients develop a B- and/or T-cell response after vaccination against Covid-19 but approx. 20% had a limited immunological response. T-cell reactivity against Covid-19 was only present in a few of the anti-S antibody negative patients.
The effect of ultraviolet irradiation compared to oral vitamin D supplementation on blood pressure of nursing home residents with dementia
Authors: Veleva Bistra I. , Caljouw Monique A. A. , Muurman Astrid , van der Steen Jenny T. , Chel Victor G. M. , Numans Mattijs E. , Poortvliet Rosalinde K. E.
Published: October 2021

Background

Observational studies have reported an inverse association between ultraviolet (UV) radiation and hypertension. The aim of this study was to assess differences in blood pressure changes between persons with dementia receiving UV light versus vitamin D (VD) supplementation.

Methods

Post-hoc analysis of randomized controlled trial data concerning nursing home residents with dementia (N = 61; 41 women, mean age 84.8 years). The participants received half-body UV irradiation, twice weekly over 6 months, at one standard erythema dose (UV group, n = 22) or 5600 international units of cholecalciferol once a week (VD group, n = 39). Short-term effects were evaluated after 1 month and long-term effects after 3 and 6 months. Differences in blood pressure changes were assessed using linear mixed models.

Results

With the VD group as a reference, the estimated difference in mean change of systolic blood pressure was − 26.0 mmHg [95% confidence interval (CI) -39.9, − 12.1, p = .000] at 1 month, 4.5 mmHg (95% CI -6.8, 15.9, p = 0.432) at 3 months, and 0.1 (95% CI -14.1, 14.3, p = 0.83) at 6 months. The estimated difference in diastolic blood pressure was − 10.0 mmHg (95% CI -19.2, − 0.7, p = 0.035) at 1 month, 3.6 mmHg (95% CI -4.1, 11.2, p = 0.358) at 3 months, and 2.7 (95% CI -6.8, 12.1, p = 0.580) at 6 months.

Conclusions

UV light had only a short-term effect but not a long-term effect on blood pressure reduction compared to VD use in this sample of normotensive to mild hypertensive nursing home residents with dementia. Future studies will be needed to determine the effect of UV light in different samples of the population and especially in a population with hypertension.
Types of second primary cancer influence overall survival in cutaneous melanoma
Authors: Zheng Guoqiao , Chattopadhyay Subhayan , Sundquist Kristina , Sundquist Jan , Försti Asta , Hemminki Akseli , Hemminki Kari
Published: October 2021

Background

Favorable survival in malignant cutaneous melanoma (melanoma) has increased the likelihood of second primary cancer (SPC). We assess the influence of patient characteristics at diagnosis of first melanoma and the type of SPC (second melanoma and other SPC) on overall survival.

Methods

We used the Swedish Cancer Registry data to assess overall survival in melanoma for the period 1990 to 2015. Kaplan-Meier curves were plotted and hazard ratios (HRs) were estimated with Cox regression models by considering SPC diagnosis as a time-dependent variable.

Results

A total of 46,726 patients were diagnosed with melanoma, and 15.3% of them developed SPC, among which, two thirds were other SPCs. Second melanomas were diagnosed early (31% during the first year) compared to non-melanoma SPCs (9.5%). Survival for women with second melanoma or other SPC (56 and 21% alive after 25 years of follow-up, respectively) exceeded the male rates (21 and 10%, respectively) but all these figures were lower than for females (60% alive) or males (48%) without SPC. Time dependent analysis showed vastly increased HRs for cancer types that are fatal also as first cancers, but SPC-specific HRs remained relatively uniform, irrespective of SPC diagnosed soon or late after first melanoma. In early-onset melanoma, SPC diagnosis after 10 years may not negatively influence overall survival.

Conclusions

As the overall survival of patients with many types of SPCs is unfavorable, advice about health lifestyle should benefit smoking patients and early detection methods may be recommended for SPCs of the breast, prostate and colorectum.
Examining the effectiveness of place-based interventions to improve public health and reduce health inequalities: an umbrella review
Authors: McGowan V J , Buckner S. , Mead R. , McGill E. , Ronzi S. , Beyer F. , Bambra C.
Published: October 2021

Background

Locally delivered, place-based public health interventions are receiving increasing attention as a way of improving health and reducing inequalities. However, there is limited evidence on their effectiveness. This umbrella review synthesises systematic review evidence of the health and health inequalities impacts of locally delivered place-based interventions across three elements of place and health: the physical, social, and economic environments.

Methods

Systematic review methodology was used to identify recent published systematic reviews of the effectiveness of place-based interventions on health and health inequalities (PROGRESS+) in high-income countries. Nine databases were searched from 1st January 2008 to 1st March 2020. The quality of the included articles was determined using the Revised Assessment of Multiple Systematic Reviews tool (R-AMSTAR).

Results

Thirteen systematic reviews were identified - reporting 51 unique primary studies. Fifty of these studies reported on interventions that changed the physical environment and one reported on changes to the economic environment. Only one primary study reported cost-effectiveness data. No reviews were identified that assessed the impact of social interventions. Given heterogeneity and quality issues, we found tentative evidence that the provision of housing/home modifications, improving the public realm, parks and playgrounds, supermarkets, transport, cycle lanes, walking routes, and outdoor gyms – can all have positive impacts on health outcomes – particularly physical activity. However, as no studies reported an assessment of variation in PROGRESS+ factors, the effect of these interventions on health inequalities remains unclear.

Conclusions

Place-based interventions can be effective at improving physical health, health behaviours and social determinants of health outcomes. High agentic interventions indicate greater improvements for those living in greater proximity to the intervention, which may suggest that in order for interventions to reduce inequalities, they should be implemented at a scale commensurate with the level of disadvantage. Future research needs to ensure equity data is collected, as this is severely lacking and impeding progress on identifying interventions that are effective in reducing health inequalities.

Trial registration

PROSPERO CRD42019158309
Relative children’s lipid accumulation with hypertension in Chinese children and adolescents
Authors: Zhang Zizhe , Zhang Li , Sun Lili , Wang Bangxuan , Yuan Yongting , Gao Huaiquan , Fu Lianguo
Published: October 2021

Background

This study aimed to develop a novel indicator associated with hypertension in Chinese children and adolescents, the relative children’s lipid accumulation product (RCLAP).

Methods

A cross-sectional study was conducted in 2018. A total of 683 students aged 8–15 years were recruited via a stratified cluster sampling Methods. Anthropometric indexes (waist circumference (WC), Body mass index (BMI), Waist-height ratio (WHtR), logarithm children LAP (LnCLAP), RCLAP per height (RCLAP-H)) were standardized using a z-score method (standardized variables: SWC, SBMI, SWHtR, SLnCLAP, SRCLAP-H). A logistic regression model was performed to evaluate the association of the above indicators with the outcome of hypertension.

Results

The overall prevalence of hypertension was 5.7% (5.5% in boys, 6.0% in girls). SWC ≥ P75, SBMI ≥ P75, SWHtR ≥ P75, SlnCLAP ≥ P75 and SRCLAP-H ≥ P75 significantly increased risk of hypertension, with odds ratios (OR) of 2.21 (95% confidence interval (CI): 1.13, 4.30), 2.30 (1.18, 4.49), 2.64 (1.35, 5.14), 4.43 (2.28, 8.61), and 4.49 (2.31, 8.71), respectively.

Conclusion

RCLAP is a novel indicator associated with hypertension in Chinese children and adolescents, and it performs better than WC, BMI, WHtR and children LAP.
Alcohol policy compliance among retailers in Bhutan: a multisite community intervention study
Authors: Gyeltshen Tshewang , Penjor Tshering , Dorji Lham , Tshering Lobzang , Dorji Kinley , Subedi Bhim Nath , Tshering Dorji , Xu Yvonne Yiru , Dorji Gampo , Gueye Ghislain Nono
Published: October 2021

Background

Alcohol use is a major public health problem in Bhutan. Compliance with regulations at the point of sale is an important strategy in alcohol control. Retail outlets were briefed on sale regulations and provided notification of rules, which they were directed to display on the premises. The extent to which licensed alcohol outlets responded to possible alcohol purchases was assessed through the use of young proxy-purchasers, adults feigning alcohol intoxication and sober adults. A total of 854 visits (pre versus post visits) were made across four district towns. Two towns (Damphu town in Tsirang district and Pema Gatshel town in Pema Gatshel district) received pre- and post-intervention purchase surveys, while the other two neighbouring towns (Khuruthang town in Punakha and Bajo town in Wangdue) were administered only baseline surveys.

Method

We used a pre- and post-test community intervention design covering all alcohol retailers both on premise (bar, hotel, restaurant, karaoke bars) and off premise (grocery shops). Compliance with alcohol regulations at the point of sale was assessed through the use of young proxy-purchasers, adults feigning alcohol intoxication and sober adults.

Results

Retailers rarely checked the age and/or identification (ID) of the proxy-purchasers before the intervention. There was a 22.7% (8.6, 37) percent increase in compliance with laws after the intervention. While some strategies are suggested, the strongest and most effective measure to prevent under-age drinking and service to intoxicated individuals is more rigorous enforcement of existing liquor laws.

Conclusion

Alcohol control requires ongoing government enforcements, supplemented by public awareness and knowledge.
Association between circulating 25-hydroxyvitamin D concentrations and hip replacement for osteoarthritis: a prospective cohort study
Authors: Hussain Sultana Monira , Wang Yuanyuan , Heath Alicia K. , Giles Graham G. , English Dallas R. , Eyles Darryl W. , Williamson Elizabeth J. , Graves Stephen E. , Wluka Anita E. , Cicuttini Flavia M.
Published: October 2021

Background

To examine the association between circulating 25(OH)D concentrations and incidence of total hip replacement for osteoarthritis in a prospective cohort study.

Methods

This study examined a random sample of 2651 participants in the Melbourne Collaborative Cohort Study who had 25(OH)D concentrations measured from dried blood spots collected in 1990-1994. Participants who underwent total hip replacement for osteoarthritis between January 2001 and December 2018 were identified by linking the cohort records to the Australian Orthopaedic Association National Joint Replacement Registry. Cox proportional hazard regression was used to estimate hazard ratios (HR) and 95% confidence intervals (CI) of total hip replacement for osteoarthritis in relation to 25(OH)D concentrations, adjusted for confounders.

Results

Eighty-six men and eighty-seven women had a total hip replacement for osteoarthritis. Compared with men in the lowest (1st) quartile of 25(OH)D concentration, the HR for total hip replacement was 2.32 (95% CI 1.05, 5.13) for those in the 2nd quartile, 2.77 (95% CI 1.28, 6.00) for those in the 3rd quartile, and 1.73 (95% CI 0.75, 4.02) for those in the highest quartile of 25(OH)D concentrations (pfor trend 0.02). There was little evidence of an association in women.

Conclusions

Higher circulating 25(OH)D concentrations were associated with an increased risk of total hip replacement for osteoarthritis in men but not in women. Although the underlying mechanism warrants further investigation, our findings highlight the need to determine the optimal levels of circulating 25(OH)D to reduce the risk of hip osteoarthritis.
Clinical and molecular feature-based nomogram model for predicting benefit from bevacizumab combined with first-generation EGFR-tyrosine kinase inhibitor (TKI) in EGFR-mutant advanced NSCLC
Authors: Zhang Yongchang , Zeng Liang , Zhang Xiangyu , Li Yizhi , Liu Lingli , Xu Qinqin , Yang Haiyan , Jiang Wenjuan , Lizaso Analyn , Qiu Luting , Hou Ting , Liu Jun , Peng Ling , Yang Nong
Published: October 2021

Background

The combination of bevacizumab and epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) could prolong progression-free survival (PFS) in patients with EGFR-mutant advanced non-small-cell lung cancer (NSCLC). Our study investigated the clinical and molecular factors that affect the efficacy of first-generation EGFR-TKI with or without bevacizumab and identify the subset of patients who can benefit from combination therapy.

Methods

Our study included 318 patients with EGFR-mutant locally advanced/advanced NSCLC treated with either first-generation EGFR-TKI combined with bevacizumab (A+T; n = 159) or EGFR-TKI monotherapy (T; n = 159). Two nomogram models to predict PFS and overall survival (OS), respectively, were constructed using two factors that impact EGFR-TKI efficacy: metastatic site and presence of concurrent mutations. The study cohort was stratified into 2 cohorts for training (n = 176) and validation (n = 142) of the nomogram model. Using the median score from the nomogram, the patients were stratified into two groups to analyze their survival outcome.

Results

The A+T group had significantly longer PFS (14.0 vs. 10.5 months; p < 0.001) and OS (37.0 vs. 26.0 months; p = 0.042) than the T group. Among the patients with concurrent mutations in tumor suppressor genes, those in the A+T group had significantly longer PFS and OS than the T group (PFS 14.5 vs. 8.0 months, p < 0.001; OS 39.0 vs. 20.0 months, p = 0.003). The higher scores from the nomograms were associated with the presence of brain/liver/pleural metastasis or concomitant gene mutations, which indicated a higher likelihood of shorter PFS and OS. The validation of the nomogram revealed that patients with lower scores had significantly longer PFS for the T group than those with higher scores (15.0 vs. 9.0 months, p = 0.002), but not for the A+T group (15.9 vs. 13.9 months, p = 0.256).

Conclusions

Using a nomogram, our study demonstrated that the addition of bevacizumab may enhance the therapeutic effectiveness of EGFR-TKI by overcoming the negative impact of certain clinical and molecular factors on the efficacy of EGFR-TKI.
Malaria diagnosis in a malaria non-endemic high-resource country: high variation of diagnostic strategy in clinical laboratories in the Netherlands
Authors: Boonstra Marrit B. , Koelewijn Rob , Brienen Eric A. T. , Silvis Welmoed , Stelma Foekje F. , Mank Theo G. , Mulder Bert , van Lieshout Lisette , van Hellemond Jaap J.
Published: October 2021

Background

Microscopic examination of thick and thin blood films is the gold standard in current guidelines for the diagnosis of malaria, but guidelines do not uniformly agree on which combination of other methods should be used and when.

Methods

Three questionnaires were sent between March 2018 and September 2019 to laboratories subscribing to the external quality assessment scheme for the diagnosis of blood and intestinal parasites of the Dutch Foundation for Quality Assessment in Medical Laboratories in order to investigate how much variation in the laboratory diagnosis of malaria between different clinical laboratories is present in the Netherlands.

Results

The questionnaires were partially or fully completed by 67 of 77 (87%) laboratories. Only 9 laboratories reported 10 or more malaria positive patients per year. Most laboratories use a different diagnostic strategy, within office versus outside office hours depending on the screening assay result. Within office hours, 62.5% (35/56) of the responding laboratories perform an immunochromatographic test (ICT) in combination with microscopic examination of thick and thin blood films without additional examinations, such as Quantitative Buffy Coat and/or rtPCR analysis. Outside office hours 85.7% (48/56) of laboratories use an ICT as single screening assay and positive results are immediately confirmed by thick and thin blood films without additional examinations (89.6%, 43/48). In case of a negative ICT result outside office hours, 70.8% (34/48) of the laboratories perform microscopic examination of the thick film the next morning and 22.9% (11/48) confirm the negative ICT result immediately. Furthermore, substantial differences were found in the microscopic examinations of thick and thin blood films; the staining, theoretical sensitivity of the thick film and determination of parasitaemia.

Conclusions

This study demonstrated a remarkably high variation between laboratories in both their diagnostic strategy as well as their methods for microscopic examination for the diagnosis of malaria in a clinical setting, despite existing national and international guidelines. While the impact of these variations on the accuracy of the diagnosis of malaria is yet unknown, these findings should stimulate clinical laboratories to critically review their own diagnostic strategy.
Maternal feeding practices and toddlers’ fruit and vegetable consumption: results from the DIT-Coombe Hospital birth cohort in Ireland
Authors: Liu Xiyao , Zhou Qianling , Clarke Keara , Younger Katherine M. , An Meijing , Li Zhouyinuo , Tan Yang , Kearney John M.
Published: October 2021

Background

Health benefits of fruit and vegetable have been well recognized. However, insufficient consumption of fruit and vegetable is prevalent among toddlers, and has become a global public health issue. Maternal feeding practices are potential factors influencing toddlers’ dietary intake, including fruit and vegetable intake. This study was conducted to explore the influence of maternal feeding practices on toddlers’ fruit and vegetable consumption in Ireland.

Methods

A follow-up to the DIT-Coombe Hospital birth cohort was conducted. Mothers in the original cohort were invited to participate in the present follow-up study by phone. A questionnaire assessing maternal feeding behavior and the child’s 3-day food diary was sent to mothers who agreed to take part in the present study by post, together with a self-addressed stamped envelope.

Results

There were 193 mother-children pairs included in the analysis, and the mean age of children was 2.4 (SD 0.7) years old. Toddlers’ mean daily intakes of vegetable and fruit were 67.57 (SD 45.95) g and 213.35 (SD 170.78) g, respectively. Logistic regression analyses showed that maternal practice of breastfeeding for more than 4 weeks was positively associated with fruit (OR = 2.93, 95% CI: 1.29–6.64) and vegetable (OR = 1.95, 95% CI: 1.00–3.81) intake or the contribution of fruit (OR = 2.62, 95% CI: 1.19–5.80) and vegetable (OR = 2.02, 95% CI: 1.02–3.99) to the total diet. Letting the child eat with other family members was associated with high vegetable intake (OR = 5.45, 95%CI: 1.69–17.61) and high contribution of vegetable to total diet (OR = 3.78, 95% CI: 1.04–13.82). Not being too worried about the child’s refusal to eat was positively associated with toddlers’ vegetable intake (OR = 2.10, 95%CI: 1.09–4.05).

Conclusions

To increase children’s fruit and vegetable intake, and develop good eating habits, parents should eat with their toddlers, be patient and not put much pressure on their children in the context of meal feeding.
Exploring change over time in community mobilization domains: results from a maternity waiting home intervention in rural Zambia
Authors: Beck Dana , Veliz Philip T. , Munro-Kramer Michelle , Boyd Carol , Sakala Isaac , Chiboola Nchimunya , Lori Jody
Published: October 2021

Background

Community mobilization (CM) is recommended as a best practice intervention for low resource settings to reduce maternal mortality. Measurement of process outcomes are lacking and little is known about how CM impacts individuals or how community members perceive its function. Given the complex and recursive nature of CM interventions, research that describes the CM process at multiple levels is needed. This study examines change in CM domains at baseline and endline in rural Zambia.

Methods

This secondary analysis uses data from a large maternity waiting homes intervention in rural Zambia that employed CM over 3 years as part of a package of interventions. A 19-item CM survey was collected from three groups (women with babies < 1, health workers, community members; n = 1202) with focus groups (n = 76) at two timepoints from ten intervention and ten comparison sites. Factor analysis refined factors used to assess temporal change through multivariable regression. Independent covariates included time (baseline vs endline), intervention vs comparison site, group (women with babies, healthworkers, community members), and demographic variables. Interaction effects were checked for time and group for each factor.

Results

Final analyses included 1202 individuals from two districts in Zambia. Factor analysis maintained domains of governance, collective efficacy, self-efficacy, and power in relationships. CM domains of self-efficacy, power in relationships, and governance showed significant change over time in multivariable models. All increases in the self-efficacy factor were isolated within intervention communities (b = 0.34, p < 0.001) at endline. Between groups comparison showed the women with babies groups consistently had lower factor scores than the healthworkers or community member groups.

Conclusions

Community mobilization interventions increase participation in communities to address health as a human right as called for in the 1978 Alma Ata Declaration. Grounded in empowerment, CM addresses socially prescribed power imbalances and health equity through a capacity building approach. These data reflect CM interventions function and have impact in different ways for different groups within the same community. Engaging directly with marginalized groups, using the community action cycle, and simultaneous quality improvement at the facility level may increase benefit for all groups, yet requires further testing in rural Zambia.
Cardiorespiratory fitness and lifestyle on severe COVID-19 risk in 279,455 adults: a case control study
Authors: Ekblom-Bak Elin , Väisänen Daniel , Ekblom Björn , Blom Victoria , Kallings Lena V. , Hemmingsson Erik , Andersson Gunnar , Wallin Peter , Salier Eriksson Jane , Holmlund Tobias , Lindwall Magnus , Stenling Andreas , Lönn Amanda
Published: October 2021

Background

The impact of cardiorespiratory fitness (CRF) and other lifestyle-related factors on severe COVID-19 risk is understudied. The present study aims to investigate lifestyle-related and socioeconomic factors as possible predictors of COVID-19, with special focus on CRF, and to further study whether these factors may attenuate obesity- and hypertension-related risks, as well as mediate associations between socioeconomic factors and severe COVID-19 risk.

Methods

Out of initially 407,131 participants who participated in nationwide occupational health service screening between 1992 and 2020,n = 857 cases (70% men, mean age 49.9 years) of severe COVID-19 were identified. CRF was estimated using a sub-maximum cycle test, and other lifestyle variables were self-reported. Analyses were performed including both unmatched,n = 278,598, and sex-and age-matched,n = 3426, controls. Severe COVID-19 included hospitalization, intensive care or death due to COVID-19.

Results

Patients with more severe COVID-19 had significantly lower CRF, higher BMI, a greater presence of comorbidities and were more often daily smokers. In matched analyses, there was a graded decrease in odds for severe COVID-19 with each ml in CRF (OR = 0.98, 95% CI 0.970 to 0.998), and a two-fold increase in odds between the lowest and highest (< 32 vs. ≥ 46 ml·min−1·kg−1) CRF group. Higher BMI (per unit increase, OR = 1.09, 1.06 to 1.12), larger waist circumference (per cm, OR = 1.04, 1.02 to 1.06), daily smoking (OR = 0.60, 0.41 to 0.89) and high overall stress (OR = 1.36, 1.001 to 1.84) also remained significantly associated with severe COVID-19 risk. Obesity- and blood pressure-related risks were attenuated by adjustment for CRF and lifestyle variables. Mediation through CRF, BMI and smoking accounted for 9% to 54% of the associations between low education, low income and blue collar/low skilled occupations and severe COVID-19 risk. The results were consistent using either matched or unmatched controls.

Conclusions

Both lifestyle-related and socioeconomic factors were associated with risk of severe COVID-19. However, higher CRF attenuated the risk associated with obesity and high blood pressure, and mediated the risk associated with various socioeconomic factors. This emphasises the importance of interventions to maintain or increase CRF in the general population to strengthen the resilience to severe COVID-19, especially in high-risk individuals.
Plasma levels of D-dimer and fibrin degradation product are unreliable for diagnosing periprosthetic joint infection in patients undergoing re-revision arthroplasty
Authors: Xu Hong , Xie Jinwei , Wang Duan , Huang Qiang , Huang Zeyu , Zhou Zongke
Published: October 2021

Background

The preoperative diagnosis of periprosthetic joint infection (PJI) in patients undergoing re-revision arthroplasty is crucial, so we evaluated whether plasma levels of D-dimer and fibrin degradation product (FDP) could aid such diagnosis.

Methods

We retrospectively analyzed data on patients who underwent re-revision hip or knee arthroplasty at our institute during 2008–2020. Patients were stratified into those who experienced PJI or not, based on 2013 International Consensus Meeting Criteria. Plasma levels of D-dimer and FDP as well as levels of the traditional inflammatory biomarkers C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and interleukin-6 were compared between the groups. The ability of these biomarkers to diagnose PJI was assessed based on the area under the receiver operating characteristic (AUC) curve, for which predictive cut-offs were optimized based on the Youden index.

Results

Based on a cut-off of 0.80 mg/L, D-dimer gave an AUC of 0.595, high sensitivity of 85.7% but poor specificity of 47.8%. Based on a cut-off of 2.80 mg/L, FDP gave an AUC of 0.550, poor sensitivity of 56.5% and poor specificity of 52.9%. CRP, ESR and interleukin-6 showed much better diagnostic ability, with AUCs > 0.82. The combination of CRP and interleukin-6 gave an AUC of 0.877, high sensitivity of 91.7% and acceptable specificity of 78.3%.

Conclusions

Plasma levels of D-dimer and FDP may be inappropriate for diagnosing PJI in patients undergoing re-revision arthroplasty, whereas the combination of serum CRP and interleukin-6 may be effective.
Effects of high flow nasal cannula on the coordination between swallowing and breathing in postextubation patients, a randomized crossover study
Authors: Rattanajiajaroen Pornpan , Kongpolprom Napplika
Published: October 2021

Background

Timing of swallows in relation to respiratory phases is associated with aspiration events. Oxygen therapy possibly affects the timing of swallows, which may alter airway protective mechanisms.

Objectives

To compare the coordination between swallowing and respiration during water infusion in post-extubation patients using high flow nasal oxygen (HFNO) with the coordination in those using low flow nasal oxygen (LFNO).

Methods

We conducted a randomized controlled crossover study in post-extubation patients. The patients extubated within 48 h were randomly assigned to two groups, namely, HFNO and LFNO. The eligible patients in each group received either HFNO with fraction of inspired oxygen (FiO2) 0.35, flow 50 L per minute (LPM), and temperature 34 °C or LFNO 5 LPM for 5 min. The coordination between swallowing and respiration was observed during continuous infusion of 10-ml water one minute three times. Respiratory phases and swallowing were monitored using electrocardiogram (EKG)-derived respiratory signals and submental electromyography (EMG), respectively. The swallowing frequency and timing of swallows in relation to respiratory phases were recorded. The coordination between swallowing and respiration was classified into 4 patterns, namely I, E, I-E, and E-I swallows. (I; inspiration and E; expiration) Subsequently, after a 5-min washout period, the patients were switched to the other type of oxygen therapy using the same procedure. The Wilcoxon Signed-Rank Test was used for statistical analysis.

Results

A total of 22 patients with a mean age of 56 years were enrolled in the study. The major indication for invasive mechanical ventilation was pneumonia with a median duration of endotracheal intubation of 2.5 days. The median total swallowing numbers (three minutes) were 18.5 times in the HFNO period and 21 times in the LFNO period (p = NS). The most common swallowing pattern was E-swallow. The patients using HFNO had higher numbers of E-swallow pattern (74.3% in HFNO vs 67.6% in LFNO; p = 0.048) and lower numbers of I-swallow pattern (14.3% in HFNO vs 23.1% in LFNO; p = 0.044). The numbers of other swallowing patterns were not different between the 2 groups.

Conclusions

Compared with LFNO, HFNO significantly increased the E-swallow and decreased the I-swallow in post-extubation patients. The findings indicated that HFNO might reduce a risk of aspiration during the post-extubation period.

Clinical trial No.: Thai clinical trial TCTR20200206004 Registered February 4, 2020. URL: http://www.clinicaltrials.in.th/index.php?tp=regtrials&menu=trialsearch&smenu=fulltext&task=search&task2=view1&id=5740.
Extracorporeal carbon dioxide removal for treatment of exacerbated chronic obstructive pulmonary disease (ORION): study protocol for a randomised controlled trial
Authors: Tonetti Tommaso , Pisani Lara , Cavalli Irene , Vega Maria Laura , Maietti Elisa , Filippini Claudia , Nava Stefano , Ranieri V. Marco
Published: October 2021

Background

Hypercapnic exacerbations are severe complications of chronic obstructive pulmonary disease (COPD), characterized by negative impact on prognosis, quality of life and healthcare costs. The present standard of care for acute exacerbations of COPD is non-invasive ventilation; when it fails, the use of invasive mechanical ventilation is inevitable, but is associated with extremely poor prognosis. Extracorporeal circuits designed to remove CO2 (ECCO2R) may enhance the efficacy of NIV to remove CO2 and avoid the worsening of respiratory acidosis, which inevitably leads to failure of non-invasive ventilation. Although the use of ECCO2R for acute exacerbations of COPD is steadily increasing, solid evidence on its efficacy and safety is scarce, thus the need for a randomized controlled trial.

Methods

multicenter randomized controlled unblinded clinical trial including 284 (142 per arm) patients with acute hypercapnic respiratory failure caused by exacerbation of COPD, requiring respiratory support with NIV. The primary outcome is event free survival at 28 days, a composite outcome defined by survival in absence of prolonged mechanical ventilation, severe hypoxemia, septic shock and second episode of COPD exacerbation. Secondary outcomes are incidence of endotracheal intubation and tracheostomy, intensive care and hospital length-of-stay and 90-day mortality.

Discussion

Acute exacerbations of COPD represent a significant burden in terms of prognosis, quality of life and healthcare costs. Lack definite evidence despite increasing use of ECCO2R justifies a randomized trial to evaluate whether patients with acute hypercapnic acidosis not responsive to NIV should undergo invasive mechanical ventilation (with all serious related risks) or be treated with ECCO2R to avoid invasive ventilation but be exposed to possible adverse events of ECCO2R. Owing to its pragmatic nature, sample size and composite primary outcome, this trial aims at providing valuable answers to relevant questions for clinical treatment of acute exacerbations of COPD.

Trial registration

ClinicalTrials.gov, NCT04582799. Registered 12 October 2020, .
Comparison of different symmetry indices for the quantification of dynamic joint angles
Authors: Siebers Hannah Lena , Alrawashdeh Waleed , Betsch Marcel , Migliorini Filippo , Hildebrand Frank , Eschweiler Jörg
Published: October 2021

Background

Symmetry is a sign of physiological and healthy movements, as pathologies are often described by increased asymmetries. Nevertheless, based on precisely measured data, even healthy individuals will show small asymmetries in their movements. However, so far there do not exist commonly accepted methods and reference values for gait symmetry in a healthy collective. Therefore, a comparison and presentation of reference values calculated by 3 different methods of symmetry indices for lower limb joint angles during walking, ascending, and descending stairs were shown.

Methods

Thirty-five healthy participants were analyzed during walking, ascending, and descending stairs with the help of the inertial measurement system MyoMotion. Using the normalized symmetry index (SInorm), the symmetry index (SI) as the integral of the symmetry function, and another normalized symmetry index (NSI), the symmetry of joint angles was evaluated. For statistical evaluation of differences, repeated measurement models and Bland–Altman-Plots were used.

Results

Apart from a bias between the symmetry indices, they were comparable in the predefined limits of 5%. For all parameters, significantly higher asymmetry was found for ankle dorsi/-plantarflexion, compared with the hip and knee flexion. Moreover, the interaction effect of the joint and movement factors was significant, with an increased asymmetry of the hip and knee during descending stairs greater than while ascending stairs or walking, but a reduced symmetry of the ankle during walking when compared to descending. The movement only showed significant effects when analyzing the SInorm.

Conclusion

Even for healthy individuals, small asymmetries of movements were found and presented as reference values using 3 different symmetry indices for dynamic lower limb joint angles during 3 different movements. For the quantification of symmetrical movements differences between the joints, movements, and especially their interaction, are necessary to be taken into account. Moreover, a bias between the methods should be noted. The potential for each presented symmetry index to identify pathological movements or track a rehabilitation process was shown but has to be proven in further research.

Trial registration: DRKS00025878.
Intraindividual comparison of [68 Ga]-Ga-PSMA-11 and [18F]-F-PSMA-1007 in prostate cancer patients: a retrospective single-center analysis
Authors: Hoberück Sebastian , Löck Steffen , Borkowetz Angelika , Sommer Ulrich , Winzer Robert , Zöphel Klaus , Fedders Dieter , Michler Enrico , Kotzerke Jörg , Kopka Klaus , Hölscher Tobias , Braune Anja
Published: October 2021

Background

The analysis aimed to compare the radiotracers [68Ga]-Ga-PSMA-11 and [18F]-F-PSMA-1007 intraindividually in terms of malignant lesions, mi(molecular-imaging)TNM staging and presumable unspecific lesions retrospectively as used in routine clinical practice.

Methods

A retrospective analysis of 46 prostate cancer patients (median age: 71 years) who underwent consecutive [68Ga]-Ga-PSMA-11- and [18F]-F-PSMA-1007-PET/CT or PET/MRI within a mean of 12 ± 8.0 days was performed. MiTNM staging was performed in both studies by two nuclear medicine physicians who were blinded to the results of the other tracer. After intradisciplinary and interdisciplinary consensus with two radiologists was reached, differences in both malignant and presumable nonspecific tracer accumulation were analyzed.

Results

Differences in terms of miTNM stages in both studies occurred in nine of the 46 patients (19.6%). The miT stages differed in five patients (10.9%), the miN stages differed in three patients (6.5%), and different miM stages occurred only in one patient who was upstaged in [18F]-F-PSMA-1007 PET. Concordant miTNM stages were obtained in 37 patients (80.4%). There was no significant difference between [18F]-F-PSMA-1007 and [68Ga]-Ga-PSMA-11 in the SUVmax locally (31.5 vs. 32.7; p = 0.658), in lymph node metastases (28.9 vs. 24.9; p = 0.30) or in bone metastases (22.9 vs. 27.6; p = 0.286). In [18F]-F-PSMA-1007 PET, more patients featured presumable unspecific uptake in the lymph nodes (52.2% vs. 28.3%; p: < 0.001), bones (71.7% vs. 23.9%; p < 0.001) and ganglia (71.7% vs. 43.5%; p < 0.001). Probable unspecific, exclusively [18F]-F-PSMA-1007-positive lesions mainly occurred in the ribs (58.7%), axillary lymph nodes (39.1%) and cervical ganglia (28.3%).

Conclusion

In terms of miTNM staging, both tracers appeared widely exchangeable, as no tracer relevantly outperformed the other. The differences between the two tracers were far more common in presumable unspecific lesions than in malignant spots. A routinely performed two-tracer study could not be shown to be superior. Since it seems at least challenging for most nuclear medicine departments to provide both [18F]-F-PSMA-1007 and [68Ga]-Ga-PSMA-11, it appears reasonable to choose the PSMA radiotracer depending on local availability with attention to the greater occurrence of nonspecific bone findings with [18F]-F-PSMA-1007.
Impact of the fear and Allee effect on a Holling type II prey–predator model
Authors: Xie Binfeng
Published: October 2021

In this paper, we propose and investigate a prey–predator model with Holling type II response function incorporating Allee and fear effect in the prey. First of all, we obtain all possible equilibria of the model and discuss their stability by analyzing the eigenvalues of Jacobian matrix around the equilibria. Secondly, it can be observed that the model undergoes Hopf bifurcation at the positive equilibrium by taking the level of fear as bifurcation parameter. Moreover, through the analysis of Allee and fear effect, we find that: (i) the fear effect can enhance the stability of the positive equilibrium of the system by excluding periodic solutions; (ii) increasing the level of fear and Allee can reduce the final number of predators; (iii) the Allee effect also has important influence on the permanence of the predator. Finally, numerical simulations are provided to check the validity of the theoretical results.
On highly efficient derivative-free family of numerical methods for solving polynomial equation simultaneously
Authors: Shams Mudassir , Rafiq Naila , Kausar Nasreen , Agarwal Praveen , Park Choonkil , Mir Nazir Ahmad
Published: October 2021

A highly efficient new three-step derivative-free family of numerical iterative schemes for estimating all roots of polynomial equations is presented. Convergence analysis proved that the proposed simultaneous iterative method possesses 12th-order convergence locally. Numerical examples and computational cost are given to demonstrate the capability of the method presented.