bluuebunny/crossref_metadata_2025 huggingface dataset:
Are Recoveries all the Same: GDP and TFP?*
Authors: Luo Sui , Huang Yu‐Fan , Startz Richard
Published: April 2021

Recessions and subsequent recoveries are frequently classified as ‘L‐shaped’ or ‘U‐shaped’, with output losses in the former being permanent and losses in the latter at least partially made up by higher than average growth during the recovery. We estimate the probability of a U‐shaped recovery for postwar NBER recessions. Most earlier recessions were U‐shaped but more recent recessions have been L‐shaped. The shape of recoveries is tracked relatively well by durable consumption, investment, labour hours and employment. Posterior probabilities for the shape of recoveries for nondurable consumption and participation rate are less decisive. However, total factor productivity appears to recover rapidly after all recessions.
“Emotionscapes of geopolitics”: Interpreting in the United Nations Security Council
Authors: Jones Alun
Published: April 2021

The agency of interpreters has been kept out of view in human geography. This paper corrects this by focusing on embodied interpretation: bodies, freighted with their own relations, expectations, and experiences in the context of “emotionscapes,” settings for emotional communication. Conceptually, “emotionscapes” enable the exploration of the potentiality of an emotion in its spatial setting. Emotionally expressive behaviour is a process of the emotion; a potentiality to be realised. Emotions are distinctively connected to specific sites and spaces. This potentiality shifts the analytical focus away from what emotion is to what emotion can do to the alteration or reproduction of relations. I argue that this is vitally important to understanding geopolitical exchange, that is, how global politics is made and remade. However, the potentiality of emotions is made more complicated when interpretive bodies are involved in geopolitical exchange. They are intrinsic to the relational fluxes, currents, and flows of emotion – its potentialities – they identify and relay emotionally laden language of others for others in geopolitical communication. They observe, relay, and mutate emotional potentiality in “emotionscapes.” In doing so, they wrestle with more than just words. They seek to capture emotions and geopolitics between real‐life people in real places. Understanding their endeavour should challenge us therefore to [re]consider geopolitical exchange in “emotionscapes” and the mediatory and performative roles played by interpretive bodies in these spaces of geopolitical knowledge production. This is my key purpose in this paper. Underpinning the paper’s conceptual ideas are qualitative data on the role of interpretive bodies in realising emotional potentialities in the “emotionscape” of the UN Security Council in New York, arguably the most high‐profile geopolitical institution.
Kinetostatic Modeling of Dual-Drive H-Type Gantry With Exchangeable Flexure Joints
Authors: Chen Silu , Wan Hongyu , Jiang Chao , Ye Liuying , Yu Hongtao , Yang Miao , Zhang Chi , Yang Guilin , Wu Jiefeng
Published: April 2021

The flexure joints are proposed to replace the rigid assembly between the cross-arm and the moving carriages of dual-drive H-type gantry (DHG) for higher reliability and fine rotational alignments. In the literature, the flexure joint of the DHG is modeled as an ideal linear torsional spring, resulting in an inaccurate estimation of the cross-arm’s angle. In this study, a generalized analytical kinetostatic model of flexure-linked DHG is built by considering the geometric nonlinearities. The expressions of beam coefficients in the model are obtained from either beam constraint model (BCM) or Timoshenko BCM (TBCM) according to the given criterion of length-to-thickness ratio. The model is capable to accurately estimate any two variables among the rotation angle of the cross-arm, the misalignment of two carriages, and the net driving force, as long as the other is known. Simulations and experiments on the testbed validate the accuracy and show practical appeals of the proposed model.
Cooling of Heated Solid Cylinder Supported on Bedded and Embedded Substrates by Impinging Air Jet
Authors: Wessies Savannah S. , Ezekoye Ofodike A.
Published: April 2021

In many industrial cooling and fire safety applications, multimode heat transfer involving radiation, convection, and conduction cools hot objects deposited on substrates. In some cases, the convective cooling is due to impinging jets on a flat surface or a small pedestal on an otherwise flat surface. The literature on jet impingement cooling is extensive, but variation in results using different correlations for nominally similar conditions is significant. For heat transfer from a small pedestal, there are relatively few studies. To characterize the cooling of a hot body that is supported on a substrate by an impinging jet, the convective heat transfer coefficient was measured using the naphthalene sublimation analogy. Two different substrate configurations were tested: bedded, where the object rests on top of the substrate, and embedded, where the top surface of the object is flush with the top of the substrate. After modeling the radiative and convective cooling components, a conductive resistance was inferred. The cooling of the hot object was modeled with good agreement to the experimental data. The error was less than 2% for the bedded case and less than 5% for the embedded. The relative contributions from the different modes of heat transfer were determined. For the embedded configuration, most of the cooling was initially due to conduction. For the bedded configuration on a relatively low thermal effusivity substrate like calcium silicate, most of the losses are due to convection and radiation. Materials with higher thermal effusivities had larger relative contributions to cooling from conduction comparatively.
Producing Steam by Spraying Water on a Heated Bed of Steel Spheres
Authors: Bouchard D. Jordan , Yang HengSheng , Chandra Sanjeev
Published: April 2021

Steam generators used in industrial baking ovens operate by pouring or spraying water on a preheated thermal mass. This paper presents a methodology to quantify the amount of steam generated from a thermal mass along with experiments to determine the effect of particle size and porosity on steam generation. Three sizes of steel spheres, 0.6 mm, 8 mm, and 16 mm in diameter, were used to construct porous media beds that were preheated in an oven. After that water was sprayed onto them from a full-cone nozzle for a fixed duration. The weight of the heated bed and the impinging water was recorded during spraying. The difference in weight change when spraying on heated and unheated beds gave the rate of evaporation. Thermocouples were used to record the internal temperature of the bed. The steam generation rate increased with particle size but there was only a minor difference when changing the bed's porosity. The counter-current flow of steam within the media bed disrupts the downward flow of water enough to leave pockets of dry material, reducing steam production. To maximize steam generation, the media size, material, and spray time should be matched to ensure the surfaces of particles remain above the boiling point of water during spraying.
Warming homogenizes apparent temperature sensitivity of ecosystem respiration
Authors: Niu Ben , Zhang Xianzhou , Piao Shilong , Janssens Ivan A. , Fu Gang , He Yongtao , Zhang Yangjian , Shi Peili , Dai Erfu , Yu Chengqun , Zhang Jing , Yu Guirui , Xu Ming , Wu Jianshuang , Zhu Liping , Desai Ankur R. , Chen Jiquan , Bohrer Gil , Gough Christopher M. , Mammarella Ivan , Varlagin Andrej , Fares Silvano , Zhao Xinquan , Li Yingnian , Wang Huiming , Ouyang Zhu
Published: April 2021

Warming-induced carbon loss may be less than previously assumed due to temperature sensitivity homogenization in a warming world.
Intermittent inverse-square Lévy walks are optimal for finding targets of all sizes
Authors: Guinard Brieuc , Korman Amos
Published: April 2021

Lévy walk patterns, commonly used by animals, are proved to be an optimal strategy for finding targets of unknown size.
Semibrittle seismic deformation in high-temperature mantle mylonite shear zone along the Romanche transform fault
Authors: Yu Zhiteng , Singh Satish C. , Gregory Emma P. M. , Maia Marcia , Wang Zhikai , Brunelli Daniele
Published: April 2021

Deep microseismicity occurs in high-temperature ductile mantle mylonite shear zones resulting from semibrittle fracturing.
C9orf72-derived arginine-containing dipeptide repeats associate with axonal transport machinery and impede microtubule-based motility
Authors: Fumagalli Laura , Young Florence L. , Boeynaems Steven , De Decker Mathias , Mehta Arpan R. , Swijsen Ann , Fazal Raheem , Guo Wenting , Moisse Matthieu , Beckers Jimmy , Dedeene Lieselot , Selvaraj Bhuvaneish T. , Vandoorne Tijs , Madan Vanesa , van Blitterswijk Marka , Raitcheva Denitza , McCampbell Alexander , Poesen Koen , Gitler Aaron D. , Koch Philipp , Berghe Pieter Vanden , Thal Dietmar Rudolf , Verfaillie Catherine , Chandran Siddharthan , Van Den Bosch Ludo , Bullock Simon L. , Van Damme Philip
Published: April 2021

Arginine-rich dipeptide repeats associated with ALS and FTD inhibit machinery for microtubule-based axonal cargo transport.
Top German psychologist found to have fabricated data
Authors: Boytchev Hristio
Published: April 2021

University investigation finds anxiety expert pressured whistleblowers.
The primitive brain of earlyHomo
Authors: Ponce de León Marcia S. , Bienvenu Thibault , Marom Assaf , Engel Silvano , Tafforeau Paul , Alatorre Warren José Luis , Lordkipanidze David , Kurniawan Iwan , Murti Delta Bayu , Suriyanto Rusyad Adi , Koesbardiati Toetik , Zollikofer Christoph P. E.
Published: April 2021

Brain evolution in earlyHomo

Human brains are larger than and structurally different from the brains of the great apes. Ponce de Leónet al.explored the timing of the origins of the structurally modern human brain (see the Perspective by Beaudet). By comparing endocasts, representations of the inner surface of fossil brain cases, from earlyHomofrom Africa, Georgia, and Southeast Asia, they show that these structural innovations emerged later than the first dispersal of the genus from Africa, and were probably in place by 1.7 to 1.5 million years ago. The modern humanlike brain organization emerged in cerebral regions thought to be related to toolmaking, social cognition, and language. Their findings suggest that brain reorganization was not a prerequisite for dispersals from Africa, and that there might have been more than one long-range dispersal of earlyHomo.

Science, this issue p.165; see also p.124
Concrete steps to diversify the scientific workforce
Authors: Tilghman Shirley , Alberts Bruce , Colón-Ramos Daniel , Dzirasa Kafui , Kimble Judith , Varmus Harold
Published: April 2021

Any barrier to entry weakens science and its societal impact
PIEZO1 mutation: a rare aetiology for fetal ascites
Authors: Stolyar Helen , Berry Teresa , Singh Amit Pal , Madan Ichhcha
Published: April 2021

We present a case of isolated fetal ascites diagnosed at 20 weeks’ gestation. No aetiology was identified on extensive prenatal workup, including prenatal microarray. The patient terminated the pregnancy at 23 weeks’ gestation. Exome sequencing was performed on the products of conception, which ended up giving insight into a possible cause for the ascites. Two heterozygous missense variants of uncertain significance were identified in the PIEZO1 gene. The paternal variant has been linked to dehydrated hereditary stomatocytosis. The father of the baby suffers from haemolytic anaemia, splenomegaly and has had jaundice throughout his life. His brother and father have similar conditions. We suspect that at least one of the gene variants identified in our exome sequencing may be responsible for the illness that runs in this family, including the fetus with isolated ascites.
Human bite wounds as a portal of entry for infective endocarditis and purulent pericarditis: a very rare association
Authors: Oyonarte Gómez Miguel , Del Castillo Gordillo Cesar , Rojas Romero Manuel , Loo Urbina Kenyin
Published: April 2021

Human bites are an infrequent cause of emergency department visits and hospital admissions. There are rarely published cases of complicated infection, such as infective endocarditis. We present a rare case of a patient with acute infective endocarditis in a healthy native valve and purulent pericarditis from a human bite. A 40-year-old man with obesity suffered deep human bites by an adult woman, with two deep lesions in the anterior thorax and one superficial lesion in the upper abdomen and admitted in intensive care unit with septic shock and a persistent aortic murmur. Echocardiography described evidence of vegetation, perforation and severe regurgitation of aortic valve. Scanner described moderate pericardial effusion. Cardiac surgery was performed, with evidence of purulent pericardial effusion after pericardiotomy, and subsequently aortic valve replacement with a 25 mm bioprosthesis. The patient showed positive progress.
Incidental diagnosis of situs inversus totalis: a perspective from an emergency department attendance
Authors: Umar Umma-Kulthum Abdullahi , Alremeithi Aysha Najim , Qayyum Hasan
Published: April 2021

A 30-year-old man of African origin presented to our emergency department (ED) with subjective fever and abdominal pain which started on the day of attendance. Vital signs and systemical examination were within normal limits. As part of his evaluation in ED, a 12-lead electrocardiogram was performed which showed features consistent with dextrocardia later confirmed on a chest X-ray as well. An ultrasound scan of the abdomen was performed which showed mirror imaging of the abdominal viscera, all of which were otherwise structurally normal. A diagnosis of situs inversus totalis was made. The patient’s symptoms resolved with analgesia and he was discharged with advice to follow-up in our hospital’s outpatient department. The diagnosis of situs inversus in the ED is a tricky one to make and most cases of this condition are discovered incidentally, as in our case. The mirror-imaged arrangement of viscera can have implications on the site of localised complaints, the physical examination, future health problems for the patient including anaesthesia risks, chronic lung conditions, cardiac complications and specialised trauma management. This anatomical variation can pose diagnostic challenges in such patients. Based on meticulous examination and readily accessible investigations including X-rays, 12-lead ECG and ultrasound, a timely diagnosis can be made.
Injury epidemiology in professional ballet: a five-season prospective study of 1596 medical attention injuries and 543 time-loss injuries
Authors: Mattiussi Adam M , Shaw Joseph W , Williams Sean , Price Phil DB , Brown Derrick D , Cohen Daniel D , Clark Richard , Kelly Shane , Retter Greg , Pedlar Charles , Tallent Jamie
Published: April 2021

Objectives

To describe the incidence rate, severity, burden and aetiology of medical attention and time-loss injuries across five consecutive seasons at a professional ballet company.

Methods

Medical attention injuries, time-loss injuries and dance exposure hours of 123 professional ballet dancers (women: n=66, age: 28.0±8.3 years; men: n=57, age: 27.9±8.5 years) were prospectively recorded between the 2015/2016 and 2019/2020 seasons.

Results

The incidence rate (per 1000 hours) of medical attention injury was 3.9 (95% CI 3.3 to 4.4) for women and 3.1 (95% CI 2.6 to 3.5) for men. The incidence rate (per 1000 hours) of time-loss injury was 1.2 (95% CI 1.0 to 1.5) for women and 1.1 (95% CI 0.9 to 1.3) for men. First Soloists and Principals experienced between 2.0–2.2 additional medical attention injuries per 1000 hours and 0.9–1.1 additional time-loss injuries per 1000 hours compared with Apprentices (p≤0.025). Further, intraseason differences were observed in medical attention, but not time-loss, injury incidence rates with the highest incidence rates in early (August and September) and late (June) season months. Thirty-five per cent of time-loss injuries resulted in over 28 days of modified dance training. A greater percentage of time-loss injuries were classified as overuse (women: 50%; men: 51%) compared with traumatic (women: 40%; men: 41%).

Conclusion

This is the first study to report the incidence rate of medical attention and time-loss injuries in professional ballet dancers. Incidence rates differed across company ranks and months, which may inform targeted injury prevention strategies.
Community-centred interventions for improving public mental health among adults from ethnic minority populations in the UK: a scoping review
Authors: Baskin Cleo , Zijlstra Geiske , McGrath Mike , Lee Caroline , Duncan Fiona Helen , Oliver Emily J , Osborn David , Dykxhoorn Jen , Kaner Eileen F S , LaFortune Louise , Walters Kate R , Kirkbride James , Gnani Shamini
Published: April 2021

Objectives

Undertake a scoping review to determine the effectiveness of community-centred interventions designed to improve the mental health and well-being of adults from ethnic minority groups in the UK.

Methods

We searched six electronic academic databases for studies published between January 1990 and September 2019: Medline, Embase, PsychINFO, Scopus, CINAHL and Cochrane. For intervention description and data extraction we used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist and Template for Intervention Description and Replication guide. Quality was assessed using Cochrane risk of bias tools. Grey literature results were deemed beyond the scope of this review due to the large number of interventions and lack of available outcomes data.

Results

Of 4501 studies, 7 met the eligibility criteria of UK-based community interventions targeting mental health in adults from ethnic minority populations: four randomised controlled trials, one pre/post-pilot study, one cross-sectional study and one ethnographic study. Interventions included therapy-style sessions, peer-support groups, educational materials, gym access and a family services programme. Common components included a focus on tackling social isolation, using lay health workers from within the community, signposting and overcoming structural barriers to access. Four studies reported a statistically significant positive effect on mental health outcomes and six were appraised as having a high risk of bias. Study populations were ethnically heterogeneous and targeted people mainly from South Asia. No studies examined interventions targeting men.

Conclusions

There is a paucity of high-quality evidence regarding community-centred interventions focused on improving public mental health among ethnic minority groups. Decision makers need scientific evidence to inform effective approaches to mitigating health disparities. Our next steps are to map promising community activities and interventions that are currently being provided to help identify emerging evidence.
Reducing police occupational needle stick injury risk following an interactive training: the SHIELD cohort study in Mexico
Authors: Beletsky Leo , Abramovitz Daniela , Baker Pieter , Arredondo Jaime , Rangel Gudelia , Artamonova Irina , Marotta Phillip , Mittal Maria Luisa , Rocha-Jimenéz Teresita , Morales Mario , Clairgue Erika , Kang Sunyou , Banuelos Arnulfo , Cepeda Javier , Patterson Thomas A , Strathdee Steffanie A
Published: April 2021

Objective

At a time of unprecedented attention to the public health impact of policing, it is imperative to understand the role of occupational safety in shaping officer behaviours. We assessed the longitudinal impact of police training in a quasi-experimental hybrid type-1 trial to reduce syringe-related occupational risk, while realigning police practices with public health prevention among people who inject drugs (PWID).

Setting

Tijuana, Mexico.

Participants

Of 1806 Tijuana municipal police trainees, 771 reporting previous exposure to syringes were randomly selected for follow-up. All participants completed at least one follow-up visit; attrition at 24 months was 8%.

Intervention

Between 2015 and 2016, officers received a training intervention (Safety and Health Integration in the Enforcement of Laws on Drugs, SHIELD) bundling occupational needle stick injury (NSI) prevention with health promotion among PWID.

Outcome measures

Longitudinal analysis with generalised linear mixed models to evaluate training impact on occupational NSI risk via NSI incidence and prevalidated Syringe Threat and Injury Correlates (STIC) score. This composite indicator integrates five self-reported risky syringe-handling practices (eg, syringe confiscation, breaking) and was used as a proxy for NSI risk due to reporting bias and concerns about reliability of NSI incidence reports.

Results

No change in self-reported NSI incidence was observed, but significant reductions in risk (16.2% decrease in STIC score) occurred at 3 months, with a sustained decrease of 17.8% through 24 months, compared with pretraining (p<0.001). Police assignment (patrol vs administration) moderated the training effect (p=0.01). Younger age, male gender, lower rank and previous NSI were independently and significantly associated with higher NSI risk overtime, although all groups demonstrated significant reductions post-training.

Conclusions

SHIELD is the first intervention to be associated with significant sustained changes in police practices that pose risk for both occupational and the public’s health. Integrating occupational safety and public health education should inform other interventions to mitigate the community health detriments of policing behaviours.

Trial registration number

NCT02444403.
Improving the patient-centred care of children with life-altering skin conditions using feedback from electronic patient-reported outcome measures: protocol for a hybrid effectiveness-implementation study (PEDS-ePROM)
Authors: Tyack Zephanie , Simons Megan , McPhail Steven M , Harvey Gillian , Zappala Tania , Ware Robert S , Kimble Roy M
Published: April 2021

Introduction

Using patient-reported outcome measures (PROMs) with children have been described as ‘giving a voice to the child’. Few studies have examined the routine use of these measures as potentially therapeutic interventions. This study aims to investigate: (1) theeffectivenessof feedback using graphical displays of information from electronic PROMs (ePROMs) that target health-related quality of life, to improve health outcomes, referrals and treatment satisfaction and (2) theimplementationof ePROMs and graphical displays by assessing acceptability, sustainability, cost, fidelity and context of the intervention and study processes.

Methods and analysis

A hybrid II effectiveness-implementation study will be conducted from February 2020 with children with life-altering skin conditions attending two outpatient clinics at a specialist paediatric children’s hospital. A pragmatic randomised controlled trial and mixed methods process evaluation will be completed. Randomisation will occur at the child participant level. Children or parent proxies completing baseline ePROMs will be randomised to: (1) completion of ePROMs plus graphical displays of ePROM results to treating clinicians in consultations, versus (2) completion of ePROMs without graphical display of ePROM results. The primary outcome of the effectiveness trial will be overall health-related quality of life of children. Secondary outcomes will include other health-related quality of life outcomes (eg, child psychosocial and physical health, parent psychosocial health), referrals and treatment satisfaction. Trial data will be primarily analysed using linear mixed-effects models; and implementation data using inductive thematic analysis of interviews, meeting minutes, observational field notes and study communication mapped to the Consolidated Framework for Implementation Research.

Ethics and dissemination

Ethical approval was obtained from Children’s Health Queensland Human Research Ethics Committee (HREC/2019/QCHQ/56290), The University of Queensland (2019002233) and Queensland University of Technology (1900000847). Dissemination will occur through stakeholder groups, scientific meetings and peer-reviewed publications.

Trial registration number

Australian New Zealand Clinical Trials Registry (ACTRN12620000174987).
Prevalence and risk factors of adverse birth outcomes in the Pacific Island region: a scoping review protocol
Authors: Kaforau Lydia Sandrah Kuman , Tessema Gizachew Assefa , Jancey Jonine , Dhamrait Gursimran Kaur , Bugoro Hugo , Pereira G F
Published: April 2021

Introduction

Fetal growth restriction, preterm birth, low birth weight and stillbirth are adverse birth outcomes that are prevalent in low-income and middle-income settings such as the Pacific Island region. It is widely accepted that the excess burden of adverse birth outcomes is attributable to socioeconomic and environmental factors that predispose families to excess risk. Our review seeks to determine the prevalence of adverse birth outcomes in the Pacific Island region and to identify the risk factors of adverse birth outcomes in the Pacific Island region.

Methods

This scoping review will follow the five-staged Arksey and O’Malley’s framework and consultation with Solomon Islands’ health stakeholders. A preliminary literature review was undertaken to understand the scope of the review. We will use Medical Subject Heading and keyword terms for adverse birth outcomes to search CINAHL, Medline, Scopus, ProQuest and Springer Link databases for articles published from 1 January 2000. The subsequent searches will be undertaken via Google Scholar and the internet browser to world health organisation and regional health organisations for published and unpublished reports on non-indexed studies. All articles retrieved will be managed with EndNote software. Eligible studies will be screened using Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow chart for final selection. In the charting phase, we will extract the data into Excel spreadsheets. The results will be presented as numerical and thematic summaries that map risk factors and prevalence to the population and cultures of the Pacific Island region.

Ethics and dissemination

Formal ethical approval is not required as primary or administrative data will not be collected. However, we will seek ethics approval for the stakeholder consultation from the Research Office of Curtin University and the Solomon Islands. The findings of this study will be published in peer-reviewed journals and presented in national and regional conferences and disseminated to stakeholders.

Ethics approval

There will be no direct contact with human or patients in the case of the scoping review; therefore, no ethics will be required. However, we will seek ethical approval from the Research Ethics Office of Curtin University and the Health Research and Ethics Committee in the Solomon Islands for stakeholder consultation. Dissemination will be made through regional conferences and publication in peer-reviewed journals.
Association between systolic blood pressure trajectories and hypertension risk at late adolescence: results from 10-year longitudinal follow-up in Chinese boys
Authors: Wang Xijie , Dong Bin , Huang Sizhe , Yang Zhaogeng , Ma Jun , Hu Jie
Published: April 2021

Objective

To identify various systolic blood pressure (SBP) trajectories in Chinese boys between 7 and 18 years of age, and to explore their high blood pressure (HBP) risk in their late adolescence years.

Design and settings

A population-based cohort study in Guangdong, China.

Participants

4541 normal tensive boys who started primary school in 2005 in Zhongshan, Guangdong were included.

Outcomes

Blood pressure and relevant measurements were obtained by annual physical examinations between 2005 and 2016. HBP was defined by SBP or diastolic blood pressure ≥95th percentile for children under 13, and BP ≥130/80 mm Hg for children ≥13 years old. Logit regression for panel data and log-binomial regression model was used to estimate the risk of HBP among SBP trajectory groups.

Results

Four distinct SBP trajectory groups via group-based trajectory modelling: low stable (13.0%), low rising (42.4%), rising (37.4%) and high rising (7.3%). The overall incidence rates of HBP during the follow-up ranged from 40.24 (95% CI 36.68 to 44.19)/1000 person-years in the low stable group to 97.08 (95% CI 94.93 to 99.27)/1000 person-years in the high rising group. Compared with children with low stable SBP, those of other SBP trajectories suffered 3.05 (95% CI 2.64 to 3.46) to 4.64 (95% CI 4.18 to 5.09) times of higher risk of HBP in their late adolescence, regardless of their age, body mass index and BP level at baseline.

Conclusions

Subgroups of SBP trajectories existed in Chinese boys, and are related to hypertension risk at late adolescence. Regular physical examinations could help identify those with higher risks at the beginning of pubertal growth.
Effects of an optimised approach to home-based respiratory care in individuals with amyotrophic lateral sclerosis: a study protocol for a randomised controlled trial
Authors: Pondofe Karen , Fregonezi Guilherme A F , Brito Ozana , Dourado Júnior Mario Emilio , Torres-Castro Rodrigo , Resqueti Vanessa R
Published: April 2021

Introduction

This study aims to investigate the effects of an optimal home-based respiratory care protocol in individuals with amyotrophic lateral sclerosis (ALS).

Methods and analysis

This is a randomised, blinded controlled trial involving patients diagnosed with ALS, both sexes, age between 18 and 80 years. Patients will be randomly allocated into the conventional respiratory care (CRC) group and the optimised respiratory care home-based (ORC) group. Primary outcomes will be peak cough flow, the number of exacerbations and ALS Functional Rating Scale Revised. Secondary outcomes will include chest wall volumes, maximal respiratory pressures, sniff nasal inspiratory pressure, nasal expiratory pressure and forced vital capacity (FVC), forced expiratory volume in the 1st second (FEV1) and FEV1/FVC. The CRC group will receive educational information about respiratory care at the clinic. The ORC group will receive conventional care and home-based care. The clinical status of all individuals will be monitored weekly through telephone calls. A 6-month intervention is planned, the outcomes will be assessed every 3 months and 3 and 6 months follow-up after final evaluation. The primary and secondary results will be described as average or median for continuous variables and absolute and relative frequencies for qualitative variables. Treatment effects or differences between the outcomes (baseline, 3 months and 6 months) of the study groups will be analysed using an analysis of variance. The level of significance will be set as p≤0.05.

Ethics and dissemination

The research ethics committee approved the study. It is expected to evaluate respiratory function in patients with ALS in the short, medium and long terms with home-based care protocol applied. The disease’s rapid progression is a limitation for performing a long-term clinical study.

Trial registration number

RBR-3z23ts; Pre-results.
Pentoxifylline for the prevention of contrast-induced nephropathy: systematic review and meta-analysis of randomised controlled trials
Authors: Wei Ling , Zhang Weizhi , Yang Yifeng , Li Dongping
Published: April 2021

Objectives

To summarise current evidence on the use of pentoxifylline (PTX) to prevent contrast-induced nephropathy (CIN).

Methods

The PubMed, Embase and CENTRAL databases were searched for randomised controlled trials including patients with and without PTX undergoing contrast media exposure. We analysed the incidence of CIN and serum creatinine changes before and after contrast media exposure. All statistical analyses were conducted with Review Manager V.5.3.

Results

We finally enrolled in seven randomised controlled trials with a total of 1484 patients in this analysis. All of seven included studies were performed in patients undergoing angioplasty or stenting. The overall rates of CIN were 8.8% and 10.4% in the PTX groups and control groups, respectively. However, no significant reduction in the CIN rate was observed in the patients treated with PTX compared with the control groups (OR 0.81, 95% CI 0.57 to 1.13, I2=0, p=0.21). All studies reported no hospital mortality and the new requirement for dialysis during the trials.

Conclusion

Perioperative administration of PTX to patients undergoing angioplasty did not significantly reduce the development of CIN but showed some weak tendency of lower serum creatinine increase. Based on the available trials, the evidence does not support the administration of PTX for the prevention of CIN. More trials with larger sample sizes are needed to evaluate the role of PTX in CIN prevention.
Magnitude of antenatal care service uptake and associated factors among pregnant women: analysis of the 2016 Ethiopia Demographic and Health Survey
Authors: Fenta Setegn Muche , Ayenew Girum Meseret , Getahun Berhanu Engidaw
Published: April 2021

Objective

Antenatal and postnatal cares are crucial for the survival and well-being of both the mother and the child. WHO recommends a minimum of four antenatal care (ANC) visits during a pregnancy. In Ethiopia, only 38% of women in the reproductive age make a minimum of first ANC visits. This value is far below the typical rates of least developed countries. This study aimed to calculate the magnitude and identify associated factors of ANC service utilisation among pregnant women in Ethiopia.

Design

Cross-sectional study design.

Setting

Ethiopia.

Participants

A total of 7913 pregnant women participated in the study.

Primary outcome measures

Antenatal care service uptake among pregnant women.

Result

Only 35.5% of the pregnant mothers have used ANC services at least four times and 64.5% of the pregnant mothers have used less than three times during their periods of pregnancy. The study showed that rich women (PR=1.077, 95% CI: 1.029 to 1.127), having access to mass media (PR=1.086, 95% CI: 1.045 to 1.128), having pregnancy complications (PR=1.203, 95% CI: 1.165 to 1.242), secondary education and above (PR=1.112, 95% CI:1.052 to 1.176), husbands’ having secondary education and above (PR=1.085, 95% CI: 1.031 to 1.142) and married (PR=1.187; 95% CI: 1.087 to 1.296), rural women (PR=0.884, 95% CI: 0.846 to 0.924) and women>30 years of age (PR=1.067, 95% CI: 1.024 to 1.111) significantly associated with the ANC service uptake.

Conclusion

The magnitude of ANC service uptake was low. This low magnitude of ANC service utilisation calls for a need to improve community awareness about maternal health. More importantly, intensive health education is required for pregnant women to have better ANC service uptake and follow-up adherence.
Study protocol and design for the assessment of paediatric pneumonia from X-ray images using deep learning
Authors: Sun Mark GF , Saha Senjuti , Shah Syed Ahmar , Luz Saturnino , Nair Harish , Saha Samir
Published: April 2021

Introduction

In low-income and middle-income countries, pneumonia remains the leading cause of illness and death in children<5 years. The recommended tool for diagnosing paediatric pneumonia is the interpretation of chest X-ray images, which is difficult to standardise and requires trained clinicians/radiologists. Current automated computational tools have primarily focused on assessing adult pneumonia and were trained on images evaluated by a single specialist. We aim to provide a computational tool using a deep-learning approach to diagnose paediatric pneumonia using X-ray images assessed by multiple specialists trained by the WHO expert X-ray image reading panel.

Methods and analysis

Approximately 10 000 paediatric chest X-ray images are currently being collected from an ongoing WHO-supported surveillance study in Bangladesh. Each image will be read by two trained clinicians/radiologists for the presence or absence of primary endpoint pneumonia (PEP) in each lung, as defined by the WHO. Images whose PEP labels are discordant in either lung will be reviewed by a third specialist and the final assignment will be made using a majority vote. Convolutional neural networks will be used for lung segmentation to align and scale the images to a reference, and for interpretation of the images for the presence of PEP. The model will be evaluated against an independently collected and labelled set of images from the WHO. The study outcome will be an automated method for the interpretation of chest radiographs for diagnosing paediatric pneumonia.

Ethics and dissemination

All study protocols were approved by the Ethical Review Committees of the Bangladesh Institute of Child Health, Bangladesh. The study sponsor deemed it unnecessary to attain ethical approval from the Academic and Clinical Central Office for Research and Development of University of Edinburgh, UK. The study uses existing X-ray images from an ongoing WHO-coordinated surveillance. All findings will be published in an open-access journal. All X-ray labels and statistical code will be made openly available. The model and images will be made available on request.
Discrepancies in self-reported financial conflicts of interest disclosures by physicians: a systematic review
Authors: Taheri Cameron , Kirubarajan Abirami , Li Xinglin , Lam Andrew C L , Taheri Sam , Olivieri Nancy F
Published: April 2021

Background

There is a high prevalence of financial conflicts of interest (COI) between physicians and industry.

Objectives

To conduct a systematic review with meta-analysis examining the completeness of self-reported financial COI disclosures by physicians, and identify factors associated with non-disclosure.

Data sources

MEDLINE, Embase and PsycINFO were searched for eligible studies up to April 2020 and supplemented with material identified in the references and citing articles.

Data extraction and synthesis

Data were independently abstracted by two authors. Data synthesis was performed via systematic review of eligible studies and random-effects meta-analysis.

Main outcomes and measures

The proportion of discrepancies between physician self-reported disclosures and objective payment data was the main outcome. The proportion of discrepant funds and factors associated with non-disclosure were also examined.

Results

40 studies were included. The pooled proportion of COI discrepancies at the article level was 81% (range: 54%–98%; 95% CI 72% to 89%), 79% at the payment level (range: 71%–89%; 95% CI 67% to 89%), 93% at the authorship level (range: 71%–100%; 95% CI 79% to 100%) and 66% at the author level (range: 8%–99%; 95% CI 48% to 78%). The proportion of funds discrepant was 33% (range: 2%–77%; 95% CI 12% to 58%). There was high heterogeneity between studies across all five analyses (I2=94%–99%). Most undisclosed COI were related to food and beverage, or travel and lodging. While the most common explanation for failure to disclose was perceived irrelevance, a median of 45% of non-disclosed payments were directly or indirectly related to the work. A smaller monetary amount was the most common factor associated with nondisclosure.

Conclusions

Physician self-reports of financial COI are highly discrepant with objective data sources reporting payments from industry. Stronger policies are required to reduce reliance on physician self-reporting of financial COI and address non-compliance.
Study protocol: content and perceived educational utility of different modalities of clinical teaching visit (CTV) workplace-based assessments within Australian general practice vocational training: a cross-sectional study
Authors: Fielding Alison , Mundy Benjamin Eric , Tapley Amanda , Klein Linda , Gani Sarah , Bentley Michael , Boland Rachael , Zbaidi Lina , van Driel Mieke L , Holliday Elizabeth , Magin Parker
Published: April 2021

Introduction

Clinical teaching visits (CTVs) are formative workplace-based assessments that involve a senior general practitioner (GP) observing a clinical practice session of a general practice registrar (specialist vocational GP trainee). These visits constitute a key part of Australian GP training. Despite being mandatory and resource-intensive, there is a paucity of evidence regarding the content and educational utility of CTVs. This study aims to establish the content and educational utility of CTVs across varying practice settings within Australia, as perceived by registrars and their assessors (‘CT visitors’). In addition, this study aims to establish registrar, CT visitor and practice factors associated with CTV content and perceived CTV utility ratings.

Methods and analysis

This study will collect data prospectively using online questionnaires completed soon after incident CTVs. Participants will be registrars and CT visitors of CTVs conducted from March 2020 to January 2021. The setting is three Regional Training Organisations across four Australian states and territories (encompassing 37% of Australian GP registrars).

Outcome factors will be a number of specified CTV content elements occurring during the CTV as well as participants’ perceptions of CTV utility, which will be analysed using univariate and multivariable regression.

Ethics and dissemination

Ethics approval has been granted by the University of Newcastle Human Research Ethics Committee, approval number H-2020-0037. Study findings are planned to be disseminated via conference presentation, peer-reviewed journals, educational practice translational workshops and the GP Synergy research subwebsite.
CopenFast trial: Faster-acting insulin Fiasp versus insulin NovoRapid in the treatment of women with type 1 or type 2 diabetes during pregnancy and lactation - a randomised controlled trial
Authors: Nørgaard Sidse Kjærhus , Mathiesen Elisabeth Reinhardt , Nørgaard Kirsten , Clausen Tine Dalsgaard , Damm Peter , Ringholm Lene
Published: April 2021

Introduction

Faster-acting insulin aspart (Fiasp) is approved for use in pregnancy and lactation, but no clinical study has evaluated its effects during this life stage in women with pre-existing diabetes. The aim of the CopenFast trial is to evaluate the effect of Fiasp compared with insulin aspart (NovoRapid) on maternal glycaemic control during pregnancy, delivery and lactation and on fetal growth and infant health.

Methods and analysis

An open-label randomised controlled trial of pregnant women with type 1 or type 2 diabetes including women on multiple daily injection (MDI) therapy or insulin pump therapy. During a 2-year inclusion period, approximately 220 women will be randomised 1:1 to Fiasp or NovoRapid in early pregnancy and followed until 3 months after delivery. At 9, 21 and 33 gestational weeks and during planned induction of labour or caesarean section, women are offered blinded continuous glucose monitoring (CGM) for 7 days. Randomisation will stratify for type of diabetes and insulin treatment modality (MDI or insulin pump therapy, respectively). Health status of the infants will be followed until 3 months of age. The primary outcome is birth weight SD score adjusted for gestational age and gender. Secondary outcomes include maternal glycaemic control including glycated haemoglobin, preprandial and postprandial self-monitored plasma glucose levels, episodes of mild and severe hypoglycaemia, maternal gestational weight gain and weight retention, CGM time spent in, above and below target ranges as well as pregnancy outcomes including pre-eclampsia, preterm delivery, perinatal mortality and neonatal morbidity. Data analysis will be performed according to the intention-to-treat principle.

Ethics and dissemination

The trial has been approved by the Regional Ethics Committee (H-19029966) on 7 August 2019. Results will be sought disseminated in peer-reviewed journals and at scientific meetings.

Trial registration number

NCT03770767
Performance of universal early warning scores in different patient subgroups and clinical settings: a systematic review
Authors: Alhmoud Baneen , Bonnici Timothy , Patel Riyaz , Melley Daniel , Williams Bryan , Banerjee Amitava
Published: April 2021

Objective

To assess predictive performance of universal early warning scores (EWS) in disease subgroups and clinical settings.

Design

Systematic review.

Data sources

Medline, CINAHL, Embase and Cochrane database of systematic reviews from 1997 to 2019.

Inclusion criteria

Randomised trials and observational studies of internal or external validation of EWS to predict deterioration (mortality, intensive care unit (ICU) transfer and cardiac arrest) in disease subgroups or clinical settings.

Results

We identified 770 studies, of which 103 were included. Study designs and methods were inconsistent, with significant risk of bias (high: n=16 and unclear: n=64 and low risk: n=28). There were only two randomised trials. There was a high degree of heterogeneity in all subgroups and in national early warning score (I2=72%–99%). Predictive accuracy (mean area under the curve; 95% CI) was highest in medical (0.74; 0.74 to 0.75) and surgical (0.77; 0.75 to 0.80) settings and respiratory diseases (0.77; 0.75 to 0.80). Few studies evaluated EWS in specific diseases, for example, cardiology (n=1) and respiratory (n=7). Mortality and ICU transfer were most frequently studied outcomes, and cardiac arrest was least examined (n=8). Integration with electronic health records was uncommon (n=9).

Conclusion

Methodology and quality of validation studies of EWS are insufficient to recommend their use in all diseases and all clinical settings despite good performance of EWS in some subgroups. There is urgent need for consistency in methods and study design, following consensus guidelines for predictive risk scores. Further research should consider specific diseases and settings, using electronic health record data, prior to large-scale implementation.

PROSPERO registration number

PROSPERO CRD42019143141.
Nutrigenetics-based intervention approach for adults with non-alcoholic fatty liver disease (NAFLD): study protocol for a randomised controlled feasibility trial
Authors: Haigh Laura , McPherson Stuart , Mathers John C , Anstee Quentin M
Published: April 2021

Introduction

Lifestyle interventions targeting weight loss and improved dietary patterns are the recommended treatment for non-alcoholic fatty liver disease (NAFLD). However, the effectiveness of current established diet therapies is suboptimal. The patatin‐like phospholipase domain containing 3 (PNPLA3) gene modifies disease outcome and hepatic lipid handling, but the role ofPNPLA3variants in modulating responsiveness to different diet therapies is unknown.

Methods and analysis

This project aims to assess the feasibility of conducting a genotype-driven randomised controlled trial (RCT) investigating the differential response to a Mediterranean diet (MD) intervention of NAFLD patients according to genotype for the rs738409 (I148M) variant ofPNPLA3. A single-centre randomised controlled feasibility trial will be undertaken. We will recruit 60 adults with NAFLD from a tertiary hepatology centre in England. In a cross-over design, participants will undertake Diet 1 (MD) and Diet 2 (control) for 4 weeks, in random order (1:1 allocation), separated by a 4 weeks washout period. Participants will complete one-to-one diet and lifestyle consultations at baseline, end of diet phase 1, end of washout and end of diet phase 2. Participants will be advised to maintain baseline levels of physical activity and body weight. The primary outcome is the acceptability and feasibility of the intervention protocol. Secondary outcomes include exploratory assessment of liver fibrosis biomarkers and lipid biomarkers.

Ethics and dissemination

Ethical approval was granted by East of Scotland Research Ethics Service REC 1 (19/ES/0112). Results will be disseminated through peer-reviewed journals and presented at local, national and international meetings and conferences. The findings of this trial will lay the foundation for a future definitive RCT by informing trial design and optimising the intervention diets, instruments and procedures.

Trial registration number

ISRCTN93410321.