bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of policy support on uptake of evidence-based continuous quality improvement activities and the quality of care for Indigenous Australians: a comparative case study
Authors: Bailie Ross , Matthews Veronica , Larkins Sarah , Thompson Sandra , Burgess Paul , Weeramanthri Tarun , Bailie Jodie , Cunningham Frances , Kwedza Ru , Clark Louise
Published: October 2017

Objectives

To examine the impact of state/territory policy support on (1) uptake of evidence-based continuous quality improvement (CQI) activities and (2) quality of care for Indigenous Australians.

Design

Mixed-method comparative case study methodology, drawing on quality-of-care audit data, documentary evidence of policies and strategies and the experience and insights of stakeholders involved in relevant CQI programmes. We use multilevel linear regression to analyse jurisdictional differences in quality of care.

Setting

Indigenous primary healthcare services across five states/territories of Australia.

Participants

175 Indigenous primary healthcare services.

Interventions

A range of national and state/territory policy and infrastructure initiatives to support CQI, including support for applied research.

Primary and secondary outcome measures

(i) Trends in the consistent uptake of evidence-based CQI tools available through a research-based CQI initiative (the Audit and Best Practice in Chronic Disease programme) and (ii) quality of care (as reflected in adherence to best practice guidelines).

Results

Progressive uptake of evidence-based CQI activities and steady improvements or maintenance of high-quality care occurred where there was long-term policy and infrastructure support for CQI. Where support was provided but not sustained there was a rapid rise and subsequent fall in relevant CQI activities.

Conclusions

Health authorities should ensure consistent and sustained policy and infrastructure support for CQI to enable wide-scale and ongoing improvement in quality of care and, subsequently, health outcomes. It is not sufficient for improvement initiatives to rely on local service managers and clinicians, as their efforts are strongly mediated by higher system-level influences.
Rubella virus infection and associated factors among pregnant women attending the antenatal care clinics of public hospitals in Hawassa City, Southern Ethiopia: a cross-sectional study
Authors: Tamirat Biniam , Hussen Siraj , Shimelis Techalew
Published: October 2017

Objective

To assess the seroprevalence of recent/acute and past exposure to rubella virus infection and associated risk factors among pregnant women.

Design

A hospital-based cross-sectional study.

Setting

The study was conducted in two public hospitals in Hawassa City, Southern Ethiopia.

Participants

A total of 422 pregnant women attending antenatal care clinics were selected using a systematic random sampling technique from March to June 2016.

Outcome measures

Data on sociodemography and related factors were collected using a structured questionnaire. Blood samples were also collected from each study participant and tested for antirubella IgM and IgG antibodies using ELISA. IgG seropositivity indicates past exposure to rubella (protective immunity). IgM seropositivity indicates recent exposure to rubella (or reinfection).

Results

The seroprevalence of antirubella IgM and IgG antibodies was 2.1% and 86.3%, respectively. Thus, the rate of susceptibility to rubella virus infection among pregnant women was found to be 13.7%. A significant association between residence site and IgG seropositivity was observed, where urban dwellers had higher past rubella exposure compared with rural residents (crude OR 6.3; 95% CI 3.29 to 12.14, p<0.001).

Conclusion

The high rate of rubella exposure and its similar distribution by sociodemography (except residence site) suggests the continuous transmission and endemicity of the infection in the study area. These findings emphasise the importance of introducing rubella-containing vaccine into routine childhood immunisation programme and vaccinating susceptible women of childbearing age.
Comparing human papillomavirus vaccine concerns on Twitter: a cross-sectional study of users in Australia, Canada and the UK
Authors: Shapiro Gilla K , Surian Didi , Dunn Adam G , Perry Ryan , Kelaher Margaret
Published: October 2017

Objective

Opposition to human papillomavirus (HPV) vaccination is common on social media and has the potential to impact vaccine coverage. This study aims to conduct an international comparison of the proportions of tweets about HPV vaccines that express concerns, the types of concerns expressed and the social connections among users posting about HPV vaccines in Australia, Canada and the UK.

Design

Using a cross-sectional design, an international comparison of English language tweets about HPV vaccines and social connections among Twitter users posting about HPV vaccines between January 2014 and April 2016 was conducted. The Health Belief Model, one of the most widely used theories in health psychology, was used as the basis for coding the types of HPV vaccine concerns expressed on Twitter.

Setting

The content of tweets and the social connections between users who posted tweets about HPV vaccines from Australia, Canada and the UK.

Population

16 789 Twitter users who posted 43 852 tweets about HPV vaccines.

Main outcome measures

The proportions of tweets expressing concern, the type of concern expressed and the proportions of local and international social connections between users.

Results

Tweets expressing concerns about HPV vaccines made up 14.9% of tweets in Canada, 19.4% in Australia and 22.6% in the UK. The types of concerns expressed were similar across the three countries, with concerns related to ‘perceived barriers’ being the most common. Users expressing concerns about HPV vaccines in each of the three countries had a relatively high proportion of international followers also expressing concerns.

Conclusions

The proportions and types of HPV vaccine concerns expressed on Twitter were similar across the three countries. Twitter users who mostly expressed concerns about HPV vaccines were better connected to international users who shared their concerns compared with users who did not express concerns about HPV vaccines.
Association between in-hospital guideline adherence and postdischarge major adverse outcomes of patients with acute coronary syndrome in Vietnam: a prospective cohort study
Authors: Nguyen Thang , Le Khanh K , Cao Hoang T K , Tran Dao T T , Ho Linh M , Thai Trang N D , Pham Hoa T K , Pham Phong T , Nguyen Thao H , Hak Eelko , Pham Tam T , Taxis Katja
Published: October 2017

Objective

We aimed to determine the association between physician adherence to prescribing guideline-recommended medications during hospitalisation and 6-month major adverse outcomes of patients with acute coronary syndrome in Vietnam.

Design

Prospective cohort study.

Setting

The study was carried out in two public hospitals in Vietnam between January and October 2015. Patients were followed for 6 months after discharge.

Participants

Patients who survived during hospitalisation with a discharge diagnosis of acute coronary syndrome and who were eligible for receiving at least one of the four guideline-recommended medications.

Exposures

Guideline adherence was defined as prescribing all guideline-recommended medications at both hospital admission and discharge for eligible patients. Medications were antiplatelet agents, beta-blockers, ACE inhibitors or angiotensin II receptor blockers and statins.

Main outcome measure

Six-month major adverse outcomes were defined as all-cause mortality or hospital readmission due to cardiovascular causes occurring during 6 months after discharge. Cox regression models were used to estimate the association between guideline adherence and 6-month major adverse outcomes.

Results

Overall, 512 patients were included. Of those, there were 242 patients (47.3%) in the guideline adherence group and 270 patients (52.3%) in the non-adherence group. The rate of 6-month major adverse outcomes was 30.5%. A 29% reduction in major adverse outcomes at 6 months after discharge was found for patients of the guideline adherence group compared with the non-adherence group (adjusted HR, 0.71; 95% CI, 0.51 to 0.98; p=0.039). Covariates significantly associated with the major adverse outcomes were percutaneous coronary intervention, prior heart failure and renal insufficiency.

Conclusions

In-hospital guideline adherence was associated with a significant decrease in major adverse outcomes up to 6 months after discharge. It supports the need for improving adherence to guidelines in hospital practice in low-income and middle-income countries like Vietnam.
Are survival and mortality rates associated with recruitment to clinical trials in teenage and young adult patients with acute lymphoblastic leukaemia? A retrospective observational analysis in England
Authors: Hough Rachael , Sandhu Sabrina , Khan Maria , Moran Anthony , Feltbower Richard , Stiller Charles , Stevens Mike C G , Rowntree Clare , Vora Ajay , McCabe Martin G
Published: October 2017

Objective

Participation rates in clinical trials are low in teenagers and young adults (TYA) with cancer. Whilst the importance of clinical trials in informing best practice is well established, data regarding individual patient benefit are scarce. We have investigated the association between overall survival and trial recruitment in TYA patients with acute lymphoblastic leukaemia (ALL).

Design

Retrospective.

Setting

National (England) TYA patients treated for ALL.

Participants

511 patients aged 15–24 years diagnosed with ALL between 2004 and 2010 inclusive, of whom 239 (46.7%) participated in the UKALL2003 trial.

Outcome measures

Patients were identified using National Clinical Trial (UKALL2003) and Cancer Registry (National Cancer Data Repository, English National Cancer Online Registration Environment) Databases. Relative survival rates were calculated for trial and non-trial patients and observed differences were modelled using a multiple regression approach. The numbers and percentages of deaths in those patients included in the survival analysis were determined for each 3-month period, p values were calculated using the two-tailed z-test for difference between proportions and 95% CIs for percentage deaths were derived using the binomial distribution based on the Wilson Score method.

Results

Patients treated on the trial had a 17.9% better 2-year survival (85.4% vs 67.5%, p<0.001) and 8.9% better 1-year survival (90.8% vs 81.9%, p=0.004) than those not on the trial. 35 (14.6%) patients recruited to the trial died in the 2 years following diagnosis compared with 86 (32.6%) of those not recruited (p<0.001).

Conclusions

TYA patients recruited to the clinical trial UKALL 2003 in England had a lower risk of mortality and a higher overall survival than contemporaneous non-trial patients. These data underline the potential for individual patient benefit in participating in a clinical trial and the importance of international efforts to increase trial participation in the TYA age group.

Trial registration number

ISRCTN07355119.
DetectaWeb Project: study protocol of a web-based detection of mental health of children and adolescents
Authors: Piqueras Jose A , Garcia-Olcina Mariola , Rivera-Riquelme Maria , Rodriguez-Jimenez Tiscar , Martinez-Gonzalez Agustin E , Cuijpers Pim
Published: October 2017

Introduction

Traditionally, research and practice addressing mental health has been conducted within a unidimensional model, explaining mental health as the presence/absence of psychological problems (distress or psychopathological symptoms). More recently, accumulative evidence has supported a bi-dimensional model, which conceptualises psychological problems and psychological strengths (well-being) as related-yet-distinct continua that, when considered together, yields a more comprehensive understanding of individuals. The DetectaWeb Project is a web-based early detection assessment of the mental health continuum (MHC) for children and adolescents and aims to: develop a web-based platform for screening of the MHC, including both psychological problems (anxiety, depression and suicidality) and personal strengths (emotional, cognitive/psychological and social aspects); examine the prevalence of the MHC among children and adolescents; and analyse key determinants (risk and protective factors) of the MHC.

Methods and analysis

We will conduct an ongoing, multicentre observational, cross-sectional study of Spanish children and adolescents. Participants will be assessed through a web-based platform. In order to validate the web-based screening system, a clinical reappraisal will be completed among a subsample of respondents. To elucidate youth’s levels of subjective distress and well-being, we will include measures of anxiety, depression, suicidality, well-being, externalising problems and socio-demographic variables.

Ethics and dissemination

Ethical approval has been obtained at all sites. All participants will sign a free and informed consent form before the assessment. Results of the study will be communicated during national and international meetings in the field of clinical and health psychology with children and adolescents. Publications will be sought in journals usually read by psychologists or psychiatrists involved in the development of epidemiological studies and interventions for mental health promotion based on resilience building for children and adolescents.
Associations between compensable injury, perceived fault and pain and disability 1 year after injury: a registry-based Australian cohort study
Authors: Giummarra Melita J , Baker Katharine S , Ioannou Liane , Gwini Stella M , Gibson Stephen J , Arnold Carolyn A , Ponsford Jennie , Cameron Peter
Published: October 2017

Objectives

Compensable injury increases the likelihood of having persistent pain after injury. Three-quarters of patients report chronic pain after traumatic injury, which is disabling for about one-third of patients. It is important to understand why these patients report disabling pain, in order to develop targeted preventative interventions. This study examined the experience of pain and disability, and investigated their sequential interrelationships with, catastrophising, kinesiophobia and self-efficacy 1 year after compensable and non-compensable injury.

Design

Observational registry-based cohort study.

Setting

Metropolitan Trauma Service in Melbourne, Victoria, Australia.

Participants

Participants were recruited from the Victorian State Trauma Registry and Victorian Orthopaedic Trauma Outcomes Registry. 732 patients were referred to the study, 82 could not be contacted or were ineligible, 217 declined and 433 participated (66.6% response rate).

Outcome measures

The Brief Pain Inventory, Glasgow Outcome Scale, EuroQol Five Dimensions questionnaire, Pain Catastrophising Scale, Pain Self-Efficacy Questionnaire, Injustice Experience Questionnaire and the Tampa Scale of Kinesiophobia.

Methods

Direct and indirect relationships (via psychological appraisals of pain/injury) between baseline characteristics (compensation, fault and injury characteristics) and pain severity, pain interference, health status and disability were examined with ordinal, linear and logistic regression, and mediation analyses.

Results

Injury severity, compensable injury and external fault attribution were consistently associated with moderate-to-severe pain, higher pain interference, poorer health status and moderate-to-severe disability. The association between compensable injury, or external fault attribution, and disability and health outcomes was mediated via pain self-efficacy and perceived injustice.

Conclusions

Given that the associations between compensable injury, pain and disability was attributable to lower self-efficacy and higher perceptions of injustice, interventions targeting the psychological impacts of pain and injury may be especially necessary to improve long-term injury outcomes.
Development and evaluation of the OHCITIES instrument: assessing alcohol urban environments in the Heart Healthy Hoods project
Authors: Sureda Xisca , Espelt Albert , Villalbí Joan R , Cebrecos Alba , Baranda Lucía , Pearce Jamie , Franco Manuel
Published: October 2017

Objectives

To describe the development and test–retest reliability of OHCITIES, an instrument characterising alcohol urban environment in terms of availability, promotion and signs of consumption.

Design

This study involved: (1) developing the conceptual framework for alcohol urban environment by means of literature reviewing and previous alcohol environment research experience; (2) pilot testing and redesigning the instrument; (3) instrument digitalisation; (4) instrument evaluation using test–retest reliability.

Setting

Data for testing the reliability of the instrument were collected in seven census sections in Madrid in 2016 by two observers.

Primary and secondary outcome measures

We computed per cent agreement and Cohen’s kappa coefficients to estimate inter-rater and test–retest reliability for alcohol outlet environment measures. We calculated interclass coefficients and their 95% CIs to provide a measure of inter-rater reliability for signs of alcohol consumption measures.

Results

We collected information on 92 on-premise and 24 off-premise alcohol outlets identified in the studied areas about availability, accessibility and promotion of alcohol. Most per cent-agreement values for alcohol measures in on-premise and off-premise alcohol outlets were greater than 80%, and inter-rater and test–retest reliability values were generally above 0.80. Observers identified 26 streets and 3 public squares with signs of alcohol consumption. Intraclass correlation coefficient between observers for any type of signs of alcohol consumption was 0.50 (95% CI −0.09 to 0.77). Few items promoting alcohol unrelated to alcohol outlets were found on public spaces.

Conclusions

The OHCITIES instrument is a reliable instrument to characterise alcohol urban environment. This instrument might be used to understand how alcohol environment associates with alcohol behaviours and its related health outcomes, and can help in the design and evaluation of policies to reduce the harm caused by alcohol.
Association of asthma–chronic obstructive pulmonary disease overlap syndrome with coronary artery disease, cardiac dysrhythmia and heart failure: a population-based retrospective cohort study
Authors: Yeh Jun-Jun , Wei Yu-Feng , Lin Cheng-Li , Hsu Wu-Huei
Published: October 2017

Objectives

Patients with asthma–chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) and cardiovascular diseases (CVDs) share common risk factors. However, the association between ACOS and the incidence of CVDs has not been reported. This study investigated the relationship between CVDs and ACOS in the general population.

Setting

Data were obtained from Taiwan’s National Health Insurance Research Database for the period 2000 to 2010.

Participants

The ACOS cohort comprised patients (n=5814) who had received a diagnosis of asthma and COPD. The non-ACOS cohort comprised patients who had not received a diagnosis of asthma or COPD and were matched to the ACOS cohort (2:1) by age, sex and index date (n=11 625).

Primary and secondary outcome measures

The cumulative incidence of CVDs—coronary artery disease (CAD), cardiac dysrhythmia (CD) and heart failure (HF)—was calculated. Cox proportional regression analysis was employed to examine the relationship between ACOS and CVDs.

Results

After adjustment for multiple confounding factors—age, sex, comorbidities and medications—patients with ACOS were associated with a significantly higher risk of CVDs; the adjusted HRs (aHRs; 95% CI) for CAD, CD and HF were 1.62 (1.50 to 1.76), 1.44 (1.30 to 1.61) and 1.94 (1.73 to 2.19), respectively, whereas those of beta-blockers treatment for CAD, CD and HF were 1.19 (0.92 to 1.53), 0.90 (0.56 to 1.45) and 0.82 (0.49 to 1.38). The aHR of atenolol treatment for CD was 1.72 (1.01 to 2.93). The aHRs (95% CIs) of ACOS without acute exacerbation of COPD (AE-COPD) for CAD, CD and HF were 1.85 (1.70 to 2.01), 1.57 (1.40 to 1.77) and 2.07 (1.82 to 2.35), respectively.

Conclusion

ACOS was associated with higher CVD risk, even without the presence of previous comorbidities or AE-COPD. No significant differences in CVD events were observed in the ACOS cohort using beta-blockers, except for those using atenolol for treating CD.
Incidence, risk factors and perinatal outcomes for placenta accreta in Australia and New Zealand: a case–control study
Authors: Farquhar Cynthia M , Li Zhuoyang , Lensen Sarah , McLintock Claire , Pollock Wendy , Peek Michael J , Ellwood David , Knight Marian , Homer Caroline SE , Vaughan Geraldine , Wang Alex , Sullivan Elizabeth
Published: October 2017

Objective

Estimate the incidence of placenta accreta and describe risk factors, clinical practice and perinatal outcomes.

Design

Case–control study.

Setting

Sites in Australia and New Zealand with at least 50 births per year.

Participants

Cases were women giving birth (≥20 weeks or fetus ≥400 g) who were diagnosed with placenta accreta by antenatal imaging, at operation or by pathology specimens between 2010 and 2012. Controls were two births immediately prior to a case. A total of 295 cases were included and 570 controls.

Methods

Data were collected using the Australasian Maternity Outcomes Surveillance System.

Primary and secondary outcome measures

Incidence, risk factors (eg, prior caesarean section (CS), maternal age) and clinical outcomes of placenta accreta (eg CS, hysterectomy and death).

Results

The incidence of placenta accreta was 44.2/100 000 women giving birth (95% CI 39.4 to 49.5); however, this may overestimated due to the case definition used. In primiparous women, an increased odds of placenta accreta was observed in older women (adjusted OR (AOR) women≥40 vs <30: 19.1, 95% CI 4.6 to 80.3) and current multiple birth (AOR: 6.1, 95% CI 1.1 to 34.1). In multiparous women, independent risk factors were prior CS (AOR ≥2 prior sections vs 0: 13.8, 95% CI 7.4 to 26.1) and current placenta praevia (AOR: 36.3, 95% CI 14.0 to 93.7). There were two maternal deaths (case fatality rate 0.7%).

Women with placenta accreta were more likely to have a caesarean section (AOR: 4.6, 95% CI 2.7 to 7.6) to be admitted to the intensive care unit (ICU)/high dependency unit (AOR: 46.1, 95% CI 22.3 to 95.4) and to have a hysterectomy (AOR: 209.0, 95% CI 19.9 to 875.0). Babies born to women with placenta accreta were more likely to be preterm, be admitted to neonatal ICU and require resuscitation.
Feasibility of using administrative data for identifying medical reasons to delay hip fracture surgery: a Canadian database study
Authors: Guy Pierre , Sheehan Katie J , Morin Suzanne N , Waddell James , Dunbar Michael , Harvey Edward , Sirett Susan , Sobolev Boris , Kuramoto Lisa , Tang Michael
Published: October 2017

Purpose

Failure to account for medically necessary delays may lead to an underestimation of early surgery benefits. This study investigated the feasibility of using administrative data to identify the National Institute for Health and Care Excellence (NICE) 124 guideline list of conditions that appropriately delay hip fracture surgery.

Methods

We assembled a list of diagnosis and procedure codes to reflect the NICE 124 conditions. The list was reviewed and updated by an advanced clinical coder. The list was refined by five clinical experts. We then screened Canadian Institute for Health Information discharge abstracts for 153 918 patients surgically treated for a non-pathological first hip fracture between 1 January 2004 and 31 December 2012 for diagnosis codes present on admission and procedure codes that antedated hip fracture surgery. We classified abstracts as having medical reasons for delaying surgery based on the presence of these codes.

Results

In total, 10 237 (6.7%; 95% CI 6.5% to 6.8%) patients had diagnostic and procedure codes indicating medical reasons for delay. The most common reasons for medical delay were exacerbation of a chronic chest condition (35.9%) and acute chest infection (23.2%). The proportion of patients with reasons for medical delays increased with time from admission to surgery: 3.9% (95% CI 3.6% to 4.1%) for same day surgery; 4.7% (95% CI 4.5% to 4.8%) for surgery 1 day after admission; 7.1% (95% CI 6.9% to 7.4%) for surgery 2 days after admission; and 15.5% (95% CI 15.1% to 16.0%) for surgery more than 2 days after admission. The trend was seen for admissions on weekday working hours, weekday after hours and on weekends.

Conclusion

Administrative data can be considered to identify conditions that appropriately delay hip fracture surgery. Accounting for medically necessary delays can improve estimates of the effectiveness of early surgery.
Hypertensive disorders of pregnancy and risk of neurodevelopmental disorders in the offspring: a systematic review and meta-analysis protocol
Authors: Maher Gillian M , O’Keeffe Gerard W , Kenny Louise C , Kearney Patricia M , Dinan Ted G , Khashan Ali S
Published: October 2017

Introduction

Hypertensive disorders of pregnancy (HDPs), that is chronic hypertension, gestational hypertension, pre-eclampsia (de novo or superimposed on chronic hypertension) and white coat hypertension, affect approximately 5%–15% of pregnancies. HDP exposure has been linked to an increased risk of autism spectrum disorder, attention deficit/hyperactivity disorder and other neurodevelopmental disorders in children. However, findings are inconsistent, and a clear consensus on the impact of HDPs on the risk of neurodevelopmental disorders is needed. Therefore, we aim to synthesise the published literature on the relationship between HDPs and the risk of neurodevelopmental disorders in the form of a systematic review and meta-analysis.

Methods and analysis

We will include cohort, case–control and cross-sectional studies in which diagnosis of an HDP was reported, and neurodevelopmental disorders were the outcome of interest based on a preprepared protocol. A systematic search of PubMed, CINAHL, Embase, PsycINFO and Web of Science will be conducted in accordance with a detailed search strategy. Two authors will independently review the titles and abstracts of all studies, perform data extraction using a standardised data collection form and assess study quality using a bias classification tool. Meta-analyses will be performed to calculate overall pooled estimates using the generic inverse variance method. This systematic review will be reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses.

Ethics and dissemination

This proposed systematic review and meta-analysis is based on published data, therefore, does not require ethics approval. Findings will be presented at scientific conferences and disseminated through publication in a peer-reviewed journal.

Registration

CRD42017068258.
Routes to diagnosis of heart failure: observational study using linked data in England
Authors: Bottle Alex , Kim Dani , Aylin Paul , Cowie Martin R , Majeed Azeem , Hayhoe Benedict
Published: October 2017

Objective

Timely diagnosis and management of heart failure (HF) is critical, but identification of patients with suspected HF can be challenging, especially in primary care. We describe the journey of people with HF in primary care from presentation through to diagnosis and initial management.

Methods

We used the Clinical Practice Research Datalink (primary care consultations linked to hospital admissions data and national death registrations for patients registered with participating primary care practices in England) to describe investigation and referral pathways followed by patients from first presentation with relevant symptoms to HF diagnosis, particularly alignment with recommendations of the National Institute for Health and Care Excellence guideline for HF diagnosis.

Results

36 748 patients had a diagnosis of HF recorded that met the inclusion criteria between 1 January 2010 and 31 March 2013. For 29 113 (79.2%) patients, this was first recorded in hospital. In the 5 years prior to diagnosis, 15 057 patients (41.0%) had a primary care consultation with one of three key HF symptoms recorded, 17 724 (48.2%) attended for another reason and 3967 (10.8%) did not see their general practitioner. Only 24% of those with recorded HF symptoms followed a pathway aligned with guidelines (echocardiogram and/or serum natriuretic peptide test and specialist referral), while 44% had no echocardiogram, natriuretic peptide test or referral.

Conclusions

Patients follow various pathways to the diagnosis of HF. However, few appear to follow a pathway supported by guidelines for investigation and referral. There are likely to be missed opportunities for earlier HF diagnosis in primary care.
Factors across the life course predict women’s change in smoking behaviour during pregnancy and in midlife: results from the National Child Development Study
Authors: Schoenaker Danielle A J M , Ploubidis George B , Goodman Alissa , Mishra Gita D
Published: October 2017

Background

Tobacco smoking before, during and after pregnancy remains one of the few preventable factors associated with poor health outcomes for mothers and their children. We investigate predictors across the life course for change in smoking behaviour during pregnancy and whether this change predicts smoking status in midlife.

Methods

Data were from the National Child Development Study (1958 British birth cohort). We included female cohort members who reported a first pregnancy up to age 33 years. Among 1468 women who smoked before pregnancy, we examined predictors reported in childhood (age 11 years), adolescence (age 16 years) and early adulthood (age 23 years) of change in smoking behaviour from 12 months before to during pregnancy using log-binomial regression. The association between change in smoking behaviour during pregnancy and smoking status in midlife (age 55 years) was examined while adjusting for predictors across the life course.

Results

Among prepregnancy smokers (39%), 26% reduced and 35% quit smoking during pregnancy. Parental smoking and lower social class during childhood, and early adulthood lower social class, depression, early smoking initiation, high smoking intensity, living with a smoker, no pregnancy planning and early motherhood were associated with lower probability of smoking reduction or cessation in pregnancy. Compared with women who smoked before and during pregnancy, women who reduced or quit were two times more likely to be non-smoker at age 55 years (95% CI 1.76 to 2.20).

Conclusions

Findings from this population-based birth cohort study lend support for smoking cessation strategies that target those at risk at various stages across the life course.
Antifibrinolytics in a rural trauma state: assessing the opportunities
Authors: Bardes James M , Palmer Amanda , Con Jorge , Wilson Alison , Schaefer Gregory
Published: October 2017

Background

Tranexamic acid (TXA) has demonstrated improved mortality among trauma patients. However, recent evidence from urban US trauma centers has failed to show a benefit among the civilian population. TXA in rural states has not been evaluated. This study aimed to evaluate the current use of TXA in the rural trauma population.

Methods

A retrospective observational review at a level 1 trauma center based in a rural environment. Records were reviewed for TXA indications. TXA indication was defined as: systolic blood pressure <90 mm Hg, blood transfusion, or with a clinical concern for ongoing bleeding. Patients were ineligible if the time since injury was >3 hours.

Results

400 patients were evaluated. 54% of patients met indications for TXA. 14% of these received TXA. 30.4% with an indication for TXA were ineligible due to arrival beyond 3 hours from time of injury. 135 patients arrived as transfers, 265 from the scene. There was no difference in TXA indications between scene and transfers (73 vs 144, p=1). Transfers were more likely to arrive beyond the 3-hour window (59 vs 7, p=0.001). Mortality for patients treated with TXA was 12.5%. This was not significantly different from patients not treated with TXA (19%).

Discussion

In a rural system, long transfers exclude most patients from treatment with TXA. A multicenter rural trauma center study will be needed to better define the optimal use of TXA in rural populations.

Level of evidence

Level IV data: therapeutic/care management.
Role of mycotoxins in herds with and without problems with tail necrosis in neonatal pigs
Authors: Van Limbergen Tommy , Devreese Mathias , Croubels Siska , Broekaert Nathan , Michiels Annelies , De Saeger Sarah , Maes Dominiek
Published: October 2017

This study aimed to investigate a possible involvement of mycotoxins in neonatal tail necrosis in piglets. Ten affected and 10 non‐affected farms were selected. Sow feed samples were analysed for the presence of 23 mycotoxins by liquid chromatography‐tandem mass spectrometry (LC‐MS/MS). Blood plasma samples of sows and their piglets were analysed for the presence of deoxynivalenol (DON), de‐epoxydeoxynivalenol, T‐2 and HT‐2 toxin, zearalenone, alfa‐zearalenol, and beta‐zearalenol, using LC‐MS/MS. Additionally, high‐resolution mass spectrometry (HRMS) was performed to detect DON‐glucuronide (DON‐Glca). There was a significant difference between case herds and control herds for mean DON concentrations in feed and sow plasma. For piglet samples, concentrations of DON were above the limit of quantification of 0.1 ng/ml in only 12 samples. Positive correlations were found between DON concentrations in sow feed and plasma of sows; DON concentration in sow feed and DON‐Glca concentration in plasma of sows; and between DON and DON‐Glca concentration in sow‐plasma. In conclusion, high prevalence of DON in feed samples was found, with significantly higher concentrations in case herds, as well as the presence of DON and DON‐Glca in sow plasma. Additional research is needed to identify risk factors, including within‐herd factors, associated with neonatal tail necrosis in piglets.
Air velocity influences thermoregulation and endurance exercise capacity in the heat
Authors: Otani Hidenori , Kaya Mitsuharu , Tamaki Akira , Watson Phillip , Maughan Ronald J.
Published: October 2017

This study examined the effects of variations in air velocity on time to exhaustion and thermoregulatory and perceptual responses to exercise in a hot environment. Eight male volunteers completed stationary cycle exercise trials at 70% peak oxygen uptake until exhaustion in an environmental chamber maintained at 30 °C and 50% relative humidity. Four air velocity conditions, 30, 20, 10, and 0 km/h, were tested, and the headwind was directed at the frontal aspect of the subject by 2 industrial fans, with blade diameters of 1 m and 0.5 m, set in series and positioned 3 m from the subject’s chest. Mean ± SD time to exhaustion was 90 ± 17, 73 ± 16, 58 ± 13, and 41 ± 10 min in 30-, 20-, 10-, and 0-km/h trials, respectively, and was different between all trials (P < 0.05). There were progressive elevations in the rate of core temperature rise, mean skin temperature, and perceived thermal sensation as airflow decreases (P < 0.05). Core temperature, heart rate, cutaneous vascular conductance, and perceived exertion were higher and evaporative heat loss was lower without airflow than at any given airflow (P < 0.05). Dry heat loss and plasma volume were similar between trials (P > 0.05). The present study demonstrated a progressive reduction in time to exhaustion as air velocity decreases. This response is associated with a faster rate of core temperature rise and a higher skin temperature and perceived thermal stress with decreasing airflow. Moreover, airflow greater than 10 km/h (2.8 m/s) might contribute to enhancing endurance exercise capacity and reducing thermoregulatory, cardiovascular, and perceptual strain during exercise in a hot environment.
Using portable near-infrared spectroscopy to predict pig subcutaneous fat composition and iodine value
Authors: Prieto N. , Dugan M.E.R. , Juárez M. , López-Campos Ó. , Zijlstra R.T. , Aalhus J.L.
Published: October 2017

This study tested the potential of portable near-infrared spectroscopy (NIRS) to predict fatty acids (FA) composition and iodine value (IV) of pig subcutaneous fat. Following carcass splitting, the inner layer of subcutaneous fat at the shoulder from the left carcass side was scanned using a hand-held NIRS probe (350–2500 nm) and analysed for FA composition using gas chromatography. The NIRS successfully predicted the total polysaturated fatty acids (PUFA) and n-3 FA proportions, polyunsaturated/saturated fatty acids (PUFA/SFA) ratio, and IV (R2 = 0.90–0.95; root-mean-square error of prediction, RMSEP = 0.019%–1.03% total FA). This portable technology also met the requirements for a quick screening of the proportions of total SFA, monounsaturated fatty acids (MUFA) and n-6 FA, n-6/n-3 ratio, and some individual FA such as C18:2n-6 and C18:3n-3 (R2 = 0.80–0.89; RMSEP = 0.37%–1.11% total FA). However, unreliable predictions were found for other individual FA with low variability (coefficient of variation = 4%–8%) such as C16:0, C18:0, and C18:1 (R2 = 0.60–0.77; RMSEP = 0.76%–1.00% total FA). These results show portable NIRS as a suitable technology to predict pig fat quality. In addition, this study has been successful in implementing this portable NIRS technology in a research abattoir to collect spectra directly on the carcass, which would enable carcass sorting based on fat composition or hardness for marketing purposes.
In silico analysis of coevolution among ERMES proteins, Pex11, and Lam6
Authors: Court Deborah A. , Khetoo Shivani , Shuvo Sabbir R. , Reitmeier Shayne D. , Hausner Georg
Published: October 2017

In eukaryotic cells, communication and dynamic interactions among different organelles are important for maintaining cellular homeostasis. The endoplasmic reticulum (ER) mitochondria encounter structure (ERMES) complex establishes membrane contact sites between ER and mitochondria and is essential for phospholipid transport, protein import, and mitochondrial dynamics and inheritance. In this work, in silico analyses were used to probe the intramolecular interactions in ERMES proteins and the interactions that support the ERMES complex. Based on mutual information (MI), sites of intramolecular coevolution are predicted in the core proteins Mmm1, Mdm10, Mdm12, Mdm34, the peroxisomal protein Pex11, and cytoplasmic Lam6; these sites are linked to structural features of the proteins. Intermolecular coevolution is predicted among the synaptotagmin-like mitochondrial lipid-binding protein (SMP) domains of Mmm1, Mdm12, and Mdm34. Segments of Pex11 and Lam6 also share MI with the SMP domains of Mmm1 and Mdm12 and with the N terminus of Mdm34, implicating Mdm34 as part of a hub for interactions between ERMES and other complexes. In contrast, evidence of limited intermolecular coevolution involving the outer membrane protein Mdm10 was detected only with Mmm1 and Pex11. The results support models for the organization of these interacting proteins and suggest roles for Pex11 and Lam6 in regulating complex formation.
Thomas–Fermi model in Rindler space
Authors: Das Sanchita , Ghosh Sutapa , Chakrabarty Somenath
Published: October 2017

In this paper, we have investigated the Thomas–Fermi model for the electron gas in Rindler space. We have observed that if the uniform acceleration is along [Formula: see text]-direction, then there is [Formula: see text]-symmetry in space. For the sake of mathematical simplicity, we have therefore assumed a two-dimensional spatial structure [Formula: see text] in Rindler space. It has been shown that in two-dimensional spatial coordinates, the electrons are distributed discontinuously but in a periodic manner in a number of rectangular strip-like domains along [Formula: see text]-direction. Some of them are having void structure, with no electrons inside such rectangular strips, while some are filled up with electrons. We call the latter type domain as the normal zone. We have also given physical interpretation for such exotic type electron distribution in Rindler space.
Element-Independent Pure Deformational and Co-Rotational Methods for Triangular Shell Elements in Geometrically Nonlinear Analysis
Authors: Tang Y. Q. , Liu Y. P. , Chan S. L.
Published: October 2017

Proposed herein is a novel pure deformational method for triangular shell elements that can decrease the element quantities and simplify the element formulation. This approach has computational advantages over the conventional finite element method for linear and nonlinear problems. In the element level, this method saves time for computing stresses, internal forces and stiffness matrices. A flat shell element is formed by a membrane element and a plate element, so that the pure deformational membrane and plate elements are derived and discussed separately in this paper. Also, it is very convenient to incorporate the proposed pure deformational method into the element-independent co-rotational (EICR) framework for geometrically nonlinear analysis. Thus, on the basis of the pure deformational method, a novel EICR formulation is proposed which is simpler and has more clear physical characteristics than the traditional formulation. In addition, a triangular membrane element with drilling rotations and the discrete Kirchhoff triangular plate element are used to verify the proposed pure deformational method, although several benchmark problems are employed to verify the robustness and accuracy of the proposed EICR formulations.
Subspace Flexibility Identification Adaptive to Different Types of Input Forces
Authors: Li P. J. , Xia Q. , Zhang J.
Published: October 2017

Impact testing is an effective means of identifying structural flexibility. However, most flexibility identification methods have strict requirements on the type of input forces. For instance, methods operated in the frequency domain may generate incorrect flexibility identification results when double or multiple clicks occur in an impact test. This article proposes a method to estimate the structural modal scaling coefficients and flexibility characteristics using a subspace identification algorithm in the time domain. The advantage of the proposed method is that it adapts to the input force type and thus has the potential to be widely used in engineering practice. Numerical and experimental examples are presented to illustrate the effectiveness and robustness of the proposed method.
THE BIOPHYSICAL PARAMETER MEASUREMENTS FROM PPG SIGNAL
Authors: BHAT SHREYA , ADAM MUHAMMAD , HAGIWARA YUKI , NG EDDIE Y. K.
Published: October 2017

Early investigation on blood circulation by Hertzman (1937) leads to the observation of vital body signs such as respiration rate, heart rate (HR), blood oxygenation and vascular assessment using photoplethysmographic (PPG) device. PPG is a noninvasive, painless optical technique used to monitor the pulsations linked to alteration in the blood volume. The PPG waveform is a summation of pulsatile and nonpulsatile components and contains useful information about the physiological systems. With the breakthrough in technology and development of powerful analytical tools, PPG devices are constantly being used in advanced medical equipments such as smart-watches and smart-wristbands for HR monitoring, pulse oximeters for measuring respiratory rate and noncontact PPG device for blood oxygen saturation measurement. This paper presents description on PPG and its characteristic waveform and working principle. It also includes brief explanation on nonlinear analysis of PPG signals and salient applications of PPG followed by its advantages and limitations.
Symmetrized topological complexity
Authors: Grant Mark
Published: October 2017

We present upper and lower bounds for symmetrized topological complexity [Formula: see text] in the sense of Basabe–González–Rudyak–Tamaki. The upper bound comes from equivariant obstruction theory, and the lower bounds from the cohomology of the symmetric square [Formula: see text]. We also show that symmetrized topological complexity coincides with its monoidal version, where the path from a point to itself is required to be constant. Using these results, we calculate the symmetrized topological complexity of all odd spheres.
Crowd region detection in outdoor scenes using color spaces
Authors: Chaudhry Huma , Rahim Mohd Shafry Mohd , Saba Tanzila , Rehman Amjad
Published: October 2017

In the last few decades, crowd detection has gained much interest from the research community to assist a variety of applications in surveillance systems. While human detection in partially crowded scenarios have achieved many reliable works, a highly dense crowd-like situation still is far from being solved. Densely crowded scenes offer patterns that could be used to tackle these challenges. This problem is challenging due to the crowd volume, occlusions, clutter and distortion. Crowd region classification is a precursor to several types of applications. In this paper, we propose a novel approach for crowd region detection in outdoor densely crowded scenarios based on color variation context and RGB channel dissimilarity. Experimental results are presented to demonstrate the effectiveness of the new color-based features for better crowd region detection.
Crustal structure of the Mid Black Sea High from wide-angle seismic data
Authors: Shillington D. J. , Minshull T. A. , Edwards R. A. , White N.
Published: October 2017

The Mid Black Sea High comprises two en echelon basement ridges, the Archangelsky and Andrusov ridges, that separate the western and eastern Black Sea basins. The sediment cover above these ridges has been characterized by extensive seismic reflection data, but the crustal structure beneath is poorly known. We present results from a densely sampled wide-angle seismic profile, coincident with a pre-existing seismic reflection profile, which elucidates the crustal structure. We show that the basement ridges are covered by approximately 1–2 km of pre-rift sedimentary rocks. The Archangelsky Ridge has higher pre-rift sedimentary velocities and higher velocities at the top of basement (
c.
6 km s
−1
). The Andrusov Ridge has lower pre-rift sedimentary velocities and velocities less than 5 km s
−1
at the top of the basement. Both ridges are underlain by approximately 20-km-thick crust with velocities reaching around 7.2 km s
−1
at their base, interpreted as thinned continental crust. These high velocities are consistent with the geology of the Pontides, which is formed of accreted island arcs, oceanic plateaux and accretionary complexes. The crustal thickness implies crustal thinning factors of approximately 1.5–2. The differences between the ridges reflect different sedimentary and tectonic histories.
The Perceptual Consequences of Curved Screens
Authors: Zannoli Marina , Banks Martin S.
Published: October 2017

Flat panels are by far the most common type of television screen. There are reasons, however, to believe that curved screens create a greater sense of immersion, reduce distracting reflections, and minimize some perceptual distortions that are commonplace with large televisions. To examine these possibilities, we calculated how curving the screen affects the field of view and the probability of seeing reflections of ambient lights. We find that screen curvature has a small beneficial effect on field of view and a large beneficial effect on the probability of seeing reflections. We also collected behavioral data to characterize perceptual distortions in various viewing configurations. We find that curved screens can in fact reduce problematic perceptual distortions on large screens, but that the benefit depends on the geometry of the projection on such screens.