bluuebunny/crossref_metadata_2025 huggingface dataset:
Ecological succession in areas degraded by bauxite mining indicates successful use of topsoil
Authors: Onésimo Cecilia M. G. , Dias Diego D. , Vale Beirão Marina , Kozovits Alessandra R. , Messias Maria Cristina T. B.
Published: October 2020

Brazilian ironstone outcrops (cangas) are nutrient‐poor stressful habitat dominated by slow‐growing woody species with high biodiversity and unique evolutionary history. Mining has produced great impacts on this ecosystem. Spontaneous regeneration of abandoned canga mined areas has not been observed. One of the active methods most widely used for ecological restoration in environments where soil has been lost or severely degraded is topsoil transposition due to the physical, chemical, and microbiological improvement of the substrate, in addition to the seed bank. Thus, plant succession was monitored for 40 months after topsoil transposition in a canga area degraded by aluminum mining, without any other type of management. A completely randomized design with 70 permanent plots (1 × 1 m) was used. Annual phytosociological surveys were carried out and floristic and vegetational spectra were constructed with the life‐forms proposed by Raunkiaer. Floristic composition was compared with a reference site. Overall, 105 species were identified. Both flora and vegetation changed over time, increasing resemblance to the reference areas. The floristic and vegetational spectra after 4 years of topsoil deposition are similar to pristine ones. The vegetation spectrum showed an increase in the dominance of phanerophytes and hemicryptophytes, while therophytes reduced their proportion. The early successional stage is dominated by weeds, like in other canga restoration studies, but did not impede the native species regeneration. Cangas's species recruited well from transposed topsoil. Unlike other studies with fertilized topsoil, our findings show the efficiency of topsoil transposition to provide initial conditions for the ecological restoration of this ecosystem.
Male family carers' experiences of formal support – a meta‐ethnography
Authors: Finn Caroline , Boland Pauline
Published: October 2020

Background

Men represent a growing proportion of unpaid family carers across Europe. Comparative studies have proposed male carers experience their caring role differently to females; men are less likely to avail of formal support services than women. Social ideas around masculinity have been linked to the help‐seeking behaviours of male carers, as well as men's attitudes around accessing formal support. More understanding about this role from the perspective of male carers is required.

Methods

The study followed a meta‐ethnography process starting with a systematic literature search of five electronic databases. The methodological quality of the selected studies was evaluated using the Mc Master checklist. Using NVivo 12 software, primary data were analysed and themes throughout the papers were identified. Results were synthesised as a meta‐ethnography that retained direct quotes from the studies.

Results

Two themes and five sub‐themes were developed from the data. The first theme was ‘Men's experiences of formal support’ which contained sub‐themes ‘Reluctance to step back’, ‘A space to share emotions’ and ‘Education diminishes burden’. The second theme was ‘Coping without Formal Support’ with sub‐themes ‘Satisfied without help’ and ‘Duty prevents help seeking’.

Conclusions

Fear of perceived failure and a loss of control in the caring relationship were key factors in men's low trust and dissatisfaction with available services. To engage more male carers, formal service providers should acknowledge men's wish to be seen as competent in the care role as well as their desire to stay involved in decision‐making around care for their family member. Support services that were collaborative, education‐based and gender‐sensitive were favoured by male carers.
Introductory data science across disciplines, using Python, case studies, and industry consulting projects
Authors: Lasser Jana , Manik Debsankha , Silbersdorff Alexander , Säfken Benjamin , Kneib Thomas
Published: October 2020

Data and its applications are increasingly ubiquitous in the rapidly digitizing world and consequently, students across different disciplines face increasing demand to develop skills to answer both academia's and businesses' increasing need to collect, manage, evaluate, apply and extract knowledge from data and critically reflect upon the derived insights. On the basis of recent experiences at the University of Ttingen, Germany, we present a new approach to teach the relevant data science skills as an introductory service course at the university or advanced college level. We describe the outline of a complete course that relies on case studies and project work built around contemporary data sets, including openly available online teaching resources.
Physaria fendleri and Ricinus communis lecithin:cholesterol acyltransferase‐like phospholipases selectively cleave hydroxy acyl chains from phosphatidylcholine
Authors: Xu Yang , Caldo Kristian Mark P. , Singer Stacy D. , Mietkiewska Elzbieta , Greer Michael S. , Tian Bo , Dyer John M. , Smith Mark , Zhou Xue‐Rong , Qiu Xiao , Weselake Randall J. , Chen Guanqun
Published: October 2020

Production of hydroxy fatty acids (HFAs) in transgenic crops represents a promising strategy to meet our demands for specialized plant oils with industrial applications. The expression of Ricinus communis (castor) OLEATE 12‐HYDROXYLASE (RcFAH12) in Arabidopsis has resulted in only limited accumulation of HFAs in seeds, which probably results from inefficient transfer of HFAs from their site of synthesis (phosphatidylcholine; PC) to triacylglycerol (TAG), especially at the sn‐1/3 positions of TAG. Phospholipase As (PLAs) may be directly involved in the liberation of HFAs from PC, but the functions of their over‐expression in HFA accumulation and distribution at TAG in transgenic plants have not been well studied. In this work, the functions of lecithin:cholesterol acyltransferase‐like PLAs (LCAT‐PLAs) in HFA biosynthesis were characterized. The LCAT‐PLAs were shown to exhibit homology to LCAT and mammalian lysosomal PLA2, and to contain a conserved and functional Ser/His/Asp catalytic triad. In vitro assays revealed that LCAT‐PLAs from the HFA‐accumulating plant species Physaria fendleri (PfLCAT‐PLA) and castor (RcLCAT‐PLA) could cleave acyl chains at both the sn‐1 and sn‐2 positions of PC, and displayed substrate selectivity towards sn‐2‐ricinoleoyl‐PC over sn‐2‐oleoyl‐PC. Furthermore, co‐expression of RcFAH12 with PfLCAT‐PLA or RcLCAT‐PLA, but not Arabidopsis AtLCAT‐PLA, resulted in increased occupation of HFA at the sn‐1/3 positions of TAG as well as small but insignificant increases in HFA levels in Arabidopsis seeds compared with RcFAH12 expression alone. Therefore, PfLCAT‐PLA and RcLCAT‐PLA may contribute to HFA turnover on PC, and represent potential candidates for engineering the production of unusual fatty acids in crops.
Incisional complications after skin closure with n‐butyl cyanoacrylate or stainless‐steel skin staples in horses undergoing colic surgery
Authors: Martinez‐Lopez Javier , Brown James A. , Werre Stephen R.
Published: October 2020

Objective

To compare the prevalence of incisional complications after skin closure with n‐butyl cyanoacrylate (NBC) or stainless‐steel skin staples (SS) after ventral midline celiotomy for colic surgery in the horse.

Study design

Retrospective study (2014‐2018).

Animals

Two hundred eighteen horses.

Methods

Medical records of horses that underwent exploratory celiotomy for colic were included when the skin was closed with NBC or SS and the horse survived ≥15 days after surgery. Records and a follow‐up questionnaire were used to determine in‐hospital and posthospital discharge incisional complications. Associations between variables were assessed by using bivariable and multivariable analysis.

Results

The cutaneous incision was closed with SS in 113 of 218 (51.8%) horses and with NBC in 105 of 218 (48.2%) horses. Follow‐up information was available in 166 of 218 horses. Five horses with incisional complications prior to discharge but without follow‐up were included in the overall analysis. Incisional complications were recorded in 17.5% (30/171) of horses, including 19.1% (17/89) of closures with SS and 15.9% (12/82) of closures with NBC (P = .54). Complications occurred before discharge in 14 of 218 (6.4%) horses and after discharge in 16 of 166 (9.6%) horses. Four horses with in‐hospital incisional complications (surgical site infection) developed a second complication after discharge (hernia). Packed cell volume was a risk factor for in‐hospital incisional complications (P = .04), and in‐hospital incisional complications were associated with posthospital discharge incisional complications (P = .01).

Conclusion

Occurrence of incisional complications did not differ between NBC and SS.

Clinical significance

N‐butyl cyanoacrylate is a suitable alternative to SS to close the cutaneous incision for ventral midline celiotomy for colic surgery in the horse.
RETROFITTING OF SELF COMPACTING RC HALF JOINTS WITH INTERNAL DEFICIENCIES BY CFRP FABRICS
Authors: M. Shakir Qasim , B. Abd Baneen
Published: October 2020

An experimental study has been conducted to scrutinize the response of reinforced self-compacting concrete half joints upgraded with CFRP strips. Fourteen RC half joints have been tested. Two values of shear slenderness ratio were considered, namely 1.5 and 1.0. Two beams have been treated as reference specimens (with the design steel), and the twelve other beams were casted with deficiency in steel of the hanger and the extended end regions relative to the control beams. Eight of these beams have been strengthened with different arrangements to discuss the influence of shear slenderness ratio and strengthening arrangement on the overall performance of such joint elements. It is found that the reduction in nib-main steel by about 50% results in decreasing load capacity by about 36% and 15% for shear slenderness ratio of 1.5 and 1.0 respectively. Also, it is found that the orthogonal arrangement combined with inclined strips yielded the best results in terms of preventing the diagonal shear failure at the re-entrant corner with maximum enhancement in load capacity by 18%. In addition, the maximum improvement in failure load when strengthening hanger region by such alignment was about 23%. Results also revealed that the effective stiffness and ductility ratio enhanced with reducing shear span of a half joint and may be adopted as a good indicator to evaluate the suitable strengthening scheme. Moreover, it is concluded that the relative displacement method for predicting the ductility ratio is more applicable than that based on the dissipated energy.
Modeling and Load Capacity Analysis of Reciprocating Hybrid Linear Guideway With Annular Groove and Sloped Recesses
Authors: Du Huanyu , Li Hongguang , Meng Guang
Published: October 2020

In this work, we research a reciprocating hybrid linear guideway and study its load capacity. This hybrid guideway's bearing surface is designed with an annular groove and two sloped shallow recesses. The analysis is based on modeling by mass-conserving cavitation algorithm (p − θ cavitation algorithm), where a modified smoothing switch function is raised for better convergence. Focusing on the normal direction to reciprocation, the load-guideway system is simplified as a single-degree-of-freedom linear time-varying system and solved by Newmark-β method. Due to the hybrid guideway's time-varying dynamic characteristics, there is a normal vibration in reciprocation. By analyzing two typical load cases in detail, the results indicate that the hybrid guideway has greater load capacity than the hydrostatic guideway, and the normal vibration is small enough for most engineering situations.
Rotordynamic Performance of the Interlocking Labyrinth Seal With a Tilting Rotor
Authors: Zhang Wanfu , Wang Yingfei , Gu Qianlei , Yin Lu , Yang Jiangang
Published: October 2020

Numerical analysis model of an interlocking labyrinth seal (ILS) is established for studying the effect of tilting rotor on its rotordynamic characteristics. The dynamic characteristic identification method based on infinitesimal theory is applied to solve the dynamic force coefficient of the seal with arbitrary elliptical orbits and eccentric positions under field conditions. The paper investigated the dynamic characteristics of the interlocking labyrinth seal with various misalignment angles (θ = 0, 0.1 deg, 0.2 deg, 0.3 deg, 0.4 deg, 0.5 deg, 0.6 deg), different pressure ratios (Pin = 6.9 bar, PR = 0.5, 0.8), locations of misalignment center (Loc = 0, L/2, L). Results show that the tilting rotor could minimize the leakage flow rate of the ILS. When the misalignment angle θ = 0.6 deg, the mass flow rate can be reduced about 2.5%. The effect of each cavity in the ILS on the stability of the system is different. The cavity with the inlet close to the rotor and the outlet away from the rotor helps to improve the system stability due to its locally antirotational flow. The effective damping of the entire ILS increases as the misalignment angle increases. The system shows the best stability when the misalignment center is close to the seal inlet. The tilting rotor has a positive effect on the stability of the ILS only except for high whirling frequency (>100 Hz) under Loc = L.
Nonlinear Vibrations of a Composite Beam in Large Displacements: Analytical, Numerical, and Experimental Approaches
Authors: Utzeri Mattia , Sasso Marco , Chiappini Gianluca , Lenci Stefano
Published: October 2020

This paper investigates the nonlinear dynamic behavior of a cantilever beam made of composite material without and with lumped mass fixed along its length. The analysis compares the results coming from analytical and numerical modeling with experimental observations. The first part focuses on the analytical model. The model takes into account the nonlinearity derived from large amplitude vibration and inertia. The second part deals with the experimental test, where the specimen and the data acquisition are defined. Then, the nonlinearity of the acquired data is determined by the fitting time history (FTH) technique. The third part deals with the finite element model. Finally, the results obtained by the analytical method, the experimental method, and the numerical method are compared between each other.
Thermal Behavior of Teeth During Restoration Procedure With Composite: Experimental Tests and Numerical Simulation
Authors: Potenza M. , Coppa P. , Cerroni L. , Bovesecchi G.
Published: October 2020

Different thermal mechanisms influence the tooth temperature during the reconstruction practice of tooth restoration: conduction in the hard tissues and their thermal capacitance, heat generation by composite curing, irradiation of the surface from the LED lamp, convection, and conduction to the environment. All these phenomena were considered into a numerical (finite difference, FD) model to simulate the temperature trend in a tooth during reconstruction with a resin composite addition, and results compared with experiments on cylindrical sample with a cavity filled with resin. Results demonstrate that all the phenomena have been sufficiently accurately described, and the way to apply the model to real teeth is recognized.
Enhancing Graduate Student Research, Recruitment, and Retention via a Summer Research Experience
Authors: Russell Jared A.
Published: October 2020

Programs that provide student research experiences at the undergraduate level are an impactful means of recruiting and preparing students for graduate academic programs. Notably, such programs, when combined with faculty mentorship, exposure to graduate-school-level academic curricula, and socialization experiences, are considered crucial to the effective recruitment and retention of students from diverse cultural backgrounds into science, technology, engineering, and mathematics (STEM)-oriented graduate academic programs. This work outlines the strategic efforts of Auburn University’s School of Kinesiology to enhance its graduate student diversity recruitment and retention processes. Highlighted are the School of Kinesiology’s goals and guiding principles related to diversity and inclusion initiatives. A detailed description of the centerpiece of this effort, the Future Scholars-Summer Research Bridge Program, is provided. Additionally, related Future Scholars-Summer Research Bridge Program topics are discussed, including securing donor support, aligning the program with institutional strategic goals, forming institutional or academic program partnerships, and addressing administrative and logistical challenges.
Dynamics of Aspergillus fumigatus in Azole Fungicide-Containing Plant Waste in the Netherlands (2016–2017)
Authors: Zhang Jianhua , Lopez Jimenez Lidia , Snelders Eveline , Debets Alfons J. M. , Rietveld Anton G. , Zwaan Bas J. , Verweij Paul E. , Schoustra Sijmen E.
Published: October 2020

Aspergillus fumigatus
is consistently present independently on season at a high abundance in plant waste material throughout the sampling period. Our study confirmed that long-term storage sites of azole-containing decaying plant material can indeed be considered hot spots, which can sustain resistance development and maintenance in
A. fumigatus
. Roughly half of individual isolates were azole resistant and carried genetic mutations that are highly similar to those found in patients with azole-resistant invasive aspergillosis. Our work suggests that environmental sources of azole resistance in
A. fumigatus
may be important, underscoring the need for further studies on environment-to-patient transmission routes.
SARS-CoV-2 and Health Care Worker Protection in Low-Risk Settings: a Review of Modes of Transmission and a Novel Airborne Model Involving Inhalable Particles
Authors: Zhang X. Sophie , Duchaine Caroline
Published: October 2020

Since the beginning of the COVID-19 pandemic, there has been intense debate over SARS-CoV-2’s mode of transmission and appropriate personal protective equipment for health care workers in low-risk settings. The objective of this review is to identify and appraise the available evidence (clinical trials and laboratory studies on masks and respirators, epidemiological studies, and air sampling studies), clarify key concepts and necessary conditions for airborne transmission, and shed light on knowledge gaps in the field.
Supplemental Material: A novel authigenic magnetite source for sedimentary magnetization
Authors: Lin Zhiyong , al. et
Published: October 2020

Geological background, methods, and further morphologies of iron (oxyhydr)oxides and FORC diagrams (Figures S1–S3).
High excess mortality in areas with young and socially vulnerable populations during the COVID-19 outbreak in Stockholm Region, Sweden
Authors: Calderón-Larrañaga Amaia , Vetrano Davide L , Rizzuto Debora , Bellander Tom , Fratiglioni Laura , Dekhtyar Serhiy
Published: October 2020

Introduction

We aimed to describe the distribution of excess mortality (EM) during the first weeks of the COVID-19 outbreak in the Stockholm Region, Sweden, according to age, sex and sociodemographic context.

Methods

Weekly all-cause mortality data were obtained from Statistics Sweden for the period 1 January 2015 to 17 May 2020. EM during the first 20 weeks of 2020 was estimated by comparing observed mortality rates with expected mortality rates during the five previous years (N=2 379 792). EM variation by socioeconomic status (tertiles of income, education, Swedish-born, gainful employment) and age distribution (share of 70+-year-old persons) was explored based on Demographic Statistics Area (DeSO) data.

Results

EM was first detected during the week of 23–29 March 2020. During the peak week of the epidemic (6–12 April 2020), an EM of 150% was observed (152% in 80+-year-old women; 183% in 80+-year-old men). During the same week, the highest EM was observed for DeSOs with lowest income (171%), lowest education (162%), lowest share of Swedish-born (178%) and lowest share of gainfully employed residents (174%). EM was further increased in areas with higher versus lower proportion of younger people (magnitude of increase: 1.2–1.7 times depending on socioeconomic measure).

Conclusion

Living in areas characterised by lower socioeconomic status and younger populations was linked to excess mortality during the COVID-19 pandemic in the Stockholm Region. These conditions might have facilitated viral spread. Our findings highlight the well-documented vulnerability linked to increasing age and sociodemographic context for COVID-19–related death.
Higher incidence of adverse events in isolated patients compared with non-isolated patients: a cohort study
Authors: Jiménez-Pericás Fátima , Gea Velázquez de Castro María Teresa , Pastor-Valero María , Aibar Remón Carlos , Miralles Juan José , Meyer García María del Carmen , Aranaz Andrés Jesús Maria
Published: October 2020

Objective

To determine whether isolated patients admitted to hospital have a higher incidence of adverse events (AEs), to identify their nature, impact and preventability.

Design

Prospective cohort study with isolated and non-isolated patients.

Setting

One public university hospital in the Valencian Community (southeast Spain).

Participants

We consecutively collected 400 patients, 200 isolated and 200 non-isolated, age ≥18 years old, to match according to date of entry, admission department, sex, age (±5 years) and disease severity from April 2017 to October 2018. Exclusion criteria: patients age <18 years old and/or reverse isolation patients.

Primary and secondary outcome measures

The primary outcome as the AE, defined according to the National Study of Adverse Effects linked to Hospitalisation (Estudio Nacional Sobre los Efectos Adversos) criteria. Cumulative incidence rates and AE incidence density rates were calculated.

Results

The incidence of isolated patients with AEs 16.5% (95% CI 11.4% to 21.6%) compared with 9.5% (95% CI 5.4% to 13.6%) in non-isolated (p<0.03). The incidence density of patients with AEs among isolated patients was 11.8 per 1000 days/patient (95% CI 7.8 to 15.9) compared with 4.3 per 1000 days/patient (95% CI 2.4 to 6.3) among non-isolated patients (p<0.001). The incidence of AEs among isolated patients was 18.5% compared with 11% for non-isolated patients (p<0.09). Among the 37 AEs detected in 33 isolated patients, and the 22 AEs detected in 19 non-isolated patients, most corresponded to healthcare-associated infections (HAIs) for both isolated and non-isolated patients (48.6% vs 45.4%). There were significant differences with respect to the preventability of AEs, (67.6% among isolated patients compared with 52.6% among non-isolated patients).

Conclusions

AEs were significantly higher in isolated patients compared with non-isolated patients, more than half being preventable and with HAIs as the primary cause. It is essential to improve training and the safety culture of healthcare professionals relating to the care provided to this type of patient.
Selenium and bone health: a protocol for a systematic review and meta-analysis
Authors: Wang Ning , Xie Dongxing , Wu Jing , Wu Ziying , He Hongyi , Yang Zidan , Yang Tuo , Wang Yilun
Published: October 2020

Introduction

Bone health affects the ability of human body to stay active, and its degradation can cause considerable morbidity and mortality. The factors related to bone health play an important role in preventing osteoporosis and its adverse consequences. However, the risk factors for osteoporosis have not been fully elucidated. Deficiency in the trace element selenium may be one of the risk factors for the development of osteoporosis. Previous studies have investigated the effects of selenium on osteoporosis; however, the results are inconclusive. Therefore, the present study aimed to systematically examine the existing literature on the associations between dietary or serum selenium and bone mineral density (BMD), osteoporosis or osteoporotic fractures, and to quantify such associations through meta-analysis.

Methods and analysis

PubMed, Embase and Cochrane Library will be searched using a specified search strategy to identify relevant studies up to October 2019. Both interventional and observational studies in humans will be included. The outcomes will include BMD and the prevalence or incidence of osteoporosis and osteoporotic fractures. For dietary or serum selenium and BMD, osteoporosis or osteoporotic fractures pooled analyses, estimates will be expressed as the mean difference, and the pooled OR, relative risk, HR or beta coefficient, and corresponding 95% CIs. Heterogeneity of the studies and publication bias will be investigated accordingly. To assess the quality and the risk of bias of the included studies, the Newcastle-Ottawa Quality Scale or the Cochrane risk of bias assessment tool will be used where appropriate.

Ethics and dissemination

Since no private and confidential patient data will be included in the reporting, approval from an ethics committee is not required. The results will be published in a peer-reviewed journal. The study raises no ethical issues.

PROSPERO registration number

CRD42019147188.
Aetiology and prognostic risk factors of mortality in patients with pneumonia receiving glucocorticoids alone or glucocorticoids and other immunosuppressants: a retrospective cohort study
Authors: Li Lijuan , Hsu Steven H , Gu Xiaoying , Jiang Shan , Shang Lianhan , Sun Guolei , Sun Lingxiao , Zhang Li , Wang Chuan , Ren Yali , Wang Jinxiang , Pan Jianliang , Liu Jiangbo , Bin Cao
Published: October 2020

Objectives

Long-term use of high-dose glucocorticoids can lead to severe immunosuppression and increased risk of treatment-resistant pneumonia and mortality. We investigated the aetiology and prognostic risk factors of mortality in hospitalised patients who developed pneumonia while receiving glucocorticoid therapy alone or glucocorticoid and other immunosuppressant therapies.

Design

Retrospective cohort study.

Setting

Six secondary and tertiary academic hospitals in China.

Participants

Patients receiving glucocorticoids who were hospitalised with pneumonia between 1 January 2013 and 31 December 2019.

Main outcomes

We analysed the prevalence of comorbidities, microbiology, antibiotic susceptibility patterns, 30-day and 90-day mortality and prognostic risk factors.

Results

Conclusions

A total of 716 patients were included, with pneumonia pathogens identified in 69.8% of patients. Significant morbidities occurred, including respiratory failure (50.8%), intensive care unit transfer (40.8%) and mechanical ventilation (36%), with a 90-day mortality of 26.0%. Diagnosis of pneumonia occurred within 6 months of glucocorticoid initiation for 69.7% of patients with Cytomegalovirus (CMV) pneumonia and 79.0% of patients with Pneumocystis jirovecii pneumonia (PCP). Pathogens, including Pneumocystis, CMV and multidrug-resistant bacteria, were identified more frequently in patients with persistent lymphocytopenia and high-dose glucocorticoid treatment (≥30 mg/day of prednisolone or equivalent within 30 days before admission). The 90-day mortality was significantly lower for non-CMV viral pneumonias than for PCP (p<0.05), with a similar mortality as CMV pneumonias (24.2% vs 38.1% vs 27.4%, respectively). Cox regression analysis indicated several independent negative predictors for mortality in this patient population, including septic shock, respiratory failure, persistent lymphocytopenia, interstitial lung disease and high-dose glucocorticoid use.

Patients who developed pneumonia while receiving glucocorticoid therapy experienced high rates of opportunistic infections, with significant morbidity and mortality. These findings should be carefully considered when determining treatment strategies for this patient population.
Information on, knowledge and utilisation of support services during pregnancy and after childbirth: cross-sectional analyses of predictors using data from the KUNO-Kids health study
Authors: Brandstetter Susanne , Rothfuß David , Seelbach-Göbel Birgit , Melter Michael , Kabesch Michael , Apfelbacher Christian
Published: October 2020

Objectives

To investigate mothers’ knowledge and utilisation of antenatal and perinatal support services as well as predictors of knowledge and service utilisation.

Design

Cross-sectional study.

Setting

Prospective birth cohort in Regensburg, Eastern Bavaria, Germany.

Participants

2455 mothers after delivery.

Outcome measures

Participants’ knowledge of distinct antenatal and perinatal support services (poor vs good, defined by median split). Participants’ use of antenatal services provided by midwife (yes, no) and of any other antenatal support services (yes, no).

Results

The vast majority of mothers knew at least some support services. Two-thirds of women (68.4%) reported to have used the services provided by midwives. 23.6% of women reported to have used at least one of the other antenatal services. Good knowledge of services was associated with higher education (OR 1.37, 95% CI 1.13 to 1.67), no migration background (OR 2.26, 95% CI 1.76 to 2.90), better health literacy (OR 1.04, 95% CI 1.03 to 1.06), while being primiparous (OR 0.72, 95% CI 0.60 to 0.86) and being unmarried/living with a partner (OR 0.71, 95% CI 0.57 to 0.89) reduced the chance. Predictors of service utilisation differed with regard to the services considered.

Conclusions

Overall, mothers had a good level of knowledge of antenatal and perinatal support services. However, we found that some groups of women were less well informed. This inequality in social predictors of knowledge of services was also partly reflected in differences in service utilisation during pregnancy.
Linkage of maternity hospital episode statistics birth records to birth registration and notification records for births in England 2005–2006: quality assurance of linkage
Authors: Coathup Victoria , Macfarlane Alison , Quigley Maria
Published: October 2020

Objectives

The objectives of this study were to describe the methods used to assess the quality of linkage between records of babies’ birth registration and hospital birth records, and to evaluate the potential bias that may be introduced because of these methods.

Design/setting

Data from the civil registration and the notification of births previously linked by the Office for National Statistics (ONS) had been further linked to birth records from the Hospital Episode Statistics (HES) for babies born in England. We developed a deterministic, six-stage algorithm to assess the quality of this linkage.

Participants

All 1 170 790 live, singleton births, occurring in National Health Service hospitals in England between 1 January 2005 and 31 December 2006.

Primary outcome measure

The primary outcome was the number of successful links between ONS birth records and HES birth records. Rates of successful linkage were calculated for the cohort and the characteristics associated with unsuccessful linkage were identified.

Results

Approximately 92% (1 074 572) of the birth registration records were successfully linked with a HES birth record. Data quality and completeness were somewhat poorer in HES birth records compared with linked birth registration and birth notification records. The quality assurance algorithms identified 1456 incorrect linkages (<1%). Compared with the linked dataset, birth records were more likely to be unlinked if babies were of white ethnic origin; born to unmarried mothers; born in East England, London, North West England or the West Midlands; or born in March.

Conclusions

It is possible to link administrative datasets to create large cohorts, allowing researchers to explore important questions about exposures and childhood outcomes. Missing data, coding errors and inconsistencies mean it is important that the quality of linkage is assessed prior to analysis.
Effects of active referral combined with a small financial incentive on smoking cessation: study protocol for a cluster randomised controlled trial
Authors: Weng Xue , Wang Man Ping , Li Ho Cheung William , Cheung Yee Tak Derek , Lau Ching Yin , Kwong Antonio Cho Shing , Lai Vienna Wai Yin , Chan Sophia Siu Chee , Lam Tai Hing
Published: October 2020

Introduction

Evidence-based smoking cessation treatments are effective but underutilised, accentuating the need for novel approaches to increase use. This trial investigates the effects of active referral combined with a financial incentive to use smoking cessation services on smoking abstinence among community smokers.

Methods and analysis

This ongoing study is a two-arm, assessor-blinded, pragmatic, cluster randomised controlled trial with follow‐ups at 1, 2, 3 and 6 months after randomisation. We aim to enrol 1134 daily smokers from 70 community sites (clusters) in Hong Kong. All participants receive Ask, Warn, Advise, Refer, Do-it-again (AWARD) guided advice and a self-help booklet at baseline. Additionally, participants in the intervention group receive an offer of referral to smoking cessation services at baseline and a small financial incentive (HK$300≈US$38) contingent on using any of such services within 3 months. The primary outcomes are bioverified abstinence (exhaled carbon monoxide <4 ppm and salivary cotinine <10 ng/mL) at 3 and 6 months. Secondary outcomes include self-reported 7-day point prevalence of abstinence, smoking reduction rate, quit attempts and the use of smoking cessation services at 3 and 6 months. Intention-to-treat approach and regression models will be used in primary analyses.

Ethics and dissemination

This protocol has been approved by the Institutional Review Board of the University of Hong Kong/Hospital Authority Hong Kong West Cluster (IRB reference number: UW 18-318). The results of this trial will be submitted for publication in peer-reviewed journals, and the key findings will be presented at national and international conferences.

Trial registration number

ClinicalTrials.gov Registry NCT03565796.
Feasibility study for supporting medication adherence for adults with cystic fibrosis: mixed-methods process evaluation
Authors: Hind Daniel , Drabble Sarah J , Arden Madelynne A , Mandefield Laura , Waterhouse Simon , Maguire Chin , Cantrill Hannah , Robinson Louisa , Beever Daniel , Scott Alex , Keating Sam , Hutchings Marlene , Bradley Judy , Nightingale Julia , Allenby Mark I , Dewar Jane , Whelan Pauline , Ainsworth John , Walters Stephen J , Wildman Martin J , O'Cathain Alicia
Published: October 2020

Objectives

To undertake a process evaluation of an adherence support intervention for people with cystic fibrosis (PWCF), to assess its feasibility and acceptability.

Setting

Two UK cystic fibrosis (CF) units.

Participants

Fourteen adult PWCF; three professionals delivering adherence support (‘interventionists’); five multi-disciplinary CF team members.

Interventions

Nebuliser with data recording and transfer capability, linked to a software platform, and strategies to support adherence to nebulised treatments facilitated by interventionists over 5 months (± 1 month).

Primary and secondary measures

Feasibility and acceptability of the intervention, assessed through semistructured interviews, questionnaires, fidelity assessments and click analytics.

Results

Interventionists were complimentary about the intervention and training. Key barriers to intervention feasibility and acceptability were identified. Interventionists had difficulty finding clinic space and time in normal working hours to conduct review visits. As a result, fewer than expected intervention visits were conducted and interviews indicated this may explain low adherence in some intervention arm participants. Adherence levels appeared to be >100% for some patients, due to inaccurate prescription data, particularly in patients with complex treatment regimens. Flatlines in adherence data at the start of the study were linked to device connectivity problems. Content and delivery quality fidelity were 100% and 60%–92%, respectively, indicating that interventionists needed to focus more on intervention ‘active ingredients’ during sessions.

Conclusions

The process evaluation led to 14 key changes to intervention procedures to overcome barriers to intervention success. With the identified changes, it is feasible and acceptable to support medication adherence with this intervention.

Trial registration number

ISRCTN13076797; Results.
Identifying heterogeneity in the risk factors of dental caries status in Chinese adolescents using Poisson mixture regression
Authors: Yuan Chao , He Jie , Sun Xiangyu , Kang Jian , Zheng Shuguo
Published: October 2020

Objective

The purpose of this study was to cluster individuals into groups with different dental health characteristics and make statistical inferences on the effect differences among different groups simultaneously to identify the heterogeneity of risk factors in Chinese adolescents by analysing the data from the 4th Chinese National Oral Health Survey.

Methods

For decayed, missing and filled permanent teeth (DMFT), mean values were statistically analysed for their relationships with different categories of all involved variables. As DMFT scores only have discrete values, Poisson mixture regression was adopted to model the heterogeneity and complex patterns in the association and to detect the subgroup. The Bayesian information criterion (BIC) was used to determine the optimal number of subgroups. A series of Wald tests were used to explore the relationship between risk factors including the interaction effects and the number of DMFT.

Results

A total of 100 986 individuals aged 12–15 years old were analysed. The model clustered different individuals into three subgroups and built three submodels for detailed statistical inference simultaneously. The number of individuals in the three subgroups were 52 576 (52.1%), 41 969 (41.5%) and 6441 (6.4%), respectively. The mean (SD) of DMFT of the three subgroups was 0.50 (1.05), 0.99 (1.21), 5.59 (2.50). The model fitting results indicated that the effects of all risk factors on DMFT appear to be different in three subgroups. Controlling the confounding effects, our analysis implied that the regional inequality was the main contributing factor to dental caries among adolescents in Chinese mainland.

Conclusions

The risk factors of dental caries exhibited heterogeneity in groups with different characteristics. The Poisson mixture regression model could cluster individuals into groups and identify the heterogeneous effects of risk factors among different groups. The findings support the need for different targeted interventions and prevention measures in groups with different dental health characteristics.
Hospitalised COVID-19 patients of the Mount Sinai Health System: a retrospective observational study using the electronic medical records
Authors: Wang Zichen , Zheutlin Amanda , Kao Yu-Han , Ayers Kristin , Gross Susan , Kovatch Patricia , Nirenberg Sharon , Charney Alexander , Nadkarni Girish , De Freitas Jessica K , O’Reilly Paul , Just Allan , Horowitz Carol , Martin Glenn , Branch Andrea , Glicksberg Benjamin S , Charney Dennis , Reich David , Oh William K , Schadt Eric , Chen Rong , Li Li
Published: October 2020

Objective

To assess association of clinical features on COVID-19 patient outcomes.

Design

Retrospective observational study using electronic medical record data.

Setting

Five member hospitals from the Mount Sinai Health System in New York City (NYC).

Participants

28 336 patients tested for SARS-CoV-2 from 24 February 2020 to 15 April 2020, including 6158 laboratory-confirmed COVID-19 cases.

Main outcomes and measures

Positive test rates and in-hospital mortality were assessed for different racial groups. Among positive cases admitted to the hospital (N=3273), we estimated HR for both discharge and death across various explanatory variables, including patient demographics, hospital site and unit, smoking status, vital signs, lab results and comorbidities.

Results

Hispanics (29%) and African Americans (25%) had disproportionately high positive case rates relative to their representation in the overall NYC population (p<0.05); however, no differences in mortality rates were observed in hospitalised patients based on race. Outcomes differed significantly between hospitals (Gray’s T=248.9; p<0.05), reflecting differences in average baseline age and underlying comorbidities. Significant risk factors for mortality included age (HR 1.05, 95% CI 1.04 to 1.06; p=1.15e-32), oxygen saturation (HR 0.985, 95% CI 0.982 to 0.988; p=1.57e-17), care in intensive care unit areas (HR 1.58, 95% CI 1.29 to 1.92; p=7.81e-6) and elevated creatinine (HR 1.75, 95% CI 1.47 to 2.10; p=7.48e-10), white cell count (HR 1.02, 95% CI 1.01 to 1.04; p=8.4e-3) and body mass index (BMI) (HR 1.02, 95% CI 1.00 to 1.03; p=1.09e-2). Deceased patients were more likely to have elevated markers of inflammation.

Conclusions

While race was associated with higher risk of infection, we did not find racial disparities in inpatient mortality suggesting that outcomes in a single tertiary care health system are comparable across races. In addition, we identified key clinical features associated with reduced mortality and discharge. These findings could help to identify which COVID-19 patients are at greatest risk of a severe infection response and predict survival.
Analgesia and anesthesia using the pericapsular nerve group block in hip surgery and hip fracture: a scoping review
Authors: Morrison Craig , Brown Brigid , Lin D-Yin , Jaarsma Ruurd , Kroon Hidde
Published: October 2020

Introduction

Pericapsular nerve group (PENG) block is a novel regional analgesia technique to reduce pain after hip surgery and hip fractures. This review was conducted to summarize current literature.

Methods

A scoping review was carried out using the Joanna Briggs Institute framework. All articles describing the use of PENG block as a regional analgesia and/or anesthesia technique for hip pain were considered eligible for inclusion. Ovid Medline, Embase, CINAHL, PubMed and Google Scholar were searched. Adult and pediatric studies were included. Excluded were articles not available in English language, not available in full-text, related to non-orthopedic indications such as soft tissue surgery, and pelvic or femoral shaft fractures.

Results

Database searches identified 345 articles, 20 of which could be included in the current review, with a combined patient number of 74. Included articles comprised case reports and case series only, describing 1 to 10 patients. In all studies, PENG block was described to provide sufficient analgesia or anesthesia. Transient motor side effects occurred only when the local anesthetic was deposited in an unintended location (n=2).

Conclusions

Current evidence of using PENG block for hip surgery or hip pain is limited to case reports and case series only. PENG block is a promising regional analgesia technique as an alternative to other regional nerve blocks such as femoral nerve block or iliac fascia nerve block. Observational and experimental studies are required to determine the effectiveness, efficacy and safety of the PENG block.
Effects of vitamin E on stroke: a systematic review with meta-analysis and trial sequential analysis
Authors: Loh Hong Chuan , Lim Renly , Lee Kai Wei , Ooi Chin Yik , Chuan Deik Roy , Looi Irene , Kah Hay Yuen , Abdul Karim Khan Nurzalina
Published: October 2020

There are several previous studies on the association of vitamin E with prevention of stroke but the findings remain controversial. We have conducted a systematic review, meta-analysis together with trial sequential analysis of randomised controlled trials to evaluate the effect of vitamin E supplementation versus placebo/no vitamin E on the risk reduction of total, fatal, non-fatal, haemorrhagic and ischaemic stroke. Relevant studies were identified by searching online databases through Medline, PubMed and Cochrane Central Register of Controlled Trials. A total of 18 studies with 148 016 participants were included in the analysis. There was no significant difference in the prevention of total stroke (RR (relative risk)=0.98, 95% CI 0.92–1.04, p=0.57), fatal stroke (RR=0.96, 95% CI 0.77–1.20, p=0.73) and non-fatal stroke (RR=0.96, 95% CI 0.88–1.05, p=0.35). Subgroup analyses were performed under each category (total stroke, fatal stroke and non-fatal stroke) and included the following subgroups (types of prevention, source and dosage of vitamin E and vitamin E alone vs control). The findings in all subgroup analyses were statistically insignificant. In stroke subtypes analysis, vitamin E showed significant risk reduction in ischaemic stroke (RR=0.92, 95% CI 0.85–0.99, p=0.04) but not in haemorrhagic stroke (RR=1.17, 95% CI 0.98–1.39, p=0.08). However, the trial sequential analysis demonstrated that more studies were needed to control random errors. Limitations of this study include the following: trials design may not have provided sufficient power to detect a change in stroke outcomes, participants may have had different lifestyles or health issues, there were a limited number of studies available for subgroup analysis, studies were mostly done in developed countries, and the total sample size for all included studies was insufficient to obtain a meaningful result from meta-analysis. In conclusion, there is still a lack of statistically significant evidence of the effects of vitamin E on the risk reduction of stroke. Nevertheless, vitamin E may offer some benefits in the prevention of ischaemic stroke and additional well-designed randomised controlled trials are needed to arrive at a definitive finding. PROSPERO registration number: CRD42020167827.
TMEM16A/ANO1 calcium-activated chloride channel as a novel target for the treatment of human respiratory syncytial virus infection
Authors: Pearson Hayley , Todd Eleanor J A A , Ahrends Mareike , Hover Samantha E , Whitehouse Adrian , Stacey Martin , Lippiat Jonathan D , Wilkens Ludwig , Fieguth Hans-Gerd , Danov Olga , Hesse Christina , Barr John N , Mankouri Jamel
Published: October 2020

Introduction

Human respiratory syncytial virus (HRSV) is a common cause of respiratory tract infections (RTIs) globally and is one of the most fatal infectious diseases for infants in developing countries. Of those infected, 25%–40% aged ≤1 year develop severe lower RTIs leading to pneumonia and bronchiolitis, with ~10% requiring hospitalisation. Evidence also suggests that HRSV infection early in life is a major cause of adult asthma. There is no HRSV vaccine, and the only clinically approved treatment is immunoprophylaxis that is expensive and only moderately effective. New anti-HRSV therapeutic strategies are therefore urgently required.

Methods

It is now established that viruses require cellular ion channel functionality to infect cells. Here, we infected human lung epithelial cell lines and ex vivo human lung slices with HRSV in the presence of a defined panel of chloride (Cl−) channel modulators to investigate their role during the HRSV life-cycle.

Results

We demonstrate the requirement for TMEM16A, a calcium-activated Cl−channel, for HRSV infection. Time-of-addition assays revealed that the TMEM16A blockers inhibit HRSV at a postentry stage of the virus life-cycle, showing activity as a postexposure prophylaxis. Another important negative-sense RNA respiratory pathogen influenza virus was also inhibited by the TMEM16A-specific inhibitor T16Ainh-A01.

Discussion

These findings reveal TMEM16A as an exciting target for future host-directed antiviral therapeutics.